Non-medical prescribing in palliative care: a regional survey

Background: The United Kingdom is considered to be the world leader in nurse prescribing, no other country having the same extended non-medical prescribing rights. Arguably, this growth has outpaced research to evaluate the benefits, particularly in areas of clinical practice where patients have complex co-morbid conditions such as palliative care. This is the first study of non-medical prescribing in palliative care in almost a decade. Aim: To explore the current position of nurse prescribing in palliative care and establish the impact on practice of the 2012 legislative changes. Design: An online survey circulated during May and June 2013. Participants: Nurse members (n = 37) of a regional cancer network palliative care group (61% response rate). Results: While this survey found non-medical prescribers have embraced the 2012 legislative changes and prescribe a wide range of drugs for cancer pain, we also identified scope to improve the transition from qualified to active non-medical prescriber by reducing the time interval between the two. Conclusion: To maximise the economic and clinical benefit of non-medical prescribing, the delay between qualifying as a prescriber and becoming an active prescriber needs to be reduced. Nurses who may be considering training to be a non-medical prescriber may be encouraged by the provision of adequate study leave and support to cover clinical work. Further research should explore the patients' perspective of non-medical prescribing

Applying a lens of temporality to better understand voice about unethical behaviour

The relationship between time and voice about unethical behaviour has been highlighted as a key area for exploration within the voice and silence field (Morrison Annual Review of Organizational Psychology and Organizational Behavior 10:79–107, 2023). Previous studies have made only modest progress in this area, so we present a temporal lens which can act as a guide for others wishing to better understand the role of time and voice. Applying the concept of theory adaptation (Jaakkola AMS Review 10:18–26, 2020), a method which attempts to build on a given field through the application of a new theoretical lens, we begin by reviewing what is known in relation to voice about unethical behaviour specifically. Then we introduce two temporal frameworks, one suggested by Ancona, Okhuysen, and Perlow (Ancona et al. The Academy of Management Review 26:645–663, 2001a; Ancona et al. The Academy of Management Review 26:512–529, 2001b) as a useful way of analysing time in organisations, and a second one by Bansal, Anna, and Wood, (Bansal et al. Academy of Management Review 43:217–241, 2018) focusing on the way organisations include voice into their temporal rhythm. We then draw conclusions about the role of time in relation to voice about unethical behaviour and identify three insights; a) it takes time for voices to generate evidence for unethical behaviour, b) perceptions of unethical behaviour change over time, and c) it is most difficult to voice about unethical behaviour at the time it is most needed. Our recommendations for future avenues of research based on these insights recommend new research designs better suited to explore the relationship between voice and time and a focus on how the formality of voice mechanisms shapes the timing of voice

Exploring the associations of culture with careers and the mediating role of HR practices:A conceptual model

Purpose: The conceptual framework developed in the present study aims to highlight the importance of human resource (HR) practices as a mediator between national culture and employees' careers. Design/methodology/approach: The approach taken is a literature review and the development of a conceptual model. Findings: The paper contributes to the literature by focusing on how culture via HR practices might influence career success. Drawing on Hofstede's cultural dimensions, five propositions are developed regarding the impact of culture on career‐relevant HR practices, and how these practices are likely to influence employee career success. Research limitations/implications: Culture's effect should not be overstated. Looking at the propositions, it is possible that the influence of HR practices on career success is more pronounced than the direct effects of culture on career success. Future work is needed to measure and compare the relative strength of different associations as well as the possibility that other HR dimensions relevant to the study of career success may exist. Originality/value: At a general level, there is ample evidence of the impact of culture on the effectiveness of a variety of individual outcomes. The paper focused on the mediating role of HR practices as opposed to advancing hypotheses about direct relationships between culture and career success

Analysis of nonlinear shear deformations in CFRP and GFRP textile laminates

Carbon fibre-reinforced polymer (CFRP) and glass fibre-reinforced polymer (GFRP) woven composites are widely used in aerospace, automotive and construction components and structures thanks to their lower production costs, higher delamination and impact strengths. They can also be used in various products in sports industry. These products are exposed to different inservice conditions such as large tensile and bending deformations. Composite materials, especially ±45° symmetric laminates subjected to tensile loads, exhibit significant material as well as geometric non-linearity before damage initiation, particularly with respect to shear deformations. Such a nonlinear response needs adequate means of analysis and investigation, the major tools being experimental tests and numerical simulations. This research deals with modelling the nonlinear deformation behaviour of CFRP and GFRP woven laminates subjected to in-plane tensile loads. The mechanical behaviour of woven laminates is modelled using nonlinear elasto-plastic as well as material models for fabrics in commercial finite-element code Abaqus. A series of tensile tests is carried out to obtain an in-plane full-field strain response of [+45/-45]2s CFRP and GFRP laminates using digital image correlation technique according to ASTM D3518/D3518M-94. The obtained results of simulations are in good agreement with experimental data

The effects of surface mixers on stratification, dissolved oxygen, and cyanobacteria in a shallow eutrophic reservoir

Top-down surface mixers are increasingly used in drinking water reservoirs to prevent the development of stratification, control cyanobacteria, and limit sediment release of soluble manganese. A targeted field investigation enabled the discrimination of artificial mixing by surface mixers from wind and convection in a shallow (6.6 m), eutrophic drinking water reservoir. Top-down surface mixers were effective at reducing vertical temperature and dissolved oxygen gradients over a 20 m radius, within which turbulent kinetic energy (TKE) input from the mixers exceeded the maximum TKE contribution from wind and convection. Meteorological conditions appeared to have a stronger influence beyond a 60 m radius from the mixers. Near-bed velocities measured using an Acoustic Doppler Velocimeter (ADV) ∼ 30 m north of the mixers were significantly lower when the mixers were not operating; when operating, ADV signal amplitude showed localized sediment resuspension. Cyanobacteria cell counts were high throughout the reservoir but counts of low-light adapted Planktothrix sp. were highest near the mixers, indicating mixer operation may improve growing conditions for Planktothrix. While the destratification goal of mixers was accomplished locally, the limited range of influence left >90% of the reservoir subject to diurnal stratification, anoxia, and potential internal loading of inorganic nutrients and soluble metals, restricting mixer effectiveness as an in-reservoir management technique to improve raw water quality in shallow systems

The impact of a supplementary medication review and counselling service within the oncology outpatient setting

The impact on the care of breast cancer patients, of a pharmacy technician-led medication review and counselling clinic, provided in an outpatient setting, was investigated using a controlled randomised study. Compared to the controls, clinic patients showed a significantly improved level of understanding of their chemotherapy support medication (95% CI for difference in mean knowledge rating scores=2.165–2.826, P<0.001) and a significant reduction in the median number of support items required (two compared to five in the control, P<0.001). This resulted in a significant reduction in mean medication expenditure per patient (£26.70 vs £10.20, 95% CI for the mean difference in cost £6.72–£26.26, P<0.001). The clinic was also associated with significant reductions in chemotherapy delays (P<0.001) and dose reductions due to side effects (P=0.003). Other benefits from the clinic were a reduction in pharmacy dispensing time and a highly significant reduction in pharmacy time spent resolving post-clinic prescription queries (P<0.001). Taking into account the initial technician training cost, the scheme represented an annual saving to the Trust of over £15 000. The clinic serves as a model for those wishing to improve outpatient services to breast cancer patients

The Ties that Double Bind Us: Career, Emotion and Narrative Coping in Difficult Working Relationships

This article examines through an autoethnographic account how career aspirations and constraints may lead individuals to endure emotionally aversive situations. It presents evidence that individuals in such situations engage in emotion‐focused coping through narrative, illustrated by the author’s autoethnographic narrative of a difficult working relationship which developed into a double bind situation. The paper suggests that narrative coping in response to a double bind can actually serve to reify and prolong such situations. The paper concludes that autoethnographic research does not lend itself to simple organisational solutions. Possible avenues for further research are outlined and discussed

Qualitative study on the implementation of professional pharmacy services in Australian community pharmacies using framework analysis

Abbreviations: BCT, Behavioural change techniques taxonomy; BCW, Behavioural change wheel; CFIR, Consolidated framework for implementation research; EPOC, Cochrane effective practice and organisation of care; FISpH, Framework for the implementation of services in pharmacy; GIF, Generic implementation framework; KPI, Key performance indicator; TDF, Theoretical domains frameworkBackground: Multiple studies have explored the implementation process and influences, however it appears there is no study investigating these influences across the stages of implementation. Community pharmacy is attempting to implement professional services (pharmaceutical care and other health services). The use of implementation theory may assist the achievement of widespread provision, support and integration. The objective was to investigate professional service implementation in community pharmacy to contextualise and advance the concepts of a generic implementation framework previously published. Methods: Purposeful sampling was used to investigate implementation across a range of levels of implementation in community pharmacies in Australia. Twenty-five semi-structured interviews were conducted and analysed using a framework methodology. Data was charted using implementation stages as overarching themes and each stage was thematically analysed, to investigate the implementation process, the influences and their relationships. Secondary analyses were performed of the factors (barriers and facilitators) using an adapted version of the Consolidated Framework for Implementation Research (CFIR), and implementation strategies and interventions, using the Expert Recommendations for Implementing Change (ERIC) discrete implementation strategy compilation. Results: Six stages emerged, labelled as development or discovery, exploration, preparation, testing, operation and sustainability. Within the stages, a range of implementation activities/steps and five overarching influences (pharmacys' direction and impetus, internal communication, staffing, community fit and support) were identified. The stages and activities were not applied strictly in a linear fashion. There was a trend towards the greater the number of activities considered, the greater the apparent integration into the pharmacy organization. Implementation factors varied over the implementation stages, and additional factors were added to the CFIR list and definitions modified/contextualised for pharmacy. Implementation strategies employed by pharmacies varied widely. Evaluations were lacking. Conclusions: The process of implementation and five overarching influences of professional services implementation in community pharmacy have been outlined. Framework analysis revealed, outside of the five overarching influences, factors influencing implementation varied across the implementation stages. It is proposed at each stage, for each domain, the factors, strategies and evaluations should be considered. The Framework for the Implementation of Services in Pharmacy incorporates the contextualisation of implementation science for pharmacy.The study was funded as part of a University of Technology Sydney (UTS) Research Excellence Scholarship (RES), comprising of an Australian Postgraduate Award (APA) Scholarship funded by the Australian Government, plus a Top-up funded by the University of Technology Sydney, received from the primary author (JCM)

Dynamic 3D shape of the plantar surface of the foot using coded structured light:a technical report

The foot provides a crucial contribution to the balance and stability of the musculoskeletal system, and accurate foot measurements are important in applications such as designing custom insoles/footwear. With better understanding of the dynamic behavior of the foot, dynamic foot reconstruction techniques are surfacing as useful ways to properly measure the shape of the foot. This paper presents a novel design and implementation of a structured-light prototype system providing dense three dimensional (3D) measurements of the foot in motion. The input to the system is a video sequence of a foot during a single step; the output is a 3D reconstruction of the plantar surface of the foot for each frame of the input. Methods Engineering and clinical tests were carried out to test the accuracy and repeatability of the system. Accuracy experiments involved imaging a planar surface from different orientations and elevations and measuring the fitting errors of the data to a plane. Repeatability experiments were done using reconstructions from 27 different subjects, where for each one both right and left feet were reconstructed in static and dynamic conditions over two different days. Results The static accuracy of the system was found to be 0.3 mm with planar test objects. In tests with real feet, the system proved repeatable, with reconstruction differences between trials one week apart averaging 2.4 mm (static case) and 2.8 mm (dynamic case). Conclusion The results obtained in the experiments show positive accuracy and repeatability results when compared to current literature. The design also shows to be superior to the systems available in the literature in several factors. Further studies need to be done to quantify the reliability of the system in clinical environment