Ring-fencing a budget for cancer drugs: is it fair?

Ring-fencing is defined as protecting funds for use in a specific area. In the NationalHealth Service in the UK, various methods to ring-fence cancer have beenemployed over the years; more recently the Cancer Drugs Fund in England hasenabled cancer drugs that would not normally be considered cost-effective to beprovided to patients. This has created variation in provision between England andthe devolved countries. While some would argue that ring-fencing allows majoradvances to be made in the treatment of a particular condition, others wouldargue that it is intrinsically unfair. In this debate, Graham and Cassidy have writtenan article arguing the affirmative position and Hughes and Duerden were invitedto respond directly to their arguments. As with all the RCPE's 'Currentcontroversies', the authors have been asked to take a deliberately polarisedposition and so the views they express may be somewhat overstated

The centre of the brain: Topographical model of motor, cognitive, affective, and somatosensory functions of the basal ganglia

The basal ganglia have traditionally been viewed as motor processing nuclei; however, functional neuroimaging evidence has implicated these structures in more complex cognitive and affective processes that are fundamental for a range of human activities. Using quantitative meta-analysis methods we assessed the functional subdivisions of basal ganglia nuclei in relation to motor (body and eye movements), cognitive (working-memory and executive), affective (emotion and reward) and somatosensory functions in healthy participants. We document affective processes in the anterior parts of the caudate head with the most overlap within the left hemisphere. Cognitive processes showed the most widespread response, whereas motor processes occupied more central structures. On the basis of these demonstrated functional roles of the basal ganglia, we provide a new comprehensive topographical model of these nuclei and insight into how they are linked to a wide range of behaviors.© 2012 Wiley Periodicals, Inc

School\u27s out: Parenting stress and screen time use in school-age children during the COVID-19 pandemic

Background During the COVID-19 pandemic, millions of children abruptly moved to online schooling, which required high levels of parental involvement. Family routines were disrupted, potentially increasing parental stress, and may be reflected in greater media screen time use in children. Objectives To determine whether (1) parenting styles and (2) parenting stress were associated with children\u27s screen time use during the pandemic compared to the pre-pandemic period. Methods Parents (\u3e 18 years of age) were recruited to complete an online survey regarding changes in their children\u27s (6–12 years) screen time use and daily activities before and during the pandemic. Stress and parental involvement were assessed using the Perceived Stress Scale (PSS) and Alabama Parenting Questionnaires respectively. General linear models assessed whether parenting style and parent stress were associated with children\u27s screen time during the pandemic, adjusting for demographic variables and daily activities. Results 104 parents were enrolled, and 73 (70.2%) parents completed the surveys. Children\u27s screen time (e.g., watching television and playing video games) increased significantly, from 2.6 to 5.9h a day (p =.001) during pandemic-related school closures. Fewer changes in children\u27s screen time use were significantly associated with greater parental involvement (p =.017). Parent stress (p =.018) significantly predicted children\u27s screen time use. Lower household income was associated with increased hours of screen time in both models (both, p \u3c.05). Conclusions: Children\u27s screen time increased significantly during the initial months of the pandemic. Parent stress and parenting styles may be modifiable risk factors to promote children\u27s well-being during the ongoing pandemic

Sponge-incrusting actinians

p. 495-503, [4] leaves of plates : ill. ; 24 cm.Includes bibliographical references (p. 502-503)

Point-of-Care Testing for Pharyngitis in the Pharmacy.

Pharyngitis (also known as sore throat) is a common, predominately viral, self-limiting condition which can be symptomatically managed without antibiotic treatment. Inappropriate antibiotic use for pharyngitis contributes to the development and spread of antibiotic resistance. However, a small proportion of sore throats caused by group A streptococcal (GAS) infection may benefit from the provision of antibiotics. Establishing the cause of infection is therefore an important step in effective antibiotic stewardship. Point-of-care (POC) tests, where results are available within minutes, can distinguish between viral and GAS pharyngitis and can therefore guide treatment in primary healthcare settings such as community pharmacies, which are often the first point of contact with the healthcare system. In this opinion article, the evidence for the use of POC testing in the community pharmacy has been discussed. Evidence suggests that pharmacy POC testing can promote appropriate antibiotic use and reduce the need for general practitioner consultations. Challenges to implementation include cost, training and 'who prescribes', with country and regional differences presenting a particular issue. Despite these challenges, POC testing for pharyngitis has become widely available in pharmacies in some countries and may represent a strategy to contain antibiotic resistance and contribute to antimicrobial stewardship

Inhaled corticosteroids for chronic obstructive pulmonary disease-the shifting treatment paradigm

Chronic obstructive pulmonary disease (COPD) guidelines suggest using inhaled corticosteroids (ICS) in patients with severe airflow limitation or those at high risk of exacerbations. This recommendation is based on evidence demonstrating that ICS, especially when prescribed in fixed-dose combinations (FDC) with long-acting β2 agonists (LABA), improve quality of life (QoL), decrease exacerbations and hospitalisations, and have been associated with a trend towards a reduction in all-cause mortality. Audit shows that routine prescribing practice frequently uses inhaler therapies outside current guidelines recommendations; severe to very severe disease constitutes about 20% of all COPD patients, but up to 75% of COPD patients are prescribed an ICS, with significant numbers given ICS/LABA as first-line maintenance therapy. The role of ICS in the treatment paradigm for COPD is changing, driven by the growing evidence of increased risk of pneumonia, and the introduction of a new class of FDC; LABA and long-acting muscarinic antagonists (LAMA), which simplify dual bronchodilation and present a plausible alternative therapy. As the evidence base for dual therapy bronchodilation expands, it is likely that maximal bronchodilation will move up the treatment algorithm and ICS reserved for those with more severe disease who are not controlled on dual therapy. This change has already manifested in local COPD algorithms, such as those at Tayside, and represents a significant change in recommended prescribing practice. This review reassesses the role of ICS in the shifting treatment paradigm, in the context of alternative treatment options that provide maximal bronchodilation

The Impact of Parental Involvement on a Structured Youth Program Experience: A Qualitative Inquiry

Parental involvement is an often proposed, but rarely researched, key element of youth programs. Questions remain regarding the impact of parental involvement on program processes and outcomes. Qualitative data were collected over a one-year period with youth participants (n=46), parents (n=26), and teachers (n=5) associated with an international immersion/service learning program for adolescents. Three main research questions guided the data analysis: (1) what role does parental involvement play in the youths’ experience in the program; (2) how does parental involvement in the program influence the parent/child relationship; and (3) what role does parental involvement play in terms of the program’s long-term impact on the youth participants? Findings suggest a relationship between parental involvement in youth programs and improved parent/child communication, bonding, and perceptions of one another. Findings also suggest that having a common ground experience prolonged the experience’s positive post-participation effects