Acceptability of oral liquid pharmaceutical products in older adults: palatability and swallowability issues.

BACKGROUND: In institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. As medicines acceptability is a key factor for compliance in the older population, this study investigated the acceptability of oral liquid pharmaceutical products in this targeted population. METHODS: An observational, multicenter, prospective study was conducted in eight geriatric hospitals and eight nursing homes in France. Observers reported several behaviours/events describing the many aspects of acceptability for various pharmaceutical products' uses in patients aged 65 and older. Acceptability scores of oral liquid pharmaceutical products were obtained using an acceptability reference framework (CAST - ClinSearch Acceptability Score Test®): a 3D-map summarizing the different users' behaviors, with two clusters defining the positively and negatively accepted profiles materialized by the green and red zones, respectively. RESULTS: Among 1288 patients included in the core study and supporting the acceptability reference framework, 340 assessments were related to the administration of an oral liquid pharmaceutical product. The mean age of these patients was 87 (Range [66-104y]; SD = 6.7), 68% were women and 16% had swallowing disorders. Globally, the oral liquid pharmaceutical products were classified as "positively accepted," the barycenter of the 340 assessments, along with the entire confidence ellipses surrounding it, were positioned on the green zone of the map. Sub-populations presenting a different acceptability profile have also been identified. For patients with swallowing disorders, the oral liquid pharmaceutical products were classified as "negatively accepted," the barycenter of the 53 assessments along with 87% of its confidence ellipses were associated with this profile. A gender difference was observed for unflavored oral liquids. In women, they were classified "negatively accepted," the barycenter of the 68 assessments with 75% of its confidence ellipses were located in the red zone, while they were classified "positively accepted" in men. CONCLUSION: This study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders. To ensure an optimal acceptability, prescribers should also consider the presence of a taste-masker in these oral liquids. As highlighted herein, palatability remains crucial in older populations, especially for women.

A Decision Support Tool Facilitating Medicine Design for Optimal Acceptability in The Older Population.

PURPOSE: Medicine acceptability, which is of the utmost importance for vulnerable patients' adherence, is driven by both user and product characteristics. Herein, a novel multivariate approach integrating the many aspects of acceptability is used to discriminate positively and negatively accepted medicines in the older population. METHODS: An observational study was carried out in eight hospitals and eight nursing homes to collect a large set of real-life data on medicines uses in older patients (≥65 years). Mapping and clustering explored these multiple observational measures and summarised the main information into an intelligible reference framework. Resampling statistics were used to validate the model's reliability. RESULTS: A three-dimensional map and two clusters defining acceptability profiles, as positive or negative, emerged from the 1079 evaluations. Factors of interest (medicines, user features…) were positioned on the map at the barycentre of their evaluations and assigned to an acceptability profile. Focusing on patients' ability to swallow, we have highlighted the tool's efficacy in demonstrating the impact of user features on medicine acceptability. CONCLUSIONS: This multivariate approach provides a relevant judgement criterion for this multi-dimensional concept. Facilitating the choice of the most appropriate dosage form to achieve optimal acceptability in a targeted population, this tool is of real potential to improve clinical decisions.

Dosage form suitability in vulnerable populations: A focus on paracetamol acceptability from infants to centenarians.

INTRODUCTION: Medicine acceptability is a multi-faceted concept driven by both product and user characteristics. Although a key factor for treatment effectiveness, especially in vulnerable populations, knowledge of those medicine features that best promote individual user acceptability remains fragmented. Focusing on paracetamol, this study has explored the appropriateness of pharmaceutical products in different dosage forms to achieve adequate patient acceptability from infants to centenarians. METHODS: This observational, multicentre, prospective study was carried out in 10 hospitals, 8 nursing homes and over 150 community dispensaries. Observers reported several behaviours/events evaluating acceptability for 1016 different pharmaceutical product uses in paediatrics (<18y.) and 1288 in the elderly (≥65y.). Using mapping and clustering, a multivariate approach offered an intelligible reference framework for each population, providing comprehensive scores: positively or negatively accepted. RESULTS: Among all the evaluations supporting the acceptability reference frameworks, there were 502 reports on paracetamol products intake. Herein we focused on the 5 products with ≥30 evaluations. Although oral suspension and powder for oral solution were positively-accepted in the paediatric group, the powder had a higher rate of negative patient reaction (p<0.001). Of those that received this formulation, 72% were ≤8y., and therefore suitable to receive the better accepted oral suspension. In the elderly, patients with swallowing disorders were preferentially treated with such powders (p<0.001), which were less often fully taken than orally disintegrating tablets (p<0.001). Even in those patients ≥90y., capsule formulations appeared to be the best accepted product in patients without swallowing alterations, and thus could be a suitable alternative to the powder in this population. CONCLUSIONS: By better integrating patient characteristics when choosing dosage forms, clinicians and caregivers may improve treatment acceptability and adherence. Moreover, hospitals and healthcare institutions could optimise purchasing to best suit their local population, disseminating information to help staff align specific dosage forms to targeted patients.

[Migration of somitic cells into the somatopleural mesoderm of the limb anlage]. / Etude de la migration des cellules somitiques dans le mésoderme somatopleural de l'ébauche de l'aile.

In chick embryos, observations were made on serial semithin transverse sections of the wing level. In addition homo- or heterotopic replacements of the wing or leg somitic mesoderm by labelled somitic or nonsomitic mesoderm were made in 2-to 2.5-day embryos. The nuclear label used was either natural (quail donor embryos in heterotopic transplantations) or isotopic (chick donors labelled with tritiated thymidine).Histological examination revealed that the first somitic cells to leave somite 15 apparently did so at the 20 to 22 somite stage, while the last ones to leave somite 20 apparently did so shortly before the 36 somite stage.Transplantation experiments with labelled donor cells revealed the routes of migratory somitic cells and the time-course of their invasion into the outgrowing limb bud (non-somitic graft cells did not noticeably invade the limb anlage). They showed furthermore that the somitic mesoderm is not regionalized with respect to its limb myogenic properties.These results are compared with those obtained in other classes of vertebrates.

On the role of the connective tissue in the patterning of the chick limb musculature.

By modifying the temporal relationship between connective tissue and myogenic cell invasion during early limb bud development new evidence of the organizing role of the connective tissue was obtained.Muscle cell-deprived wing buds were allowed to grow up to stages 22 to 27 of Hamburger and Hamilton, when they received a transplant of quail myogenic cells (somitic mesoderm or wing premuscular mass) into the dorsal face of their presumptive upper arm. Muscular arrangement in forearm and hand was analyzed 4 days later. In 8 out of 14 of those cases which had received a graft of premuscular mass before stage 25 of Hamburger and Hamilton, muscle development took place distally to the graft-site in accordance with the wing segment.

Attempt to produce a chick/mouse heteroclass musculature.

Heteroclass chick/mouse chimaeras were prepared by transplanting somitic presumptive myogenic cells or limb bud myoblasts from donor mouse embryos into chick hosts, to replace (1) previously extirpated brachial somitic mesoderm or (2) experimentally deleted limb premuscular masses. Since mouse and chick cells can be distinguished by differential staining affinities, this parameter was used to verify the viability of the implant and to assess its fate. Our analyses showed that transplanted mouse somitic myogenic stem cells or limb bud myoblasts did not participate in the host brachial musculature, whatever the experimental conditions.