Pharmacy staff views on the implementation of patient handheld medication tools to improve information transfer: a qualitative study

Background: The risks of poor information transfer across healthcare settings are well documented, particularly for medication. Various patient-held tools have been designed to hold information about patients’ medicines to improve information transfer. Anecdotal evidence suggests some are more widely implemented than others, but there has been little research exploring the reasons why. Our objectives were to explore the facilitators and barriers to implementation of patient handheld medication information from the perspective of pharmacy staff, to understand why some tools are more widely implemented than others and to make recommendations as appropriate. Method: Semi-structured interviews were conducted with 15 pharmacists and pharmacy technicians working in wards and/or dispensary of a London hospital organisation. Participants were recruited using convenience sampling. We asked about six purposefully selected tools designed to be carried by patients to provide information about their medicines, including both national and local tools, and those that were new and established. Interviews were audio-recorded and transcribed verbatim. We used framework analysis, based on a theory of behavioural change. Results: The majority of participants expressed the view that older tools, such as the steroid card and warfarin booklet, were used more often than newer tools such as a medication passport and a specific insulin passport. Interview data suggested that pharmacy staff did not have enough information and training about the proper use of the newer tools and therefore lacked confidence in providing them to their patients. In addition, they perceived that they were not integrated into policies and procedures with a lack of guidance regarding their use. Conclusion: We identified the main barriers to effective implementation of tools to increase patient safety across healthcare settings to be lack of guidance and training for newer tools. Making a tool available is not sufficient to ensure its use. Recommendations include clarifying guidance within the hospital organisation to standardise use of all tools and raising awareness and providing training to both healthcare professionals and patients about their use

Information security: Listening to the perspective of organisational insiders

Aligned with the strategy-as-practice research tradition, this article investigates how organisational insiders understand and perceive their surrounding information security practices, how they interpret them, and how they turn such interpretations into strategic actions. The study takes a qualitative case study approach, and participants are employees at the Research & Development department of a multinational original brand manufacturer. The article makes an important contribution to organisational information security management. It addresses the behaviour of organisational insiders – a group whose role in the prevention, response and mitigation of information security incidents is critical. The article identifies a set of organisational insiders’ perceived components of effective information security practices (organisational mission statement; common understanding of information security; awareness of threats; knowledge of information security incidents, routines and policy; relationships between employees; circulation of stories; role of punishment provisions; and training), based on which more successful information security strategies can be developed

Feline low-grade alimentary lymphoma: an emerging entity and a potential animal model for human disease

Background: Low-grade alimentary lymphoma (LGAL) is characterised by the infiltration of neoplastic T-lymphocytes, typically in the small intestine. The incidence of LGAL has increased over the last ten years and it is now the most frequent digestive neoplasia in cats and comprises 60 to 75% of gastrointestinal lymphoma cases. Given that LGAL shares common clinical, paraclinical and ultrasonographic features with inflammatory bowel diseases, establishing a diagnosis is challenging. A review was designed to summarise current knowledge of the pathogenesis, diagnosis, prognosis and treatment of feline LGAL. Electronic searches of PubMed and Science Direct were carried out without date or language restrictions. Results: A total of 176 peer-reviewed documents were identified and most of which were published in the last twenty years. 130 studies were found from the veterinary literature and 46 from the human medicine literature. Heterogeneity of study designs and outcome measures made meta-analysis inappropriate. The pathophysiology of feline LGAL still needs to be elucidated, not least the putative roles of infectious agents, environmental factors as well as genetic events. The most common therapeutic strategy is combination treatment with prednisolone and chlorambucil, and prolonged remission can often be achieved. Developments in immunohistochemical analysis and clonality testing have improved the confidence of clinicians in obtaining a correct diagnosis between LGAL and IBD. The condition shares similarities with some diseases in humans, especially human indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. Conclusions: The pathophysiology of feline LGAL still needs to be elucidated and prospective studies as well as standardisation of therapeutic strategies are needed. A combination of conventional histopathology and immunohistochemistry remains the current gold-standard test, but clinicians should be cautious about reclassifying cats previously diagnosed with IBD to lymphoma on the basis of clonality testing. Importantly, feline LGAL could be considered to be a potential animal model for indolent digestive T-cell lymphoproliferative disorder, a rare condition in human medicine