An extensive literature search was undertaken in April 2015 (20-24), which included UK and non-UK studies since 1999. Inclusion and exclusion criteria were applied to search for studies in which participants included nurse prescribers who practiced in primary or community care settings. Studies that only used a quantitative methodology and those not available in English were excluded. The literature search yielded 124 papers, with 50 papers remaining after the initial screen of full papers against the inclusion/exclusion criteria. The papers were reviewed and graded for their quality, with a further 13 papers excluded. A three-step qualitative analysis technique of metasynthesis was applied to the remaining 37 papers. Identification of similarities and differences enabled first-order interpretations to be identified, which were grouped into broader themes (second-order interpretations) by identifying concepts that applied to two or more studies. Further interpretation through synthesis of translation enabled third-order interpretations to emerge. Findings From the metasynthesis of the 37 papers, nine themes emerged: patient-centred care; benefits to the service; the need for knowledge; professional accountability and boundary setting; safety consciousness; barriers to effective prescribing; role preservation; power-shifts and inter-professional relationships; and culture of prescribing.

Many large companies operate some form of occupational health service (OHS). More companies now require specific evaluative information to justify the continued provision of an in-house OHS. This is in the face of increased pressure to control costs, combined with an awareness that the service itself can induce activity (supplier-induced demand) and could be substituted with health care provided or even funded outside the company. The lack of routinely collected data and the conceptual difficulty in defining and measuring the outcomes of an OHS provide challenges for economic evaluation. A purely human capital approach, where people are valued by their wage rates, is likely to be insufficient, since OHSs have multiple objectives. These objectives include fulfilling statutory obligations, contributing to the creation of a culture of partnership, reduction of potential costs to the company (sickness benefit, production loss, poor performance, litigation, insurance) and providing a suitable environment for the cost-effective reduction of the social and health service costs of illness at work. Evidence is needed to quantify some of these arguments and demonstrate to decision makers the value generated by OHSs. The aim of this paper is to consider the practicality of different economic evaluation methodologies, specifically cost models, contingent valuation (willingness-to-pay) and development of OHS-specific outcome measures. In considering different approaches, we present the results of our research in two UK companies.

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Influenced by the Department of Health’s aim to increase the uptake of the influenza immunization to 70% among those eligible, this study aimed to compare three methods of promoting influenza immunization among over 65 year old patients in a GP practice, and to identify if a particular promotion method was more effective among either of two defined age groups. The sample (n=90) was randomly allocated into three intervention groups, and then subdivided into two age groups. A different subject experimental design was used to compare the groups. Statistical analysis of the data showed no significant difference in influenza immunization uptake between the three intervention groups, or the age-defined sub-groups. However, although not significant at 5% significance level, participants aged 72 years and over showed a greater uptake among those visited by a health professional. The findings suggest that a larger study using the same interventions would produce significant results.

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Competence is a fundamental requirement for health-care practice and not least in relation to prescribing. Practitioners have a responsibility to ensure they are competent and to confirm this competence in order to maintain registration with their professional body. However, it is recognised that self-assessment of competence can be problematic and has potential to be ineffective. This article aims to alert prescribers to some key considerations to enable them to undertake a more effective self-assessment of prescribing practice which not only confirms competence but also supports development.

CLoK Central Lancashire online Knowledge www.clok.uclan.ac.uk Calculation skills: Cardiovascular Disease Cardiovascular disease (CVD) accounts for approximately one third of deaths in England and Wales, with the associated morbidity costing the NHS in England alone almost 8 million pounds in 2010 (NICE, 2014). Modifiable risk factors include hypertension, smoking and raised cholesterol levels. As such, the Joint Formulary Committee (2016) identify that preventative measures, through the use of lipidregulating drugs, should be taken where there is a high risk of developing CVD and to prevent recurrence in those with recognised CVD.