Comparison of pharmacist and public views and experiences of community pharmacy medicines-related services in England

Background: Services provided by community pharmacists designed to support people using medicines are increasing. In England, two national services exist: Medicine Use Reviews (MUR) and New Medicines Service (NMS). Very few studies have been conducted seeking views of the public, rather than service users, on willingness to use these services or expectations of these services, or determined whether views align with pharmacist perceptions. Objective: To compare the perceptions of pharmacists and the general public on medicines-related services, particularly MUR and NMS services. Methods: Two parallel surveys were conducted in one area of England: one involved the general public and was administered using a street survey, and the other was a postal survey of community pharmacists. Similar questionnaires were used, seeking views of services, awareness, reasons for using services, and perceived benefits. Results: Response rates were 47.2% (1,000/2,012 approached) for the public and 40.8% (341/836) for pharmacists. Few people had experienced a discussion in a private consultation room or were aware of the two formal services, although their willingness to use them was high. Pharmacists estimated time spent on service provision as 10 minutes for MUR and 12 minutes for NMS, which aligned with acceptability to both pharmacists and the public. Pharmacists underestimated the willingness of the public to wait for an informal discussion or to make appointments for formal services. Both pharmacists and the public had high expectations that services would be beneficial in terms of increasing knowledge and understanding, but public expectations and experiences of services helping to sort out problems fell well below pharmacists’ perceptions. People who had experienced a pharmacy service had different perceptions of pharmacists. Conclusion: Views differed regarding why people use services and key aspects of service delivery. For services to improve, the pharmacy profession needs a better awareness of what the public, especially those with potential to benefit from services, view as acceptable and desirable

Medicine-related services in community pharmacy: public preferences for pharmacy attributes and promotional methods and comparison with pharmacists' perceptions

Background: Public awareness of pharmacy services designed to support use of medicines is low, yet little is known about how the public view promotion of these services or their preferences for the attributes of pharmacies from which they would like to receive them. Objective: To compare the public’s preferred attributes of pharmacies and methods for promoting medicine-related services with community pharmacists’ perceptions of their customers’ views. Method: Parallel surveys of the general public, using a street survey, and community pharmacists, via a postal survey in South East England. Results: Response rates were: public 47.2% (1000/2012) and pharmacists 40.8% (341/836) respectively. Pharmacists’ perceptions of customer preferences for using the same pharmacy, independent ownership and personal knowledge of the pharmacist were higher than actual public preferences. More pharmacists also thought approachability and previous good service would be important than the public. The public’s desires for long opening hours and for a pharmacy with a good relationship with their doctor’s surgery was higher than pharmacists believed. The majority of the public prefer not to interrupt a pharmacist busy in the dispensary, which was not perceived by pharmacists as a factor. Pharmacists’ perceptions aligned more with the preferences of regular medicines users and frequent pharmacy users. Both groups viewed direct recommendation as the most effective approach for promoting pharmacy services, particularly by doctors and pharmacy staff. Pharmacists’ expectations of the effectiveness of posters and mass media methods were much higher than those of the public. Conclusions: Pharmacists and pharmacy owners must ensure good relationships with local medical practices to enable them to maximise opportunities for using the promotional methods judged most effective in encouraging use of medicine-related services. Staff must be approachable and enable access to pharmacists ensuring perceptions of pharmacist busyness are not a deterrent

The topography of transmembrane segment six is altered during the catalytic cycle of P-glycoprotein

Structural evidence has demonstrated that P-glycoprotein (P-gp) undergoes considerable conformational changes during catalysis, and these alterations are important in drug interaction. Knowledge of which regions in P-gp undergo conformational alterations will provide vital information to elucidate the locations of drug binding sites and the mechanism of coupling. A number of investigations have implicated transmembrane segment six (TM6) in drug-P-gp interactions, and a cysteine-scanning mutagenesis approach was directed to this segment. Introduction of cysteine residues into TM6 did not disturb basal or drug-stimulated ATPase activity per se. Under basal conditions the hydrophobic probe coumarin maleimide readily labeled all introduced cysteine residues, whereas the hydrophilic fluorescein maleimide only labeled residue Cys-343. The amphiphilic BODIPY-maleimide displayed a more complex labeling profile. The extent of labeling with coumarin maleimide did not vary during the catalytic cycle, whereas fluorescein maleimide labeling of F343C was lost after nucleotide binding or hydrolysis. BODIPY-maleimide labeling was markedly altered during the catalytic cycle and indicated that the adenosine 5'-(beta,gamma-imino)triphosphate-bound and ADP/vanadate-trapped intermediates were conformationally distinct. Our data are reconciled with a recent atomic scale model of P-gp and are consistent with a tilting of TM6 in response to nucleotide binding and ATP hydrolysis

Propuesta de solución para personas que, tras superar el Cáncer, presentan problemas para retomar de manera efectiva su vida laboral, social y familiar

La presente investigación nació de una inspiración al identificar una problemática social de la que lamentablemente ninguna institución o el propio Estado se han hecho cargo, y radica en las dificultades que tiene una persona que ha superado el cáncer para regresar a su vida social, laboral y familiar de manera efectiva, debido a las secuelas físicas y psicológicas propias de la enfermedad y tratamiento. Los avances tecnológicos y preventivos contra el cáncer aseguran que la tasa de sobrevivencia se incrementará año a año, por lo que gran parte de la población tendrá que enfrentarse a la problemática identificada, que afecta directamente a su calidad de vida. Con la aplicación de metodologías ágiles y apoyo de la investigación científica, se ha logrado empatizar con los pacientes de cáncer que han superado la enfermedad, con la intención de conocer sus principales miedos, frustraciones y necesidades. Tras el testeo de prototipos, se ha arribado a una propuesta que pretende crear valor, primero, generando oportunidades laborales en personas que han superado el cáncer y que actualmente son especialistas en alguna de las categorías que se proponen en la solución, y por ende, están habilitadas para aportar con su conocimiento, creando contenido audiovisual, segundo, este contenido será difundido a través de cursos usando como medio una plataforma digital para llegar al mayor número de personas que hayan pasado por un tratamiento de cáncer y que tengan dificultades para retomar su vida pasada y bienestar. La oportunidad para emprender este modelo de negocio es clara, dado que en el mercado peruano no existen empresas que brinden servicios similares, y es una innovación disruptiva ya que busca construir una comunidad colaborativa de valor, a través de la participación de diversos actores que compartan el propósito. En cuanto a la parte financiera, la tasa de retorno es del 70%, superior al 6.5% que los socios han definido como su costo de oportunidad, lo cual garantiza la rentabilidad del proyecto. Finalmente, con la implementación de la presente propuesta, se espera generar impacto sostenible en tres Objetivos de Desarrollo Social (ODS): (a) educación de calidad, (b) trabajo decente y (c) fin de la pobreza.The present investigation was born from an inspiration when identifying a social problem that unfortunately no institution or the State itself has taken charge of, and it is based on the difficulties that a person who has overcome cancer has to return to his social, work and family life in an effective way, due to the physical and psychological sequels typical of the disease and treatment. The technological and preventive advances against cancer assure that the survival rate will increase year after year, so a great part of the population will have to face the identified problem, which directly affects their quality of life. With the application of agile methodologies and support of scientific research, it has been possible to empathize with cancer patients who have overcome the disease, with the intention of knowing their main fears, frustrations and needs. After the testing of prototypes, a proposal has been arrived at that intends to create value, first, by generating job opportunities in people who have overcome cancer and are currently specialists in one of the categories proposed in the solution, and therefore, are able to contribute with their knowledge, creating audiovisual content, second, this content will be disseminated through courses using a digital platform to reach the greatest number of people who have gone through cancer treatment and who have difficulties in resuming their past lives and well-being. The opportunity to undertake this business model is clear, since in the Peruvian market there are no companies that provide similar services, and it is a disruptive innovation since it seeks to build a collaborative community of value, through the participation of various actors who share the purpose. As for the financial part, the rate of return is 70%, higher than the 6.5% that the partners have defined as their opportunity cost, which guarantees the profitability of the project. Finally, with the implementation of this proposal, it is expected to generate sustainable impact on three Social Development Objectives (ODS): (a) quality education, (b) decent work and (c) end of poverty.Tesi

Driving performance and neurocognitive skills of long-term users of sedating antidepressants

Objective: To assess driving performance and neurocognitive skills of long‐term users of sedating antidepressants, in comparison to healthy controls. Methods: Thirty‐eight long‐term (>6 months) users of amitriptyline (n = 13) and mirtazapine (n = 25) were compared to 65 healthy controls. Driving performance was assessed using a 1‐h standardised highway driving test in actual traffic, with road‐tracking error (standard deviation of lateral position [SDLP]) being the primary measure. Secondary measures included neurocognitive tasks related to driving. Performance differences between groups were compared to those of blood alcohol concentrations of 0.5 mg/ml to determine clinical relevance. Results: Compared to controls, mean increase in SDLP of all antidepressant users was not significant, nor clinically relevant (+0.75 cm, 95% CI: - 0.83 cm; +2.33 cm). However, users treated less than 3 years (n = 20) did show a significant and clinically relevant increase in SDLP (+2.05 cm). No significant effects were observed on neurocognitive tasks for any user group, although large individual differences were present. Most results from neurocognitive tests were inconclusive, while a few parameters confirmed non‐inferiority for users treated longer than 3 years. Conclusion: The impairing effects of antidepressant treatment on driving performance and neurocognition mitigate over time following long‐term use of 3 years

An explorative approach to understanding individual differences in driving performance and neurocognition in long-term benzodiazepine users

Objective: Previous research reported cognitive and psychomotor impairments in long‐term users of benzodiazepine receptor agonists (BZRAs). This article explores the role of acute intoxication and clinical complaints. Methods: Neurocognitive and on‐road driving performance of 19 long‐term (≥6 months) regular (≥twice weekly) BZRA users with estimated plasma concentrations, based on self‐reported use, exceeding the therapeutic threshold (CBZRA+), and 31 long‐term regular BZRA users below (CBZRA−), was compared to that of 76 controls. Results: BZRA users performed worse on tasks of response speed, processing speed, and sustained attention. Age, but not CBZRA or self‐reported clinical complaints, was a significant covariate. Road‐tracking performance was explained by CBZRA only. The CBZRA + group exhibited increased mean standard deviation of lateral position comparable to that at blood‐alcohol concentrations of 0.5 g/L. Conclusions: Functional impairments in long‐term BZRA users are not attributable to self‐reported clinical complaints or estimated BZRA concentrations, except for road‐tracking, which was impaired in CBZRA + users. Limitations to address are the lack of assessment of objective clinical complaints, acute task related stress, and actual BZRA plasma concentrations. In conclusion, the results confirm previous findings that demonstrate inferior performance across several psychomotor and neurocognitive domains in long‐term BZRA users

Iconic dishes, culture and identity: the Christmas pudding and its hundred years’ journey in the USA, Australia, New Zealand and India

Asserting that recipes are textual evidences reflecting the society that produced them, this article explores the evolution of the recipes of the iconic Christmas pudding in the United States, Australia, New Zealand and India between the mid-nineteenth and the mid-twentieth centuries. Combining a micro-analysis of the recipes and the cookbook that provided them with contemporary testimonies, the article observes the dynamics revealed by the preparation and consumption of the pudding in these different societies. The findings demonstrate the relevance of national iconic dishes to the study of notions of home, migration and colonization, as well as the development of a new society and identity. They reveal how the preservation, transformation and even rejection of a traditional dish can be representative of the complex and sometimes conflicting relationships between colonists, migrants or new citizens and the places they live in