Healthcare professional experiences and attitudes on unlicensed/off-label paediatric prescribing and paediatric clinical trials.

Objectives: To investigate the knowledge and views of a range of healthcare professionals (consultant paediatricians, general practitioners (GPs), community pharmacists and paediatric nurses) regarding the use of unlicensed/off-label medicines in children and the participation of children in clinical trials.

Methods: A regional study in which a survey instrument with 39 items was issued to 500 randomly selected GPs, all community pharmacists (n?=?512), 50 hospital consultants and 150 paediatric nurses in Northern Ireland.

Results: Approximately half (46.5%) of the 1,212 healthcare professionals approached responded to the questionnaire. The majority of respondents indicated their familiarity with the term unlicensed (82.9%) or off-label (58.6%) prescribing with the most frequently quoted reason for such prescribing being younger age (33.6%). Apart from community pharmacists, most respondents reported having gained their knowledge through personal experience. Even though a large percentage of respondents expressed concerns about the safety (77.8%) or efficacy (87.9%) of unlicensed/off-label prescribing in children, only 30.7% reported informing parents/guardians of these concerns on the use of such medicines in children. In addition, only 56% of respondents believed that unlicensed/off-label medicines should undergo clinical trials in children. Overall, 28.4% of respondents (20.1% of GPs, 41.4% of community pharmacists, 27.7% of paediatric nurses and 94% of consultant paediatricians) indicated their willingness to be actively involved in, and recruit their patients for paediatric clinical research.

Conclusion: The use of unlicensed and off-label medicines remains a major issue in paediatric medicine. Until such times as more licensed medicines are available for children, clear guidance should be developed to allow consistency in practice across the spectrum of healthcare professionals who are involved with such medicines in their routine practice.

Pitfalls in Strategic Planning: Lessons for Legitimacy

The paper considers how planning as a political activity is underpinned by concepts of justice and how professional practitioners are consistently faced with making ethical choices in the public interest. The key objective is therefore to identify the centrality of ethics in praxis. In this context, political liberal theory is empirically useful in exploring both the role of participants and the processes employed in strategic planning. A case study analysis generates key issues which are relevant to planning in the wider arena and an extensive series of interviews provides interesting insights into the dynamic between those involved and the effectiveness of procedures followed.

Securing the human in critical security studies: the insecurity of a secure ethics

This article argues that Critical Security Studies (CSS), exemplified by Ken Booth’s Theory of World Security, has outlined an ethics of security as emancipation of the ‘human’, but also a highly problematic security of ethics. After drawing out how the ethics of CSS operates, we examine the security of this ethics by examining it against a hard case, that of the 199899 Kosovo crisis. Confronting this concrete situation, we draw out three possibilities for action used at the time to secure the human: ‘humanitarian containment’, military intervention and hospitality. Assessing each against Booth’s requirements for ethical security action, we counter that, in fact, no option was without risks, pitfalls and ambiguities. Ultimately, if any action to promote the security and the emancipation of the human is possible, it must embrace and prioritise the fundamental insecurity of ethics, or else find itself paralysed through a fear of making situations worse.

The role of the Professional Engineer in the 21st century

In light of the current world economic and environmental crisis due in part to
unsustainable development and poor financial planning, 21st Century engineers are faced with unprecedented challenges of developing a sustainable world in balance with the forces of nature to combat global environmental, social and economic crises. The European Union, the United States of America and a number of other countries have identified that smart solutions and highly skilled professionals are needed to survive climate change and create long-term prosperity. In this paper the evolution of the changing career of the engineer will be presented. The policy background to the current system of engineering education at bachelor’s and graduate level in Ireland will be introduced and perceptions of engineering as a profession by society in general, and by
school leavers selecting third level courses will be discussed. The role of the engineer as a specialist, expert or generalist will also be studied in terms of the changing demands and needs of society. Finally the responsibility of universities, through broad-based multidisciplinary teaching and training, to prepare the next crop of engineers will be examined.