Aim Polypharmacy exists in children and young people (CYP), generates clinician concern and a desire to undertake deprescribing, tempered by concerns about parental acceptability. The aim of this study was to validate and apply a questionnaire to assess the attitudes of CYP and their parents/guardians towards polypharmacy and deprescribing. Methods A paediatric version of the Revised Patient Attitudes Towards Deprescribing (rPATD) was developed – the Child and Parent Attitudes Towards Deprescribing (CHATD) questionnaire. Validation steps included: Content evaluation panel, face validity (piloting), factor analysis, internal reliability and test re-test reliability. Participants were prospectively recruited from three UK paediatric hospitals. The questionnaire includes two global questions and four factors concerning participants medications: burden, appropriateness, concerns about stopping, and involvement. Results 216 participant responses were analysed (149 parents, 67 CYP). Factor analysis showed the CHATD questionnaire aligned well with the underlying structure of the rPATD with good internal reliability and test-retest reliability. In comparison to their parents, CYP felt their medications were more burdensome (3.0 vs 2.4, p=0.003), less appropriate (3.6 vs 4.2 p=0.008) and wanted and experienced less involvement (3.8 vs 4.8 p<0.001). Most parents (70%) and 55% of CYPs were happy to have a medication deprescribed if the doctor agreed. Conclusions The CHATD questionnaire is a valid, reliable tool for assessing deprescribing attitudes among children, young people, and parents. Whilst CYP and their parents showed some concern over the stopping of their medications, most parents and CYP were willing to have a medication deprescribed under the guidance of their doctor.

Introduction: Heart failure (HF) is a complex condition often accompanied by comorbidities such as renal dysfunction, diabetes mellitus (DM), chronic respiratory diseases, frailty, and anaemia, necessitating intricate management involving multiple therapeutics. Objectives: This retrospective cohort study aims to characterize prescribing patterns and identify potentially inappropriate polypharmacy in individuals with HF and multimorbidity. Methods: Data was collected from 234 HF adults with multimorbidity under the care of the HF multidisciplinary team at Liverpool University Hospital Foundation Trust (LUHFT) from January 2020 -February 2021. Results: The mean age was 71.5±13.9 and 44% were female. ACCI was 6.9±3.3, CFS was 5.5±3.2, polypharmacy burden was high at 10.2±3.9, and ACB was 1.45±0.9. ACB was higher in those with CFS≥6 vs. those with CFS<6 (1.5±1.1 vs. 1.1±0.9; p=0.02). The proportion of adults with HF on treatment for depression was 19.7%, chronic pain 35%, and chronic constipation 19.7%. Fifteen percent received oral iron instead of the appropriate intravenous iron replacement, while 17.9% of the cohort were observed to be nearing the end of their lives. Regarding PIM use, 9% were on either DAPT/anticoagulant plus anti-platelet therapy beyond 12 months of an acute coronary event. One in five patients received PPIs without clear justification. Conclusion: Adults with frailty and HF have a higher ACB. This study identifies targets for de-prescribing interventions in HF, including inappropriate PPI and DAPT/anticoagulant plus anti-platelet therapy, which are seeing in 1:5 and 1:10 adults with HF in the clinic, respectively. Tailored guidelines can aid shared decision-making, reducing drug-related complications in this group.

Phase 1 clinical drug trials critically depend on the participation of healthy volunteers to evaluate the safety and pharmacokinetics of new medicinal products. Current selection criteria and health definitions often overlook the unique health profiles of transgender and nonbinary individuals, potentially excluding them from participating in these essential early-stage studies. This review aims to identify and discuss current knowledge gaps and considerations regarding the inclusion of transgender and nonbinary participants in Phase 1 clinical drug trials. We highlight the need for research on how gender-affirming hormone therapy may affect drug pharmacokinetics and call for the development of inclusive biological reference ranges that account for the physiological effects of hormone therapies.