Optimizing patient education of oncology medications: A descriptive survey of pharmacist-provided patient education in Canada.

BACKGROUND: The incidence of cancer is increasing in Canada due to an aging and growing population. This frequently necessitates chemotherapy, which is a high-risk treatment, often given as a part of a complex regimen with serious side effects. A review of the evidence of pharmacy-provided patient education initiatives targeted to oncology patients revealed that minimal is known about this service. OBJECTIVE: The objective of this study was to determine the different models of patient education of oncology medications delivered by pharmacists to adult oncology patients in a hospital or cancer center in Canada. METHODS: The study design was a descriptive online survey developed by the investigation team and was distributed to pharmacists who provided patient education to adult oncology patients. The primary outcome of this research project was to describe self-reported pharmacist-provided patient education of oncology medications across Canada. The survey data was analyzed quantitatively with Opinio survey software. RESULTS: Sixty-four pharmacists completed the survey. Key findings of the study were that approximately 50% of pharmacists spend up to 25% of their time providing direct patient care and that not all adult oncology patients are receiving education by a pharmacist. CONCLUSIONS: Pharmacists provide patient education at the first treatment, change in therapy, and on request of another healthcare professional. Most cover administration, side effects, their prevention and management, and drug-interactions. Frequently used teaching methods include structured patient education delivery process, customized teaching for each patient, and repetition of key educational points.

Alterations of the glutathione redox state improve apical meristem structure and somatic embryo quality in white spruce (Picea glauca).

In white spruce, an improvement of somatic embryo number and quality can be achieved through experimental manipulations of the endogenous levels of reduced (GSH) and oxidized (GSSG) glutathione. An optimal protocol for embryo production included an initial application of GSH in the maturation medium, followed by replacement with GSSG during the remaining maturation period. Under these conditions, the overall embryo population more than doubled, and the percentage of fully developed embryos increased from 22% to almost 70%. These embryos showed improved post-embryonic growth and conversion frequency. Structural studies revealed remarkable differences between embryo types, especially in storage product deposition pattern and organization of the shoot apical meristem (SAM). Compared with their control counterparts, glutathione-treated embryos accumulated a larger amount of starch during the early stages of development, and more protein and lipid bodies during the second half of development. Differences were also noted in the organization of SAMs. Shoot meristems of control embryos were poorly organized and were characterized by the presence of intercellular spaces, which caused separation of the subapical cells. Glutathione-treated embryos had well-organized meristems composed of tightly packed cells which lack large vacuoles. The improved organization of the shoot apical meristems in treated embryos was ascribed to a lower production of ethylene. Differences in meristem structure between control and treated embryos were also related to the localization pattern of HBK1, a shoot apical meristem 'molecular marker' gene with preferential expression to the meristematic cells of the shoot pole. Expression of this gene, which was localized to the apical cells in control embryos, was extended to the subapical cells of treated embryos. Overall, it appears that meristem integrity and embryo quality are under the direct control of the glutathione redox state.