The Use of Minipigs for Testing the Local Intranasal Toxicity of Fentanyl

The local intranasal toxicity of a nasal formulation of the opioid analgesic fentanyl was investigated in this  study. Minipigs were used as the experimental model. Fentanyl was administered using the formulation and  the device intended for human use. Doses of 400 μg fentanyl were administered 5 times daily to the minipigs  for 4 weeks. In addition, the spreading pattern of the formulation in the minipig nasal cavity was investigated  by applying a formulation containing methylene blue at necropsy. Results: The methylene blue spread to the middle parts of the endoturbinates. The No-Observed-Adverse-  Effect-Level (NOAEL) of intranasally administered fentanyl in minipigs was documented to be above 5 x  400 μg/day. After necropsy, no relevant treatment related macroscopic or microscopic findings were  observed, but minimal focal deciliation/degradation of the respiratory epithelium was seen in one animal.  In conclusion, intranasal administration of 400 μg fentanyl 5 times daily for a period of 4 weeks did not  cause any treatment related changes in the nasal cavity of the minipig.

Recruiting people with severe mental illness through community pharmacies:real-world experiences from a UK study

BACKGROUND: Proxy recruitment of patient participants through community pharmacies may be a valuable strategy to maximise participation. This paper focuses on the feasibility of such a recruitment strategy for research involving people who experience severe mental illness. METHODS: Fifty-three community pharmacies, including 50 'Research Ready' pharmacies, were asked to recruit people with severe mental illness for participation in research. Pharmacists were asked to provide participant information to anyone presenting a prescription meeting specific criteria. RESULTS: Thirteen recruitment sites (25%) (from 4 distinct organisations) were approved to recruit patient participants. Eighty-five percent (n = 11) failed to recruit any potential participants. CONCLUSIONS: Proxy recruitment of people with severe mental illness through community pharmacies was challenging with challenges in both pharmacy- and participant-recruitment. Further investigation into supporting community pharmacists' engagement with recruiting patients with SMI as research participants is required

A scoping review on occupational science research in European contexts

Background A survey showed European occupational scientists cover a broad range in occupational science (OS) research, however, no contemporary overviews of European OS research exists, and current research may provide valuable information for OS and occupational therapy. Aim The aim was to provide an overview of contemporary European OS research. Materials and method A scoping review was performed, including studies conducted in Europe and published in the British Journal of Occupational Therapy (BJOT), the Scandinavian Journal of Occupational Therapy (SJOT) or the Journal of Occupational Science (JOS) between 2015 and 2020. The journals were systematically searched, and quality assessment and thematic analysis were undertaken. Results Findings from 93 articles identified many studies from the Nordic countries. Most studies applied qualitative research methods. Theoretical concepts from OS were used in data generating and discussions. A wide range of demographics, and living conditions were explored. Recent articles took a reflexive stance on the positionality of the researcher/s. Conclusions This review highlights the diversity of OS research, suggesting a solid theoretical knowledge base within European OS research. Significance The results contribute to further development and maturation of the discipline of OS in Europe and internationally

Swedish patients’ trust in the bioequivalence of interchangeable generics. What factors are important for low trust?

Background: Generic substitution (GS), is a cost-containment strategy meant to contain pharmaceutical expenditure without compromising health objectives. In order to shape GS into a policy that is both efficient and safe it is crucial to understand which factors are most important for patients’ trust in GS. Objective: To assess Swedish patients’ level of trust in the bioequivalence of cheap and expensive generic medicines, and the association between trust and various factors. Methods: A cross-sectional study was conducted. Questionnaires were handed out at 12 community pharmacies in Sweden, selected through stratified sampling, between March and April 2015. The questionnaire included seven socio-demographic questions in addition to 18 items divided into three sections: the ‘views on generic medicine’-scale, information on and prior experiences of GS, financial aspects and change of color/name. Odds Ratios (ORs) were estimated applying adjusted logistic regression analyses with trust in the bioequivalence of generic medicines used as outcome variable and various factors as predictors. Results: A total of 719 patients participated (response rate 85.7%). The results show that 70.7% of the respondents’ trust that cheap and expensive interchangeable generic medicines are equal. Of the respondents 36.0% considered the change in appearance and 40.8% the change in names to complicate adherence. Lower trust in the bioequivalence of generic medicines were associated with being female (aOR=1.82, 95%CI 1.20:2.75, p<0.01), patients perceiving that changes in product name and appearance make adherence more complicated (aOR=2.18, 95%CI 1.48:3.19, p<0.001), disagreeing in that GS saves money for me (the customer) (aOR=2.68, 95%CI 1.58:4.55, p<0.001) or that GS saves money for society (aOR=3.21, 95%CI 1.46:7.08, p<0.01). Conclusions: Seven out of ten respondents had trust in the bioequivalence of generic medicines, and one in three considered GS to complicate adherence. Four factors were associated with lower trust in GS, i.e. female gender, agreeing that changes in product name and appearance complicates adherence, disagreeing in that GS saves money for me or disagreeing in that GS saves money for the society. Low trust in GS needs to be addressed, not least in the communication between health professionals and patients

A framework for industrial systems modeling and simulation

To successfully compete in a global market, manufacturing production systems are being forced to reduce time to market and to provide improved responsiveness to changes in market conditions. The organizations that comprise the business links in the production system must constantly make tradeoffs between time and cost in order to achieve a competitive but quick response to consumer demand. Due to the inherent uncertainty of consumer demand, these tradeoffs are, by definition, made with incomplete information and can incur significant financial and competitive risk to the organization. Partnerships between organizations are a mechanism for increasing the information in the decision making process by combining information from the two partners. Partnerships are inherently difficult to implement due to trust issues. A mechanism for investigating and validating the mutual benefit to partnering would be useful in designing and implementing partnerships. This paper describes the development of a software framework for industrial systems modeling and simulation. The framework provides a mechanism for investigating changes to industrial systems in a manner which minimizes the effort and computational power needed to develop focused simulations. The architecture and it`s component parts are described

Online and Blended Learning Courses for Healthcare Professionals and Policymakers on Patients' Perspectives on Medicine:A Project Report

In order for healthcare professionals to better engage with patients, they need to understand and integrate the perspectives of patients into their daily work. In this project, we developed two courses for healthcare professionals on patients’ perspectives on medicine. One course was an online course that introduced the patients’ perspectives on medicine and explained its importance for healthcare and health policy. The second course was a blended learning course, consisting of online modules and face-to-face webinars, which specified how to explore patients’ perspectives in qualitative interviews, and how to develop implementation plans. Patients participated in the development, execution, and evaluation of both courses. Overall, more than 2000 healthcare professionals enrolled in the first course and, in just over a year, 191 participants completed the online course; 57 healthcare professionals registered in the second blended learning course and six participants completed both components of the course. The relevance of knowledge gained was positively evaluated. Participants especially appreciated the participation of patients. Based on the feedback, the second blended learning course was adapted to run online and both courses continue to be freely available to all interested healthcare professionals on the Coursera platform

Are European Blue Economy ambitions in conflict with European environmental visions?

We report the outcomes of a comprehensive study of the potential consequences of the implementation of the EU Maritime Spatial Planning Directive (MSPD) in Danish waters. The analyses are anchored in a framework developed in support of data-driven Ecosystem-Based Maritime Spatial Planning. The data for the models include not only human stressors but also information on the distribution of ecosystem components ranging from planktonic communities over benthic communities to fish, seabirds and marine mammals. We have established a baseline, based on state-of-the-art data sets, with respect to combined effects upon ecosystem components. Future scenarios for the developments in human stressors were estimated for 2030 and 2050 based on information on existing policies, strategies and plans and were compared to the baseline. In addition, we developed a scenario for implementation of the Marine Strategy Framework Directive (MSFD), i.e. working towards meeting the objectives of Good Environmental Status. Our results indicate that (1) combined human stressors will possibly increase in 2030 and 2050 compared to the baseline, (2) increased combined human stressors are likely to lead to a worsening of the environmental and ecological status sensu the Marine Strategy Framework Directive and the Water Framework Directive (WFD), and (3) the MSPD implementation process appears to conflict with the MSFD and WFD objectives. Accordingly, we are sceptical of claims of an untapped potential for Blue Growth in Danish marine waters.publishedVersio

Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials

Background: Physiotherapy has long been a routine component of patient rehabilitation following hip joint replacement. The purpose of this systematic review was to evaluate the effectiveness of physiotherapy exercise after discharge from hospital on function, walking, range of motion, quality of life and muscle strength, for osteoarthritic patients following elective primary total hip arthroplasty. Methods: Design: Systematic review, using the Cochrane Collaboration Handbook for Systematic Reviews of Interventions and the Quorom Statement. Database searches: AMED, CINAHL, EMBASE, KingsFund, MEDLINE, Cochrane library (Cochrane reviews, Cochrane Central Register of Controlled Trials, DARE), PEDro, The Department of Health National Research Register. Handsearches: Physiotherapy, Physical Therapy, Journal of Bone and Joint Surgery (Britain) Conference Proceedings. No language restrictions were applied. Selection: Trials comparing physiotherapy exercise versus usual/standard care, or comparing two types of relevant exercise physiotherapy, following discharge from hospital after elective primary total hip replacement for osteoarthritis were reviewed. Outcomes: Functional activities of daily living, walking, quality of life, muscle strength and range of hip joint motion. Trial quality was extensively evaluated. Narrative synthesis plus meta-analytic summaries were performed to summarise the data. Results: 8 trials were identified. Trial quality was mixed. Generally poor trial quality, quantity and diversity prevented explanatory meta-analyses. The results were synthesised and meta-analytic summaries were used where possible to provide a formal summary of results. Results indicate that physiotherapy exercise after discharge following total hip replacement has the potential to benefit patients. Conclusion: Insufficient evidence exists to establish the effectiveness of physiotherapy exercise following primary hip replacement for osteoarthritis. Further well designed trials are required to determine the value of post discharge exercise following this increasingly common surgical procedure