Experiences and Outcomes of Using e-Prescribing for Opioids: Rapid Scoping Review.

BACKGROUND: e-Prescribing is designed to assist in facilitating safe and appropriate prescriptions for patients. Currently, it is unknown to what extent e-prescribing for opioids influences experiences and outcomes. To address this gap, a rapid scoping review was conducted. OBJECTIVE: This rapid scoping review aims to (1) explore how e-prescribing has been used clinically; (2) examine the effects of e-prescribing on clinical outcomes, the patient or clinician experience, service delivery, and policy; and (3) identify current gaps in the present literature to inform future studies and recommendations. METHODS: A rapid scoping review was conducted following the guidance of the JBI 2020 scoping review methodology and the World Health Organization guide to rapid reviews. A comprehensive literature search was completed by an expert librarian from inception until November 16, 2022. Three databases were electronically searched: MEDLINE (Ovid), Embase (Ovid), and Scopus (Elsevier). The search criteria were as follows: (1) e-prescribing programs targeted to the use or misuse of opioids, including those that were complemented or accompanied by clinically focused initiatives, and (2) a primary research study of experimental, quasi-experimental, observational, qualitative, or mixed methods design. An additional criterion of an ambulatory component of e-prescribing (eg, e-prescribing occurred upon discharge from acute care) was added at the full-text stage. No language limitations or filters were applied. All articles were double screened by trained reviewers. Gray literature was manually searched by a single reviewer. Data were synthesized using a descriptive approach. RESULTS: Upon completing screening, 34 articles met the inclusion criteria: 32 (94%) peer-reviewed studies and 2 (6%) gray literature documents (1 thesis study and 1 report). All 33 studies had a quantitative component, with most highlighting e-prescribing from acute care settings to community settings (n=12, 36%). Only 1 (3%) of the 34 articles provided evidence on e-prescribing in a primary care setting. Minimal prescriber, pharmacist, and clinical population characteristics were reported. The main outcomes identified were related to opioid prescribing rates, alerts (eg, adverse drug events and drug-drug interactions), the quantity and duration of opioid prescriptions, the adoption of e-prescribing technology, attitudes toward e-prescribing, and potential challenges with the implementation of e-prescribing into clinical practice. e-Prescribing, including key features such as alerts and dose order sets, may reduce prescribing errors. CONCLUSIONS: This rapid scoping review highlights initial promising results with e-prescribing and opioid therapy management. It is important that future work explores the experience of prescribers, pharmacists, and patients using e-prescribing for opioid therapy management with an emphasis on prescribers in the community and primary care. Developing a common set of quality indicators for e-prescribing of opioids will help build a stronger evidence base. Understanding implementation considerations will be of importance as the technology is integrated into clinical practice and health systems.

Bottom-Up Then Top-Down Synthesis of Gold Nanostructures Using Mesoporous Silica-Coated Gold Nanorods.

Gold nanostructures were synthesized by etching away gold from heat-treated mesoporous silica-coated gold nanorods (AuNR@mSiO2), providing an example of top-down modification of nanostructures made using bottom-up methodology. Twelve different types of nanostructures were made using this bottom-up-then-top-down synthesis (BUTTONS), of which the etching of the same starting nanomaterial of AuNR@mSiO2 was found to be controlled by how AuNR@mSiO2 were heat treated, the etchant concentration, and etching time. When the heat treatment occurred in smooth moving solutions in round-bottomed flasks, red-shifted longitudinal surface plasmon resonance (LSPR) was observed, on the order of 10-30 min, indicating increased aspect ratios of the gold nanostructures inside the mesoporous silica shells. When the heat treatment occurred in turbulent solutions in scintillation vials, a blue shift of the LSPR was obtained within a few minutes or less, resulting from reduced aspect ratios of the rods in the shells. The influence of the shape of the glassware, which may impact the flow patterns of the solution, on the heat treatment was investigated. One possible explanation is that the flow patterns affect the location of opened pores in the mesoporous shells, with the smooth flow of solution mainly removing CTAB surfactants from the pores along the cylindrical body of mSiO2, therefore increasing the aspect ratios after etching, and the turbulent solutions removing more surfactants from the pores of the two ends or tips of the silica shells, hence decreasing the aspect ratios after etching. These new stable gold nanostructures in silica shells, bare and without surfactant protection, may possess unique chemical properties and capabilities. Catalysis using heat-treated nanomaterials was studied as an example of potential applications of these nanostructures.

Enhanced Single-Strand Breaks of a Nucleic Acid by Gold Nanoparticles under X-ray Irradiation.

The hydroxyl radical concentration-dependent yield of single-strand breaks (SSBs), obtained through correction of scavenging and hindrance effects caused by gold nanoparticles (AuNPs), for fluorophore- and quencher-labeled DNA on AuNPs was 10 times that of free DNA based on fluorescence measurements of X-ray-irradiated DNA on AuNPs. By comparing the fluorescence data that revealed the number of SSBs with the results of mass spectrometry measurements that detected the total damage to DNA, we found that SSBs dominated DNA damage for DNA on AuNPs whereas non-SSB damage dominated for free DNA. The yield of RNA SSBs under X-ray irradiation was similar to that of DNA in the presence of AuNPs, whereas free RNA was more resistive to radiation than DNA. These results indicated the enhanced SSBs were likely catalyzed through the conversion from nucleobase damage to SSBs by AuNPs. The outcome of this work impacts materials and environmental science, sensing, nanotechnology, biology, and medicine.

Fast Fluorescence Titration Quantification of Plasmid DNA with DNA Attractive Magnetic Nanoparticles.

Fluorescence titration using magnetic nanoparticles (FTMN) was performed as a rapid, inexpensive, and simple method for quantifying the amount of fluorophore-intercalated plasmid DNA on these DNA attractive nanoparticles. Binding of the propidium iodide (PI)-intercalated DNA (PI/DNA) to polyethylenimine (PEI)-coated monodisperse iron oxide magnetic nanoparticles (PEI-MNs) was confirmed with transmission electron microscopy after the two species were mixed in water for less than a minute. The amount of DNA on PEI-MNs in aqueous solution, however, could not be easily determined using direct fluorescence measurements due to strong scattering by aggregated MNs, especially at high nanoparticle concentrations. Instead, fluorescence measurements were taken immediately after the solution of PI/DNA and PEI-MN mixtures was treated with a magnet to pull the PEI-MNs out of the solution. The detected fluorescence signal of the remaining free PI/DNA in the solution decreased as the concentration of PEI-MNs in the pre-treated solutions increased, resulting in a titration curve, which was used to determine the amount of DNA on MNs, the dissociation constant, and binding energy after the concentration of PEI-MNs was calibrated with microwave-plasma atomic emission spectroscopy. Quantitative polymerase chain reaction was used to understand the binding of DNA to MNs and to measure the amount of free PI/DNA in solution, and the results were similar to those obtained with the FTMN method.

Surface modification induced cuprous oxide nanoparticle toxicity to duckweed at sub-toxic metal concentrations.

Nanoparticle capping agents are critical for controlling the growth, oxidation state, and final particle size during aqueous synthesis. However, despite the known phytotoxicity of cetyltrimethylammonium bromide (CTAB) to plants, it is used to synthesize metal oxide nanoparticles of uniform size and with mesoporous structure. Among the few studies that have investigated how CTAB influences nanoparticle toxicity, CTAB has never been identified as the primary cause of nanoparticle toxicity in environmental systems; rather nanoparticle surface charge or morphology was identified as the driver of toxicity in environmentally relevant systems. In the current study, CTAB release from CTAB surface modified Cu2O nanoparticles (SM-Cu2O NPs) inhibited duckweed (Landoltia punctata) growth, even when administered at subtoxic Cu concentrations. Organic ligands, such as humic acid (HA) and ethylenediaminetetraacetic acid (EDTA), lessened growth inhibition associated with exposure to SM-Cu2O NPs, likely through electrostatic and hydrophobic interactions with CTAB. Such results highlight the need for a more holistic approach to nanoparticle surface modification and improved communication between toxicologists and synthetic chemists to develop green alternatives for nanoparticle synthesis.

Identification of Individual Reaction Steps in Complex Radical Reactions Involving Gold Nanoparticles.

A triple-jump model is invoked to help identify individual reaction steps in complex chemical reactions involving radical reactants in the presence of gold nanoparticles. The model consists of three sequential reaction phases: production of radicals, stabilization of radicals, and conversion from radical intermediates to final products. Isolated reaction phases were studied with electron paramagnetic resonance spectroscopy. As examples of the model, we investigated the spin trapping reaction with BMPO and the hydroxylation of 3-CCA, and the results supported the model. For X-ray irradiation of gold nanoparticle aqueous solutions, hydroxyl radicals were found to be scavenged by nanoparticles in the first phase. The stabilization phase was largely unaffected by gold nanoparticles, whereas conversion of radical intermediates was catalyzed. Such a step-wise model is thus proven useful for determining the exact catalytic step in the presence of nanoparticle catalysts in complex reactions such as DNA strand breaks, polymerization and hydroxylation that are important to many fields including X-ray nanochemistry.

Sealable Spherical Mesoporous Silica Shell Nanoreactors as Fiducial Nanoscale Probes for X-rays.

Molecular reactions in aqueous solutions are often used as dosimetric probes. A major problem with this approach is that other species such as nanoparticles or radical scavenging chemicals can often interfere with these reactions. The results measured in the presence of nanomaterials and scavengers therefore cannot correctly indicate the true dose based on the calibrated results obtained in solutions free of the interfering species. Storing these molecular probes in nanoreactors can overcome this problem. Here we demonstrate for the first time that it is possible to place common probe molecules inside spherical mesoporous silica shells and seal the pores after impregnation for the purpose of using the so-formed nanoreactors as X-ray dose probes. The reactions are isolated from the external environment, while the sealed shells still allow X-rays to freely penetrate through the walls of the nanoreactors. These nanoreactor probes can therefore fiducially report the dose of X-rays, whether the nanoreactors are in solutions, in dry form, or in the presence of scavengers and catalysts in solution.

X-ray-Mediated Release of Molecules and Engineered Proteins from Nanostructure Surfaces.

Many applications call for initiation of chemical reactions with highly penetrating X-rays with nanometer precision and little damage to the surroundings, which is difficult to realize because of low interaction cross-sections between hard X-rays and organic matters. Here, we demonstrate that a combination of computational protein design of single conjugation site green fluorescent proteins and nanomaterial engineering of silica-covered gold nanoparticles can enhance the release efficiencies of proteins from the surface of nanoparticles. The nanoparticles, to which the proteins are attached through DNA linkers, provide increased X-ray absorption without scavenging radicals, and single conjugation sites allow efficient release of proteins.

Sub-monolayer silver loss from large gold nanospheres detected by surface plasmon resonance in the sigmoidal region.

Nanosilver becomes labile upon entering the human body or the environment. This lability creates silver species with antimicrobial properties that make nanosilver attractive as active components in many consumer products, wound dressings, and agricultural applications. Because lability depends strongly on morphology, it is imperative to use a material with constant lability throughout kinetic studies so that accurate lability data can be acquired with efficient detection. Here 2.5nm thick silver was coated onto 90-nm diameter gold nanosphere cores and this surface silver layer was gradually removed by either chemical or X-ray radiation etching. The most sensitive region of a sigmoidal surface plasmon resonance (SPR) response as a function of silver thickness was found for the first time between 0.9- and 1.6-nm thick silver, revealing a new nanosilver standard for lability studies. The SPR peak position detection sensitivity is 8nm (SPR peak shift)/nm (silver thickness change) within this steepest region of the plasmon response curve whereas outside, sensitivity drops to 1nm/nm. Since the centroid of SPR profiles can be discerned with 0.25nm precision, the 8-nm/nm sensitivity means it is possible to detect a 0.3-angstrom or sub-monolayer change in silver thickness. The SPR response simulated by discrete dipole approximation (DDA) was an identical sigmoidal function between 0 and 2nm of silver coating. These findings were supported by several other analytical measurements, which confirmed no silver recoating during these etching processes.

Chemical enhancement by nanomaterials under X-ray irradiation.

We report here a new phenomenon of dynamic enhancement of chemical reactions by nanomaterials under hard X-ray irradiation. The nanomaterials were gold and platinum nanoparticles, and the chemical reaction employed was the hydroxylation of coumarin carboxylic acid. The reaction yield was enhanced 2000 times over that predicted on the basis of the absorption of X-rays only by the nanoparticles, and the enhancement was found for the first time to depend on the X-ray dose rate. The maximum turnover frequency was measured at 1 × 10(-4) s(-1) Gy(-1). We call this process chemical enhancement, which is defined as the increased yield of a chemical reaction due to the chemical properties of the added materials. The chemical enhancement described here is believed to be ubiquitous and may significantly alter the outcome of chemical reactions under X-ray irradiation with the assistance of nanomaterials.