A nipple shield delivery system for oral drug delivery to breastfeeding infants : Microbicide delivery to inactivate HIV

A new drug delivery method for infants is presented which incorporates an active pharmaceutical ingredient (API)-loaded insert into a nipple shield delivery system (NSDS). The API is released directly into milk during breastfeeding. This study investigates the feasibility of using the NSDS to deliver the microbicide sodium dodecyl sulfate (SDS), with the goal of preventing mother-to-child transmission (MTCT) of HIV during breastfeeding in low-resource settings, when there is no safer alternative for the infant but to breastfeed. SDS has been previously shown to effectively inactivate HIV in human milk. An apparatus was developed to simulate milk flow through and drug release from a NSDS. Using this apparatus milk was pulsed through a prototype device containing a non-woven fiber insert impregnated with SDS and the microbicide was rapidly released. The total SDS release from inserts ranged from 70 to 100% of the average 0.07 g load within 50 ml (the volume of a typical breastfeed). Human milk spiked with H9/HIVIIIB cells was also passed through the same set-up. Greater than 99% reduction of cell-associated HIV infectivity was achieved in the first 10 ml of milk. This proof of concept study demonstrates efficient drug delivery to breastfeeding infants is achievable using the NSDS

Perceptions of U.S. Medical Residents Regarding Amount and Usefulness of Sexual Health Instruction in Preparation for Clinical Practice

Despite patient demand for sexual health discussions with their physicians, sexuality instruction in residency is often lacking. This exploratory quantitative study assessed the amount and usefulness of sexuality instruction received by a sample of medical residents, as well as the residents\u27 self-perceived readiness regarding addressing sexuality issues. Data were obtained through a self-administered survey with 130 resident respondents. The majority reported receiving little/no formal sexuality instruction. Many indicated that additional sexuality instruction would be useful in their practice. Although the majority reported comfort discussing sexuality, they reported rarely/never initiating these discussions. Recommendations for changes in graduate medical education programming are provided