Development of a web-based tool for automated processing and cataloging of a unique combinatorial drug screen

Facing totally resistant bacteria, traditional drug discovery efforts have proven to be of limited use in replenishing our depleted arsenal of therapeutic antibiotics. Recently, the natural anti-bacterial properties of metal ions in synergy with metal-coordinating ligands have shown potential for generating new molecule candidates with potential therapeutic downstream applications. We recently developed a novel combinatorial screening approach to identify compounds with copper-dependent anti-bacterial properties. Through a parallel screening technique, the assay distinguishes between copper-dependent and independent activities against Mycobacterium tuberculosis with hits being defined as compounds with copper-dependent activities. These activities must then be linked to a compound master list to process and analyze the data and to identify the hit molecules, a labor intensive and mistake-prone analysis. Here, we describe a software program built to automate this analysis in order to streamline our workflow significantly. We conducted a small, 1440 compound screen against M. tuberculosis and used it as an example framework to build and optimize the software. Though specifically adapted to our own needs, it can be readily expanded for any small- to medium-throughput screening effort, parallel or conventional. Further, by virtue of the underlying Linux server, it can be easily adapted for chemoinformatic analysis of screens through packages such as OpenBabel. Overall, this setup represents an easy-to-use solution for streamlining processing and analysis of biological screening data, as well as offering a scaffold for ready functionality expansion.

(Re-)reading medical trade catalogs: the uses of professional advertising in British medical practice, 1870-1914

This article explores how medical practitioners read, used, and experienced medical trade catalogs in late-nineteenth- and early-twentieth-century Britain. Reader responses to the catalog, a book-like publication promoting medical tools, appliances, and pharmaceuticals, have been chronically understudied, as have professional reading practices within medicine more generally. Yet, evidence suggests that clinicians frequently used the catalog and did so in three main ways: to order medical products, to acquire new information about these products, and to display their own product endorsements and product designs. The seemingly widespread nature of these practices demonstrates an individual and collective professional desire to improve medical practice and highlights the importance of studying professional reading practices in the cultural history of medicine.

[Execute Yinpian drug catalogue, traditional Chinese medicine Yinpian prescription dispensing rule, completely solve the problem of the dispensing specified varieties]

For solve confusion of the dispensing specified varieties of traditional Chinese medicine Yinpian, the state administration of traditional Chinese medicine had decreed in 2009 the on the Traditional Chinese Medicine Yinpian prescription name and the dispensing specified varieties notification, Require various regions medical institutions to solve the problem. But the notification permit that each medical institutions formulate the traditional Chinese medicine Yinpian prescription name and standards of the dispensing Specified varieties, be sure to cause each medical institutions on parallel tracks in the dispensing Specified varieties. Beijing the Beijing traditional Chinese medicine Yinpian prescription dispensing rule. It nor did completely solve the problem of the dispensing specified varieties, there is a difference between doctor and harmacist. So formulate statute universal and scientific, Completely solve the problem of the dispensing specified varieties, It is Long-cherished wish of government and traditional Chinese medicine sector for many years The article on appearance of the dispensing specified varieties problem, and think about actual statute of the dispensing specified varieties, and discuss Solving system, consider formulate and execute Yinpian drug catalogue and Chinese medicine Yinpian prescription dispensing rule by country and local two level, It provides legal protection to thoroughly resolve the dispensing Specified varieties Both can resolve that prescription of traditional Chinese medicine Yinpian unified provisioning in entire country, And conducive to defend local medical genre medication features, and defend precious local features processing varieties and conducive to exploit new drug, and conducive to inherit and evolve traditional Chinese medicine scientifically, It is simple and feasible final way to Chinese medicine Yinpian dispensing specified varieties.

[The National List of recommendations-- what is it based on?]

The National List of recommendations is a scientific survey of the most used drugs. It separates the drugs into three groups: 1) recommended drugs, 2) drugs only to be used in special circumstances, and 3) drugs which should not be used in normal circumstances because of too limited efficacy or serious adverse reactions. The list is made by specialists chosen by the scientific bodies. The Institute of Rational Pharmacotherapy acts as secretariat. The primary selection criterion is the relationship between effect and adverse reactions, while price issues are not considered. Special consideration has been given to how the effect is expressed, composite measurements of effect and to extrapolation. The list, which is updated annually, is available at the IRF's homepage. The list of recommendations is primarily an instrument for general practitioners and drug committees; in future it should be integrated into the regional drug lists.

[How do general practitioners keep up-to-date on pharmacotherapy?]

BACKGROUND

Traditional methods for dissemination of knowledge, such as lecture-based courses and distribution of guidelines, have shown only modest effect on improving the quality of GPs' prescription practice. We aimed at assessing GPs' own views on various sources of knowledge within pharmacotherapy, and their attitudes to a potentially effective educational method: audit and feedback.

MATERIAL AND METHODS

A questionnaire regarding the use of and views on various sources of knowledge concerning pharmacotherapy was sent to GPs in continuing medical education (CME) groups participating in an intervention study on quality improvement of prescription practice.

RESULTS

302 of 479 GPs (63 %) responded. The Norwegian Pharmaceutical Catalogue was the most widely used source of information on drugs. Industry- based sources were generally regarded as less useful and without great influence on prescription practice, but were nevertheless often mentioned as a source of information in specific prescribing situations. The GPs rated CME groups as useful and influential, and 94 % viewed the exposure of own prescription data in the CME group as unproblematic.

INTERPRETATION

Audit and feedback in CME groups seems to be a suitable educational method in pharmacotherapy. Industry- based information sources are rated as being of low value, but seem to have influence on prescription practice.

[Lack of consensus on drug interactions: a descriptive analysis of information on interactions in the Laegemiddelkatalog, Medicinfortegnelse and product descriptions]

INTRODUCTION

Practitioners' experience with inconsistencies between two Danish handbooks and the SPCs have lead to this comparative analysis of information on drug interactions in these publications. On the same background, a Danish database with drug interactions based on evidence and transparency is established.

MATERIALS AND METHOD

The material comprises information on 62 randomly selected drugs marketed in Denmark and described in the Laegemiddelkatalog, Medicinfortegnelse and 62 SPCs. A total of 586 drug interactions was analysed. This is a comparative analysis of the discrepancies of the information, the exactness of the name of the interacting drug, and applicability for health care personnel.

RESULTS

The comparison of the three sources shows inconsistency for 78% of the interactions. Fifty-nine percent of the interactions are mentioned in one source only. The distribution among the categories in the exactness of the name of the interacting drug (p=0.02), and applicability for health care personnel (p=0.0001) is not uniform for the three sources. The SPCs are less exact in mentioning the interacting drug and more often recommend actions to be taken to ameliorate drug interactions.

DISCUSSION

The consistency among the sources is relatively low. The inconsistency may contribute to patients' exposure to potentially severe drug interactions, first and foremost because of the omission of potentially severe drug interactions in the sources. It may also contribute to confusion on the part of health care personnel and drug users, which once again may lead to inadequate drug utilisation. There is a need for information on drug interactions and a consensus nationally in Denmark and probably internationally as well.

Unity from diversity: the evidential use of anecdotal reports of adverse drug reactions and interactions

Anecdotal case reports contribute about one-third of the published literature on adverse drug reactions and interactions, but are regarded as providing poor-quality evidence. However, they can occasionally provide proof of cause and effect, and there are many other reasons for publishing them. Because an anecdote is a narrative, narratological paradigms from literature, art, and music can show how we can make evidential use of anecdotes. Useful paradigms are the dramatic unities (of time, place, and action), comprehensive catalogues, and pattern formations. Here I give examples of each of these types of paradigm and show how they can be used to interpret anecdotes about adverse drug reactions and interactions. The dramatic unities show how a proper classification of adverse drug reactions can be achieved, according to dose-relation, time-course, and susceptibility factors; use of this classification should improve the evidential use of anecdotal reports. A high background incidence of the effect (the medical equivalent of subplots, which violate the unity of action) makes it more difficult to detect adverse drug effects using anecdotal reports. To make best evidential use of the corpus of anecdotal reports of adverse drug reactions, comprehensiveness is important: each suspected adverse reaction should be reported in detail and reactions should be reported in sufficient numbers for proper classification and for patterns to be recognized. One form of pattern recognition, teleoanalysis of data, should, when possible, include not only randomized controlled trials and observational studies, but also case series and anecdotal reports.

[What information is given on adverse drug reactions from new drugs?]

BACKGROUND

It is not known to what extent information on previously unknown adverse reactions is communicated to doctors after the approval of a new drug.

MATERIAL AND METHODS

We included seven drugs, approved between 1982 and 1995 and the first in their class to be approved in Norway. We recorded the number of adverse reactions listed in the annual editions of the Norwegian physicians' desk reference(Felleskatalogen) from the first edition that included the drug and up until the 2001 edition.

RESULTS

Only 51 % of the adverse reactions listed in the 2001 edition were included in the first post-approval edition. On average, 1.6 new adverse reactions were added for each drug every year. By contrast: in a group of 12 drugs approved before 1970, 0.14 new adverse reactions were added for each drug every year between 1989 and 2001.

INTERPRETATION

With a new drug it is to be expected that many adverse reactions are not acknowledged as such. Caution is warranted because of the fact that even though it is not listed in the physicians' desk reference, any event appearing in a patient exposed to a new drug may be an adverse reaction.

[Computerized decision support in drug prescribing II: A national database to provide up-to-date and unbiased information]

Prescribers today encounter increasing demands for up-to-date knowledge of medical advances and drug therapies, and for a straightforward dialogue with patients. Cost-effective drug treatment calls for fast and intuitive access to information about drugs, treatment strategies and patient data. There are several computer-based drug-prescribing systems in Sweden. Information independent of the drug industry is wanting, as are uniform national standards for medical content and functionality. Decision-support systems must facilitate decisions about therapy, drug distribution and intake, as well as quality work, i.e. support the entire process which defines an effective drug therapy. A very important feature is access to a patient's drug list showing all current drugs. This joint initiative by county councils aims at drawing up a national Swedish specification of requirements for a suitable decision-support system and at creating a national entity responsible for distributing unbiased information from a unique database to a range of computerized medical records systems.

[Drug regulation: theory and practice]

Regulation of drugs from the public administration is an activity which is produced in different countries independently from the sanitary model they own. In the field of public financing of drugs there have been several measures to improve the efficiency of their use. However, the analysis of the impact of these measures is complex and this may justify the shortage of objectivable results, especially at long term. The objective of this study is to perform a systematic review of such measures due to the need to have information about the different alternatives before making a decision. The introduction of an isolated measure is in many cases compensated by other changes in other regulating or aiding fields which suggests the creation of an integral strategy which affects different fields (supply/demand of drugs and prescribers). It seems necessary to suggest a social debate taking as a basis the scientific information available at the moment and promote the taking of decisions which lead to a rational use of the available pharmacological resources.

[Presence of excipients in pharmaceutical products in 3 sources of therapeutic information]

OBJECTIVE

To evaluate the level of agreement between information compiled from the Vademecum, the Pharmaceutical Catalogue and instruction leaflets on the four excipients most commonly used to prepare pharmaceutical products (saccharin, saccharose, lactose and ethanol).

DESIGN

Descriptive study.

SETTING

Primary care.

PATIENTS AND OTHER PARTICIPANTS

658 orally administered preparations of pharmaceutical products were chosen. Their composition formulas in the Vademecum, Pharmaceutical Catalogue and instruction leaflets were compared with a theoretical model constructed as the most reliable source of information on excipients.

RESULTS

Saccharin and saccharose were the most frequently described and quantified excipients, and lactose the least. Saccharin was quantified in 97.3% of cases in which it was used as an excipient, saccharose in 95%, ethanol in 91.4% and lactose in 17.5%. Saccharin is also the excipient which coincided most in the three sources examined, followed by saccharose, lactose and ethanol. The Vademecum did not state the presence of saccharose in 62% of preparations and of lactose in 39.7%. Instruction leaflets were the source with the lowest rate of failing to state the excipients.

CONCLUSIONS

Saccharose and lactose are excipients frequently omitted from the composition of orally taken pharmaceutical products in the Vademecum. Instruction leaflets provide the most reliable source out of the three analysed. The need to make available for doctors simple texts, contributing more reliable and up-to-date information, is underlined.