Intraosseous Drug Administration in Children and Adults During Cardiopulmonary Resuscitation

2007 ◽  
Vol 41 (10) ◽  
pp. 1679-1686 ◽  
Author(s):  
Marcia L Buck ◽  
Barbara S Wiggins ◽  
Jefferson M Sesler
Keyword(s):  
Drug Delivery ◽  
Animal Models ◽  
Cardiopulmonary Resuscitation ◽  
Drug Administration ◽  
English Language ◽  
Data Extraction ◽  
Common Adverse Effect ◽  
Systemic Circulation ◽  
Small Scale ◽  
Intravenous Access

Objective: To review and assess the available literature on the use of intraosseous (IO) drug administration during cardiopulmonary resuscitation, addressing the benefits and risks of using this method of drug delivery in children and adults. Data Sources: The MEDLINE (1950–July 2007) database was searched for pertinent abstracts, using the key term intraosseous infusions. Additional references were obtained from the bibliographies of the articles reviewed. Manufacturer Web sites were used to obtain information about IO insertion devices. Study Selection and Data Extraction: All available English-language clinical trials, retrospective studies, and review articles describing IO drug administration were reviewed. Studies conducted in animal models to evaluate the effectiveness and safety of IO drug administration were also included. Data Synthesis: IO access uses the highly vascularized bone marrow to deliver fluids and medications during cardiopulmonary resuscitation. This route, developed in the 1940s, has been revived In the past decade as a means of achieving rapid vascular access when intravenous access cannot be obtained. The primary advantage of IO access is the high success rate (approximately 80%). Most trained providers can place an IO line within 1–2 minutes. A number of small-scale studies and retrospective reviews have established the usefulness of this route for the delivery of many commonly used resuscitation drugs. In addition, animal models have demonstrated rapid drug delivery to the systemic circulation. While all resuscitation drugs can be given by the IO route, administration of ceftriaxone, chloramphenicol, Phenytoin, tobramycin, and vancomycin may result in lower peak serum concentrations. The most common adverse effect seen with IO use, extravasation, has been reported in 12% of patients. Compartment syndrome, osteomyelitis, and tibial fracture are rare, but have also been reported. Conclusions: IO administration is a safe and effective method for delivering drugs during cardiopulmonary resuscitation. It should be considered whenever intravenous access cannot be rapidly obtained.

Nanodiamond as a drug delivery vehicle and gene therapy tool

2021 ◽  
Author(s):  
Moataz Dowaidar
Keyword(s):  
Drug Delivery ◽  
Animal Model ◽  
Animal Models ◽  
Drug Administration ◽  
Scale Up ◽  
Toxicity Tests ◽  
Medical Applications ◽  
Delivery Vehicle ◽  
Medication Delivery

Using nanodiamond (ND) as an effective medication delivery vehicle offers tremendous optimism and anticipation. This topic has received considerable attention despite being a relatively young field of nanodiamond research. Great efforts have concentrated on material development, surface conjugation, and cytotoxicity research, all aimed at using ND for bio/medical applications, notably in bioimaging and more effective drug administration. ND-mediated medication delivery has made considerable progress in the past decade. Different techniques of conjugating different ND surface medicines to ND-X complexes target different cancers or tumors; extremely favorable results were obtained from cell and animal models. While this affects the field of nanomedicine, it is not yet apparent whether and when clinical translations will occur. Many issues persist. Materials are the first issue. The Nanodiamond originates from numerous manufacturing firms in varied sizes and shapes, created with different techniques with different surfaces and impurities. It exhibits highly diverse surface characteristics and cytotoxicity. All applications must take care of the surface, conjugation and toxicity tests. It's time-consuming and cost-consuming, and outcomes vary. These add to the cost of developing an animal and clinical complex. To establish requirements for nanodiamond materials appropriate for medical use, characterization or regulation is essential. This helps to scale up and decrease manufacturing costs, and also to converge on the outcome for applications. Moreover, while numerous imaging and therapeutic applications have been made using ND to create ND-X for drug administration, the route to clinics seems hard. As a result, the majority of cellular and animal research is a short-term observation with no long-term safety evaluation.The maximum allowable dose of ND and medication inside the animal appears to be an important parameter for clinical translation; the outcome (or fate) and biodistribution of nanodiamond retention in the animal's body requires long-term evidence to support ND's safe therapeutic use.ND's future focus will be on bio/medical applications. Many concepts were accomplished at the animal model level. This feat will surely draw attention from pharmaceutical, medical, and material producers. Clinical translations are expected in the future as interdisciplinary efforts are incorporated into the development of ND-mediated drug delivery.Nanodiamond particle aggregation and well-dispersed nanodiamonds for bio/medical applications. Studies of numerous animal models of the biodistribution of ND throughout the animal's body and its long-term destiny in the organs. Controlled drug delivery through ND-mediated, pH-sensitive animal model delivery. Nanodiamond conjugation methods use covalent bonding or physical adsorption for distribution to optimize efficacy and decrease the adverse effects of anticancer medicines. Recently, advancements in ND-drugs have targeted various animal models of malignancies.of drugs supplied to target locations are more efficient, and drug retention in tumors is longer than a pure drug. Promising clinical translations.

Issues in Contemporary Drug Delivery: Part V: Total Parenteral Nutrition

1992 ◽  
Vol 8 (1) ◽  
pp. 6-19
Author(s):  
Pamela A. Mohler ◽  
Umesh V. Banakar
Keyword(s):  
Drug Delivery ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Animal Studies ◽  
English Language ◽  
Human Subjects ◽  
Case Reports ◽  
Data Extraction ◽  
Compatibility Studies ◽  
Stability Data

Objective: To provide an overview of common compounding and administration guidelines for total parenteral nutrition (TPN). The compatibility of various drug products with TPN preparations is also discussed. Data Sources: References were selected from published bibliographies of specialized nutrition and drug-nutrient interaction articles, package inserts and manufacturer's information, and specific topic searches in MEDLINE computerized database (English language, through 1989). Study Selection: Studies that investigated stability were selected preferentially to those studying compatibility alone; when stability data were not available, compatibility studies were included. Studies using products marketed in the US were chosen preferentially to those using European products; studies and case reports using human subjects were selected in preference to animal studies. Sixty percent of the initially identified studies were selected for inclusion. Data Extraction: Studies were reviewed by the authors for internal consistency and statistical validity. Data Synthesis: Intravenous solutions can be manufactured to meet various nutritional specifications. As additional nutrients and drugs are incorporated, the risk of incompatibility and instability of the admixture increases. Stability data are relatively sparse, leading to a dependence on compatibility studies for decision making. Conclusions: A wide variety of TPN formulations can be compounded to meet the individual needs of patients of all ages and assorted disease states. Addition of specific drugs to the TPN preparation may improve the efficiency of drug delivery and improve overall therapeutic response. Care must be taken, however, to ensure that incompatible compounds are not combined in a single TPN preparation.

Development of Solid-Self Micron Emulsifying Drug Delivery Systems

2013 ◽  
Vol 6 (2) ◽  
pp. 2014-2021
Author(s):  
Preethi Sudheer ◽  
Koushik Y ◽  
Satish P ◽  
Uma Shankar M S ◽  
R S Thakur
Keyword(s):  
Drug Delivery ◽  
Systemic Circulation ◽  
Water Soluble ◽  
Future Research ◽  
Steady Increase ◽  
Liquid Form ◽  
Lipophilic Compounds ◽  
Modern Drug ◽  
Pharmaceutical Scientist ◽  
Pharmacologically Active

As a consequence of modern drug discovery techniques, there has been a steady increase in the number of new pharmacologically active lipophilic compounds that are poorly water soluble and solubility is one of the most important parameter to achieve desired concentration of drug in systemic circulation for therapeutic response. It is a great challenge for pharmaceutical scientist to convert those molecules into orally administered formulation with sufficient bioavailability.  Among the several approaches to improve oral bioavailability of these molecules, Self-micron emulsifying drug delivery system (SMEDDS) is one of the approaches usually used to improve the bioavailability of hydrophobic drugs. However, conventional SMEDDS are mostly prepared in a liquid form, which can have several disadvantages. Accordingly, solid SMEDDS (S-SMEDDS) prepared by solidification of liquid/semisolid self-micron emulsifying (SME) ingredients into powders have gained popularity. This article provides an overview of the recent advancements in S-SMEDDS such as methodology, techniques and future research directions.

Use of real-time videoconferencing to deliver physical therapy services: A scoping review of published and emerging evidence

2019 ◽  
Vol 26 (10) ◽  
pp. 581-589 ◽  
Author(s):  
Stephanie Horsley ◽  
Gunnar Schock ◽  
Stacey L Grona ◽  
Kara Montieth ◽  
Bryttnee Mowat ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Real Time ◽  
English Language ◽  
Data Extraction ◽  
Therapy Assessment ◽  
Process Outcomes ◽  
Study Characteristics ◽  
Therapy Services ◽  
Videoconferencing Technology ◽  
Physical Therapy Services

Introduction Telehealth may be a viable means to deliver physical therapy services across a range of practice settings and health conditions; however, there is limited uptake of telehealth in clinical practice. The purpose of this study is to examine and describe trends, gaps and opportunities in published and emerging evidence regarding the use of real-time videoconferencing to deliver physical therapy services. Methods Four databases and three trial registries were searched using terms for physical therapy and telehealth. Inclusion criteria were primary studies, systematic reviews and published trial registries that had the following features: physical therapy assessment and/or treatment, real-time videoconferencing and English language. Title/abstract, full text screening and data extraction were completed by pairs of independent reviewers. Descriptive statistics stratified by published research and trial registry records were used to summarize study characteristics. Results A total of 100 studies (80 published and 20 trial registries) were included. Australia, Canada and the US have the highest proportion of published and emerging research (63%). The majority of conditions studied were musculoskeletal (42%). Computers were the most common videoconferencing technology used (31%) and only 14% of studies reported using a secure platform. The majority of studies examined health outcomes (64%) and process outcomes (65%), while only 32% reported system outcomes. Discussion Research in the field of telehealth and physical therapy is growing and becoming increasingly diverse with the advancements in technology.

scholarly journals Diversity in health professional education scholarship: a document analysis of international author representation in leading journals

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e043970
Author(s):  
Brittany Buffone ◽  
Ilena Djuana ◽  
Katherine Yang ◽  
Kyle J Wilby ◽  
Maguy S El Hajj ◽  
...  
Keyword(s):  
Health Professional ◽  
Professional Education ◽  
Teaching And Learning ◽  
Western Europe ◽  
English Language ◽  
Data Extraction ◽  
Document Analysis ◽  
Original Research ◽  
Health Professional Education ◽  
Eligibility Criteria

ObjectivesThe global distribution of health professionals and associated training programmes is wide but prior study has demonstrated reported scholarship of teaching and learning arises from predominantly Western perspectives.DesignWe conducted a document analysis to examine authorship of recent publications to explore current international representation.Data sourcesThe table of contents of seven high-impact English-language health professional education journals between 2008 and 2018 was extracted from Embase.Eligibility criteriaThe journals were selected according to highest aggregate ranking across specific scientific impact indices and stating health professional education in scope; only original research and review articles from these publications were included for analysis.Data extraction and synthesisThe table of contents was extracted and eligible publications screened by independent reviewers who further characterised the geographic affiliations of the publishing research teams and study settings (if applicable).ResultsA total 12 018 titles were screened and 7793 (64.8%) articles included. Most were collaborations (7048, 90.4%) conducted by authors from single geographic regions (5851, 86%). Single-region teams were most often formed from countries in North America (56%), Northern Europe (14%) or Western Europe (10%). Overall lead authorship from Asian, African or South American regions was less than 15%, 5% and 1%, respectively. Geographic representation varied somewhat by journal, but not across time.ConclusionsDiversity in health professional education scholarship, as marked by nation of authors’ professional affiliations, remains low. Under-representation of published research outside Global North regions limits dissemination of novel ideas resulting in unidirectional flow of experiences and a concentrated worldview of teaching and learning.

scholarly journals SARS-CoV-2-associated gastrointestinal and liver diseases: what is known and what is needed to explore

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dina Sweed ◽  
Eman Abdelsameea ◽  
Esraa A. Khalifa ◽  
Heba Abdallah ◽  
Heba Moaz ◽  
...  
Keyword(s):  
English Language ◽  
Data Extraction ◽  
Oral Route ◽  
Main Body ◽  
Disease Manifestation ◽  
Gi Symptoms ◽  
Septic Focus ◽  
Pubmed Search ◽  
Risk Patients ◽  
Respiratory Droplets

Abstract Background The pandemic of COVID19 which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first described in China as an unexplained pneumonia transmitted by respiratory droplets. Gastrointestinal (GI) and liver injury associated with SARS-CoV-2 infection were reported as an early or sole disease manifestation, mainly outside China. The exact mechanism and incidence of GI and liver involvement are not well elucidated. Main body We conducted a PubMed search for all articles written in the English language about SARS-CoV-2 affecting the GI and liver. Following data extraction, 590 articles were selected. In addition to respiratory droplets, SARS-CoV-2 may reach the GI system through the fecal-oral route, saliva, and swallowing of nasopharyngeal fluids, while breastmilk and blood transmission were not implicated. Moreover, GI infection may act as a septic focus for viral persistence and transmission to the liver, appendix, and brain. In addition to the direct viral cytopathic effect, the mechanism of injury is multifactorial and is related to genetic and demographic variations. The most frequently reported GI symptoms are diarrhea, nausea, vomiting, abdominal pain, and bleeding. However, liver infection is generally discovered during laboratory testing or a post-mortem. Radiological imaging is the gold standard in diagnosing COVID-19 patients and contributes to understanding the mechanism of extra-thoracic involvement. Medications should be prescribed with caution, especially in chronic GI and liver patients. Conclusion GI manifestations are common in COVID-19 patients. Special care should be paid for high-risk patients, older males, and those with background liver disease.

Brexanolone: A Novel Drug for the Treatment of Postpartum Depression

2020 ◽  
pp. 089719002097962
Author(s):  
Edna Patatanian ◽  
David R. Nguyen
Keyword(s):  
Adverse Effects ◽  
Postpartum Depression ◽  
English Language ◽  
Neuronal Excitability ◽  
Data Extraction ◽  
Background Information ◽  
Pharmacologic Therapy ◽  
Loss Of Consciousness ◽  
Efficacy And Safety ◽  
Pubmed Search

Objectives: To review the pharmacology, efficacy, and safety of Brexanolone and define its role in the treatment of postpartum depression. Date Sources: A MEDLINE/PubMed search was conducted (1980-May 2020) using the following keywords: postpartum depression, antidepressants, pharmacologic therapy, drug therapy, and brexanolone to identify relevant articles. Study Selection/Data Extraction: Literature search was limited to human studies published in the English language. Phase I, II, and III studies evaluating the pharmacology, efficacy, safety of brexanolone for postpartum depression were included. Bibliographies of relevant articles evaluating postpartum depression and treatment were reviewed for additional citations and background information. Data Synthesis: Brexanolone is a soluble, proprietary, injectable formulation of allopregnanolone, a neuroactive steroid that modulates neuronal excitability. Allopregnanolone levels increase during pregnancy and decrease substantially after birth. These fluctuations have profound effects on anxiety and depression. Three clinical trials established the efficacy and safety of brexanolone in the treatment of postpartum depression. In all 3 trials, brexanolone had an acceptable safety profile and was well tolerated. The most common adverse effects were loss of consciousness, sedation, dry mouth, headache, dizziness, and flushing. Due to sudden loss of consciousness and excessive sedation, continuous pulse oximetry is recommended. Conclusion: Brexanolone has a novel mechanism of action and appears to be safe and effective for the treatment of moderate to severe postpartum depression. At present, high cost, serious adverse effects, and restricted access may limit its use in clinical practice.

Lead in Mineral or Multivitamin-Multimineral Products

2021 ◽  
pp. 106002802110233
Author(s):  
C. Michael White
Keyword(s):  
English Language ◽  
Data Extraction ◽  
The United States ◽  
Third Party ◽  
Reference Level ◽  
Study Selection ◽  
Pubmed Search ◽  
Zinc Supplements ◽  
Average Lead ◽  
Year 2000

Objective Assess the current daily interim reference level of lead and the amount contained in current mineral and multivitamin-multimineral (MVM) products. Data Sources PubMed search from 1980 to May 15, 2021, limited to the English language, via the search strategy ((mineral OR multivitamin OR calcium OR iron OR magnesium OR copper OR zinc OR chromium OR selenium) AND (heavy metals OR Pb OR lead)). Study Selection and Data Extraction Narrative review of studies assessing lead content in mineral or MVM products. Data Synthesis Products containing different calcium forms (dolomite, bone meal, natural carbonate) have historically had higher lead levels than others (refined carbonate, lactate, gluconate, acetate, sevelamer), but the gap has closed considerably since the year 2000. Although only limited assessments of magnesium and zinc supplements have been conducted, no alarming average lead amounts were found. MVM products assessed since 2007 had low median or mean lead concentrations. However, large interproduct differences exist, with many products having very little lead and some products having concerning amounts. Relevance to Patient Care and Clinical Practice It is difficult for pharmacists and consumers to know the amount of lead in an actual product unless it is tested in an independent third-party lab. The United States Pharmacopeia and NSF International will provide a seal on the products stating that the products have a low level of lead, but even so, children could receive more lead than the Food and Drug Administration’s Interim Reference Level. Conclusions The threat from lead exposure in mineral and MVM products have diminsihed considerably over time but some products can still have excessive amounts. Without third-party testing, it is difficult for clinicians and consumers to know which outlier products to avoid.

Recent Advances: Antiinfectives

1995 ◽  
Vol 29 (10) ◽  
pp. 1035-1040 ◽  
Author(s):  
Laurie L Briceland ◽  
John D Cleary ◽  
Courtney V Fletcher ◽  
Daniel P Healy ◽  
Charles A Peloquin
Keyword(s):  
Infectious Diseases ◽  
English Language ◽  
Data Extraction ◽  
Information Service ◽  
Ulcer Disease ◽  
Additional Information ◽  
Study Selection ◽  
Enterococcus Spp ◽  
Scientific Meetings ◽  
Clinically Significant

Objective: To update readers on the significant changes in infectious diseases pharmacotherapy. Data Sources: An Index Medians and Iowa Drug Information Service search (1993–1994) of English-language literature pertaining to the selected topic areas was performed. Additional information from abstracts presented at scientific meetings were identified by the authors. Study Selection and Data Extraction: All identified studies were screened and those judged relevant to the update were evaluated. Data Synthesis: New or clinically significant data since 1992 that related to peptic ulcer disease, microbial resistance (e.g., Enterococcus spp., Streptococcus pneumoniae, Mycobacterium tuberculosis, Candida albicans), immunomodulators, and AIDS were evaluated and compared with previous data. Conclusions: There have been several exciting and significant changes in infectious diseases pharmacotherapy evident from this review.

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