How enzymatic hydrolysis of polysorbate 20 influences colloidal protein stability

Polysorbates (PS) are esters of ethoxylated sorbitol anhydrides of different composition and are widely used surfactants in biologics. PSs are applied to increase protein stability and concomitant shelf-life via shielding against e.g., interfacial stresses. Due to the presence of specific lipolytic host cell protein (HCP) contaminations in the drug substance, PSs can be degraded via enzymatic hydrolysis. Surfactant hydrolysis leads to the formation of degradants, such as free fatty acids that might form fatty acid particles. In addition, PS degradation may reduce surfactant functionality and thus reduce the protection of the active pharmaceutical ingredient (API). Although enzymatic degradation was observed and reported in the last years, less is known about the relationship between certain polysorbate degradation patterns and the increase of mechanical and interfacial stress towards the API. In this study, the impact of specifically hydrolyzed polysorbate 20 (PS20) towards the stabilization of two monoclonal antibodies (mAbs) during accelerated shaking stress conditions was investigated. The results show that a specific enzymatic degradation pattern of PS20 can influence the colloidal stability of biopharmaceutical formulations. Furthermore, the kinetics of the appearance of visual phenomena, opalescence, and particle formation depended on the polysorbate degradation fingerprint as induced via the presence of surrogate enzymes. The current case study shows the importance of focusing on specific polysorbate ester fractions to understand the overall colloidal protein stabilizing effect. The performed study gives first insight into the functional properties of PS and helps to evaluate the impact of PS degradation in the formulation development of biopharmaceuticals in general.

Healthcare professionals' attitudes to mandatory COVID-19 vaccination: Cross-sectional survey data from four European countries

Mandatory vaccinations are widely debated since they restrict individuals' autonomy in their health decisions. As healthcare professionals (HCPs) are a common target group of vaccine mandates, and also form a link between vaccination policies and the public, understanding their attitudes toward vaccine mandates is important. The present study investigated physicians' attitudes to COVID-19 vaccine mandates in four European countries: Finland, France, Germany, and Portugal. An electronic survey assessing attitudes to COVID-19 vaccine mandates and general vaccination attitudes (e.g. perceived vaccine safety, trust in health authorities, and openness to patients) was sent to physicians in the spring of 2022. A total of 2796 physicians responded. Across all countries, 78% of the physicians were in favor of COVID-19 vaccine mandates for HCPs, 49% favored COVID-19 vaccine mandates for the public, and 67% endorsed COVID-19 health passes. Notable differences were observed between countries, with attitudes to mandates found to be more positive in countries where the mandate, or similar mandates, were in effect. The associations between attitudes to mandates and general vaccination attitudes were mostly small to neglectable and differed between countries. Nevertheless, physicians with more positive mandate attitudes perceived vaccines as more beneficial (in Finland and France) and had greater trust in medical authorities (in France and Germany). The present study contributes to the body of research within social and behavioral sciences that support evidence-based vaccination policymaking.

Acceptance, Advocacy, and Perception of Health Care Providers on COVID-19 Vaccine: Comparing Early Stage of COVID-19 Vaccination with Latter Stage in the Eastern Region of Saudi Arabia

Vaccination of healthcare providers has recently gained focused attention of public health officials. As HCPs have direct contact with the population, and HCPs significantly influence the population, this study aimed to compare the acceptance rate, advocacy rate, and beliefs about the COVID-19 vaccine among HCPs in two time periods. In this repeated cross-sectional study, different HCPs were assessed in two periods ten months apart, i.e., November to December 2020 and September to October 2021, which were before and after COVID-19 vaccine approval by authorities. The study was conducted in Qatif Central Hospital, Eastern Region of Saudi Arabia. There were 609 respondents: 236 participants in the first period and 373 participants in the second period. Only 13 participants did not get the COVID-19 vaccine. There was around a 40% difference in the acceptance rate between the two study periods; the latter period was higher at 94.7%. Furthermore, 24.1% was the difference between the willingness to advocate the COVID-19 vaccine for others; the first period had a lower percentage (60.1%). Overall, results of the study showed that vaccine hesitancy, as well as the willingness to advocate for the vaccine, were improved between the pre-vaccine approval period and post-vaccine approval period, showing that the efforts made by the government improved COVID-19 acceptance and advocacy among HCPs. However, vaccine hesitancy is not a new issue, and for a better understanding of HCPs' beliefs, a qualitative study is needed.

Evaluation of Systemic Antifungal Prescribing Knowledge and Practice in the Critical Care Setting among ICU Physicians and Clinical Pharmacists: A Cross-Sectional Study

Management of invasive fungal infections (IFI) and subsequent treatment choices remain challenging for physicians in the ICU. Documented evidence shows increased practice of the inappropriate use of antifungal agents in the ICU. Continuous education of healthcare providers (HCPs) represents the cornerstone requirement for starting an antifungal stewardship program (AFS). This study aimed at evaluating knowledge gaps in systemic antifungal prescribing among physicians and clinical pharmacists in a critical care setting. A cross-sectional, multi-center, survey-based study was conducted in five tertiary hospitals located in Al-Ahsaa, Saudi Arabia between January and May 2021. A self-administered questionnaire was distributed among the targeted clinicians. A total of 63 clinicians were involved (65.5% ICU physicians and 34.5% clinical pharmacists). It was noted that a minority of the participating HCPs (3.2%) had overall good knowledge about antifungal prescribing, but the majority had either moderate (46%) or poor (50.8%) knowledge. The difference in overall knowledge scores between the ICU physicians and the clinical pharmacists (p = 0.925) was not significant. However, pharmacists showed better scores for the pharmacokinetics of antifungal therapy (p = 0.05). This study has revealed a significant gap in the knowledge and practice of clinicians as regards prescribing antifungal therapy in our area. Although the results cannot be generalized, the outcome of this study has exposed the need for a tailored training program essential for carrying out an AFS program.

Dataset concerning the mental health of healthcare professionals during COVID-19 pandemic in Bangladesh

The present dataset is concerned with an article entitled "Effect of COVID-19 pandemic on mental health among Bangladeshi healthcare professionals: A cross-sectional study" [1]. This data article consists of a dataset regarding the mental health of Bangladeshi healthcare professionals (HCPs) during the ongoing COVID-19 pandemic. We collected the data from July 15, 2020, to September 20, 2020, using Google survey tools (Google Forms). A total of 355 complete responses have been obtained from the Bangladeshi HCPs aged between 20-60 years (male: 204, female: 151). We obtained informed consent from all participants for this study. We assessed the sociodemographic profile and four psychometric measures of HCPs working in Bangladesh during the COVID-19 pandemic. A structured questionnaire was used to collect the demographic information. We used the UCLA loneliness scale-8 (UCLA-8), the patient health questionnaire-9 (PHQ-9), the 7-item generalized anxiety disorder scale (GAD-7), and the Pittsburgh sleep quality index (PSQI) were applied to measure loneliness, depression, generalized anxiety, and sleep disturbance, respectively. This dataset presents the descriptive analysis of psychometric variables of participants. Also, the dataset might be used as a platform for future research on psychometric evaluation using the above scales. We included participants regardless of the sociodemographic backgrounds of HCPs. Therefore, the policymakers, government, and non-government organizations can use this data to develop different programs for promoting the mental health of HCPs and the general population in Bangladesh.

Assessing the polysorbate degradation fingerprints and kinetics of lipases - how the activity of polysorbate degrading hydrolases is influenced by the assay and assay conditions

Two of the most widely used surfactants to stabilize biologicals against e.g. interfacial stresses are polysorbate 20 (PS20) and polysorbate 80 (PS80). In recent years, numerous cases of hydrolytic polysorbate (PS) degradation in liquid formulations of biopharmaceuticals have been observed. Concomitant with the degradation of PSs, formulated proteins become inherently instable and more susceptible to aggregation. Furthermore, poorly soluble fatty acids (FA) are released from the PSs, which might lead to FA precipitation and the formation of visible and subvisible particles. Therefore, possible particle inducing factors have to be monitored closely. The major root cause of hydrolytic PS degradation in biologicals is the presence of enzymatic active host cell proteins (HCP), like lipases and esterases, which are co-purified with the active pharmaceutical ingredient. Such contaminants can be detected via their hydrolytic activity, either using ester-based substrates or PS itself. However, each approach has its up- and downsides, which makes the comparison of the results from other publications difficult. It was therefore the aim of the present study to investigate the impact of lipase specificities on the assay readouts. This study evaluates three different surrogate (model) lipases with distinctively different degradation kinetics and substrate specificities using specific analytical methods. The analytical panel contains on one hand two lipase activity assays with ester-based substrates, either detecting the release of para-nitrophenol or 4-methylumbelliferone, and on the other hand two PS-based monitoring analyses (fluorescence micelle assay and reverse phase high performance liquid chromatography - charged aerosol detection), which detect hydrolytic "activity" directly in the target substrate. Thereby, strengths and weaknesses of each assay are discussed, and recommendations are made for the respective use cases. Our results show that the determined lipase activities vary not only from assay to assay, but also significantly for the lipase tested, thus showing a different degradation fingerprint in the RP-HPLC-CAD chromatogram. This demonstrates that a comprehensive monitoring approach is essential to assess potential HCP contaminations.

Impact of educational intervention on the best immunization practices among practicing health care professionals in a south Indian city

Background and Aims

Maintaining the quality and safety of immunization is as important as the efficacy of vaccines in vaccine-preventable diseases (VPD) programs. The aim of this study was to determine the problems associated with different stages of vaccine use and to assess the outcome of an educational intervention on safety and quality use of vaccines among health care providers.

Methods

A pilot prospective interventional study was conducted over a period of 2 years at 271 sites in Mysuru, India. The study population was health care professionals (HCPs) involved in immunization and a sample of parents (one per site). A validated questionnaire was used as a study tool. An educational intervention on best immunization practice was conducted for the enrolled HCPs and the impact of the educational intervention was assessed using the study tool after 3 weeks.

Results

The total number of the study population was 594 (323 HCPs and 271 parents). Of these, 41.49% were working at community health care facility and 33.13% were enrolled from primary care centers. There were statistically significant improvements in post interventional assessment of all stages of the immunization process including storage (p -0.001), transportation (p -0.001), administration (p 0.001), monitoring and reporting of adverse events following immunization (AEFIs) (p -0.001), knowledge of AEFIs (p 0.001), and HCP-parent communication (p 0.001). AEFI reporting improved by 30% in the post education phase.

Conclusion

Continuous education and motivation can result in positive behavioral changes on best immunization practices amongst HCPs involved in immunization, which may help to improve and maintain the safety and quality use of vaccines in immunization centers irrespective of the type of facility.

Occupational stress, burnout, and organizational readiness for change: A longitudinal study among HIV HCPs in China

Literature suggests that organizational readiness for change (ORC) could facilitate adaptation and implementation of new projects or practices in clinical settings. Limited data are available regarding the longitudinal associations between ORC and psychosocial conditions of HCPs. Using six waves of longitudinal data collected between 2013 and 2016 from 357 HIV HCPs in Guangxi, China, we identify sociodemographic and occupational characteristics that impact ORC and examine how occupational stress and burnout affect ORC adjusting for potential cofounders. A mixed effect model was used to assess the associations of ORC with psychosocial variables controlling for key background variables, and within-cluster and within-subject correlation over time. The ORC level was stable over time. Ethnical minority HCPs reported lower ORC compared with those of Han ethnicity. HCPs with administrative responsibility reported significantly lower ORC compared with the ones without administrative responsibility. HCPs with high school education attainment showed lower ORC compared to those with some college education. The ORC level was negatively associated with occupational stress and burnout controlling all the background variables. It is important to integrate reducing stress and alleviating burnout in the workplace into efforts to promote the acceptance and adaptation of new intervention.

Physical and Emotional Burden of Rheumatoid Arthritis: Data from RA Matters, a Web-Based Survey of Patients and Healthcare Professionals

INTRODUCTION

This survey assessed the impact of rheumatoid arthritis (RA) on the lives of patients based on the perceptions of both patients and healthcare professionals (HCPs).

METHODS

This is a cross-sectional survey of patients with RA. Data were collected from patients and HCPs who manage RA using a structured, closed-ended questionnaire in their local language. Respondents for the survey were recruited from survey panels of verified unique responses. The survey focused on the impact of disease on four domains: daily activities, relationships, work and aspirations.

RESULTS

Overall, 1231 adult patients with RA and 270 rheumatologists or other HCPs were surveyed between November 2016 and February 2017. Almost one in three patients believed that the impact of RA is not well understood by people without the disease. Fifty-eight percent [95% confidence interval (CI) 55-61%] of patients felt frustrated when they were unable to undertake or complete daily activities because of their disease. Fifty-seven percent (95% CI 54-60%) of patients wished to be able to accept their life with RA. Forty-three percent (95% CI 40-46%) of patients hoped that the physical impact of RA will be better understood in future. Forty percent (95% CI 37-43%) of patients were forced to take long-term leave/retirement or experienced slow career progression since being diagnosed with RA. Twenty-three percent (95% CI 21-25%) of patients had difficulties in taking care of personal grooming, whereas 8% (95% CI 6-10%) of patients reported that RA ruined their life. Similar responses were observed among HCPs.

CONCLUSION

Patients and HCPs feel that the physical and emotional impact of RA is not well understood by people without the disease. In RA treatment decisions, patients' personal goals and patient-reported outcomes should be taken into consideration along with clinical targets.

FUNDING

Eli Lilly and Company (Indianapolis, IN, USA).

Mindfulness-Based IARA Model® Proves Effective to Reduce Stress and Anxiety in Health Care Professionals. A Six-Month Follow-Up Study

Changes in the health care environment, together with specific work-related stressors and the consequences on workers’ health and performance, have led to the implementation of prevention strategies. Among the different approaches, those which are mindfulness-based have been institutionally recommended with an indication provided as to their effectiveness in the management of stress. The aim of the present study was to analyze the efficacy of the mindfulness-based IARA Model^® (an Italian acronym translatable into meeting, compliance, responsibility, autonomy) in order to ameliorate perceived stress, anxiety and enhance emotional regulation among health care professionals (HCPs; i.e., doctors, nurses, and healthcare assistants). Four hundred and ninety-seven HCPs, 215 (57.2%) of which were women, were randomly assigned to a mindfulness-based training or control group and agreed to complete questionnaires on emotion regulation difficulties (DERS), anxiety, and perceived stress. Results showed that HCPs who attended the IARA training, compared to the control group, had better emotional regulation, anxiety and stress indices after 6 months from the end of the intervention. Furthermore, the results confirmed the positive relationship between emotional regulation, perceived stress and anxiety. The present study contributes to literature by extending the effectiveness of IARA in improving emotional regulation and well-being in non-clinical samples. Moreover, the study provides support for the idea that some specific emotional regulation processes can be implicated in perceived stress and anxiety. From the application point of view, companies should invest more in stress management intervention, monitoring and training, in order to develop worker skills, emotional self-awareness, and relational resources.

The evolving role of social media in health-care delivery: measuring the perception of health-care professionals in Eastern Saudi Arabia

Purpose

The objective of this study is to evaluate the perception of health-care professionals in Saudi Arabia toward the usages of social media in health-care delivery.

Methods

In this cross-sectional study, an online-based questionnaire was distributed among the health-care professionals residing in the eastern region of Saudi Arabia. Their perception toward the uses of social media in health-care service delivery was evaluated by analyzing their attitude toward its benefits and risks involved.

Results

The sample size was 120 participants, and 80% of them agreed with the benefits of using social networks in health-care services and considered that the use of these technologies in the provision of health services improves their professional knowledge and is a suitable tool for patient education and public health awareness. However, some respondents (20%) believed that there are several risks associated with the use of social media, such as ethical or legal challenges, the risk to the patient's health status, or the breaching of the privacy and confidentiality of the patient.

Conclusion

The results of this research indicate that social media can be a useful tool by which physicians may promote their services and publish general health information. However, there are potential problems in the use of social networks that can have negative consequences for patients and HCPs. This implies that precautions must be taken to avoid ruptures of patient privacy and other risks that can result in legal action against health professionals damaging their image and professional status. The study also found that the participants are willing to use social media for professional purposes.

Knowledge and Practices Relating to Acute Pesticide Poisoning Among Health Care Providers in Selected Regions of Tanzania

BACKGROUND

Acute pesticide poisoning (APP) is commonly underdiagnosed in Tanzania. Studies in developing countries suggest that a lack of diagnostic skills among health care providers (HCPs) undermines surveillance for APP. This study aimed at characterizing experience and skills of Tanzanian HCPs regarding APP diagnosis and management.

METHODOLOGY

The population included HCPs responsible for managing APP in Kilimanjaro and Arusha regions (n = 91). The resulting sample included 66 respondents (response rate: 73%). The data were collected in 2005 using a standardized questionnaire.

RESULTS

Half of all respondents (50%) reported handling at least 1 APP case with 15% reporting handling more than 5 cases in the past. Reported experience of handling an APP case was marginally higher in respondents who reported ⩾4 years of work experience in the health sector compared with those with <4 years of work experience (odds ratio = 1.32; 95% confidence interval = 0.9-1.5). Most of the respondents had high knowledge of exposure routes, reporting awareness of oral (98.5%), inhalational (93.9%), and dermal (77%) routes. The study revealed low awareness of pesticide classification by chemical groups (29%) or World Health Organization hazard (0%) and weak knowledge on pesticide label instructions (55%). Organophosphates accounted for 35% of the pesticide products reported by respondents as being responsible for poisoning. Some treatment options were incorrectly reported as first aid options, and some reported first aid options were wrong or inappropriate.

CONCLUSIONS

The study revealed that HCPs in northern Tanzania lack adequate skills to diagnose and manage APP. For effective surveillance of APP, there is a need to include training on hazards, classification, diagnosis, and health effects in the training programmes for all HCPs in Tanzania.

Barriers faced by healthcare professionals when managing falls in older people in Kuala Lumpur, Malaysia: a qualitative study

OBJECTIVE

To explore the barriers faced by healthcare professionals (HCPs) in managing falls among older people (aged above 60 years) who have a high risk of falling.

RESEARCH DESIGN

The study used a qualitative methodology, comprising 10 in-depth interviews and two focus group discussions. A semistructured topic guide was used to facilitate the interviews, which were audio recorded, transcribed verbatim and checked for accuracy. Data were analysed thematically using WeftQDA software.

PARTICIPANTS

20 HCPs who managed falls in older people.

SETTING

This study was conducted at the Primary Care Clinic in the University Malaya Medical Centre (UMMC), Malaysia.

RESULTS

Four categories of barriers emerged-these were related to perceived barriers for older people, HCPs' barriers, lack of caregiver support and healthcare system barriers. HCPs perceived that older people normalised falls, felt stigmatised, were fatalistic, as well as in denial regarding falls-related advice. HCPs themselves trivialised falls and lacked the skills to manage falls. Rehabilitation was impeded by premature decisions to admit older people to nursing homes. Lastly, there was a lack of healthcare providers as well as a dearth of fall education and training on fall prevention for HCPs.

CONCLUSIONS

This study identified barriers that explain poor fall management in older people with a high risk of falls. The lack of structured fall prevention guidelines and insufficient training in fall management made HCPs unable to advise patients on how to prevent falls. The findings of this study warrant evidence-based structured fall prevention intervention targeted to patients as well as to HCPs.