A mixed-method study of community pharmacy staff's use, perceptions and acceptance of barcode scanning technology : pharmacy's experience of scanning technology

Introduction Increasing technology is a strategic goal within pharmacy to facilitate medicines' dispensing. Barcode scanning technology (BST) is considered low cost and reliable with potential safety benefits. A barrier to BST implementation within hospital pharmacy includes staff resistance; however, few studies explore BST within community pharmacy. To address this, pharmacy staff's use, perceptions and acceptance of BST within Scottish community pharmacies were examined. Methods Community pharmacies within Scotland using BST to scan medicines were identified using Twitter, eNewsletters and snowball sampling; 57 pharmacies were identified. Between May-Aug 2019, managers/owners participated in semi-structured interviews to explore BST use, and staff operating BST completed an online questionnaire to examine perceptions and acceptance. Interview data underwent content analysis and questionnaire data presented as medians (IQR). Results BST was used for various purposes, most commonly for dispensed item verification (n = 43 pharmacies) and to identify falsified medicines (n = 10 pharmacies). Twenty pharmacy managers/owners were interviewed which revealed multiple scanners and BST functionalities. Thirty-five participants from 16 pharmacies participated in the questionnaire. Staff considered BST as easy to use. There were positive perceptions and acceptance of BST for dispensed item verification, and negative perceptions and less acceptance of BST for identifying falsified medicines. Discussion BST implementation was identified in a minority of Scotland's 1,254 community pharmacies, and greater effort may be needed to increase technology utilisation. The variation of BST use may affect safety due to increased complexity. BST's purpose may underpin staff perceptions and acceptance. Future studies should explore barriers and observe BST use in practice. Public interest summary Barcode scanning technology (BST) may help pharmacy staff to dispense medicines safely. Hospital pharmacy staff have reported disliking using BST to scan medicines; however, no similar research has been carried out within community pharmacy. This study examined Scottish community pharmacies’ use of BST to scan medicines, and the pharmacy staff's views. Fifty-seven pharmacies were identified. BST was most commonly used to verify that the correct medicine was selected during dispensing (n = 43 pharmacies) and to identify 'falsified medicines' which were not safe to dispense (n = 10 pharmacies). Staff considered BST as easy to use, but were more positive and accepting of BST for verifying the correct medicine than for identifying falsified medicines. This suggests BST's purpose may underpin pharmacy staff perceptions and acceptance. A small number of pharmacies in Scotland used BST for this purpose, therefore more efforts may be needed to promote technology use

Pharmacist and patient perspectives on the use of video consultations in primary care pharmacy in Scotland

Although over 80% of patients and 94% of healthcare professionals feel video consultations should be offered for healthcare appointments, use in pharmacy has been limited both before and during the COVID-19 pandemic (1, 3). Human Factors is the study of the interactions between humans, the tools and technologies they use and the complex environments in which they work (4). Applying human factors can assist in understanding the influence that each component of a system has on the use of video consultations. The aim of this study was to understand the factors influencing patients' and community and general practice pharmacists' use of video consultations (VCs), using a human factors approach

Implementation of pharmacist-led services in primary care : a mixed-methods exploration of pharmacists' perceptions of a national educational resource package

Background: To help alleviate the global pressure on primary care, there has been an increase in the number of clinical pharmacists within primary care. Educational resources are necessary to support this workforce and their development within this role. An educational resource package was developed in Scotland to support the General Practice Clinical Pharmacists (GPCPs), containing a hard copy Competency and Capability Framework (CCF), an online platform (TURAS) and both clinical and educational supervisors in 2016. Objective: To examine the implementation of a competency-based educational resource package through the exploration of pharmacists’ perceptions of its adoption, acceptability, appropriateness, and feasibility. Methods: Participants were GPCPs who had been part of a national training event between 2016 and 2018. The participants were given the opportunity to complete an online questionnaire or a semi-structured telephone interview. Both data collection tools were based on Proctor’s model of implementation outcomes: adoption, acceptability, appropriateness and feasibility. Areas covered included GPCPs’ perceptions and level of adoption of the educational resource package developed to support them in their role. Results: Of a potential 164 participants, 52 (31.7%) completed the questionnaire and 12 (7.3%) completed the interview. GPCPs indicated widespread adoption and were accepting of the resources; however, it was suggested that its value was undermined, as it was not associated with a qualification. The appropriateness and feasibility of the resources depended on GPCPs’ individual situation (including current role, previous job experience, time available, support received from peers and supervisors, and perceptions of resources available). Conclusions: The suitability of the CCF was evidenced by participants’ adoption and acceptance of the resource, indicating the necessity of a competence-based framework to support the GPCPs’ role. However, its suitability was hindered in terms of varied perceptions of appropriateness and feasibility. Despite the limited sample size, the results indicate that the value of these resources should be promoted across primary care; nevertheless further facilitation is required to allow GPCPs to fully engage with the resources

Pharmacist and patient perspectives on the use of video consultations in primary care pharmacy in Scotland

Although over 80% of patients and 94% of healthcare professionals feel video consultations should be offered for healthcare appointments, use in pharmacy has been limited both before and during the COVID-19 pandemic (1, 3). Human Factors is the study of the interactions between humans, the tools and technologies they use and the complex environments in which they work (4). Applying human factors can assist in understanding the influence that each component of a system has on the use of video consultations. The aim of this study was to understand the factors influencing patients' and community and general practice pharmacists' use of video consultations (VCs), using a human factors approach

Competencies required for general practice clinical pharmacists providing the Scottish pharmacotherapy service : a modified eDelphi study

Due to work load pressures in primary care, increasing efforts are being made internationally to implement pharmacists working alongside general practitioners. While there is wide interest in the contributions pharmacists can make within primary care, there is limited research which explores the competencies pharmacists need to safely and effectively provide care in this arena. Therefore, a modified eDelphi study was conducted between July 2019 and January 2020 among pharmacists working in General Practice in Scotland in order to a) generate a list of competencies required to undertake pharmacotherapy tasks within General Practice using content analysis; and b) establish consensus regarding the importance of these competencies using a rating scale ranging from 1 (“not important”) to 10 (“very important”). A framework of competencies was developed, containing eight competency categories with a total of 31 individual competency items. Overall, study participants considered all eight competency categories as being important, with a mode of 10 and a median > 8; agreement among participants was high, with the majority of individual competency items rated 8 or above by more than 75% of participants. There was, however, variation in responses with regards to specific tasks such as medicines reconciliation and medication compliance reviews. Findings indicate that the GP setting requires a broad set of competencies – covering areas including the use of IT systems; clinical knowledge; and communicating with patients and other health care professionals. This implies that further emphasis on clinical and consultation skills should be added to training programmes aimed at GP pharmacists; furthermore, ongoing support is also needed with regards to generic skills such as the use of IT systems, documentation, and general procedures and processes within primary care, some of which might need to be tailored to the specific practice context

Pharmacist and patient perspectives on the use of video consultations in primary care pharmacy in Scotland

Although over 80% of patients and 94% of healthcare professionals feel video consultations should be offered for healthcare appointments, use in pharmacy has been limited both before and during the COVID-19 pandemic (1, 3). Human Factors is the study of the interactions between humans, the tools and technologies they use and the complex environments in which they work (4). Applying human factors can assist in understanding the influence that each component of a system has on the use of video consultations. The aim of this study was to understand the factors influencing patients' and community and general practice pharmacists' use of video consultations (VCs), using a human factors approach

Dietary supplementation with inulin-propionate ester or inulin improves insulin sensitivity in adults with overweight and obesity with distinct effects on the gut microbiota, plasma metabolome and systemic inflammatory responses: a randomised cross-over trial

Objective: To investigate the underlying mechanisms behind changes in glucose homeostasis with delivery of propionate to the human colon by comprehensive and coordinated analysis of gut bacterial composition, plasma metabolome and immune responses. Design: Twelve non-diabetic adults with overweight and obesity received 20 g/day of inulin-propionate ester (IPE), designed to selectively deliver propionate to the colon, a high-fermentable fibre control (inulin) and a low-fermentable fibre control (cellulose) in a randomised, double-blind, placebo-controlled, cross-over design. Outcome measurements of metabolic responses, inflammatory markers and gut bacterial composition were analysed at the end of each 42-day supplementation period. Results: Both IPE and inulin supplementation improved insulin resistance compared with cellulose supplementation, measured by homeostatic model assessment 2 (mean±SEM 1.23±0.17 IPE vs 1.59±0.17 cellulose, p=0.001; 1.17±0.15 inulin vs 1.59±0.17 cellulose, p=0.009), with no differences between IPE and inulin (p=0.272). Fasting insulin was only associated positively with plasma tyrosine and negatively with plasma glycine following inulin supplementation. IPE supplementation decreased proinflammatory interleukin-8 levels compared with cellulose, while inulin had no impact on the systemic inflammatory markers studied. Inulin promoted changes in gut bacterial populations at the class level (increased Actinobacteria and decreased Clostridia) and order level (decreased Clostridiales) compared with cellulose, with small differences at the species level observed between IPE and cellulose. Conclusion: These data demonstrate a distinctive physiological impact of raising colonic propionate delivery in humans, as improvements in insulin sensitivity promoted by IPE and inulin were accompanied with different effects on the plasma metabolome, gut bacterial populations and markers of systemic inflammation

Working with Indigenous, local and scientific knowledge in assessments of nature and nature's linkages with people

Working with indigenous and local knowledge (ILK) is vital for inclusive assessments of nature and nature's linkages with people. Indigenous peoples' concepts about what constitutes sustainability, for example, differ markedly from dominant sustainability discourses. The Intergovernmental Platform on Biodiversity and Ecosystems Services (IPBES) is promoting dialogue across different knowledge systems globally. In 2017, member states of IPBES adopted an ILK Approach including: procedures for assessments of nature and nature's linkages with people; a participatory mechanism; and institutional arrangements for including indigenous peoples and local communities. We present this Approach and analyse how it supports ILK in IPBES assessments through: respecting rights; supporting care and mutuality; strengthening communities and their knowledge systems; and supporting knowledge exchange. Customary institutions that ensure the integrity of ILK, effective empowering dialogues, and shared governance are among critical capacities that enable inclusion of diverse conceptualizations of sustainability in assessments

The Most Metal-Poor Stars. IV : The Two Populations with [Fe/H] <~ -3.0

We discuss the carbon-normal and carbon-rich populations of Galactic halo stars having [Fe/H] lsim -3.0, utilizing chemical abundances from high-resolution, high signal-to-noise model-atmosphere analyses. The C-rich population represents ~28% of stars below [Fe/H] = -3.1, with the present C-rich sample comprising 16 CEMP-no stars, and two others with [Fe/H] ~ -5.5 and uncertain classification. The population is O-rich ([O/Fe] gsim +1.5); the light elements Na, Mg, and Al are enhanced relative to Fe in half the sample; and for Z > 20 (Ca) there is little evidence for enhancements relative to solar values. These results are best explained in terms of the admixing and processing of material from H-burning and He-burning regions as achieved by nucleosynthesis in zero-heavy-element models in the literature of "mixing and fallback" supernovae (SNe); of rotating, massive, and intermediate-mass stars; and of Type II SNe with relativistic jets. The available (limited) radial velocities offer little support for the C-rich stars with [Fe/H] < -3.1 being binary. More data are required before one could conclude that binarity is key to an understanding of this population. We suggest that the C-rich and C-normal populations result from two different gas cooling channels in the very early universe of material that formed the progenitors of the two populations. The first was cooling by fine-structure line transitions of C II and O I (to form the C-rich population); the second, while not well defined (perhaps dust-induced cooling?), led to the C-normal group. In this scenario, the C-rich population contains the oldest stars currently observed.Peer reviewe

Aberrant epithelial GREM1 expression initiates colonic tumorigenesis from cells outside the stem cell niche

Hereditary mixed polyposis syndrome (HMPS) is characterized by the development of mixed-morphology colorectal tumors and is caused by a 40-kb genetic duplication that results in aberrant epithelial expression of the gene encoding mesenchymal bone morphogenetic protein antagonist, GREM1. Here we use HMPS tissue and a mouse model of the disease to show that epithelial GREM1 disrupts homeostatic intestinal morphogen gradients, altering cell fate that is normally determined by position along the vertical epithelial axis. This promotes the persistence and/or reacquisition of stem cell properties in Lgr5-negative progenitor cells that have exited the stem cell niche. These cells form ectopic crypts, proliferate, accumulate somatic mutations and can initiate intestinal neoplasia, indicating that the crypt base stem cell is not the sole cell of origin of colorectal cancer. Furthermore, we show that epithelial expression of GREM1 also occurs in traditional serrated adenomas, sporadic premalignant lesions with a hitherto unknown pathogenesis, and these lesions can be considered the sporadic equivalents of HMPS polyps