Pharmacy services to UK emergency departments : a descriptive study

Objective To describe current hospital pharmacy services and facilities provided to United Kingdom Emergency Departments (EDs), identify potential roles for pharmacy technicians and possible benefits pharmacists may bring to the ED. Setting Emergency care specialist interest group workshop at an UK Clinical Pharmacy Association (UKCPA) conference in 2004. Workshop attendance was open to pharmacists and technicians. Method A descriptive study using a voluntary self-completed questionnaire covering ED services, pharmacy services and facilities to the ED and potential roles and benefits. Results Of 40 questionnaires distributed, 31/40 (78%) were returned representing 25 NHS hospitals. Most (72%) EDs received some level of pharmacy service. Emergency Department skill-mix, ED service models and pharmacy services varied. Pharmacists’ current roles were similar across EDs, with input into guideline development and review 12/25 (48%), patient group directions 11/25 (44%), provision of training 11/25 (44%), provision of advice (general and clinical)/liaison 10/25 (40%) and drug history taking 11/25 (40%). Potential roles identified for pharmacy technicians included assessment of patients’ own drugs, support for drug history taking, stock management and drug storage. Further benefits pharmacists could bring to EDs included rationalisation of medicines on admission, identification of ADRs causing admission, support with complex medicine issues, new prescribing skills, supporting the maximum waiting time target and facilitating discharge. Conclusion Pharmacy services have developed to support service provision in EDs with similar roles to in-patient pharmacists. Pharmacy services in some EDs are now extensive with funded, full-time pharmacy posts but pharmacy service review is required to optimise ED patient care where there is limited or no current pharmacy input. New pharmacy services must fit with local ED service models and skill mix. Evaluation of these new services is vital to maximise benefit to patients and the NHS.Peer reviewe

Tree rings and ice cores reveal C-14 calibration uncertainties during the Younger Dryas

The Younger Dryas interval during the Last Glacial Termination was an abrupt return to glacial-like conditions punctuating the transition to a warmer, interglacial climate. Despite recent advances in the layer counting of ice-core records of the termination, the timing and length of the Younger Dryas remain controversial. Also, a steep rise in the concentration of atmospheric radiocarbon at the onset of the interval, recorded primarily in the Cariaco Basin, has been difficult to reconcile with simulations of the Younger Dryas carbon cycle. Here we discuss a radiocarbon chronology from a tree-ring record covering the Late Glacial period that has not been absolutely dated. We correlate the chronology to ice-core timescales using the common cosmic production signal in tree-ring C-14 and ice-core Be-10 concentrations. The results of this correlation suggest that the Cariaco record may be biased by changes in the concentration of radiocarbon in the upper ocean during the early phase of the Younger Dryas climate reversal in the Cariaco basin. This bias in the marine record may also affect the accuracy of a widely used radiocarbon calibration curve over this interval. Our tree-ring-based radiocarbon record is easily reconciled with simulated production rates and carbon-cycle changes associated with reduced ocean ventilation during the Younger Dryas