IntroductionPoor medication adherence is common in children and adolescents with chronic illness, but there is uncertainty about the best way to enhance medication adherence in this group. The authors conducted a systematic review of controlled trials examining interventions that aim to improve medication adherence. Method A comprehensive literature search was undertaken to locate controlled trials that described specifi c interventions aiming to improve adherence to long-term medication, where participants were aged 18 years and under, medication adherence was reported as an outcome measure, and which could be implemented by individual health practitioners. Studies were reviewed for quality and outcome. Results 17 studies met inclusion criteria: seven studies examined educational strategies, seven studies examined behavioural interventions and three studies examined educational intervention combined with other forms of psychological therapies. Only two of seven studies reported a clear benefi t for education on medication adherence, whereas four of seven trials indicated a benefi t of behavioural approaches on medication adherence. One trial reported that combining education with behavioural management may be more effective than education alone. Studies which combined education with other non-medication specifi c psychological interventions failed to demonstrate a benefi cial effect on medication adherence. Only two studies examined adherencepromoting interventions in young people with established adherence problems. Conclusion These fi ndings suggest that education interventions alone are insuffi cient to promote adherence in children and adolescents, and that incorporating a behavioural component to adherence interventions may increase potential effi cacy. Future research should examine interventions in high-risk groups. INTRODUCTIONAdherence has been defi ned as 'the extent to which a person's behaviour corresponds with agreed recommendations from a healthcare provider'. 1 Medication adherence refers to the degree to which the medications taken refl ect the prescriber's intention. 2 3 Poor medication adherence is common, especially in chronic illness, 1 3 4 and is associated with poorer outcomes. 3 5 6 Interventions to promote adherence may be effective, although benefi ts are not consistently demonstrated across studies. 4 A systematic review of interventions to enhance medication adherence in children and adolescents with chronic illness Angela J Dean, 1-3 Julie Walters, 4 Anthony Hall 4,5Most existing reviews of adherence-promoting interventions have focused on adults. However, many young people experience chronic illness 7 8 and poor medication adherence. 9-12 Involvement of families in medication routines, 12 13 and varying developmental capacities of children and adolescents 11 12 14 15 may infl uence medication adherence, reinforcing the need to identify interventions with demonstrated effi cacy in young people rather than translating fi ndings from adult research. 9 11 A review of interven...

Background:The inconsistent definition of non-therapeutic medication omissions, under-reporting, and a poor understanding of their associated factors hamper efforts to improve medication administration practices. Aim: To examine the incidence of non-therapeutic medication omissions among acutely ill medical and surgical adult patients; and to identify the patient-, drug-and system-related predictors of these omissions. Method: A medication chart audit of 288 acutely ill adult medical and surgical patients admitted to 4 target wards (2 surgical and 2 medical) at an Australian hospital. Patients admitted to these wards from December 2008 to November 2009, with at least one regularly prescribed medication, were eligible. The sample was stratified according to gender, season and ward. A medication chart audit identified medication omissions, and data were collected on gender, age, length of stay, comorbidities, medication history and clinical pharmacy review. Results: Of the 288 medication charts audited, 220 (75%) had one or more medication omissions. Of the 15 020 medication administration episodes, there were 1687 omissions, resulting in an omission rate per medication administration episode of 11%. Analgesics and aperients were the most frequently omitted medications, with failure to sign the medication record and patient refusal, the main reasons for omission. Female gender (p < 0.001) and the number of medication administration episodes (p < 0.001) were statistically significant predictors of non-therapeutic medication omissions. Conclusion: The high incidence of medication omissions suggests there is need for an agreed definition of medication omission and its inclusion as a reportable incident. Increasing medication reconciliation via implementation of the Medication Management Plan may also reduce the opportunity for error. J Pharm Pract Res 2011; 41: 188-91.

Although a substantial backyard might be considered an iconic Australian feature, by the late 1990s, almost all new suburban houses had minimal provision of soft-landscaped private open space. This paper presents results of research that has investigated important aspects of this phenomenon. It has measured the changes on a sample basis and has attempted to relate the changes to their planning policy context. The environmental significance has been assessed in relation to the literature. Quantitative analyses of examples from older and newer suburban form are presented. They indicate that this is happening irrespective of size of lot and appears connected with a trend to larger dwellings in relation to the lots area. It represents a loss that has serious ecological implications for the community as a whole, including a significant reduction in biodiversity, sustainable drainage and a beneficent microclimate, in addition to lower standards of domestic amenity. It does not appear that the reduction in size is being required by planning polices. Planning codes, while not actually encouraging the trend, do nothing to prevent it. The phenomenon is to be found even under progressive planning regimes and in nearly all masterplanned estates.

TX 75083-3836, U.S.A., fax 01-972-952-9435. AbstractOver the last two years Noble Denton has been undertaking a Joint Industry Project (JIP) to investigate how to improve the integrity of the moorings used by Floating Production Systems (FPSs). The JIP has surveyed the world wide performance of all types of FPS mooring systems including FPSOs, semi submersible production units and Spars. Wide ranging support from 23 sponsoring organizations including operators, floating production contractors, regulatory authorities, equipment suppliers and inspection companies has enabled access to a significant pool of data. This paper utilizes the JIP data to discuss the following:• Causes of system degradation • Consequences of mooring failure • Key areas to check on a mooring system • Fatigue implications of friction induced bending • Options for in-water inspection • The importance of connector design • Methods to detect line failure • Contingency planning A few pioneering floating production units have now been on station for many years. Review of inspection data from these units shows that selective repair may be needed to maintain the design specification right up to the end of the operational life. It has been found that wear can be faster on leeside, as opposed to windward lines and that certain weighted chain designs are susceptible to damage.The likelihood of line failure and the implications need to be better appreciated. Following failure, it may well take several months to implement a full repair, due to a lack of spares/procedures and possible non-availability of suitable vessels. However, it has been found that carefully planned and coordinated inspection operations can detect potential issues early on before more serious deterioration takes place. In general, mooring monitoring/instrumentation and access for in-water inspection seem not to be as advanced as might be expected for a system which is safety critical. Hence good practice recommendations are included which can be applied to both existing and planned future units.

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