A Comparative Study of Vertebral Pathologies and Anomalies in Two Medieval British Populations

A holistic approach to palaeopathological studies using historical documentation and clinical, archaeological and epidemiological literature can provide important information as to the health, lifestyles, socioeconomic and occupational status of individuals from the past. Applying this approach, the study provides an overview and comparative analysis of the spinal health of two contemporaneous British skeletal samples from the medieval period; St Owen’s Cemetery, an urban based population from Gloucester (n=68) and Poulton a rural, agrarian community from Cheshire (n=70). Sex and age at death were estimated using a variety of osteological techniques and descriptive statistics and Chi-square statistical tests were computed to identify and assess inter- and intra-population differences. Although some significant differences were observed, both skeletal samples had similar types and anatomical locations of the pathological conditions observed. St Owen’s Cemetery exhibits higher frequencies of degenerative conditions and vertebral fractures, whereas Poulton displays higher frequencies of congenital conditions such as lumbosacral anomalies and cervical vertebral synostosis (possible Klippel-Feil Syndrome). Age of onset of degenerative conditions is markedly earlier in Poulton indicating occupational status from a younger age than their contemporaries in St Owen’s. Females are more affected by degenerative conditions and vertebral fractures than the males in both samples. The frequency of the aforementioned conditions increases dramatically with age suggesting the fractures could be related to osteoporosis. Significant differences were observed between population samples in the frequency of osteoarthritis in the thoracic segment of middle adult males and females in which St Owen’s exhibit double the amount. This indicates that biomechanical stresses were more likely to have been placed on the thoracic segment such as carrying heavier loads and repetitive bending and twisting in a singular occupational role in an urban setting such as a craft (cordwainer) or working for a merchant guild. Frequency of infectious lesions is comparable in both samples, indicating similar exposure to pathogens albeit there may be differences in the type of infections present. Males are more affected than the females in the rural sample suggesting that pathogens in the soil and livestock may be the cause of the lesions observed. The findings of this study are generally consistent with other published data, although frequency of vertebral trauma in the urban sample far exceeds other contemporary sites. The study presented here provides a glimpse into medieval life in both the large town and the rural farming community in the British Isles. Further studies include comparing data from more contemporary urban and rural populations to produce a more holistic study on medieval health and lifestyle in the British Isles including further analysis of larger skeletal samples from Poulton and St Owen’s. Additional observation of complete skeletons including body mass and stature and radiographic analyses will give further supportive evidence for some diagnoses

Virtual patient educational programme to teach counselling to clinical pharmacists: development and proof of concept

Pharmacist–patient counselling can benefit patients and optimise care, but appropriate training is required. A virtual patient (VP) tool to teach pharmacists non-vitamin K oral anticoagulant counselling was developed; the VP may be used for continuing professional development. The objective was to develop and show proof of concept of the VP. A cyclic development approach was adopted whereby the client, developers and a steering group informed VP design, content and aesthetic. This included formal and informal evaluation; ethical approval was not required. The VP received varied feedback. Positive feedback concerned the technology and the high-standard of animations. Negative elements concerned international VP use and differences in practice, also technological comments, regarding VP delivery and usability on various electronic devices. The VP was reported to be ‘valuable’ and realistic with high-quality animations. The steering group commented on VP’s clinical appropriateness, cultural relevance and usability. Areas highlighted for improvement were rectified during development, including the incorporation of printable feedback. European considerations concerned differences in culture and practice. The development process successfully developed the VP and the proof of the concept was demonstrated. This will inform future VP development; a large-scale VP evaluation is underway

A qualitative exploration of the barriers and enablers to supporting informal and familial carers within community pharmacies

Objectives: There are approximately 5.3 million informal carers in the United Kingdom, many of whom support family in their health despite being unpaid and often unsupported. Many visit pharmacies to collect medicines and look for advice. This work explores informal carer support within community pharmacies (CP). Methods: Semi-structured video interviews exploring perspectives on the role of CP in supporting carers were conducted in autumn 2022. The study received institutional ethical approval. Interviews were audio-recorded, transcribed verbatim, and analysed using a reflexive thematic approach. Key findings: In total 25 interviews were conducted with 13 carers and 12 pharmacy staff. Three themes were identified:-What support do carers need through CP?—medicines management, navigating services, and carers health and wellbeing.-Barriers to CP better supporting carers—relationships with CP, carer needs, identification as a ‘carer’.-Enablers to CP better supporting carers—support is a team effort, and CP as a community ‘hub’. Conclusions: There is a trusted relationships between carers and pharmacy staff which can contribute to establishing pharmacies as a safe space of support, this includes medicines-specific support and navigating services, but also carer health and wellbeing support. Pharmacy staff may need to reconsider approaches to identifying and supporting carers and not just treating them as an extension of supporting a patient. In making this support accessible, relationships with pharmacy staff are important, as well as embracing CP as a ‘community hub’, although pharmacy staff may need training and information to facilitate them in this role

Poiseuille geometry shear flow apparatus for small-angle scattering experiments

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Virtual patient technology to educate pharmacists and pharmacy students on patient communication: a systematic review

Background Virtual patients (VPs) are a sub-type of healthcare simulation that have been underutilised in health education. Their use is increasing, but applications are varied, as are designs, definitions and evaluations. Previous reviews have been broad, spanning multiple professions not accounting for design differences. Objectives The objective was to undertake a systematic narrative review to establish and evaluate VP use in pharmacy. This included VPs that were used to develop or contribute to communication or counselling skills in pharmacy undergraduates, pre-registration pharmacists and qualified pharmacists. Study selection Eight studies were identified using EBSCO and were quality assessed. The eligibility criteria did not discriminate between study design or outcomes but focused on the design and purpose of the VP. All the included studies used different VP applications and outcomes. Findings Four themes were identified from the studies: knowledge and skills, confidence, engagement with learning, and satisfaction. Results favoured the VPs but not all studies demonstrated this statistically due to the methods. VP potential and usability are advantageous, but technological problems can limit use. VPs can help transition knowledge to practice. Conclusions VPs are an additional valuable resource to develop communication and counselling skills for pharmacy students; use in other pharmacy populations could not be established. Individual applications require evaluation to demonstrate value due to different designs and technologies; quality standards may help to contribute to standardised development and implementation in varied professions. Many studies are small scale without robust findings; consequently, further quality research is required. This should focus on implementation and user perspectives

Establishing the acceptability and usability of an animated virtual patient simulation.

Background: An animated, video-based, virtual patient (VP) has been developed to allow pharmacists to learn how, and practice how, to advise patients taking non-vitamin K oral anticoagulants, a group of high-risk medicines. VPs are well-established resources but have historically only been accessed within specific online teaching sessions or at university sites; this new VP represents a mobile design that can be accessed from anywhere. Objective: To investigate the usability and acceptability of the VP application with a focus on exploring perspectives on accessibility. Methods: The study used an exploratory sequential mixed method design consisting of a satisfaction survey and interviews. Survey data were analysed descriptively to assess satisfaction with the application and to identify interview discussion areas. Interview data were analysed using the Framework Approach to thematic analysis. Participants were hospital or community pharmacists, or pre-registration pharmacists. Results: A total of 94 survey responses were collected and 22 respondents went on to take part in an interview. Participants reported liking the concept and delivery of the VP, particularly the high-quality technology. They also reported finding it usable, and appeared to favour its mobility and accessibility, particularly as the VP can be used on any internet accessible device, including mobile phones, with no specific requirements. Amendments that were suggested included quickening the delivery of some animations and improving navigation within the application, possibly through a button to return to the previous step should a mistake be made. Conclusions: The mobile VP appeared to be functional and usable, with the majority of users reporting satisfaction with use across a range of devices. Users reported positively about the VP's remote access, but navigation around the application requires development