Describing interruptions, multi-tasking and task-switching in the community pharmacy: A qualitative study in England

Background: There is growing evidence base around interruptions and distractions in the community pharmacy setting. There is also evidence to suggest these practices may be associated with dispensing errors. Up to date, qualitative research on this subject is limited. Objective: To explore interruptions and distractions in the community setting; utilising an ethnographic approach to be able to provide a detailed description of the circumstances surrounding such practices. Setting: Community pharmacies in England, July to October 2011. Method: An ethnographic approach was taken. Non participant, unstructured observations were utilised to make records of pharmacists’ every activities. Case studies were formed by combining field notes with detailed information on pharmacists and their respective pharmacy businesses. Content analysis was undertaken both manually and electronically, utilising NVivo 10. Results: Response rate was 12% (n=11). Over fifteen days, a total of 123 hours and 58 minutes of observations were recorded in 11 separate pharmacies of 11 individual pharmacists. The sample was evenly split by gender (female n=6; male n=5) and pharmacy ownership (independent n=5; multiple n=6). Employment statuses included employee pharmacists (n=6), owners (n=4) and a locum (n=1). Average period of registration as a pharmacist was 19 years (range 5-39 years). Average prescriptions busyness of pharmacies ranged from 2,600 – 24,000 items dispensed per month. Two key themes were: “Interruptions and task-switching” and “distractions and multi-tasking.” All observed pharmacists’ work was dominated by interruptions, task-switches, distractions and multi-tasking, often to manage a barrage of conflicting demands. These practices were observed to be part of a deep-rooted culture in the community setting. Directional work maps illustrated the extent and direction of task switching employed by pharmacists. Conclusions: In this study pharmacists’ working practices were permeated by interruptions and multi-tasking. These practices are inefficient and potentially reduce patient safety in terms of dispensing accuracy

Surface-sampling mass spectrometry to study proteins and protein complexes

This review aims to summarise the current capabilities of surface mass spectrometry (MS) approaches that offer intact protein analysis, and that of non-covalent complexes. Protein analysis is largely achieved via matrix-assisted laser desorption/ionisation (MALDI), which is in itself a surface analysis approach or solvent-based electrospray ionisation (ESI). Several surface sampling approaches have been developed based on ESI, and those that have been used for intact protein analysis will be discussed below. The extent of protein coverage, top-down elucidation, and probing of protein structure for native proteins and non-covalent complexes will be discussed for each approach. Strategies for improving protein analysis, ranging from sample preparation, and sampling methods to instrument modifications and the inclusion of ion mobility separation in the workflow will also be discussed. The relative benefits and drawbacks of each approach will be summarised, providing an overview of current capabilities

A specific case in the classification of woods by FTIR and chemometric: discrimination of Fagales from Malpighiales

Fourier transform infrared (FTIR) spectroscopic data was used to classify wood samples from nine species within the Fagales and Malpighiales using a range of multivariate statistical methods. Taxonomic classification of the family Fagaceae and Betulaceae from Angiosperm Phylogenetic System Classification (APG II System) was successfully performed using supervised pattern recognition techniques. A methodology for wood sample discrimination was developed using both sapwood and heartwood samples. Ten and eight biomarkers emerged from the dataset to discriminate order and family, respectively. In the species studied FTIR in combination with multivariate analysis highlighted significant chemical differences in hemicelluloses, cellulose and guaiacyl (lignin) and shows promise as a suitable approach for wood sample classification

An exploration of parents’ preferences for foot care in juvenile idiopathic arthritis: a possible role for the discrete choice experiment

Background: An increased awareness of patients’ and parents’ care preferences regarding foot care is desirable from a clinical perspective as such information may be utilised to optimise care delivery. The aim of this study was to examine parents’ preferences for, and valuations of foot care and foot-related outcomes in juvenile idiopathic arthritis (JIA).<p></p> Methods: A discrete choice experiment (DCE) incorporating willingness-to-pay (WTP) questions was conducted by surveying 42 parents of children with JIA who were enrolled in a randomised-controlled trial of multidisciplinary foot care at a single UK paediatric rheumatology outpatients department. Attributes explored were: levels of pain; mobility; ability to perform activities of daily living (ADL); waiting time; referral route; and footwear. The DCE was administered at trial baseline. DCE data were analysed using a multinomial-logit-regression model to estimate preferences and relative importance of attributes of foot care. A stated-preference WTP question was presented to estimate parents’ monetary valuation of health and service improvements.<p></p> Results: Every attribute in the DCE was statistically significant (p < 0.01) except that of cost (p = 0.118), suggesting that all attributes, except cost, have an impact on parents’ preferences for foot care for their child. The magnitudes of the coefficients indicate that the strength of preference for each attribute was (in descending order): improved ability to perform ADL, reductions in foot pain, improved mobility, improved ability to wear desired footwear, multidisciplinary foot care route, and reduced waiting time. Parents’ estimated mean annual WTP for a multidisciplinary foot care service was £1,119.05.<p></p> Conclusions: In terms of foot care service provision for children with JIA, parents appear to prefer improvements in health outcomes over non-health outcomes and service process attributes. Cost was relatively less important than other attributes suggesting that it does not appear to impact on parents’ preferences.<p></p&gt

Patient acceptability of home monitoring for neovascular age-related macular degeneration reactivation:a qualitative study

Neovascular age-related macular degeneration (nAMD) is a chronic, progressive condition and the commonest cause of visual disability in older adults. This study formed part of a diagnostic test accuracy study to quantify the ability of three index home monitoring (HM) tests (one paper-based and two digital tests) to identify reactivation in nAMD. The aim of this qualitative research was to investigate patients’ or participants’ views about acceptability and explore adherence to weekly HM. Semi-structured interviews were held with 78/297 participants (26%), with close family members (n = 11) and with healthcare professionals involved in training participants in HM procedures (n = 9) (n = 98 in total). A directed thematic analytical approach was applied to the data using a deductive and inductive coding framework informed by theories of technology acceptance. Five themes emerged related to: 1. The role of HM; 2. Suitability of procedures and instruments; 3. Experience of HM; 4. Feasibility of HM in usual practice; and 5. Impediments to patient acceptability of HM. Various factors influenced acceptability including a patient’s understanding about the purpose of monitoring. While initial training and ongoing support were regarded as essential for overcoming unfamiliarity with use of digital technology, patients viewed HM as relatively straightforward and non-burdensome. There is a need for further research about how use of performance feedback, level of support and nature of tailoring might facilitate further the implementation of routinely conducted HM. Home monitoring was acceptable to patients and they recognised its potential to reduce clinic visits during non-active treatment phases. Findings have implications for implementation of digital HM in the care of older people with nAMD and other long-term conditions

Application of chemometric analysis to infrared spectroscopy for the identification of wood origin

Chemical characteristics of wood are used in this study for plant taxonomy classification based on the current Angiosperm Phylogeny Group classification (APG III System) for the division, class and subclass of woody plants. Infrared spectra contain information about the molecular structure and intermolecular interactions among the components in wood but the understanding of this information requires multivariate techniques for the analysis of highly dense datasets. This article is written with the purposes of specifying the chemical differences among taxonomic groups, and predicting the taxa of unknown samples with a mathematical model. Principal component analysis, t-test, stepwise discriminant analysis and linear discriminant analysis, were some of the chosen multivariate techniques. A procedure to determine the division, class, subclass and order of unknown samples was built with promising implications for future applications of Fourier Transform Infrared spectroscopy in wood taxonomy classification

The global pharmacy workforce: a systematic review of the literature

The importance of health workforce provision has gained significance and is now considered one of the most pressing issues worldwide, across all health professions. Against this background, the objectives of the work presented here were to systematically explore and identify contemporary issues surrounding expansion of the global pharmacy workforce in order to assist the International Pharmaceutical Federation working group on the workforce

How do pharmacists in English general practices identify their impact? An exploratory qualitative study of measurement problems

Background: In England, there is an ongoing national pilot to expand pharmacists’ presence in general practice. Evaluation of the pilot includes numerical and survey-based Key Performance Indicators (KPIs) and requires pharmacists to electronically record their activities, possibly by using activity codes. At the time of the study (2016), no national evaluation of pharmacists’ impact in this environment had been formally announced. The aim of this qualitative study was to identify problems that English pharmacists face when measuring and recording their impact in general practice. Methods: All pharmacists, general practitioners (GPs) and practice managers working across two West London pilot sites were invited, via e-mail, to participate in a focus group study. Appropriately trained facilitators conducted two audio-recorded, semi-structured focus groups, each lasting approximately one hour, to explore experiences and perceptions associated with the KPIs. Audio-recordings were transcribed verbatim and the data analysed thematically. Results: In total, 13 pharmacists, one GP and one practice manager took part in the study. Four major themes were discerned: inappropriateness of the numerical national KPIs (“whether or not we actually have positive impact on KPIs is beyond our control”); depth and breadth of pharmacists’ activity (“we see a huge plethora of different patients and go through this holistic approach - everything is looked at”); awareness of practice based pharmacists’ roles (“I think the really important [thing] is that everyone knows what pharmacists in general practice are doing”); and central evaluation versus local initiatives (“the KPIs will be measured by National Health Service England regardless of what we think” versus “what I think is more pertinent, are there some local things we’re going to measure?”). Conclusions: Measures that will effectively capture pharmacists’ impact in general practice should be developed, along with a set of codes reflecting the whole spectrum of pharmacists’ activities. Our study also points out the significance of a transparent, robust national evaluation, including exploring the needs/expectations of practice staff and patients regarding pharmacists’ presence in general practice

Synthesis and reactivity of group 13 and group 14 dipyrrinato complexes

Herein, the synthesis, reactivity, and high pressure crystallographic studies of group 13 and group 14 dipyrrinato complexes is reported. A series of germanium(II) and tin(II) dipyrrinato complexes (3.1–3.14) have been synthesised with varying steric bulk through substitutions of the alpha-position with H, Me or Ph substituent, and at the meso-position with either H, Ph, Mes or Tmp substituent. Synthesis of group 14 dipyrrinato complexes with protons in the alpha- position are achieved via oxidation of the proligands in THF in situ, followed by deprotonation and the addition of 7 equivalents of the metal(II) halide. Whereas germanium(II) and tin(II) dipyrrinato complexes with bulkier alpha-substituents are synthesised via metathesis reactions between the lithium dipyrrinato complex and the metal(II) halide in THF. This lead to the first metal(II) complex stabilised by the ligand dipyrromethene (2.1). Complexes 3.4 and 3.7 were studies by high pressure crystallography. A series of homoleptic and heteroleptic gallium(III) dipyrrinato complexes (2.4-2.8) have been synthesised in a similar manner, via metathesis reactions with the lithium dipyrrinato complex and the metal(III) halide, and by varying the ratio of ligand to halide gives either the homoleptic or heteroleptic gallium(III) dipyrrinato complex. The BODIPYs 2.1-2.3 were synthesised and characterised by 1H, UV/Vis and fluorescence spectroscopy to allow comparison of optical and electrochemical properties of the metal complexes. The germanium dipyrrinato complexes were reacted with a series of compounds to investigate the importance of the lone pair and chloride ion on the fluorescence of germanium dipyrrinato complexes. Reactions with sulfur and organic azides gave germanium(IV) dipyrrinato complexes 4.1-4.4, halide abstraction reactions resulted in germanium (4.6) and indium (4.5) dipyrrinato complexes depending on the halide abstraction agent used. The halide was also exchanged for an azide or tert-butoxide moiety (4.7 and 4.8)

Synthesis and reactivity of group 13 and group 14 dipyrrinato complexes

Herein, the synthesis, reactivity, and high pressure crystallographic studies of group 13 and group 14 dipyrrinato complexes is reported. A series of germanium(II) and tin(II) dipyrrinato complexes (3.1–3.14) have been synthesised with varying steric bulk through substitutions of the alpha-position with H, Me or Ph substituent, and at the meso-position with either H, Ph, Mes or Tmp substituent. Synthesis of group 14 dipyrrinato complexes with protons in the alpha- position are achieved via oxidation of the proligands in THF in situ, followed by deprotonation and the addition of 7 equivalents of the metal(II) halide. Whereas germanium(II) and tin(II) dipyrrinato complexes with bulkier alpha-substituents are synthesised via metathesis reactions between the lithium dipyrrinato complex and the metal(II) halide in THF. This lead to the first metal(II) complex stabilised by the ligand dipyrromethene (2.1). Complexes 3.4 and 3.7 were studies by high pressure crystallography. A series of homoleptic and heteroleptic gallium(III) dipyrrinato complexes (2.4-2.8) have been synthesised in a similar manner, via metathesis reactions with the lithium dipyrrinato complex and the metal(III) halide, and by varying the ratio of ligand to halide gives either the homoleptic or heteroleptic gallium(III) dipyrrinato complex. The BODIPYs 2.1-2.3 were synthesised and characterised by 1H, UV/Vis and fluorescence spectroscopy to allow comparison of optical and electrochemical properties of the metal complexes. The germanium dipyrrinato complexes were reacted with a series of compounds to investigate the importance of the lone pair and chloride ion on the fluorescence of germanium dipyrrinato complexes. Reactions with sulfur and organic azides gave germanium(IV) dipyrrinato complexes 4.1-4.4, halide abstraction reactions resulted in germanium (4.6) and indium (4.5) dipyrrinato complexes depending on the halide abstraction agent used. The halide was also exchanged for an azide or tert-butoxide moiety (4.7 and 4.8)