A cluster randomised controlled trial of a pharmacist-led collaborative intervention to improve statin prescribing and attainment of cholesterol targets in primary care

Background: Small trials with short term follow up suggest pharmacists’ interventions targeted at healthcare professionals can improve prescribing. In comparison with clinical guidance, contemporary statin prescribing is sub-optimal and achievement of cholesterol targets falls short of accepted standards, for patients with atherosclerotic vascular disease who are at highest absolute risk and who stand to obtain greatest benefit. We hypothesised that a pharmacist-led complex intervention delivered to doctors and nurses in primary care, would improve statin prescribing and achievement of cholesterol targets for incident and prevalent patients with vascular disease, beyond one year.<p></p> Methods: We allocated general practices to a 12-month Statin Outreach Support (SOS) intervention or usual care. SOS was delivered by one of 11 pharmacists who had received additional training. SOS comprised academic detailing and practical support to identify patients with vascular disease who were not prescribed a statin at optimal dose or did not have cholesterol at target, followed by individualised recommendations for changes to management. The primary outcome was the proportion of patients achieving cholesterol targets. Secondary outcomes were: the proportion of patients prescribed simvastatin 40 mg with target cholesterol achieved; cholesterol levels; prescribing of simvastatin 40 mg; prescribing of any statin and the proportion of patients with cholesterol tested. Outcomes were assessed after an average of 1.7 years (range 1.4–2.2 years), and practice level simvastatin 40 mg prescribing was assessed after 10 years.<p></p> Findings: We randomised 31 practices (72 General Practitioners (GPs), 40 nurses). Prior to randomisation a subset of eligible patients were identified to characterise practices; 40% had cholesterol levels below the target threshold. Improvements in data collection procedures allowed identification of all eligible patients (n = 7586) at follow up. Patients in practices allocated to SOS were significantly more likely to have cholesterol at target (69.5% vs 63.5%; OR 1.11, CI 1.00–1.23; p = 0.043) as a result of improved simvastatin prescribing. Subgroup analysis showed the primary outcome was achieved by prevalent but not incident patients. Statistically significant improvements occurred in all secondary outcomes for prevalent patients and all but one secondary outcome (the proportion of patients with cholesterol tested) for incident patients. SOS practices prescribed more simvastatin 40 mg than usual care practices, up to 10 years later.<p></p> Interpretation: Through a combination of educational and organisational support, a general practice based pharmacist led collaborative intervention can improve statin prescribing and achievement of cholesterol targets in a high-risk primary care based population

Exploring the relationships of Email Overload, Stress and Burnout in Social Workers

Technostress is the inability to cope with information and communication technology which may result in stress and burnout. Email overload, stress, and burnout among social workers is a phenomenon that may impact retention in social and human service organizations. This mixed methods design uses the transactional theory of stress as the theoretical framework for measuring the relationship of email overload (email invasion, email volume, and email rapid response extraction) to stress and burnout in the social work workforce. This dissertation also explores the generational cohort, gender, and social work degree as predictors of email overload. Participants in this study were social workers recruited through one of three membership organizations: Juvenile Detentions Centers and Alternative Programs (JDCAP), National Partnership for Juvenile Services (NPJS), and the Pennsylvania Council for Children, Youth, and Family Services (PCCYFS). Students enrolled at Kutztown University were also included in this study. There were 119 (N=119) participants that completed the email overload survey and six (N=6) participants that were interviewed. The findings of the study show that email overload was statistically significant and GenXers and Millennials reported higher levels of stress, anxiety and depression, and poor coping that that of the Boomer generational cohort. Further studies on email overload and technology overload may provide a basis for needed technology self-care strategies for social workers

Audiogenic reflex seizures in cats

This study aims at characterizing feline audiogenic reflex seizures (FARS). An online questionnaire was developed to capture information from owners with cats suffering FARS. This was collated with the medical records from the primary veterinarian. Ninety-six cats were included. Myoclonic seizures were one of the cardinal signs of this syndrome (90/96), frequently occurring prior to generalized tonic-clonic seizures (GTCS) in this population. Other features include a late-onset (median 15 years) and absence seizures (6/96), with most seizures triggered by high frequency sounds amid occasional spontaneous seizures (up to 20%). Half the population (48/96) had hearing impairment or were deaf. One third of cats (35/96) had concurrent diseases, most likely reflecting the age distribution. Birmans were strongly represented (30/96). Levetiracetam gave good seizure control. The course of the epilepsy was non-progressive in the majority (68/96) with an improvement over time in some (23/96). Only 33/96 and 11/90 owners respectively felt the GTCS and myoclonic seizures affected their cat’s quality of life (QoL). Despite this, many owners (50/96) reported a slow decline in their cat’s health becoming less responsive (43/50), not jumping (41/50), uncoordinated or weak in the pelvic limbs (24/50), and exhibiting dramatic weight loss (39/50). These signs were exclusively reported in cats experiencing seizures for >2 years with 42/50 owners stating these signs affected their cat’s QoL. In gathering data on audiogenic seizures in cats, we have identified a new epilepsy syndrome named FARS with a geriatric-onset. Further studies are warranted to investigate potential genetic predispositions to this condition

A Hybrid Godunov Method for Radiation Hydrodynamics

From a mathematical perspective, radiation hydrodynamics can be thought of as a system of hyperbolic balance laws with dual multiscale behavior (multiscale behavior associated with the hyperbolic wave speeds as well as multiscale behavior associated with source term relaxation). With this outlook in mind, this paper presents a hybrid Godunov method for one-dimensional radiation hydrodynamics that is uniformly well behaved from the photon free streaming (hyperbolic) limit through the weak equilibrium diffusion (parabolic) limit and to the strong equilibrium diffusion (hyperbolic) limit. Moreover, one finds that the technique preserves certain asymptotic limits. The method incorporates a backward Euler upwinding scheme for the radiation energy density and flux as well as a modified Godunov scheme for the material density, momentum density, and energy density. The backward Euler upwinding scheme is first-order accurate and uses an implicit HLLE flux function to temporally advance the radiation components according to the material flow scale. The modified Godunov scheme is second-order accurate and directly couples stiff source term effects to the hyperbolic structure of the system of balance laws. This Godunov technique is composed of a predictor step that is based on Duhamel's principle and a corrector step that is based on Picard iteration. The Godunov scheme is explicit on the material flow scale but is unsplit and fully couples matter and radiation without invoking a diffusion-type approximation for radiation hydrodynamics. This technique derives from earlier work by Miniati & Colella 2007. Numerical tests demonstrate that the method is stable, robust, and accurate across various parameter regimes.Comment: accepted for publication in Journal of Computational Physics; 61 pages, 15 figures, 11 table

Experimental and simulation study results for video landmark acquisition and tracking technology

A synopsis of related Earth observation technology is provided and includes surface-feature tracking, generic feature classification and landmark identification, and navigation by multicolor correlation. With the advent of the Space Shuttle era, the NASA role takes on new significance in that one can now conceive of dedicated Earth resources missions. Space Shuttle also provides a unique test bed for evaluating advanced sensor technology like that described in this report. As a result of this type of rationale, the FILE OSTA-1 Shuttle experiment, which grew out of the Video Landmark Acquisition and Tracking (VILAT) activity, was developed and is described in this report along with the relevant tradeoffs. In addition, a synopsis of FILE computer simulation activity is included. This synopsis relates to future required capabilities such as landmark registration, reacquisition, and tracking

Study and simulation results for video landmark acquisition and tracking technology (Vilat-2)

The results of several investigations and hardware developments which supported new technology for Earth feature recognition and classification are described. Data analysis techniques and procedures were developed for processing the Feature Identification and Location Experiment (FILE) data. This experiment was flown in November 1981, on the second Shuttle flight and a second instrument, designed for aircraft flights, was flown over the United States in 1981. Ground tests were performed to provide the basis for designing a more advanced version (four spectral bands) of the FILE which would be capable of classifying clouds and snow (and possibly ice) as distinct features, in addition to the features classified in the Shuttle experiment (two spectral bands). The Shuttle instrument classifies water, bare land, vegetation, and clouds/snow/ice (grouped)

'Help for hay fever', a goal-focused intervention for people with intermittent allergic rhinitis, delivered in Scottish community pharmacies: study protocol for a pilot cluster randomized controlled trial

<b>Background</b> Despite the availability of evidence-based guidelines for managing allergic rhinitis in primary care, management of the condition in the United Kingdom (UK) remains sub-optimal. Its high prevalence and negative effects on quality of life, school performance, productivity and co-morbid respiratory conditions (in particular, asthma), and high health and societal costs, make this a priority for developing novel models of care. Recent Australian research demonstrated the potential of a community pharmacy-based ‘goal-focused’ intervention to help people with intermittent allergic rhinitis to self-manage their condition better, reduce symptom severity and improve quality of life. In this pilot study we will assess the transferability of the goal-focused intervention to a UK context, the suitability of the intervention materials, procedures and outcome measures and collect data to inform a future definitive UK randomized controlled trial (RCT). <p></p> <b>Methods/design</b> A pilot cluster RCT with associated preliminary economic analysis and embedded qualitative evaluation. The pilot trial will take place in two Scottish Health Board areas: Grampian and Greater Glasgow and Clyde. Twelve community pharmacies will be randomly assigned to intervention or usual care group. Each will recruit 12 customers seeking advice or treatment for intermittent allergic rhinitis. Pharmacy staff in intervention pharmacies will support recruited customers in developing strategies for setting and achieving goals that aim to avoid/minimize triggers for, and eliminate/minimize symptoms of allergic rhinitis. Customers recruited in non-intervention pharmacies will receive usual care. The co-primary outcome measures, selected to inform a sample size calculation for a future RCT, are: community pharmacy and customer recruitment and completion rates; and effect size of change in the validated mini-Rhinoconjunctivitis Quality of Life Questionnaire between baseline, one-week and six-weeks post-intervention. Secondary outcome measures relate to changes in symptom severity, productivity, medication adherence and self-efficacy. Quantitative data about accrual, retention and economic measures, and qualitative data about participants’ experiences during the trial will be collected to inform the future RCT.<P></P> <b>Discussion</b> This work will lay the foundations for a definitive RCT of a community pharmacy-based ‘goal-focused’ self-management intervention for people with intermittent allergic rhinitis. Results of the pilot trial are expected to be available in April 2013