'Inappropriate prescribing of preventative medication in patients with life-limiting illness : a systematic review.', BMJ supportive and palliative care., 7 (2). pp. 113-121. Further information on publisher's website: Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. Methods:A systematic literature search of four databases was undertaken (Medline, Embase, CINAHL, PsycINFO) from inception to April 2015 to identify peer-reviewed, observational studies assessing inappropriate prescribing of preventative medication in patients with life limiting illness.Inclusion criteria were: participants had a life limiting illness; prescribed/dispensed/using preventative medication; medication appropriateness assessed as a specific study aim or outcome. Results:We found 19 studies meeting our eligibility criteria. The methods used to assess medication appropriateness included criteria developed for the elderly such as the Beers criteria, and STOPP criteria, Delphi consensus and expert clinical opinion. Lipid regulating drugs (12 studies),antihypertensive (11 studies) and anti-diabetic medications (9 studies) were the most common classes of inappropriate medication identified. Conclusion:Patients with life limiting illnesses are prescribed preventative medications considered inappropriate in the context of diminished life expectancy. The way in which preventative medication appropriateness is assessed in patients with life limiting illness varies considerably -with some methodologies utilising criteria previously developed for elderly populations. Given this lack of standardisation, improving the prescribing in this context requires an approach that is specifically designed and validated for populations with life limiting illness.3
Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details.
BackgroundIn 2003, the National Health Service in England and Wales, despite its large investment in information and communication technology, had not set a national research agenda. The National Health Service has three main research and development programs: one is the Service Delivery and Organisation program, commissioned in 2003, and the others are two parallel “scoping exercises” to help set a research agenda. This paper reports on one of those projects. A parallel literature review was carried out by others and has been reported elsewhere.ObjectiveThe objective was to explore the concerns of stakeholders and to review relevant policy in order to produce recommendations and a conceptual map of eHealth research.MethodsThere were two parallel strands. For the stakeholder consultation, 37 professionals representing 12 “stakeholder” groups participated in focus groups or interviews. Discussion was prompted by eHealth “scenarios” and analyzed using thematic content analysis. Subsequently, 17 lay participants, in three focus groups, discussed and prioritized these themes. For the policy review, 26 policy makers were interviewed, and 95 policy documents were reviewed. Recommendations were subsequently reviewed in a conference workshop. Recommendations for research from both strands were combined into a conceptual map.ResultsThemes from stakeholder consultation and policy review were combined as 43 recommendations under six headings. Four of these headings (using, processing, sharing, and controlling information) describe the scope of eHealth research. The other two relate to how research should be carried out (ensuring best practice is first identified and disseminated) and to the values considered important by stakeholders (in particular, measuring improvement in health).ConclusionsThe scope of eHealth research (using, processing, sharing, controlling information) derived empirically from this study corresponds with “textbook” descriptions of informatics. Stakeholders would like eHealth research to include outcomes such as improved health or quality of life, but such research may be long term while changes in information technology are rapid. Longer-term research questions need to be concerned with human behavior and our use of information, rather than particular technologies. In some cases, “modelling” longer-term costs and benefits (in terms of health) may be desirable.
. (2015) 'Widening the scope for early cancer detection : identication of alarm symptoms by community pharmacies.', International journal of clinical pharmacy., 37 (3). pp. 465-470. Further information on publisher's website:http://dx.doi.org/10.1007/s11096-015-0078-3Publisher's copyright statement:The nal publication is available at Springer via http://dx.doi.org/10.1007/s11096-015-0078-3.Additional information: Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details.
Directors of nursing can help focus trust board meetings on clinical matters. Further research is required to determine whether greater clinical content in trust board meetings has impacts on clinical practice or organizational performance.
IntroductionThe management of minor conditions represents a significant burden for urgent and emergency care services and reduces the capacity to provide specialist care for higher acuity healthcare need. A pilot Digital Minor Illness Service (DMIRS) was commenced in the North East of England in December 2017 to feasibility test the NHS 111 referral to community pharmacy for patients presenting with minor conditions. ObjectivesA formative evaluation of the service activity data and qualitative investigation of stakeholders involved in the service design, management, delivery and use, aims to present and investigate the service outcomes. MethodRoutine service activity data was evaluated during Jan-Dec 2018 to investigate the demographics of patients included in the service; the presenting conditions; and how those referrals were managed by community pharmacies. Semi-structured interviews with NHS 111 call handlers, project team members, community pharmacists and patients were undertaken to investigate the design, management, implementation and delivery of the service. Results13,246 NHS 111 patient calls were referred to community pharmacy during the evaluative period. The most common presenting conditions were acute pain (n = 1144, 8.6%) and cough (n = 887, 6.7%). A large volume of complaints (47.1%, 6233) were resolved in community pharmacy. Stakeholders explained the structured approach to service design, PLOS ONEData Availability Statement: The data underlying the results is included in the supporting materials organisation and implementation facilitated successful delivery and management. Patients reported positive experiences with accessing care via DMIRS. ConclusionsDMIRS demonstrated that patients could be referred to community pharmacy for the management of minor conditions, shifting a burden away from urgent and emergency care. The service data provides key information for further optimisation of service design, and stakeholder training and awareness. The service was acceptable and valued by patients. Evidence from the DMIRS pilot has been utilised to inform recent national healthcare policy and practice around the management of minor conditions within the urgent and emergency care setting.
Objective. To describe the implementation of and student pharmacist experience with high-fidelity training in medication dispensing and clinical checking processes and procedures. Methods. An actual dispensary in a large teaching hospital was used as the setting in which to provide undergraduate student pharmacists the opportunity to develop skills and knowledge regarding the process and procedures of medication dispensing and clinical checking. The sessions were facilitated by a member of the hospital pharmacy team and overseen by a faculty member. Students were required to conduct legal and clinical checks and process anonymized hospital prescriptions. Students recorded their experiences in their professional portfolio as blog entries, which were then discussed with academic staff members on a biweekly basis. Content analysis of the blogs was conducted to investigate the student experience. Results. Forty-eight students attended 30 hours of dispensing sessions over a 20-week period from September to April. Content analysis of 102 blog entries demonstrated students reporting observations and experiences which mapped to the three components of communities of practice: the domain of pharmacy practice, the working dynamics of a community of professionals within the workplace, and the commonality of practice and shared repertoire of resources. Conclusion. The high-fidelity teaching of students about the dispensing and checking process in an actual dispensary environment supports student pharmacists' knowledge and skills development. The work-based nature of this approach also provides experiential learning opportunities for students to observe and participate in the professional community of practice.
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