Impact of ‘Chief-Pharmacist System’ on drug expenditures and rational drug use

International Journal of Clinical Pharmacy - Background Over the last few years, pharmacists in China have been searching for effective strategies to expand their roles in pharmaceutical care. In...     

‘Trapping’ in drug use and sex work careers

This paper examines the reinforcement of sex work and drug use. Data from 92 survey and in-depth interviews were analysed to examine associations between vulnerabilities and ‘trapping’: mutually reinforcing sex work and problematic drug use. Three-quarters of participants had used drugs and half had sold sex before 18. Half had been in care and half had been homeless. One in 5 (21%) had run away or left home before 16 and 80% had been convicted for acquisitive offences. Nevertheless, these experiences did not explain trapping.

There were strong associations between being trapped and convictions (81%); and being trapped and outdoor/drift sex work (92%). After adjustment for the other vulnerabilities in the logistic regression only outdoor/drift sex work remained significant: with sex workers involved in outdoor/drift sex-work having an adjusted odds ratio of over 7 (95% c.i. 1.7–28.3) of being trapped. Moreover, since the sample over-represents the extent of problematic drug use amongst indoor sex workers the study underestimates differences in trapping potential between sex markets. We conclude that outdoor/drift sex markets may reinforce vulnerability, sex work and problematic drug use. Interventions are recommended to disentangle sex and drugs markets, and reduce the sex industry's potential for exploitation and abuse.     

Evolving ‘-omics’ technologies in the drug development process

The strength of the ‘-omics’ technologies lies in their ability to monitor the activity of biomolecules in a large-scale, high-throughput fashion shortening the overall time needed for the discovery of a new drug. Recent advances in technology have resulted in a higher reproducibility and enhanced sensitivity, thus allowing for a more precise deciphering of a pathologic process. However, because of strict standardization criteria that demands strong financial support and the availability of highly specialized experts, the importance of dedicated core facilities or specialized units becomes central. Today, the ‘omics’ approach in biomedicine has become more pathway-oriented and is complemented by several other experimental approaches, data analyses, pathway informatics, literature mining and mathematical modeling processes, all of which are contained within systems biology. The authors believe that systems biology is an integrated approach that can offer a solution to some of the major bottlenecks in drug discovery and can foster target identification, allowing the drug to target molecules relevant to disease pathways. In this perspective, the authors touch on the present state of the mainstream ‘-omics’ technologies already in use in drug discovery as well as their shortcomings and perspectives for future applications.     

Superparamagnetic iron oxide nanoparticle ‘theranostics’ for multimodality tumor imaging,gene delivery,targeted drug and prodrug delivery

The superparamagnetic iron oxide nanoparticle (SPIO) ‘theranostics’, which contain imaging probes for tumor diagnosis and therapeutic compounds for therapy in a single nanoparticle, might provide significant benefits compared with exiting tumor imaging and therapeutic strategies. In this review, we summarize the progress of SPIO ‘theranostics’ that integrate tumor targeting, multimodality imaging, and gene delivery or targeted drug and prodrug delivery. This review describes various methods of SPIO synthesis, surface coating and characterization. Different tumor-targeting strategies, such as antibody fragments, nucleotides and receptor ligands, are discussed to improve SPIO delivery for multimodality imaging. We also examine the utility of SPIOs for gene delivery, siRNA delivery and imaging. Several methods for drug encapsulation and conjugation onto SPIOs are compared for targeted drug delivery, site-specific release and imaging-guided drug delivery. Finally, we also review the pharmacokinetics (including biodistribution) of SPIOs based on their characteristics.     

‘Smart’ nanoparticles as drug delivery systems for applications in tumor therapy

Introduction: In the therapy of clinical diseases such as cancer, it is important to deliver drugs directly to tumor sites in order to maximize local drug concentration and reduce side effects. This objective may be realized by using ‘smart’ nanoparticles (NPs) as drug delivery systems, because they enable dramatic conformational changes in response to specific physical/chemical stimuli from the diseased cells for targeted and controlled drug release.

Areas covered: In this review, we first briefly summarize the characteristics of ‘smart’ NPs as drug delivery systems in medical therapy, and then discuss their targeting transport, transmembrane and endosomal escape behaviors. Lastly, we focus on the applications of ‘smart’ NPs as drug delivery systems for tumor therapy.

Expert opinion: Biodegradable ‘smart’ NPs have the potential to achieve maximum efficacy and drug availability at the desired sites, and reduce the harmful side effects for healthy tissues in tumor therapy. It is necessary to select appropriate NPs and modify their characteristics according to treatment strategies of tumor therapy.     

In situ gel systems as ‘smart’ carriers for sustained ocular drug delivery

Introduction: In situ gel systems refer to a class of novel delivery vehicles, composed of natural, semisynthetic or synthetic polymers, which present the unique property of sol–gel conversion on receipt of biological stimulus.

Areas covered: The present review summarizes the latest developments in in situ gel technology, with regard to ophthalmic drug delivery. Starting with the mechanism of ocular absorption, the review expands on the fabrication of various polymeric in situ gel systems, made up of two or more polymers presenting multi-stimuli sensitivity, coupled with other interesting features, such as bio-adhesion, enhanced penetration or sustained release. Various key issues and challenges in this area have been addressed and critically analyzed.

Expert opinion: The advent of in situ gel systems has inaugurated a new transom for ‘smart’ ocular delivery. By virtue of possessing stimuli-responsive phase transition properties, these systems can easily be administered into the eye, similar to normal eye drops. Their unique gelling properties endow them with special features, such as prolonged retention at the site of administration, followed by sustained drug release. Despite the superiority of these systems as compared with conventional ophthalmic formulations, further investigations are necessary to address the toxicity issues, so as to minimize regulatory hurdles during commercialization.     

Three ‘D’s: Design approach,dimensional printing,and drug delivery systems as promising tools in healthcare applications

The development of pharmaceutical drug products is required for the treatment of disease, which has resulted in an increasing number of approvals by regulatory agencies across the globe. To establish a hassle-free manufacturing process, the systematic use of a quality-by-design (QbD) approach combined with process analytical technology (PAT) and printing techniques can revolutionize healthcare applications. Printing technology has been emerged in various dimensions, such as 3D, 4D, and 5D printing, with respect to their production capabilities, durability, and accuracy of pharmaceutical manufacturing, which can efficiently deliver novel patient-centric healthcare products with holistic characteristics. In this review, we provide current trends in pharmaceutical product development using a design approach and high-quality printing techniques.     

Injection drug users’ and their risk networks’ experiences of and attitudes towards drug dealer violence in Baltimore,Maryland

BackgroundA large portion of violence associated with drug use is due to drug dealing. These analyses sought to examine injection drug users’ attitudes and experiences of drug dealer violence.MethodsThe current study used the 18-month follow up data of STEP into Action (STEP) study, an HIV prevention intervention among drug injectors and their risk network members conducted in Baltimore, Maryland. Four scales assessed acceptability of drug dealer violence, willingness to talk to drug users about avoiding drug dealer violence, social norms about reporting drug dealer violence and intentions to report drug dealer violence to the police.ResultsMany (44%) of the 373 participants reported witnessing drug dealers’ acts of violence within the prior 6 months. Although the majority of participants disagreed with statements on the acceptability of dealers using violence, only a minority indicated that they would call the police if they observed dealer violence. Most participants indicated that they would be interested in talking to drug users about how to avoid violent dealers. Males were more likely to report that violence was acceptable, whereas African Americans were less likely to condone violence. Those who were homeless and had higher incomes were more likely to report witnessing drug dealer violence.ConclusionsThese results suggest that it may be feasible to train current and former drug users and their risk network members in methods to promote violence reduction among drug dealers.     

‘围城’

今年以来,关于药店的话题最热的有两个:放开药店审批和平价药店。而这两个热点之间显而易见地存在着必然的因果关联。 自去年底,各地相继解冻了“封停”两、三年的零售药店开办申请,并进一步取消距离限制,药店急剧增长的势头让业外人都咋舌惊叹。有人统计,自去年放开药店经营审批以来,广东新开药店3077家;而江苏在半年内净增药店     

Development of a ‘ready-to-use’ tool that includes preventability,for the assessment of adverse drug events in oncology

Background Adverse drug events (ADEs) occur frequently in oncology and justify continuous assessment and monitoring. There are several methods for detecting them, but the trigger tool method seems the most appropriate. Although a generic tool exists, its use for ADEs in oncology has not been convincing. The development of a focused version is therefore necessary. Objective To provide an oncology-focused trigger tool that evaluates the prevalence, harm, and preventability in a standardised method for pragmatic use in ADE surveillance. Setting Hospitals with cancer care in France. Method The tool has been constructed in two steps: (1) constitution of an oncology-centred list of ADEs; 30 pharmacists/practitioners in cancer care from nine hospitals selected a list of ADEs using a method of agreement adapted from the RAND/UCLA Appropriateness Method; and (2) construction of three standardised dimensions for the characterisation of each ADE (including causality, severity, and preventability). Main outcome measure The main outcome measure was validation of the tool, including preventability criteria. Results The tool is composed of a final list of 15 ADEs. For each ADE, a ‘reviewer form’ has been designed and validated by the panel. It comprises (1) the trigger(s), (2) flowcharts to guide the reviewer, (3) criteria for grading harm, and (4) a standardised assessment of preventability with 6–14 closed sentences for each ADE in terms of therapeutic management and/or prevention of side-effects. Conclusion A complete ‘ready-to-use’ tool for ADE monitoring in oncology has been developed that allows the assessment of three standardised dimensions.     

On the ‘micro’-pharmacodynamic and pharmacokinetic mechanisms that contribute to long-lasting drug action

Introduction: Optimal drug therapy often requires continuing high levels of target occupancy. Besides the traditional pharmacokinetic (PK) contribution thereto, drug–target interactions that comprise successive ‘microscopic’ steps as well as the intervention of the cell membrane and other ‘micro’-anatomical structures nearby may help attaining this objective.

Areas covered: This article reviews the ‘micro’-pharmacodynamic (PD) and PK mechanisms that may increase a drug’s residence time. Special focus is on induced-fit- and bivalent ligand binding models as well as on the ability of the plasma membrane surrounding the target to act as a repository for the drug (e.g., microkinetic model), to actively participate in the binding process (e.g., exosite model) and, along with microanatomical elements like synapses and interstitial spaces, to act on the drug’s diffusion properties (reduction in dimensionality and drug-rebinding models).

Expert opinion: The PK profile, as well as the target dissociation kinetics of a drug, may fail to account for its long-lasting efficiency in intact tissues and in vivo. This lacuna could potentially be alleviated by incorporating some of the enumerated ‘microscopic’ mechanisms and, to unveil them, dedicated experiments on sufficiently physiologically relevant biological material like cell monolayers can already be implemented early on in the lead optimization process.