Rusted

The goal of this ensemble was to transform an element that represents deterioration into an element that is part of something new

Measuring medicine-related experiences from the patient perspective: a systematic review

Background There is an increasing drive to measure and so improve patients’ experiences and outcomes of health care. This also applies to medicines, given their ubiquity as health care interventions. Patients’ experiences of using medicines vary and instruments which measure these are seen as an essential component to improve care. We aimed to identify generic measures of patients’ experiences of using prescription medicines and to examine their properties and suitability for use in research or practice. Methods Multiple electronic databases were searched: Medline, Embase, PsycINFO, PsycARTICLES, CINAHL Plus, the PROQOLID®, and Google Scholar. We identified, critically appraised and summarized generic questionnaires assessing one or more aspects of the medicine use experience among adult patients using prescription medicines for chronic conditions, and the process of questionnaire-development, degree of patient-involvement, and/or validation processes. Results 15 questionnaires were included. Of these, nine measures were multidimensional, covering various aspects of medicine use. Six instruments covered only a single domain, assessing a specific facet of using medicines. Domains covered were: effectiveness; convenience, practicalities and/or managing medicines; information, knowledge and/or understanding; side effects; relationships and/or communication with health professionals; impact on daily living and/or social life; general satisfaction; attitudes; beliefs, concerns, and/or perceptions; medical follow-up and/or adherence-related issues; treatment- and/or medicine-related burden, perceived control or autonomy; self-confidence about medicine use; availability and accessibility; and medicine-related quality of life. None of the identified questionnaires covered all domains. Instruments varied in the extent of both patient involvement in their development and in validation. Conclusion There is a scarcity of psychometrically sound, comprehensive, generic measures of experiences of using prescription medicines among adult patients living with chronic illnesses. There is a need for further development and/or validation of existing instruments suitable for use in this populatio

Development of a tool to support person-centred medicine-focused consultations with stroke survivors

Objective: To develop a tool to support medicine-focused person-centred consultations between community pharmacists and stroke survivors. Method: Semi-structured interviews with 15 stroke survivors and 16 community pharmacists were conducted. Thematic analysis of the data was performed and emerging themes examined to determine their relevance to the principles of delivering person-centred care. Findings were used to generate a framework from which a consultation tool was created. Face validity and the feasibility of using the tool in practice were explored with participating pharmacists. Results: Three major themes were identified; personal, process and environmental factors. A tool, in two parts, was developed, A ‘Getting to know me’ form which would help the pharmacist to appreciate the individual needs of the stroke survivor and a consultation guide to facilitate the consultation process. Pharmacists considered that both were useful and would support a person-centred medicine-focussed consultation. Conclusion: A consultation tool, reflecting the needs of stroke survivors, has been developed and is feasible for use within community pharmacy practice. Practice implications: Pharmacists must recognise the individual needs of stroke survivors to ensure that they provide consultations which are truly person-centred. The tool developed could support medicine-related consultations with patients with other long term conditions

A Computational Account of Borderline Personality Disorder: Impaired Predictive Learning about Self and Others Through Bodily Simulation

Social dysfunction is a prominent and disabling aspect of borderline personality disorder. We reconsider traditional explanations for this problem, especially early disruption in the way an infant feels physical care from its mother, in terms of recent developments in computational psychiatry. In particular, social learning may depend on reinforcement learning though embodied simulations. Such modeling involves calculations based on structures outside the brain such as face and hands, calculations on one\u27s own body that are used to make inferences about others. We discuss ways to test the role of embodied simulation in BPD and potential implications for treatment

Comparison of pharmacist and public views and experiences of community pharmacy medicines-related services in England

Background: Services provided by community pharmacists designed to support people using medicines are increasing. In England, two national services exist: Medicine Use Reviews (MUR) and New Medicines Service (NMS). Very few studies have been conducted seeking views of the public, rather than service users, on willingness to use these services or expectations of these services, or determined whether views align with pharmacist perceptions. Objective: To compare the perceptions of pharmacists and the general public on medicines-related services, particularly MUR and NMS services. Methods: Two parallel surveys were conducted in one area of England: one involved the general public and was administered using a street survey, and the other was a postal survey of community pharmacists. Similar questionnaires were used, seeking views of services, awareness, reasons for using services, and perceived benefits. Results: Response rates were 47.2% (1,000/2,012 approached) for the public and 40.8% (341/836) for pharmacists. Few people had experienced a discussion in a private consultation room or were aware of the two formal services, although their willingness to use them was high. Pharmacists estimated time spent on service provision as 10 minutes for MUR and 12 minutes for NMS, which aligned with acceptability to both pharmacists and the public. Pharmacists underestimated the willingness of the public to wait for an informal discussion or to make appointments for formal services. Both pharmacists and the public had high expectations that services would be beneficial in terms of increasing knowledge and understanding, but public expectations and experiences of services helping to sort out problems fell well below pharmacists’ perceptions. People who had experienced a pharmacy service had different perceptions of pharmacists. Conclusion: Views differed regarding why people use services and key aspects of service delivery. For services to improve, the pharmacy profession needs a better awareness of what the public, especially those with potential to benefit from services, view as acceptable and desirable

An insight into light as a chronobiological therapy in affective disorders

The field of chronobiology has vastly expanded over the past few decades, bringing together research from the fields of circadian rhythms and sleep. The importance of the environmental day–night cycle on our health is becoming increasingly evident as we evolve into a 24-hour society. Reducing or changing sleep times against our natural instincts to rest at night has a detrimental impact on our well-being. The mammalian circadian clock, termed "the suprachiasmatic nucleus", is responsible for synchronizing our behavioral and physiological outputs to the environment. It utilizes light transcoded by specialized retinal photoreceptors as its cue to set internal rhythms to be in phase with the light–dark cycle. Misalignment of these outputs results in symptoms such as altered/disturbed sleep patterns, changes in mood, and physical and mental exhaustion – symptoms shared by many affective clinical disorders. Key links to circadian abnormalities have been found in a number of disorders, such as seasonal affective disorder, nonseasonal depression, and bipolar affective disorder. Furthermore, therapies developed through chronobiological research have been shown to be beneficial in the treatment of these conditions. In this article, we discuss the impact of circadian research on the management of affective disorders, giving evidence of how a misaligned circadian system may be a contributor to the symptoms of depression and how moderating circadian rhythms with light therapy benefits patients

Development and validation of a revised instrument to measure burden of long-term medicines use: the Living with Medicines Questionnaire version 3

Objectives To revise the Living with Medicines Questionnaire (LMQ-2), which measures the burden of using prescribed medicines, to include cost and expand side effects and social issues. Methods New statements were developed and validated through cognitive interviews with medicines users and these and a global visual analogue scale (VAS) added to the 42-item LMQ-2. Construct validity was assessed through exploratory and confirmatory factor analyses using an on-line public survey. Criterion-related validity was measured against the Treatment Satisfaction Questionnaire with Medication (TSQM-II) and the EQ-5D-5L, in patients using community pharmacies, general practices and out-patient clinics. Reliability was assessed by test-re-test using on-line public distribution. Results The 58-item interim instrument (n=729) was reduced to 41 items after factor analysis, which confirmed an eight-domain structure: relationships with health professionals, practicalities, interferences, effectiveness, side effects, concerns, cost, autonomy, constructed as medicines burden. All subscales, except autonomy, loaded onto this construct and showed acceptable internal consistency. LMQ-VAS correlated with total LMQ scores (r=0.571). Criterion validation (n=422) demonstrated total LMQ scores negatively correlated with TSQM scores for global satisfaction (r=-0.616); domain scores showed similar correlations: effectiveness (r=-0.628), side-effects (r=-0.597), practicalities (r=-0.529). Total LMQ score was negatively correlated with EQ VAS (r=-0.383) and showed weak/moderate relationships with individual EQ-5D-5L dimensions. Test-retest (n=30) showed intra-class correlation coefficients of 0.954 (total LMQ score), 0.733-0.929 (domain scores) and 0.789 (global item). Conclusion The LMQ-3 instrument has acceptable construct, criterion-related and known-groups validity, and is internally consistent as a measure of medicines burden, although reliability requires further confirmation. It could be used to measure the outcome of interventions designed to reduce the burden of polypharmacy

Validation of an instrument to measure patients' experiences of medicine use: the Living with Medicines Questionnaire

Background: Medicine-related burden is an increasingly recognised concept, stemming from the rising tide of polypharmacy, which may impact on patient behaviours, including non-adherence. No instruments currently exist which specifically measure medicine-related burden. The Living with Medicines Questionnaire was developed for this purpose. Objectives: This study validated the Living with Medicines Questionnaire in a sample of adults using regular prescription medicines in the UK. Methods: Questionnaires were distributed in community pharmacies and public places in south-east England, or online via UK health websites and social media. A total of 1177 were returned 507 (43.1%) from pharmacy distribution and 670 (56.9%) on-line. Construct validity was assessed by principal components analysis and item reduction undertaken on the original 60-item pool. Known-groups analysis assessed differences in mean total scores between participants using different numbers of medicines and those requiring assistance with medicine use. Internal consistency was assessed by Cronbach’s alpha. Free-text comments were analysed thematically to substantiate underlying dimensions. Results: A 42-item, 8-factor, structure, comprising inter-correlated dimensions (patient-doctor relationships and communication about medicines; patient-pharmacist communication about medicines; interferences to daily life; practical difficulties; effectiveness; acceptance of medicine use; autonomy/control over medicines; and concerns about medicine use) was derived, which explained 57.4% of the total variation. Six of the eight subscales have acceptable internal consistency (? > 0.7). More positive experiences were observed among patients using eight or fewer medicines compared to nine or more, and those independent with managing/using their medicines versus those requiring assistance. Free-text comments, provided by almost a third of respondents, supported the domains identified. Conclusions: The resultant Living with Medicines Questionnaire (LMQ-2) is a valid and reliable multidimensional measure of prescription medicine use experiences, which covers more diverse domains than existing questionnaires. However, further validation work is necessary

Complexity of Medicine Regimens and Patient Perception of Medicine Burden

From the patient perspective, medicine burden is more than the number of medicines, or the complexity of medicine regimens they need to manage. Relationships between the number of medicines, regimen complexity and patient perception of medicine burden are under-researched. This cross-sectional study measured regimen complexity and determined how this and patient perceived burden are affected by the therapeutic group. Regimen complexity was measured in patients presenting prescriptions to six community pharmacies in South-East England. A sub-sample (166) also completed the Living with Medicines Questionnaire which measures patient perceived burden. The 492 patients were prescribed 2700 medicines (range 1 to 23). Almost half used at least one non-oral formulation. Complexity was correlated strongly with the number of medicines (r = 0.94), number of therapeutic groups (r = 0.84) and number of formulations (r = 0.73). Patients using medicines for skin, eye and respiratory conditions had the highest complexity scores. Increasing the number of medicines, frequency of dosing, number of non-oral formulations and number of different therapeutic groups all increased medicine burden. Although cardiovascular medicines were the most common medicines used by the majority of patients (60%), those for neurological, psychiatric and gastro-intestinal conditions were most strongly associated with high burden. Studies are required to determine medicine burden in different conditions, especially neurological conditions, including chronic pain