Additional experimental evidence for a solar influence on nuclear decay rates

Additional experimental evidence is presented in support of the recent hypothesis that a possible solar influence could explain fluctuations observed in the measured decay rates of some isotopes. These data were obtained during routine weekly calibrations of an instrument used for radiological safety at The Ohio State University Research Reactor using Cl-36. The detector system used was based on a Geiger-Mueller gas detector, which is a robust detector system with very low susceptibility to environmental changes. A clear annual variation is evident in the data, with a maximum relative count rate observed in January/February, and a minimum relative count rate observed in July/August, for seven successive years from July 2005 to June 2011. This annual variation is not likely to have arisen from changes in the detector surroundings, as we show here.Comment: 8 pages, 6 figure

'We do not seem to engage with dentists':A qualitative study of primary healthcare staff and patients in the North East of England on the role of pharmacists in oral healthcare

Objective: To explore the attitudes towards, and perceptions of, primary care healthcare staff and patients, regarding the role of clinical pharmacists in the provision of oral health advice and collaboration with dentists in general practice. Design: Interpretivist methodology using qualitative semi-structured interviews and focus groups. Participants 22 participants; 10 pharmacists; 3 general practitioners; 2 nurses; 1 practice manager; 6 patients. Setting Primary care general medical practices in the North East of England and the University of Sunderland Patient Carer and Public Involvement group. Methods: One-to-one semi-structured interviews were performed with primary care healthcare staff. An iterative approach using constant comparative analysis facilitated the ongoing enrichment of data; salient themes were identified using Framework Analysis and related back to extant literature. A focus group was held with patients to further explore key themes. Results: Four salient and inter-related themes emerged: enhanced clinical roles; indicating rapidly changing roles of pharmacists working in general practice, increased responsibility and accountability of pharmacist prescribers and the delivery of advanced clinical services; limited knowledge; indicating basic understanding of appropriate oral health advice, but limited insight and provision of advice to patients with regards to links with systemic diseases and medication; geographical/situational isolation of the dental team; indicating the disparate contexts and challenges of multidisciplinary working in oral health, and patients’ attitudes towards dental care; integration of oral health advice; indicating the potential of pharmacists to integrate oral health advice into current roles and to target specific patient groups in practice. Conclusions: The lack of integration between oral and general healthcare services potentially impacts negatively on patient care, requiring further interprofessional oral health education. The developing role of the pharmacist in general practice represents an opportunity to integrate oral health advice and/or interventions into the management of patients in this setting

Multidisciplinary prevention of medication related osteonecrosis of the jaw

Background: Medication related osteonecrosis of the jaw (MRONJ), is a rare adverse effect of anti-resorptive or anti-angiogenic drug therapy that can cause significant morbidity; commonly prescribed drugs, such as bisphosphonates, used to treat a variety of cancers and osteoporosis have been associated with MRONJ (1). A multidisciplinary approach to the promotion and prioritisation of preventative strategies to ensure patients are dentally fit prior to the prescription of implicated medications is recommended; current evidence suggests that patients have limited knowledge relating to MRONJ and that preventative strategies are rarely implemented (2,3,4). Objective: To explore the impact of MRONJ on quality of life and to explore the attitudes and perceptions of patients towards the multidisciplinary approach to the prevention of the condition. Method: Using a Grounded Theory approach and integrating a process of constant comparison in the iterative enrichment of data sets, semi-structured interviews were undertaken, transcribed and analysed using Ritchie and Spencer’s (2002) Framework Analysis(7). 23 patients; 6 patients with MRONJ, 13 patients prescribed a bisphosphonate and 4 patients with osteoporosis not currently prescribed any medication were recruited from primary care general medical practices and secondary care dental services in England. Salient themes were identified and related back to extant literature in the field. Results: Five salient and inter-related themes emerged: (1) quality of life, indicating the physical, psychological and social impact of MRONJ; (2) limited knowledge, indicating limited awareness of the condition, risk factors and preventative strategies; (3) patient specific, referring to the complexity of patients, polypharmacy, prioritising aspects of care and personal responsibility; (4) inter-professional management, indicating a perceived organisational hierarchy, professional roles and responsibilities, articulation of risk and communication; (5) wider context, indicating potential demands on NHS resources, and barriers to dental care. Conclusions: MRONJ has a significant impact on quality of life yet appropriate preventative education is not apparent. Effective inter-professional patient education and prevention to mitigate against the risk of developing MRONJ is required

An audit of antimicrobial prescribing by dental practitioners in the north east of England and Cumbria

Background Inappropriate prescribing of antimicrobials is a significant threat to global public health. In England, approximately 5% of all antimicrobial items are prescribed by dentists, despite the limited indications for their use in the treatment of oral infections in published clinical guidelines. The objective of this study was to survey antimicrobial prescribing by dental practitioners in North East England and Cumbria, identify educational and training needs and develop a self-assessment tool that can be used for Continued Professional Development by individual practitioners. Methods During October 2016, 275 dental practitioners used a standardised form to record anonymous information about patients who had been prescribed antimicrobials. Clinical information and prescribing details were compared against clinical guidelines published by the Faculty of General Dental Practitioners UK. Results Dental practitioners provided data on 1893 antimicrobial prescriptions. There was documented evidence of systemic spread, such as pyrexia in 18% of patients. Dentists recorded patients’ pain (91.1% of patients), local lymph gland involvement (41.5%) gross diffuse swelling (55.5%) dysphagia (7.2%) and trismus (13.6%). Reasons for prescribing antimicrobials included patient expectations (25.8%), patient preference (24.8%), time pressures (10.9%), and patients uncooperative with other treatments (10.4%). The most commonly prescribed antimicrobials were amoxicillin, accounting for 61.2% of prescriptions, followed by metronidazole (29.9%). Most prescriptions for amoxicillin were for either 5 days (66.8%) or 7 days (29.6%) and most prescriptions for metronidazole were for a 5-day course (65.2%) or 7-day (18.6%) course. Conclusion In most cases, when an antimicrobial was prescribed, practitioners used the correct choice of agents and usually prescribed these at the correct dose. However, some evidence of suboptimal prescribing practices when compared to the Faculty of General Dental Practitioner guidelines were identified. The audit has identified training needs across the region and aided the development of Continued Professional Development sessions. Further work to identify barriers and facilitators for improving antimicrobial prescribing and determining appropriate methods to improve clinical practice are required

Dense and accurate motion and strain estimation in high resolution speckle images using an image-adaptive approach

Digital image processing methods represent a viable and well acknowledged alternative to strain gauges and interferometric techniques for determining full-field displacements and strains in materials under stress. This paper presents an image adaptive technique for dense motion and strain estimation using high-resolution speckle images that show the analyzed material in its original and deformed states. The algorithm starts by dividing the speckle image showing the original state into irregular cells taking into consideration both spatial and gradient image information present. Subsequently the Newton-Raphson digital image correlation technique is applied to calculate the corresponding motion for each cell. Adaptive spatial regularization in the form of the Geman-McClure robust spatial estimator is employed to increase the spatial consistency of the motion components of a cell with respect to the components of neighbouring cells. To obtain the final strain information, local least-squares fitting using a linear displacement model is performed on the horizontal and vertical displacement fields. To evaluate the presented image partitioning and strain estimation techniques two numerical and two real experiments are employed. The numerical experiments simulate the deformation of a specimen with constant strain across the surface as well as small rigid-body rotations present while real experiments consist specimens that undergo uniaxial stress. The results indicate very good accuracy of the recovered strains as well as better rotation insensitivity compared to classical techniques

The potential to quantify polypharmacy in older adult hospital inpatients using electronic prescribing software: A feasibility study

Polypharmacy in older adults is a growing problem, as some drugs may be either unnecessary or even harmful. Admission to hospital under a Medicine for the Elderly specialist physicians represents an opportunity to review patients’ medication. The recent introduction of electronic prescribing to some hospitals in the United Kingdom allows the development of tools to measure polypharmacy in in-patients, and subsequently to assess the efficacy of interventions that aim to optimize medication prescribing. We tested the feasibility of developing an Excel-based software code that measured the number of medications a group of patients were taking at admission and how many of these were still prescribed on discharge. Electronic prescribing data was obtained from the Royal Derby Hospital, over a period of 52 weeks from April 2017 to March 2018 for all patients over the age of 65 years who were admitted onto the medicine for the elderly wards and subsequently discharged. On admission, the median number of eligible medications was 11 (interquartile range IQR 8 to 15). At the time of discharge, the median number of eligible medications retained since admission was 9 (IQR 6 to 12). This represents a median number of medications that have been removed from the current medication regimen of 2 (IQR 1 to 3, p [less than] 0.001). Electronic prescribing software in hospitals allows the development of tools to measure the burden of medications, and to examine the efficacy of future interventions that are developed to optimize drug prescribing in older adults

Simulated learning in a mock ward setting: a tool for developing clinical knowledge, improving patient safety and inspiring future hospital pharmacists.

Title: Simulated learning in a mock ward setting: a tool for developing clinical knowledge, improving patient safety and inspiring future hospital pharmacists. Authors: Sturrock A, Wales J, Hardisty J, Statham L Institution: University of Sunderland Background: Traditional didactic teaching and learning methods can provide fundamental knowledge, but do not develop the clinical skills that are required to apply knowledge to complex, patent focused scenarios. Simulated learning sessions have been successfully implemented as a tool for developing the required skills in a safe and realistic setting (Aggarwal et al 2010). Recent investment at the University provided the creation of four purpose built mock wards each replicating the clinical environment of an acute hospital setting. Aim: To explore the perceptions of pharmacy students towards simulated learning as a tool for developing clinical knowledge and stimulating an interest in hospital pharmacy. Method: A series of simulated learning sessions were delivered to Stage 3 pharmacy students; students participated in mock ward rounds and sessions utilising SimMan® 3G technology. A particular focus was directed towards patient safety and the safe prescribing of high risk drugs, such as insulin and opioid analgesics. A qualitative evaluation was performed, consisting of a focus group with a representative sample of 8 students. Results: Students perceived simulated learning to have improved their retention of knowledge and their ability to apply concepts to the care of patients. Students reported that the sessions required them to adapt to unfamiliar and challenging situations; a skill which will be beneficial for them in practice. Following the sessions, a number of students expressed a desire to pursue a career in hospital pharmacy. One of the key observations made was the high level of engagement in the simulated ward sessions compared to traditional classroom activities; the interactive nature of the sessions facilitated a higher level of discussion around key topics. Students highlighted the potential benefits of increasing the number of interactive resources in the sessions; further utilisation of SimMan® 3G and additional facilitators, such as nursing staff, medics and patients could enhance the realism of the simulation. Conclusion: Students perceive that simulated learning can enhance knowledge retention and develop the ability to adapt to challenging situations. Simulated ward activities can be utilised to develop aspirations towards a career in hospital pharmacy

Hospital doctors’ attitudes to brief educational messages that aim to modify diagnostic test requests: a qualitative study

Background: Avoidable use of diagnostic tests can both harm patients and increase the cost of healthcare. Nudge-type educational interventions have potential to modify clinician behaviour while respecting clinical autonomy and responsibility, but there is little evidence how this approach may be best used in a healthcare setting. This study aims to explore attitudes of hospital doctors to two nudge-type messages: one concerning potential future cancer risk after receiving a CT scan, another about the financial costs of blood tests. Methods: We added two brief educational messages to diagnostic test results in a UK hospital for one year. One message on the associated long-term potential cancer risk from ionising radiation imaging to CT scan reports, and a second on the financial costs incurred to common blood test results. We conducted a qualitative study involving telephone interviews with doctors working at the hospital to identify themes explaining their response to the intervention. Results: Twenty eight doctors were interviewed. Themes showed doctors found the intervention to be highly acceptable, as the group had a high awareness of the need to prevent harm and optimise use of finite resources, and most found the nudge-type approach to be inoffensive and harmless. However, the messages were not seen as personally relevant because doctors felt they were already relatively conservative in their use of tests. Cancer risk was important in decision-making but was not considered to represent new knowledge to doctors. Conversely, financial costs were considered to be novel information that was unimportant in decision-making. Defensive medicine was commonly cited as a barrier to individual behaviour change. The educational cancer risk message on CT scan reports increased doctors’ confidence to challenge decisions and explain risks to patients and there were some modifications in clinical practice prompted by the financial cost message. Conclusion: The nudge-type approach to target avoidable use of tests was acceptable to hospital doctors but there were barriers to behaviour change. There was evidence doctors perceived this cheap and light-touch method can contribute to culture change and form a foundation for more comprehensive educational efforts to modify behaviour in a healthcare environment