Cost effectiveness of cascade testing for familial hypercholesterolaemia, based on data from familial hypercholesterolaemia services in the UK

Peer reviewedPublisher PD

Fentanyl related overdose in Indianapolis: Estimating trends using multilevel Bayesian models

Introduction: The opioid epidemic has been largely attributed to changes in prescribing practices over the past 20 years. Although current overdose trends appear driven by the opioid fentanyl, heroin has remained the focus of overdose fatality assessments. We obtained full toxicology screens on lethal overdose cases in a major US city, allowing more accurate assessment of the time-course of fentanyl-related deaths. Methods: We used coroner data from Marion County, Indiana comprising 1583 overdose deaths recorded between January 1, 2010 and April 30, 2017. Bayesian multilevel models were fitted to predict likelihood of lethal fentanyl-related overdose using information about the victim's age, race, sex, zip code, and date of death. Results: Three hundred and seventy-seven (23.8%) overdose deaths contained fentanyl across the seven-year period. Rates rose exponentially over time, beginning well below 15% from 2010 through 2013 before rising to approximately 50% by 2017. At the beginning of the study period, rates of fentanyl overdose were lowest among Black persons but increased more rapidly, eventually surpassing Whites. Currently, White females may be at particularly low risk of fentanyl overdose and Black females at high risk. Rates were highest for younger and middle-aged groups. Over time, fentanyl was more likely detected without the presence of other opioids. Conclusions: Fentanyl has increasingly been detected in fatal overdose deaths in Marion County. Policy and program responses must focus on education for those at highest risk of fentanyl exposure and death. These responses should also be tailored to meet the unique needs of high-risk demographics.This publication was supported by the Grant Number, 5 NU17CE002721-02, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services

Development and psychometric testing of an instrument to measure safety climate perceptions in community pharmacy

A positive and strong safety culture underpins effective learning from patient safety incidents in health care, including the community pharmacy (CP) setting. To build this culture, perceptions of safety climate must be measured with context-specific and reliable instruments. No pre-existing instruments were specifically designed or suitable for CP within Scotland. We therefore aimed to develop a psychometrically sound instrument to measure perceptions of safety climate within Scottish CPs.  The first stage, development of a preliminary instrument, comprised three steps: (i) a literature review; (ii) focus group feedback; and (iii) content validation. The second stage, psychometric testing, consisted of three further steps: (iv) a pilot survey; (v) a survey of all CP staff within a single health board in NHS Scotland; and (vi) application of statistical methods, including principal components analysis and calculation of Cronbach's reliability coefficients, to derive the final instrument.  The preliminary questionnaire was developed through a process of literature review and feedback. This questionnaire was completed by staff in 50 CPs from the 131 (38%) sampled. 250 completed questionnaires were suitable for analysis. Psychometric evaluation resulted in a 30-item instrument with five positively correlated safety climate factors: leadership, teamwork, safety systems, communication and working conditions. Reliability coefficients were satisfactory for the safety climate factors (α > 0.7) and overall (α = 0.93).  The robust nature of the technical design and testing process has resulted in the development of an instrument with sufficient psychometric properties, which can be implemented in the community pharmacy setting in NHS Scotland

Development of an online palliative care medicines training series for health and social care staff

Aim or goal of work: Frontline support staff working in General Practice (GP) (i.e. receptionists), Community Pharmacies (CP) and Care Homes are likely to face issues concerning palliative care medicines amongst their patient group. Previous service evaluations by the authors found a need for sustainable and accessible palliative care training for these staff. A national online training resource on palliative medicines for health and social care staff was subsequently developed and is currently being evaluated. Design, methods & approach taken: Various education and training materials for these staff groups were consolidated and re-developed into one interactive course, comprised of Core sessions for all staff (e.g. Introduction to Palliative Care) and discipline specific sessions i.e. Pharmacy (e.g. Dispensing Opioids) and Care Home (e.g. Palliative Medicines & Risk of Falls) staff. User feedback was obtained via a questionnaire measuring satisfaction, usefulness and impact. Results: All 50 participants (11 staff from GP Practices, Community Pharmacies (n=9) and Care Homes (n=30)) agreed that the training was useful and with the correct degree of difficulty. Participants liked the delivery format and felt the training was “informative” and “easy to access”. Staff also reported that managers were supportive of them undertaking the training. The training provided a good introduction and, for some, a refresher to palliative care. Some participants provided real-life examples of how the training had been beneficial to (and applied by) them in the workplace. Conclusions and lessons learned: This new training resource provides education in an engaging, accessible format to frontline health and social care multi-disciplinary teams. It will be available nationally from November 2016 to support the provision of palliative care by frontline staff at the point of need

Development of the NES online palliative care medicines training series for health and social care support staff

Previous Macmillan Cancer Support and Health Board funded palliative care pharmacy service evaluations in NHS Greater Glasgow & Clyde (urban) and NHS Highland (rural) (1-4) observed a steady integration of the community pharmacy team into local palliative care services. Frontline staff in General Practice, Community Pharmacies and Care Homes in these areas were found to lack knowledge about palliative care medicines amongst their patient group. Both evaluations resulted in the development and testing of training materials in a variety of face-to-face and online formats and for different support staff

The protocol of a clinical effectiveness trial comparing standard step-up care, early combination DMARD therapy and early use of TNF inhibitors for the treatment of moderate to severe psoriatic arthritis: the 3-arm parallel group SPEED randomized controlled trial

Objectives: The aim of the Severe Psoriatic arthritis – Early intervEntion to control Disease trial is to compare outcomes in psoriatic arthritis (PsA) patients with poor prognostic factors treated with standard step-up conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), combination csDMARDs or a course of early biologics. Design: This multicentre UK trial was embedded within the MONITOR-PsA cohort, which uses a trial within cohort design. Methods and analysis: Patients with newly diagnosed PsA and at least one poor prognostic factor (polyarthritis, C-reactive protein >5 mg/dL, health assessment questionnaire >1, radiographic erosions) were randomized equally and open-label to either standard care with ‘step-up’ csDMARD therapy, initial therapy with combination csDMARDs (methotrexate with either sulfasalazine or leflunomide) or to early biologics induction therapy (adalimumab plus methotrexate). The primary outcome is the PsA disease activity score at week 24. Ethics: Ethical approval for the study was granted by the South Central Research Ethics Committee (ref 18/SC/0107). Discussion: Treatment recommendations for PsA suggest more intensive therapy for those with poor prognostic factors but there are no studies that have previously used prognostic factors to guide therapy. Applying initial intensive therapy has shown improved outcomes in other inflammatory arthritides but has never been tried in PsA. Combination csDMARDs have shown some superiority over single therapies but there are limited data and concerns about side effects. Early use of biologics has also been shown to be superior to methotrexate but these drugs are costly and not usually funded first line. However, if a short course of biologics can rapidly suppress inflammation allowing treatment to be withdrawn and response maintained on methotrexate, this may be a cost-effective model for early use. Trial registration: ClinicalTrials.gov (NCT03739853) and EudraCT (2017-004542-24)

Practitioner accounts and knowledge production: an analysis of three marketing discourses

Responding to repeated calls for marketing academicians to connect with marketing actors, we offer an empirically-sourced discourse analysis of the ways in which managers portray their practices. Focusing on the micro-discourses and narratives that marketing actors draw upon to represent their work we argue that dominant representations of marketing knowledge production present a number of critical concerns for marketing theory and marketing education. We also evidence that the often promoted idea of a need to close the gap between theory - as a dominant discourse - and practice, as a way of doing marketing, is problematic to pursue. We suggest that a more fruitful agenda resides in the development of a range of polyphonic and creative micro-discourses of management, promoting context, difference and individual meaning in marketing knowledge production