The impact of a post-take ward round pharmacist on the risk score and enactment of medication-related recommendations

There is a scarcity of published research describing the impact of a pharmacist on the post-take ward round (PTWR) in addition to ward-based pharmacy services. The aim of this paper was to evaluate the impact of clinical pharmacists' participation on the PTWR on the risk assessment scores of medication-related recommendations with and without a pharmacist. This includes medication-related recommendations occurring on the PTWR and those recommendations made by the ward-based pharmacist on the inpatient ward. A pre-post intervention study was undertaken that compared the impact of adding a pharmacist to the PTWR compared with ward-based pharmacist services alone. A panel reviewed the risk of not acting on medication recommendations that was made on the PTWR and those recorded by the ward-based pharmacist. The relationship between the risk scores and the number and proportion of recommendations that led to action were compared between study groups. There were more medication-related recommendations on the PTWR in the intervention group when a pharmacist was present. Proportionately fewer were in the 'very high and extreme' risk category. Although there was no difference in the number of ward pharmacist recommendations between groups, there was a significantly higher proportion of ward pharmacist recommendations in the "very high and extreme" category in those patients who had been seen on a PTWR attended by a pharmacist than when a pharmacist was not present. There were a greater proportion of "low and medium" risk actionable medication recommendations actioned on the PTWR in the intervention group; and no difference in the risk scores in ward pharmacist recommendations actioned between groups. Overall, the proportion of recommendations that were actioned was higher for those made on the PTWR compared with the ward. The addition of a pharmacist to the PTWR resulted in an increase in low, medium, and high risk recommendations on the PTWR, more very high and extreme risk recommendations made by the ward-based pharmacist, plus an increased number of recommendations being actioned during the patients' admission

Social trajectories or disrupted identities? : Changing and competing models of teacher professionalism under New Labour

Since the 1988 Education Reform Act, the teacher’s role in England has changed in many ways, a process which intensified under New Labour after 1997. Conceptions of teacher professionalism have become more structured and formalized, often heavily influenced by government policy objectives. Career paths have become more diverse and specialised. In this article, three post-1997 professional roles are given consideration as examples of these new specialised career paths: Higher Level Teaching Assistants, Teach First trainees and Advanced Skills Teachers. The article goes on to examine such developments within teaching, using Bourdieu’s concept of habitus to inform the analysis, as well as Bernstein’s theories of knowledge and identity. The article concludes that there has been considerable specialization and subsequent fragmentation of roles within the teaching profession, as part of workforce remodelling initiatives. However, there is still further scope for developing a greater sense of professional cohesion through social activism initiatives, such as the children's agenda. This may produce more stable professional identities in the future as the role of teachers within the wider children’s workforce is clarified

The choice agenda in the Australian supported housing context: a timely reflection

The last 30 years has seen significant developments in the Australian housing sector for people with disabilities. Despite much change in the sector, and advancements in disability services, the range of current supported housing options for younger Australian adults with a neurological disability remains vastly under-developed. This is despite a widely accepted and endorsed recognition that, as is the general population, people with all forms of disability have a right to housing of their choice. This paper presents a timely critique of the key actions made by the Australian disability and housing sectors and subsequently proposes a more informed approach to supported housing design and development: one that is based on a comprehensive understanding of consumer housing priorities and preferences, and is conducive to a person’s biopsychosocial health

Computational Non-Newtonian Hemodynamics of Small Vessels

The significance of non-Newtonian hemodynamics of small blood vessels is addressed via the description and critical discussion of cogent models within Computational Fluid Dynamics (CFD) software, in this case ANSYS-CFX. Several applicable hemodynamical shear-thinning models are presented and the relevance with respect to prediction of Shear Strain Rate (SSR) rigorously examined, in order to critically evaluate salient literature. It is found that the small vessels explored, in line with the aforementioned literature, that non-Newtionian evaluation of the fluid behavior is indeed negligible. The work presented herein is a precursor to investigation of more complex geometries and hemodynamic simulations, which are being actively researched. This is a technical note which attempts to address the significance of Newtonian/non-Newtonian flows in small blood vessels

What should an index of school segregation measure?

The article aims to make a methodological contribution to the education segregation literature, providing a critique of previous measures of segregation used in the literature, as well as suggesting an alternative approach to measuring segregation. Specifically, the paper examines Gorard, Fitz and Taylor's finding that social segregation between schools, as measured by free school meals (FSM) entitlement, fell significantly in the years following the 1988 Education Reform Act. Using Annual Schools Census data from 1989 to 2004, the paper challenges the magnitude of their findings, suggesting that the method used by Gorard et al. seriously overstates the size of the fall in segregation. We make the case for a segregation curve approach to measuring segregation, where comparisons of the level of segregation are possible regardless of the percentage FSM eligibility. Using this approach, we develop a new method for describing both the level and the location of school segregation

The impact of a pharmacist on post-take ward round prescribing and medication appropriateness

Background Medication communication and prescribing on the post-take ward round following patient admission to hospital can be suboptimal leading to worse patient outcomes. Objective To evaluate the impact of clinical pharmacist participation on the post-take ward round on the appropriateness of medication prescribing, medication communication, and overall patient health care outcomes. Setting Tertiary referral teaching hospital, Brisbane, Australia. Method A pre-post intervention study was undertaken that compared the addition of a senior clinical pharmacist attending the post-take ward was compared to usual wardbase pharmacist service, with no pharmacist present of the post-take ward round. We assessed the proportion of patients with an improvement in medication appropriateness from admission to discharge, using the START/STOPP checklists. Medication communication was assessed by the mean number of brief and in-depth discussions, with health care outcomes measured by comparing length of stay and 28-day readmission rates. Main outcome measures: Medication appropriateness according to the START/STOPP list, number and type of discussions with team members and length of stay and readmission rate. Results Two hundred and sixty patients were recruited (130 pre- and 130-post-intervention), across 23 and 20 post-take ward rounds, respectively. Post-intervention, there was increase in the proportion of patients who had an improvement medication appropriateness (pre-intervention 25.4%, post-intervention 36.9%; p = 0.004), the number of in-depth discussions about patients’ medication (1.9 ± 1.7 per patient pre-intervention, 2.7 ± 1.7 per patient post-, p < 0.001), and the number relating to high-risk medications (0.71 ± 1.1 per patient pre-intervention, to 1.2 ± 1.2 per patient post-, p < 0.05). Length of stay and 28-day mortality were unchanged. Conclusion Clinical pharmacist participation on the post-take ward round leads to improved medication-related communication and improved medication appropriateness but did not significantly improve health care outcomes

Advanced integrated safeguards using front-end-triggering devices

This report addresses potential uses of front-end-triggering devices for enhanced safeguards. Such systems incorporate video surveillance as well as radiation and other sensors. Also covered in the report are integration issues and analysis techniques

Valuing initial teacher education at Master's level

The future of Master’s-level work in initial teacher education (ITE) in England seems uncertain. Whilst the coalition government has expressed support for Master’s-level work, its recent White Paper focuses on teaching skills as the dominant form of professional development. This training discourse is in tension with the view of professional learning advocated by ITE courses that offer Master’s credits. Following a survey of the changing perceptions of Master’s-level study during a Post Graduate Certificate in Education course by student teachers in four subject groups, this paper highlights how the process of professional learning can have the most impact on how they value studying at a higher level during their early professional development

What do Australian dermatologists expect to be paid for store-and-forward teledermoscopy? A preliminary investigation

Introduction: Determining appropriate remuneration for teledermoscopy service is important because inadequate remuneration can be a barrier to practitioner uptake and participation. This study explores dermatologist remuneration expectations for a single lesion store-and-forward teledermoscopy consultation. Methods: Fourteen dermatologists participated in telephone interviews during May–June 2017. Questions regarding remuneration focused on a clinical scenario involving teledermoscopy of a single lesion suspected to be skin cancer. The initial scenario was an existing patient, with a provisional diagnosis of benign neoplasm from the images, to be followed-up with routine skin checks, taking three minutes to review. Participants indicated their remuneration expectation by selecting from an ascending array of pre-determined remuneration ranges. The question was repeated a further four times with one aspect of the scenario changed each time; consultation length, source (patient or general practitioner), required follow-up, and a new rather than existing patient. Participants were also asked how appropriate they thought teledermoscopy was for the scenario, and whether they would choose to undertake the consultation presented. Results: Nine dermatologists selected the AU$61–90 or AU$91–120 remuneration ranges for the initial scenario. When given the opportunity to comment on teledermoscopy service provision in Australia, respondents reflected that it was a valuable, advanced dermatology service, but they would prefer face-to-face consultation with patients where possible to allow for a full body examination. Discussion: Dermatologists expect to be remunerated in the range of AU$61–120 for a single lesion store-and-forward teledermoscopy consultation when face-to-face examination is not possible