Rates of sexually transmitted infections (STIs) are rising despite significant management efforts in traditional healthcare settings. The growing number of individuals affected by STIs demonstrates a ...gap in care. Pharmacy-based STI clinical services are a potential solution to improve care.
To identify and summarize research about the implementation of pharmacy-based STI services, focusing on program characteristics, barriers, facilitators, and pharmacist and patient experiences.
A search of PubMed, Embase, and Cochrane Database of Systematic Reviews was conducted for papers evaluating STI expanded-scope clinical services performed by regulated pharmacists in an outpatient/community pharmacy setting. Study setting, design, data collection method, outcomes, target infection, services offered, patient population, and barriers and facilitators are reported.
Twelve studies, 11 cross-sectional and 1 randomized control trial, were identified in this review. All studies focused on chlamydia, and two included gonorrhea and trichomoniasis or syphilis. Eleven services investigated STI screening, with four also offering treatment, and two offering partner treatment. Overall, patients reported positive experiences, found the services accessible, and trusted pharmacists. Pharmacists recognized the importance of STI services, were keen, and felt comfortable performing clinical tasks. Patients described convenience as a key facilitator, and concerns about privacy, particularly at the pharmacy counter, and the stigma and fear of judgement associated with STIs as primary barriers. For facilitators, pharmacists reported increased job satisfaction and a sense of relieving the burden on traditional STI services; for barriers, pharmacists highlighted patient recruitment, communication challenges, and lack of remuneration.
Research on pharmacy-based STI services includes predominately small-scale, cross-sectional studies, and focuses on chlamydia screening. Both patients and pharmacists perceive these services to be acceptable and feasible, though strategies addressing patient privacy and recruitment, pharmacist competency, training, and remuneration must be considered to support the success of pharmacy-based STI services.
Participation in sorority recruitment often results in acute vocal impairment. The purpose of this investigation was to characterize the extent to which voice function and laryngeal appearance may be ...altered by participation in this social phenomenon.
Using a within-participant repeated measures design, nine women participating as sorority recruiters completed the study protocol. The following data were collected at two time points, immediately before and after the completion of two weeks of sorority recruitment: stroboscopic laryngeal imaging, vocal acoustic measures, and perceptual measures of vocal effort and voice quality.
Perceived phonatory effort and overall severity of voice quality were significantly impaired following sorority recruitment. All participants had evidence of mucosal changes in the form of one or more the following: observed edema, erythema, increased vascularity, glottic margin changes. No significant differences in acoustic measures were identified.
Increased perceived vocal effort, increased overall severity ratings of voice quality, and deleterious vocal fold tissue changes observed support the hypothesis that the acute vocal loading that is characteristic of the sorority recruitment process contributes to a decline in voice function in the short term. Acoustic measures taken either lacked the sensitivity for the perceived decline in voice function or the participants, who were otherwise healthy, managed to adapt the acoustic signal to the tissue changes observed. The extent to which these acute changes may be mitigated with vocal hygiene and voice training is an area for future study.
Whereas recent clinical studies report metastatic melanoma survival rates high as 30-50%, many tumors remain nonresponsive or become resistant to current therapeutic strategies. Analyses of The ...Cancer Genome Atlas (TCGA) skin cutaneous melanoma (SKCM) data set suggests that a significant fraction of melanomas potentially harbor gain-of-function mutations in the gene that encodes for the ErbB4 receptor tyrosine kinase. In this work, a drug discovery strategy was developed that is based on the observation that the Q43L mutant of the naturally occurring ErbB4 agonist Neuregulin-2beta (NRG2β) functions as a partial agonist at ErbB4. NRG2β/Q43L stimulates tyrosine phosphorylation, fails to stimulate ErbB4-dependent cell proliferation, and inhibits agonist-induced ErbB4-dependent cell proliferation. Compounds that exhibit these characteristics likely function as ErbB4 partial agonists, and as such hold promise as therapies for ErbB4-dependent melanomas. Consequently, three highly sensitive and reproducible (Z' > 0.5) screening assays were developed and deployed for the identification of small-molecule ErbB4 partial agonists. Six compounds were identified that stimulate ErbB4 phosphorylation, fail to stimulate ErbB4-dependent cell proliferation, and appear to selectively inhibit ErbB4-dependent cell proliferation. Whereas further characterization is needed to evaluate the full therapeutic potential of these molecules, this drug discovery platform establishes reliable and scalable approaches for the discovery of ErbB4 inhibitors.
Cancer is a global health problem in need of transformative treatment solutions for improved patient outcomes. Many conventional treatments prove ineffective and produce undesirable side effects ...because they are incapable of targeting only cancer cells within tumors and metastases post administration. There is a desperate need for targeted therapies that can maximize treatment success and minimize toxicity. Nanoparticles (NPs) with tunable physicochemical properties have potential to meet the need for high precision cancer therapies. At the forefront of nanomedicine is biomimetic nanotechnology, which hides NPs from the immune system and provides superior targeting capabilities by cloaking NPs in cell-derived membranes. Cancer cell membranes expressing "markers of self" and "self-recognition molecules" can be removed from cancer cells and wrapped around a variety of NPs, providing homotypic targeting and circumventing the challenge of synthetically replicating natural cell surfaces. Compared to unwrapped NPs, cancer cell membrane-wrapped NPs (CCNPs) provide reduced accumulation in healthy tissues and higher accumulation in tumors and metastases. The unique biointerfacing capabilities of CCNPs enable their use as targeted nanovehicles for enhanced drug delivery, localized phototherapy, intensified imaging, or more potent immunotherapy. This review summarizes the state-of-the-art in CCNP technology and provides insight to the path forward for clinical implementation.
Cytotoxic T‐lymphocyte associated protein‐4 (CTLA‐4) and the Programmed Death Receptor 1 (PD‐1) are immune checkpoint molecules that are well‐established targets of antibody immunotherapies for the ...management of malignant melanoma. The monoclonal antibodies, Ipilimumab, Pembrolizumab, and Nivolumab, designed to interfere with T cell inhibitory signals to activate immune responses against tumors, were originally approved as monotherapy. Treatment with a combination of immune checkpoint inhibitors may improve outcomes compared to monotherapy in certain patient groups and these clinical benefits may be derived from unique immune mechanisms of action. However, treatment with checkpoint inhibitor combinations also present significant clinical challenges and increased rates of immune‐related adverse events. In this review, we discuss the potential mechanisms attributed to single and combined checkpoint inhibitor immunotherapies and clinical experience with their use.
Combination checkpoint inhibitor therapy with the anti‐PD‐1 Nivolumab and anti‐CTLA‐4 Ipilimumab antibodies is approved in advanced melanoma. This may offer enhanced efficacy over single agent treatments but is associated with toxicity. Herein, we summarize evidence for the potential merits, immunological mechanisms, and clinical challenges of combination treatment compared with monotherapy.
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