Polypharmacy in elderly cancer patients : challenges and the way clinical pharmacists can contribute in resource-limited settings

The aim of this study was to address the problems associated with polypharmacy in elderly cancer patients and to highlight the role of pharmacists in such cases in resource‐limited settings. A narrative review of existing literature was performed to summarize the evidence regarding the impact of polypharmacy in elderly cancer patients and the pharmaceutical strategies to manage it. This review emphasizes the significance of polypharmacy, which is often ignored in real clinical practice. Polypharmacy in the elderly cancer population is mainly due to: chemotherapy with one or more neoplastic agents for cancer treatment, treatment for adverse drug reactions due to neoplastic agents, the patient's comorbid conditions, or drug interactions. The role of the clinical pharmacist in specialized oncology hospitals or oncology departments of tertiary care hospitals is well established; however, this is not the case in many developing countries. A clinical pharmacist can contribute to solving the problems associated with polypharmacy by identifying the risks associated with polypharmacy and its management in resource‐limited settings. As in many developed countries, the involvement of a clinical pharmacist in cancer care for elderly patients may play a vital role in the recognition and management of polypharmacy‐related problems. Further research can be conducted to support this role

Single mode, extreme precision Doppler spectrographs

The 'holy grail' of exoplanet research today is the detection of an earth-like planet: a rocky planet in the habitable zone around a main-sequence star. Extremely precise Doppler spectroscopy is an indispensable tool to find and characterize earth-like planets; however, to find these planets around solar-type stars, we need nearly one order of magnitude better radial velocity (RV) precision than the best current spectrographs provide. Recent developments in astrophotonics (Bland-Hawthorn & Horton 2006, Bland-Hawthorn et al. 2010) and adaptive optics (AO) enable single mode fiber (SMF) fed, high resolution spectrographs, which can realize the next step in precision. SMF feeds have intrinsic advantages over multimode fiber or slit coupled spectrographs: The intensity distribution at the fiber exit is extremely stable, and as a result the line spread function of a well-designed spectrograph is fully decoupled from input coupling conditions, like guiding or seeing variations (Ihle et al. 2010). Modal noise, a limiting factor in current multimode fiber fed instruments (Baudrand & Walker 2001), can be eliminated by proper design, and the diffraction limited input to the spectrograph allows for very compact instrument designs, which provide excellent optomechanical stability. A SMF is the ideal interface for new, very precise wavelength calibrators, like laser frequency combs (Steinmetz et al. 2008, Osterman et al. 2012), or SMF based Fabry-Perot Etalons (Halverson et al. 2012). At near infrared wavelengths, these technologies are ready to be implemented in on-sky instruments, or already in use. We discuss a novel concept for such a spectrograph.Comment: IAU Proceedings, General Assembly 2012. 4 page