1,899 research outputs found

    Harper: Problems of the Family

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    Annulment in Church and State

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    Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice

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    Objective: To determine whether a pharmacist can effectively review repeat prescriptions through consultations with elderly patients in general practice. Design: Randomised controlled trial of clinical medication review by a pharmacist against normal general practice review. Setting: Four general practices. Participants: 1188 patients aged 65 or over who were receiving at least one repeat prescription and living in the community. Intervention: Patients were invited to a consultation at which the pharmacist reviewed their medical conditions and current treatment. Main outcome measures: Number of changes to repeat prescriptions over one year, drug costs, and use of healthcare services. Results: 590 (97%) patients in the intervention group were reviewed compared with 233 (44%) in the control group. Patients seen by the pharmacist were more likely to have changes made to their repeat prescriptions (mean number of changes per patient 2.2 v 1.9; difference=0.31, 95% confidence interval 0.06 to 0.57; P=0.02). Monthly drug costs rose in both groups over the year, but the rise was less in the intervention group (mean difference ÂŁ4.72 per 28 days, -ÂŁ7.04 to -ÂŁ2.41); equivalent to ÂŁ61 per patient a year. Intervention patients had a smaller rise in the number of drugs prescribed (0.2 v 0.4; mean difference -0.2, -0.4 to -0.1). There was no evidence that review of treatment by the pharmacist affected practice consultation rates, outpatient consultations, hospital admissions, or death rate. Conclusions: A clinical pharmacist can conduct effective consultations with elderly patients in general practice to review their drugs. Such review results in significant changes in patients' drugs and saves more than the cost of the intervention without affecting the workload of general practitioners

    The systematic position of Unio caffer (Pelecypoda: Unionoida: Unionidae)

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    Some anatomical, adult shell and larval features of Unto coffer Krauss are described and compared to those reported in previous accounts of this and other species. The findings necessitate the removal of U. caffer from the nominal genus Cafferia Simpson, for which it is the type species, and its return to the genus Unio Philipsson, in the Unionidae: Unioninae. Cafferia consequently becomes a junior subjective synonym of Unto.Unio caffer is characterized in part by zigzag beak sculpture, dimorphic septal spacing between the marsupial, outer (comparatively dense) and the non-marsupial, inner (more distant) demibranchs and also within the marsupial demibranchs, the presence of perforated marsupial septa and imperforate non-marsupial septa, the occurrence of hermaphrodites in some but apparently not all populations, production of subtriangular glochidia with a hook at the ventral margin of each valve, short-term incubation of larvae in the marsupial demibranchs, and by its disjunct occurrence in the southern Ethiopian region (other Unio occurring only in the Palearctic).These adult shell and anatomical features relate this species to those of several nominal genera in the Oriental region, although the latter are distinguished from it by the production of subovate, hookless glochidia

    IMPACT: The Journal of the Center for Interdisciplinary Teaching and Learning. Volume 9, Issue 1, Winter 2020

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    Explicitly established to foreground interdisciplinary teaching and learning, Impact also welcomes evidence and discussion of experiential learning. Often the two – interdisciplinary teaching and experiential learning – co-exist. Yet even when they do not, both practices model how to think in myriad ways and to notice how knowledge is constructed. As our winter 2019 issue makes clear, interdisciplinary teaching and learning and experiential learning often begin with questions. Why does it matter that students grapple directly with archival material? What happens when undergraduates practice psychology by training dogs? Do students understand financial literacy? This issue also asks questions about students’ reading habits and faculty expectations of them as readers

    How doctors' communication style and race concordance influence African-Caribbean patients when disclosing depression

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    Objective: To determine the impact of doctors' communication style and doctor-patient race concordance on UK African-Caribbeans' comfort in disclosing depression. Methods: 160 African-Caribbean and 160 white British subjects, stratified by gender and history of depression, participated in simulated depression consultations with video-recorded doctors. Doctors were stratified by black or white race, gender and a high (HPC) or low patient-centred (LPC) communication style, giving a full 2. Ă—. 2. Ă—. 2 factorial design. Afterwards, participants rated aspects of doctors' communication style, their comfort in disclosing depression and treatment preferences. Results: Race concordance had no impact on African-Caribbeans' comfort in disclosing depression. However a HPC versus LPC communication style made them significantly more positive about their interactions with doctors (p = 0.000), their overall comfort (p = 0.003), their comfort in disclosing their emotional state (p = 0.001), and about considering talking therapy (p = 0.01); but less positive about considering antidepressant medication (p =0.01). Conclusion: Doctors' communication style was shown to be more important than patient race or race concordance in influencing African Caribbeans' depression consultation experiences. Changing doctors' communication style may help reduce disparities in depression care. Practice Implications: Practitioners should cultivate a HPC style to make African-Caribbeans more comfortable when disclosing depression, so that it is less likely to be missed
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