Comparison of the traditional pharmaceutical validation method versus an assisted pharmaceutical validation in hospitalized patients

Objective: To analyze pharmaceutical interventions that have been carried out with the support of an automated system for validation of treatments vs. the traditional method without computer support. Method: The automated program, ALTOMEDICAMENTOS® version 0, has 925 052 data with information regarding approximately 20 000 medicines, analyzing doses, administration routes, number of days with such a treatment, dosing in renal and liver failure, interactions control, similar drugs, and enteral medicines. During eight days, in four different hospitals (high complexity with over 1 000 beds, 400-bed intermediate, geriatric and monographic), the same patients and treatments were analyzed using both systems. Results: 3,490 patients were analyzed, with 42 155 different treatments. 238 interventions were performed using the traditional system (interventions 0.56% / possible interventions) vs. 580 (1.38%) with the automated one. Very significant pharmaceutical interventions were 0.14% vs. 0.46%; significant was 0.38% vs. 0.90%; non-significant was 0.05% vs. 0.01%, respectively. If both systems are simultaneously used, interventions are performed in 1.85% vs. 0.56% with just the traditional system. Using only the traditional model, 30.5% of the possible interventions are detected, whereas without manual review and only the automated one, 84% of the possible interventions are detected. Conclusions: The automated system increases pharmaceutical interventions between 2.43 to 3.64 times. According to the results of this study the traditional validation system needs to be revised relying on automated systems. The automated program works correctly in different hospitals.

An interaction and network perspective of horizontal relationships in the portuguese pharmaceutical industry

Doutoramento em Gestão

Community pharmacists’ understanding, attitudes, practice and perceived barriers related to providing pharmaceutical care: a questionnaire-based survey in Macao

Purpose: To explore the knowledge, attitudes, practice and perceived barriers of community pharmacists regarding provision of pharmaceutical care as well as provide recommendations on how to advance the service during the early stage of development in Macao. Methods: A questionnaire comprising 10 items was used to collect respondents’ demographic information and to evaluate their understanding of pharmaceutical care, attitude towards service provision, current practice and perceived barriers. Descriptive and comparative analysis of the results was conducted. Results: While 95 % of the participating pharmacists agreed that patients’ health was their primary responsibility, only 57 % believed that they can provide better pharmaceutical care in the future. The majority spent most of their work time counselling patients (90 %) and checking prescription (70 %). Only a small portion monitored adverse drug reaction and drug compliance (44 %), engaged in health screening or drug safety promotion (20 %) or maintained patient medication records (4 %). Insufficient communication with physicians (90 %), lack of time (79 %) and lack of physical space at the pharmacy (76 %) were considered the most significant barriers. Conclusion: A suboptimal level of pharmaceutical care is provided by pharmacists in Macao. Considering the barriers identified and integrating other country experiences, establishing an enabling atmosphere using policy and regulatory measures is the fundamental element for advancing pharmaceutical care by community pharmacists.

Moderating effects of contextual factors on relationship between pharmaceutical marketing strategies and physician prescription decision: A review

Decision–making by physicians on patients’ treatment has received increased research attention. Research on the effect of marketing strategies on prescription behaviour has tended to generate controversial results. While some researchers reported a strong influence, some found only moderate effects, while others find no influence at all. The main objective of this paper is to review the influence of the marketing strategies by pharmaceutical firms and contextual factors on physician attitude to drug prescription. The paper presents comprehensive information on pharmaceutical marketing efforts through exhaustive review of relevant literature, and identifies the moderating effects of contextual factors on physician prescribing decisions. It also presents a crucial conceptual model for explaining the theoretical linkages between marketing strategies of pharmaceutical firms, contextual factors and the decision of the physician regarding drug prescription.

Essays on competition in the pharmaceutical industry

Chapter 1: Patents and Entry Competition in the Pharmaceutical Industry: The Role of Marketing Exclusivity. Effective patent length for innovation drugs is severely curtailed because of extensive efficacy and safety tests required for FDA approval, raising concern over adequacy of incentives for new drug development. The Hatch-Waxman Act extends patent length for new drugs by five years, but also promotes generic entry by simplifying approval procedures and granting 180-day marketing exclusivity to a first generic entrant before the patent expires. In this paper we present a dynamic model to examine the effect of marketing exclusivity. We find that marketing exclusivity may be redundant and its removal may increase generic firms' profits and social welfare. ^ Chapter 2: Why Authorized Generics?: Theoretical and Empirical Investigations Facing generic competition, the brand-name companies some-times launch generic versions themselves called authorized generics. This practice is puzzling. If it is cannibalization, it cannot be profitable. If it is divisionalization, it should be practiced always instead of sometimes. I explain this phenomenon in terms of switching costs in a model in which the incumbent first develops a customer base to ready itself against generic competition later. I show that only sufficiently low switching costs or large market size justifies launch of AGs. I then use prescription drug data to test those results and find support. ^ Chapter 3: The Merger Paradox and R&D Oligopoly theory says that merger is unprofitable, unless a majority of firms in industry merge. Here, we introduce R&D opportunities to resolve this so-called merger paradox. We have three results. First, when there is one R&D firm, that firm can profitably merge with any number of non-R&D firms. Second, with multiple R&D firms and multiple non-R&D firms, all R&D firms can profitably merge. Third, with two R&D firms and two non-R&D firms, each R&D firms prefer to merge with a non-R&D firm. With three or more than non-R&D firms, however, the R&D firms prefer to merge with each other.^

Instrumental and sensory analyses for the characterization of food, phytotherapeutic or pharmaceutical hemp products

To address the request to develop rapid and easy methods for determining the cannabinoids, an HPLC-UV method (8 min) to separate and quantify the 10 main cannabinoids in hemp inflorescences was developed, and in-house validated. Moreover, the antioxidant activity of cannabidiol (CBD) in two oily matrices was investigated and compared to that of α-tocopherol, in relation to the growing market of oily solutions containing cannabidiol. Then, since no univocal legislation on the evaluation of quality and authenticity of hemp seed oil (HSO) exists, the composition and quality of cold-pressed HSOs were also explored, highlighting a great variability in terms of oxidative state minor compounds content. From the sensory point of view, a panel was trained, a specific sensory wheel and a profile sheet were developed. Due to the Covid-19 pandemic, the sensory evaluation was also performed at home. The panel showed a good performance both in the laboratory and remotely. Moreover, a focus group was used to investigate consumers’ attitudes, pointing out that a high-quality HSO has to be cold-pressed and green for them. Then, the evaluation of stability during the storage of HSOs was investigated. The results showed that photo-oxidation did not seem to significantly affect the quality of the oil during the first 3 months of storage. Finally, a study about the evolution of the volatile profile of 9 HSOs, under accelerated oxidation conditions, allowed identifying volatile markers of HSOs oxidation and freshness. This Ph.D. was developed in the context of the scholarship “Harmonized procedures of analysis of medical, herbal, food and industrial cannabis: development and validation of cannabinoids’ quality control methods, of extraction and preparation of derivatives from the plant raw material, according to the product destination” funded by Enecta S.r.l.

Analytical approaches for the measurement of sulfide in biological and pharmaceutical fields

Hydrogen sulfide (H2S) is a widely recognized gasotransmitter, with key roles in physiological and pathological processes. The accurate quantification of H2S and reactive sulfur species (RSS) may hold important implications for the diagnosis and prognosis of various diseases. However, H2S species quantification in biological matrices is still a challenge. Among the sulfide detection methods, monobromobimane (MBB) derivatization coupled with reversed phase high-performance liquid chromatography (RP-HPLC) is one of the most reported. However, it is characterized by a complex preparation and time-consuming process, which may alter the actual H2S level. Moreover, quantitative validation has still not been described based on a survey of previously published works. In this study, we developed and validated an improved analytical protocol for the MBB RP-HPLC method. Main parameters like MBB concentration, temperature, reaction time, and sample handling were optimized, and the calibration method was further validated using leave-one-out cross-validation (CV) and tested in a clinical setting. The method shows high sensitivity and allows the quantification of H2S species, with a limit of detection (LOD) of 0.5 µM and a limit of quantification (LOQ) of 0.9 µM. Additionally, this model was successfully applied in measurements of H2S levels in the serum of patients subjected to inhalation with vapors rich in H2S. In addition, a properly procedure was established for H2S release with the modified MBB HPLC-FLD method. The proposed analytical approach demonstrated the slow-release kinetics of H2S from the multilayer Silk-Fibroin scaffolds with the combination of different H2S donor’s concentration with respect to the weight of PLGA nanofiber. In the end, some efforts were made on sulfide measurements by using size exclusion chromatography fluorescence/ultraviolet detection and inductively coupled plasma-mass spectrometry (SEC-FLD/UV-ICP/MS). It’s intended as a preliminary study in order to define the feasibility of a separation-detection-quantification platform to analyze biological samples and quantify sulfur species.

Computer vision in aseptic pharmaceutical manufacturing: a deep learning-based approach to vial inspection and pack formation during a lyophilizer loading cycle

Vision systems are powerful tools playing an increasingly important role in modern industry, to detect errors and maintain product standards. With the enlarged availability of affordable industrial cameras, computer vision algorithms have been increasingly applied in industrial manufacturing processes monitoring. Until a few years ago, industrial computer vision applications relied only on ad-hoc algorithms designed for the specific object and acquisition setup being monitored, with a strong focus on co-designing the acquisition and processing pipeline. Deep learning has overcome these limits providing greater flexibility and faster re-configuration. In this work, the process to be inspected consists in vials’ pack formation entering a freeze-dryer, which is a common scenario in pharmaceutical active ingredient packaging lines. To ensure that the machine produces proper packs, a vision system is installed at the entrance of the freeze-dryer to detect eventual anomalies with execution times compatible with the production specifications. Other constraints come from sterility and safety standards required in pharmaceutical manufacturing. This work presents an overview about the production line, with particular focus on the vision system designed, and about all trials conducted to obtain the final performance. Transfer learning, alleviating the requirement for a large number of training data, combined with data augmentation methods, consisting in the generation of synthetic images, were used to effectively increase the performances while reducing the cost of data acquisition and annotation. The proposed vision algorithm is composed by two main subtasks, designed respectively to vials counting and discrepancy detection. The first one was trained on more than 23k vials (about 300 images) and tested on 5k more (about 75 images), whereas 60 training images and 52 testing images were used for the second one.

Characterization Of Single Use Reactor Used For The Manufacturing Of Formulated Products Within The Pharmaceutical Industry

Mixing is a fundamental unit operation in the pharmaceutical industry to ensure consistent product quality across different batches. It is usually carried out in mechanically stirred tanks, with a large variety of designs according to the process requirements. A key aspect of pharmaceutical manufacturing is the extensive and meticulous cleaning of the vessels between runs to prevent the risk of contamination. Single-use reactors represent an increasing trend in the industry since they do not require cleaning and sterilization, reducing the need for utilities such as steam to sterilize equipment and the time between production batches. In contrast to traditional stainless steel vessels, single-use reactors consist of a plastic bag used as a vessel and disposed of after use. This thesis aims to characterize the fluid dynamics features and the mixing performance of a commercially available single-use reactor. The characterization employs a combination of various experimental techniques. The analysis starts with the visual observation of the liquid behavior inside the vessel, focusing on the vortex shape evolution at different impeller speeds. The power consumption is then measured using a torque meter to quantify the power number. Particle Image Velocimetry (PIV) is employed to investigate local fluid dynamics properties such as mean flow field and mean and rms velocity profiles. The same experimental setup of PIV is exploited for another optical measurement technique, the Planar Laser-Induced Fluorescence (PLIF). The PLIF measurements complete the characterization of the reactor with the qualitative visualization of the turbulent flow and the quantitative assessment of the system performance through the mixing time. The results confirm good mixing performances for the single-use reactor over the investigated impeller speeds and reveal that the filling volume plays a significant role in the fluid dynamics of the system.

Iis--integrated Interactome System: A Web-based Platform For The Annotation, Analysis And Visualization Of Protein-metabolite-gene-drug Interactions By Integrating A Variety Of Data Sources And Tools.

High-throughput screening of physical, genetic and chemical-genetic interactions brings important perspectives in the Systems Biology field, as the analysis of these interactions provides new insights into protein/gene function, cellular metabolic variations and the validation of therapeutic targets and drug design. However, such analysis depends on a pipeline connecting different tools that can automatically integrate data from diverse sources and result in a more comprehensive dataset that can be properly interpreted. We describe here the Integrated Interactome System (IIS), an integrative platform with a web-based interface for the annotation, analysis and visualization of the interaction profiles of proteins/genes, metabolites and drugs of interest. IIS works in four connected modules: (i) Submission module, which receives raw data derived from Sanger sequencing (e.g. two-hybrid system); (ii) Search module, which enables the user to search for the processed reads to be assembled into contigs/singlets, or for lists of proteins/genes, metabolites and drugs of interest, and add them to the project; (iii) Annotation module, which assigns annotations from several databases for the contigs/singlets or lists of proteins/genes, generating tables with automatic annotation that can be manually curated; and (iv) Interactome module, which maps the contigs/singlets or the uploaded lists to entries in our integrated database, building networks that gather novel identified interactions, protein and metabolite expression/concentration levels, subcellular localization and computed topological metrics, GO biological processes and KEGG pathways enrichment. This module generates a XGMML file that can be imported into Cytoscape or be visualized directly on the web. We have developed IIS by the integration of diverse databases following the need of appropriate tools for a systematic analysis of physical, genetic and chemical-genetic interactions. IIS was validated with yeast two-hybrid, proteomics and metabolomics datasets, but it is also extendable to other datasets. IIS is freely available online at: http://www.lge.ibi.unicamp.br/lnbio/IIS/.

Study Of The Homogeneity Of Drug Loaded In Polymeric Films Using Near-infrared Chemical Imaging And Split-plot Design.

Split-plot design (SPD) and near-infrared chemical imaging were used to study the homogeneity of the drug paracetamol loaded in films and prepared from mixtures of the biocompatible polymers hydroxypropyl methylcellulose, polyvinylpyrrolidone, and polyethyleneglycol. The study was split into two parts: a partial least-squares (PLS) model was developed for a pixel-to-pixel quantification of the drug loaded into films. Afterwards, a SPD was developed to study the influence of the polymeric composition of films and the two process conditions related to their preparation (percentage of the drug in the formulations and curing temperature) on the homogeneity of the drug dispersed in the polymeric matrix. Chemical images of each formulation of the SPD were obtained by pixel-to-pixel predictions of the drug using the PLS model of the first part, and macropixel analyses were performed for each image to obtain the y-responses (homogeneity parameter). The design was modeled using PLS regression, allowing only the most relevant factors to remain in the final model. The interpretation of the SPD was enhanced by utilizing the orthogonal PLS algorithm, where the y-orthogonal variations in the design were separated from the y-correlated variation.

Impact Of Pharmacist Interventions On Drug-related Problems And Laboratory Markers In Outpatients With Human Immunodeficiency Virus Infection.

Substantial complexity has been introduced into treatment regimens for patients with human immunodeficiency virus (HIV) infection. Many drug-related problems (DRPs) are detected in these patients, such as low adherence, therapeutic inefficacy, and safety issues. We evaluated the impact of pharmacist interventions on CD4+ T-lymphocyte count, HIV viral load, and DRPs in patients with HIV infection. In this 18-month prospective controlled study, 90 outpatients were selected by convenience sampling from the Hospital Dia-University of Campinas Teaching Hospital (Brazil). Forty-five patients comprised the pharmacist intervention group and 45 the control group; all patients had HIV infection with or without acquired immunodeficiency syndrome. Pharmaceutical appointments were conducted based on the Pharmacotherapy Workup method, although DRPs and pharmacist intervention classifications were modified for applicability to institutional service limitations and research requirements. Pharmacist interventions were performed immediately after detection of DRPs. The main outcome measures were DRPs, CD4+ T-lymphocyte count, and HIV viral load. After pharmacist intervention, DRPs decreased from 5.2 (95% confidence interval [CI] =4.1-6.2) to 4.2 (95% CI =3.3-5.1) per patient (P=0.043). A total of 122 pharmacist interventions were proposed, with an average of 2.7 interventions per patient. All the pharmacist interventions were accepted by physicians, and among patients, the interventions were well accepted during the appointments, but compliance with the interventions was not measured. A statistically significant increase in CD4+ T-lymphocyte count in the intervention group was found (260.7 cells/mm(3) [95% CI =175.8-345.6] to 312.0 cells/mm(3) [95% CI =23.5-40.6], P=0.015), which was not observed in the control group. There was no statistical difference between the groups regarding HIV viral load. This study suggests that pharmacist interventions in patients with HIV infection can cause an increase in CD4+ T-lymphocyte counts and a decrease in DRPs, demonstrating the importance of an optimal pharmaceutical care plan.

Intensification Of Bioactive Compounds Extraction From Medicinal Plants Using Ultrasonic Irradiation.

Extraction processes are largely used in many chemical, biotechnological and pharmaceutical industries for recovery of bioactive compounds from medicinal plants. To replace the conventional extraction techniques, new techniques as high-pressure extraction processes that use environment friendly solvents have been developed. However, these techniques, sometimes, are associated with low extraction rate. The ultrasound can be effectively used to improve the extraction rate by the increasing the mass transfer and possible rupture of cell wall due the formation of microcavities leading to higher product yields with reduced processing time and solvent consumption. This review presents a brief survey about the mechanism and aspects that affecting the ultrasound assisted extraction focusing on the use of ultrasound irradiation for high-pressure extraction processes intensification.

Gastroprotective Effects (in Rodents) Of A Flavonoid Rich Fraction Obtained From Syngonanthus Macrolepsis.

Syngonanthus macrolepis, popularly known in Brazil as 'sempre-vivas', is a plant from the family Eriocaulaceae, it is found in the states of Minas Gerais and Bahia. The species contains a variety of constituents, including flavonoids with gastroprotective effect. In this work, a flavonoid-rich fraction (Sm-FRF) obtained from scapes of S. macrolepis was investigated for preventing gastric ulceration in mice and rats. The activity was evaluated in models of induced gastric ulcer (absolute ethanol, stress, non-steroidal anti-inflammatory drugs and pylorus ligation). The cytoprotective mechanisms of the Sm-FRF in relation to sulfhydryl (SH) groups, nitric oxide (NO) and antioxidant enzymes were also evaluated. The Sm-FRF (100 mg/kg, p.o.) significantly reduced gastric injury in all models, and did not alter gastric juice parameters after pylorus ligation. The results indicate significant gastroprotective activity for the Sm-FRF, which probably involves the participation of both SH groups and the antioxidant system. Both are integral parts of the gastrointestinal mucosa's cytoprotective mechanisms against aggressive factors.