IntroductionCommunity pharmacists and their teams have remained accessible to the public providing essential services despite immense pressures during the COVID-19 pandemic. They have successfully expanded the influenza vaccination programme and are now supporting the delivery of the COVID-19 vaccination roll-out.AimThis rapid realist review aims to understand how community pharmacy can most effectively deliver essential and advanced services, with a focus on vaccination, during the pandemic and in the future.MethodAn embryonic programme theory was generated using four diverse and complementary documents along with the expertise of the project team. Academic databases, preprint services and grey literature were searched and screened for documents meeting our inclusion criteria. The data were extracted from 103 documents to develop and refine a programme theory using a realist logic of analysis. Our analysis generated 13 context-mechanism-outcome configurations explaining when, why and how community pharmacy can support public health vaccination campaigns, maintain essential services during pandemics and capitalise on opportunities for expanded, sustainable public health service roles. The views of stakeholders including pharmacy users, pharmacists, pharmacy teams and other healthcare professionals were sought throughout to refine the 13 explanatory configurations.ResultsThe 13 context-mechanism-outcome configurations are organised according to decision makers, community pharmacy teams and community pharmacy users as key actors. Review findings include: supporting a clear role for community pharmacies in public health; clarifying pharmacists’ legal and professional liabilities; involving pharmacy teams in service specification design; providing suitable guidance, adequate compensation and resources; and leveraging accessible, convenient locations of community pharmacy.DiscussionCommunity pharmacy has been able to offer key services during the pandemic. Decision makers must endorse, articulate and support a clear public health role for community pharmacy. We provide key recommendations for decision makers to optimise such a role during these unprecedented times and in the future.

Objective Chronic pain due to osteoarthritis (OA) is a major clinical problem, and existing analgesics often have limited beneficial effects and/or adverse effects, necessitating the development of novel therapies. Epoxyeicosatrienoic acids (EETs) are endogenous antiinflammatory mediators, rapidly metabolized by soluble epoxide hydrolase (EH) to dihydroxyeicosatrienoic acids (DHETs). We undertook this study to assess whether soluble EH–driven metabolism of EETs to DHETs plays a critical role in chronic joint pain associated with OA and provides a new target for treatment. Methods Potential associations of chronic knee pain with single‐nucleotide polymorphisms (SNPs) in the gene‐encoding soluble EH and with circulating levels of EETs and DHETs were investigated in human subjects. A surgically induced murine model of OA was used to determine the effects of both acute and chronic selective inhibition of soluble EH by N‐[1‐(1‐oxopropy)‐4‐piperidinyl]‐N′‐(trifluoromethoxy)phenyl]‐urea (TPPU) on weight‐bearing asymmetry, hind paw withdrawal thresholds, joint histology, and circulating concentrations of EETs and DHETs. Results In human subjects with chronic knee pain, 3 pain measures were associated with SNPs of the soluble EH gene EPHX2, and in 2 separate cohorts of subjects, circulating levels of EETs and DHETs were also associated with 3 pain measures. In the murine OA model, systemic administration of TPPU both acutely and chronically reversed established pain behaviors and decreased circulating levels of 8,9‐DHET and 14,15‐DHET. EET levels were unchanged by TPPU administration. Conclusion Our novel findings support a role of soluble EH in OA pain and suggest that inhibition of soluble EH and protection of endogenous EETs from catabolism represents a potential new therapeutic target for OA pain.

Our national survey demonstrates increased use of medical and laparoscopic management of ectopic pregnancy in the UK. In the UK in 2000, 35% of cases were managed by laparoscopy, 63% by laparotomy and 1% with medication. A recent review in the USA revealed increasing rates of medical management and decreasing rates of laparotomy; a trend driven by both cost-effectiveness and patient choice. A total of 119 early pregnancy units were surveyed regarding the nature and management of the three most recent cases of ectopic pregnancy; in addition, feasibility of training residents was also requested. Participants reported on 124 cases with a median of five cases per month per department. A total of 57% of cases were managed laparoscopically, 31% medically, 5% by laparotomy and 6% conservatively. Out of 44 centres, 29 have the facilities for training in both intermediate laparoscopic surgery and early pregnancy ultrasound.

Key Content Cervical cancer is the commonest gynaecological malignancy diagnosed in pregnancy. Cancer symptoms may mimic complications of pregnancy, thus delaying diagnosis. Staging of cervical cancer in pregnancy is essential to determine an individual management plan. Treatment of cervical cancer in pregnancy is complex and depends on the stage of cancer and the gestation of the pregnancy. Involvement of a multidisciplinary team is essential in the care of a woman with cervical cancer in pregnancy. Learning Objectives To understand how to diagnose, stage and treat cervical cancer in pregnancy. To know the risks to the fetus in each trimester, with regard to the various surgical and chemotherapeutic options available to treat cervical cancer in pregnancy. To understand the psychological effects on a woman of a cancer diagnosis in pregnancy. Ethical Issues How should maternal and fetal risks be balanced while investigating and treating cervical cancer in pregnancy? Consideration of termination of pregnancy to allow timely treatment, alternatively risking delay in treatment and progression of disease.

Ovarian torsion may have significant fertility implications. Interleukin-6 is a pro-inflammatory cytokine, which may act as a helpful diagnostic test. Our objective was to investigate the accuracy of serum interleukin-6 in the diagnosis of ovarian torsion in women with ultrasonographic evidence of an ovarian cyst. An electronic search of published data, unpublished dissertations, theses and conference proceedings was performed. The systematic review involved observational studies. The studies had to provide data to construct 2 × 2 tables. A modified QUADAS tool was used to assess the quality of studies. Sensitivity, specificity, positive and negative predictive value, likelihood ratios and diagnostic odds ratios were calculated. Three studies were identified. Two were included in the meta-analysis. The prevalence of torsion was 30% (21/70). The pooled sensitivity was 85.1% and the pooled specificity was 84.1%. Although further cohort studies would be required, there may be a role for interleukin-6 in the diagnosis of ovarian torsion.

A web-based survey was e-mailed to all specialty trainees ST Years 3-7 (n = 773) to assess their competence in emergency laparoscopic procedures. The trainees were asked about their competence level in a diagnostic laparoscopy; a salpingectomy; a salpingotomy; and an oophorectomy/cystectomy for adnexal torsion. Subsequently, they were asked how they would manage a tubal ectopic pregnancy with contralateral tubal disease. We received 202 responses (26%) and of these: 79% of trainees can perform a diagnostic laparoscopy independently; 32% can perform a salpingectomy and 12% can perform a salpingotomy independently; 14% can manage an adnexal torsion without supervision.

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Purpose – Recent years have seen the advocacy of person-centred approaches to dementia care. An important component of this approach has been the use of arts in the promotion of health and well-being. However, relatively little attention has been given to the barriers and facilitators experienced in trying to implement these types of interventions in a dementia care setting. It is therefore, the purpose of this paper is to help to redress this neglect by examining the process of implementing a personalised musical intervention for the clients of a specialist dementia home care service. Design/methodology/approach – Drawing on interviews with five project stakeholders, the paper examines, not only the potential benefits to be gained from the musical intervention but also identifies the barriers experienced in its implementation and ways in which they could be overcome. Findings – It was found that although the musical intervention had a potentially positive impact, there were multi-levelled barriers to its implementation including issues of training, leadership as well as contextual issues such as commissioning and resourcing more generally. Originality/value – The key role played by these issues in the process of implementation suggests that practice should transcend its focus on individual wellbeing and address the wider factors that can facilitate or prevent its fulfilment. While the multi-levelled nature of the obstacles identified suggest that the implementation of innovative interventions within health and social care settings should adopt a similarly eclectic approach.