An exploratory study of the views of community pharmacy staff on the management of patients with undiagnosed skin problems.

Objective: The aim of this study was to explore pharmacist and medicine counter assistant (MCA) perceptions of community pharmacy management of patients presenting with symptomatic skin problems. Methods: The study involved semi-structured telephone interviews with 10 pharmacists and 15 MCAs from seven pharmacies. Interviews focused on perceptions of their role in managing symptomatic skin problems and views on why people sought pharmacy advice and any barriers to management. Advice from the local ethics committee was that approval was not required for the study. We analysed the interviews using the framework approach. Key finding: Pharmacists identified two key themes that defined their role; triage and reassurance. In contrast, MCAs defined their role as information gatherers and independent advisors. Themes identified by both pharmacists and MCAs relating to the use of pharmacy as a source of advice were convenience, the perceived non-serious nature of conditions and inaccessibility of the GP. Additionally, MCAs believed familiarity with the pharmacist was important. Both pharmacists and MCAs identified their lack of dermatological knowledge as a barrier with pharmacists reporting insufficient time to deal effectively with patients. MCAs identified the potential for misdiagnosis by pharmacists as another potential barrier. Conclusion: Our findings suggest that the role of pharmacists and MCAs is complementary; MCAs screen and provide the necessary information to pharmacists who then decide upon an appropriate course of action for the patient. Nevertheless, a major barrier to pharmacy-supported self-care of symptomatic skin problems is a perceived lack of knowledge and training in dermatology

The role of community pharmacists in supporting self-management in patients with psoriasis.

Background: The majority of patients with psoriasis have mild to moderate disease which can be managed in primary care with topical therapies. The supportive role of pharmacists for patients with long-term dermatological conditions is largely unknown. Objective: To assess the impact of an educational intervention delivered by community pharmacists to improve self-management for people with psoriasis. Method: The study involved a pre- and post-intervention design. Seven community pharmacies were selected based on their location (urban, rural etc.) and the pharmacists recruited via local comprehensive research networks. Patients with mild to moderate psoriasis were recruited either opportunistically or via a letter of invite by pharmacists who undertook a face-to-face consultation with one follow-up visit after 6 weeks. The primary outcome was the change in person-centred dermatology self-care index (PEDESI) score and secondary outcomes were the self-assessed psoriasis and severity index (SAPASI), measuring disease severity and the dermatology quality of life index (DLQI). Key findings: A total of 47 patients were recruited. At 6 weeks, 42/47 (89.3%) patients completed the follow-up consultation. There was a significant increase in mean PEDESI scores (25.15 versus 17.78, P < 0.001) at 6 weeks compared to baseline. Similarly, SAPASI (11.60 versus 7.74, P < 0.001) and DLQI (7.21 versus 4.14, P < 0.001) scores improved significantly. Conclusion: Pharmacist-assisted support for patients with psoriasis improved knowledge, reduced disease severity and the impact on quality of life. These results suggest that community pharmacists might have an important role to play in facilitating self-management for patients with psoriasis

Managing projects for change: Contextualised project management

This paper will detail three projects which focussed on enhancing online learning at a large Australian distance education University within a School of Business,School of Health and School of Education. Each project had special funding and took quite distinctive project management approaches, which reflect the desire to embed innovation and ownership at the instructor and student interface. By responding to the stakeholder requirements these three projects provide insight into a) how integrated professional development serves to enable change in practice; b) why leadership at both junior and senior levels of the organisation is an important driver to support instructor engagement for real change; c) what role external private contractors can play; and, d) how instructors were integrated through the varied project management approaches. The integrating theme of the paper is instructor engagement for real change. Each project will be detailed as mini-cases and key lessons drawn out that describe and explain the challenges, opportunities and scope of varied project management approaches to suit the distinct four contexts. This paper builds on and brings together considerable investigation into how we can support and enhance dissemination of a variety of project-based models that respond to contextual needs and issues. The multiple school case study methodology serves to provide an approach that is both robust and cognisant of current trends in increased university investment through shortterm project funding. The final recommendations will highlight how different approaches to project management are both desirable and essential for successfully embedding change of instructor practices for enhancing student learning in distance education modes

The Battle for Higher Standards

In the aftermath of the federal mandates imposed through No Child Left Behind, the state-led effort to establish common math and English standards across states—known as the Common Core State Standards—seemed a welcome change in the approach to improving student achievement and success. However, the effort to ensure that students were ready for college or the workforce became the political target of those who distrust federal mandates and fear a nationalized education agenda bent on social engineering. The standards became intertwined with NSA spying, data mining, and federal grants for education with strings attached

The clinical effectiveness of different parenting programmes for children with conduct problems : a systematic review of randomised controlled trials

Background Conduct problems are common, disabling and costly. The prognosis for children with conduct problems is poor, with outcomes in adulthood including criminal behaviour, alcoholism, drug abuse, domestic violence, child abuse and a range of psychiatric disorders. There has been a rapid expansion of group based parent-training programmes for the treatment of children with conduct problems in a number of countries over the past 10 years. Existing reviews of parent training have methodological limitations such as inclusion of non-randomised studies, the absence of investigation for heterogeneity prior to meta-analysis or failure to report confidence intervals. The objective of the current study was to systematically review randomised controlled trials of parenting programmes for the treatment of children with conduct problems. Methods Standard systematic review methods were followed including duplicate inclusion decisions, data extraction and quality assessment. Twenty electronic databases from the fields of medicine, psychology, social science and education were comprehensively searched for RCTs and systematic reviews to February 2006. Inclusion criteria were: randomised controlled trial; of structured, repeatable parenting programmes; for parents/carers of children up to the age of 18 with a conduct problem; and at least one measure of child behaviour. Meta-analysis and qualitative synthesis were used to summarise included studies. Results 57 RCTs were included. Studies were small with an average group size of 21. Meta-analyses using both parent (SMD -0.67; 95% CI: -0.91, -0.42) and independent (SMD -0.44; 95% CI: -0.66, -0.23) reports of outcome showed significant differences favouring the intervention group. There was insufficient evidence to determine the relative effectiveness of different approaches to delivering parenting programmes. Conclusion Parenting programmes are an effective treatment for children with conduct problems. The relative effectiveness of different parenting programmes requires further research

Patient and pharmacist perceptions of a pharmacist-led educational intervention for people with psoriasis.

BACKGROUND: Chronic plaque psoriasis is an inflammatory skin condition that affects up to 3% of the UK population and most patients have mild to moderate disease that can be effectively managed with topical therapies in primary care. In recent years, community pharmacists in the UK have been encouraged to adopt a more clinically focused role, particularly around supporting those with longterm conditions. However, little is known about how pharmacists might help support those with longterm skin conditions. OBJECTIVES: To determine patient and participating pharmacists' views of an educational intervention delivered in community pharmacy to those with mild to moderate chronic plaque psoriasis. METHODS: Pharmacists recruited patients either opportunistically when they presented at the pharmacy with a prescription for psoriasis treatment, or via a letter of invitation to those identified from their pharmacy medication records as using prescribed topical treatment for psoriasis. The intervention consisted of one face-to-face consultation and a follow-up appointment after approximately 6 weeks. Structured telephone interviews were conducted with 38 of the patients who participated in the intervention after completion of the follow-up visit. The interviews sought information on patients' reasons for joining the study, measures of satisfaction with the pharmacy consultation and perceptions on whether the pharmacist's advice improved their skin condition. The data generated were analysed quantitatively with open responses coded for subsequent analysis. In addition, semi-structured telephone interviews conducted with all seven participating pharmacists, explored their perceptions on the value of the intervention for both themselves and patients and the potential for wider adoption of such a service. All interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: Nearly three-quarters of patients (74%) joined the study to learn more about their condition and its management and half, (51%) reported improvements in knowledge after the intervention. The majority (84%) of patients believed that their psoriasis had improved as a result of the advice they received during the intervention. Pharmacists also improved their knowledge of psoriasis and its management and welcomed the opportunity for greater patient interaction, believing that patients benefited from the intervention and saw pharmacists as members of the healthcare team managing their condition. However, ensuring patients returned for the second appointment and juggling the demands of the study with other work was sometimes problematic. There were mixed views on the wider adoption of the intervention. CONCLUSION: In the present study, patients felt that their psoriasis improved as a result of the advice from pharmacists and this view was shared by pharmacists. Further work with a larger patient cohort is necessary to explore the extent to which these findings are generalisable to the wider population of pharmacists and patients with mild to moderate psoriasis

Growth Mindset: Associations with Apprehension, Self-Perceived Competence, and Beliefs about Public Speaking

The relationships among growth mindset for public speaking (i.e., the implicit theory that public speaking abilities can be developed and improved) and beliefs about the nature of public speaking, public speaking apprehension (PSA), and self-perceived public speaking competence (SPPSC) were investigated in intensive and traditional formats of a general education public speaking course. In general, growth mindset was associated with lower PSA, higher SPPSC, and more sophisticated beliefs about public speaking. Mindset remained somewhat stable, PSA significantly decreased, and SPPSC significantly increased from the beginning to the end of the course. More sophisticated beliefs about public speaking as an expressive, transformational, and audience-centric endeavor also tended to increase. However, there were several important differences between intensive and traditional formats. In particular, changes in the intensive format were more consistent across variables and had larger effect sizes

An exploratory study of community pharmacist diagnosis and management of dermatitis and acne.

BACKGROUND: Dermatitis and acne account for a large number of general practitioner appointments yet are amenable to treatment with products available to purchase from community pharmacies. OBJECTIVES: 1. The clinical appropriateness of community pharmacy interventions for these conditions 2. Patient reported measures of the effectiveness of the pharmacist's management of their condition. METHODS: Nine community pharmacies opportunistically recruited patients presenting with suspected cases of both conditions, taking digital images and audio-recording the consultation. These files were uploaded to a secure site and independently reviewed by three dermatology specialists. Following their consultation, patients received a questionnaire to assess their views on the effectiveness of the treatment provided and their level of satisfaction with pharmacy management. RESULTS: Forty patients (36 dermatitis and 4 acne) were recruited. Of 113 assessments (7 not rated due to missing data) reviewed, specialists agreed with pharmacist's diagnosis in 33.6% of cases, disagreed in 38.9% but were unable to determine the diagnosis in 27% of cases. Treatment was deemed appropriate in 42% of cases, inappropriate in 27% and indeterminate in 31% of cases. Twenty-three patients (58%) returned a questionnaire and 12 of these (54.5%, 1 missing) stated that their condition had cleared completely following pharmacist advised treatment. Almost all (91.3%) were very satisfied or satisfied with the advice and/or treatment provided. CONCLUSION: Specialists judged the clinical appropriateness of pharmacist diagnosis and management as suboptimal yet patients were more positive. This study indicates a possible need for greater assessment-related training in dermatology for study pharmacists and further work to determine the generalisability of findings

The development and feasibility testing of a community pharmacy-based guidelines for the assessment and management of acne vulgaris.

The following describes a research study commissioned by Galderma to explore the development of guidelines for community pharmacists on how to assess and manage patients who present with acne. Background: Acne vulargis (or simply acne) is an extremely common skin condition affecting up to 85% of teenagers and which, for a small proportion of individuals, can persist into adulthood. The majority of patients have mild to moderate disease which is amenable to treatment with topical acne therapies. Community pharmacies have been advocated as a first port of call for minor ailments, which includes skin conditions such as acne. While acne treatments are available over-the-counter, there is an array of different products available which can lead to confusion amongst patients and pharmacy team members. Furthermore, acne can be associated with psychosocial co-morbidities and lead to problems such as scarring hence the importance of a holistic assessment to ensure that patients are effectively managed and referred, where appropriate, to other healthcare providers. There are currently no pharmacy-specific guidelines published in the public domain to support UK-based pharmacy teams in the assessment and management of those seeking advice and or treatment for acne. The purpose of the present study was, therefore, to develop and feasibility test such a guideline to help support pharmacy teams to appropriately assess and manage patients seeking advice on acne. Method: The study was conducted in three separate phases: semi-structured interviews with consultant dermatologists; an online Delphi study; and, a quantitative evaluation. The semi-structured interviews were used to gather information for the development of the initial statements for the Delphi and the final phase was used to evaluate, from the perspectives of community pharmacists and patients, the guideline developed from the Delphi. Results: Interviews were conducted with five consultant dermatologists with an interest in acne. Emergent themes from these interviews were used, together with the literature, to develop the statements for the first round of the Delphi. A total of 49 statements were developed relating to patient consulation (7), clinical management (10), treatment (4), referral (9), lifestyle factors (16) and monitoring (3). The Delphi was conducted for three rounds with 19 panellists representing an interprofessional mix of dermatologists, GPs with a special interest in dermatology, specialist dermatology nurses, community pharmacists with an interest in dermatology, and expert patients. The response rate was 79% (n=15/19) and stable for all three rounds. Consensus level was set at 80% summative of strongly agree and agree. This was achieved for 21 out of the 49 statements, relating to: patient consultation (2/7) ; clinical management (4/10) ; treatment (1/4) ; referral (7/9) ; lifestyle factors (4/16) ; and, monitoring (3/3). In many instances, there was strong sense among panellists that assessment of acne was a role for the pharmacist rather than suitably qualified non-pharmacist staff. The final guideline was evaluated in 9 community pharmacies on 35 patients seeking advice on acne. Though limited in size, the median rating for the helpfulness of the guideline was 4 out of 5 (interquartile range 4-4) which suggested that it potentially was of value to pharmacists. Conclusion: The Delphi process, utilising an interprofessional expert group, was successfully used to create a novel pharmacy-specific guideline to support pharmacy teams when dealing with patients seeking advice on acne. Although the guideline was piloted with a small number of pharmacies, it appeared to be of value though further work with a larger number of pharmacies and patients is required to more fully evaluate the usefulness and value of the tool