Social media guidelines: recommendations for the development of undergraduate pharmacy student guidelines.

Background and Objective: The ubiquitous nature of social media (SoMe) involves merging of personal-professional personas. Healthcare organisations publish guidance on how to use social media responsibly. However, inappropriate use of social media continues to be evident amongst undergraduate pharmacy students with potential implications for their fitness to practise. There is evidence of a lack of understanding of how online behaviour, or e-professionalism, relates to the student code of conduct. There remains a need within the pharmacy undergraduate student population for guidance which will be similarly acceptable and directly applicable to their context. Objective: to develop peer-group designed recommendations for pharmacy student SoMe guidelines. Design: Qualitative, activity-based focus groups were conducted based on a topic guide informed by existing literature and a previous study by the research team. The topic guide also formed the framework for thematic data analysis. The study was approved by university Ethical Review Committee. Results: Focus groups were conducted across four Master of Pharmacy (MPharm) stages (S1: n=10; S2: n=5; S3: n=8; S4: n=6). All except one participant (n=29) were aged under 24 with near equal male:female ratio (n=15:14). The majority of participants did not use SoMe guidelines despite daily SoMe use, but rather used personal judgement to decide on appropriate SoMe content. Some elements of existing guidance were seen as valuable but lacked balance of content/tone and examples of appropriate SoMe behaviours. There was no agreement on 'appropriate behaviours' however general concerns emerged around guidance impinging personal personas and impacting perceptions of e-professionalism. Conclusion: Social media guidelines for undergraduate pharmacy students should address concerns surrounding eprofessionalism. These should include examples of good practice, yet should contain clear 'points for practice' in a simple, user-friendly format alongside a lecture or video presentation. Whilst students were aware of profession-specific guidance, student-specific guidance was viewed as beneficial to support undergraduate students, in particular with the blurred boundaries between personal-professional personas. The results of this study have been used to inform the delivery of SoMe support for students within the MPharm course. Further work is being undertaken to explore the definition of appropriate online behaviours and provision of guidance as part of doctoral studies

Community pharmacist clinical portal enabled access to aspects of patients' primary and secondary care EHR: exploring the general public's views in NHS Tayside.

Background and Objective: Community pharmacist access to aspects of patients' primary and secondary care electronic healthcare records (EHR) was piloted in NHS Tayside, Scotland. While policy makers and pharmacists are largely in favour of community pharmacist access, and there is an unmet service need based on GP workforce-workload evidence, the general public's perspectives of pharmacist EHR access had yet to be explored in Scotland. Objective: to determine the general public's perspectives of community pharmacist EHR access in NHS Tayside. Design: A survey methodology using paper-based questionnaires posted to a random sample of the general public in NHS Tayside (March-May 2017). Quantitative data were analysed using descriptive statistics (IBM SPSS version_21_). The study was approved by university Ethical Review Committee. Results: Of 1000 surveys distributed, 205 returned, (27 undeliverable), providing a response rate of 21%. Although some were unsure (23%; n = 47/203), most indicated their community pharmacist would be better able to recognise problems with medicines/healthcare given access to patients' EHR (63%; n = 127/203), knew why each medicine was prescribed (74%; n = 150/203), and thought that a long-term condition would make access to patient records essential (73%; n = 148/203). Few respondents were against/were non-committal on community pharmacists having read or read-and-write access to EHR. For example, the Emergency Care Summary (ECS) (13%; n = 27/201) where, if access were permitted, respondents preferred that consent should not be required on each and every occasion: ECS (73%; n = 148/203). Many felt access to patients' EHR would mean the pharmacist was better informed so could provide better care (68%; n = 136/200) and that mistakes were less likely to happen (71%; n = 142/200). Conclusion: Findings from this survey recognised community pharmacists could contribute more to improving patient care and safety, as part of the wider healthcare team, if they were better informed through access to patients' EHR. Enabling treatment of common clinical conditions in community pharmacy brings benefits to patients while reducing pressure on GP appointments. While there remain areas of uncertainty, and this is a small albeit representative sample from one area in Scotland, this study demonstrates support for community pharmacist access to patients' EHR with a preference for a simplified consent process

When you are homeless, you are not thinking about your medication, but your food, shelter or heat for the night: behavioural determinants of homeless patients' adherence to prescribed medicines.

Objectives This study aimed to explore behavioural determinants of homeless patients' adherence to prescribed medicines using Theoretical Domains Framework (TDF). Study design A qualitative study using semi-structured, face-to-face interviews. Methods Participants were recruited from a homelessness primary healthcare centre in Aberdeen, United Kingdom (UK). Face-to-face interviews were audio-recorded and transcribed verbatim. Thematic analysis of the interview data was conducted using the Framework Approach based on the Theoretical Domains Framework. National Health Service ethical and Research and Development (R&D) approval was obtained. Results Twenty-five patients were interviewed, at which point data saturation was achieved. A total of 13 out of 14 Theoretical Domains Framework domains were identified that explained the determinants of adherence or non-adherence to prescribed medicines. These included: beliefs about consequences (e.g. non-adherence leading to poor health); goals of therapy (e.g. being a normal person with particular reference to methadone adherence); and environmental context and resources (e.g. stolen medicines and the lack of secure storage). Obtaining food and shelter was higher priority than access and adherence to prescribed medicines while being homeless. Conclusions Behavioural determinants of non-adherence identified in this study were mostly related to participants' homelessness and associated lifestyle. Results are relevant to developing behaviour change interventions targeting non-adherent homeless patients and to the education of healthcare professionals serving this vulnerable population

An initial exploration of the perceptions of preparedness to practise among Saudi Arabian trained hospital pharmacists

Background: There is a dearth of literature on perceptions of preparedness to practise, which explores the extent to which educational institutions prepare their students to fulfil their professional role. Objective: The aim of this study was to explore perceptions of preparedness to practise among Saudi Arabian pharmacy graduates working in hospital. Method: Face-to-face, semi-structured interviews were conducted with ten hospital pharmacists based in four hospitals in the Eastern Province of Saudi Arabia who had qualified within the last five years from a Saudi Arabian School of Pharmacy. Interviews focused on expectations of hospital practise, perceptions of preparedness and challenges encountered, and reflections on how to better prepare students. Interviews were audio-recorded, transcribed and analysed thematically by two independent researchers using the Framework Approach. Results: Five key themes were identified: expectations versus reality of practise; issues relating to university course; practice related training; adapting to the work environment; and proposed improvements to undergraduate education. Participants were generally disappointed to find practise was not as expected. University training was largely didactic, with skills such as critical thinking not being sufficiently developed. Where practice related training was provided, it was variable in length and content. Cultural issues, most notably working in a mixed sex environment, were also considered to impact preparedness. Suggested improvements included greater focus on skills development and structured training placements. Conclusions: Participants experiences in university, and experiential placements varied greatly and were perceived to impact greatly on preparedness to practise. Further multiple perspective exploration of perceptions of preparedness to practise is warranted

Scottish adherence to antihypertensive medication in the elderly: promoting evidence-based community pharmacy services.

Background and Objective: Detection and treatment of hypertension continues to be a major public health challenge affecting between 30 and 45% of the general population, increasing steeply with age. Many studies have shown the benefit of antihypertensive agents in improving clinical outcomes. However, their effectiveness is dependent on persistent adherence to prescribed medication. Objectives (1) to assess adherence to antihypertensive medication; (2) to examine patient-specific factors associated with antihypertensive medication adherence among Scottish adults aged 65 years plus. Design: Pre-registration pharmacy trainees (pre-regs) undertaking postgraduate placement-in-practice based in community pharmacies across Scotland were invited to take part. Each pre-reg invited and consented up to 15 patients (aged 65 plus; at least one prescribed medication) presenting with a prescription which indicated treatment for hypertension, to take part in a telephone interview. Pre-regs added pharmacy dispensing data to a paper-based structured data collection tool for later online data entry. The structured interview focused on patient's beliefs about medicines and medication adherence. The study had NHS ethical approval. Results: Of the 130 pre-regs working in community pharmacy in Scotland 92% (n=119) took part with a patient-participant response rate of 75% (n=1332). 94% of respondents always-or-often strive to follow doctor's instructions and have a strict routine for use of their regular medicines. 87% rarely-or-never get confused about their medicines. 78% of respondents believed their medication prevented them becoming ill; unpleasant side effects were reported by 8%. 93% said taking medication did not disrupt their life. Respondents had visited a medical practice twice in previous 6 months. 69% reported normal blood pressure. 49% of respondents had previously smoked daily; 13% currently smoke. Conclusion: The SAAME study provides strong evidence of patients adhering to antihypertensive medication, also a model for promoting evidenced-based community pharmacy services: public health data year-on-year; raise the profile of clinical research in community pharmacy services. Feedback suggests pharmacies have concerns about telephone interviews preventing calls coming in so would prefer the option of face-to-face interviews; also direct online entry of data, and; online consent forms for the pre-regs. Future research is planned around evaluating pre-reg engagement, training needs, impact on community pharmacy based tutors and staff

Estimation of transient increases in bleeding risk associated with physical activity in children with haemophilia

BACKGROUND: Although it is widely appreciated that vigorous physical activity can increase the risk of bleeding episodes in children with haemophilia, the magnitude of the increase in risk is not known. Accurate risk estimates could inform decisions made by children with haemophilia and their parents about participation in physical activity and aid the development of optimal prophylactic schedules. The aim of this study is to provide an accurate estimate of the risks of bleeding associated with vigorous physical activity in children with haemophilia. METHODS/DESIGN: The study will be a case-crossover study nested within a prospective cohort study. Children with moderate or severe haemophilia A or B, recruited from two paediatric haematology departments in Australia, will participate in the study. The child, or the child's parent or guardian, will report bleeding episodes experienced over a 12-month period. Following a bleeding episode, the participant will be interviewed by telephone about exposures to physical activity in the case period (8 hours before the bleed) and 2 control periods (an 8 hour period at the same time on the day preceding the bleed and an 8 hour period two days preceding the bleed). Conditional logistic regression will be used to estimate the risk of participating in vigorous physical activity from measures of exposure to physical activity in the case and control periods. DISCUSSION: This case-control study will provide estimates of the risk of participation in vigorous physical activity in children with haemophilia

An evaluation of mental health clinical pharmacist prescribers within primary care medical practices in NHS Highland.

Background: A pilot has been conducted during which a specialist mental health clinical pharmacist prescriber (SMHCPP) consulted with patients by appointment at one of two GP Practices. Purpose: To evaluate the SMHCPP delivered pharmaceutical care to patients with anxiety disorders and/or depression in NHS Highland. Methods: Both pharmacists handed out a study pack to patients. Patient study packs included a questionnaire based on the CARE Measure plus 5-point Likert scale attitudinal statements all subject to statistical analysis. Ethical approval had been gained. Results: Eleven of 70 surveys were returned (response rate 16%) with an even gender split. Most were employed (n=9). Wellbeing was good (n=3), fair (n=6) or poor (n=2). All (n=11) thought the pharmacist excellent at 'making you feel at ease', 'really listening', 'being interested in you as a whole person', 'showing care and compassion', 'being positive', 'explaining things clearly'. Most said the pharmacist was excellent at 'letting you tell your story' (n=10), 'fully understanding your concerns' (n=10), 'helping you take control' (n=9) and 'making a plan of action with you' (n=8). All (n=11) strongly agreed/agreed they were 'confident that a pharmacist will prescribe as safely as a GP' also that they wanted their 'pharmacist and doctor to work together to make sure I am receiving the best treatment'. However, 'given the choice, I prefer to consult a GP rather than a pharmacist' half (n=5) were unsure, some strongly agreed (n=1)/agreed (n=1) but others strongly disagreed (n=2)/disagreed (n=2). Conclusions: Overall, this small sample from a difficult to reach population were positive about care they received from the SMHCPP

Troubling "understanding mathematics-in-depth": Its role in the identity work of student-teachers in England

Copyright @ The Author(s) 2013. This article is published with open access at Springerlink.comThis article has been made available through the Brunel Open Access Publishing Fund.In this paper, we focus on an initiative in England devised to prepare non-mathematics graduates to train as secondary mathematics teachers through a 6-month Mathematics Enhancement Course (MEC) to boost their subject knowledge. The course documentation focuses on the need to develop “understanding mathematics in-depth” in students in order for them to become successful mathematics teachers. We take a poststructural approach, so we are not interested in asking what such an understanding is, about the value of this approach or about the effectiveness of the MECs in developing this understanding in their participants. Instead we explore what positions this discourse of “understanding mathematics in-depth” makes available to MEC students. We do this by looking in detail at the “identity work” of two students, analysing how they use and are used by this discourse to position themselves as future mathematics teachers. In doing so, we show how even benign-looking social practices such as “understanding mathematics in-depth” are implicated in practices of inclusion and exclusion. We show this through detailed readings of interviews with two participants, one of whom fits with the dominant discourses in the MEC and the other who, despite passing the MEC, experiences tensions between her national identity work and MEC discourses. We argue that it is vital to explore “identity work” within teacher education contexts to ensure that becoming a successful mathematics teacher is equally available to all.King’s College Londo

Epistemic roles of materiality within a collaborative invention project at a secondary school

In this study, we examined maker‐centred learning from an epistemic perspective, highlighting the agentic role of material engagement and artefacts in learning and creativity. The use of physical materials plays a crucial role in maker activities where the socio‐epistemic aspects of knowledge creation entangle with the designing and making of physical artefacts. By taking a case study perspective, we analysed video data from nine design sessions involving a team of students (aged 13 to 14) developing an invention. First, we analysed knowledge that was built during the process. Our analysis revealed how design ideas evolved from preliminary to final stages and, together with the expressed design problems and conversations preceding the ideas, formed an epistemic object pursued by the team. Next, we included non‐human agencies into the analysis to understand the role of materials in the process. Features of materials and human design intentions both constrained and enabled idea improvement and knowledge creation, intermixing meanings and materials. Material making invited the students to not only rely on human rationalisation, but also to think together with the materials.In this study, we examined maker-centred learning from an epistemic perspective, highlighting the agentic role of material engagement and artefacts in learning and creativity. The use of physical materials plays a crucial role in maker activities where the socio-epistemic aspects of knowledge creation entangle with the designing and making of physical artefacts. By taking a case study perspective, we analysed video data from nine design sessions involving a team of students (aged 13 to 14) developing an invention. First, we analysed knowledge that was built during the process. Our analysis revealed how design ideas evolved from preliminary to final stages and, together with the expressed design problems and conversations preceding the ideas, formed an epistemic object pursued by the team. Next, we included non-human agencies into the analysis to understand the role of materials in the process. Features of materials and human design intentions both constrained and enabled idea improvement and knowledge creation, intermixing meanings and materials. Material making invited the students to not only rely on human rationalisation, but also to think together with the materials.Peer reviewe