Compatibility of parenteral nutrition admixture (PNA) and intravenous medications (IVMs) is a major consideration for clinicians and clinical pharmacists, especially when concurrent administration of PNA with IVMs is unavoidable. This is relatively common in children and neonates, where limited vascular access can be challenging. The purpose of this paper is to create a risk assessment tool that will assist clinical judgment in evaluating the potential incompatibility risk between PNA media and the IVMs when they are administered together through the same intravenous line.
View Article and Find Full Text PDFThe EMA defines acceptability as "the overall ability and willingness of the patient to use, and their caregiver to administer, the medicine as intended" [1]. This paper seeks to outline issues of acceptability in relation to injectable therapy, namely intravenous (IV), intramuscular (IM) and subcutaneous (SC) administration routes, and to lay a foundation to identify a minimum set of data that would satisfy Regulatory Authorities when discussing the acceptability of an injectable product. In addition, it will alert drug product developers to other factors that might contribute to good practice, alternative administration strategies and overall adherence to achieve successful treatment.
View Article and Find Full Text PDFBackground: Children with medical complexity (CMC) have inter-related health and social needs; however, interventions to identify and respond to social needs have not been adapted for CMC. The objective of this study was to evaluate the feasibility of implementing social needs screening and assessment within pediatric complex care programs.
Methods: We implemented systematic social needs assessment for CMC (SSNAC) at two tertiary care centers in three phases: (1) pre-implementation, (2) implementation, and (3) implementation monitoring.
Palatability is amongst the most important determinants of whether or not a child will take a medicine. In order to increase concordance with treatment regimens it is often necessary to utilise a range of formulation techniques to improve the palatability of medicines. These can include selecting a different molecule or version of a molecule (such as a different polymorph or salt form), various taste masking techniques and/or the inclusion of flavours and sweeteners.
View Article and Find Full Text PDFDrug release within the oral cavity can be of paramount importance for formulations that are designed for specific purposes such as taste-masking, faster onset of therapeutic action, localization of treatment or avoidance of first-pass metabolism. Preclinical methods for assessment of dissolution in the oral cavity are necessary for design and development of these formulation but currently there is no consensus on what variables should be defined to achieve biorelevance in these tests. In this study, biorelevant simulated salivary fluids (SSFs) that can be uniformly applied for oral cavity dissolution testing were developed.
View Article and Find Full Text PDFAcceptable palatability of an oral dosage form is crucial to patient compliance. Excipients can be utilised within a formulation to mask the bitterness of a drug. One such category is the bitter-blockers.
View Article and Find Full Text PDFEur J Pharm Biopharm
January 2020
Recently there has been an increased interest to develop specialised dosage forms that are better suited to specific patient populations, such as paediatrics and geriatrics. In these patient populations the acceptability of the oral dosage form can be paramount to the products success. However, many Active Pharmaceutical Ingredients (APIs) are known to cause an aversive taste response.
View Article and Find Full Text PDFA lack of evidence to guide the design of age-appropriate and acceptable dosage forms has been a longstanding knowledge gap in paediatric formulation development. The Children's Acceptability of Oral Formulations (CALF) study captured end-user perceptions and practices with a focus on solid oral dosage forms, namely tablets, capsules, chewables, orodispersibles, multiparticulates (administered with food) and mini-tablets (administered directly into the mouth). A rigorous development and testing phase produced age-adapted questionnaires as measurement tools with strong evidence of validity and reliability.
View Article and Find Full Text PDFWe identified tryptic peptides in yeast cell lysates that map to translation initiation sites downstream of the annotated start sites using the peptide-spectrum matching algorithms OMSSA and Mascot. To increase the accuracy of peptide-spectrum matching, both algorithms were run using several standardized parameter sets, and Mascot was run utilizing a, b, and y ions from collision-induced dissociation. A large fraction (22%) of the detected N-terminal peptides mapped to translation initiation downstream of the annotated initiation sites.
View Article and Find Full Text PDFThe development of paediatric medicines can be challenging since this is a diverse patient population with specific needs. For example, the toxicity of excipients may differ in children compared to adults and children have different taste preferences. Acceptable palatability of oral paediatric medicinal products is of great importance to facilitate patient adherence.
View Article and Find Full Text PDFObesity is a global disease with epidemic proportions. Bariatric surgery or modified lifestyles go a long way in mitigating the vast weight gain. Patients following these interventions usually undergo massive weight loss.
View Article and Find Full Text PDFA beat-to-beat variation in the cardiac action potential duration is a phenomenon known as alternans. Alternans has been linked to ventricular fibrillation, and thus the ability to predict the onset of alternans could be clinically beneficial. Theoretically, it has been proposed that the slope of a restitution curve, which relates the duration of the action potential to the preceding diastolic interval, can predict the onset of alternans.
View Article and Find Full Text PDFAnnu Int Conf IEEE Eng Med Biol Soc
April 2010
Real-time optical registration of electrical activity in the heart allows the study of arrhythmogenic mechanisms, in particular due to global ischemia. It is known that global ischemia increases electrical heterogeneity in the heart. However, inter-ventricular differences between the right (RV) and left ventricle (LV) during ischemia and their relationship to arrhythmogenesis remains poorly understood.
View Article and Find Full Text PDFWith the variety of bariatric procedures available today, there is a steadily growing stream of massive weight loss patients. Although there have been major advances in upper extremity and upper and lower truncal contouring, the lower extremity often remains the most difficult to treat. Historically, thigh reductions were designed to treat minor medial thigh laxity.
View Article and Find Full Text PDFThe arm deformity encountered in most patients who have had massive weight loss is severe. The excess crosses the axilla as an extension of the posterior axillary fold. Surgical treatment requires crossing the axilla with the excision.
View Article and Find Full Text PDFAn upper body lift is needed whenever a massive weight loss patient presents with a "dropped out" lateral inframammary crease. It is a combination of a brachioplasty, upper-back resection, and breast reconstruction. The operation is designed to reverse the particular deformity a patient presents with.
View Article and Find Full Text PDFPlast Reconstr Surg
August 2007
Background: Belt lipectomy combines traditional abdominoplasty with a circumferential excision of skin and fat, with resultant buttock and lateral thigh lifts. Because of the extensive nature of the procedure, postoperative pain management can be difficult. Epidural analgesia has been shown to be efficacious in treating postoperative pain.
View Article and Find Full Text PDFBioactivation of parent drug to reactive metabolite(s) followed by protein haptenation has been suggested to be a critical step in the elicitation of cutaneous drug reactions. Although liver is believed to be the primary organ of drug bioactivation quantitatively, other organs including skin may also metabolize drugs. Cultured human epidermal keratinocytes and dermal fibroblasts have been shown to be capable of bioactivating sulfonamides and sulfones, giving rise to haptenated proteins.
View Article and Find Full Text PDFIn performing brachioplasty, the authors have created a double-ellipse marking technique to avoid overresecting and leave adequate skin for closure. After resecting, they prevent the interference of soft-tissue swelling during wound closure by immediately closing each segment with temporary staples. Their technique is ideal for patients with massive weight loss.
View Article and Find Full Text PDFBody contouring of massive weight loss patients is the latest frontier in plastic surgery. It is important to become familiar with the presentation of these patients and with the delineation and effective treatment of their deformities. Because they usually present with circumferential excess, circumferential belt lipectomy treats their truncal contour as a unit.
View Article and Find Full Text PDFPlast Reconstr Surg
January 2003
When some patients with circumferential truncal excess undergo traditional abdominoplasty, the trunk is not addressed as a unit. Belt lipectomy, a procedure that combines abdominoplasty with circumferential excision of skin and fat, is often more ideal for these patients. In this article, the authors review the literature on belt lipectomy and evaluate their series of 32 patients who underwent belt lipectomy at the University of Iowa.
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