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For decades, health services researchers have grappled with fundamental questions of how research can best inform policy and practice (Roper 1997; Hadley 2000; Epstein 2001; Fielding, Marks et al. 2002; [...]

The COVID-19 pandemic presented unprecedented challenges for healthcare services. The provision of the Palliative Care Consultancy Service at Western Health, a major metropolitan health service in Melbourne, Australia, was no [...]

The Australian Technical Advisory Group on Immunisation and New Zealand Ministry of Health recommend all children aged ≥ 5 years receive either of the two mRNA COVID‐19 vaccines: Comirnaty (Pfizer), available in both Australia and New Zealand, or Spikevax (Moderna), available in Australia only. Both vaccines are efficacious and safe in the general population, including children. Children and adolescents undergoing treatment for cancer and immunosuppressive therapy for non‐malignant haematological conditions are particularly vulnerable, with an increased risk of severe or fatal COVID‐19. There remains a paucity of data regarding the immune response to COVID‐19 vaccines in immunosuppressed paediatric populations, with data suggestive of reduced immunogenicity of the vaccine in immunocompromised adults. Considering the safety profile of mRNA COVID‐19 vaccines and the increased risk of severe COVID‐19 in immunocompromised children and adolescents, COVID‐19 vaccination is strongly recommended for this at‐risk population. We provide a number of recommendations regarding COVID‐19 vaccination in this population where immunosuppressive, chemotherapeutic and/or targeted biological agents are used. These include the timing of vaccination in patients undergoing active treatment, management of specific situations where vaccination is contraindicated or recommended under special precautions, and additional vaccination recommendations for severely immunocompromised patients. Finally, we stress the importance of upcoming clinical trials to identify the safest and most efficacious vaccination regimen for this population. This consensus statement provides recommendations for COVID‐19 vaccination in children and adolescents aged ≥ 5 years with cancer and immunocompromising non‐malignant haematological conditions, based on evidence, national and international guidelines and expert opinion. The Australian and New Zealand Children’s Haematology/Oncology Group.

Recently, linguistic patterns have been correlated with corporate mobility. According to Dell (1992), those who use communication styles that are direct, definitive, and confrontational move up the corporate ladder more [...]

In children with cancer and febrile neutropenia, the diagnostic yield of pre-antibiotic blood cultures is significantly higher than post-antibiotic cultures. In the absence of new fever or clinical instability, blood cultures beyond 48 hours of persistent fever have limited value.

HOW OFTEN DO YOU EXCLAIM: `There are just never enough hours in the day', as you juggle your work and personal life? And on top of this, you know you [...]

International data indicate that rates of clinical trial enrolment for Adolescents and Young Adults (AYAs) with cancer are markedly lower than for any other age group. This paper reviews the recent literature reporting international trends in clinical trial enrolment since 2010. Subsequently, we present the first population-based, national assessment of clinical trial enrolment for AYAs with cancer in Australia. Reported rates of trial enrolment from Australia, Canada, the United States, and the United Kingdom were variable, though consistently low, ranging between 2% and 29%. Trial enrolment was higher for younger AYAs (typically 15–19 years) and those attending pediatric hospitals, and this was replicated in the recent Australian data. The findings highlight a lack of substantial improvement in AYA clinical trial enrolment and in particular, a need for improved opportunities to access trials for patients treated at adult centers.

Recurrences frequently occur following surgical removal of primary tumors. In many cancers, adjuvant therapies have limited efficacy. Surgery provides access to the tumor microenvironment, creating an opportunity for local therapy, in particular immunotherapy, which can induce local and systemic anti-cancer effects. Here, we develop a surgically optimized biodegradable hyaluronic acid-based hydrogel for sustained intraoperative delivery of Toll-like receptor 3 agonist poly(I:C) and demonstrate that it significantly reduces tumor recurrence after surgery in multiple mouse models. Mechanistically, poly(I:C) induces a transient interferon alpha (IFNα) response, reshaping the tumor/wound microenvironment by attracting inflammatory monocytes and depleting regulatory T cells. We demonstrate that a pre-existing IFN signature predicts response to the poly(I:C) hydrogel, which sensitizes tumors to immune checkpoint therapy. The safety, immunogenicity, and surgical feasibility are confirmed in a veterinary trial in canine soft tissue tumors. The surgically optimized poly(I:C)-loaded hydrogel provides a safe and effective approach to prevent cancer recurrence.

Bacillus cereuscan cause serious infections in immunosuppressed patients. This population may be susceptible to B. cereuspneumonia, bacteremia, cellulitis, and rarely cerebral abscess. Here we report an 8-year-old boy undergoing induction therapy for acute lymphoblastic leukemia who developed multifocal B. cereuscerebral abscesses, highlighting the propensity for B. cereusto develop cerebral abscesses. A review of the literature over the past 25 years identified another 11 cases (3 children and 8 adults) of B. cereuscerebral abscess in patients undergoing cancer therapy. B. cereuscerebral abscesses were associated with a high mortality rate (42) and significant morbidity. Notably, B. cereusbacteremia with concomitant cerebral abscess was associated with induction chemotherapy for acute leukemia in both children and adults (10 of 12 case reports). Our case report and review of the literature highlights the propensity for B. cereusto develop cerebral abscess(es). Therefore, early consideration for neuroimaging should be given for any neutropenic cancer patient identified with B. cereusbacteremia, in particular those with acute leukemia during induction therapy.

Enrolled nurses must convert to first-level registration or their job opportunities will be greatly reduced, according to a UKCC report. Nurses can develop their competence by developing a profile that will help to focus on future professional development needs. ENs may have to put forward a case for funding and it is important to ensure that resources are used cost effectively. Conversion should be just one of several ways to develop a nursing career.

Hepatic sinusoidal obstruction syndrome (HSOS), also known as veno-occlusive disease, is a well-recognized toxic complication after autologous and allogeneic hematopoietic stem cell transplant, during treatment of Wilms tumor and rhabdomyosarcoma associated with actinomycin-D, and during acute lymphoblastic leukemia therapy due to oral 6-thioguanine. However, its occurrence in the context of chemotherapy regimens for other childhood malignancies is rare. We report a 5-year-old girl with high-risk anaplastic medulloblastoma, who developed severe HSOS during her second cycle of maintenance chemotherapy, consisting of vincristine, cisplatin, and cyclophosphamide. She was treated with defibrotide with complete resolution of the HSOS. These findings and a review of the literature, highlight the occurrence of HSOS in children outside the established settings of hematopoietic stem cell transplantation, Wilms tumor, rhabdomyosarcoma, and acute lymphoblastic leukemia.

Perilobar nephrogenic rests (NR) are precursor lesions that may display genetic changes similar to their associated Wilms tumor (WT). Two patients presented with WT, both with perilobar NR and 1 with bilateral, multifocal metachronous WT. Both patients' WT displayed monosomy 22 as the predominant cytogenetic change, and the constitutional cytogenetic analysis was normal. The purpose of our study was to identify at what stage in the morphologic progression from NR to WT the monosomy 22 occurred by using a fluorescent in situ hybridization probe for chromosome 22 in the subtypes of perilobar NR and WT present in both cases. Section and core fluorescent in situ hybridization with a chromosome 22 probe was performed on formalin-fixed, paraffin-embedded tissues containing WT and perilobar NR. We also performed fluorescent-based microsatellite analysis on some of the WT in the bilateral case to determine whether there was a preferential loss of the same allele of chromosome 22. Sclerotic and dormant perilobar NR showed a rate of monosomy 22 of only approximately 30%, but this increased to approximately 50% in hyperplastic and adenomatous NR. Monosomy 22 was present in 60%-80% of nuclei in WT. Microsatellite analysis showed loss of homozygosity, with preferential loss of the same allele of chromosome 22 in the tumors examined. There are differences in the rate of detection of monosomy 22 in perilobar NR and WT, suggesting loss of chromosome 22 in the progression of perilobar NR to WT in a subset of tumors.

Approximately 7% of women with breast cancer are diagnosed before the age of 40 years, and this disease accounts for more than 40% of all cancer in women in this age group. Survival rates are worse when compared to those in older women, and multivariate analysis has shown younger age to be an independent predictor of adverse outcome. Inherited syndromes, specifically BRCA1and BRCA2, must be considered when developing treatment algorithms for younger women. Chemotherapy, endocrine, and local therapies have the potential to significantly impact both the physiologic health—including future fertility, premature menopause, and bone health—and the psychological health of young women as they face a diagnosis of breast cancer.

Allogeneic bone marrow transplantation (BMT) without a total body irradiation (TBI) conditioning regimen was investigated in children with juvenile myelomonocytic leukemia (JMML). Eight consecutive patients with JMML (n 6) or monosomy 7 (n 2) underwent BMT at a median age of 20 months. Donor source included fully matched related (n 3), mismatched related (n 2), or fully matched unrelated (n 3). The conditioning regimen included busulfan, cyclophosphamide, and etoposide (VP16) (melphalan was substituted for VP16 in one patient). The first patient in the series underwent TBI. Graft-versus-host disease prophylaxis was with cyclosporin and methotrexate and in vivo T-cell depletion (Campath 1 g) for mismatched and unrelated transplants. Seven and two patients, respectively, received chemotherapy and splenectomy before BMT. At a median follow-up of 48 months after BMT, five patients remained in remission. The overall survival rate was 63 at 5 years. All deaths occurred in patients with refractory disease at the time of BMT. Allogeneic BMT without TBI appears to be effective therapy for JMML and avoids some of the potential late sequelae of TBI in preschool children.

In this article, we describe a technique for obtaining jejunal biopsies endoscopically using an infant Crosby or Watson capsule. The method is quick, safe, and may be particularly useful if radiological screening is unavailable.

The article discusses the creation of the online resource called WebQuest and how it can be used to teach science to students. Topics include a brief description of the online resource, the requirements for the creation of a teacher page and student page in WebQuest, and a summary of the student's interaction in a WebQuest activity.

The article reports on several initiatives made by the Chartered Institute of Environmental Health (CIEH) to prevent infections in motoway cafes. It discusses a range of food safety qualifications provided by the CIEH's awarding body to cover several industry sectors. One important development mentioned was the introduction by Ofqual of the Qualification and Credit Framework (QCF), in which each unit of training is allocated credit that can be put towards awards, diplomas and certificates.

Several letters to the editor are presented in response to the articles published in previous issues, including articles about the rapid methods of chilling cooked foods, light pollution monitoring and welfare services for hoarders.

The article offers an update on the CIEH training. According to the author, the CIEH training division which develops and delivers a range of qualifications through a network of centers in Great Britain and overseas is involved in projects for specific target groups. One project is the safefood for life education programme, which is designed to put fun into learning about food hygiene and offers an online educational resource for teachers.