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Revista de Saude Publica Dec 2017Quaternary prevention consists in the identification of persons at risk of excessive medicalization and their protection against new unnecessary interventions, avoiding...
Quaternary prevention consists in the identification of persons at risk of excessive medicalization and their protection against new unnecessary interventions, avoiding iatrogenic damages. Here, we argue about the importance of quaternary prevention in specific primary and secondary prevention. The recent great development of preventive medicine, biomedicalization of risks and their treatment as if they were diseases, and the powerful influence of the commercial interests of pharmaceutical industries on the production of medical-sanitary knowledge alter classifications, create diseases and pre-diseases, lower cutoff points, and erase the distinction between prevention and healing. This situation converts larger amounts of asymptomatic persons into sick individuals and diverts clinical attention and resources from sick persons to the healthy, from older adults to young persons, and from the poor to the rich. Quaternary prevention facilitates and induces the development and systematization of operational knowledge and guidelines to contain hypermedicalization and the damages of preventive actions in professional care, especially in primary health care.
Topics: Asymptomatic Diseases; Humans; Medicalization; Preventive Health Services; Unnecessary Procedures
PubMed: 29211199
DOI: 10.11606/S1518-8787.2017051000041 -
Advanced Drug Delivery Reviews 2020Considering the multifaceted protective and homeostatic roles of the complement system, many consequences arise when drug carriers, and particulate pharmaceutical... (Review)
Review
Considering the multifaceted protective and homeostatic roles of the complement system, many consequences arise when drug carriers, and particulate pharmaceutical formulations clash with complement proteins, and trigger complement cascade. Complement activation may induce formulation destabilization, promote opsonization, and affect biological and therapeutic performance of pharmaceutical nano- and micro-particles. In some cases, complement activation is beneficial, where complement may play a role in prophylactic protection, whereas uncontrolled complement activation is deleterious, and contributes to disease progression. Accordingly, design initiatives with particulate medicines should consider complement activation properties of the end formulation within the context of administration route, dosing, systems biology, and therapeutic perspective. Here we examine current progress in mechanistic processes underlying complement activation by pre-clinical and clinical particles, identify opportunities and challenges ahead, and suggest future directions in nanomedicine-complement interface research.
Topics: Animals; Complement Activation; Complement System Proteins; Drug Carriers; Humans; Microspheres; Nanoparticles; Pharmaceutical Preparations
PubMed: 32389761
DOI: 10.1016/j.addr.2020.04.012 -
International Journal For Quality in... Mar 2021Medication errors are a common problem in hospitals and a major driver of adverse patient outcomes. Barcode verification technology is a promising strategy to help...
BACKGROUND
Medication errors are a common problem in hospitals and a major driver of adverse patient outcomes. Barcode verification technology is a promising strategy to help ensure safe medication preparation practices.
OBJECTIVES
The objectives of this study were (i) to assess the effects of a barcode-assisted medication preparation and administration system regarding the rate of medication preparation errors and (ii) to compare the time spent on medication preparation tasks by medical staff.
METHODS
A quasi-experimental study with a pre-post design was conducted, from August 2017 to July 2018, in two mixed medical/surgical units of a tertiary teaching hospital. The primary aim was to assess the effects of a barcode-based electronically assisted medication preparation and administration system linked to the hospital's electronic medication administration record regarding the rate of medication preparation errors and time-based staff performance. Data were collected using direct observation. Adjusted and unadjusted logistic models were used for error frequencies and linear regression models for time performance.
RESULTS
5932 instances of medication selection and dosing during 79 medication preparation procedures were observed. The overall medication preparation error incidence decreased from 9.9% at baseline to 4.5% at post-intervention, corresponding to a relative risk reduction of 54.5% (P < 0.001). However, the adjusted effect by registered nurses (RNs) and nurses' work experience of total medication preparation errors showed only borderline significance (odds ratio [OR] 0.64, P = 0.051). For adjusted error-specific analyses, significant error reductions were found in wrong medication errors (OR 0.38, P < 0.010) and wrong dosage errors (OR 0.12, P = 0.004). Wrong patient, wrong form and ambiguous dispenser errors did not occur at post-intervention. Errors of omission (OR 1.53, P = 0.17), additional doses (OR 0.63, P = 0.64) and wrong dispenser boxes (OR 0.51, P = 0.11) did not change significantly. The time necessary to prepare medications for a 24-h period also decreased significantly-from 30.2 min to 17.2 min (beta = -6.5, P = 0.047), while mean preparation time per individual medication dose fell from 24.3 s to 15.1 s (beta = -5.0, P = 0.002).
CONCLUSION
Use of the new barcode technology significantly reduced the rate of some medication preparation errors in our sample. Moreover, the time necessary for medication preparation, both per 24-h period and per single-medication dose, was significantly reduced.
Topics: Electronic Data Processing; Humans; Medication Errors; Medication Systems, Hospital; Pharmaceutical Preparations; Technology
PubMed: 33783482
DOI: 10.1093/intqhc/mzab043 -
Journal of Pharmaceutical Sciences May 2017Salt formation is one of the primary approaches to improve the developability of ionizable poorly water-soluble compounds. Solubility determination of the salt... (Review)
Review
Salt formation is one of the primary approaches to improve the developability of ionizable poorly water-soluble compounds. Solubility determination of the salt candidates in aqueous media or biorelevant fluids is a critical step in salt screening. Salt solubility measurements can be complicated due to dynamic changes in both solution and solid phases. Because of the early implementation of salt screening in research, solubility measurements often are performed using minimal amount of material. Some salts have transient high solubility on dissolution. Recognition of these transients can be critical in developing these salts into drug products. This minireview focuses on challenges in salt solubility measurements due to the changes in solution caused by self-buffering effects of dissolved species and the changes in solid phase due to solid-state phase transformations. Solubility measurements and their accurate interpretation are assessed in the context of dissolution monitoring and solid-phase analysis technologies. A harmonized method for reporting salt solubility measurements is recommended to reduce errors and to align with the U.S. Pharmacopeial policy and Food and Drug Administration recommendations for drug products containing pharmaceutical salts.
Topics: Chemistry, Pharmaceutical; Hydrogen-Ion Concentration; Pharmaceutical Preparations; Salts; Solubility
PubMed: 28153596
DOI: 10.1016/j.xphs.2017.01.023 -
Journal of Pharmacy Practice Feb 2023Timely medication administration is integral to patient care, and operational delays can challenge timely administration. Within an inpatient pharmacy of an academic...
BACKGROUND
Timely medication administration is integral to patient care, and operational delays can challenge timely administration. Within an inpatient pharmacy of an academic medical center, intravenous medications were historically compounded on a patient-specific basis. In 2020, the pharmacy began batching frequently-utilized medications. This analysis explored the impact of compounded sterile batching on pharmacy and nursing services.
METHODS
This pre- and post-interventional study compared data from February through March 2020 with a seasonally matched period from 2019. The primary endpoint was difference in time to administration of urgent (STAT) medications. Secondary endpoints included timeframes for a pharmacy technician to prepare, a pharmacist to check, and a nurse to administer the medications, as well as reprinted labels and estimated waste.
RESULTS
On average, it took one hour and 43 minutes to administer a STAT medication in 2019 and one hour and 57 minutes in 2020 ( = 0.122). It took about four hours to administer routine medications in 2019 and 2020 ( = 0.488). The number of labels reprinted decreased from 616 in 2019 to 549 in 2020 ( = 0.195), relating to decreased missing doses. The mean time to check and send a medication decreased from 2019 to 2020 for STAT orders ( < 0.001), and there was no difference in wasted medications looking at all orders in this time.
CONCLUSION
Anticipatory batching decreased time to prepare, check, and send medications, though there was no effect on waste or on time to administration. Future studies can examine the correlation between pharmacy operations and medication administration.
Topics: Humans; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacists; Pharmacies; Pharmacy
PubMed: 34165027
DOI: 10.1177/08971900211027134 -
Journal of Controlled Release :... Jan 2018Poorly water-soluble drugs are a significant and ongoing issue for the pharmaceutical industry. An overview of recent developments for the preparation of spray-dried... (Review)
Review
Poorly water-soluble drugs are a significant and ongoing issue for the pharmaceutical industry. An overview of recent developments for the preparation of spray-dried delivery systems is presented. Examples include amorphous solid dispersions, spray dried dispersions, microparticles, nanoparticles, surfactant systems and self-emulsifying drug delivery systems. Several aspects of formulation are considered, such as pre-screening, choosing excipient(s), the effect of polymer structure on performance, formulation optimisation, ternary dispersions, fixed-dose combinations, solvent selection and component miscibility. Process optimisation techniques including nozzle selection are discussed. Comparisons are drawn with other preparation techniques such as hot melt extrusion, freeze drying, milling, electro spinning and film casting. Novel analytical and dissolution techniques for the characterization of amorphous solid dispersions are included. Progress in understanding of amorphous supersaturation or recrystallisation from solution gathered from mechanistic studies is discussed. Aspects of powder flow and compression are considered in a section on downstream processing. Overall, spray drying has a bright future due to its versatility, efficiency and the driving force of poorly soluble drugs.
Topics: Administration, Oral; Biological Availability; Desiccation; Drug Delivery Systems; Pharmaceutical Preparations; Solubility; Technology, Pharmaceutical; Water
PubMed: 29117503
DOI: 10.1016/j.jconrel.2017.11.005 -
Journal of Pharmaceutical and... Dec 2014Vibrational spectroscopy (MIR, NIR and Raman) based hyperspectral imaging is one of the most powerful tools to analyze pharmaceutical preparation. Indeed, it combines... (Review)
Review
Vibrational spectroscopy (MIR, NIR and Raman) based hyperspectral imaging is one of the most powerful tools to analyze pharmaceutical preparation. Indeed, it combines the advantages of vibrational spectroscopy to imaging techniques and allows therefore the visualization of distribution of compounds or crystallization processes. However, these techniques provide a huge amount of data that must be processed to extract the relevant information. This review presents fundamental concepts of hyperspectral imaging, the basic theory of the most used chemometric tools used to pre-process, process and post-process the generated data. The last part of the present paper focuses on pharmaceutical applications of hyperspectral imaging and highlights the data processing approaches to enable the reader making the best choice among the different tools available.
Topics: Chemistry, Pharmaceutical; Electronic Data Processing; Pharmaceutical Preparations; Spectrum Analysis; Technology, Pharmaceutical; Vibration
PubMed: 24809748
DOI: 10.1016/j.jpba.2014.04.012 -
Physical Review. E Feb 2023The morphology and motion behavior of a cell are highly influenced by its external biological, chemical, and physical stimuli, and geometric confinement. In this paper,...
The morphology and motion behavior of a cell are highly influenced by its external biological, chemical, and physical stimuli, and geometric confinement. In this paper, it is revealed that the mean curvature of the substrate significantly influences the adhesion of vesicles. By employing the variational method and investigating the Helfrich free energy, the configuration of axisymmetric vesicles adhered to curved spherical substrates is obtained theoretically. Moreover, numerical simulations based on the finite element method are also carried out to investigate the adhesion of vesicles on curved substrates with complex shapes. It is found that for a fixed area of a vesicle, its total free energy depends mainly on the mean curvature of the adhesion region but is insensitive to the specific shape of the substrate, and the total free energy monotonically decreases with the increase in the mean curvature. In addition, possible biological significances of the curvature-dependent adhesion, such as the shape of the cell and antibiofouling, are discussed. This study may deepen our understanding of the underlying mechanisms of adhesion in cellular activities.
PubMed: 36932565
DOI: 10.1103/PhysRevE.107.024405 -
Physical Review. E Jan 2023The spontaneous emergence of patterns in nature, such as stripes and spots, can be mathematically explained by reaction-diffusion systems. These patterns are often...
The spontaneous emergence of patterns in nature, such as stripes and spots, can be mathematically explained by reaction-diffusion systems. These patterns are often referred as Turing patterns to honor the seminal work of Alan Turing in the early 1950s. With the coming of age of network science, and with its related departure from diffusive nearest-neighbor interactions to long-range links between nodes, additional layers of complexity behind pattern formation have been discovered, including irregular spatiotemporal patterns. Here we investigate the formation of Turing patterns in simplicial complexes, where links no longer connect just pairs of nodes but can connect three or more nodes. Such higher-order interactions are emerging as a new frontier in network science, in particular describing group interaction in various sociological and biological systems, so understanding pattern formation under these conditions is of the utmost importance. We show that a canonical reaction-diffusion system defined over a simplicial complex yields Turing patterns that fundamentally differ from patterns observed in traditional networks. For example, we observe a stable distribution of Turing patterns where the fraction of nodes with reactant concentrations above the equilibrium point is exponentially related to the average degree of 2-simplexes, and we uncover parameter regions where Turing patterns will emerge only under higher-order interactions, but not under pairwise interactions.
PubMed: 36797896
DOI: 10.1103/PhysRevE.107.014216 -
Journal of Medical Systems Mar 2021The aims were to develop an integrated electronic medication reconciliation (ieMR) platform, evaluate its effects on preventing potential duplicated medications, analyze...
Developing an Integrated Electronic Medication Reconciliation Platform and Evaluating its Effects on Preventing Potential Duplicated Medications and Reducing 30-Day Medication-Related Hospital Revisits for Inpatients.
The aims were to develop an integrated electronic medication reconciliation (ieMR) platform, evaluate its effects on preventing potential duplicated medications, analyze the distribution of the potential duplicated medications by the Anatomical Therapeutic and Chemical (ATC) code for all inpatients, and determine the rate of 30-day medication-related hospital revisits for a geriatric unit. The study was conducted in a tertiary medical center in Taiwan and involved a retrospective quasi pre-intervention (July 1-November 30, 2015) and post-intervention (October 1-December 31, 2016) study design. A multidisciplinary team developed the ieMR platform covering the process from admission to discharge. The ieMR platform included six modules of an enhanced computer physician order entry system (eCPOE), Pharmaceutical-care, Holistic Care, Bedside Display, Personalized Best Possible Medication Discharge Plan, and Pharmaceutical Care Registration System. The ieMR platform prevented the number of potential duplicated medications from pre (25,196 medications, 2.3%) to post (23,413 medications, 3.8%) phases (OR 1.71, 95% CI, 1.68-1.74; p < .001). The most common potential duplicated medications classified by the ATC codes were cardiovascular system (28.4%), alimentary tract and metabolism (26.4%), and nervous system (14.9%), and by chemical substances were sennoside (12.5%), amlodipine (7.5%), and alprazolam (7.4%). The rate of medication-related 30-day hospital revisits for the geriatric unit was significantly decreased in post-intervention compared with that in pre-intervention (OR = 0.12; 95% CI, 0.03-0.53; p < .01). This study indicated that the ieMR platform significantly prevented the number of potential duplicated medications for inpatients and reduced the rate of 30-day medication-related hospital revisits for the patients on the geriatric unit.
Topics: Continuity of Patient Care; Medical Order Entry Systems; Medical Records Systems, Computerized; Medication Errors; Medication Reconciliation; Patient Care Team; Pharmaceutical Preparations; Pharmacy Service, Hospital; Quality Assurance, Health Care; Retrospective Studies; Taiwan
PubMed: 33644834
DOI: 10.1007/s10916-021-01717-8