Pharmacological role of efflux transporters: Clinical implications for medication use during breastfeeding

The World Health Organisation recommends exclusive breastfeeding for the first six months of an infant’s life and in combination with solid food thereafter. This recommendation was introduced based on research showing numerous health benefits of breastfeeding for both the mother and the infant. However, there is always concern regarding the transfer of medications from mother to their breastfed baby via milk. Pharmacokinetic properties of a drug are usually used to predict its transferability into breast milk. Although most drugs are compatible with breastfeeding, cases of toxic drug exposure have been reported. This is thought to be due to active transport mechanisms whereby efflux transporter proteins expressed in the epithelial cells of the mammary gland actively secrete drugs into milk. An example of such efflux transporters including the breast cancer resistance protein which is strongly induced during lactation and this could result in contamination of milk with the substrates of this transporter which may place the suckling infant at risk of toxicity. Furthermore, there is little known about the substrate specificity of most efflux transporters as we have highlighted in this review. There also exists some degree of contradiction between in vivo and in vitro studies which makes it difficult to conclusively predict outcomes and drug-drug interactions

MyCourseMap: an interactive visual map to increase curriculum transparency for university students and staff

MyCourseMap is an interactive curriculum map created to increase curriculum transparency for both students and staff. It provides access to the entire curriculum at a glance, displays alignment of unit learning outcomes, assessments, course learning outcomes, and graduate attributes and links video from employers, graduates and students to help students reflect on the curriculum and its relevance. A prototype developed for the Bachelor of Pharmacy course at Curtin University as a proof-of-concept was tested and evaluated in 2014 and 2015. This evaluation utilised a mixed-methods approach using a blend of quantitative and qualitative data through online survey and structured focus group discussions. From the evaluation, the perceived benefits of the MyCourseMap include students’ increased understanding of their degree structure and its relevance to their chosen profession. From a staff perspective, the MyCourseMap helps with review and development of curriculum and professional accreditation. Barriers and challenges have led to prototype refinements

3D visualization and 3D printing in abnormal gastrointestinal system manifestations of situs ambiguus

Situs ambiguus is a rare congenital condition whereby sufferers have abnormally positioned viscera (1,2). In such cases, it is dangerous to perform traditional diagnostic examinations, such as colonoscopy, thus anatomy is explored through invasive surgeries instead. By reconstructing a patient’s viscera three-dimensionally, it is possible to trace the physical origins of the patient’s symptoms, while eliminating the necessity for invasive surgery. We present a case of situs ambiguus with use of a combination of different approaches including 3D visualizations and patient-specific 3D printing technique to assist clinical diagnosis and patient management. This case highlights the potential value of utilising the latest visualization tools in the diagnostic assessment of complicated pathologies

What do breastfeeding women taking herbal galactagogues perceive of community pharmacists’ role in breastfeeding support? A qualitative study

Information from pharmacists may affect breastfeeding womens’ decisions and choice of therapy. Community pharmacies remain one of the main sources of herbal medicines in Australia. In this study, we aimed to explore the perspectives of breastfeeding women on pharmacists’ role and whether there is potential for role expansion, as well as the facilitators and barriers in meeting their healthcare-related needs in the community pharmacy setting. Semi-structured in-depth interviews were conducted with 20 Western Australian women who were using one or more herbal galactagogues while breastfeeding. Participants’ views were classified into three major themes: (i) facilitators and (ii) barriers to an increased role of pharmacists; and (iii) implementation of breastfeeding related-services in community pharmacy settings. Overall perspectives of participants were positive about the potential for role expansion of pharmacists to meet their breastfeeding-related needs. Whilst most participants perceived community pharmacies as convenient sources of trusted information, some recognised barriers to an increased role of pharmacists. Several breastfeeding support services perceived to be useful in community pharmacy settings were identified. Issues raised highlighted areas of pharmacy practice which required improvement and revealed opportunities for expansion of pharmacists’ role to better support women and promote breastfeeding in the community

Multi-organ segmentation for 3D visualisation of abdominal structure to enhance learning experience in medical education and pre-surgical planning of abdominal abnormalities

Background Medical image segmentation plays an important role in assisting clinical diagnosis, as well as medical education to enhance learning anatomy and pathology. A 3D anatomical model which can be either visualised as 3D reconstruction or virtual reality views or 3D printed models adds valuable information to standard 2D visualisations for assessing the depth of the abdominal region structures and abnormalities and enhancing the learning experience. Aim. This study aims to explore the methodology and efficiency for 3D segmentation of abdominal organs comparing the abdominal region of the normal human anatomy intestinal using an open source software 3D Slicer. Methods Two CT scans of anonymised images with normal and intestinal enteritis were selected to be segmented, analysed, and converted into 3D virtual anatomical models. The models were used in comparison to assess limited areas that could not be assessed via 2D visualisation and depict differences from the soft tissue organs. Results The majority of the organs were able to be image processed and converted into 3D visualisation. Evidently, the gastrointestinal system poses varying challenges due to irregular pathway and difficulties to distinguished density value towards adjacent organs. Despite the challenge, 3D segmentation of the small and large intestines were visualised and differentiated. Conclusion This study demonstrates the feasibility of utilising 3D slicer for multi-organ segmentations, although it still poses many challenges and limits to soft tissue components. Further development of automatic segmentation is necessary to make the image processing and segmentation approach more practical for routine applications

The use, perceived effectiveness and safety of herbal galactagogues during breastfeeding: A qualitative study

The World Health Organization recommends breastfeeding as the normal infant feeding method and that infants being breastfed should be regarded as the control group or norm reference in all instances. There are many factors which could contribute to a new mother ceasing breastfeeding early, with the most commonly reported reason being perceived insufficient breast milk supply. The use of herbal galactagogues is increasingly common worldwide. Literature review identified a need for more research in the area of herbal galactagogue use during breastfeeding. Twenty in-depth semi-structured interviews were undertaken with breastfeeding women who used herbal galactagogues, to document use and explore their perceived effectiveness and safety of herbal galactagogues. Several indicators of breastfeeding adequacy were mentioned as participants described their experiences with the use of herbal galactagogues. Confidence and self-empowerment emerged as an over-arching theme linked to positive experiences with the use of herbal galactagogues. Despite the lack of clinical trial data on the actual increase in measured volume of breast milk production, indicators of breastfeeding adequacy boosted participants’ confidence levels and resulted in psychological benefits. This study highlighted the importance of considering the potential psychological benefits of using herbal galactagogues, and how this translates into breastfeeding adequacy

Realist evaluation of cancer rehabilitation services in South Wales (REEACaRS): a mixed methods study protocol

Introduction Long-term and late effects of cancer treatments can cause functional limitations and reduce quality of life. Cancer rehabilitation services, which can comprise physical exercise, psychological support and educational interventions depending on the individual’s needs, have been found to have a positive effect on health-related quality of life worldwide. However, accessibility or the lack of awareness on available help can act as barriers and influence the uptake of services, resulting in people having unmet rehabilitation needs. In Wales, UK, 41% of people, who have had health and social care needs resulting from cancer and its treatments, reported that they did not receive care when needed. The reason for this lack of support has not yet been fully investigated. The aim of this study is to investigate the conditions in which cancer rehabilitation services work and their underpinning mechanisms in South Wales, UK, specifically addressing barriers, facilitators and costs. Methods and analysis Realist evaluation, which explains for whom a service works in what circumstances and how through context-mechanism-outcome pattern conjunctions, will be used in three phases to investigate the conditions in which cancer rehabilitation services work and their underpinning mechanisms. Phase 1 will be secondary analysis of a cancer rehabilitation database from a local Health Board to give context to who are accessing rehabilitation. Phase 2 will be thematic analysis of face-to-face, semistructured rehabilitation participant (n=20) and healthcare professional (n=20) interviews to explore the mechanisms of how cancer rehabilitation works. Phase 3 will be two case studies and cost-consequences analysis of cancer rehabilitation services. Ethics and dissemination This study received favourable ethical opinion from London South-East Research Ethics Committee (17/LO/2123) in December 2017. This project is part of the author’s PhD thesis and it is expected that the findings will be disseminated in academic journals and at local and international conferences

The effectiveness of schemes that refine referrals between primary and secondary care - the UK experience with glaucoma referrals: the Health Innovation & Education Cluster (HIEC) Glaucoma Pathways Project

Objectives: A comparison of glaucoma referral refinement schemes (GRRS) in the UK during a time period of considerable change in national policy and guidance. Design: Retrospective multisite review. Setting: The outcomes of clinical examinations by optometrists with a specialist interest in glaucoma (OSIs) were compared with optometrists with no specialist interest in glaucoma (non-OSIs). Data from Huntingdon and Nottingham assessed non-OSI findings, while Manchester and Gloucestershire reviewed OSI findings. Participants: 1086 patients. 434 patients were from Huntingdon, 179 from Manchester, 204 from Gloucestershire and 269 from Nottingham. Results: The first-visit discharge rate (FVDR) for all time periods for OSIs was 14.1% compared with 36.1% from non-OSIs (difference 22%, CI 16.9% to 26.7%; p<0.001). The FVDR increased after the April 2009 National Institute for Health and Clinical Excellence (NICE) glaucoma guidelines compared with pre-NICE, which was particularly evident when pre-NICE was compared with the current practice time period (OSIs 6.2–17.2%, difference 11%, CI −24.7% to 4.3%; p=0.18, non-OSIs 29.2–43.9%, difference 14.7%, CI −27.8% to −0.30%; p=0.03). Elevated intraocular pressure (IOP) was the commonest reason for referral for OSIs and non-OSIs, 28.7% and 36.1%, respectively, of total referrals. The proportion of referrals for elevated IOP increased from 10.9% pre-NICE to 28.0% post-NICE for OSIs, and from 19% to 45.1% for non-OSIs. Conclusions: In terms of ‘demand management’, OSIs can reduce FVDR of patients reviewed in secondary care; however, in terms of ‘patient safety’ this study also shows that overemphasis on IOP as a criterion for referral is having an adverse effect on both the non-OSIs and indeed the OSIs ability to detect glaucomatous optic nerve features. It is recommended that referral letters from non-OSIs be stratified for risk, directing high-risk patients straight to secondary care, and low-risk patients to OSIs