Stressors in the pharmacy: An observational of interruptions in pharmacy

Errors in the healthcare field are a significant problem. Interruptions leading to distractions can cause errors as these interruptions can distract the pharmacy workers from their tasks. Hence it is important to study interruptions, their types, how they are caused, where they come from, when they occur, how long they last, and how pharmacists and technicians feel about them. The objectives of this observational study were to: 1) classify interruptions based on the type of interruption and cause, time, location, and duration, 2) identify differences in interruption types, duration and frequency across days of the week or time of day, and the analysis of these stressors can aid in improving the processes and increasing safety within the pharmacy. Poster originally presented at the MU Spring 2011 Undergraduate Research and Creative Achievements Forum

A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors

Background: Many cancer survivors following primary treatment have prolonged poor quality of life.Aim: To determine the effectiveness of a bespoke digital intervention to support cancer survivors.Design: Pragmatic parallel open randomised trial.Setting: UK general practices.Methods: People having finished primary treatment (&lt;= 10 years previously) for colo-rectal, breast or prostate cancers, with European-Organization-for-Research-and-Treatment-of-Cancer QLQ-C30 score &lt;85, were randomised by online software to: 1) detailed ‘generic’ digital NHS support (‘LiveWell’;n=906), 2) a bespoke complex digital intervention (‘Renewed’;n=903) addressing symptom management, physical activity, diet, weight loss, distress, or 3) ‘Renewed-with-support’ (n=903): ‘Renewed’ with additional brief email and telephone support. Results: Mixed linear regression provided estimates of the differences between each intervention group and generic advice: at 6 months (primary time point: n’s respectively 806;749;705) all groups improved, with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both intervention groups. By 12 months there were: small improvements in EORTC QLQ-C30 for Renewed-with-support (versus generic advice: 1.42, 95% CIs 0.33-2.51); both groups improved global health (12 months: renewed: 3.06, 1.39-4.74; renewed-with-support: 2.78, 1.08-4.48), dyspnoea, constipation, and enablement, and lower NHS costs (generic advice £265: in comparison respectively £141 (153-128) and £77 (90-65) lower); and for Renewed-with-support improvement in several other symptom subscales. No harms were identified.Conclusion: Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provides limited additional short term benefit, but additional longer term improvement in global healthenablement and symptom management, with substantially lower NHS costs.<br/

A randomised controlled trial of a digital intervention (renewed) to support symptom management, wellbeing and quality of life in cancer survivors

Background: Many cancer survivors following primary treatment have prolonged poor quality of life. Aim: To determine the effectiveness of a bespoke digital intervention to support cancer survivors. Design: Pragmatic parallel open randomised trial. Setting: UK general practices. Methods: People having finished primary treatment (<= 10 years previously) for colo-rectal, breast or prostate cancers, with European-Organization-for-Research-and-Treatment-of-Cancer QLQ-C30 score <85, were randomised by online software to: 1)detailed ‘generic’ digital NHS support (‘LiveWell’;n=906), 2) a bespoke complex digital intervention (‘Renewed’;n=903) addressing symptom management, physical activity, diet, weight loss, distress, or 3) ‘Renewed-with-support’ (n=903): ‘Renewed’ with additional brief email and telephone support. Results: Mixed linear regression provided estimates of the differences between each intervention group and generic advice: at 6 months (primary time point: n’s respectively 806;749;705) all groups improved, with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both intervention groups. By 12 months there were: small improvements in EORTC QLQ-C30 for Renewed-with-support (versus generic advice: 1.42, 95% CIs 0.33-2.51); both groups improved global health (12 months: renewed: 3.06, 1.39-4.74; renewed-with-support: 2.78, 1.08-4.48), dyspnoea, constipation, and enablement, and lower NHS costs (generic advice £265: in comparison respectively £141 (153-128) and £77 (90-65) lower); and for Renewed-with-support improvement in several other symptom subscales. No harms were identified. Conclusion: Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provides limited additional short term benefit, but additional longer term improvement in global health enablement and symptom management, with substantially lower NHS costs

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Experimental Placebo Analgesia Changes Resting-State Alpha Oscillations

The lack of clear understanding of the pathophysiology of chronic pain could explain why we currently have only a few effective treatments. Understanding how pain relief is realised during placebo analgesia could help develop improved treatments for chronic pain. Here, we tested whether experimental placebo analgesia was associated with altered resting-state cortical activity in the alpha frequency band of the electroencephalogram (EEG). Alpha oscillations have been shown to be influenced by top-down processes, which are thought to underpin the placebo response. Seventy-three healthy volunteers, split into placebo or control groups, took part in a well-established experimental placebo procedure involving treatment with a sham analgesic cream. We recorded ongoing (resting) EEG activity before, during, and after the sham treatment. We show that resting alpha activity is modified by placebo analgesia. Post-treatment, alpha activity increased significantly in the placebo group only (p < 0.001). Source analysis suggested that this alpha activity might have been generated in medial components of the pain network, including dorsal anterior cingulate cortex, medial prefrontal cortex, and left insula. These changes are consistent with a cognitive state of pain expectancy, a key driver of the placebo analgesic response. The manipulation of alpha activity may therefore present an exciting avenue for the development of treatments that directly alter endogenous processes to better control pain

Experimental design, behavioral and event-related potential results.

<p>(<b>a</b>) <b>Summary of the experimental placebo procedure used in the present study</b>. Three blocks of repetitive laser stimulation (pre-conditioning, conditioning, and post-conditioning) were administered to the right forearm. During the pre-conditioning block, the laser stimulation was moderately painful. Prior to the conditioning block, a placebo analgesic cream was applied to the right forearm, over the area of laser stimulation. During the conditioning block, the laser energy was surreptitiously reduced to non-painful levels in the placebo group, to condition participants to believe the cream possessed analgesic properties. Participants in the control group were informed that the laser energy was reduced. Moderately painful laser stimulation was resumed during the post-conditioning block. Four resting EEG recordings were also taken during the procedure (blue) to monitor changes in alpha activity. (<b>b</b>) <b>Topographical map of the scalp</b>. To aid statistical analysis, we averaged the power data across electrodes in nine scalp regions. This gave us one value for alpha power in each region during each recording. Abbreviations: LA, left anterior; LM, left middle; LP, left posterior; CA, central anterior; CM, central middle; CP, central posterior; RA, right anterior; RM, right middle; RP, right posterior. (<b>c</b>) <b>Mask for region of interest analysis</b>. The regions in this mask encompass the bilateral dorsolateral prefrontal cortex (DLPFC) (brodmann areas 9, 10 and 46) and bilateral insulae. (<b>d</b>) <b>Pain reduction from the pre-conditioning block to the post-conditioning block in each group</b>. The plot shows the mean with standard deviation bars of pain reduction in each group. The placebo treatment group demonstrated significantly increased pain reduction compared with the control treatment group (<i>p</i> < 0.001). Points lying outside of the whiskers represent outliers. (<b>e</b>) <b>The changes in alpha power over the course of the procedure</b>. Each value represents alpha power averaged across all electrodes. This has been compared with the average alpha power in recording 1 for each group. In this way, we can see how alpha power has changed from the first recording. The placebo treatment group (blue) demonstrated increased alpha power following conditioning (from recording 3 to recording 4), while alpha power decreased in the control treatment group (green) over the same period. The change in alpha power following conditioning between the placebo and control group differed significantly. (<b>f</b>) <b>Topographic maps of alpha power in recording 4 (R4)</b>. Maps are shown of alpha power in each group, and the difference between the groups. Alpha power is in units of 10*log₁₀(µV²/Hz).</p

Significant sources of alpha activity.

<p>(<b>a</b>) Contrasts shown are R3-R2 (top) and R4-R3 (bottom) in the healthy placebo (left) and healthy control groups (right). Both groups demonstrated significantly increased activity in the dACC/SMA from R2 to R3. From R3 to R4, alpha activity increased in the bilateral mPFC and left insula in the placebo group, but decreased in the mPFC in the control group. The false discovery rate was <i>q</i> ≤ 0.005. (<b>b</b>) The change in alpha activity in the dACC/SMA from R2 to R3 significantly correlated with expectation of pain relief in the placebo group (r = 0.357, p = 0.022). (<b>c</b>) Correlation between change in alpha power in the left DLPFC from R2 to R3 and the change in alpha in dACC/SMA. (<b>d</b>) Correlation between change in alpha power in the right DLPFC from R2 to R3 and the change in alpha in dACC/SMA. There were a significant positive correlations between change in alpha in the dACC/SMA and in the left and right DLPFC from R2 to R3 (<i>p</i> < 0.001). Abbreviations: R2, recording 2; R3, recording 3; R4, recording 4; DLPFC, dorsolateral prefrontal cortex; dACC, dorsal anterior cingulate cortex; SMA, supplementary motor area; mPFC, medial prefrontal cortex; STG, superior temporal gyrus.</p

Experiences of using a supported digital intervention for cancer survivors in primary care:a qualitative process evaluation

Background: increasing healthy behaviours (e.g. physical activity) can improve cancer survivors’ quality of life. Renewed is a digital intervention developed to provide behaviour change advice with brief healthcare practitioner support. A three-arm randomised controlled trial (Renewed, Renewed with support or a control condition) suggested that prostate cancer survivors in the supported arm had slightly greater estimates of improvements in quality of life compared to other cancer survivors. This study explored participants’ experiences using Renewed to understand how it might have worked and why it might have provided greater benefit for prostate cancer survivors and those in the supported arm. Methods: thirty-nine semi-structured telephone interviews with cancer survivors’ (breast, colorectal, prostate) from the Renewed trial explored their experiences of using Renewed and their perceptions of the intervention. Data were analysed using inductive thematic analysis. Results: some participants only used Renewed modestly but still made behaviour changes. Barriers to using Renewed included low perceived need, joining the study to advance scientific knowledge or ‘to give back’, or due to perceived availability of support in their existing social networks. Prostate cancer survivors reported less social support outside of Renewed compared to participants with other cancers. Conclusion: Renewed may support healthy behaviour changes among cancer survivors even with limited use. Interventions targeting individuals who lack social support may be beneficial. Implications for cancer survivors: cancer survivors’ experiences may inform the development of digital interventions to better serve this population.<br/