Discoveries and Innovations in Drug Development (Vol. 26, No. 1, Full Issue)

For the month of January 2022, APBN looks at some discoveries and innovation in pharmacology. In Features, Dr Harish Dave, Co-Founder and Chief Medical Officer of AUM Biosciences, discusses today's shifting paradigm in oncology drug development towards highly selective, minimally toxic, and patient-centric treatments, while Jade Pallett, Chief Technology Officer for Zoono UK & Europe, sheds light on how antimicrobial coatings outdo traditional methods of disinfection. Then, we have A/Prof Alexandra Sharland, Dr Nicole Mifsud, and Eric Son to elucidate how understanding antigen-specificity of host T cells can reduce organ transplantation rejection. Finally, in Spotlights, we have two interviews – one where we speak to Mr Willson Deng, CEO of Arcstone, on the role of digital technology in supporting MedTech manufacturing, and the other with Liu Qun, Head of IQVIA, China, where we learn more about the Chinese biopharmaceutical market.

Provision of social-norms feedback to general practices whose antibiotic prescribing is increasing: a national randomized controlled trial

Aim The Chief Medical Officer of England writes an annual social-norms-feedback letter to the highest antibiotic-prescribing GP practices. We investigated whether sending a social-norms-feedback letter to practices whose prescribing was increasing would reduce prescribing. Subject and methods We conducted a two-armed randomised controlled trial amongst practices whose STAR-PU-adjusted prescribing was in the 20th–95th percentiles and had increased by > 4% year-on-year in the 2 previous financial years. Intervention practices received a letter on 1st March 2018 stating ‘The great majority (80%) of practices in England reduced or stabilised their antibiotic prescribing rates in 2016/17. However, your practice is in the minority that have increased their prescribing by more than 4%.’. Control practices received no letter. The primary outcome was the STAR-PU-adjusted rate of antibiotic prescribing in the months from March to September 2018. Results We randomly assigned 930 practices; ten closed or merged pre-trial, leaving 920 practices — 448 in the intervention and 472 in the control. An autoregressive and moving average model of first order ARMA(1,1) correlation structure showed no effect of the intervention (β < −0.01, z = −0.50, p = 0.565). Prescribing reduced over time in both arms (β < −0.01, z = −36.36, p < 0.001). Conclusions A social-norms-feedback letter to practices whose prescribing was increasing did not decrease prescribing compared to no letter. Trial registration NCT03582072.

Role of Family Physician in Periodic Health Assessment Screening: A Review

A family physician is considered the first line of healthcare with patients. In the public sector, a medical officer is a generalist with no postgraduate training. The periodic health assessment has its roots at least as far back as the industrial revolution, employers paid for annual medical fitness examinations and tests to assess the state of their workers with intention of keeping their workforce healthy and safe. The technique is now included into the work of primary care physicians and is still practiced across multiple countries but it may be named with a different name such as Periodic health examination (PHE). The PHE allows for the implementation of evidence-based preventative measures, the education of patients on lifestyle issues, the updating of vaccines, and, most importantly, the detection of risk factors and diagnoses by updating the patient's cumulative profile. In low-risk individuals, however, treatment may not be essential every year. There’s serious question about the value of Periodic health assessment/examination. In this article we’ll be reviewing the PHE, its value and the role of family physician in it.

Effect of Gender, Age and Vaccine on Reactogenicity and Incapacity to Work after COVID-19 Vaccination: A Survey among Health Care Workers

Background The aim of our study was to assess the influence of gender and age on reactogenicity by the different vaccines and their combinations. Further parameters were the reduction in working capacity after vaccination and the influence of the time of day when vaccines were administered. Methods We conducted a survey on COVID-19 vaccinations and eventual reactions among employees of 89 hospitals of the Helios Group. On May 19th, 2021 employees received an invitation by e-mail from the chief medical officer with a link to the survey tool. Participation was voluntary and non-traceable. The survey was closed on June 21st, 2021. Results 8,375 participants reported on 16,727 vaccinations. Reactogenicity was reported in 75% of COVID-19 vaccinations. In 23% the capacity to work was affected. Major risk factors were female gender, younger age and vaccine other than BNT162b2. ChAdOx induced impairing reactogenicity mainly after the prime vaccination (70.5%), while mRNA-1273 led to more pronounced reactions after the second dose (71.7%). Heterologous prime-booster vaccinations with ChAdOx followed by either mRNA-1273 or BNT162b2 were associated with the highest risk for impairment (81.4%). The time of day of the vaccinations showed no influence. Conclusions Young women had the highest chance to experience reactogenicity and to be unable to work after COVID-19 vaccination. When vaccinating a large part of a workforce, especially in professions with a higher proportion of women like health care, employers as well as employees must be prepared for a noticeable amount of absenteeism. Trial registration The study was approved by the Ethic Committee of the Aerztekammer Berlin on May 27th, 2021 (Eth-37/21) and registered in the German Clinical Trials Register (DRKS 00025745). The study was supported by the Helios research grant HCRI-ID 2021-0272.

Food Control System in Sri Lanka and Perception of Public Health Inspectors on Implementation of Control Measures

Background: Many health problems encountered today arising from consumption of unsafe food. Contamination of food and feeds arising from naturally occurring toxicants, microbiological contaminants, chemical contaminants such as additives used above the permitted levels, pesticide and veterinary residues in food or as toxic components from food processing could have deleterious effects in humans and animals. Food control measures are critical in fostering food safety management of a nation. Methods: In depth review of the existing legislation on food safety and hygiene and the food control system was done. International literature and reports were reviewed to compare the current global situation and the Sri Lankan situation. In depth interviews were conducted among the Public Health Inspectors who comprise the majority of authorized officers Results: The food control legislation which was enacted in 1980 has been amended only twice in 1991 and 2011. There are over 50 Regulations brough in time to time under the Food Act of 1980. The food control system is mainly centralized and the implementation is done mainly at the level of the Medical Officer of Health (MOH). Many provisions of the legislation are outdated and needs revisions. The perception of the Public Health Inspectors reveled that a vast majority are not satisfied with the current food control system and are the opinion that the improvements should be made in all areas related to the food control system. Conclusion: The food control system in Sri Lanka should be revisited and be improved and updated to be in line with the current global trends. The capacities of the analytical system as well as the authorized officers should be improved in order to ensure effective implementation of the food control system.

Educational Intervention Aimed at Street Food Vendors to Improve Knowledge and Practices on Food Safety and Hygiene

Background: Street foods is ready- to- eat foods and beverages prepared which are sold by vendors in streets and other public places for immediate consumption or consumption at a later time without further processing or preparation. Street vended foods forms a distinctive part of food industry because they are mostly affordable, easily accessible. Food handlers play an important role in food safety and in transmission of food poisoning, because they can introduce pathogens into foods during production, processing, distribution and serving. Therefore, the understanding of food safety procedures and the potential factors that causes food borne diseases is very essential for all food handlers. Objective: The study was conducted with the objective of assessing the level of knowledge and practices on food safety and hygiene in street food vendors and improve the knowledge and practices through an educational intervention targeting the street food vendors. Methods: A descriptive cross-sectional study was conducted to assess the knowledge and practices of the street food vendors. An educational intervention was carried out using the mode of one-to-one knowledge sharing discussion facilitated by pictorial materials. The intervention was conducted in all street food vendors in a selected medical Officer of Health area in the Colombo district. Similar MOH area in the Colombo district was used as the control area. Interviewer administered questionnaire was used to assess the level of knowledge and a checklist was used to assess the practices. Results: The knowledge and practices level were not satisfactory in the baseline study. The knowledge improved in a statistically significant proportion (P<0.05) following the intervention in the intervention group. However, the level of improvement of practices was not statistically significant at the post interventional assessment (P>0.05). Conclusions: The intervention was successful in improving the knowledge of the street food vendors significantly. However, the practice level did not show a statistically significant improvement.

G Vernon Davies: unsung pioneer of old age psychiatry in Victoria

Objective: To provide a biography of G Vernon Davies who took up a career in old age psychiatry in 1955 at the age of 67 at Mont Park Hospital in an era when there few psychiatrists working in the field. Conclusion: In the 1950s and 1960s, Vernon Davies worked as an old age psychiatrist and published papers containing sensible practical advice informed by contemporary research and experience, broadly applicable to both primary and secondary care, presented in a compassionate and empathetic manner. His clinical research in old age psychiatry resulted in the first doctoral degree in psychiatry awarded at the University of Melbourne at the age of 79. Before commencing old age psychiatry, he served in the Australian Army Medical Corps as a Regimental Medical Officer and received the Distinguished Service Order. He spent 3 years as a medical missionary in the New Hebrides before settling at Wangaratta where he worked as a physician for over 30 years. He contributed to his local community in a broad range of activities. Vernon Davies is an Australian pioneer of old age psychiatry.