Deprescribing of Medicines in Care Homes - A Five-Year Evaluation of Primary Care Pharmacist Practices

(1) Background: This project evaluates the outcomes of a novel pharmacy-led model of deprescribing unnecessary medications for care home patients. A feasibility study was conducted in 2015 to explore exposure to inappropriate polypharmacy in patients residing in care homes over a one-year timescale. The aim of this study was to present the results of this ongoing service evaluation over a five-year period. (2) Methods: Data collection and risk assessment tools developed during the feasibility study were used to measure the prevalence, nature, and impact of deprescribing interventions by primary care pharmacists over a five-year period. A random sample of approximately 5% of safety interventions were screened twice yearly by the pharmacist leads as part of standard practice. (3) Results: Over a period of five years there were 23,955 interventions (mean 2.3 per patient) reported from the 10,405 patient reviews undertaken. Deprescribing accounted for 53% of total estimated financial drug savings, equating to £431,493; and 16.1% of all interventions were related to safety. (4) Conclusions: Medication reviews in care homes, undertaken by primary care pharmacists who are linked to GP practices, generate a wide range of interventions commonly involving deprescribing, which contributes significantly to the continuous optimisation of the prescribing and monitoring of medicines

Synthetic and theoretical investigations involving compounds containing low oxidation state main group elements

The work presented in this thesis is concerned with synthetic and theoretical investigations involving compounds containing low oxidation state elements from across the main group. Chapter 1 provides a general introduction to low oxidation state group 13 chemistry, with an emphasis on the preparation and reactivity of group 13 metal(I) halides and alkyls. Additionally, the jV-heterocyclic carbene class of ligand and its group 13 valence isoelectronic analogues are discussed. Chapter 2 details the use of the low oxidation state gallium halide species, 'Gal9, as a new reducing agent in organic synthesis, predominantly in the reactivity towards a-functionalised ketones. Isolation of inorganic intermediates aided in the proposal of reaction mechanisms, including the first structural characterisation of a gallium enediolato complex. Chapter 3 investigates the dissolution of the indium(I) halides, which in the case of the bromide and iodide, afforded the first structurally characterised molecular indium(I) halide complex and neutral indium subhalide complex, respectively. For the first time, the study also established that InBr can be crystallised from an organic solvent. Chapter 4 explores the synthesis, electronic structure and reactivity of unprecedented magnesium(I) and related magnesium(II) hydride complexes. The magnesium(I) complexes contain the first structurally characterised Mg-Mg bonds while the magnesium(II) hydrides are the first structurally characterised examples of neutral complexes of the type {L Mg(//- in - 1 or 2). Chapter 5 pertains to theoretical studies involving low oxidation state group 14 and 15 amidinate and guanidinate complexes, based on experimental investigations that led to several digermynes and diarsenes. In part, the study deals with multiple bonding, or lack thereof, between the corresponding metal centres. Chapter 6 describes the electronic structure of novel main group and transition metal complexes bearing Group 13 heterocyclic ligands, examples of which illustrate the first structurally characterised Ga-Sn bond and shortest Ga-Pt bond.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Synthetic and theoretical investigations involving compounds containing low oxidation state main group elements

The work presented in this thesis is concerned with synthetic and theoretical investigations involving compounds containing low oxidation state elements from across the main group. Chapter 1 provides a general introduction to low oxidation state group 13 chemistry, with an emphasis on the preparation and reactivity of group 13 metal(I) halides and alkyls. Additionally, the jV-heterocyclic carbene class of ligand and its group 13 valence isoelectronic analogues are discussed. Chapter 2 details the use of the low oxidation state gallium halide species, 'Gal9, as a new reducing agent in organic synthesis, predominantly in the reactivity towards a-functionalised ketones. Isolation of inorganic intermediates aided in the proposal of reaction mechanisms, including the first structural characterisation of a gallium enediolato complex. Chapter 3 investigates the dissolution of the indium(I) halides, which in the case of the bromide and iodide, afforded the first structurally characterised molecular indium(I) halide complex and neutral indium subhalide complex, respectively. For the first time, the study also established that InBr can be crystallised from an organic solvent. Chapter 4 explores the synthesis, electronic structure and reactivity of unprecedented magnesium(I) and related magnesium(II) hydride complexes. The magnesium(I) complexes contain the first structurally characterised Mg-Mg bonds while the magnesium(II) hydrides are the first structurally characterised examples of neutral complexes of the type {L Mg(//- in - 1 or 2). Chapter 5 pertains to theoretical studies involving low oxidation state group 14 and 15 amidinate and guanidinate complexes, based on experimental investigations that led to several digermynes and diarsenes. In part, the study deals with multiple bonding, or lack thereof, between the corresponding metal centres. Chapter 6 describes the electronic structure of novel main group and transition metal complexes bearing Group 13 heterocyclic ligands, examples of which illustrate the first structurally characterised Ga-Sn bond and shortest Ga-Pt bond

Service Delivery at a Satellite Campus: A Durban University of Technology Case Study

ABSTRACT The goal of this paper is to report on the SERVQUAL gap which causes unsuccessful service delivery at a satellite campus of a University of Technology in South Africa. Using a quantitative research design, the study adopts a SERVQUAL model adapted to a tertiary environment containing 5 dimensions of service quality (tangibles, responsiveness, empathy, assurance and reliability). A convenience sampling technique was applied, the data was collected from 99 respondents at the Durban University of Technology (DUT) and the results and discussion are presented. The findings reveal that, on average, customers had high expectations in assurance, responsiveness and reliability dimensions and their highest perceptions were found in the empathy dimension. This paper will benefit management of higher education institutions in identifying cost-effective ways of reducing service quality gaps with particular reference to satellite campuses

Exploring the perspectives of selectors and collecters of trial outcome data : An international qualitative study

Acknowledgements The authors would like to thank all interviewees that took part in this study, as well as our colleagues and fellow members of the Trial Forge, HRB-TMRN, and MRC Trial Methodology Hubs networks that supported in identifying potential participants. Funding This project was funded by the Chief Scientist Office, grant number HIPS/18/04Peer reviewedPublisher PD

A protocol for a systematic review of randomised evaluations of strategies to improve recruitment of rural participants to randomised controlled trials

Peer reviewedPublisher PD

Educating for Indigenous health equity: An international consensus statement

The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence, for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role, and in fact may be complicit in perpetuating inequities. This article seeks to examine the factors underpinning medical education’s role in Indigenous health inequity, in order to inform interventions to address these factors. The authors developed a consensus statement that synthesizes evidence from research, evaluation, and the collective experience of an international research collaboration including experts in Indigenous medical education. The statement describes foundational processes that limit Indigenous health development in medical education and articulates key principles that can be applied at multiple levels to advance Indigenous health equity. The authors recognize colonization, racism, and privilege as fundamental determinants of Indigenous health that are also deeply embedded in Western medical education. In order to contribute effectively to Indigenous health development, medical education institutions must engage in decolonization processes and address racism and privilege at curricular and institutional levels. Indigenous health curricula must be formalized and comprehensive, and must be consistently reinforced in all educational environments. Institutions’ responsibilities extend to advocacy for health system and broader societal reform to reduce and eliminate health inequities. These activities must be adequately resourced and underpinned by investment in infrastructure and Indigenous leadership