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Brooks S, Harper A, Pack L, Wheatley T. 460 THE IMPACT OF THE BONE MDT: EXPLORING CHANGES IN BONE PROTECTION DECISIONS BETWEEN 2015 AND 2018. Age Ageing 2021. [DOI: 10.1093/ageing/afab116.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The Hip fracture Multidisciplinary metabolic bone Team (MDT) was developed in June 2016 as a collaboration between Orthogeriatricians and the Metabolic Bone Team. The objective was to improve the quality of bone protection treatment decisions. This audit aimed to assess the impact of the new MDT by reviewing treatment decisions prior to and post its introduction. Data collection and.
Methodology
Case notes were reviewed for admissions from September to October 2015 and from September to November 2018. For both time periods the inpatient list, discharge summary and blood tests were reviewed in order to collect data regarding demographics, type of surgery, co-morbidities, calcium and vitamin D levels, bone protection prior to admission and bone protection decisions at discharge.
Results
In 2015, 83% of patients were admitted with no form of bone protection. Around 6% of patients were admitted on a bisphosphonate and 36% were discharged on a bisphosphonate. Less than 2% of people received denosumab prior to their admission, with this number rising to 9.4% at discharge. In 2018, 77% of patients were admitted on no form of bone protection. 5.4% were admitted on a bisphosphonate rising to 16% on discharge. No patients were admitted on denosumab, but 27% were discharged having received it in hospital, or with a plan to receive it from their GP.
Conclusions
There was a fall in bisphosphonate use and a significant increase in the frequency of denosumab prescription after the introduction of the Bone MDT. This MDT facilitated better decision-making through access to the further specialist skills from the endocrinologist and specialist nurses. Individual case discussion enhanced the delivery of personalised medicine.
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Affiliation(s)
- S Brooks
- Princess Royal Hospital, Haywards Heath
| | - A Harper
- Princess Royal Hospital, Haywards Heath
| | - L Pack
- Princess Royal Hospital, Haywards Heath
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Jones J, Pack L, Hunter JH, Valliere-Douglass JF. Native size-exclusion chromatography-mass spectrometry: suitability for antibody-drug conjugate drug-to-antibody ratio quantitation across a range of chemotypes and drug-loading levels. MAbs 2021; 12:1682895. [PMID: 31769727 PMCID: PMC6927766 DOI: 10.1080/19420862.2019.1682895] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Native size-exclusion chromatography-mass spectrometry (nSEC-MS) is an analytical methodology that is appropriate for accurately quantitating the drug-to-antibody ratio (DAR) on a wide variety of interchain cysteine-linked antibody-drug conjugates (ADCs), irrespective of chemotype. In the current preclinical environment, novel ADCs conjugated with unique drug-linkers need to progress toward the clinic as quickly as possible. Platform analytical approaches can reduce time-to-clinic because key process development and optimization activities can be decoupled from the development of bespoke, molecule-specific analytical methods. In this work, we assessed the potential of nSEC-MS as a platformable, quantitative DAR method. The nSEC-MS method was evaluated according to performance characteristics and parameters described in the ICH guideline Validation of Analytical Procedures: Text and Methodology Q2(R1). In order to comprehensively assess the accuracy and bias of nSEC-MS DAR quantitation, ADCs were generated using three different drug-linker chemotypes with DARs ranging from 2 to 8. These molecules were tested by hydrophobic interaction chromatography (HIC) and nSEC-MS, and DARs obtained from both methods were compared to assess the degree to which nSEC-MS quantitation aligned with the HIC release assay. Our results indicated that there is no bias introduced by nSEC-MS quantitation of DAR and that SEC-MS data can be bridged to HIC data without the need for a correction factor or offset. nSEC-MS was also found to be suitable for unbiased DAR quantitation in the other ADC chemotypes that were evaluated. Based on the totality of our work, we conclude that, used as intended, nSEC-MS is well suited for quantitating DAR on a variety of interchain cysteine-linked ADCs in an accurate, unbiased manner.
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Affiliation(s)
- Jay Jones
- Analytical Sciences, Seattle Genetics Inc., Bothell, WA, USA
| | - Laura Pack
- Quality, Seattle Genetics Inc., Bothell, WA, USA
| | - Joshua H Hunter
- Conjugation Process Development, Seattle Genetics Inc., Bothell, WA, USA
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Ruesch MN, Benetti L, Berkay E, Cirelli DJ, Frantz N, Gastens MH, Kelley WP, Kretsinger J, Lewis M, Novick S, Rellahan B, Pack L, Stroop CJM, Subashi A, Yin P, Zeng M, Stults J. Strategies for Setting Patient-Centric Commercial Specifications for Biotherapeutic Products. J Pharm Sci 2020; 110:771-784. [PMID: 33035537 DOI: 10.1016/j.xphs.2020.09.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 12/28/2022]
Abstract
Commercial specifications for a new biotherapeutic product are a critical component of the product's overall control strategy that ensures safety and efficacy. This paper describes strategies for setting commercial specifications as proposed by a consortium of industry development scientists. The specifications for some attributes are guided by compendia and regulatory guidance. For other product quality attributes (PQAs), product knowledge and the understanding of attribute criticality built throughout product development should drive specification setting. The foundation of PQA knowledge is an understanding of potential patient impact through an assessment of potency, PK, immunogenicity and safety. In addition to PQA knowledge, the ability of the manufacturing process to consistently meet specifications, typically assessed through statistical analyses, is an important consideration in the specification-setting process. Setting acceptance criteria that are unnecessarily narrow can impact the ability to supply product or prohibit consideration of future convenient dosage forms. Patient-centric specifications enable appropriate control over higher risk PQAs to ensure product quality for the patient, and flexibility for lower risk PQAs for a sustainable supply chain. This paper captures common strategic approaches for setting specifications for standard biotherapeutic products such as monoclonal antibodies and includes considerations for ensuring specifications are patient centric.
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Affiliation(s)
- Margaret N Ruesch
- Worldwide Research, Development and Medical, Pfizer Inc., Andover, MA 01810, USA.
| | | | | | - David J Cirelli
- Worldwide Research, Development and Medical, Pfizer Inc., Andover, MA 01810, USA
| | - Neha Frantz
- Biogen, Research Triangle Park, NC 27709, USA
| | | | - Wayne P Kelley
- Pharma Research & Development, GlaxoSmithKline, King of Prussia, PA 19406, USA
| | - Juliana Kretsinger
- Bioproduct Analytical Development, Eli Lilly and Company, Indianapolis, IN 46285, USA
| | - Mike Lewis
- Janssen R&D, LLC, Malvern, PA 19355, USA
| | - Shawn Novick
- BioPhia Consulting, Inc., Lake Forest, IL 60045, USA
| | | | - Laura Pack
- Product Quality, Seagen, Bothell, WA 98021, USA
| | | | - Ann Subashi
- Global Product Development, Pfizer Inc., Groton, CT, USA
| | - Ping Yin
- Global Regulatory Affairs, Vertex Pharmaceuticals, Boston, MA 02210, USA
| | - Ming Zeng
- Parenteral Science & Technology, Bristol-Myers Squibb Company, New Brunswick, NJ 08903, USA
| | - John Stults
- Genentech, Inc., South San Francisco, CA 94080, USA.
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Feldsine PT, Falbo-Nelson MT, Brunelle SL, Forgey RL, Al-Hasani S, Ball C, Beatty S, Blanchfield B, Bowen B, Bremer N, Brookman D, Brookman S, Brushaber M, Bryant J, Bryant D, Bryant R, Chlebowski ET, Copeland F, Culak DA, Dalley E, Destro C, Finkenbiner D, Frissora R, Fung DYC, Garcia GR, Gray MR, Hagen CJ, Harshavardhan T, Hart-Thakur R, Inami G, Johnson S, Kandakai LV, Lessard D, Lin S, Liu V, Matiuck S, McAteer L, Miller L, Moon B, Nasri H, Pack L, Pilot K, Price C, Pruett P, Ramirez C, Richter D, Schmieg JA, Schultz G, Sloan EM, Sprague DM, Tebay D, Tomer J, Tuncan E, Warburton D, Watson M, West D. Assurance Enzyme Immunoassay for Detection of Enterohemorrhagic Escherichia coli 0157:H7 in Selected Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.3.530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Five foods types were analyzed by the Assurance EHEC (Escherichia coli 0157:H7) enzyme immunoassay (EIA) and by the Bacteriological Analytical Manual (BAM) culture method. Each sample of each food type at each inoculation level was simultaneously analyzed by both methods. A total of 21 laboratories representing state and federal government agencies and private industry in the United States and Canada participated. Samples were inoculated with E. coli 0157:H7, except for one lot of poultry that was naturally contaminated. A total of 1304 samples and controls were analyzed and confirmed, of which 473 were positive and 818 were negative by both methods. Thirteen samples were positive by BAM but negative by EIA. Because of the study design, it was not possible for the BAM method to produce false-negative or falsepositive results. The Assurance method for detection of E. coli OI57:H7 in selected foods has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
| | | | | | - Robin L Forgey
- BioControl Systems, Inc., 19805 N. Creek Parkway, Bothell, WA 98011
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Feldsine PT, Albo-Nelson MT, Brunelle SL, Forgey RL, Al-Hasani S, Ball C, Beatty S, Blanchfield B, Bowen B, Bremer N, Brookman D, Brookman S, Brushaber M, Bryant J, Bryant D, Bryant R, Chlebowski ET, Copeland F, Culak DA, Dalley E, Destro C, Finkenbiner D, Frissora R, Fung DYC, Garcia GR, Gray MR, Hagen CJ, Harshavardhan T, Hart-Thakur R, Inami G, Johnson S, Kandakai LV, Lessard D, Lin S, Liu V, Matiuck S, McAteer L, Miller L, Moon B, Nasri H, Pack L, Pilot K, Price C, Pruett P, Ramirez C, Richter D, Schmieg JA, Schultz G, Sloan EM, Sprague DM, Tebay D, Tomer J, Tuncan E, Warburton D, Watson M, West D. Visual Immunoprecipitate Assay (VIP) for Detection of Enterohemorrhagic Escherichia coli (EHEC) 0157:H7 in Selected Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.3.517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Five foods representative of a variety of food products were analyzed by the Visual Immunoprecipitate Assay (VIP) and the Bacteriological Analytical Manual (BAM) culture method for the presence of Escherichia coli 0157: H7. A total of 21 laboratories representing state and federal government agencies, as well as private industry, in the United States and Canada participated. Food types were inoculated with strains of E. coli 0157:H7, with the exception of one lot of poultry, which was naturally contaminated. During this study, a total of 1377 samples and controls were analyzed and confirmed, of which 508 were positive and 867 were negative by both methods. Two samples were positive by BAM and negative by VIP. Because of the study design, it was not possible for the BAM method to produce false-negative or false-positive results. The VIP assay for detection of EHEC in selected foods has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
| | | | | | - Robin L Forgey
- BioControl Systems, Inc., 19805 N. Creek Parkway, Bothell, WA 98011
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Koch E, Pack L, Zwicker LA, Lopez-Mendez C, Aburto EM. Osteosarcoma in the proximal humerus of a mare. EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- E. Koch
- Atlantic Veterinary College; Charlottetown Prince Edward Island Canada
| | - L. Pack
- Atlantic Veterinary College; Charlottetown Prince Edward Island Canada
| | - L. A. Zwicker
- Atlantic Veterinary College; Charlottetown Prince Edward Island Canada
| | - C. Lopez-Mendez
- Atlantic Veterinary College; Charlottetown Prince Edward Island Canada
| | - E. M. Aburto
- Atlantic Veterinary College; Charlottetown Prince Edward Island Canada
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Ahuja TS, Abbott KC, Pack L, Kuo YF. HIV-associated nephropathy and end-stage renal disease in children in the United States. Pediatr Nephrol 2004; 19:808-11. [PMID: 15141343 DOI: 10.1007/s00467-004-1482-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2003] [Revised: 03/01/2004] [Accepted: 03/03/2004] [Indexed: 10/26/2022]
Abstract
Single-center studies have reported that HIV-associated nephropathy (HIVAN) can occur in children and may have a clinical course and prognosis similar to that of adults. However, the prevalence and survival has not been reported for a national sample of children with HIVAN and end-stage renal disease (ESRD) on dialysis in the United States. We utilized the United States Renal Data System (USRDS) database to determine the prevalence, demographic information, and survival of children with HIVAN and ESRD in the United States. The Kaplan-Meier method was used to estimate survival of children with HIVAN and the log-rank test was used to compare their survival with children with focal segmental glomerulosclerosis (FSGS) and adults with HIVAN. Cox regression analysis was used to model adjusted hazard ratios (AHR) with HIVAN as a cause of ESRD and its impact on mortality during the study period, adjusted for potential confounders. Of the 7,732 patients identified with HIVAN, only 60 were younger than 21 years and were classified as children; 50% were males and the majority (88.3%) was black. The cumulative percentage survival of children with HIVAN at 12, 24, and 36 months was better than adults with HIVAN (76%, 62%, and 54% vs. 60%, 43%, and 34%). Survival of children with HIVAN who started dialysis after 1996 was significantly better than those who started dialysis in or before 1996 (log rank P value <0.043). However, the major factor associated with better survival on Cox proportional hazard analysis was female gender (male vs. female AHR 2.85, 95% confidence interval 1.04-6.73). We conclude that only a small number of children with HIVAN and ESRD have received dialysis in the United States. The prognosis of these children is better than that of adults with HIVAN and among children with HIVAN females have better survival than males.
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Affiliation(s)
- Tejinder S Ahuja
- Department of Medicine, Division of Nephrology, University of Texas Medical Branch, Galveston, Texas 77555, USA.
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Abstract
The medical records of eight dogs with histopathologically confirmed infiltrative thyroid carcinoma treated with external beam radiation were reviewed and a retrospective analysis of survival and local tumor control were performed. The dogs received a definitive radiotherapy protocol of 46.8-48 Gray. All dogs had a reduction in tumor size to a clinically undetectable level on follow up examinations. Kaplan-Meier analysis indicated a median survival time of 24.5 months. Pulmonary metastasis was detected in three dogs and one of these dogs had concurrent bone metastasis. One dog had bone metastasis alone. Two dogs were alive at the censor. This study suggests that fractionated, definitive radiation therapy using multiple, moderate doses of radiation is an effective treatment for local control of invasive thyroid carcinoma in dogs.
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Affiliation(s)
- L Pack
- University of Georgia, College of Veterinary Medicine, Department of Anatomy and Radiology, Athens 30602, USA
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Dalrymple-Hay MJ, Dawkins S, Pack L, Deakin CD, Sheppard S, Ohri SK, Haw MP, Livesey SA, Monro JL. Autotransfusion decreases blood usage following cardiac surgery -- a prospective randomized trial. Cardiovasc Surg 2001; 9:184-7. [PMID: 11250189 DOI: 10.1016/s0967-2109(00)00100-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION 10% of blood issued by the National Blood Service (220,000) is utilised in cardiac procedures. Transfusion reactions, infection risk and cost should stimulate us to decrease this transfusion rate. We tested the efficacy of autotransfusion of washed postoperative mediastinal fluid in a prospective randomized trial. PATIENTS AND METHODS 166 patients undergoing coronary artery bypass grafting (CABG), valve or CABG + valve procedures were randomized into three groups. The indication for transfusion was a postoperative haemoglobin (Hb) < 10 g/l or a packed cell volume (PCV) < 30. When applicable, group A patients received washed post-operative drainage fluid. Group B all received blood processed from the cardiopulmonary bypass (CPB) circuit following separation from CPB and if appropriate washed post-operative drainage fluid. Group C were controls. Groups were compared using analysis of variance. RESULTS There was no significant difference in age, sex, type of operation, CPB time and preoperative Hb and PCV between the groups. Blood requirements were as shown. [table - see text] Twelve patients in group A and 10 in group B did not require a homologous transfusion following processing of the mediastinal drainage fluid. CONCLUSION Autotransfusion of washed postoperative mediastinal fluid can decrease the amount of homologous blood transfused following cardiac surgery. There was no demonstrable benefit in processing blood from the CPB circuit as well as mediastinal drainage fluid.
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Dalrymple-Hay MJ, Pack L, Deakin CD, Shephard S, Ohri SK, Haw MP, Livesey SA, Monro JL. Autotransfusion of washed shed mediastinal fluid decreases the requirement for autologous blood transfusion following cardiac surgery: a prospective randomized trial. Eur J Cardiothorac Surg 1999; 15:830-4. [PMID: 10431866 DOI: 10.1016/s1010-7940(99)00112-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES The National Blood Service issues 2.2 million units of blood per year, 10% of these (220000) are utilized in cardiac procedures. Transfusion reactions, infection risk and cost should stimulate us to decrease this transfusion rate. We test the efficacy of autotransfusion following surgery in a prospective randomized trial. METHODS One hundred and twelve patients undergoing CABG, valve or CABG + valve procedures were randomized into two groups. Group A received washed postoperative drainage fluid and group C were controls. The indication for transfusion was a postoperative haemoglobin (Hb) < 10 g/l or a PCV < 30. There was no significant difference in preoperative and operative variables between the groups. RESULTS Twenty-eight patients in group A and 46 in group C required homologous transfusion (P = 0.0008). Group A patients required 298+/-49 ml of banked blood per patient, group C 508+/-49 ml (P = 0.003). There was no difference in total blood required (volume autotransfused + volume banked blood transfused) between the groups (group A 404+/-50 ml, group C 508+/-50 ml) or in mean total mediastinal fluid drainage (group A 652+/-51 ml, group C 686+/-50ml). The mean Hb concentration was significantly higher in group A on day 1 (11.2 g/dl+/-51 vs. 10.6 g/dl+/-13 (P = 0.002)). No morbidity was associated with autotransfusion. CONCLUSION Autotransfusion can decrease the amount of homologous blood transfused following cardiac surgery. This represents a benefit to the patient and a decrease in cost to the health service.
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Affiliation(s)
- M J Dalrymple-Hay
- Wessex Cardiothoracic Centre, Department of Cardiothoracic Surgery, Southampton General Hospital, UK.
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Gilroy BJ, Lofstedt J, Pack L, McBurney SR. Paranasal sinus cyst as a cause of stridor in a standardbred colt. Can Vet J 1999; 40:49-51. [PMID: 9919367 PMCID: PMC1539655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Sinus cysts are epithelium-lined, fluid-filled cavities that can occur in the paranasal sinuses of horses. Extensive damage to the permanent tooth buds was a significant feature in this case. The sequellae of these abnormalities, although not apparent at the time of presentation, remain an important consideration for prognosis.
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Affiliation(s)
- B J Gilroy
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown
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Pack L. Flint doctor tells why. Mich Hosp 1985; 21:16-20. [PMID: 10274269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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