Factors influencing palliative care in advanced dementia : A systematic review

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.Background: Dementia is a progressive neurodegenerative life-limiting disease. The international literature indicates that patients with advanced dementia can benefit from palliative care (PC) provided during the end-of-life phase. However, evidence indicates that currently many fail to access such provision despite the increased recognition of their palliative needs. Aim: To investigate the factors influencing provision of PC services for people with advanced dementia. Methods: A systematic review of mixed method studies written in English was undertaken. 11 electronic databases including Embase, Medline, PubMed, CINAHL and Scopus from 2008 to 2018 were searched. Narrative synthesis and content analysis were used to analyse and synthesise the data. Key findings: In total, 34 studies were included. 25 studies providing qualitative data, 6 providing quantitative data and 3 mixed methods studies. The findings identified organisational, healthcare professionals and patients-related barriers and facilitators in provision of PC for people with advanced dementia from perspective of stakeholders across different care settings. The most commonly reported barriers are lack of skills and training opportunities of the staff specific to PC in dementia, lack of awareness that dementia is a terminal illness and a palliative condition, pain and symptoms assessment/management difficulties, discontinuity of care for patients with dementia and lack of coordination across care settings, difficulty communicating with the patient and the lack of advance care planning. Conclusions: Even though the provision of PC was empirically recognised as a care step in the management of dementia, there are barriers that hinder access of patients with dementia to appropriate facilities. With dementia prevalence rising and no cure on the horizon, it is crucial that health and social care regulatory bodies integrate a palliative approach into their care using the identified facilitators to achieve optimal and effective PC in this population.Peer reviewe

A study of oral counselling and audit processes for dispensed medications in community pharmacy.

The concept of professional audit was introduced to the pharmacy profession by the Royal Pharmaceutical Society in 1992. Since then audit has been promoted as a tool for raising the standard of practice and improving the quality of patient care. The aim of this study was to develop and implement an audit cycle as a tool to explore a community pharmacy service whilst assessing the impact of audit on the service provision and examining its acceptability and feasibility in community settings. The study was based on six stages of an audit cycle. The first stage comprised of semi- structured interviews with community pharmacists, in which provision of oral counselling for dispensed medications was prioritised. This was a service without an universally accepted definition, an issue which was addressed in stage two of the study using a Nominal Group technique. In stage three, the level and content of oral advice given for dispensed medications in community pharmacies were established. It was found that 33% of all the dispensed medications received oral advice in community pharmacies. Standards for the extent of advice for repeat medications as well as items dispensed for the first time were set in stage four which were implemented in the next stage. Feasibility and acceptability of the audit processes and tools devised during the study were examined in a group of self selected pharmacists in stage six of this study. Analysing the findings indicated that the provision of oral advice for dispensed medications was influenced by multitude of variables including the ownership or employment status of pharmacist, number of years of post registration as well as medication status as a repeat or new. The only variable remaining significant in predicting community pharmacists counselling behaviour for different patient groups as well as various therapeutic groups was medication status as repeat or new. Implementation of the audit cycle resulted in pharmacists meeting the agreed standards for provision of counselling demonstrating that audit can be a flexible tool which can accommodate different levels of practice and still achieve an improvement of standards. Implementation of audit continually raises standards of pharmacists' counselling services helping them to meet the public expectations as well as preparing pharmacists to face the challenges involved in embarking on the new roles such as provision of medicine management and the repeat dispensing services as proposed by the Government

WHO AWaRe Classification for Antibiotic Stewardship: Tackling Antimicrobial Resistance - A Descriptive Study from an English NHS Foundation Trust Prior to and During the COVID-19 Pandemic

© 2023 Abdelsalam Elshenawy, Umaru and Aslanpour. This is an open-access accepted manuscript version of an article which has been published in final form at https://doi.org/10.3389/fmicb.2023.1298858Antimicrobial resistance (AMR) is a silent and rapidly escalating pandemic, presenting a critical challenge to global health security. During the pandemic, this study was undertaken at a NHS Foundation Trust in the United Kingdom to explore antibiotic prescribing trends for respiratory tract infections (RTIs), including pneumonia, and the COVID-19 pandemic across the years 2019 and 2020. This study, guided by the WHO’s AWaRe classification, sought to understand the impact of the pandemic on antibiotic prescribing and antimicrobial stewardship (AMS). The research methodology involved a retrospective review of medical records from adults aged 25 and older admitted with RTIs, including pneumonia, in 2019 and 2020. The application of the AWaRe classification enabled a structured description of antibiotic use. The study evaluated antibiotic use in 640 patients with RTIs. Notably, it observed a slight increase in the use of amoxicillin/clavulanic acid and a substantial rise in azithromycin prescriptions, highlighting shifts in prescribing trends. Despite these changes, some antibiotics displayed steady consumption rates. These findings highlight the importance of understanding antibiotic use patterns during the AMR threat. The increase in the usage of “Watch” category antibiotics during the pandemic emphasises the urgency of robust AMS measures. The research confirms that incorporating the AWaRe classification in prescribing decisions is crucial for patient safety and combating antibiotic misuse. This study provides essential insights into the changing landscape of antibiotic prescribing during a global health crisis, reinforcing the necessity for ongoing AMS vigilance to effectively address AMR challenges.Peer reviewe

Performance Evaluation Metrics for Cloud, Fog and Edge Computing: A Review, Taxonomy, Benchmarks and Standards for Future Research

Optimization is an inseparable part of Cloud computing, particularly with the emergence of Fog and Edge paradigms. Not only these emerging paradigms demand reevaluating cloud-native optimizations and exploring Fog and Edge-based solutions, but also the objectives require significant shift from considering only latency to energy, security, reliability and cost. Hence, it is apparent that optimization objectives have become diverse and lately Internet of Things (IoT)-specific born objectives must come into play. This is critical as incorrect selection of metrics can mislead the developer about the real performance. For instance, a latency-aware auto-scaler must be evaluated through latency-related metrics as response time or tail latency; otherwise the resource manager is not carefully evaluated even if it can reduce the cost. Given such challenges, researchers and developers are struggling to explore and utilize the right metrics to evaluate the performance of optimization techniques such as task scheduling, resource provisioning, resource allocation, resource scheduling and resource execution. This is challenging due to (1) novel and multi-layered computing paradigm, e.g., Cloud, Fog and Edge, (2) IoT applications with different requirements, e.g., latency or privacy, and (3) not having a benchmark and standard for the evaluation metrics. In this paper, by exploring the literature, (1) we present a taxonomy of the various real-world metrics to evaluate the performance of cloud, fog, and edge computing; (2) we survey the literature to recognize common metrics and their applications; and (3) outline open issues for future research. This comprehensive benchmark study can significantly assist developers and researchers to evaluate performance under realistic metrics and standards to ensure their objectives will be achieved in the production environments

Medicines Related Problems (MRPs) originating in Primary care settings in Older Adults - A Systematic Review

© The Author(s) 2021. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/)Background: As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health. Aim: To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature. Design and Setting: Systematic review of primary studies on MRPs originating in Primary Care in older people. Methods: Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool. Results: There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs. Conclusion: This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.Peer reviewe

A systematic review of counterfeit and substandard medicines in field quality surveys

This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.phpCounterfeit and substandard medicines pose a great threat to public health and the economy worldwide. Reports suggest their prevalence is increasing and can no longer be ignored. A detailed account on the current nature of the problem and identification of knowledge limitations in terms of geographical location, medicine classes, and type of medicine analysis performed is not available. Our objective was to systematically review articles that have reported investigations of counterfeit and substandard medicinesPeer reviewe

Optimising medicines use by South Asian and Middle Eastern groups in a primary care setting in the UK: validation of a tool to identify medicine-related problems

The ethnic minority groups (EMGs) are perceived to be more prone to medicine-related problems (MRPs) than the general population in United Kingdom. There is, therefore, a need for improved detection and prevention of MRPs in EMGs, such as South Asians (SA) and Middle Eastern (ME) populations, to avoid unnecessary GP visits and potential hospital admissions. In this cross-sectional study, the data were collected in 80 face-to-face semi-structured interviews using Gordon’s MRPs tool from seven pharmacies in London. The study involved patients aged over 18 from SA/ME origins who were prescribed three or more medicines. Interviews were audiotaped, transcribed verbatim and analysed thematically using Gordon’s coding frame and Nvivo 10. All issues under each of the main themes were explored and compared in an attempt to systematically adapt the Gordon’s MRPs tool for SA/ME populations. Some modifications were made to the original Gordon’s MRPs questionnaire to capture patients’ views regarding the use of medicines and the access to services. This also helped in identifying MRPs specific to SA/ME populations and proposing recommendations to address them. This included targeted medication use reviews (MURs), and tailored interventions to patients’ needs in improving medication use and access to services

Status and trends of e-Health tools in Kuwait: A narrative review

Background: Kuwait is witnessing an alarming increase in diabetes and high prevalence of multi-drug resistant strains. E-Health solutions have the potential to deliver timely, quality and cost-effective solutions to these public health challenges. However, little is known about the existing e-health solutions in Kuwait. Aims: This study aims to explore the current e-health tools and applications in Kuwait, and the factors that affect their adoption and implementation. Methods: A literature search was carried out for articles on e-health in Kuwait using the following electronic databases: PubMed, Google Scholar, Scopus, Web of Science, CINAHL, Medline and Proquest. Reference lists of all included items were additionally searched. A manual search was also conducted using WHO EMRO Virtual Health Sciences Library and MOH policies and standards. Results: 1121 papers were retrieved from databases and 29 papers were added from manual searching of reference lists. 495 papers were considered for review after the removal of duplicates. Thirty studies met the inclusion/exclusion criteria. Implementing electronic health records and establishing a childhood-onset diabetes registry are the main e-Health achievements to date. Implementing e-Health tools has been hindered by various socio-political, financial, infrastructural, organizational, technical and individual barriers. Conclusion: The modest e-Health achievements warrant bigger and faster implementation steps focusing on developing an e-Health policy framework and drawing an implementation road-map that is evidence based and research informed

Evaluation of Pregnancy Outcomes in Iranian Women with Uterine Myomas

Background: To investigate the impacts of myomas on the outcomes of pregnancy in Iranian pregnant women with uterine fibroids. Materials and Methods: In this retrospective cohort study, the consequences of myomas on pregnancy were investigated in Iranian pregnant women referred to the perinatology clinic of Mahdieh Hospital (Tehran, Iran). One-hundred and sixty pregnant women diagnosed with uterine myoma were enrolled in the study as the case group. The control group consisted of 160 pregnant women without fibroma. The characteristics of the myomas and their relationships with pregnancy outcomes were surveyed. Results: Non-cephalic presentation, preterm labor, and Cesarean delivery were significantly higher in the case group in comparison with the control group. 106 patients (66.7%) had myomas larger than 5 cm in diameter. Intramural fibroids were seen in 132 (83%) patients. In addition, 133 (83.6%) patients had myomas in the body (corpus) of the uterus. Considering the number of myomas, 124 (78%) patients revealed one myoma in uterus. Uterine myomas during pregnancy rendered an important risk factor for cesarean delivery, breech presentation, and preterm delivery. However, there were no significant correlations between uterine myomas and IUGR, premature membranes rupture, either abortion or bleeding in the first trimester, low birth weight, and severe postpartum bleeding. Conclusion: Our results showed that the presence of myoma could modulate pregnancy outcomes. Our results can be useful in improving the quality of prenatal care and education

Barriers to implementing antimicrobial stewardship programmes in three Saudi hospitals: Evidence from a qualitative study

© 2019 International Society for Chemotherapy of Infection and Cancer Objectives: This study explored antimicrobial stewardship programme (ASP) team members’ perspectives regarding factors influencing the adoption and implementation of these programmes in Saudi hospitals. Methods: This was a qualitative study based on face-to-face semistructured interviews with healthcare professionals involved in ASPs and activities across three Ministry of Health (MoH) hospitals in Saudi Arabia (n = 18). Interviews were also conducted with two representatives of a General Directorate of Health Affairs in a Saudi region and two representatives of the Saudi MoH (n = 4) between January–February 2017. Results: Despite the existence of a national strategy to implement ASPs in Saudi MoH hospitals, their adoption and implementation remains low. Hospitals have their own antimicrobial stewardship policies, but adherence to these is poor. ASP team members highlight that lack of enforcement of policies and guidelines from the MoH and hospital administration is a significant barrier to ASP adoption and implementation. Other barriers include disintegration of teams, poor communication, lack of recruitment/shortage of ASP team members, lack of education and training, and lack of health information technology (IT). Physicians’ fears and concerns in relation to liability are also a barrier to their adoption of ASPs. Conclusion: This is the first qualitative study exploring barriers to ASP adoption and implementation in Saudi hospitals from the perspective of ASP team members. Formal endorsement of ASPs from the MoH as well as hospital enforcement of policies and provision of human and health IT resources would improve the adoption and implementation of ASPs in Saudi hospitals