Lääkehuollon konsultaatio - toimintamallin kehittäminen lääkekaappien tarkastamiseen sosiaali- ja terveydenhuollon yksiköissä

Apteekkifarmasian erikoistumisopinnot proviisoreille, PD ProjektityöSosiaali- ja terveysministeriö julkaisi vuonna 2006 oppaan ”Turvallinen lääkehoito – Valtakunnallinen opas lääkehoidon toteuttamisesta sosiaali- ja terveydenhuollossa”. Sen tarkoituksena on yhtenäistää lääkehoidon toteuttamisen periaatteita, selkeyttää vastuunjakoa sekä määrittää vähimmäisvaatimukset, joiden tulee toteutua kaikissa lääkehoitoa toteuttavissa julkisissa ja yksityisissä sosiaali- ja terveydenhuollon yksiköissä. Oppaan mukaan lääkehoidon toteuttamisen tulee perustua yksikössä laadittuun lääkehoitosuunnitelmaan, joka ohjaa käytännön toimintaa. Apteekkariliitto käynnisti keväällä 2009 työryhmän, joka on kehittänyt lääkehoitosuunnitelmalomakkeen apteekkien käyttöön. Vaikka Turvallinen lääkehoito -oppaassa ei anneta selkeitä määräyksiä esimerkiksi yksikköjen lääkekaappien tarkastamisesta, kehotetaan siinä kuitenkin yhteistyöhön farmasian ammattilaisten kanssa. Apteekit ovatkin perinteisesti tarkastaneet vanhainkotien lääkekaapit säännöllisin välein. Projektityön tarkoituksena oli kehittää toimintamalli lääkehuollon konsultaatioon. Lääkehuollon konsultaatio on laajempi käsite kuin lääkekaapin tarkastaminen. Konsultaatiossa apteekin farmaseutti tai proviisori toimii asiantuntijana sosiaali- ja terveydenhuollon yksikön lääkkeiden käsittelyyn ja lääkehoidon turvalliseen toteuttamiseen liittyvissä asioissa. Yhdessä hoitohenkilökunnan kanssa pyritään havaitsemaan yksikön kehittämiskohteita ja löytämään ratkaisuja toiminnan turvallisuuden parantamiseksi. Lomakkeen tueksi ja konsultaatioon valmistautumista helpottamaan laadittiin taustamateriaali. Lomakkeen kehittäminen aloitettiin tutustumalla lääkehuoltoa koskeviin viranomaismääräyksiin. Lomakemallia ja taustamateriaalia muokattiin edelleen työryhmän kokouksissa. Kahdelta apteekkifarmaseutilta sekä sairaala-apteekissa työskentelevältä proviisorilta pyydettiin kommentteja ennen pilotointien aloittamista. Lomaketta pilotoitiin neljässä eri apteekissa. Itse pilotoin lomaketta kolmessa sosiaalihuollon yksikössä. Pilotoijat ohjeistettiin kaikki samalla tavalla. He vastasivat asetettuihin kysymyksiin sekä kommentoivat vapaamuotoisesti työtä. Yhdestä apteekista ei saatu lainkaan kommentteja. Pilotointien jälkeen lomaketta muotoiltiin selkeämmäksi ja muutamia uusia kohtia lisättiin. Kaikki pilotoijat kokivat lomakkeen erittäin hyödylliseksi ja taustamateriaalin lomaketta tukevaksi ja selventäväksi. Farmasian oppimiskeskus järjesti koulutuksen apteekkien farmaseuttiselle henkilökunnalle lääkehuollon konsultaatiosta. Lääkehuollon konsultaatio on uusi lääkitysturvallisuutta tukeva palvelu apteekkien käyttöön koneellisen annosjakelun, lääkehoitosuunnitelmalomakkeen sekä lääkehoidon kokonaisarvioinnin lisäksi

Designing and implementing a COPD discharge care bundle

National surveys have revealed significant differences in patient outcomes following admission to hospital with acute exacerbation of COPD which are likely to be due to variations in care. We developed a care bundle, comprising a short list of evidence-based practices to be implemented prior to discharge for all patients admitted with this condition, based on a review of national guidelines and other relevant literature, expert opinion and patient consultation. Implementation was then piloted using action research methodologies with patient input. Actively involving staff was vital to ensure that the changes introduced were understood and the process followed. Implementation of a care bundle has the potential to produce a dramatic improvement in compliance with optimum health care practice

Finishing a whole-genome shotgun: Release 3 of the Drosophila melanogaster euchromatic genome sequence

BACKGROUND: The Drosophila melanogaster genome was the first metazoan genome to have been sequenced by the whole-genome shotgun (WGS) method. Two issues relating to this achievement were widely debated in the genomics community: how correct is the sequence with respect to base-pair (bp) accuracy and frequency of assembly errors? And, how difficult is it to bring a WGS sequence to the accepted standard for finished sequence? We are now in a position to answer these questions. RESULTS: Our finishing process was designed to close gaps, improve sequence quality and validate the assembly. Sequence traces derived from the WGS and draft sequencing of individual bacterial artificial chromosomes (BACs) were assembled into BAC-sized segments. These segments were brought to high quality, and then joined to constitute the sequence of each chromosome arm. Overall assembly was verified by comparison to a physical map of fingerprinted BAC clones. In the current version of the 116.9 Mb euchromatic genome, called Release 3, the six euchromatic chromosome arms are represented by 13 scaffolds with a total of 37 sequence gaps. We compared Release 3 to Release 2; in autosomal regions of unique sequence, the error rate of Release 2 was one in 20,000 bp. CONCLUSIONS: The WGS strategy can efficiently produce a high-quality sequence of a metazoan genome while generating the reagents required for sequence finishing. However, the initial method of repeat assembly was flawed. The sequence we report here, Release 3, is a reliable resource for molecular genetic experimentation and computational analysis

2016 Research & Innovation Day Program

A one day showcase of applied research, social innovation, scholarship projects and activities.https://first.fanshawec.ca/cri_cripublications/1003/thumbnail.jp

The prevalence and socio-demographic associations of household food insecurity in seven slum sites across Nigeria, Kenya, Pakistan, and Bangladesh. A cross-sectional study

Although the proportion of people living in slums is increasing in low- and middle-income countries and food insecurity is considered a severe hazard for health, there is little research on this topic. This study investigated and compared the prevalence and socio-demographic associations of household food insecurity in seven slum settings across Nigeria, Kenya, Pakistan, and Bangladesh. Data were taken from a cross-sectional, household-based, spatially referenced survey conducted between December 2018 and June 2020. Household characteristics and the extent and distribution of food insecurity across sites was established using descriptive statistics. Multivariable logistic regression of data in a pooled model including all slums (adjusting for slum site) and site-specific analyses were conducted. In total, a sample of 6,111 households were included. Forty-one per cent (2,671) of all households reported food insecurity, with varying levels between the different slums (9-69%). Household head working status and national wealth quintiles were consistently found to be associated with household food security in the pooled analysis (OR: 0·82; CI: 0·69-0·98 & OR: 0·65; CI: 0·57-0·75) and in the individual sites. Households which owned agricultural land (OR: 0·80; CI: 0·69-0·94) were less likely to report food insecurity. The association of the household head's migration status with food insecurity varied considerably between sites. We found a high prevalence of household food insecurity which varied across slum sites and household characteristics. Food security in slum settings needs context-specific interventions and further causal clarification

The impact of moderate or late preterm birth on social understanding

Background: Preterm birth (<37 gestational weeks) accounts for an increasing proportion of global births each year. Moderate or late preterm birth (MLPT) (32+0/7 - 36+6/7 gestational weeks) accounts for over 80% of preterm births yet represents only a fraction of research into prematurity. Whilst outcomes of MLPT were previously considered similar to those of individuals born full-term, more recent evidence suggests this is not the case. Despite the frequency of MLPT, there is a paucity of information surrounding the prevalence of common neurodevelopmental outcomes and association with gestational age. Neonatal follow up is prioritised towards those born at the earliest gestations, with no current guidelines addressing the potential cascading impact of MLPT for children or their parents. Method: A large scale systematic review and meta-analysis was employed to delineate the prevalence of autism characteristics for individuals born preterm. Two empirical studies to define the prevalence and profile of social abilities within a sample of MLPT children were conducted. These studies combined eye-tracking, behavioural tasks and standardised questionnaires to address these questions in a robust manner. A qualitative interview study was conducted to explore mothers’ perspectives of having a child born MLPT. Healthcare provision, clinical support and educational needs were discussed. Results: The prevalence of autism characteristics in preterm individuals was estimated at 6-20%, with lower estimates obtained for diagnostic assessments compared to screening tools. Only a small proportion of MLPT children scored above clinical threshold on validated parent report screening measures. Mothers of MLPT born infants highlight the need for further information and support prior to the birth of their child. Conclusions: Preterm birth is associated with an increased prevalence of social cognitive and neurodevelopmental difficulties, with screening tools an efficient strategy to identify MLPT children for whom further neurodevelopmental assessment may be warranted. Subsequently, service provision and routine additional developmental follow up is encouraged to ensure every child has appropriate and timely support. Future research should actively involve parents and caregivers of MLPT born children as co-researchers to ensure future directions are in line with their priorities

The prevalence and profile of autism in individuals born preterm:a systematic review and meta-analysis

INTRODUCTION: Preterm birth (<37 weeks) adversely affects development in behavioural, cognitive and mental health domains. Heightened rates of autism are identified in preterm populations, indicating that prematurity may confer an increased likelihood of adverse neurodevelopmental outcomes. The present meta-analysis aims to synthesise existing literature and calculate pooled prevalence estimates for rates of autism characteristics in preterm populations. METHODS: Search terms were generated from inspection of relevant high-impact papers and a recent meta-analysis. Five databases were searched from database creation until December 2020 with PRISMA guidelines followed throughout. RESULTS: 10,900 papers were retrieved, with 52 papers included in the final analyses, further classified by assessment method (screening tools N=30, diagnostic assessment N=29). Pooled prevalence estimates for autism in preterm samples was 20% when using screening tools and 6% when using diagnostic assessments. The odds of an autism diagnosis were 3.3 times higher in individuals born preterm than in the general population. CONCLUSIONS: The pooled prevalence estimate of autism characteristics in individuals born preterm is considerably higher than in the general population. Findings highlight the clinical need to provide further monitoring and support for individuals born preterm. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s11689-021-09382-1

ReproducibiliTea Birmingham

Materials from ReproducibiliTea sessions in Birmingham. Templates and presentations are available for others to use and edit