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medicines optimisation

Leila Rooshenas, Daisy Elliott, Julia Wade, Marcus Jepson, Sangeetha Paramasivan, Sean Strong, Caroline Wilson, David Beard, Jane M Blazeby, Alison Birtle, Alison Halliday, Chris A Rogers, Rob Stein, Jenny L Donovan
BACKGROUND: Randomised controlled trials (RCTs) are essential for evidence-based medicine and increasingly rely on front-line clinicians to recruit eligible patients. Clinicians' difficulties with negotiating equipoise is assumed to undermine recruitment, although these issues have not yet been empirically investigated in the context of observable events. We aimed to investigate how clinicians conveyed equipoise during RCT recruitment appointments across six RCTs, with a view to (i) identifying practices that supported or hindered equipoise communication and (ii) exploring how clinicians' reported intentions compared with their actual practices...
October 2016: PLoS Medicine
Thamani T Gondo, Veronica C Obuseng, Lesego C Mmualefe, Harriet Okatch
HS-SPME was optimised using blank plant sample for analysis of organochlorine pesticides (OCPs) of varying polarities in selected medicinal plants obtained from northern part of Botswana, where OCPs such as DDT and endosulfan have been historically applied to control disease carrying vectors (mosquitos and tsetse fly). The optimised SPME parameters were used to isolate analytes from root samples of five medicinal plants obtained from Maun and Kasane, Botswana. The final analytes determination was done with a gas chromatograph equipped with GC-ECD and analyte was confirmed using electron ionisation mass spectrometer (GC-MS)...
2016: Journal of Analytical Methods in Chemistry
Marine Desarmenien, Anne Laure Blanchard-Courtois, Bara Ricou
Advances in intensive care medicine have created a new disease called the chronic critical illness. While a significant proportion of severely ill patients who twenty years ago would have died survive the acute phase, they remain heavily dependent on intensive care for a prolonged period of time. These patients, who can be called "Patient Long Séjour" in French (PLS) or Prolonged Length of Stay patients in English, develop specific health issues that are still poorly recognised. They require special care, which differs from treatments that are given during the acute phase of their illness...
2016: Swiss Medical Weekly
Richard Peck, Patrick Smith
Prescribers have been practicing stratified medicine for many years. Patient characteristics, usually non-genetic, including age, comorbidities and concomitant medications are taken into account when deciding which drug to prescribe. In addition, the majority of drugs require dose adjustments across patient subgroups, usually determined by non-genetic differences between the subgroups. Whilst pharmacogenetics hold promise for enhancing treatment stratification and even treatment individualisation, non-genetic factors will continue to be very important...
May 25, 2010: Pharmaceuticals
Marius Hittinger, Julia Janke, Hanno Huwer, Regina Scherließ, Nicole Schneider-Daum, Claus-Michael Lehr
The development of new formulations for pulmonary drug delivery is a challenge on its own. New in vitro models which address the lung are aimed at predicting and optimising the quality, efficacy and safety of inhaled drugs, to facilitate the more rapid translation of such products into the clinic. Reducing the complexity of the in vivo situation requires that such models reproducibly reflect essential physiological factors in vitro. The choice of cell types, culture conditions and the experimental set-up, can affect the outcome and the relevance of a study...
September 2016: Alternatives to Laboratory Animals: ATLA
Albert Farrugia
No abstract text is available yet for this article.
October 3, 2016: Medical Journal of Australia
F Nejatbakhsh, L Shirbeigi, R Rahimi, H Abolhassani
The male reproductive function can be influenced by many different factors, including genetic, environmental and socioeconomic parameters leading to a progressive decline. However, the cause of infertility cannot be found in a significant proportion of couples, and even with the presence of the sign of testicular dysfunction or obstructive azoospermia, the main aetiology is not identified. In the absence of knowledge about predisposing factor, targeted therapeutic modalities for male infertility may not be possible, and a wide variety of empiric drug approaches, even with low scientific evidence, have been utilised in current conventional medicine...
October 2016: Andrologia
Jan Breckwoldt, Jan R Ludwig, Joachim Plener, Torsten Schröder, Hans Gruber, Harm Peters
BACKGROUND: Distributing a fixed amount of teaching hours over a longer time period (spaced approach) may result in better learning than delivering the same amount of teaching within a shorter time (massed approach). While a spaced approach may provide more opportunities to elaborate the learning content, a massed approach allows for more economical utilisation of teaching facilities and to optimise time resources of faculty. Favourable effects of spacing have been demonstrated for postgraduate surgery training and for spacing intervals of weeks to months...
September 26, 2016: BMC Medical Education
Ann Bellerby, Deborah Susan Needham
Nursing students, nurses and other healthcare professionals involved in prescribing, dispensing, administration and monitoring of medicines should be able to navigate and use the British National Formulary (BNF) effectively. Recent changes to the structure of the BNF have resulted in new symbols, additional sections in drug and drug-class monographs, and a reduction in the amount of cross-referencing between chapters. This article explores how healthcare professionals can access the information in the BNF to ensure that medicines use is optimised, therapeutic effects are maximised, and adverse drug reactions and drug interactions are minimised...
September 21, 2016: Nursing Standard
T J H Siebers, A J van Winkelhoff
Treatment of infectious diseases is complex and success is dependent upon a number of factors. The proper prescription and correct dosage of antimicrobials are important elements in this respect. Incorrect prescription and insufficient dosage can result not only in treatment failure but also contribute to the development of antimicrobial resistance. In order to achieve correct antibiotic dosages it is necessary to gain insight in pharmacokinetic and pharmacodynamic principles. It is also vital to differentiate among various types of infections and to adjust antibiotic prescription to the clinical situation of the individual patient accordingly...
September 2016: Nederlands Tijdschrift Voor Tandheelkunde
G Folléa
OBJECTIVES: In a context of regular review of transfusion practice, the aim of this review is to present an update of the scientific basis of the so-called "patient blood management" (PBM), the state of its development in Europe, and possible ways to progress its development further in France. METHODS: Analysis and synthesis of the data from scientific literature on the scientific basis of PBM (methods, indications, efficacy, risks, efficiency). RESULTS: PBM appears as an evidence-based, patient centred, multidisciplinary approach, aiming to optimise the care of patients who might need transfusion and, consequently, the use of blood products...
September 14, 2016: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
Marcus Lee, Thomas Modine, Nicolo Piazza, Darren Mylotte
Individualised, patient-centred care is a central tenet of modern medicine. The variety of transcatheter heart valves currently available affords the opportunity to select the most appropriate device for each individual patient. Prosthesis selection should be based on operator experience and pre-procedural multimodal three-dimensional imaging. Herein, we outline a number of clinical scenarios where specific transcatheter heart valve technologies have the potential to optimise clinical outcome.
September 18, 2016: EuroIntervention
Kali Zhou, Thomas Fitzpatrick, Nick Walsh, Ji Young Kim, Roger Chou, Mellanye Lackey, Julia Scott, Ying-Ru Lo, Joseph D Tucker
BACKGROUND: Advances in therapy for hepatitis B virus (HBV) and hepatitis C virus (HCV) have ushered in a new era in chronic hepatitis treatment. To maximise the effectiveness of these medicines, individuals must be engaged and retained in care. We analysed operational interventions to enhance chronic viral hepatitis testing, linkage to care, treatment uptake, adherence, and viral suppression or cure. METHODS: We did a systematic review of operational interventions, and did meta-analyses for sufficiently comparable data...
September 5, 2016: Lancet Infectious Diseases
Sabine Salloch
Evidence-based medicine (EBM) and medical professionalism are two prominent notions in current medical debates. However, proponents of professionalism fear a restriction in doctors' freedom to make their best decisions for individual patients caused by the influence of EBM and highly standardised decision procedures. The challenge which EBM allegedly poses to physicians' discretion forms the starting point for an analysis of the relationship between professionalism, as an inherent value system of medical practice, and EBM, as an approach to optimise the decision-making for individual patients...
August 31, 2016: Medicine, Health Care, and Philosophy
Neil S Garton, Michael D Barker, Rob P Davis, Clement Douault, Edward Hooper-Greenhill, Emma Jones, Huw D Lewis, John Liddle, Dave Lugo, Scott McCleary, Alex G S Preston, Cesar Ramirez-Molina, Margarete Neu, Tracy J Shipley, Don O Somers, Robert J Watson, David M Wilson
The optimisation of the azanaphthyridine series of Spleen Tyrosine Kinase inhibitors is described. The medicinal chemistry strategy was focused on optimising the human whole blood activity whilst achieving a sufficient margin over hERG activity. A good pharmacokinetic profile was achieved by modification of the pKa. Morpholine compound 32 is a potent SYK inhibitor showing moderate selectivity, good oral bioavailability and good efficacy in the rat Arthus model but demonstrated a genotoxic potential in the Ames assay...
October 1, 2016: Bioorganic & Medicinal Chemistry Letters
S Deepthi, K Satheeshkumar
Ophiorrhiza mungos is a herbaceous medicinal plant which contains a quinoline alkaloid, camptothecin (CPT), an anticancer compound. A high-yielding cell line, O. mungos cell line-3 (OMC3) was selected from cell suspension cultures of O. mungos using cell aggregate cloning method and established cell suspension culture. OMC3 cell suspension produced significantly high biomass (9.25 ± 1.3 g/flask fresh weight (FW)) and CPT yield (0.095 ± 0.002 mg g(-1) dry weight (DW)) compared with the original cell suspension...
August 31, 2016: Applied Microbiology and Biotechnology
N Apaydin, S Çomoğlu, Y Özer, H Avci, H Eş, K S Orhan
OBJECTIVE: To investigate rhinology-related malpractice claims with the aim of optimising safe practice. METHODS: The database of the National Institute of Forensic Medicine was reviewed. In total, 241 otorhinolaryngology malpractice case reports dating from 2005 to 2012 were evaluated, and 83 malpractice cases related to rhinology treatments were separated. RESULTS: There was no significant difference between the number of male (n = 42) and female (n = 41) claimants...
August 30, 2016: Journal of Laryngology and Otology
Bernardo Bollen Pinto, Glen Atlas, Bart F Geerts, Karim Bendjelid
The oesophageal Doppler (OD) is a minimally invasive haemodynamic monitor used in the surgical theatre and the ICU. Using the OD, goal-directed therapy (GDT) has been shown to reduce perioperative complications in high-risk surgical patients. However, most GDT protocols currently in use are limited to stroke volume optimisation. In the present manuscript, we examine the conceptual models behind new OD-based measurements. These would provide the clinician with a comprehensive view of haemodynamic pathophysiology; including pre-load, contractility, and afterload...
August 27, 2016: Journal of Clinical Monitoring and Computing
Joseph F Standing
Understanding the dose-concentration-effect relationship is a fundamental component of clinical pharmacology. Interpreting data arising from observations of this relationship requires the use of mathematical models; that is pharmacokinetic (PK) models to describe the relationship between dose and concentration and pharmacodynamic (PD) models describing the relationship between concentration and effect. Drug development requires several iterations of pharmacometric model-informed learning and confirming. This includes modelling to understand the dose-response in pre-clinical studies, deriving a safe dose for first-in-man, and the overall analysis of Phase I/II data to optimise the dose for safety and efficacy in Phase III pivotal trials...
August 27, 2016: British Journal of Clinical Pharmacology
Julia Blitz, Jill Edwards, Bob Mash, Steve Mowle
CONTEXT: The Royal College of General Practitioners in partnership with the South African Academy of Family Physicians obtained funding to run a series of 'Training the Trainers' courses for trainers of family medicine registrars, with a view to strengthening clinical supervision of postgraduate registrars. The authors wanted to establish whether it was worthwhile for the course to be provided on an ongoing basis after the funded project was completed. INTERVENTION: Development of a pilot tool for evaluation visits after a faculty development course...
September 2016: Education for Primary Care
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