PURPOSE: To explore the perceived and potential roles of pharmacists in the care of young people aged 10-24years with chronic illness, through the exemplar of juvenile arthritis, from the perspectives of UK community and hospital pharmacists, health service commissioners, rheumatology health professionals, and lay advocates. METHODS: A sequential mixed methods study design comprises the following: focus groups with community and hospital pharmacists; telephone interviews with pharmacy and rheumatology stakeholders and commissioners; and multidisciplinary group discussions to prioritize roles generated by the first two qualitative phases. RESULTS: The high priority roles for pharmacists, identified by pharmacists and rheumatology staff, were developing generic health care skills among young people; transferring information effectively across care interfaces; building trusting relationships with young people; helping young people to find credible online health information; and the need to develop specialist expertise. Participants identified associated challenges for pharmacists in supporting young people with chronic illness. These challenges included parents collecting prescription refills alone, thus reducing opportunities to engage, and pharmacist isolation from the wider health care team. CONCLUSIONS: This study has led to the identification of specific enhancements to pharmacy services for young people, which have received the endorsement of a wide range of stakeholders. These suggestions could inform the next steps in developing the contribution of community and hospital pharmacy to support young people with chronic illness in the optimal use of their medication
Medulloblastoma (MB) is a highly malignant brain tumor that occurs primarily in children. Although surgery, radiation and high-dose chemotherapy have led to increased survival, many MB patients still die from their disease, and patients who survive suffer severe long-term side effects as a consequence of treatment. Thus, more effective and less toxic therapies for MB are critically important. Development of such therapies depends in part on identification of genes that are necessary for growth and survival of tumor cells. Survivin is an inhibitor of apoptosis protein (IAP) that regulates cell cycle progression and resistance to apoptosis, is frequently expressed in human MB, and when expressed at high levels predicts poor clinical outcome. Therefore, we hypothesized that Survivin may play a critical role in growth and survival of MB cells and that targeting it may enhance MB therapy. Here we show that Survivin is overexpressed in tumors from patched (Ptch) mutant mice, a model of Sonic hedgehog (SHH)-driven MB. Genetic deletion of survivin in Ptch mutant tumor cells significantly inhibits proliferation and causes cell cycle arrest. Treatment with small molecule antagonists of Survivin impairs proliferation and survival of both murine and human MB cells. Finally, Survivin antagonists impede growth of MB cells in vivo. These studies highlight the importance of Survivin in SHH-driven MB, and suggest that it may represent a novel therapeutic target in patients with this disease.
Medication reconciliation is an important process in reducing medication errors in many countries. Canada, the USA, and UK have incorporated medication reconciliation as a priority area for national patient safety initiatives and goals. The UK national guidance excludes the pediatric population. The aim of this review was to explore the occurrence of medication discrepancies in the pediatric population. The primary objective was to identify studies reporting the rate and clinical significance of the discrepancies and the secondary objective was to ascertain whether any specific interventions have been used for medication reconciliation in pediatric settings. The following electronic bibliographic databases were used to identify studies: PubMed, OVID EMBASE (1980 to 2012 week 1), ISI Web of Science, ISI Biosis, Cumulative Index to Nursing and Allied Health Literature, and OVID International Pharmaceutical Abstracts (1970 to January 2012). Primary studies were identified that observed medication discrepancies in children under 18 years of age upon hospital admission, transfer and discharge, or had reported medication reconciliation interventions. Two independent reviewers screened titles and abstracts for relevant articles and extracted data using pre-defined data fields, including risk of bias assessment. Ten studies were identified with variances in reportage of stage and rate of discrepancies. Studies were heterogeneous in definitions, methods, and patient populations. Most studies related to admissions and reported consistently high rates of discrepancies ranging from 22 to 72.3 % of patients (sample size ranging from 23 to 272). Seven of the studies were low-quality observational studies and three studies were 'grey literature' non-peer reviewed conference abstracts. Studies involving small numbers of patients have shown that medication discrepancies occur at all transitions of care in children. Further research is required to investigate and demonstrate how implementing medication reconciliation can reduce discrepancies and potential patient harm.
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