Organisational barriers to thrombolysis treatment of acute ischaemic stroke

ABSTRACT

Background: Intravenous thrombolysis with fibrinolytic drugs such as alteplase is not implemented widely in any country although the treatment is both effective and cost-effective in selected patients within a 3-h window after acute ischaemic stroke. The purpose of the present study was to describe the organisational barriers to delivery of thrombolysis for acute ischaemic stroke with special regard to the Danish healthcare system.

Method: Systematic and unsystematic searches of medical, economic and grey literature on organisational barriers to thrombolysis treatment were performed in Cochrane, PubMed, EMBASE, Cinahl, Econlit, NHS EED, SvedMed+ and the Health Technology Assessment (HTA) database. The search periods were 1996-2006.

Findings: Three main types of literature on organisational barriers were found: medical literature including HTA reports on barriers related to the 3-h window, economic literature on barriers related to the lack of capacity to provide the treatment on a 24-h basis, and grey literature/policy papers on standards and demands to the hospitals and healthcare systems who implements the treatment.

Conclusion: Information on organisational barriers can be extracted from different types of literature (medical, economic and grey literature/policy papers), but organisational barriers are most often not the primary study objective in the relevant literature. This review showed a broad spectrum of possible organisational barriers to the delivery of thrombolysis treatment of acute ischaemic stroke.     

Perceived barriers to quitting smoking among alcohol dependent patients in treatment

Little is known about the perceived barriers to quitting smoking among alcohol abusers. In addition to the usual barriers perceived by smokers, alcohol dependent smokers may have a few barriers unique to their addictive lifestyle. The Barriers to Quitting Smoking in Substance Abuse Treatment (BQS-SAT) was administered to 96 alcohol dependent smokers in residential substance abuse treatment. The BQS-SAT is designed to assess perceived barriers to quitting smoking among alcohol abusers using eleven true-false items. One open-ended item was included to gather information about potential additional barriers. The majority of respondents reported withdrawal-related barriers such as expecting to feel irritable, anxious, restless, and about half expected intolerable urges to smoke if they were to quit smoking, as most smokers do. However, concerns about effects on sobriety and needing cigarettes to cope with feeling down were also endorsed by almost half of the patients. Total number of perceived barriers was significantly related to smoking history, expected effects from smoking, and smoking temptation but was not associated with severity of alcohol use or dependence on admission. Providing corrective feedback about these barriers could be useful when addressing smoking with patients who have alcohol abuse or dependence.     

Service provision and barriers to care for men who have sex with men engaging in chemsex and sexualised drug use in England

BackgroundChemsex and sexualised drug use (SDU) among men who have sex with men (MSM) has become a public health issue because of its associated sexual risks. Some MSM engaging in SDU require further help and support, but it is not clear if this need is being met. This research seeks to understand MSM and service provider (SP) perspectives of the current standard of service provision for MSM engaging in SDU.MethodSemi-structured interviews were conducted with 13 MSM and 16 SPs in England (January-December 2019). MSM who reported taking one of ten substances for sex in the past 12 months were recruited from a mailing list or a community organisation providing chemsex support. Potential SP participants were recruited via an email sent from their local healthcare NHS Trust. Data for MSM and SPs were analysed separately using thematic analysis.ResultsMSM participants had a median age of 34 years (range 23–66).The majority of SPs recruited were genitourinary medicine (GUM) consultants. We found that the main reason for engagement in SDU was because of the enhanced sexual experience. Most MSM recruited were satisfied with their sexual health service provision, but barriers to care were highlighted by both MSM and SPs. Four themes relating to barriers to care were identified: accessibility of sexual health services, funding of services, SP's attitudes towards MSM who engage in SDU, and services outside sexual healthcare.ConclusionSPs appeared to have adopted a harm reduction approach to MSM engaging in SDU, but for MSM wanting further help and assistance in relation to their SDU additional barriers to care existed. Training healthcare providers outside of sexual health services regarding chemsex and SDU may reduce some of these barriers, but funding for sexual health services needs to be improved to maintain and further develop services.     

动物体内屏障的结构

屏障的存在意义不仅是保护性结构,更重要的是能维持屏障所在组织器官内环境的恒定。本文介绍了动物体内12种屏障的结构及其主要功能。     

Prodrugs as therapeutics

Prodrugs are bioreversible derivatives of drug molecules used to overcome some barriers to the utility of the parent drug molecule. These barriers include, but are not limited to, solubility, permeability, stability, presystemic metabolism and targeting limitations. The patent literature shows a dramatic increase in numbers of prodrug patents (> 2000% increase in 2002 compared to 1993), with claims for cancer treatment comprising 37% of these. This increase is largely due to the rise from North American-based multinationals and some smaller drug delivery companies mirroring the overall trend. In 2001 and 2002, 14% of all new approved chemical drugs were prodrugs. It appears that prodrugs to overcome barriers to the delivery of problematic drug candidates are becoming an integral part of the drug discovery paradigm.     

Attitudes of police officers towards syringe access,occupational needle-sticks,and drug use: A qualitative study of one city police department in the United States

Removal of legal barriers to syringe access has been identified as an important part of a comprehensive approach to reducing HIV transmission among injecting drug users (IDUs). Legal barriers include both “law on the books” and “law on the streets,” i.e., the actual practices of law enforcement officers. Changes in syringe and drug control policy can be ineffective in reducing such barriers if police continue to treat syringe possession as a crime or evidence of criminal activity. Despite the integral role of police officers in health policy implementation, little is known of their knowledge of, attitudes toward, and enforcement response to harm-minimisation schemes. We conducted qualitative interviews with 14 police officers in an urban police department following decriminalisation of syringe purchase and possession. Significant findings include: respondents were generally misinformed about the law legalising syringe purchase and possession; accurate knowledge of the law did not significantly change self-reported law enforcement behaviour; while anxious about accidental needle sticks and acquiring communicable diseases from IDUs, police officers were not trained or equipped to deal with this occupational risk; respondents were frustrated by systemic failures and structural barriers that perpetuate the cycle of substance abuse and crime, but blamed users for poor life choices. These data suggest a need for more extensive study of police attitudes and behaviours towards drug use and drug users. They also suggest changes in police training and management aimed at addressing concerns and misconceptions of the personnel, and ensuring that the legal harm reduction programs are not compromised by negative police interactions with IDUs.     

Barriers to methamphetamine withdrawal treatment in Australia: Findings from a survey of AOD service providers

Introduction and Aims. Despite the high prevalence of methamphetamine use and dependence in Australia, withdrawal treatment access for methamphetamine accounts for only 9.3% of total withdrawal treatment presentations. Furthermore, treatment completion for methamphetamine users is one of the lowest of all drugs. There is not a clear understanding for the reasons why methamphetamine withdrawal treatment presentations and efficacy is so low. This study examined the current practices and barriers to methamphetamine withdrawal treatment in Australia. Design and Methods. Twenty‐four interviews were conducted with employees from alcohol and other drug services from around Australia. These services were questioned about a range of issues relating to methamphetamine withdrawal treatment including current treatment practices, perception of the effectiveness of current treatment and barriers to treatment. Results. The study found that current practices in the treatment of methamphetamine withdrawal are diverse and uncertain. Service providers identified a great number of barriers to the treatment of methamphetamine withdrawal that encompass personal, social, cultural and organisational barriers. Discussion and Conclusions. The results of this study suggest that alcohol and other drug service providers are not clear about the best way to respond to clients seeking methamphetamine withdrawal treatment. Furthermore, the study showed a general pessimism about withdrawal treatment for this group. Treatment services should consider improving withdrawal protocols, educating clinicians and reconsidering entry criteria to better respond to methamphetamine users who have made the important first step into withdrawal treatment.[Pennay AE, Lee NK. Barriers to methamphetamine withdrawal treatment in Australia: Findings from a survey of AOD service providers. Drug Alcohol Rev 2009]     

Barriers to accessing care in patients with chronic hepatitis C: the impact of depression

Aliment Pharmacol Ther 2010; 32: 1163–1173

Summary

Background Patients with hepatitis C viral (HCV) may perceive barriers to accessing speciality care for HCV, and these barriers may be related to depressive symptoms. Aim To evaluate the relationship between barriers to care, demographics, and depressive symptoms. Methods A cross‐sectional analysis of 126 patients referred for HCV at two speciality HCV clinics. Barriers to care, depressive symptoms and sociodemographics were measured using standardized instruments. A retrospective chart review was conducted to collect clinical outcome data. Results Depressive symptoms were reported in 26%. Common barriers included lack of personal financial resources; lack of HCV knowledge in the community; lack of professionals competent in HCV care; stigmatization of HCV; and long distances to clinics offering care. After we controlled for sociodemographics, depression accounted for an additional 7–18% of variability in all barriers (all p values <0.01). Lower depression, marital and employment status were associated with subsequent receipt of HCV treatment in 38% (45/120) of patients; perceived barriers were not. Conclusions Depression is independently associated with perceived barriers to care. Higher depressive scores, but not perceived barriers, were associated with nontreatment. Healthcare providers who diagnose HCV need to be cognizant of numerous perceived barriers to accessing HCV care, and the impact that depression may have on these perceptions and receipt of treatment.     

A qualitative assessment of perceived barriers to inter‐professional working between community pharmacists and general practitioners

Pharmacists are being challenged to move from a dispensing role to that of patient advocate, but barriers between general practitioners and community pharmacists may hinder the development of this role This qualitative study, using focus groups, sought to explore perceived barriers between GPs and community pharmacists Five GPs focus groups and six community pharmacist focus groups were convened; all discussions were audiotaped, transcribed and analysed by interpretative phenomenology The main themes from all the focus groups were the shopkeeper image of community pharmacy, access, awareness and hierarchy These themes, which acted as barriers in the GP‐pharmacist relationship, must be addressed in order to improve this key partnership in primary care     

Theoretical background for inward rectification

Theoretical background has been reviewed for inward rectification due to a potassium current termed IRK. The Eyring rate theory in which the thermodynamic rate coefficient for chemical reactants (channels and ions in this case) can be described in terms of energy barriers for potassium ions can mimic not only the polarity and degree of rectification but also the voltage-dependence of the barium-induced IRK block. The model predicts that the blocking site locates 30-70% depth from the outer margin of the IRK channel.     

Drug transporters in the central nervous system: brain barriers and brain parenchyma considerations.

Drug transport in the central nervous system is highly regulated not only by the blood-brain and the blood-cerebrospinal fluid barriers but also in brain parenchyma. The novel localization of drug transporters in brain parenchyma cells, such as microglia and astrocytes, suggest a reconsideration of the present conceptualization of brain barriers as it relates to drug transport. That is, the cellular membranes of parenchyma cells act as a second "barrier" to drug permeability and express transporters whose properties appear similar to those localized at the conventional brain barriers. This review will focus on the molecular characteristics, localization, and substrate specificities of several classes of well known membrane drug transporters (i.e., the organic cation, organic anion, nucleoside, P-glycoprotein, and multidrug resistance proteins) in the brain. Comparisons to similar transporters localized within the peripheral system and clinical implications of the functional expression of specific drug transport families will be discussed when appropriate. Nutrient and neurotransmitter transporters, whose characteristics have been reviewed extensively elsewhere, will not be considered in this review.     

Rate-limiting barriers to intestinal drug absorption: A review

The intestinal epithelium is composed of several structures that could serve as barriers to the transfer of drugs from the GI lumen to the systemic circulation. An aqueous stagnant layer that overlies the apical membrane and the subepithelial blood flow are potential barriers to the absorption of drugs that readily penetrate the absorbing cell of the epithelium. The apical, basal, and basement membranes are potential barriers to the absorption of less permeable drugs. The cytoplasm of the absorbing cell is a relatively thick barrier that must also be traversed. While the location and structure of these potential barriers are well known, those barriers that are operative and the kinds of molecules for which they are operative are not known. The structure and permeability properties of the potential barriers are considered, along with the roles of the paracellular pathway and countercurrent exchange in the villus circulation.     

Treatment barriers identified by substance abusers assessed at a centralized intake unit

The 59-item Barriers to Treatment Inventory (BTI) was administered to 312 substance abusers at a centralized intake unit following assessment but before treatment entry to assess their views on barriers to treatment. Factor analysis identified 25 items in 7 well-defined latent constructs: Absence of Problem, Negative Social Support, Fear of Treatment, Privacy Concerns, Time Conflict, Poor Treatment Availability, and Admission Difficulty. The factorial structure of the barriers is consistent with the findings of other studies that asked substance abusers about barriers to treatment and is conceptually compatible with Andersen's model of health care utilization. Factors were moderately to highly correlated, suggesting that they interact with one another. Selected characteristics were generally not predictive of barrier factors. Overall, results indicate that the BTI has good content validity and is a reliable instrument for assessing barriers to drug treatment. The potential utility of the BTI in assessment settings is discussed.     

Retrospective clinical analysis for drug rescue: for new indications or stratified patient groups

The increasing realization that many existing drugs do indeed provide opportunities for additional therapeutic indications suggests we should not only be alert for this potential among marketed drugs but also within the pool of developmental drugs, of which (owing to attrition) there are many more examples in existence. We present examples of drug repurposing by retrospective clinical trial analysis and suggest that this strategy presents a promising way of rescuing failed developmental candidates. We contend that the commercial barriers to successful drug rescue are less problematic than for drug repurposing. We indicate practical means for mining data from past clinical trials, either for new indications or for specific patient groups.     

Barriers to counseling patients with obesity: a study of Texas community pharmacists.

OBJECTIVE: To assess barriers to the counseling of obese patients and identify pharmacists' characteristics associated with these barriers. DESIGN: Cross-sectional mail survey. SETTING: Texas. PARTICIPANTS: 139 community pharmacists. INTERVENTION: Self-administered questionnaire. MAIN OUTCOME MEASURES: Respondents' perceived barriers to pharmacists' counseling of obese patients. RESULTS: The top three barriers to counseling included lack of time (76.8%), lack of patient demand or expectations (55.8%), and lack of reimbursement/compensation (49.3%). Pharmacists indicated that they rarely to sometimes counseled obese patients and were somewhat comfortable with counseling about obesity management. They perceived obesity management strategies to be somewhat effective in weight loss, but were neutral regarding their confidence in achieving positive outcomes with counseling. Pharmacists who were more experienced were more likely to indicate that obesity is controllable without medications. Those who considered obesity controllable without medications were significantly more likely to view the various obesity management strategies as less effective, compared with those who did not share this belief. Pharmacists who viewed lack of privacy as a barrier were significantly less confident in achieving positive outcomes as a result of counseling. Creating awareness among patients about pharmacists' ability to counsel was perceived as most important in overcoming barriers. CONCLUSION: Pharmacists identified several barriers to counseling of obese patients. Pharmacists' demographics and beliefs about obesity were significantly associated with their perceived barriers.     

把握中药现代化发展契机

在中国的药物研发版图中,从来都没有忽略对中药现代化的规划.如果说抗战时期甚至建国初期对中药的开发,是迫于国内缺医少药的无奈,那么国家在"十五"、"十一五"计划中对中药现代化的重视,则是出于中医药发展的战略考虑.传承了两千多年的中药,其相关产品仅占全球中草药市场年销售额160亿美元的3%～5%,而日本、韩国的中草药市场份额却占了90%之多,然而其中80%的原材料都是从中国进口的.拥有得天独厚的中药原材料资源,却在整个产业链条中居于下游地位.这组数字足可以激发中国的中药现代化热情.     

迎难而行的动物类中药注射剂

动物类中药,尤其是注射剂型的开发,存在异种蛋白去除要求高、有效成分提取和分离难度大、产品研发上市风险大等诸多难题。鉴于以上原因,动物类中药注射剂产业成为众多中药针剂生产企业望而却步的领域,目前专注动物类中药注射剂研发的企业并不多,成功研发上市并发挥积极作用的动物类中药注射剂产品更是风毛麟角。随着现代技术尤其是生物分子技术（蛋白质组学及多肽分予学等）的发展,动物类中药注射剂的研究面临着新的机遇和挑战。     

潜力巨大的动物类中药开发

尽管受到各种原因的限制，动物类中药总体发展速度缓慢，研究相对薄弱，但是动物类中药在中医药领域的重要价值是毋庸置疑的。     

陈可冀：辩证看待动物类中药发展

只要动物类中药制剂的开发能以国际所认可的标准及态度去进行,这些已经被沿用了几千年的传统药物将能有更广阔的开发应用前景。     

Barriers and facilitators to cannabis treatment

Introduction and Aims. Despite its continued widespread use, relatively few individuals with cannabis use disorders present to treatment services. There is a dearth of research examining the reasons for this observed underutilisation of treatment. The aim of this paper is to examine barriers and facilitators to entry into cannabis treatment. Design and Methods. Three surveys of regular cannabis users in treatment (n = 100), in the community (n = 100) and from a widespread Internet sample (n = 294). Results. Perceived barriers included: not being aware of treatment options; thinking treatment is unnecessary; not wanting to stop using cannabis; and wanting to avoid the stigma associated with accessing treatment. Perceived facilitators included: improving available information on treatment; keeping treatment specific to cannabis; offering additional services, such as telephone support; and simplifying treatment admission processes. Discussion and Conclusions. Participant's perceptions differed significantly depending on their age, gender and treatment status. Participants in treatment typically reported barriers intrinsic to the individual while participants from the community reported barriers relating to the treatment available. Reported facilitators were more homogenous and most commonly related to availability of information. [Gates P, Copeland J, Swift W, Martin G. Barriers and facilitators to cannabis treatment. Drug Alcohol Rev 2012;31:311–319]