Phase I pharmacokinetic study of the novel antitumor agent SR233377.

SR233377 is a novel thioxanthenone analogue that demonstrated solid tumor selectivity in vitro with activity confirmed in vivo against several murine tumors including those of colon, pancreas, and mammary origin. Its primary preclinical dose-limiting toxicities included myelosuppression and neurological toxicity. The neurological toxicity was acute and could be ameliorated in mice when the drug was administered as a 1-h infusion instead of rapid i.v. injection. As a result of its preclinical efficacy profile, SR233377 entered Phase I clinical investigation. The compound was administered i.v. over 2 h on day 1 repeated every 28 days. The starting dose was 33 mg/m2 (one-tenth the mouse LD10). Escalations continued to 445 mg/m2 (six escalations), where dose-limiting toxicity was observed. At this dose, acute ventricular arrhythmias, including one patient with torsades de pointes and transient cardiac arrest, occurred. Because this toxicity might have been related to the plasma peak, the protocol was amended to a 24-h infusion beginning at 225 mg/m2. With this dose, prolongation of the corrected QT interval (QTc) over the pretreatment levels resulted. Because prolonged QTc is a known forerunner to acute ventricular arrhythmias, clinical development of SR233377 was stopped. However, preclinical antitumor and toxicity studies with analogues are underway with hopes of identifying a new clinical candidate with similar antitumor effects that is devoid of cardiac toxic effects.     

Analysis of Social Interactions as Goal-Directed Behaviors in Children with Autism

An ecological psychology framework that considers the intentions of the child within the child's own social context was used to study the complexity of social interactions of 16 children with autism or Down syndrome. Children were observed in their homes and behaviors were recorded. Records were then analyzed by dividing behavior based on the children's own goals. Goal-directed behaviors were then categorized. Statistical analyses revealed similar social contexts and opportunities to receive bids from others for both groups. Differences in the frequencies and complexities of children's behaviors depended on behavioral intent. Socially intended behaviors were less frequent, less self-initiated, and less complex in children with autism. These findings are discussed as problems of attention and executive function, because social behaviors were more likely to occur secondarily, within the context of another ongoing behavior.     

A commentary on ethical decision-making in the pharmacy profession and the APhA Code of Ethics

The American Pharmacists Association Code of Ethics (“Code”) was established in 1852 and has undergone 5 modifications, most recently in 1994. As point of care shifts from product to cognitive clinical service, pharmacists are expected to encounter an increasing quantity and complexity of ethical and moral dilemmas. In view of this professional transformation and current worldwide challenges, this seems an appropriate time for dialogue on a modification of the Code. The 3 important questions before the profession are as follows:(1) Is the scope of available ethical guidance adequate?(2) Are pharmacists competent in ethical decision-making?(3) Is current pharmacy education and training adequately preparing students for ethical decision-making?The first question is included as part of the Pharmacy Law, Ethics, and Risk course at the University of Utah College of Pharmacy. The following commentary is based on a student’s persuasive paper that the Code should remain unmodified owing to the following factors: greater detail does not ensure improved guidance, and modification may lead to confusion in professional role and responsibilities and may not consider patients’ values and preferences in decision-making. To improve ethical decision-making in the pharmacy profession, this commentary further suggests that questions 2 and 3 are key to facilitating improved readiness and competency in pharmacists’ ethical decision-making. Pharmacy students should be given a more thorough education in ethics, and practicing pharmacists should continually expand their knowledge and continued professional development in ethics.     

Recruitment and retention of older adolescent and young adult female survivors of childhood cancer in longitudinal research

Purpose/Objectives: To describe the challenges encountered in the recruitment and retention of a sample of older adolescent and young adult female survivors of childhood cancer for a longitudinal study testing a targeted psychosocial intervention aimed at enhancing hope.Data Sources: Published literature on constructing longitudinal intervention studies and strategies in the recruitment and retention of childhood cancer survivors in research was used to develop the protocol of this study.Data Synthesis: Using empirical literature to construct the study's design resulted in achieving certain goals for the design, but not in the recruitment and retention of study participants. Using online technology to deliver the intervention and collect data was efficient and effective. Traditional approaches to recruitment and retention of those survivors, however, were not effective. Use of more novel approaches to enroll study participants demonstrated only modest success.Conclusions: Additional research is needed on strategies to successfully recruit and retain older adolescents and young adult female survivors of childhood cancer in longitudinal intervention studies.Implications for Nursing: The improvement in the psychological well-being of female survivors of childhood cancer remains an important outcome in ongoing care. The need to continue to identify creative and effective ways to recruit and retain those survivors is warranted.     

Public vs. private insurance: Cost, use, accessibility, and outcomes of services for children with autism spectrum disorders

Very little research has been conducted on insurance type (private vs. public funded) and costs, accessibility, and use of services of children with autism. Analysis of five parent reported outcomes: (a) out-of-pocket expenditures, (b) variety of services used, (c) access to services, (d) child and family service outcomes, and (e) satisfaction with payer of services against private and public insurance was completed. Parents/caregivers completed a survey regarding recent usage of nine specific services—inpatient care, medication management, counseling or training, individual therapy, in-home behavior therapy, speech and language therapy, occupational therapy, case management, and respite care. Across all respondents (n = 107), 73.5% were privately insured; 21.2% were publicly insured. Based on insurance type, no statistically significant differences in outcome variables were found, findings that were not consistent with previous research. However, an indirect association was found between out-of-pocket expense and parent satisfaction with the payer of services, access to care, and family outcomes. Further, a significantly higher percentage of total out-of-pocket expenditures were allocated to speech language therapy among publicly insured children than among privately insured children (p = .03) and parent stress was a moderating variable between access to care and variety of services used.