Exploring the interprofessional relationships between community pharmacists and general practitioners undertaking a collaborative medicines management service

To improve the outcomes of drug therapy, there is increasing interest in the community pharmacist providing medicines management services (MMS) (Department of Health, 2000b, 2003a). In 2001, the Department of Health funded the Community Pharmacy Medicines Management Project (CPMMP) to evaluate the introduction of a community pharmacy led MMS. This thesis set out to critically assess the views and experiences of community pharmacists and general practitioners (GPs) participating in the CPMMP; exploring how relationships and perceptions of each other could influence community pharmacists carrying out a MMS, from the viewpoint of both community pharmacists and GPs. This is a qualitative study whereby eight focus groups were conducted with thirty five community pharmacists, and semi-structured telephone interviews were carried out with twenty one GPs and twenty eight community pharmacists. Data was analysed using the broad principles of Grounded Theory (Glaser and Strauss, 1967). Almost all pharmacists and GPs stated they had a good working relationship with each other prior to the MMS commencing, although a number of attitudinal barriers were identified. These included professional hierarchy, GPs' lack of awareness of a pharmacist's training and role in health care, and concerns that commercial interests could potentially affect a community pharmacist's advice. However, these data suggested that where there was an established relationship between the two professions, the most positive feedback about the MMS was reported. These data also suggested that some GPs were not supportive for community pharmacists to undertake a MMS and were generally unwillingly for the community pharmacist to have full access to patients' medical records. There were also some concerns around boundary encroachment. The project had a limited impact on improving relationships between community pharmacists and GPs, with relationships and GPs' perceptions remaining unaltered in many instances. This piece of research has highlighted that attitudinal barriers need to be addressed in order to accomplish effective collaborative working between community pharmacists and GPs

Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Objective To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists’ assessment of the training, and the time implications of undertaking the training. Methods Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencieswere calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists’ diaries were analysed thematically. Key findings All six pharmacists received 22 h of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30were completed) stated theywere satisfied or very satisfiedwith the various elements of the training package.Analysis of free-text comments and the pharmacists’ diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety

Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Objective: To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists’ assessment of the training, and the time implications of undertaking the training. Methods: Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists’ diaries were analysed thematically. Key findings: All six pharmacists received 22 hours of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists’ diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions: Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety

Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Abstract Objective To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists' assessment of the training, and the time implications of undertaking the training. Methods Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists' diaries were analysed thematically. Key findings All six pharmacists received 22 h of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists' diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety

Ionised carbon and galaxy activity

We investigate the possibility that the decrease in the relative luminosity of the 158 micron [CII] line with the far-infrared luminosity in extragalactic sources stems from a stronger contribution from the heated dust emission in the more distant sources. Due to the flux limited nature of these surveys, the luminosity of the detected objects increases with distance. However, the [CII] luminosity does not climb as steeply as that of the far-infrared, giving the decline in the L_[CII]/L_FIR ratio with L_FIR. Investigating this further, we find that the [CII] luminosity exhibits similar drops as measured against the carbon monoxide and radio continuum luminosities. The former may indicate that at higher luminosities a larger fraction of the carbon is locked up in the form of molecules and/or that the CO line radiation also contributes to the cooling, done mainly by the [CII] line at low luminosities. The latter hints at increased activity in these galaxies at greater distances, so we suggest that, in addition to an underlying heating of the dust by a stellar population, there is also heating of the embedded dusty torus by the ultra-violet emission from the active nucleus, resulting in an excess in the far-infrared emission from the more luminous objects.Comment: 9 pages, accepted by A&

Ecosystem resilience despite large-scale altered hydroclimatic conditions

Climate change is predicted to increase both drought frequency and duration, and when coupled with substantial warming, will establish a new hydroclimatological model for many regions. Large-scale, warm droughts have recently occurred in North America, Africa, Europe, Amazonia and Australia, resulting in major effects on terrestrial ecosystems, carbon balance and food security. Here we compare the functional response of above-ground net primary production to contrasting hydroclimatic periods in the late twentieth century (1975-1998), and drier, warmer conditions in the early twenty-first century (2000-2009) in the Northern and Southern Hemispheres. We find a common ecosystem water-use efficiency (WUE e: Above-ground net primary production/ evapotranspiration) across biomes ranging from grassland to forest that indicates an intrinsic system sensitivity to water availability across rainfall regimes, regardless of hydroclimatic conditions. We found higher WUE e in drier years that increased significantly with drought to a maximum WUE e across all biomes; and a minimum native state in wetter years that was common across hydroclimatic periods. This indicates biome-scale resilience to the interannual variability associated with the early twenty-first century drought - that is, the capacity to tolerate low, annual precipitation and to respond to subsequent periods of favourable water balance. These findings provide a conceptual model of ecosystem properties at the decadal scale applicable to the widespread altered hydroclimatic conditions that are predicted for later this century. Understanding the hydroclimatic threshold that will break down ecosystem resilience and alter maximum WUE e may allow us to predict land-surface consequences as large regions become more arid, starting with water-limited, low-productivity grasslands. © 2013 Macmillan Publishers Limited. All rights reserved

An embedded longitudinal multi-faceted qualitative evaluation of a complex cluster randomized controlled trial aiming to reduce clinically important errors in medicines management in general practice

<p>Abstract</p> <p>Background</p> <p>There is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER) intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care.</p> <p>Methods</p> <p>Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway), relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework.</p> <p>Results</p> <p>We conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists’ explicitly designated role as a change agent. However, important concerns were identified about the likely sustainability of this new model of delivering care, in the absence of an appropriate support network for pharmacists and career development pathways.</p> <p>Conclusions</p> <p>This embedded qualitative inquiry has helped to understand the complex organizational and social environment in which the trial was undertaken and the PINCER intervention was delivered. The longitudinal element has given insight into the dynamic changes and developments over time. Medication errors and ways to address these are high on stakeholders’ agendas. Our results further indicate that pharmacists were, because of their professional standing and skill-set, able to engage with the complex general practice environment and able to identify and manage many clinically important errors in medicines management. The transferability of the PINCER intervention approach, both in relation to other prescribing errors and to other practices, is likely to be high.</p

A global horizon scan of the future impacts of robotics and autonomous systems on urban ecosystems

Technology is transforming societies worldwide. A major innovation is the emergence of robotics and autonomous systems (RAS), which have the potential to revolutionize cities for both people and nature. Nonetheless, the opportunities and challenges associated with RAS for urban ecosystems have yet to be considered systematically. Here, we report the findings of an online horizon scan involving 170 expert participants from 35 countries. We conclude that RAS are likely to transform land use, transport systems and human–nature interactions. The prioritized opportunities were primarily centred on the deployment of RAS for the monitoring and management of biodiversity and ecosystems. Fewer challenges were prioritized. Those that were emphasized concerns surrounding waste from unrecovered RAS, and the quality and interpretation of RAS-collected data. Although the future impacts of RAS for urban ecosystems are difficult to predict, examining potentially important developments early is essential if we are to avoid detrimental consequences but fully realize the benefits

Exploring the interprofessional relationships between community pharmacists and general practitioners undertaking a collaborative medicines management service

To improve the outcomes of drug therapy, there is increasing interest in the community pharmacist providing medicines management services (MMS) (Department of Health, 2000b, 2003a). In 2001, the Department of Health funded the Community Pharmacy Medicines Management Project (CPMMP) to evaluate the introduction of a community pharmacy led MMS. This thesis set out to critically assess the views and experiences of community pharmacists and general practitioners (GPs) participating in the CPMMP; exploring how relationships and perceptions of each other could influence community pharmacists carrying out a MMS, from the viewpoint of both community pharmacists and GPs. This is a qualitative study whereby eight focus groups were conducted with thirty five community pharmacists, and semi-structured telephone interviews were carried out with twenty one GPs and twenty eight community pharmacists. Data was analysed using the broad principles of Grounded Theory (Glaser and Strauss, 1967). Almost all pharmacists and GPs stated they had a good working relationship with each other prior to the MMS commencing, although a number of attitudinal barriers were identified. These included professional hierarchy, GPs' lack of awareness of a pharmacist's training and role in health care, and concerns that commercial interests could potentially affect a community pharmacist's advice. However, these data suggested that where there was an established relationship between the two professions, the most positive feedback about the MMS was reported. These data also suggested that some GPs were not supportive for community pharmacists to undertake a MMS and were generally unwillingly for the community pharmacist to have full access to patients' medical records. There were also some concerns around boundary encroachment. The project had a limited impact on improving relationships between community pharmacists and GPs, with relationships and GPs' perceptions remaining unaltered in many instances. This piece of research has highlighted that attitudinal barriers need to be addressed in order to accomplish effective collaborative working between community pharmacists and GPs.EThOS - Electronic Theses Online ServiceGBUnited Kingdo