Enhancing Communication about Paediatric Medicines: Lessons from a Qualitative Study of Parents' Experiences of Their Child's Suspected Adverse Drug Reaction

Background: There is little research on parents’ experiences of suspected adverse drug reactions in their children and hence little evidence to guide clinicians when communicating with families about problems associated with medicines. Objective: To identify any unmet information and communication needs described by parents whose child had a suspected adverse drug reaction. Methods: Semi-structured qualitative interviews with parents of 44 children who had a suspected adverse drug reaction identified on hospital admission, during in-patient treatment or reported by parents using the Yellow Card Scheme (the UK system for collecting spontaneous reports of adverse drug reactions). Interviews were conducted face-to-face or by telephone; most interviews were audiorecorded and transcribed. Analysis was informed by the principles of the constant comparative method. Results: Many parents described being dissatisfied with how clinicians communicated about adverse drug reactions and unclear about the implications for their child’s future use of medicines. A few parents felt that clinicians had abandoned their child and reported refusing the use of further medicines because they feared a repeated adverse drug reaction. The accounts of parents of children with cancer were different. They emphasised their confidence in clinicians’ management of adverse drug reactions and described how clinicians prospectively explained the risks associated with medicines. Parents linked symptoms to medicines in ways that resembled the established reasoning that clinicians use to evaluate the possibility that a medicine has caused an adverse drug reaction. Conclusion: Clinicians’ communication about adverse drug reactions was poor from the perspective of parents, indicating that improvements are needed. The accounts of parents of children with cancer indicate that prospective explanation about adverse drug reactions at the time of prescription can be effective. Convergence between parents and clinicians in their reasoning for linking children’s symptoms to medicines could be a starting point for improved communication

Consequences of various landscape-scale ecosystem management strategies and fire cycles on age-class structure and harvest in boreal forests

At the landscape scale, one of the key indicators of sustainable forest management is the age-class distribution of stands, since it provides a coarse synopsis of habitat potential, structural complexity, and stand volume, and it is directly modified by timber extraction and wildfire. To explore the consequences of several landscape-scale boreal forest management strategies on age-class structure in the Mauricie region of Quebec, we used spatially explicit simulation modelling. Our study investigated three different harvesting strategies (the one currently practiced and two different strategies to maintain late seral stands) and interactions between fire and harvesting on stand age-class distribution. We found that the legacy of initial forested age structure and its spatial configuration can pose short- (<50 years) to medium-term (150-300 years) challenges to balancing wood supply and ecological objectives. Also, ongoing disturbance by fire, even at relatively long cycles in relation to historic levels, can further constrain the achievement of both timber and biodiversity goals. For example, when fire was combined with management, harvest shortfalls occurred in all scenarios with a fire cycle of 100 years and most scenarios with a fire cycle of 150 years. Even a fire cycle of 500 years led to a reduction in older forest when its maintenance was not a primary constraint. Our results highlight the need to consider the broad-scale effects of natural disturbance when developing ecosystem management policies and the importance of prioritizing objectives when planning for multiple resource use

PEArL: a systems approach to demonstrating authenticity in information systems design

The process of information systems (IS) design has been dominated by the demands inherent in providing a technical solution to a perceived problem or need. Engineering IS design methods applied in order to satisfy the problem situation tend to have a preoccupation with verifying specifications as being mathematically correct. Diffculties arise when the ideas underpinning verification are extended in an attempt to ‘prove’ the validity of a proposed design for an IS. A pure engineering approach does not facilitate a response to the subjective elements within social situations, which experience has shown to be essential in demonstrating the pertinence of new designs to those concerned. We suggest that, by applying interpretivist systems ideas, it is possible to support concerned individuals in reflecting upon crucial aspects of the inquiry, enabling those individuals to judge the relevance or ‘authenticity’ of the learning, according to their own values and beliefs. The elements of participants, engagement, authority, relationships and learning are suggested as being crucial. These make up the mnemonic PEArL, which is offered as an aide-mémoire for those concerned with IS design

Consensus guidelines for the definition, detection and interpretation of immunogenic cell death.

Cells succumbing to stress via regulated cell death (RCD) can initiate an adaptive immune response associated with immunological memory, provided they display sufficient antigenicity and adjuvanticity. Moreover, multiple intracellular and microenvironmental features determine the propensity of RCD to drive adaptive immunity. Here, we provide an updated operational definition of immunogenic cell death (ICD), discuss the key factors that dictate the ability of dying cells to drive an adaptive immune response, summarize experimental assays that are currently available for the assessment of ICD in vitro and in vivo, and formulate guidelines for their interpretation

Development and potential role of type-2 sodium-glucose transporter inhibitors for management of type 2 diabetes

There is a recognized need for new treatment options for type 2 diabetes mellitus (T2DM). Recovery of glucose from the glomerular filtrate represents an important mechanism in maintaining glucose homeostasis and represents a novel target for the management of T2DM. Recovery of glucose from the glomerular filtrate is executed principally by the type 2 sodium-glucose cotransporter (SGLT2). Inhibition of SGLT2 promotes glucose excretion and normalizes glycemia in animal models. First reports of specifically designed SGLT2 inhibitors began to appear in the second half of the 1990s. Several candidate SGLT2 inhibitors are currently under development, with four in the later stages of clinical testing. The safety profile of SGLT2 inhibitors is expected to be good, as their target is a highly specific membrane transporter expressed almost exclusively within the renal tubules. One safety concern is that of glycosuria, which could predispose patients to increased urinary tract infections. So far the reported safety profile of SGLT2 inhibitors in clinical studies appears to confirm that the class is well tolerated. Where SGLT2 inhibitors will fit in the current cascade of treatments for T2DM has yet to be established. The expected favorable safety profile and insulin-independent mechanism of action appear to support their use in combination with other antidiabetic drugs. Promotion of glucose excretion introduces the opportunity to clear calories (80–90 g [300–400 calories] of glucose per day) in patients that are generally overweight, and is expected to work synergistically with weight reduction programs. Experience will most likely lead to better understanding of which patients are likely to respond best to SGLT2 inhibitors, and under what circumstances

History and Applications of Dust Devil Studies

Studies of dust devils, and their impact on society, are reviewed. Dust devils have been noted since antiquity, and have been documented in many countries, as well as on the planet Mars. As time-variable vortex entities, they have become a cultural motif. Three major stimuli of dust devil research are identified, nuclear testing, terrestrial climate studies, and perhaps most significantly, Mars research. Dust devils present an occasional safety hazard to light structures and have caused several deaths

A randomised controlled trial of rosuvastatin for the prevention of aminoglycoside-induced kidney toxicity in children with cystic fibrosis

The PROteKT study tested the hypothesis that rosuvastatin can inhibit aminoglycoside-induced nephrotoxicity in children with Cystic Fibrosis (CF). This open label, parallel group, randomised controlled trial recruited children and young people aged 6 to 18 years with CF at 13 paediatric CF treatment centres in the UK. Participants were randomised equally to either receive oral rosuvastatin (10 mg once daily) or no intervention (control) throughout clinically indicated treatment with intravenous tobramycin. The primary outcome was the difference between the groups in mean fold-change in urinary Kidney Injury Molecule-1 (KIM-1). Fifty (rosuvastatin n = 23, control n = 27) participants were recruited between May 2015 and January 2017. Primary outcome data was available for 88% (rosuvastatin n = 20, control n = 24). The estimated mean treatment difference in the geometric mean-fold change of normalised KIM-1 was 1.08 (95% CI 0.87–1.35, p = 0.48). In total there were 12 adverse reactions, all mild, reported by five participants randomised to rosuvastatin, and one serious adverse event in each group. Whilst no protective effect of rosuvastatin was seen, there was a lower than expected level of nephrotoxicity in the cohort. Therefore, we can neither confirm nor refute the hypothesis that rosuvastatin protects against aminoglycoside nephrotoxicity