Optimising translational oncology in clinical practice: Strategies to accelerate progress in drug development.

Despite intense efforts, the socioeconomic burden of cancer remains unacceptably high and treatment advances for many common cancers have been limited, suggesting a need for a new approach to drug development. One issue central to this lack of progress is the heterogeneity and genetic complexity of many tumours. This results in considerable variability in therapeutic response and requires knowledge of the molecular profile of the tumour to guide appropriate treatment selection for individual patients. While recent advances in the molecular characterisation of different cancer types have the potential to transform cancer treatment through precision medicine, such an approach presents a major economic challenge for drug development, since novel targeted agents may only be suitable for a small cohort of patients. Identifying the patients who would benefit from individual therapies and recruiting sufficient numbers of patients with particular cancer subtypes into clinical trials is challenging, and will require collaborative efforts from research groups and industry in order to accelerate progress. A number of molecular screening platforms have already been initiated across Europe, and it is hoped that these networks, along with future collaborations, will benefit not only patients but also society through cost reductions as a result of more efficient use of resources. This review discusses how current developments in translational oncology may be applied in clinical practice in the future, assesses current programmes for the molecular characterisation of cancer and describes possible collaborative approaches designed to maximise the benefits of translational science for patients with cancer.

Joint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(®). Executive Summary of the 2010 Position Development Conference on Interpretation and use of FRAX® in clinical practice.

The International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) convened the FRAX(®) Position Development Conference (PDC) in Bucharest, Romania, on November 14, 2010, following a two-day joint meeting of the ISCD and IOF on the "Interpretation and Use of FRAX(®) in Clinical Practice." These three days of critical discussion and debate, led by a panel of international experts from the ISCD, IOF and dedicated task forces, have clarified a number of important issues pertaining to the interpretation and implementation of FRAX(®) in clinical practice. The Official Positions resulting from the PDC are intended to enhance the quality and clinical utility of fracture risk assessment worldwide. Since the field of skeletal assessment is still evolving rapidly, some clinically important issues addressed at the PDCs are not associated with robust medical evidence. Accordingly, some Official Positions are based largely on expert opinion. Despite limitations inherent in such a process, the ISCD and IOF believe it is important to provide clinicians and technologists with the best distillation of current knowledge in the discipline of bone densitometry and provide an important focus for the scientific community to consider. This report describes the methodology and results of the ISCD-IOF PDC dedicated to FRAX(®).

Pharmacological treatment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes: development of practice recommendations in a Swiss canton

OBJECTIVES: In 2002, the canton of Fribourg, Switzerland, implemented a coordinated pharmaceutical care service in nursing homes to promote rational drug use. In the context of this service, a project was conducted to develop recommendations for the pharmacological management of behavioral and psychological symptoms of dementia (BPSD) in nursing home residents. DESIGN AND METHODS: Selected evidence-based guidelines and meta-analysis sources related to the management of depression, insomnia, and agitation in dementia patients were systematically searched and evaluated. Evidence and controversies regarding the pharmacological treatment of the most common BPSD symptoms were reviewed, and treatment algorithms were developed. RESULTS: Ten evidence-based guidelines and meta-analyses for BPSD management were identified, with none specifically addressing issues related to nursing home residents. Based on this literature, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. For depression, SSRIs are considered the first choice if an antidepressant is required. No clear evidence has been found for sleep disturbances; the underlying conditions need to be investigated closely before the introduction of any drug therapy. Many drugs have been investigated for the treatment of agitation, and if necessary, antipsychotics could be used, although they have significant side effects. Several areas of uncertainty were identified, such as the current controversy about typical and atypical antipsychotic use or the appropriateness of cholinesterase inhibitors for controlling agitation. Treatment algorithms were presented to general practitioners, pharmacists, and medical directors of nursing homes in the canton of Fribourg, and will now be implemented progressively, using educational sessions, pharmaceutical counseling, and monitoring. CONCLUSION: Based on existing evidence-based studies, recommendations were developed for the practice of pharmacological management of depression, sleep disturbances, and agitation in nursing home residents. It should be further studied whether these algorithms implemented through pharmaceutical care services will improve psychotropic drug prescriptions and prevent drug-related problems in nursing home residents

Development of pharmaceutical care services in nursing homes: practice and research in a Swiss canton.

OBJECTIVE: The aim of this study was to assess the implementation process and economic impact of a new pharmaceutical care service provided since 2002 by pharmacists in Swiss nursing homes. SETTING: The setting was 42 nursing homes located in the canton of Fribourg, Switzerland under the responsibility of 22 pharmacists. METHOD: We developed different facilitators, such as a monitoring system, a coaching program, and a research project, to help pharmacists change their practice and to improve implementation of this new service. We evaluated the implementation rate of the service delivered in nursing homes. We assessed the economic impact of the service since its start in 2002 using statistical evaluation (Chow test) with retrospective analysis of the annual drug costs per resident over an 8-year period (1998-2005). MAIN OUTCOME MEASURES: The description of the facilitators and their implications in implementation of the service; the economic impact of the service since its start in 2002. RESULTS: In 2005, after a 4-year implementation period supported by the introduction of facilitators of practice change, all 42 nursing homes (2,214 residents) had implemented the pharmaceutical care service. The annual drug costs per resident decreased by about 16.4% between 2002 and 2005; this change proved to be highly significant. The performance of the pharmacists continuously improved using a specific coaching program including an annual expert comparative report, working groups, interdisciplinary continuing education symposia, and individual feedback. This research project also determined priorities to develop practice guidelines to prevent drug-related problems in nursing homes, especially in relation to the use of psychotropic drugs. CONCLUSION: The pharmaceutical care service was fully and successfully implemented in Fribourg's nursing homes within a period of 4 years. These findings highlight the importance of facilitators designed to assist pharmacists in the implementation of practice changes. The economic impact was confirmed on a large scale, and priorities for clinical and pharmacoeconomic research were identified in order to continue to improve the quality of integrated care for the elderly.

Exploring the role and transformative potential of human rights in development practice and food security : case study from Malawi

Avhandlingen är en analys av den roll som mänskliga rättigheter spelar i utvecklingssamarbete i allmänhet och tre matsäkerhetsprojekt i Malawi i synnerhet. Författaren undersöker huruvida mänskliga rättigheter kan bidra till samhälleliga förändringsprocesser. Undersökningen har en diskursiv syn på mänskliga rättigheter; rättigheter ses som sociala konstruktioner skapade av människor, konstruktioner som förändras i takt med att aktörerna ger dem ny mening. Människorättsbaserade utvecklingsstrategier riktar uppmärksamheten mot olika aktörers skyldigheter samt vikten av att mänskliga rättigheter inte kränks genom utvecklingspolitiska beslut. En analys som utgår från mänskliga rättigheter kan leda till att nya frågor lyfts fram: vem har skyldigheter, vem har rättigheter, och varför förverkligas inte dessa? Fokus flyttas till hur politiska, ekonomiska och juridiska strukturer kan förändras så att de främjar mänskliga rättigheter. Författaren använder empiriskt material från Malawi för att visa vilken roll mänskliga rättigheter och så kallade människorättsprinciper spelar inom tre projekt: (1) ett mathjälpsprojekt; (2) ett rättighetsbaserat projekt med fokus på att stärka strategier för livsuppehälle; (3) ett juridiskt projekt inom ramen för vilket man skapat ett lagförslag om rätten till föda. Analysen visar att det rättighetsbaserade projektet strävade efter den mest djupgående samhälleliga förändringen. Människorättsprinciperna ansvarighet och deltagande handlade inte endast om verksamheten inom projektet utan man strävade även efter att stärka dessa principer mellan medborgare och myndigheter. Rättigheter, som ett sätt att tala, tänka och handla, inte som abstrakta juridiska normer, påverkade de lokala aktörernas sätt att kräva bl.a. tjänster av lokala myndigheter. Teoretiskt kan man säga att det rättighetsbaserade projektet representerar ett aktörsperspektiv på mänskliga rättigheter där aktörernas egna uppfattningar om vad de är berättigade till samt krav på myndigheters ansvar formade vilken mening rättigheterna kom att få.

A Mixed-Method Study of Educator Knowledge and Practice Related to Student Socio-moral Development

The purpose of this study was to explore elementary educators’ knowledge of moral development, how this knowledge relates to their beliefs and sense of efficacy pertaining to character education practices and the socio-moral reasoning of their students. It was hypothesized that educators’ beliefs and practices related to character education would reflect their pedagogy rather than knowledge of moral development theory. It was further hypothesized that there would be differences in student socio-moral reasoning specifically the beliefs and desires that guide actions would differ based on grade and gender. This mixed-method study employing self-report questionnaires, open response vignettes, and semi-structured educator interviews yielded quantitative and qualitative data. Findings indicated socio-moral reasoning of students differed according to grade (age) and gender. Knowledge of moral development theory was found to vary among participants however some practices employed by educators did align with a social cognitive approach to moral development. Significant variables identified consistently among educator and student participants included, autonomy, social competence, sense of school community, and supportiveness. These variables, in conjunction with a sense of fairness, have been identified elsewhere as foundational to moral development (Nucci, 2009), and intrinsic motivation (Ryan & Deci, 2000) and are relevant to educators working to develop student socio-moral reasoning as an aspect of character.

Citizanship into Practice in England : The continuing professional development challenge. 'La práctica de la ciudadanía en Inglaterra : el reto del desarrollo profesional continuo'.

Resumen tomado del autor

Development appraisal in practice: some evidence from the planning system

Due to the requirement to demonstrate financial feasibility of policy proposals and scheme-specific planning obligations, development viability and development appraisal have become core themes in the English planning system. The objective of this paper is to evaluate the application of development appraisal in practice. The paper reviews the literature and the models available to assess the viability of development and analyses a sample 19 development viability appraisals to identify practice. The paper concludes that the practice of development appraisal deviates significantly from the tenets of capital budgeting theory. In particular, in addition to a propensity to oversimplify the timing of income and expenditure, the way in which debt, developer’s return and value and cost change are handled in practice illustrates a major gap between mainstream capital budgeting theory and development appraisal in practice.

Social development: bridging the theory-practice divide, past and present

Introduces a collection of articles appearing in a special issue that reflect on social development, considering the various intellectual forms social development has taken, how development thinking has been shaped by different concepts in different periods, and how contributors' personal experiences with social development research has been applied to social development practice.

Integrating science into humanitarian and development planning and practice to enhance community resilience

There has been an increased emphasis upon the application of science for humanitarian and development planning, decision-making and practice; particularly in the context of understanding, assessing and anticipating risk (e.g. HERR, 2011). However, there remains very little guidance for practitioners on how to integrate sciences they may have had little contact with in the past (e.g. climate). This has led to confusion as to which ‘science’ might be of use and how it would be best utilised. Furthermore, since this integration has stemmed from a need to be more predictive, agencies are struggling with the problems associated with uncertainty and probability. Whilst a range of expertise is required to build resilience, these guidelines focus solely upon the relevant data, information, knowledge, methods, principles and perspective which scientists can provide, that typically lie outside of current humanitarian and development approaches. Using checklists, real-life case studies and scenarios the full guidelines take practitioners through a five step approach to finding, understanding and applying science. This document provides a short summary of the five steps and some key lessons for integrating science.