Quality assurance in drug demand reduction in European countries: an overview

Background: The EMCDDA, through its network of National Focal Points, collects information on the quality assurance systems for drugs-related interventions across European countries. European National Drug Strategies include recommendations for systems and approaches for the assurance of the quality of interventions.

Methods: We searched National Drug Strategies for elements related to quality assurance in drug demand reduction and summarised information through questionnaires administered to the EMCDDA Network of National Focal Points.

Results: In total, 15 National Drug Strategies and 60 questionnaires were analysed. Almost all the strategies include quality-related topics. Frequently, the Ministry of Health leads quality assurance although sometimes jointly with the Ministries of Education, Labour, Family and Social Welfare. Accreditation systems are common, but implemented in different ways. Training and education are widely provided, for the vast majority of countries, consisting of short-term training to keep professionals updated. Guidelines and Standards are gathering momentum as the major tools for the implementation of evidence-based recommendations and are usually available across countries.

Conclusions: Although the evidence base for interventions in drug demand reduction is becoming available and accepted, attention needs to be given to implementation issues. The European countries are rapidly moving towards paying greater attention to the quality of interventions.     

Dual photoacoustic/ultrasound multi-parametric imaging from passion fruit-like nano-architectures

Ultrasound (US) imaging is a well-established diagnostic technique to image soft tissues in real time, while photoacoustic (PA) is an emerging imaging technique employed to collect molecular information. Integration of PA and US imaging provides complementary information enhancing diagnostic accuracy without employing ionizing radiations. The development of contrast agents able to combine PA and US features is pivotal to improve the significance of PAUS imaging and for PAUS-guided treatment of neoplasms. Here, we demonstrate in relevant ex-vivo models that disassembling passion fruit-like nano-architectures (pfNAs) can be employed in PAUS imaging. pfNAs are composed by silica nanocapsules comprising aggregates of commercial NIR-dyes-modified polymers and ultrasmall gold nanoparticles. The intrinsic US and PA features of pfNAs have been fully characterized and validated in tissue-mimicking materials and in ex vivo preparations. Moreover, the application of a multi-parametric approach has allowed the increase of information extrapolated from collected images for a fine texture analysis.     

Iloprost use and medical management of systemic sclerosis-related vasculopathy in Italian tertiary referral centers: results from the PROSIT study

Clinical and Experimental Medicine - Vasculopathy is a crucial feature of systemic sclerosis (SSc), and Raynaud’s phenomenon (RP) and digital ulcers (DU) have a deep impact on the quality of...     

The changing face of chronic autoimmune atrophic gastritis: an updated comprehensive perspective

Chronic autoimmune atrophic gastritis (CAAG) is an organ-specific autoimmune disease, which affects the corpus–fundus gastric mucosa. Although it has been described for several years, the real pathophysiological mechanisms, the natural history and the possible neoplastic complications are not completely known. Atrophy of the gastric mucosa is the endpoint of the chronic processes, with the loss of glandular cells and their replacement by intestinal-type epithelium, pyloric-type glands, and fibrous tissue. As a consequence, hydrochloric acid, pepsin and intrinsic-factor is impaired resulting in pernicious anemia. The exact causal agent is not yet known, but both genetic and environmental factors seem to play a decisive role.Moreover, the clinical onset may assume different characteristics; differently from what previously observed, recent evidence has reported the onset of CAAG at a younger age, frequently with iron deficiency anemia or upper gastro-intestinal symptoms.The diagnosis of CAAG might be challenging and usually requires the combination of clinical, serological and histopathologic data; moreover, CAAG patients are often misdiagnosed as refractory to HP eradication therapy, probably because achlorhydria might allow urease-positive bacteria other than H pylori to colonize the stomach, causing positive ¹³C-urea breath test results.However, biopsy is the most reliable method to evaluate the presence of metaplastic atrophic gastritis. In order to assess the severity of gastric atrophy and intestinal metaplasia, OLGA and OLGIM staging systems have been proposed and seem to correlate with the risk of developing gastric adenocarcinoma. Indeed, CAAG represents a pre-neoplastic condition, as patients with CAAG are very likely to develop either type-1 gastric neuroendocrine tumors and gastric adenocarcinomas, as well as several other neoplastic diseases. To date, the need, the intervals and cost-effectiveness of endoscopic/histological surveillance for patients with CAAG/pernicious anemia are yet to be established.     

Time to Entry for New Cancer Medicines: From European Union–Wide Marketing Authorization to Patient Access in Belgium,Estonia, Scotland,and Sweden

Objectives

First, to quantify the median time from European Union (EU)-wide approval to first use (launch) for a sample of cancer medicines and number of launches in Belgium, Estonia, Scotland, and Sweden as of June 2015. Second, to assess whether longer times to launch or lack of launches affected medicines with high or low expected additional clinical benefit. Third, to identify possible determinants of the probability of a cancer medicine to be launched.

Evaporating solvents with a warm air-stream: effects on adhesive layer properties and resin-dentin bond strengths

OBJECTIVES: This study evaluated the effect of a warm or cold air-dry stream for solvent evaporation on the microtensile resin-dentin bond strength (muTBS), nanoleakage pattern (SEM), degree of conversion (DC) and solvent evaporation rates (SE) of an ethanol/water- (Adper Single Bond, [SB] 3MESPE) and an acetone-based (Prime & Bond 2.1, [PB] Dentsply), two-step etch-and-rinse adhesive system. MATERIALS AND METHODS: Adhesives were applied on demineralized dentin surfaces. For SE, a warm or cold air-dry stream (10 s) was applied prior to light-activation (10 s). Bonded sticks (0.8mm2) were tested in tension (0.5 mm/min). Two bonded sticks from each tooth were immersed in a 50% (w/v) solution of silver nitrate (24 h), photodeveloped (8 h) and analyzed by SEM. The DC and solvent evaporation rate of the adhesives were evaluated under FTIR and analytical balance, respectively. Data were analyzed by two-way ANOVA and Tukey test (alpha=0.05). RESULTS: Higher muTBS and lower nanoleakage were observed when the SE step was performed with warm air-dry stream. However, the DC of the adhesives was not altered by the use of a warm air-dry. CONCLUSIONS: The use of a warm air-dry stream seems to be a clinical tool to improve the bond strength and the quality of the hybrid layer (less nanoleakage infiltration), since it might reduce the number of pores within the adhesive layer.     

Effect of 3-year water storage on the performance of one-step self-etch adhesives applied actively on dentine

Objectives

To evaluate the effect of the application method on the immediate and 3-year resin-dentine bond strength (μTBS) and nanoleakage (NL) for 3 one-step self-etch adhesives (Adper Prompt L-Pop; Clearfil S³ Bond and Xeno III).

Methods

The occlusal enamel of 42 human molars were removed to expose a flat dentine surface. The adhesives were applied under inactive or active application. After light-curing (600 mW/cm² for 10 s), composite buildups were constructed incrementally and sectioned to obtain bonded sticks (0.8 mm²) to be tested in tension immediately or after 3 years of water storage of water storage. For NL, 2 bonded sticks from each tooth at each time were coated with nail varnish, placed in silver nitrate and polished down with SiC paper. The μTBS data was submitted to a two-way repetead mesures ANOVA and Tukey's test for each adhesive (α = 0.05).

Results

The active application showed higher immediate and 3-year μTBS than the inactive application (p < 0.05). An increase in the silver nitrate deposition was seen for all conditions after 3 years; however this was more pronounced for all materials under inactive application (p < 0.05).

Conclusions

The active application improves the immediate bonding performance of the adhesive systems. Reductions of the bond strength were observed for all materials after 3 years, however reduced degradation rate was observed when the materials are applied actively in dentine.     

Color stability of composites: effect of immersion media

Coloring in drinks decreases the color stability of composite restorations, reducing their longevity. The purpose of this in vitro study was to evaluate the effect of immersion media on color stability of seven different composite resins (Solidex - Shofu, Resilab-Wilcos, Signum - Heraeus, Epricord - Tokuyama, Adoro - Ivoclar Vivadent, Admira - Voco and Sinfony - 3MESPE). Seven resin-based composite specimens were prepared using a cylindrical teflon mold 2 mm thick and 10 mm in diameter Fifteen specimens of each resin were light-cured according to manufacturers' instructions and randomized into 3 groups (n= 5) according to immersion media: coffee, cola beverage and water A digital spectrophotometer Easy Shade (VITA) was used to evaluate the color changes at baseline and 7 days after immersion in each solution. Specimens were stored in the different staining media for 24 h/day during one week. The color differences were analyzed by two-way ANOVA and Tukey 's test (p< 0.05). Color change was observed after one week of immersion and there were statistical differences in staining, composite and interaction factors. The least staining was observed in Admira (deltaE= 3.934+/-0.814) and Resilab (deltaE= 3.993+/-0.735), followed by Adoro (deltaE= 4.044+/-1.001), Epri-cord (deltaE= 4.049+/-1.234), Signum (deltaE= 4.260+/-1.785), Solidex (deltaE=5,122+/-0.534) and Sinfony (deltaE=5.126+/-0.838). All of the composites tested except Adoro were susceptible to staining by substances present in coffee and cola, when stored in beverage for seven days. The lowest deltaE means were obtained with Admira.