Detailed analysis of medication records suggests a number of areas of medication administration that would benefit from review.

IBS patients' GI and anxiety responses to changes in tryptophan load differ from controls. This suggests a difference in serotonergic functioning between these two groups and provides evidence to support the hypothesis that 5-HT dysfunction is involved in IBS.

Background: Interprofessional facilitators and teachers are regarded as central to the effective delivery of interprofessional education (IPE). As the IPE literature continues to expand, most studies have focused on reporting learner outcomes, with little attention paid to IPE facilitation. However, a number of studies have recently emerged reporting on this phenomenon.Aim: To present a synthesis of qualitative evidence on the facilitation of IPE, using a metaethnographic approach.Methods: Electronic databases and journals were searched for the past 10 years. Of the 2,164 abstracts initially found, 94 full papers were reviewed, and subsequently 12 papers were included. Two researchers independently completed each step in the review process. The quality of these papers was assessed using a modified critical appraisal checklist.Results: Seven key concepts embedded in the included studies were synthesised into three main factors which provided an insight into the nature of IPE facilitation. Specifically, the synthesis found that IPE facilitation is influenced by 'contextual characteristics'; 'facilitator experiences' and 'use of different facilitation strategies'.Conclusions: IPE facilitation is a complex activity affected by contextual, experiential and pedagogical factors. Further research is needed to explore the effects of these factors in IPE.

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Pulmonary colonization by Burkholderia cepacia in cystic fibrosis (CF) may be associated with enhanced deterioration of pulmonary function. This may be due to a more florid host inflammatory response than in colonization by Pseudomonas aeruginosa, leading to greater lung injury.Circulating markers of inflammation were determined during infective exacerbations and periods of clinical stability in an 18 month prospective study in adults with CF colonized by P. aeruginosa (n=41). B. cepacia (n=13) and in adults who intermittently grew B. cepacia (n=6).There were no differences between the levels of the inflammation markers measured in the three groups (P. aeruginosa, B. cepacia, B. cepacia intermittent) at any of the assessment points. When clinically stable, levels of inflammatory markers in all groups were elevated compared to a matched non-CF population, indicating, continuous inflammation and the potential for lung damage between infective exacerbations.This study does not support the hypothesis that pulmonary colonization with Burkholderia cepacia is associated with a heightened inflammatory response compared with Pseudomonas aeruginosa colonization. Eur Respir J 1999; 14: 435±438. Pulmonary colonization by Burkholderia cepacia in cystic fibrosis (CF) may lead to chronic asymptomatic carriage, acceleration of a gradual deterioration in pulmonary function or, a rapid often fatal deterioration with fever, a high peripheral white cell count and progressive consolidation on the chest radiograph [1±3]. The mechanism by which B. cepacia causes pulmonary deterioration is unclear. Although virulence factors have been identified, none appears to account for its pathogenicity [4±6]. Furthermore, in animal models, B. cepacia is less virulent than Pseudomonas aeruginosa and appears to have less potential for tissue invasion [7].The pathogenicity of B. cepacia could be explained by a more vigorous host immune and inflammatory reaction than is provoked by P. aeruginosa. This prospective study, compared measurements of inflammatory markers at the onset and end of infective pulmonary exacerbations and during clinically stable periods in CF patients whose lungs were infected with B. cepacia, with those of a group of severity matched control subjects whose lungs were infected with P. aeruginosa. Patients and methodsA prospective study was conducted over an 18 month period in the Manchester Adult Cystic Fibrosis Unit. Thirteen patients with CF were chronically infected with B. cepacia (growth of the organism in three successive sputum specimens within a 6-month period). All agreed to participate in the study, forming the B. cepacia (BC) group. Patients colonized with P. aeruginosa were invited to participate in the study if their forced expiratory volume in one second (FEV1) % predicted, body mass index and Shwachman score were within the range of the B. cepacia group; 34 such patients formed the P. aeruginosa colonized (PA) group. Patients who grew B. cepacia intermittently, assessed through their sputum, but failed t...

Purpose: This study aimed to explore the patient’s experience of the radiotherapy pathway with a view to improving patient-centred services.Methods: Women’s views about the radiotherapy pathway were gathered through a focus group. Focus groups have been used extensively in qualitative research to gather rich meaningful data. A thematic analysis of the transcript identified areas of importance for the women, which could be used to direct service improvement.Results: Five main themes emerged: information, communication and support, dignity and individualised care, service accessibility and staff relationships. Generally, staff were viewed as professionals and the radiotherapy service well run although women did identify several unmet needs during radiotherapy. Lack of information and perceived time constraints of busy staff was revealed. However women did feel treated with dignity, respect and as individuals. ‘End-of-treatment’ was a particular focus; women felt dedicated time with staff would enable discussion, information giving and support around this vulnerable time. In addition, women felt that communication barriers and time constraints influenced the information and support they experienced during radiotherapy.Conclusion: The use of a focus group enabled service users to identify clear areas for improvement at a local level. Priorities include information, communication and support and the ‘end-of-treatment’.

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