Integrating community pharmacy and NHS Direct - pharmacists' views

AIM:To establish the views of community pharmacists on NHS Direct and its forthcoming integration with community pharmacy. DESIGN: Postal questionnaire survey. SUBJECTS AND SETTING: Pharmacists working in community pharmacies within the area of the NHS Direct Pharmacy pilot scheme - Essex, Barking and Havering. RESULTS: The response rate to the postal survey was 72% (263/364). Most pharmacies were generally supportive of NHS Direct (80%) and the pharmacy scheme in principle (83%), although their experience of the scheme in practice was limited. Perhaps because of this, the majority of pharmacists were unsure as to whether NHS Direct was referring appropriately, or whether the pharmacy would be able to meet the needs of patients without further referral. Almost half believed that patients referred by NHS Direct should be seen in a quiet area, away from the counter. Over two-thirds of pharmacists were willing to accommodate an NHS Direct information point in their pharmacy, although space was an issue. CONCLUSION: Overall the results of this study suggested that community pharmacists welcome their increasing involvement in the developing immediate care system. As the Government commitment in the NHS plan to integrate community pharmacy with NHS Direct becomes a reality across England and Wales over coming months the implications for pharmacists, in terms of workload and the adequacy of premises, will become clearer. Careful audit of the operation of the scheme will be essential

How helpful is NHS Direct? Postal survey of callers

NHS Direct, the new 24 hour telephone advice line staffed by nurses, was established to “provide easier and faster information for people about health, illness and the NHS so that they are better able to care for themselves and their families.” In March 1998, three first wave sites started in Lancashire, Milton Keynes, and Northumbria. As part of an extensive evaluation of this new service, we surveyed callers to determine how helpful they found the advice offered

Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial

OBJECTIVE: To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults. DESIGN: Pragmatic, cluster randomised community intervention trial. Setting: 12 general practices in Sheffield; four randomly selected as intervention populations, and eight as control populations. PARTICIPANTS: All those aged 65 and over in the least active four fifths of the population responding to a baseline survey. There were 2283 eligible participants from intervention practices and 4137 from control practices. INTERVENTION: Eligible subjects were invited to free locally held exercise classes, made available for two years. MAIN OUTCOME MEASURES: All cause and exercise related cause specific mortality and hospital service use at two years, and health status assessed at baseline, one, and two years using the SF-36. A cost utility analysis was also undertaken. RESULTS: Twenty six per cent of the eligible intervention practice population attended one or more exercise sessions. There were no significant differences in mortality rates, survival times, or admissions. After adjusting for baseline characteristics, patients in intervention practices had a lower decline in health status, although this reached significance only for the energy dimension and two composite scores (p,0.05). The incremental average QALY gain of 0.011 per person in the intervention population resulted in an incremental cost per QALY ratio of J17 174 (95% CI =J8300 to J87 120). CONCLUSIONS: Despite a low level of adherence to the exercise programme, there were significant gains in health related quality of life. The programme was more cost effective than many existing medical interventions, and would be practical for primary care commissioning agencies to implement

Nurses' views of using computerized decision support software in NHS Direct

Background. Nurses working in NHS Direct, the 24-hour telephone advice line in England, use computerized decision support software to recommend to callers the most appropriate service to contact, or to advise on self-care. Aims. To explore nurses' views of their roles and the computerized decision support software in NHS Direct. Methods. Qualitative analysis of semi-structured interviews with 24 NHS Direct nurses in 12 sites. Findings. Nurses described both the software and themselves as essential to the clinical decision-making process. The software acted as safety net, provider of consistency, and provider of script, and was relied upon more when nurses did not have clinical knowledge relevant to the call. The nurse handled problems not covered by the software, probed patients for the appropriate information to enter into the software, and interpreted software recommendations in the light of contextual information which the software was unable to use. Nurses described a dual process of decision-making, with the nurse as active decision maker looking for consensus with the software recommendation and ready to override recommendations made by the software if necessary. However, nurses' accounts of the software as a guide, prompt or support did not fully acknowledge the power of the software, which they are required to use, and the recommendation of which they are required to follow under some management policies. Over time, the influence of nurse and software merges as nurses internalize the software script as their own knowledge, and navigate the software to produce recommendations that they feel are most appropriate. Conclusions. The nurse and the software have distinct roles in NHS Direct, although the effect of each on the clinical decision-making process may be difficult to determine in practice

Health utility after emergency medical admission: a cross-sectional survey

Objectives: Health utility combines health related quality of life and mortality to produce a generic outcome measure reflecting both morbidity and mortality. It has not been widely used as an outcome measure in evaluations of emergency care and little is known about the feasibility of measurement, typical values obtained or baseline factors that predict health utility. We aimed to measure health utility after emergency medical admission, to compare health utility to age, gender and regional population norms, and identify independent predictors of health utility. Methods: We selected 5760 patients across three hospitals who were admitted to hospital by ambulance as a medical emergency. The EQ-5D questionnaire was mailed to all who were still alive 30 days after admission. Health utility was estimated by applying tariff values to the EQ-5D responses or imputing a value of zero for those who had died. Multivariable analysis was used to identify independent predictors of health utility at 30 days. Results: Responses were received from 2488 (47.7%) patients, while 541 (9.4%) had died. Most respondents reported some or severe problems with each aspect of health. Mean health utility was 0.49 (standard deviation 0.35) in survivors and 0.45 (0.36) including non-survivors. Some 75% had health utility below their expected value (mean loss 0.32, 95% confidence interval 0.31 to 0.33) and 11% had health utility below zero (worse than death). On multivariable modelling, reduced health utility was associated with increased age and lower GCS, varied according to ICD10 code and was lower among females, patients with recent hospital admission, steroid therapy, or history of chronic respiratory disease, malignancy, diabetes or epilepsy. Conclusions: Health utility can be measured after emergency medical admission, although responder bias may be significant. Health utility after emergency medical admission is poor compared to population norms. We have identified independent predictors or health utility that need to be measured and taken into account in nonrandomized evaluations of emergency care

The Green River Natural Analogue as a field laboratory to study the long-term fate of CO2 in the subsurface

Understanding the long-term response of CO2 injected into porous reservoirs is one of the most important aspects to demonstrate safe and permanent storage. In order to provide quantitative constraints on the long-term impacts of CO2-charged fluids on the integrity of reservoir-caprock systems we recovered some 300m of core from a scientific drill hole through a natural CO2 reservoir, near Green River, Utah. We obtained geomechanical, mineralogical, geochemical, petrophysical and mineralogical laboratory data along the entire length of the core and from non CO2-charged control samples. Furthermore, we performed more detailed studies through portions of low permeability layers in direct contact with CO2-charged layers. This was done to constrain the nature and penetration depths of CO2-promoted fluid-mineral reaction fronts. The major reactions identified include the dissolution of diagenetic dolomite cements and hematite grain coatings, and the precipitation of ankerite and pyrite and have been used as input for geochemical 1D reactive transport modelling, to constrain the magnitude and velocity of the mineral-fluid reaction front. In addition, we compared geomechanical data from the CO2-exposed core and related unreacted control samples to assess the mechanical stability of reservoir and seal rocks in a CO2 storage complex following mineral dissolution and precipitation for thousands of years. The obtained mechanical parameters were coupled to mineralogy and porosity. Key aim of this work was to better quantify the effect of long-term chemical CO2/brine/rock interactions on the mechanical strength and elastic properties of the studied formations

GRB 171010A/SN 2017htp: a GRB-SN at z = 0.33

The number of supernovae known to be connected with long-duration gamma-ray bursts (GRBs) is increasing and the link between these events is no longer exclusively found at low redshift (z ≲ 0.3) but is well established also at larger distances. We present a new case of such a liaison at z = 0.33 between GRB 171010A and SN 2017htp. It is the second closest GRB with an associated supernova of only three events detected by Fermi-LAT. The supernova is one of the few higher redshift cases where spectroscopic observations were possible and shows spectral similarities with the well-studied SN 1998bw, having produced a similar Ni mass (⁠ M Ni =0.33±0.02 M ⊙ MNi=0.33±0.02 M⊙ ⁠) with slightly lower ejected mass (⁠ M ej =4.1±0.7 M ⊙ Mej=4.1±0.7 M⊙ ⁠) and kinetic energy (⁠ E K =8.1±2.5× 10 51 erg EK=8.1±2.5×1051 erg ⁠). The host-galaxy is bigger in size than typical GRB host galaxies, but the analysis of the region hosting the GRB revealed spectral properties typically observed in GRB hosts and showed that the progenitor of this event was located in a very bright H ii region of its face-on host galaxy, at a projected distance of ∼ 10 kpc from its galactic centre. The star-formation rate (SFRGRB ∼ 0.2 M⊙ yr−1) and metallicity (12 + log(O/H) ∼8.15 ± 0.10) of the GRB star-forming region are consistent with those of the host galaxies of previously studied GRB–SN systems