On-call hospital pharmacy services in NHS England: service provision and documentation of medicines advice calls

Objectives UK hospital pharmacy services have historically been delivered during typical ‘office’ hours, which include the provision of medicines advice via the pharmacy's medicines information department. Outside office hours, an on-call service operates whereby pharmacists handle requests for medicine supply and advice. It is not known how this out-of-hours service operates. The aim of this study was to quantify the extent and scope of its provision across England. Methods A piloted self-administered survey was sent to every chief pharmacist in England representing acute hospitals and mental health trusts (n=218). Key findings Just over half (n=116/218, 53.2%) of chief pharmacists returned a completed survey. Most hospitals provided an on-call pharmacy service (87.1%, n=101/116). Nearly all on-call pharmacy services (91.1%, n=92/101) provided both supply of medication and medicines advice. Two-thirds (66.2%) of pharmacists who provided on-call services were junior. The majority of trusts (83.1%, n=74/89) receive <20 calls for medicines advice per week. Hospital nurses/midwives were seen as the most common users of the on-call pharmacy service. Medicines advice was documented by on-call pharmacists all (49.5%, n=47/95) or some of the time (49.5%, n=47/95). Just under half of trusts (41.1%, n=39/95) had a standard policy for the documentation of medicines advice. Two-thirds (66.7%, n=62/93) of respondents stated that advice was documented using paper-based forms. Most trusts (81.1%, n=77/95) provided training prior to pharmacists being on-call, with medicines information pharmacists involved in nearly 80% of cases (n=61/77) (respondents could select more than one option). Conclusions Medicines advice is an integral part of the pharmacy on-call service, which was provided by junior staff. Variability existed in resourcing the service across trusts. In addition to existing standards for documentation of medicines advice, professional standards should be developed for on-call hospital pharmacy service provision and training

Is staff counselling an effective intervention in employee distress : an investigation of two employee counselling services in the National Health Service.

A number of broad questions were addressed (a) Is counselling effective?, (b) Are post-counselling gains maintained at follow-up? (c) Does the sgape of change across counselling sessions adhere to the 'dose-effect' model?, (d) Do measures of distress and interpersonal problems differ in the extent of pre-post change? and (e) Are there any within-group differences in the extent of pre-post change on measures?, (f) A further aim of the study was to collect qualitative accounts of the intervention from clients, to build up a 'picture' of clients experiences of service use: To obtain a consumers point of view. The study took place at two sites, one in London, the second in the Midlands. A prepost-follow-up design was adopted. In addition, measures were completed for each session of counselling. Finally, clients also completed an evaluation questionnaire. Hypotheses were, generally, supported by analyses. There were substantial pre-post reductions on measures of distress and interpersonal problems, which were maintained at follow-up. Significant reductions on measures across sessions of counselling were observed, with change curves adhering to the 'dose-effect' model. Qualitative analyses built-up a picture of the rationale for service use and the costs and benefits that clients perceived from counselling. Discussion focused on a number of issues: The first, the difference between the reported study and the bulk of psychotherapeutic studies, secondly, the methodological and practical issues that arose during the study and, thirdly, the need to approach applied counselling research from a new perspective, that is less dependent on the techniques developed by efficacy studies

A live test of automated facies prediction at wells for CO(2) storage projects

At least 900 m of image log data have been interpreted in detail through the Late Cretaceous and Cenozoic succession intersected at two purpose-drilled injection wells of the CO2CRC Otway Project. Interpretations have been calibrated against core observations where possible. Natural clusters for the combined signature of a common suite of coincident well log data were determined using an unsupervised Naive Bayesian classification algorithm called Autoclass. A deterministic relationship between these modelled clusters and interpreted image log facies provides a two-step facies prediction algorithm that can be applied using well log data acquired at other wells intersecting sedimentary successions prospective for CO2 storage. Earlier this year the Division of Resources & Energy, Department of Trade & Investment, of the Australian state of New South Wales drilled a new stratigraphic test well within the Pondie Range Trough of the Darling Basin. The new well, Mena Murtee-1, was drilled close to a 2D seismic tie line linking the Pondie Range Trough depocenter with an old petroleum exploration well, Pondie Range-1, that is sited on a flanking high. Analyses and interpretation of data acquired at Mena Murtee-1 is the latest step in reducing the uncertainty surrounding CO2 storage potential within the Darling Basin. Interpretation of core and image log data acquired at the new well has provided a means by which to test facies predictions made on the basis of the models developed within the Otway Basin.Mark Bunc

Medicines advice out of hours: exploring the opinions of healthcare professionals on the use and provision of on-call pharmacy services in England

Provision of NHS hospital pharmacy services has historically been delivered during typical ‘office’ hours. During these hours most pharmacy departments provide a medicines information (MI) service where any healthcare professional can ask for medicines advice. Outside of these hours questions are handled by an on-call pharmacist. This study aimed to investigate the provision of pharmacy services and medicines advice out of hours, from the perspective of pharmacists and other healthcare professionals, in NHS England. A mixed methods approach was used: an online survey of all Chief Pharmacists in England (2012: n=220) and semi-structured interviews of on-call pharmacists (2014: n=8) and doctors and nurses (2015: n=3 & n=4 respectively) in the East of England. The online survey provided information about the provision of on-call pharmacy services in England, documentation of calls handled, and provision of relevant training. Semi-structured interviews generated 19 themes, grouped into 5 meta themes: documentation, individual’s knowledge and experience, information accessibility, use of service, and awareness of service. On-call pharmacy services were provided by most hospitals, predominantly by less senior staff with limited years’ experience. Documentation of questions was variable, and less than half of Trusts had a documentation policy. Documentation by on-call pharmacists was found to be affected by their knowledge and experience, if they had any concerns about the enquirer’s understanding, the time the call was received, and remuneration and Information Technology (IT) issues. Both Chief Pharmacists and on-call pharmacists identified that training mainly consisted of operational issues, with on-call pharmacists believing a greater role could be played by MI staff in this training. Drug administration and ‘medication safety check’ were the main types of medicines advice questions sought out of hours. Chief Pharmacists stated on-call pharmacy services were well advertised but doctors and nurses seemed unaware of its provision and means of access; on-call pharmacists perceived this to be due to a lack of promotion. Access to information out of hours, particularly patients’ drug and clinical information, by on-call pharmacists was a barrier to providing medicines advice. This is the first insight into the national landscape of on-call pharmacy services. There is a clear role for MI services to support on-call pharmacy services, and national standards should be developed for provision, information accessibility, documentation and training. National pharmacy policy makers could also consider structured training, repeated on a regular basis, for all on-call pharmacists

Sustainable infrastructure development through use of calcined excavated waste clay as a supplementary cementitious material

Major infrastructure development projects in London produce large quantities of London clay and use significant volumes of concrete. Portland cement (CEM I) in concrete is normally partially replaced by supplementary cementitious materials such as ground granulated blastfurnace slag or pulverised fuel ash. The supply of supplementary cementitious materials is critical to the production of sustainable concrete. This study has investigated use of waste London clay as a supplementary cementitious material. The optimum calcined clay was produced at 900 °C and concrete made with 30 wt% of CEM I replaced by calcined clay had 28-day strengths greater than control samples. Compressive strengths of concrete containing calcined London clay were similar to concrete containing ground granulated blastfurnace slag and pulverised fuel ash. The production of calcined London clay emits ∼70 kg CO2/tonne and this is 91% lower than CEM I. 30 wt% replacement of CEM I by calcined London clay therefore produces concrete with ∼27% lower embodied carbon. London clay can be calcined to form a technically viable supplementary cementitious material and use of this in concrete would enable major civil infrastructure projects to contribute to a circular economy

Applications of Synchrotron-Source IR Spectroscopy for the Investigation of Insect Wings

Synchrotron-source infrared (IR) spectroscopy offers an effective method to characterise the chemical composition across surfaces. The intense light source allows the detection of trace quantities of different chemical components with a superior signal-to-noise ratio, while the highly collimated light enables high-resolution spatial mapping of the chemical distribution. In this chapter, we introduce synchrotron-source IR spectroscopy, using the infrared microspectroscopy (IRM) beamline at the Australian Synchrotron as an example. We then discuss the use of synchrotron-source IR spectroscopy to analyse insect wings in terms of experimental setup and a summary of the results in two different modes of operation, transmission and attenuated total reflection (ATR). Insect wings possess unique anti-wetting, self-cleaning, anti-biofouling and bactericidal properties and provide inspiration for biomimetic surfaces on synthetic materials which possess similar properties, useful in a range of industries

Bandage contact lens and topical steroids are risk factors for the development of microbial keratitis after epithelium-off CXL

Objective:To investigate the role of bandage contact lenses (BCL) and topical steroids as risk factors for the development of microbial keratitis after epithelium-off corneal collagen cross-linking (CXL). Methods and Analysis:Patients undergoing CXL between February 2011 and July 2017 were included. Patients were divided into two groups: those who were treated postoperatively with a BCL, topical antimicrobial and steroids (group 1) and those who received only a topical antimicrobial until healing of the epithelial defect before introduction of topical steroids (group 2). Results:1273 eyes of 964 patients were included. Group 1 comprised 316 eyes and group 2 comprised 957 eyes. There were no significant differences in the presence of persisting corneal haze or scarring between the two groups (p=0.57). Microbial keratitis occurred in nine eyes (0.71% of eyes) of eight (0.83%) patients (one case was bilateral) out of 1273 eyes. Staphylococcus aureus was cultured from corneal scrapes in seven out of nine (77.8%) cases and from contiguous sites in the two cases. All cases occurred in group 1 (incidence=2.85%) and none in group 2 (p<0.0001). A greater proportion of patients who developed microbial keratitis were atopic (75%, p=0.4). Conclusion:The use of BCL and topical steroids prior to healing of the epithelium is a significant risk factor for microbial keratitis. S. aureus is the most common micro-organism and is likely to originate from an endogenous site. Not using a BCL and delaying the introduction of topical steroids until epithelial healing significantly reduce the risk of developing microbial keratitis without increasing the risk of persistent corneal haze

Enabling human pluripotent stem cell derived megakaryocyte

Annually 4.5 million platelet units are transfused in Europe and the United States. These are obtained solely from allogeneic donations and have a shelf life of 5-7 days. To address the corresponding supply challenge, Moreau et al. have devised a novel process for producing megakaryocytes (MKs, the platelet precursor cell) in vitro. A transcription-factor driven, forward-programming approach converts human pluripotent stem cells into MKs. This strategy has the unique advantage of generating high yields of pure MKs in chemically defined medium through the establishment of 2-3 month long-term cultures. This could lead to the production of a consistent, reliable supply of platelets which overcomes the logistical, financial and biosafety challenges for health organisations worldwide. However to enable commercialisation of platelet manufacture, process optimisation and scale-up are essential. Medium can contribute a significant proportion of the cost of a cell based product. We have used tissue culture flasks to represent static culture and compared this to a scaled-down automated bioreactor system (ambr15, Sartorius) to evaluate feasibility and optimisation factors for the growth of forward programmed (FoP) MKs in scalable stirred-suspension culture. The medium supply and exchange strategy were analysed using high temporal resolution growth curves for three medium exchange regimes. We assessed the productivity of the medium, showing that approximately 1.3 million cells are produced per millilitre of medium. Common metabolites lactate and ammonium were unlikely to be limiting proliferation and only 20% of glucose was depleted. Using novel deterministic modelling software developed by our group, we have constructed a model of forward-programmed MKs growth. Based on inhibitor production, the model demonstrates the most efficient expansion strategy using the exchange strategies and observed growth characteristics of proliferating populations. Cell populations were identified using flow cytometry and phenotype analysis. This type of mechanistic modelling can be used to inform and optimise manufacturing strategy for scaled production of FoPMKs for platelet production and more generally for the manufacturing of cell based therapies