Background Clinical practice guidelines or recommendations often require timely and regular updating as new evidence emerges, because this can alter the risk-benefit trade-off. The scientific process of developing and updating guidelines accompanied by adequate implementation can improve outcomes. To promote better management of patients receiving vancomycin therapy, we updated the guideline for the therapeutic drug monitoring (TDM) of vancomycin published in 2015. Methods Our updated recommendations complied with standards for developing trustworthy guidelines, including timeliness and rigor of the updating process, as well as the use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. We also followed the methodology handbook published by the National Institute for Health and Clinical Excellence and the Spanish National Health System. Results We partially updated the 2015 guideline. Apart from adults, the updated guideline also focuses on pediatric patients and neonates requiring intravenous vancomycin therapy. The guideline recommendations involve a broadened range of patients requiring TDM, modified index of TDM (both 24-hour area under the curve and trough concentration), addition regarding the necessity and timing of repeated TDM, and initial dose for specific subpopulations. Overall, 1 recommendation was deleted and 3 recommendations were modified. Eleven new recommendations were added, and no recommendation was made for 2 clinical questions. Conclusions We updated an evidence-based guideline regarding the TDM of vancomycin using a rigorous and multidisciplinary approach. The updated guideline provides more comprehensive recommendations to inform rational and optimized vancomycin use and is thus of greater applicability.

The aim of this study was to compare the skin permeation of liposomes, transfersomes and ethosomes of lamivudine under non-occlusive conditions. The liposome and transfersomes prepared by thin film hydration method and ethosomes were prepared by slight modification on hot method. The Liposomal formulation (LP1) ethosomal formulation (ET2) and transfersomal (TF2) formulation showed highest entrapment 49.76 ± 2.1%, 81.97 ± 1.5% and 83.81 ± 1.4%, optimal nanometric size range 515 ± 4.6 nm, 374 ± 8.9nm and 315 ± 8.5nm and smallest polydispersity index0.529±0.019,0.432± 0.011 and 0.422± 0.009 respectively. The results of skin fluorescence experiments showed that penetration depth and fluorescence intensity of calcein from ethosomes and transfersomes was much greater than that from liposomes. Stability studies indicated that there was no significant physical change in vesicular formulation for 45 days at different temperatures. The in vitro result indicates that liposome retrain on the surface of skin due to poor permeation power, transfersomes improve penetrates of lamivudine and made drug easiest to accumulate in the skin. Ethosomes enhances permeation the drug to the deeper layer of skin and enter into systemic circulation rather than skin deposition. Transferosomes and ethosomes are able to cross the stratumcorneum and permeate drug to deeper tissue compare to liposomes.

BackgroundThis study describes the patterns and socioeconomic influences of tobacco use among adults in tobacco-cultivating regions of rural southwest China.MethodsA cross-sectional survey was conducted in 8681 adults aged ≥18 years in rural areas of Yunnan Province, China from 2010 to 2011. A standardized questionnaire was administered to obtain data about participants’ demographic characteristics, individual socioeconomic status, ethnicity, self-reported smoking habits, and exposure to secondhand smoke (SHS). The socioeconomic predictors of current smoking, nicotine addiction, and SHS exposure were analyzed using multivariate logistic regression.ResultsThe prevalence rates of tobacco use were much higher in men compared with women (current smoking 68.5% vs. 1.3%; and nicotine dependence 85.2% vs. 72.7%). However, the rate of SHS exposure was higher in women compared with men (76.6% vs. 70.5%). Tobacco farmers had higher prevalence rates of current smoking, nicotine dependence, and SHS exposure compared with participants not engaged in tobacco farming (P<0.01). Most tobacco users (84.5%) reported initiating smoking during adolescence. A total of 81.1% of smokers smoked in public places, and 77.6% smoked in workplaces. Individuals belonging to an ethnic minority had a lower probability of SHS exposure and nicotine dependence. Individual educational level was found to be inversely associated with the prevalence of current smoking, exposure to SHS, and nicotine dependence. Higher annual household income was associated with a greater risk of nicotine dependence.ConclusionsThis study suggests that tobacco control efforts in rural southwest China must be tailored to address tobacco-cultivating status and socioeconomic factors.

No abstract