Report of the European Medicines Agency Conference on RNA-Based Medicines

RNA-based medicines have potential to treat a large variety of diseases, and research in the field is very dynamic. Proactively, The European Medicines Agency (EMA) organized a virtual conference on February 2, 2023 to promote the development of RNA-based medicines. The initiative addresses the goal of the EMA Regulatory Science Strategy to 2025 to "catalyse the integration of science and technology in medicines development." The conference focused on RNA technologies (excluding RNA vaccines) and involved different stakeholders, including representatives from academia, industry, regulatory authorities, and patient organizations. The conference comprised presentations and discussion sessions conducted by panels of subject matter experts. In this meeting report, we summarize the presentations and recap the main themes of the panel discussions.

Commentary on the EMA reflection paper on the pharmaceutical development of medicines for use in the older population

Older people are often affected by impaired organ and bodily functions resulting in multimorbidity and polypharmacy, turning them into the main user group of many medicines. Very often, medicines have not specifically been developed for older people, causing practical medication problems for them like limited availability of easy to swallow formulations, easy to open packaging and dosing instructions for enteral administration. In 2020, the European Medicines Agency (EMA) published a reflection paper 'Pharmaceutical development of medicines for use in the older population', which discusses how the emerging needs of an ageing European population can be addressed by medicines regulation. The paper intends to help industry to better consider the needs of older people during pharmaceutical/clinical medicines development by summarising data on the most relevant topics, providing early suggestions on how to move forward and prompting expert discussions and studies into knowledge gaps. Topics include patient acceptability, (dis)advantages of an administration route, formulation, dosage form, packaging, dosing device and user instruction. While the paper is directed at older people and the pharmaceutical industry, the reflections are also relevant to younger patients with similar disease-related needs and of value to other stakeholders parties, e.g., healthcare professionals, academics, patients and caregivers, as the paper makes clear what can be expected from industry and where collaborative work is needed. This commentary provides an overview of the different steps in the development of the reflection paper, discusses points considered most controversial and/or subject to (multidisciplinary) expert discussions and indicates their value for real world clinical practice.

Evaluating the impact of integrated development: are we asking the right questions? A systematic review

Background: Emerging global transformations - including a new Sustainable Development Agenda - are revealing increasingly interrelated goals and challenges, poised to be addressed by similarly integrated, multi-faceted solutions. Research to date has focused on determining the effectiveness of these approaches, yet a key question remains: are synergistic effects produced by integrating two or more sectors?  We systematically reviewed impact evaluations on integrated development interventions to assess whether synergistic, amplified impacts are being measured and evaluated.

Methods: The International Initiative for Impact Evaluation’s (3ie) Impact Evaluation Repository comprised our sampling frame (n = 4,339). Following PRISMA guidelines, we employed a three-stage screening and review process.

Results: We identified 601 journal articles that evaluated integrated interventions. Seventy percent used a randomized design to assess impact with regard to whether the intervention achieved its desired outcomes. Only 26 of these evaluations, however, used a full factorial design to statistically detect any synergistic effects produced by integrating sectors. Of those, seven showed synergistic effects.

Conclusions: To date, evaluations of integrated development approaches have demonstrated positive impacts in numerous contexts, but gaps remain with regard to documenting whether integrated programming produces synergistic, amplified outcomes. Research on these program models needs to extend beyond impact only, and more explicitly examine and measure the synergies and efficiencies associated with linking two or more sectors. Doing so will be critical for identifying effective integrated development strategies that will help achieve the multi-sector SDG agenda.

Evaluating integrated development: are we asking the right questions? A systematic review

Background: Emerging global transformations - including a new Sustainable Development Agenda - are revealing increasingly interrelated goals and challenges, poised to be addressed by similarly integrated, multi-faceted solutions. Research to date has focused on determining the effectiveness of these approaches, yet a key question remains: are synergistic effects produced by integrating two or more sectors?  We systematically reviewed impact evaluations on integrated development interventions to assess whether synergistic, amplified impacts are being measured and evaluated. Methods: The International Initiative for Impact Evaluation’s (3ie) Impact Evaluation Repository comprised our sampling frame (n = 4,339). Following PRISMA guidelines, we employed a three-stage screening and review process. Results: We identified 601 journal articles that evaluated integrated interventions. Seventy percent used a randomized design to assess impact with regard to whether the intervention achieved its desired outcomes. Only 26 of these evaluations, however, used a full factorial design, the only design capable of statistically detecting synergistic effects produced by integrating sectors. Of those, seven showed synergistic effects. Conclusions: To date, evaluations of integrated development approaches have demonstrated positive impacts in numerous contexts, but gaps remain with regard to documenting whether integrated programming produces synergistic, amplified outcomes. Research on these program models needs to extend beyond impact only, and more explicitly examine and measure the synergies and efficiencies associated with linking two or more sectors. Doing so will be critical for identifying effective integrated development strategies that will help achieve the multi-sector SDG agenda.

One size fits all? Gender as an issue in obesity

This study investigated differences in the psychopathology of severely obese men and women in primary care in the North East of Ireland in comparison to clinical and community norms. One hundred thirty-eight participants (31.2% male and 68.8% female) were measured on eating disorders, depression, anxiety, self-concept and quality of life using standard self-report instruments. On the Eating Disorder Inventory, male and female scores on body dissatisfaction and female scores on bulimia were elevated to a degree that they did not differ significantly from clinical norms (P < 0.05). Female scores on the personal and social domains of self-concept fell significantly below community norms, whereas male scores on the same domains matched community levels. Significantly, more women than men scored in the severe range for depression and anxiety. Most female scores on the Eating Disorder Examination Questionnaire corresponded to clinical levels. Male participants reported higher quality of life overall. The findings suggest that gender differences should be considered regarding interventions, and that gender-specific treatment approaches might improve treatment outcomes. Moreover, screening for depression and anxiety ought to be part of obesity care for women.

Management of supracondylar fractures of the femur with Zickel supracondylar nails

Twenty-one cases of supracondylar fracture of the femur treated at St Vincent's Hospital, Melbourne, during 1983-86, by intramedullary Zickel supracondylar nails were reviewed. The causes were high energy trauma in young patients (six), minor trauma in elderly patients (13), and metastatic malignant fracture (two). The functional results were considered excellent in 10, good in six and poor in five. There were two cases of superficial wound infection. All cases united after 3-6 months. The best functional results were in those patients below 60 years or with pathological fractures. It is concluded that internal fixation of supracondylar fractures of the femur with Zickel supracondylar nails is a successful technique and can be performed by open and closed methods. It is most useful in osteoporotic or pathological bone which is unsuitable for bone plating.

"What next?": an educational program for parents of newborns

A community agency, a volunteer group and a hospital staff collaborated to provide a hospital based education program for parents of newborns. The program rationale, design, development, and evaluation are presented. "What next?" represents a family life education program which seeks to alleviate the normal stresses of becoming a parent. In a supportive small group hospital setting, trained volunteers provide parents with information about post partum adjustments, child development, parenting and community resources. Experience indicates that this is a replicable program.

New fibreglass casting system in orthopaedic practice

The composition, manufacture and application of a new fibreglass casting system for use in orthopaedic practice are described. The performance of the first 51 fibreglass casts used in routine fracture work is reviewed. The advantages (the cast is waterprof, extremely light and strong) and the disadvantages (an ultraviolet light source is required to cure the cast and the fiberglass tape is rather expensive) are evaluated.

Complications of left heart anoaphy. A study of 1,000 consecutive cases

A study of 1,000 consecutive left heart cineangiocardiograms was made to determine the frequency of various complications. Ten per cent of angiographic procedures caused minor complications such as nausea, vomiting, transient arrhythmias, loss of pulse, or hives. Most of these complications were gone before the patient left the cardiac catheterization laboratory.

Major problems were associated with 3.1% of the angiograms performed. The majority involved either vessel thrombosis (1.2%) or cardiac complications such as arrhythmias, intramyocardial dye injection, or myocardial infarcts (1.4%). Femoral arterial thrombosis was especially frequent in patients with mitral valve disease and low cardiac index. The use of lidocaine-lubricated catheters, tape traction hemostasis, and Fogerty catheter clot removal virtually eliminated brachial arterial thromboses. This route is now used almost exclusively for left heart angiography at our institution.

Most cardiac complications resulted from open-end catheter angiography, especially through transseptal catheters. The frequency of major cardiac complications has decreased markedly since the regular use of closed-tip catheters via the brachial artery route was begun for left heart angiography.