The Difference in Pharmacists’ Interventions across the Diverse Settings in a Children’s Hospital

Aims: This study aimed to document and compare the nature of clinical pharmacists’ interventions made in different practice settings within a children’s hospital. Methods: The primary investigator observed and documented all clinical interventions performed by clinical pharmacists for between 35–37 days on each of the five study wards from the three practice settings, namely general medical, general surgical and hematology-oncology. The rates, types and significance of the pharmacists’ interventions in the different settings were compared.Results: A total of 982 interventions were documented, related to the 16,700 medication orders reviewed on the five wards in the three practice settings over the duration of the study. Taking medication histories and/or patient counselling were the most common pharmacists’ interventions in the general settings; constituting more than half of all interventions. On the Hematology-Oncology Ward the pattern was different with drug therapy changes being the most common interventions (n = 73/195, 37.4% of all interventions). Active interventions (pharmacists’ activities leading to a change in drug therapy) constituted less than a quarter of all interventions on the general medical and surgical wards compared to nearly half on thespecialty Hematology-Oncology Ward. The majority (n = 37/42, 88.1%) of a random sample of the active interventions reviewed were rated as clinically significant. Dose adjustment was the most frequent active interventions in the general settings, whilst drug addition constituted the most common active interventions on the Hematology-Oncology Ward. The degree of acceptance of pharmacists’ active interventions by prescribers was high (n = 223/244, 91.4%).Conclusions: The rate of pharmacists’ active interventions differed across different practice settings, being most frequent in the specialty hematology-oncology setting. The nature and type of the interventions documented in the hematologyoncology were also different compared to those in the general medical and surgical settings

Reason, conscience and equity: bishops as the king's judges in later Medieval England

It has long been recognized that many late medieval bishops were heavily involved in secular government. Scholars have tended to characterize these activities in fairly general terms, labelling those who chose to serve the crown as ‘administrators’, ‘bureaucrats’ or ‘civil servants’. In fact, they are better described as king’s judges, for a large part of what bishops did in government was dispensing justice in the king’s name. The first part of this article explores the contexts of this judicial activity, showing that bishops were especially active in institutions such as parliament, chancery and the council which offered justice to the king’s subjects on a discretionary basis. Discretionary justice was closely informed by the precepts of natural law, which in turn derived authority from the abstract notion of the divine will. The second half of the article suggests that the strong theological underpinning of discretionary justice meant that bishops’ involvement in secular government did not stand in opposition to their spiritual vocation or their role as leaders of the church. I argue that the sweeping and rather disparaging contemporary and modern characterizations of ‘civil-servant’ bishops as self-serving careerists ought to be replaced by a more nuanced understanding of the rationale and motivation of those senior clergymen who involved themselves in secular governance

The politics of pessimism: Albert de Broglie and conservative politics in the early Third-Republic

The Great Alliance: Economic Recovery and the Problems of Power 1945–1951 by Jim Phillips and Britain in the Second World War: A Social History by Harold L. Smit