Professional identity in pharmacy

This thesis uses the findings from a study of pharmacists and non-pharmacists to explore the concept of professional identity in pharmacy. Pharmacists are well-established as providers of healthcare in hospitals and community pharmacies and their position as dispensers of prescribed medicines, and advisors on medicines in general seem relatively secure, as does their clinical role in hospital and their extended role in community pharmacy. However, previous studies have suggested that there is still ambiguity over the identity of pharmacists. Government policy in particular can be oblique and there seemed to be a need to clarify who pharmacists are. Consequently, a study was designed to address this topic. The concept of professional identity in pharmacy is made up of three dimensions: how pharmacists see themselves, how pharmacists believe others see them and how others do see pharmacists. This study investigated all three dimensions of professional identity in pharmacy.The research adopted a grounded theory approach and a qualitative study was undertaken in two stages. The first stage involved 21 pharmacists taking part in group interviews. The second stage involved 85 pharmacists, pharmacy support staff, nurses, doctors and lay pharmacy users participating in individual interviews. The data were analysed using the framework method.Analysis of the data generated for this study revealed nine identities for pharmacists: the medicines maker; the supplier; the scientist; the medicines advisor; the clinical practitioner; the minor medical practitioner; the unremarkable character; the business person and the manager. The pharmacists' identity as medicines advisor is considered the core identity which exists for pharmacists today and this manifests itself in different ways, depending on the setting or organisation worked in.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Understanding pharmacy careers : from undergraduate education to future career plans

Informed by a sociological approach, this thesis provides an account of the theoretical and empirical context of pharmacy students' undergraduate careers, beginning with the decision to enter higher education and ending with the final undergraduate year of a pharmacy student's education. The main aim of the published work and of the academic field that it contributes to is to advance understanding of why young people choose to study pharmacy (and thus choose pharmacy as a career), and career aspirations and influences over the course of their pharmacy school career. By establishing what influences and shapes pharmacy students' choices this thesis also provides an account of the degree to which career preferences are limited initially by awareness of opportunities, by socialisation and habitus, and how these are related to undergraduate career success.The thesis reports findings from studies using a range of methods including focus groups, surveys, and secondary analysis of pharmacy student data from a number of sources. Subjects investigated by the work are British undergraduate MPharm students and graduates. Numbers applying to study pharmacy, numbers accepted, and numbers entering the MPharm are compared and the relative risk of attrition from the MPharm, are also examined. Findings reported here are relevant to undergraduate pharmacy education policy-makers, heads of pharmacy schools, pharmacist employers, the General Pharmaceutical Council (GPhC) and to those responsible for pharmacy workforce planning.While the primary aim of the thesis is to improve understanding of (undergraduate) pharmacy careers through the application of a number of sociological theories and perspectives, the thesis also considers the ways that findings can usefully inform pharmacy education and policy agendas.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Internationally trained pharmacists in Great Britain: what do registration data tell us about their recruitment?

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

ICES Viewpoint background document: Impact from exhaust gas cleaning systems (scrubbers) on the marine environment (Ad hoc).

Shipping is a diverse industry that connects the world. The distribution and intensity of commercial shipping is increasing and there is a growing need to assess and mitigate the impacts of vessel activities on the marine environment. New global standards on sulphur content in marine fuels have led to an increasing number of ships installing exhaust gas cleaning systems (EGCS), also known as scrubbers, to reduce their emissions of sulphur oxides to the atmosphere. Ships equipped with a scrubber can continue to use heavy fuel oil, and the process results in discharges of large volumes of acidified water that contain a mix of contaminants, such as heavy metals, polycyclic aromatic hydrocarbons (PAHs), oil residues, and nitrates. For the most common type of scrubber, open loop, this polluted water is directly discharged back to the sea, trading reductions in air pollution for increased water pollution. The scrubber discharge mixture has demonstrated toxic effects in laboratory studies, causing immediate mortality in plankton and exhibiting negative synergistic effects. The substances found in scrubber discharge water are likely to have further impacts in the marine environment through bioaccumulation, acidification and eutrophication. The impacts of scrubber discharge water can be completely avoided through the use of alternative fuels, such as distilled low sulphur fuels. Distilled fuels have the added benefit that they remove the threat of heavy fuel oil spills from shipping activities. If the use of alternative fuels is not adopted, and scrubbers continue to be considered an equivalent method to meet the sulphur emissions limits, then there is urgent need for:1) significant investment in technological advances and port reception facilities to allow zero discharge closed loop scrubber systems;2) improved protocols and standards for measuring, monitoring and reporting on scrubber discharge water acidity and pollutants;3) evidence-based regulations on scrubber water discharge limits that consider the full suite of contaminants

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study

Background: The spectrum of neurological and psychiatric complications associated with paediatric SARS-CoV-2 infection is poorly understood. We aimed to analyse the range and prevalence of these complications in hospitalised children and adolescents. Methods: We did a prospective national cohort study in the UK using an online network of secure rapid-response notification portals established by the CoroNerve study group. Paediatric neurologists were invited to notify any children and adolescents (age <18 years) admitted to hospital with neurological or psychiatric disorders in whom they considered SARS-CoV-2 infection to be relevant to the presentation. Patients were excluded if they did not have a neurological consultation or neurological investigations or both, or did not meet the definition for confirmed SARS-CoV-2 infection (a positive PCR of respiratory or spinal fluid samples, serology for anti-SARS-CoV-2 IgG, or both), or the Royal College of Paediatrics and Child Health criteria for paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Individuals were classified as having either a primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or PIMS-TS with neurological features (PIMS-TS neurology group). The denominator of all hospitalised children and adolescents with COVID-19 was collated from National Health Service England data. Findings: Between April 2, 2020, and Feb 1, 2021, 52 cases were identified; in England, there were 51 cases among 1334 children and adolescents hospitalised with COVID-19, giving an estimated prevalence of 3·8 (95% CI 2·9–5·0) cases per 100 paediatric patients. 22 (42%) patients were female and 30 (58%) were male; the median age was 9 years (range 1–17). 36 (69%) patients were Black or Asian, 16 (31%) were White. 27 (52%) of 52 patients were classified into the COVID-19 neurology group and 25 (48%) were classified into the PIMS-TS neurology group. In the COVID-19 neurology group, diagnoses included status epilepticus (n=7), encephalitis (n=5), Guillain-Barré syndrome (n=5), acute demyelinating syndrome (n=3), chorea (n=2), psychosis (n=2), isolated encephalopathy (n=2), and transient ischaemic attack (n=1). The PIMS-TS neurology group more often had multiple features, which included encephalopathy (n=22 [88%]), peripheral nervous system involvement (n=10 [40%]), behavioural change (n=9 [36%]), and hallucinations at presentation (n=6 [24%]). Recognised neuroimmune disorders were more common in the COVID-19 neurology group than in the PIMS-TS neurology group (13 [48%] of 27 patients vs 1 [<1%] of 25 patients, p=0·0003). Compared with the COVID-19 neurology group, more patients in the PIMS-TS neurology group were admitted to intensive care (20 [80%] of 25 patients vs six [22%] of 27 patients, p=0·0001) and received immunomodulatory treatment (22 [88%] patients vs 12 [44%] patients, p=0·045). 17 (33%) patients (10 [37%] in the COVID-19 neurology group and 7 [28%] in the PIMS-TS neurology group) were discharged with disability; one (2%) died (who had stroke, in the PIMS-TS neurology group). Interpretation: This study identified key differences between those with a primary neurological disorder versus those with PIMS-TS. Compared with patients with a primary neurological disorder, more patients with PIMS-TS needed intensive care, but outcomes were similar overall. Further studies should investigate underlying mechanisms for neurological involvement in COVID-19 and the longer-term outcomes. Funding: UK Research and Innovation, Medical Research Council, Wellcome Trust, National Institute for Health Research