Interactions among the larvae of Aedes aegypti (L.), Ae. albopictus (Skuse), and Ae. triseriatus (Say) were studied in trispecific and bispecific mixed populations under laboratory and field conditions. Competitive stress (as evidenced by the average time to first, 50, and 75% pupation and the total pupation periods for mixed populations of each species in comparison with their single species controls) was more pronounced in mixed cultures reared in glass jars in the laboratory than in tires under field conditions. In the laboratory, the larval development of Ae. aegypti reared together with Ae. albopictus or Ae. triseriatus, or both, larvae was accelerated significantly. Conversely, the time to pupation for Ae. albopictus and Ae. triseriatus was delayed when reared with Ae. aegypti. However, the average wing length of female Ae. albopictus and Ae. triseriatus was greater in the mixed cultures than in single species cultures. These data indicated that the effect of intraspecific competition was greater than interspecific competition. Adequate food and higher temperature appeared to promote rapid development and higher survival of the immature stages of the three Aedes species in tires placed in the field. In general, Ae. triseriatus larvae required a longer period for larval development and had greater larval mortality than either Ae. aegypti or Ae. albopictus. In mixed populations of Ae, albopictus and Ae. aegypti in the jars and food-rich tires, the periods needed to attain first, 50, and 75% cumulative pupation were not significantly different than in single species controls. We conclude that no clear-cut displacement occurred in mixed experimental populations of Ae. aegypti and Ae. albopictus.

Frequency of the labral brush movements of first, second, and fourth instars of Aedes aegypti (L.) and Aedes albopictus (Skuse) was studied comparatively in the laboratory. A frequency of 197 strokes per min for the first and second instars was observed in the former species compared to 118 strokes per min in the latter species. A faster ingestion rate of algal cells also was observed in first and second instars of Ae. aegypti (mean 57.5 cells per s) compared with first and second instars of Ae. albopictus (mean 22.4 cells per s). The digestive enzymes chymotrypsin (EC 3.4.21.1) and trypsin (EC 3.4.21.4) were more active in the peritrophic membrane (including food contents) than in the midgut epithelium of both species. Chymotrypsin activity in 11-d-old third and fourth instars of Ae. albopictus was 28 times higher than in the corresponding stadia of Ae. aegypti, indicating that the former species may have a superior enzymatic process for digesting food proteins.

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Without question, health care delivery, and clinical pharmacy’s purpose in it, is changing rapidly all over the world. Pharmacy’s place in the new health care environment is ensured only to the extent that the purpose of pharmaceutical care is understood and transmitted to the global structures of these developing organizational patterns and paradigm shifts. While the current trend toward commodification of illness and treatment seems to be driving efforts to consolidate the economic factors of pharmaceutical distribution, a new type of practice—patient-driven health care—has continued to shape the interactions of pharmacists and patients all over the world. A thorough understanding of the above factors involved in pharmacy’s history, present, and future are necessary for clinical practice preparation, as well as for value justification. How clinical pharmacy will succeed in this kind of social and economic milieu is precisely why this series of lectures and roundtables will help us embrace many of the vexing issues that clinical pharmacy administrators and practitioners face in daily practice.

Objectives Prescribing drugs outside regulatory recommendation is known as off‐label use. Studies have reported widespread off‐label drug use in oncology practice. But the clinical, economic and humanistic outcomes for such practice are often uncertain. Hence, it is important to gather oncology practitioners’ perspective for the creation of clinical practice framework and policies. The aim of the study was to evaluate perception of oncology practitioners on off‐label use in cancer therapy. Methods This study employed a cross‐sectional design implemented in the form of the self‐administered questionnaire at National Cancer Centre Singapore where more than 50% cancer patients of the country are treated. Key findings Eighty‐one practitioners involving nurses (38%), medical oncologist (37%) and pharmacists (25%) were surveyed. The majority of practitioners (57%) agreed off‐label use as indispensable practice in cancer therapy. Main reasons cited include advanced cancers where standard lines of treatment are exhausted (58%), lack of alternative approved drug (43%) and rare tumours (47%). Compared with other practitioners, medical oncologists viewed Phase 2 (73% versus 31%, P = 0.001) and conference abstracts (56% versus 23%, P = 0.003) as reasonable evidence for off‐label use. Major concerns included lack of efficacy (58%), patient understanding (47%), uncertain safety (43%) and out‐of‐pocket cost (41%) associated with off‐label use. Most viewed need for obtaining informed consent (86%) and institutional guidance (75%) as important elements in practice framework. Conclusion The study provides insights about off‐label drug use practice and establishes the need for robust clinical guidance and educational strategies for oncology practitioners.

Background The COVID-19 pandemic has increased usage of medication delivery service (MDS) significantly. MDS improves adherence to medication and clinical outcomes. Objectives To study behavioral change factors that affect adoption of MDS, determine existing patient satisfaction level, and make recommendations to improve MDS adoption. Methods A single-institution, cross-sectional survey was conducted at the outpatient pharmacy of the largest ambulatory cancer centre in Singapore. The survey consisted of sections on demographics, Theory of Planned Behavior constructs and patient satisfaction questions. Descriptive analysis and logistic regression were used. Results A total of 881 patients responded. Respondents were mostly Chinese, female and subsidized patients, with a mean age of 62.4 years old. MDS use is strongly predicted by favourable attitude (OR 3.54, 95%CI 2.64–4.75; p < 0.001) and subjective norm (OR 3.07, 95%CI 2.30–4.09; p < 0.001) towards its use and greater perceived behavioral control (OR 2.48; 95%CI 1.86–3.30; p < 0.001). Being ill or frail has been identified as facilitators, while absence of face-to-face consultation and cost of delivery were barriers to the adoption of MDS. Encouragingly, the satisfaction level of our existing patients was generally high (80.2, SD16.7). Recommendation to improve MDS adoption targets facilitators and barriers identified and aims to further elevate patient satisfaction level. Establishment of a centralised pharmacy for MDS together with a call centre would be essential in the long run. Conclusions MDS is becoming increasingly important, in line with our national strategy. Implementation of suggested short-term and long-term measures will encourage its use.

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34 Background: Accessible Cancer Care to Enable Support for Cancer Survivors (ACCESS) is a multidisciplinary survivorship care model launched at the National Cancer Centre Singapore, the largest ambulatory cancer centre serving 70% of adult cancer patients in the public sector. ACCESS employs routine distress screening to triage patients with varying care needs and complexities. This study aims to examine the feasibility, delivery, and acceptance of ACCESS in providing appropriate service referrals to cancer patients in clinical settings. Methods: As part of an ongoing evaluation, we evaluated ACCESS for a 6-month implementation period between September 2019 and February 2020. Feasibility was assessed by proportions of (1) eligible breast and gynecological cancer patients who completed the locally adapted Distress Thermometer (DT) screening tool, (2) highly distressed patients, and (3) highly distressed patients requiring multidisciplinary meetings (MDM). Delivery was characterized by the mode and number of supportive care team (SCT) reviews required. Acceptance rates of SCT reviews by distressed patients and the uptake rate of service referrals recommended by the SCT were tabulated. Results: ACCESS screened 1074/1471 (73.0%) of all eligible patients within the 6-month period and identified 239/1074 (22.3%) as highly distressed for follow-up with the SCT. Eventually, 84.5% agreed to SCT review, with approximately one-fourth (26.7%) requiring MDM reviews. The majority (62.4%) of all distressed patients were identified at their first DT completion, whereas 19.8% and 7.4% were identified at their second and third completions respectively. The most common modes of follow-up were phone reviews (49.9%) and face-to-face in clinic waiting areas (48.6%). The SCT recommended 80 referrals to distressed patients for the following services: psychosocial (27.2%), cancer rehabilitation (5.9%), and home hospice (5.0%). The acceptance rates of the referrals for psychosocial, rehabilitation, and hospice services were 43.6%, 75.0%, and 80.0% respectively. Conclusions: ACCESS is a feasible model for triaging Asian cancer patients based on distress levels, and identifying complex patients requiring care personalization through MDM. The poorer acceptance rate of psychosocial services highlights patients’ preference for interventions targeting physical than psychosocial issues. Future studies should explore whether the uptake of psychosocial services is higher in the post-COVID era.