Early detection of bowel disease in symptomatic patients attending community pharmacies

With evidence that a substantial number of individuals manage symptoms without seeking medical help, a pharmacy service with symptom management guided by a screening tool should assist in the triage of clients with underlying health conditions. This research describes the successful development, validation and testing of an assessment questionnaire to guide pharmacy staff in identification of pharmacy clients at risk of serious bowel conditions, with referral of clients for further investigation where warranted

Will Australians pay for health care advice from a community pharmacist? A video vignette study

Background: Large proportion of Australians have access to pharmacists' health advice at no cost. The impact of a proposed co-payment levy for general practitioner (GP) consultation by Australian government is unclear. This raises an interesting question about consumers' perceived value of health-related consultations. Objective: This survey of representative sample of Western Australians explores the hypothesis that Australians are willing to pay for advanced model of pharmacy consultation. Methods: Two videos illustrating current-services and quality-enhanced-service (QES) incorporating systematic assessment of symptoms and referral to GP if necessary, were used. Participants viewed videos online and completed a willingness-to-pay (WTP) questionnaire about their perception and WTP for each service. Logistic regression and McNemar tests were used to identify WTP groups. Results: Of the 175 respondents, one in nine (19/175, 11%) were willing to pay and (35/175) 20% might consider paying for advice at pharmacies as per current-practice. Almost one in four (49/175, 28%) were willing to pay and (47/175) 27% would consider paying for QES (McNemar Test P < 0.001). Conclusions: The majority of West Australians may be willing to pay for consultation at pharmacies that offers more private, time-intensive experience with documented GP referral where required. Further research is warranted to test WTP with actual customers to confirm these results

A Model for Assessment and Referral of Clients with Bowel Symptoms in Community Pharmacies

BACKGROUND: To expedite diagnosis of serious bowel disease, efforts are required to signpost patients with high-risk symptoms to appropriate care. Community pharmacies are a recognised source of health advice regarding bowel symptoms. This study aimed to examine the effectiveness of a validated self-administered questionnaire, Jodi Lee Test (JLT), for detection, triage and referral of bowel symptoms suggestive of carcinoma, in pharmacies. METHOD: 'Usual Practice' was monitored for 12 weeks in 21 pharmacies in Western Australia, documenting outcomes for 84 clients presenting with bowel symptoms. Outcome measures were: acceptance of verbal advice from the pharmacist; general practitioner consultation; and diagnosis. Trial of the JLT involved staff training in the research protocol and monitoring of outcomes for 80 recruited clients over 20 weeks. Utility of the JLT was assessed by post-trial survey of pharmacy staff. RESULTS: Significantly more referrals were made by staff using the JLT than during Usual Practice: 30 (38%) vs 17 (20%). Clients' acceptance of referrals was also higher for the intervention group (40% vs 6%). Two-thirds of pharmacy staff agreed that the JLT could be incorporated into pharmacy practice, and 70% indicated they would use the JLT in the future. CONCLUSION: A pre-post design was considered more appropriate than a randomised control trial due to an inability to match pharmacies. Limitations of this study were: lack of control over adherence to the study protocol by pharmacy staff,\; no direct measure of client feedback on the JLT; and loss to follow-up. The JLT was effective in prompting decision-making by pharmacy staff and inter-professional care between pharmacies and general practice, in triage of clients at risk of bowel cancer

Feature Selection Model using Naive Bayes ML Algorithm for WSN Intrusion Detection System

Intrusion detection models using machine-learning algorithms are used for Intrusion prediction and prevention purposes. Wireless sensor network has a possibility of being attacked by various kinds of threats that will de-promote the performance of any network. These WSN are also affected by the sensor networks that send wrong information because of some environmental causes in- built disturbances misaligned management of the sensors in creating intrusion to the wireless sensor networks. Even though signified routing protocols cannot assure the required security in wireless sensor networks. The idea system provides a key solution for this kind of problem that arises in the network and predicts the abnormal behavior of the sensor nodes as well. But built model by the proposed system various approaches in detecting these kinds of intrusions in any wireless sensor networks in the past few years. The proposed system methodology gives a phenomenon control over the wireless sensor network in detecting the inclusions in its early stages itself. The Data set pre-processing is done by a method of applying the minimum number of features for intrusion detection systems using a machine learning algorithm. The main scope of this article is to improve the prediction of intrusion in a wireless sensor network using AI- based algorithms. This also includes the finest feature selection methodologies to increase the performance of the built model using the selected classifier, which is the Bayes category algorithm. Performance accuracy in the prediction of different attacks in wireless sensor networks is attained at nearly 95.8% for six selected attributes, a Precision level of 0.958, and the receiver operating characteristics or the area under the curve is equal to 0.989

Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability): A systematic review of systematic reviews.

ObjectiveTo synthesize the current evidence for subcutaneous hydration and medication infusions from systematic reviews and to assess their methodological quality.IntroductionPeripheral intravascular cannula/catheter insertion is a common invasive procedure for administering fluids and medications. Venous depletion is a growing concern for several patient populations. Subcutaneous access for the administration of isotonic solutions and medications is an alternative; however, vascular access assessment and planning guidelines rarely consider this route.MethodsSystematic review of systematic reviews (PROSPERO CRD42018046504). We searched 6 databases published in English language from 1990 to June 2020, identifying subcutaneous infusions an alternate route for fluids or medication. Methodological quality was evaluated using AMSTAR 2 criteria and data for mechanisms of infusion and outcomes related to effectiveness, safety, efficiency and acceptability extracted. The Johanna Briggs Institute's grades of recommendation informed the strength of recommendation.ResultsThe search yielded 1042 potential systematic reviews; 922 were excluded through abstract and duplicate screen. Of the remaining articles, 94 were excluded, and 26 were included. Overall, evidence is strong for recommending subcutaneous hydration infusions for older adults, weak for pediatric patients and inconclusive for palliative patients. There is strong evidence for 10 medications; weak evidence supporting 28 medications; however, there are eight medications with inconclusive evidence to make a recommendation and four medications not appropriate for subcutaneous delivery.ConclusionSubcutaneous access should be considered alongside intravenous therapy for hydration in older adults, and several medications. There are additional benefits in terms of ease of use and cost-effectiveness of this mode. Inclusion of subcutaneous access in clinical guidelines may promote uptake of this route to help preserve vessel health of vulnerable patients. Further high-quality research is needed to inform subcutaneous infusion therapy in a variety of populations (including pediatrics and palliative care) and medications and clarifying the mechanism of delivery

Cancer care coordinator: Promoting multidisciplinary care- A pilot study in Australian general practice

Aim: We hypothesised that patients treated for breast cancer would benefit from targeted therapeutic action delivered by general practitioners on the recommendations of a multidisciplinary team based in primary care. Methods: Patients scheduled for follow-up visits at a hospital surgical clinic were invited to complete a self-administered care needs assessment and be interviewed by a breast care nurse. Members of the multidisciplinary team discussed the audio-recorded interviews within 2 weeks. The team made recommendations for each patient, which were presented to the general practitioner as a suggested ‘care plan’. Health status information was collected via the Short Form 36 and Anxiety and Depression data via the Hospital anxiety and Depression Scale at recruitment and 3 months later. Results: Among the 74 women who were invited to participate, 21 were recruited over a 6-month period (28%), 19 of whom completed the study (90%). The mean age was 55 years (range 38–61 years) and the mean time in follow-up was 23 months (range 16–38 months). The team identified a median of three problems per patient (range 2–7) and made an average of two recommendations per patient for referral to an allied health professional (range 0–5). At 3 months, 17 women had attended their general practitioner, 11 of whom felt their condition had improved as a result of the intervention. There was no significant change in Short Form 36 or Hospital Anxiety and Depression Scale score after the intervention. Conclusions: Primary care-based multidisciplinary review of treated breast cancer patients is feasible and, for most, results in benefit. However, only a minority of eligible patients participated in this pilot study and the logistics of organising the reviews warrants careful consideration

Current practice in dialysis central venous catheter management: multi-disciplinary renal team perspectives

Aim: To explore the current practices related to the insertion, management and removal of dialysis central venous catheters (CVCs) used in patients with chronic kidney disease requiring haemodialysis. Methods: This qualitative descriptive study involved semi-structured interviews with surgeons, interventional radiologists, renal physicians, dialysis nurses, renal access nurses and renal researchers involved in the care of patients with chronic kidney disease requiring haemodialysis. Data were collected from staff at eight hospitals in six states and territories of Australia. Thirty-eight face-to-face interviews were conducted. A modified five-step qualitative content analysis approach was used to analyse the data. Results: Improved visualization technology and its use by interventional radiologists has steered insertions to specialist teams in specialist locations. This is thought to have decreased risk and improved patient outcomes. Nurses were identified as the professional group responsible for maintaining catheter access integrity, preventing access failure and reducing access-related complications. While best practice was considered important, justifications for variations in practice related to local patient and environment challenges were identified. Conclusion: The interdisciplinary team is central in the insertion, maintenance, removal and education of patients regarding dialysis CVCs. Clinicians temper research-based decision-making about central dialysis access catheter management with knowledge of individual, environmental and patient factors. Strategies to ensure guidelines are appropriately translated for use in a wide variety of settings are necessary for patient safety