Older people's experiences of changed medication appearance : a survey

This report details a survey of older people's experiences of changed medication appearance. The aims of the study were: • To develop a questionnaire in partnership with older people to survey older people’s views on fluctuating medication appearance • To elicit older people’s experiences of medication that changed appearance due to ‘generic prescribing’ and ‘parallel import’ practices and its impact on their medication taking practices. These common pharmacy practices mean that the same tablet medication can be issued to older people in different colours, sizes and shapes to their previous prescriptions. Older people from a local User/Carer Forum highlighted these problems to the research team and asked that we investigate to explore the extent of the problem. An eight-item questionnaire was developed and distributed to 2000 older people (50 years+) across participating PCTs in Greater Manchester in 2008. A 29% response rate was achieved. The data was analysed using the SPSS statistical package. Findings include: •63.3% experienced a change in the appearance of their tablet medications. •74.1% did not seek advice regarding the change in the appearance of their tablet medications. •Older people noted changes to the actual tablets, tablet packaging and written information that accompanies tablets. Changes are occurring to the colour, size and shape of tablets more than changes to packaging and written information. The majority of respondents had experienced changes in the appearance of their prescribed tablet medication in the previous two years which were not due to change in medication or dose etc. Worryingly, for some respondents, these changes prompted negative experiences such as anxiety, confusion and upset. Of particular concern was that a small number omitted the affected tablet medications and did not seek help or advice from GPs, pharmacists or relatives. Six older people have been study advisors from inception to dissemination of this study and significantly added to its quality. The study demonstrates substantive public engagement / user involvement in research. The findings suggest nurses and others have a role to play in promoting better medicines management and identifying those most at risk from changed appearance of medications

Tafenoquine: A New 8- Aminoquinoline

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Preparation and Study of the Antibacterial Applications and Oxidative Stress Induction of Copper Maleamate-Functionalized Mesoporous Silica Nanoparticles

Mesoporous silica nanoparticles (MSNs) are an interesting class of nanomaterials with potential applications in different therapeutic areas and that have been extensively used as drug carriers in different fields of medicine. The present work is focused on the synthesis of MSNs containing a maleamato ligand (MSN-maleamic) and the subsequent coordination of copper(II) ions (MSN-maleamic-Cu) for the exploration of their potential application as antibacterial agents. The Cu-containing nanomaterials have been characterized by different techniques and the preliminary antibacterial effect of the supported maleamato-copper(II) complexes has been tested against two types of bacteria (Gram positive and Gram negative) in different assays to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The biological results showed a moderate antibacterial activity against Escherichia coli which motivated a more detailed study of the antibacterial mechanism of action of the synthesized maleamate-containing nanosystems and whose findings showed oxidative stress generation in bacterial cells. All the prepared nanomaterials were also tested as catalysts in the “solvent free” selective oxidation of benzyl alcohol, to observe if there is a potential correlation between the catalytic oxidation capacity of the materials and the observed oxidative stress in bacteria. This may help in the future, for a more accurate rational design of antibacterial nanosystems, based on their observed catalytic oxidation activity.This research was funded by Ministerio de Ciencia, Innovación y Universidades Spain-FEDER, grants number CTQ2015-66164-R and CTQ2017-90802-REDT and by Agencia Nacional de Promoción Científica y Tecnológica (ANPCyT) (PICT 2015 Nº1558)

Older people's experiences of changed medication appearance due to generic prescribing: a qualitative study

Research was undertaken in response to requests by older people in Rochdale Borough to investigate an issue of great concern to them namely prescription medications constantly changing appearance due to generic prescribing. When branded drugs are still in their ‘patent’ period, which is a number of years after they are introduced into the market, there is only one sole supplier. Expiration of this period allows other manufacturers to ‘mimic’ the branded product, at a fraction of the cost. It is an NHS directive for prescribers to use the generic drug name when a drug is prescribed unless there is a clinical justification for using the brand name. When people receive their tablet medicines from their pharmacist, the brand and so the appearance (colour, size, shape) can be vastly different to those dispensed following their previous prescription despite having the same active ingredient. This is often due to a lack of standardisation practice required amongst manufacturers. Drugs are made to British and European Pharmacopoeia standards but these do not specify colour, size and shape. Medicines are required to be of 'essential similarity' but that does not include appearance. Many pharmacists believe that standardisation, should not only include size, shape, colour but also packaging. Packaging changes from the same company on consecutive orders presents considerable challenge to pharmacists as well as patients.This patient experience study involved in-depth qualitative interviews with 32 people across Greater Manchester aged between 62 and 88 years of age taking three or more prescribed tablet medications. Findings revealed that these older people were challenged by the changes in their medications which impacted on their confidence and forced them to repeatedly double check their medicine regimes. The older people we interviewed felt they were only able to cope with the changes in medicine appearance due to their own diligence and because they had capacity to do so. Most were very concerned that as they became older and their capacity to self-manage medicines reduced, that they would be at risk of medication errors. They also believed there were many older people less capable than themselves who were already struggling to cope with medicine appearance changes. One participant said “You wouldn’t buy an orange cabbage would you?” to illustrate how disconcerting they found changes to their established medicines. This study builds on the team’s other Greater Manchester-wide research of the same topic which was a survey of 2000 older people and which painted a much more negative picture (Williamson et al 2009) [available from http://usir.salford.ac.uk/2989/] and many older people reported being stressed or confused with the changes in medication appearance. Study recommendations centre on future research and multiple agency work to:• Improve written information and information processes • Consider of the use of pictures on boxes of medications• Require manufacturers to notify pharmacists and explain changes and provide standardised packaging in terms of quantity (28 or 30 day packs)• Scope individual strategies - formal and informal - that people use to manage their medicines at home as a means of identifying risk • Identify training / education needs amongst primary care workers e.g. district nurses, pharmacists and GPs and partners such as Local Authorities in supporting older people with their medicines and identifying those most at risk e.g. vulnerable adults• Explore the frequency and nature of changes to individual’s medication appearance • Undertake economic analyses of generic prescribing practices including cost and quality of life implications• Explore the impact of changed appearance of medication with the wider older population including those who are less able to participate e.g. seldom heard or marginalised groups, those who are socially isolated and especially those at higher risk of negative effects such as those with reduced capacity to self manage medications• Devise a public information poster explaining 1) how large savings from generic prescribing are reinvested into patient services and 2) how when drugs come off patent, other manufacturers are free to produce them at lower cost, as long as they maintain efficacy 3) how pharmacists cannot order medicines from a specific manufacturer as it depends what wholesaler has in stock 4) the requirement to bulk some tablets up with excipients 5) the need for patients to talk to their pharmacis

Knowledge, attitudes, and practices of community pharmacists toward the management of acne vulgaris in Palestine: a cross-sectional study

Background Acne vulgaris (AV) is a common dermatological disease affecting almost 85% of teenagers. Patients with AV usually present at community pharmacies during the early stages of their disease. Aim The aim of this study was to assess community pharmacists’ knowledge, attitudes, and practice toward AV management in West Bank in Palestine. Methods This study was a cross-sectional questionnaire-based study. The questionnaire included four sections: 1) demographic, 2) knowledge, 3) attitude and practice items related causes, and 4) treatment options and counseling during management of patients with AV. A convenience sampling method was implemented in this study. Parametric and non-parametric tests were used to compare different issues as appropriate. P < 0.05 were considered significant. Result A total of 270 community pharmacists were interviewed, and more than half (54.1%) were males. The study revealed that community pharmacists had an inadequate level of knowledge on management of AV; only 7.7% had high levels of knowledge. Pharmacists have positive attitude regarding AV management, but inadequate knowledge was reflected on their treatment practices; only 10% of participants independently dealt with AV without referral. Pharmacists with a low level of knowledge showed five times more referrals than those with a high level of knowledge (OR: 5.3; P < 0.001), and those with a bachelor degree showed three times more referrals than postgraduates (OR: 3.3; P < 0.001). Conclusion There is a demand to update dermatological knowledge of community pharmacists and encourage them to attend structured training programs about the management of AV.Funding source: None

Extraction and demonstration of uterotonic activity from the root of steganotaenia araliacea hochst

Steganotaenia araliacea used for assisting labour in folk medicine.The root of Steganotaenia araliacea is used for assisting labour in folk medicine. Recent reports indicate that the root could possess uterotonic substances. The study aimed to evaluate three methods for the extraction of uterotonic principles from the root of S. araliacea growing in Zambia. Roots of the plant were collected from Chongwe District of Zambia. The air-dried roots were size-reduced, and the powdered material extracted with hot ethanol, hot distilled water, and cold distilled water. The solvent extracts were 0concentrated and dried at 110 C. Solutions of the hot aqueous and cold aqueous extracts were prepared in distilled water and used for organ bath experiments to demonstrate uterotonic activities using strips of pregnant rat uterus. The frequencies and amplitude of contractile forces were recorded. The amplitudes were plotted against log concentration of extract with GraphPad Prism software, and the EC50 values determined. The results showed that percentage yields were 31.3 % for the hot aqueous extract, 8.15 % for the ethanolic extract, and 3.27 % for the cold aqueous extract. The cold aqueous extract showed higher potency (EC50 of 0.54 mg/ml) compared to the hot aqueous extract (EC50 of 2.09 mg/ml). The conclusion were that root extracts of S. araliacea possess demonstrable uterotonic effects. Extraction of the roots for this purpose could benefit from preliminary defatting with organic solvents, followed by successive extraction with hot and cold water.Office of Global AIDS/US Department of State

Dual Anticancer and Antibacterial Properties of Silica-Based Theranostic Nanomaterials Functionalized with Coumarin343, Folic Acid and a Cytotoxic Organotin(IV) Metallodrug

Five different silica nanoparticles functionalized with vitamin B12, a derivative of coumarin found in green plants and a minimum content of an organotin(IV) fragment (1-MSN-Sn, 2-MSN-Sn, 2-SBA-Sn, 2-FSPm-Sn and 2-FSPs-Sn), were identified as excellent anticancer agents against triple negative breast cancer, one of the most diagnosed and aggressive cancerous tumors, with very poor prognosis. Notably, compound 2-MSN-Sn shows selectivity for cancer cells and excellent luminescent properties detectable by imaging techniques once internalized. The same compound is also able to interact with and nearly eradicate biofilms of Staphylococcus aureus, the most common bacteria isolated from chronic wounds and burns, whose treatment is a clinical challenge. 2-MSN-Sn is efficiently internalized by bacteria in a biofilm state and destroys the latter through reactive oxygen species (ROS) generation. Its internalization by bacteria was also efficiently monitored by fluorescence imaging. Since silica nanoparticles are particularly suitable for oral or topical administration, and considering both its anticancer and antibacterial activity, 2-MSN-Sn represents a new dual-condition theranostic agent, based primarily on natural products or their derivatives and with only a minimum amount of a novel metallodrug.We would like to thank funding from RTI2018-094322-B-I00 funded by MCIN/AEI/10.13039/501100011033 and by “ERDF A way of making Europe”, by the “European Union” and the University of the Basque Country UPV/EHU (GIC18/143). M.F. is grateful to Instituto de Salud Carlos III (ISCIII) for project No DTS20/00109 (AES20-ISCIII) and PI22/00789 (AES22-ISCIII). M.F. and K.O.P. acknowledge the support of Microscopy & Dynamic Imaging Unit of CNIC, Madrid, Spain. The Unit is part of the ReDiB-ICTS and has the support of FEDER, “Una manera de hacer Europa.” The CNIC is supported by the Instituto de Salud Carlos III (ISCIII), the Ministerio de Ciencia e Innovación (MCIN) and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (grant CEX2020-001041-S funded by MICIN/AEI/10.13039/501100011033)

Post-COVID-19 assessment in a specialist clinical service: a 12-month, single-centre, prospective study in 1325 individuals

INTRODUCTION: Post-COVID-19 complications require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated post-COVID-19 clinical service to include hospitalised and non-hospitalised patients. METHODS: In a single-centre, observational analysis, we report the demographics, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post-COVID-19 service between April 2020 and April 2021, comparing by referral route: posthospitalised (PH), non-hospitalised (NH) and post emergency department (PED). Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression. RESULTS: 1325 individuals were assessed (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%). Compared with the PH and PED groups, the NH group were younger (median 44.6 (35.6-52.8) years vs 58.3 (47.0-67.7) years and 48.5 (39.4-55.7) years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be of ethnic minority (30.9%, 52.7% and 41.0%) or seen later after symptom onset (median (IQR): 194 (118-298) days, 69 (51-111) days and 76 (55-128) days; all p<0.0001). All groups had similar rates of onward specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were more likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). Hospitalised patients had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 716 (54.0%) individuals reported <75% optimal health (median 70%, IQR 55%-85%). Less than half of employed individuals could return to work full time at first assessment. CONCLUSION: Post-COVID-19 symptoms were significant in PH and NH patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required