An overview of pharmacist roles in palliative care: a worldwide comparison

Background. In order to fulfil the complex needs of terminally ill patients, palliative care demands an in­ter-professional collaborative network, including doctors, nurses, dieticians and social workers. Pharmacists in particular are essential members of this team, given the level of reliance on medications in this setting. The purpose of this review is to identify roles and services performed by palliative care pharmacists in dedicated palliative care settings worldwide and to map these findings against the Advanced Pharmacy Practice Framework. Material and methods. Quasi-systematic review. Search strategy: Google Scholar, Medline/PubMed, Scopus and Embase were searched utilizing selected MeSH terms. Results. A total of 24 sources of information were included in the review. This literature was collected from a range of countries, predominantly from the USA, UK and Australia with singular reports from Mexico, Japan, Qatar, Canada, Poland and Sweden. The literature identifies that pharmacist roles in palliative care are varied and quite extensive. Roles that were specifically tailored to the palliative setting included: aggressive symptom management (in particular pain control), deprescribing, advising on the use of complementary and alternative therapies, extemporaneous compounding of non-standard dosage forms and maintaining a timely supply of medications. Pharmacists in the UK, USA, Canada and Australia were found to perform an advanced level of practice (as their reported roles fulfilled the criteria of the majority of the domains in the APPF). However, pharmacists in other countries, in particular Mexico and Poland, did not present such an extensive scope of practice. Conclusion. The literature identifies that there are differences in the types of palliative pharmacist practice between countries, which may have varying levels of impact upon patient outcomes. As pharmacists can make significant contributions to palliative care, it is important to encourage the benchmarking of practice across different clinical settings and countries to promote a consistent and equitable practice

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Wielonarządowe powikłania odległe po radioterapii i chemioterapii chłoniaka Hodgkina

Forty-nine-year-old woman with a history of long-term complications after radiotherapy and chemotherapy including coronary artery disease and pulmonary fibrosis was admitted to our center. Further complications — pulmonary hypertension, heart failure, and multiple heart valves insufficiency — were diagnosed. Here we present images from diagnostic procedures that allowed us to visualize those disturbances.49-letnia kobieta z historią odległych powikłań po radioterapii i chemioterapii, włącznie z chorobą wieńcową i zwłóknieniem płuc, została przyjęta do naszego ośrodka. Kolejne powikłania – nadciśnienie płucne, niewydolność serca i niedomykalność wielu zastawek serca - zostały zdiagnozowane. Prezentujemy tutaj zdjęcia z procedur diagnostycznych, które pozwoliły na zwizualizowanie tych nieprawidłowości

Pregnancy outcomes in women after the Fontan procedure

Women with single ventricle physiology after the Fontan procedure, despite numerous possible complications, can reach adulthood and give birth. Pregnancy poses a hemodynamic burden for distorted physiology of Fontan circulation, but according to the literature, it is usually well tolerated unless the patient is a “failing” Fontan. Our study aimed to assess maternal and fetal outcomes in patients after the Fontan procedure followed up in two tertiary Polish medical centers. We retrospectively evaluated all pregnancies in women after the Fontan procedure who were followed up between 1995–2022. During the study period, 15 women after the Fontan procedure had 26 pregnancies. Among 26 pregnancies, eleven ended with miscarriages, and 15 pregnancies resulted in 16 live births. Fetal complications were observed in 9 (56.3%) live births, with prematurity being the most common complication (n = 7, 43.8%). We recorded 3 (18.8%) neonatal deaths. Obstetrical complications were present in 6 (40%) out of 15 completed pregnancies—two (13.3%) cases of abruptio placentae, two (13.3%) pregnancies with premature rupture of membranes, and two (13.3%) patients with antepartum hemorrhage. There was neither maternal death nor heart failure decompensation during pregnancy. In two (13.3%) women, atrial arrhythmia developed. One (6.7%) patient in the second trimester developed ventricular arrhythmia. None of the patients suffered from systemic thromboembolism during pregnancy. Pregnancy in women after the Fontan procedure is well tolerated. However, it is burdened by a high risk of miscarriage and multiple obstetrical complications. These women require specialized care provided by both experienced cardiologists and obstetricians