Parkwood Hospital

Traditional extemporaneous compounding methods of solid oral dosage forms required in early-stage studies are laborious, and the drug's solid state may affect the biopharmaceutical performance of the medicine. Maintaining the intended drug form in all stages of drug product development is critical. In this study, we evaluated the potential of Semi-solid extrusion (SSE) 3D printing to maintain a crystalline solid dispersion and automate small-batch tablet production suitable for preclinical and first-in-human (FIH) studies using high-solubility acetaminophen and low-solubility celecoxib as model compounds. Two drug-loaded pharma-inks were developed for each drug, containing 0.22 % w/w and 23 % w/w acetaminophen, and 0.2 % w/w and 30 % w/w celecoxib, respectively. Dose-flexible tablets were printed by SSE 3D printing at room temperature, covering a wide range of acetaminophen doses (0.5 mg, 150 mg, and 250 mg), and celecoxib doses (0.5 mg, 100 mg, and 200 mg) from the low or high drug-loaded pharma-inks, respectively. In vitro drug release confirmed the immediate release properties of the tablets. X-ray diffraction and DSC of the tablets confirmed crystalline acetaminophen and celecoxib dispersions post-printing. This work demonstrates that SSE 3D printing technology can be employed as a straightforward and cost-effective method to rapidly manufacture small batches of dose-flexible oral solid dosage forms on demand, suitable for early-stage studies, while maintaining API crystallinity and providing flexible dosing.

Compounding medications in pharmacies is a common practice for patients with prescriptions that are not available commercially, but it is a laborious and error-prone task. The incorporation of emerging technologies to prepare personalised medication, such as 3D printing, has been delayed in smaller pharmacies due to concerns about potential workflow disruptions and learning curves associated with novel technologies. This study examines the use in a community pharmacy of a pharmaceutical 3D printer to auto-fill capsules and blisters using semisolid extrusion, incorporating an integrated quality control system. This retains the customisation and automation advantages of 3D printing, speeding up the manufacturing process while increasing familiarity for pharmacists. Minoxidil capsules (2.5 mg and 5mg doses) were prepared using a pharmaceutical 3D printer and dispensed to 9 patients in a community compounding pharmacy setting in Spain. This innovative production method was compared to the conventional manual capsule filling. All capsules met the European Pharmacopeia standards for mass uniformity, drug content and dissolution, and demonstrated stability at 25°C and 65% relative humidity for three months, matching the typical treatment duration. The 3D printer offers greater precision and efficiency and reduced operator involvement by more than half compared to manual capsule filling, making the process faster and more cost-effective. This study offers for the first time a clear roadmap for implementing a pharmaceutical 3D printer in a community pharmacy for automated compounding to prepare reliable and precise personalised medication for patients, marking a valuable step forward in precision medicine.

Reducing cost is a critical objective for project teams. However, unlike the research on topics such as cost overruns, cost reduction literature is limited. Previous studies have primarily examined cost estimation and reduction models or high-level cost reduction strategies. Therefore, it is necessary to identify specific actions that project teams can take to reduce cost. By focusing on the “cost drivers” of infrastructure projects, researchers have a practically relevant lens through which cost reduction can be promoted and studied. Thus, this integrative literature review establishes a foundation for infrastructure project cost drivers knowledge, addressing three research questions revolving around deriving a definition, classification scheme, and conceptual framework of cost drivers. This paper first produces a definition of cost drivers by critically analyzing cost driver concepts and perspectives and existing definitions. Second, cost drivers were drawn from relevant articles and classified to produce a taxonomy of 14 key cost drivers. Third, a conceptual framework (two-by-two matrix) of cost driver types was developed to acknowledge the influence project teams can have. Finally, a research agenda proposes further investigation in cost drivers and reduction research regarding each cost driver, apt research methods, and necessary project contexts. This paper’s theoretical contribution is a deepening of infrastructure project cost drivers knowledge using a definition, taxonomy, and conceptual framework. The practical contribution is a deepened awareness of the key opportunities for—and threats to—cost reduction for project teams, as well as knowledge of those cost drivers that they actually have an influence over, that is, to reduce their project’s cost.

To evaluate the effectiveness of educational programs in reducing urinary tract infections (UTIs) in individuals with spinal cord injuries (SCI). A search of all relevant literature published up to and including July 2012 was conducted using multiple databases. Methodological quality was rated using the PEDro tool for randomized control trials (RCTs) and the Downs and Black tool for non-RCTs; levels of evidence were assigned using a modified Sackett scale. Four articles were selected for review. As a result of an education program, a level 2 prospective control trial reported a reduction in number of UTIs (p=.02), but a level 2 RCT did not. A pre-post study found a reduction in number of UTIs while a case-control study did not; however, these studies did not compute statistics. There is limited positive evidence that education programs reduce the incidence of UTIs. Optimal urinary health of individuals with SCI may be optimized via education programs that provide information and enhance skills.

Learning Objectives 1. Define FES.2. Identify parameters of FES as appropriate for individual patient/patient populations.3. Understand the clinical application of FES.4. Identify indications and c...

Retinal vein occlusion (RVO) is an obstruction of the retinal venous system, and macular edema (ME) is a complication of RVO that can lead to blindness. The Canadian incidence of visual impairment (VI) due to ME secondary to RVO is unknown. This observational, retrospective study used records from the Southwestern Ontario database to observe the annual incidence, demographics, and comorbidity characteristics of patients with VI due to ME secondary to RVO. From 47,166 patients, 73 with RVO (>40 years old) were identified: 53 with branch retinal vein occlusion (BRVO), 20 with central retinal vein occlusion (CRVO). The annual incidence of VI (visual acuity <20/40 in Snellen equivalent) due to ME secondary to BRVO was (mean (95%CI)) 0.056% (0.011–0.072), and to CRVO was 0.021% (0.008–0.081). Furthermore, a greater proportion of RVO patients had hypertension (68% versus 14%) or dyslipidemia (16% versus 10%), when compared to a healthy control cohort of 76,077 subjects (P < 0.05). This study presents a description of the characteristics of patients with VI due to ME secondary to RVO in a real-world Canadian setting. The results demonstrate that BRVO was more frequent than CRVO, and that RVO in this patient population was associated with several vascular comorbidities.