Geology of the Pomona quadrangle, Illinois.

Cover title.Bibliography: p. 15-16

One lithium level >1.0 mmol/L causes an acute decline in eGFR: findings from a retrospective analysis of a monitoring database

Objectives Lithium is a mainstay of bipolar disorder treatment, however, there are still differences in opinion on the effects of lithium use on renal function. The aim of this analysis was to determine if there is an association between short-term exposure to various elevated lithium levels and estimated-glomerular filtration rate (eGFR) at ≤3 months, 6 months (±3 months) and 1 year (±3 months) follow-up. Setting Norfolk-wide (UK) lithium register and database. Participants 699 patients from the Norfolk database. Primary outcome measures eGFR change from baseline at ≤3 months, 6 months (±3 months) and 1 year (±3 months) after exposure to a lithium level within these ranges: 0.81–1.0 mmol/L (group 2), 1.01–1.2 mmol/L (group 3) and 1.21–2.0 mmol/L (group 4). The reference group was patients whose lithium levels never exceeded 0.8 mmol/L. Results Compared to the reference group, groups 3 and 4 showed a significant decrease in eGFR in the first 3 months after exposure (p=0.047 and p=0.040). At 6 months (±3 months) postexposure group 4 still showed a decline in eGFR, however, this result was not significant (p=0.298). Conclusions These results show for the first time that a single incident of a lithium level >1.0 mmol/L is associated with a significant decrease in eGFR in the following 3 months when compared to patients whose lithium levels never exceeded 0.8 mmol/L. It is still not known whether the kidneys can recover this lost function and the impact that more than a single exposure to a level within these ranges can have on renal function. These results suggest that lithium level monitoring should be undertaken at least every 3 months, in line with current UK guidelines and not be reduced further until the impact of more than one exposure to these lithium levels has been fully established

Controller performance assessment in set point tracking and regulatory control

Recent critiques of minimum variance benchmarking for single-input-single-output control loops have focused on the need for assessment of performance during set point changes and also on the need to pay attention to the movements in the manipulated variable. This paper examines factors that influence the minimum variance performance measure of a SISO control loop. It discusses the reasons why performance during set point changes differs from the regulatory performance during operation at a constant set point. The results demonstrate how regulatory performance is influenced by the nature of a disturbance, and that correlation of signals within a control loop can indicate whether the disturbance is random or deterministic. The paper is illustrated with simulated, experimental and industrial examples

The potential for deprescribing in care home residents with Type 2 diabetes

Background: Type 2 diabetes is a common diagnosis in care home residents that is associated with potentially inappropriate prescribing and thus risk of additional suffering. Previous studies found that diabetes medicines can be safely withdrawn in care home residents, encouraging further investigation of the potential for deprescribing amongst these patients. Objectives: Describe comorbidities and medicine use in care home residents with Type 2 diabetes; identify number of potentially inappropriate medicines prescribed for these residents using a medicines optimisation tool; assess clinical applicability of the tool. Setting Thirty care homes for older people, East Anglia, UK. Method: Data on diagnoses and medicines were extracted from medical records of 826 residents. Potentially inappropriate medicines were identified using the tool ‘Optimising Safe and Appropriate Medicines Use’. Twenty percent of results were validated by a care home physician. Main outcome measure: Number of potentially inappropriate medicines. Results: The 106 residents with Type 2 diabetes had more comorbidities and prescriptions than those without. Over 90 % of residents with Type 2 diabetes had at least one potentially inappropriate medication. The most common was absence of valid indication. The physician unreservedly endorsed 39 % of the suggested deprescribing, and would consider discontinuing all but one of the remaining medicines following access to additional information. Conclusion: UK care home residents with Type 2 diabetes had an increased burden of comorbidities and prescriptions. The majority of these patients were prescribed potentially inappropriate medicines. Validation by a care home physician supported the clinical applicability of the medicines optimisation tool

A tool to evaluate patients' experience of nursing care in Australian general practice: Development of the Patient Enablement and Satisfaction Survey (PESS)

Australian health policy initiatives have increasingly supported the employment of nurses in general practice. An understanding of the impact of nursing care on patients in this setting is integral to assuring quality, safety and a patient-centred focus

Development and implementation of a nurse-led walk-in centre: evidence lost in translation?

Objectives: The design of the first Australian public nurse-led primary care walk-in centre was modelled on those established in the English National Health Service (NHS). An independent evaluation of the first 12 months of operation of the Australian Ca

Polychlorinated biphenyls (PCBs), hexabromocyclododecanes (HBCDDs) and degradation products in topsoil from Australia and the United Kingdom

AbstractHexabromocyclododecane (HBCDD) is listed under the Stockholm Convention on persistent organic pollutants, yet very few data are available on HBCDD concentrations in soil. Median concentrations of total hexabromocyclododecanes (ΣHBCDDs) from soils from the UK (n = 24) were 0.73 ng g−1 dry weight (range <0.01–430 ng g−1) and exceed significantly (p = 0.002) those in Australian soils (n = 17, median = 0.10 ng g−1, range <0.0002–5.6 ng g−1). Concentrations of polychlorinated biphenyls (PCBs) (average = 4.7 ng ΣPCBs g−1, range = 0.39–21 ng g−1) were determined in 19 UK samples and found to be statistically indistinguishable (p > 0.05) from those of HBCDDs; thereby underlining the extent to which HBCDDs have migrated into the UK environment. Moreover, PCB concentrations in this study are not markedly lower than those recorded in UK soils sampled in the mid-1980s indicating that the initial rapid decline in UK contamination with PCBs following bans on their manufacture and use, has not been maintained. Degradation products of HBCDD: pentabromocyclododecenes (PBCDs) and tetrabromocyclododecadienes (TBCDs) were detected in some UK soil samples with semi-quantitative concentrations ranging between 0.01 and 7.3 ng g−1 for ΣPBCDs and 0.01–1.3 ng g−1 for ΣTBCDs. In Australian soils only ΣTBCDs were detected at concentrations ranging from 0.0023 to 0.45 ng g−1. Chiral signatures of HBCDDs were racemic or non-racemic in all samples indicating minimal edaphic enantioselective degradation. A horizontal transect at the most contaminated UK location (a suburban garden) revealed a marked decrease in concentrations of HBCDDs with increasing distance from buildings

Stakeholder perceptions of a nurse led walk-in centre

BACKGROUND As many countries face primary care medical workforce shortages and find it difficult to provide timely and affordable care they seek to find new ways of delivering first point of contact health care through developing new service models. In common with other areas of rural and regional Australia, the Australian Capital Territory (ACT) is currently experiencing a general practitioner (GP) workforce shortage which impacts significantly on the ability of patients to access GP led primary care services. The introduction of a nurse led primary care Walk-in Centre in the ACT aimed to fulfill an unmet health care need in the community and meet projected demand for health care services as well as relieve pressure on the hospital system. Stakeholders have the potential to influence health service planning and policy, to advise on the potential of services to meet population health needs and to assess how acceptable health service innovation is to key stakeholder groups. This study aimed to ascertain the views of key stakeholders about the Walk-in Centre. METHODS Stakeholders were purposively selected through the identification of individuals and organisations which had organisational or professional contact with the Walk-in Centre. Semi structured interviews around key themes were conducted with seventeen stakeholders. RESULTS Stakeholders were generally supportive of the Walk-in Centre but identified key areas which they considered needed to be addressed. These included the service's systems, full utilisation of the nurse practitioner role and adequate education and training. It was also suggested that a doctor could be available to the Centre as a source of referral for patients who fall outside the nurses' scope of practice. The location of the Centre was seen to impact on patient flows to the Emergency Department. CONCLUSION Nurse led Walk-in Centres are one response to addressing primary health care medical workforce shortages. Whilst some stakeholders have reservations about the model others are supportive and see the potential the model has to provide accessible primary health care. Any further developments of nurse-led Walk-in Centres need to take into account the views of key stakeholders so as to ensure that the model is acceptable and sustainable.This study was funded by Australian Capital Territory (ACT) Health

The national consultation skills for pharmacy practice program in England

Background: Pharmacy professionals are playing an increasing role in caring for patients, yet evidence has shown their consultation skills are lacking. Objective: This article aims to discuss the need to enhance pharmacy professionals' (pharmacists and pharmacy technicians) consultation skills in England and describe the development of a national consultation skills training program to meet these needs. Methods: The Centre for Pharmacy Postgraduate Education led on a project to create a consultation skills training program for all pharmacy professionals across England. The program embedded a set of consultation skills practice standards developed by a large task and finish group consisting of pharmacy professionals of varying roles from the National Health Service, private pharmacy organizations and academia. Key findings: A Consultation Skills for Pharmacy Practice (CSfPP) training program, consisting of a distance learning workbook and website, was produced and disseminated to all registered pharmacy professionals in England, in March 2014. Conclusions: The first consultation skills training program of its kind was created that aimed to address the growing need to improve the consultations skills of pharmacy professionals in England. Future work will examine the reception of the CSfPP among pharmacy professionals and the impact it has on their practice