Pharmacists' perceptions of their emerging general practice roles in UK primary care: a qualitative interview study

This is the final version of the article. Available from Royal College of General Practitioners via the DOI in this record.BACKGROUND: UK general practice is experiencing a workload crisis. Pharmacists are the third largest healthcare profession in the UK; however, their skills are a currently underutilised and potentially highly valuable resource for primary health care. This study forms part of the evaluation of an innovative training programme for pharmacists who are interested in extended roles in primary care, advocated by a UK collaborative '10-point GP workforce action plan'. AIM: To explore pharmacists' perceptions of primary care roles including the potential for greater integration of their profession into general practice. DESIGN AND SETTING: A qualitative interview study in UK primary care carried out between October 2015 and July 2016. METHOD: Pharmacists were purposively sampled by level of experience, geographical location, and type of workplace. Two confidential semi-structured telephone interviews were conducted - one before and one after the training programme. A constant comparative, inductive approach to thematic analysis was used. RESULTS: Sixteen participants were interviewed. The themes related to: initial expectations of the general practice role, varying by participants' experience of primary care; the influence of the training course with respect to managing uncertainty, critical appraisal skills, and confidence for the role; and predictions for the future of this role. CONCLUSION: There is enthusiasm and willingness among pharmacists for new, extended roles in primary care, which could effectively relieve GP workload pressures. A definition of the role, with examples of the knowledge, skills, and attributes required, should be made available to pharmacists, primary care teams, and the public. Training should include clinical skills teaching, set in context through exposure to general practice, and delivered motivationally by primary care practitioners.Funding was provided by Health Education England (South West)

A Comparison of Maize Stalk Rot Occurrence in Bt and Non-Bt Hybrids

Stalk rots, caused by a complex of fungal species, are among the most widespread and destructive diseases of maize. Larvae of the European corn borer (ECB) (Ostrinia nubilalis) promote stalk rot development by creating entry points for fungi, serving as vectors of pathogens, and causing physiological stress that may predispose plants to stalk decay. Field experiments were conducted in 1998, 1999, and 2000 to determine whether the use of transgenic Bt hybrids expressing insecticidal proteins would influence stalk rot symptoms (pith disintegration, pith discoloration, and lodging). Five hybrids representing different Bt types (or “Bt events”) (176, BT11, MON810, DBT418, and CBH351) were paired with their near-isogenic, non-Bt counterparts and subjected to treatments of manual and natural infestation with ECB larvae. Manual infestation resulted in significantly more ECB tunneling than natural infestation in 1998 and 1999 and significantly more lodging in 1998. There were significant linear correlations between ECB injury and stalk rot symptoms in non-Bt hybrids in 1998 and 1999, but not in 2000. A standard foliar insecticide treatment for ECB did not significantly affect stalk rot symptoms. In 1998, Bt hybrids had significantly less ECB tunneling, stalk discoloration, pith disintegration, and lodging compared with non-Bt hybrids, but these effects depended upon the Bt event and the infestation treatment. Similar but less pronounced effects of Bt events were observed in 1999. The 2000 results were more variable; the amount of pith disintegration was significantly lower but discoloration was significantly higher in the BT11 hybrid compared with its non-Bt counterpart, and the amount of lodging was significantly higher in the event 176 hybrid compared with its non-Bt counterpart. The ratio of stalk strength to grain weight did not consistently differ between Bt and non-Bt hybrids. These results indicate that, although specific Bt events in some years may cause reductions in stalk rot, the overall effect of Bt transformation on stalk rot occurrence is highly variable

An experimental study of the near wake of a two-dimensional hypersonic blunt body with mass addition

An experimental investigation of the steady, laminar near-wake flow field of a two-dimensional, adiabatic, circular cylinder with surface mass transfer has been made at a free-stream Mach number of 6.0. The pressure and mass-concentration fields associated with the transfer of argon, nitrogen or helium into the near wake were studied for mass transfer from the forward stagnation region, and from the base. For sufficiently low mass transfer rates from the base, for which a recirculating zone exists, the entire near-wake flow field correlates with the momentum flux, not the mass flux, of the injectant, and the mass-concentration field is determined by counter-current diffusion into the reversed flow. For mass addition from the forward stagnation region, the pressure field is undisturbed and the mass-concentration field is nearly uniform in the region of reversed flow. The axial decay of argon mass concentration in the intermediate wake, downstream of the neck, is explained with the aid of an integral solution in the incompressible plane, from which the location of the virtual origin for the asymptotic far-wake solution has been derived as one result

Effectiveness of a practice change intervention in reducing alcohol consumption in pregnant women attending public maternity services

Published online: 31 August 2022BACKGROUND: The aim of this study was to examine the effect of a practice change intervention to support the implementation of guideline-recommended care for addressing alcohol use in pregnancy on self-reported alcohol use during pregnancy. METHODS: A randomized, stepped-wedge controlled trial in three clusters (sectors) within the Hunter New England Local Health District (NSW, Australia). We evaluated a practice change intervention that supported the introduction of a new model of care for reducing alcohol use in pregnancy, consistent with local and international guidelines, and implemented in random order across the sectors. Each week throughout the study period, pregnant women who attended any public antenatal services within the previous week, for a 27-28 or 35-36 week gestation visit, were randomly sampled and invited to participate in the survey. The intended intervention for all women was Brief advice (to abstain from alcohol and information about potential risks). Women identified as medium-risk alcohol consumers using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) were to be offered referral to a phone coaching service, and women identified as high-risk were to be offered referral to a Drug and Alcohol Service. Rates of self-reported alcohol use (AUDIT-C risk level and special occasion drinking) were summarized and compared in groups of women pre-intervention and post-intervention using multivariable logistic regression. RESULTS: Surveys were completed by 1309 women at pre-intervention and 2540 at post-intervention. The majority of women did not drink during pregnancy (pre-intervention: 89.68%; post-intervention: 90.74%). There was no change in the proportion of women classified as No risk from drinking (AUDIT-C score = 0) or Some risk from drinking (AUDIT-C score ≥ 1) pre- or post-intervention (p = 0.08). However, a significant reduction in special occasion drinking was observed (pre-intervention: 11.59%; post-intervention: 8.43%; p < 0.001). CONCLUSIONS: Special occasion drinking was reduced following implementation of guideline-recommended care. Failure to change other patterns of alcohol use in pregnancy may reflect barriers to implementing the model of care in antenatal care settings and the need to address other social determinants of alcohol use. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (registration number: ACTRN12617000882325; date: 16 June 2017).Tracey W. Tsang, Melanie Kingsland, Emma Doherty, John Wiggers, John Attia, Luke Wolfenden, Adrian Dunlop, Belinda Tully, Ian Symonds, Chris Rissel, Christophe Lecathelinais and Elizabeth J. Elliot

Designing and undertaking randomised implementation trials: guide for researchers

Implementation science is the study of methods to promote the systematic uptake of evidence based interventions into practice and policy to improve health. Despite the need for high quality evidence from implementation research, randomised trials of implementation strategies often have serious limitations. These limitations include high risks of bias, limited use of theory, a lack of standard terminology to describe implementation strategies, narrowly focused implementation outcomes, and poor reporting. This paper aims to improve the evidence base in implementation science by providing guidance on the development, conduct, and reporting of randomised trials of implementation strategies. Established randomised trial methods from seminal texts and recent developments in implementation science were consolidated by an international group of researchers, health policy makers, and practitioners. This article provides guidance on the key components of randomised trials of implementation strategies, including articulation of trial aims, trial recruitment and retention strategies, randomised design selection, use of implementation science theory and frameworks, measures, sample size calculations, ethical review, and trial reporting. It also focuses on topics requiring special consideration or adaptation for implementation trials. We propose this guide as a resource for researchers, healthcare and public health policy makers or practitioners, research funders, and journal editors with the goal of advancing rigorous conduct and reporting of randomised trials of implementation strategies

Alcohol consumption and sport: a cross-sectional study of alcohol management practices associated with at-risk alcohol consumption at community football clubs

BackgroundExcessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs participate in at-risk alcohol consumption at levels above that of communities generally. There has been limited research investigating the predictors of at-risk alcohol consumption in sporting settings, particularly at the non-elite level. The purpose of this study was to examine the association between the alcohol management practices and characteristics of community football clubs and at-risk alcohol consumption by club members.MethodsA cross sectional survey of community football club management representatives and members was conducted. Logistic regression analysis (adjusting for clustering by club) was used to determine the association between the alcohol management practices (including alcohol management policy, alcohol-related sponsorship, availability of low- and non-alcoholic drinks, and alcohol-related promotions, awards and prizes) and characteristics (football code, size and location) of sporting clubs and at-risk alcohol consumption by club members.ResultsMembers of clubs that served alcohol to intoxicated people [OR: 2.23 (95% CI: 1.26-3.93)], conducted &lsquo;happy hour&rsquo; promotions [OR: 2.84 (95% CI: 1.84-4.38)] or provided alcohol-only awards and prizes [OR: 1.80 (95% CI: 1.16-2.80)] were at significantly greater odds of consuming alcohol at risky levels than members of clubs that did not have such alcohol management practices. At-risk alcohol consumption was also more likely among members of clubs with less than 150 players compared with larger clubs [OR:1.45 (95% CI: 1.02-2.05)] and amongst members of particular football codes.ConclusionsThe findings of this study suggest a need and opportunity for the implementation of alcohol harm reduction strategies targeting specific alcohol management practices at community football clubs.<br /

Technoscientia est Potentia?: Contemplative, interventionist, constructionist and creationist idea(l)s in (techno)science

Within the realm of nano-, bio-, info- and cogno- (or NBIC) technosciences, the ‘power to change the world’ is often invoked. One could dismiss such formulations as ‘purely rhetorical’, interpret them as rhetorical and self-fulfilling or view them as an adequate depiction of one of the fundamental characteristics of technoscience. In the latter case, a very specific nexus between science and technology, or, the epistemic and the constructionist realm is envisioned. The following paper focuses on this nexus drawing on theoretical conceptions as well as empirical material. It presents an overview of different technoscientific ways to ‘change the world’—via contemplation and representation, intervention and control, engineering, construction and creation. It further argues that the hybrid character of technoscience makes it difficult (if not impossible) to separate knowledge production from real world interventions and challenges current science and technology policy approaches in fundamental ways