Clinical Therapeutics/Volume 37, Number 3, 2015
Editor-in-Chief’s Note When to Drool Is Cool Numerous times over the years dentists or dental hygienists have said, “Rinse and spit.” We awkwardly lean over and spit into a sink-like porcelain or stainless steel bowl. Such specialized sinks are actually called cuspidors. Cuspidor is the word in the Portuguese language for a person who spits.1 A cuspidor is also a receptacle for persons who use chewing tobacco. On this side of the Atlantic the name for these vessels somehow morphed from cuspidor to spittoon. Spit vessels or jars were used in China in the 16th century, which is approximately when cultivating tobacco for snuff began there.2 Smaller spittoons with tight caps, sometimes called pocket spittoons, were introduced in the 20th century to capture the saliva of patients with tuberculosis (TB). Today, snuff and chewing tobacco users often carry modern versions called mud jugs. These containers have internal funnels and weighted bottoms. Richard I. Shader, MD As second-year medical students, we were trained to collect and stain sputum from patients suspected of having TB. After we acid-fast stained for the TB bacillus in sputum, we examined these smear slides by microscopy. Now with the resurgence of TB, especially in immunocompromised patients, sputum microscopy is being used again. Sputum can be subjected to molecular cytologic analyses for the diagnosis of lung cancer. Bacteria contained in sputum can be cultured to amplify any bacteria present. In the 1980s my colleagues and I became interested in drug-induced dry mouth and in the potential of saliva use to estimate drug concentrations in plasma. We soon learned that amounts of drug in saliva were influenced by whether drugs were ionized at normal plasma pH. This limitation is well described by Mucklow and colleagues.3 We learned that the extent of protein binding could also affect saliva versus plasma concentrations. This point is also well documented.4 We learned that the use of cotton pledgets yielded inconsistent volumes of saliva. As a result of these factors we did not pursue further work with saliva. This past October I attended a conference on the uses of saliva in medicine and dentistry. Many highly informative talks were presented. New advances in collecting and measurement techniques particularly intrigued me. I approached the conference chair, Dr. Jill L. Maron, about publishing selected papers. She enthusiastically agreed, and some are being published this month as our themed issue.5–11 Dr. Maron is also our Topic Editor for Youth and Children. Richard I. Shader, MD Editor-in-Chief
REFERENCES 1. 2. 3. 4.
Spittoon. http://en.wikipedia.org/wiki/Spittoon. Accessed January 15, 2015. Spittoons through history. https://www.flasr.com/spittoon. Accessed January 15, 2015. Mucklow JC, Bending MR, Kahn GC, et al. Drug concentration in saliva. Clin Pharm Ther. 1978;24:563–570. Slevin ML, Johnston A, Woollard RC, et al. Relationship between protein binding and extravascular drug concentrations of a water-soluble drug, cytosine arabinoside. J R Soc Med. 1986;76:365–368. 5. Maron J. Bringing salivary diagnostics into the 21st century. Clin Ther. 2015;37:496–497.
March 2015
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Clinical Therapeutics 6. Shirtcliff EA. Salivary cortisol results obtainable within minutes of sample collection correspond with traditional immunoassays. Clin Ther. 2015;37:505–514. 7. Iyengar A. detecting infection in neonates: promises and challenges of a salivary approach. Clin Ther. 2015;37:523–539. 8. Peres JC. Novel techniques for augmenting saliva collection: bacon rules and lozenge drools. Clin Ther. 2015;37:515–522. 9. Wren ME. Not all biofluids are created equal - chewing over salivary diagnostics and the epigenome. Clin Ther. 2015;37:529–539. 10. Wong DT. Salivary extracellular non-coding RNA: emerging biomarkers for molecular diagnostics. Clin Ther. 2015;37:540–551. 11. Khanna P, Walt DR. Salivary diagnostics using a portable point-of-service platform: a review. Clin Ther. 2015;37:498–504.
http://dx.doi.org/10.1016/j.clinthera.2015.02.005
Pharmacoeconomics, Outcomes and Health Policy (POHP) Specialty Updates POHP Updates are published annually and are available as FREE ACCESS content on the journal’s website. The previous POHP Update, entitled “Patient-Centered Outcomes,” was published in Volume 36, Number 5 of Clinical Therapeutics. To view the previous POHP Update, see the articles below: 1. Coon, CD and Lau DT. Informing Drug Development and Clinical Practice Through Patient-Centered Outcomes Research. 2. Hasnain-Wynia, R and Beal, AC. Role of the Patient-Centered Outcomes Research Institute in Addressing Disparities and Engaging Patients in Clinical Research. 3. Peay, HL et al. A Community-Engaged Approach to Quantifying Caregiver Preferences for the Benefits and Risks of Emerging Therapies for Duchenne Muscular Dystrophy. 4. Clerson, P et al. EVAPIL-R Scale: Continuous Development and Validation of a Tool to Assess Patient-Reported Tolerability of Different Contraceptive Methods in Longitudinal Studies. 5. Cappelleri, JC. Overview of Classical Test Theory and Item Response Theory for the Quantitative Assessment of Items in Developing Patient-Reported Outcomes Measures. 6. Andrae, DA et al. Item-Level Assessment of the Irritable Bowel Syndrome Quality of Life Questionnaire in Patients With Diarrheal Irritable Bowel Syndrome. 7. Edelen, MO et al. Correspondence Between the RAND–Negative Impact of Asthma on Quality of Life Item Bank and the Marks Asthma Quality of Life Questionnaire. 8. Hays, RD et al. Evaluating the Psychometric Properties of the CAHPS Patient-Centered Medical Home Survey.
Oncology Specialty Updates Oncology Updates are available as FREE ACCESS content on the journal’s website. The previous Oncology Update, entitled “Targeted Therapies in Oncology,” was published in Volume 35, Number 9 of Clinical Therapeutics. To view the previous Oncology Update, see the articles below: 1. 2. 3. 4.
Klein, A. Targeted Therapies in Oncology Come of Age. Danilov, AV. Targeted Therapy in Chronic Lymphocytic Leukemia: Past, Present, and Future. Martell, RE et al. Discovery of Novel Drugs for Promising Targets. Goffin, JR and Zbuk, K. Epidermal Growth Factor Receptor: Pathway, Therapies, and Pipeline.
482
Volume 37 Number 3
Editor-in-Chief’s Note When to Drool Is Cool Numerous times over the years dentists or dental hygienists have said, “Rinse and spit.” We awkwardly lean over and spit into a sink-like porcelain or stainless steel bowl. Such specialized sinks are actually called cuspidors. Cuspidor is the word in the Portuguese language for a person who spits.1 A cuspidor is also a receptacle for persons who use chewing tobacco. On this side of the Atlantic the name for these vessels somehow morphed from cuspidor to spittoon. Spit vessels or jars were used in China in the 16th century, which is approximately when cultivating tobacco for snuff began there.2 Smaller spittoons with tight caps, sometimes called pocket spittoons, were introduced in the 20th century to capture the saliva of patients with tuberculosis (TB). Today, snuff and chewing tobacco users often carry modern versions called mud jugs. These containers have internal funnels and weighted bottoms. Richard I. Shader, MD As second-year medical students, we were trained to collect and stain sputum from patients suspected of having TB. After we acid-fast stained for the TB bacillus in sputum, we examined these smear slides by microscopy. Now with the resurgence of TB, especially in immunocompromised patients, sputum microscopy is being used again. Sputum can be subjected to molecular cytologic analyses for the diagnosis of lung cancer. Bacteria contained in sputum can be cultured to amplify any bacteria present. In the 1980s my colleagues and I became interested in drug-induced dry mouth and in the potential of saliva use to estimate drug concentrations in plasma. We soon learned that amounts of drug in saliva were influenced by whether drugs were ionized at normal plasma pH. This limitation is well described by Mucklow and colleagues.3 We learned that the extent of protein binding could also affect saliva versus plasma concentrations. This point is also well documented.4 We learned that the use of cotton pledgets yielded inconsistent volumes of saliva. As a result of these factors we did not pursue further work with saliva. This past October I attended a conference on the uses of saliva in medicine and dentistry. Many highly informative talks were presented. New advances in collecting and measurement techniques particularly intrigued me. I approached the conference chair, Dr. Jill L. Maron, about publishing selected papers. She enthusiastically agreed, and some are being published this month as our themed issue.5–11 Dr. Maron is also our Topic Editor for Youth and Children. Richard I. Shader, MD Editor-in-Chief
REFERENCES 1. 2. 3. 4.
Spittoon. http://en.wikipedia.org/wiki/Spittoon. Accessed January 15, 2015. Spittoons through history. https://www.flasr.com/spittoon. Accessed January 15, 2015. Mucklow JC, Bending MR, Kahn GC, et al. Drug concentration in saliva. Clin Pharm Ther. 1978;24:563–570. Slevin ML, Johnston A, Woollard RC, et al. Relationship between protein binding and extravascular drug concentrations of a water-soluble drug, cytosine arabinoside. J R Soc Med. 1986;76:365–368. 5. Maron J. Bringing salivary diagnostics into the 21st century. Clin Ther. 2015;37:496–497.
March 2015
481
Clinical Therapeutics 6. Shirtcliff EA. Salivary cortisol results obtainable within minutes of sample collection correspond with traditional immunoassays. Clin Ther. 2015;37:505–514. 7. Iyengar A. detecting infection in neonates: promises and challenges of a salivary approach. Clin Ther. 2015;37:523–539. 8. Peres JC. Novel techniques for augmenting saliva collection: bacon rules and lozenge drools. Clin Ther. 2015;37:515–522. 9. Wren ME. Not all biofluids are created equal - chewing over salivary diagnostics and the epigenome. Clin Ther. 2015;37:529–539. 10. Wong DT. Salivary extracellular non-coding RNA: emerging biomarkers for molecular diagnostics. Clin Ther. 2015;37:540–551. 11. Khanna P, Walt DR. Salivary diagnostics using a portable point-of-service platform: a review. Clin Ther. 2015;37:498–504.
http://dx.doi.org/10.1016/j.clinthera.2015.02.005
Pharmacoeconomics, Outcomes and Health Policy (POHP) Specialty Updates POHP Updates are published annually and are available as FREE ACCESS content on the journal’s website. The previous POHP Update, entitled “Patient-Centered Outcomes,” was published in Volume 36, Number 5 of Clinical Therapeutics. To view the previous POHP Update, see the articles below: 1. Coon, CD and Lau DT. Informing Drug Development and Clinical Practice Through Patient-Centered Outcomes Research. 2. Hasnain-Wynia, R and Beal, AC. Role of the Patient-Centered Outcomes Research Institute in Addressing Disparities and Engaging Patients in Clinical Research. 3. Peay, HL et al. A Community-Engaged Approach to Quantifying Caregiver Preferences for the Benefits and Risks of Emerging Therapies for Duchenne Muscular Dystrophy. 4. Clerson, P et al. EVAPIL-R Scale: Continuous Development and Validation of a Tool to Assess Patient-Reported Tolerability of Different Contraceptive Methods in Longitudinal Studies. 5. Cappelleri, JC. Overview of Classical Test Theory and Item Response Theory for the Quantitative Assessment of Items in Developing Patient-Reported Outcomes Measures. 6. Andrae, DA et al. Item-Level Assessment of the Irritable Bowel Syndrome Quality of Life Questionnaire in Patients With Diarrheal Irritable Bowel Syndrome. 7. Edelen, MO et al. Correspondence Between the RAND–Negative Impact of Asthma on Quality of Life Item Bank and the Marks Asthma Quality of Life Questionnaire. 8. Hays, RD et al. Evaluating the Psychometric Properties of the CAHPS Patient-Centered Medical Home Survey.
Oncology Specialty Updates Oncology Updates are available as FREE ACCESS content on the journal’s website. The previous Oncology Update, entitled “Targeted Therapies in Oncology,” was published in Volume 35, Number 9 of Clinical Therapeutics. To view the previous Oncology Update, see the articles below: 1. 2. 3. 4.
Klein, A. Targeted Therapies in Oncology Come of Age. Danilov, AV. Targeted Therapy in Chronic Lymphocytic Leukemia: Past, Present, and Future. Martell, RE et al. Discovery of Novel Drugs for Promising Targets. Goffin, JR and Zbuk, K. Epidermal Growth Factor Receptor: Pathway, Therapies, and Pipeline.
482
Volume 37 Number 3
