A systematic review of the outcome data supporting the Healthy Living Pharmacy concept and lessons from its implementation

Background The Healthy Living Pharmacy (HLP) project, launched in England, UK in 2009 was a novel approach of introducing public health services within community pharmacy to tackle local health inequalities. A national roll-out followed a reported successful pilot; subsequent local evaluations ensued. Objectives To summarise reported outcomes and investigate contextual factors that indicate the presence, absence and maturity of implementation determinants, thus offering useful lessons to stakeholders in implementing future initiatives to achieve successful outcomes. Methods A systematic review was conducted to identify all publications reporting on the HLP project. All HLP articles and conference abstracts were considered for inclusion and were assessed for methodological quality. The Consolidated Framework for Implementation Research (CFIR) was utilised to identify potential implementation determinants reported. Each article was then analysed to identify reported economic, humanistic or clinical outcomes. Results The review included six peer-reviewed journal articles and 12 conference abstracts. Joanna Briggs Institute Qualitative Assessment and Review Instrument indicated deficiencies in methodological quality. Through adoption of the CFIR framework, the implementation determinants relevant to the implementation of HLP into community pharmacy were identified. A resonating issue emerged in that the absence of adopting an evidence-based implementation process limited the ability to capture meaningful outcome data. This resulted in a lack of evidence to support sustainability and the failure to address many of the well cited barriers, e.g. lack of awareness amongst patients, public and other healthcare professionals, and weak support for future investment in resource for training and dissemination. Conclusions Healthcare systems are increasingly called on to adopt evidence-based interventions that improve quality, control costs, and maximize value, thus offering opportunity to accelerate the implementation of clinical pharmacy services and programs aimed at improving patient care. Interventions, such as the HLP project require focused efforts on implementation and evaluation of those implementation efforts to produce effective and lasting changes in complex health care systems

Patient and public perception and experience of community pharmacy services post-discharge in the UK: a rapid review and qualitative study

OBJECTIVES: To investigate the perception and experience of patients and the public (PP) about community pharmacy (CP) services and other primary care services after hospital discharge back home. DESIGN AND SETTING: A rapid review and qualitative study exploring PP perceptions of primary care, focusing on CP services in the UK. METHODS: A mixed-methods approach was adopted including a rapid review undertaken between 24 April and 8 May 2019 across four databases (MEDLINE, EMBASE, PsycINFO and CINAHL). Semistructured interviews were then conducted investigating for shifts in current PP perception, but also nuanced opinion pertaining to CP services. A convenience sampling technique was used through two online PP groups for recruitment. Thematic framework analysis was applied to interview transcripts. PARTICIPANTS: Any consenting adults ≥18 years old were invited regardless of their medical condition, and whether they had used post-discharge services or not. RESULTS: Twenty-five studies met the inclusion criteria. Patients were generally supportive and satisfied with primary care services. However, some barriers to the use of these services included: resource limitations; poor communication between healthcare providers or between patient and healthcare providers; and patients' lack of awareness of available services. From the 11 interviewees, there was a lack of awareness of CP post-discharge services. Nevertheless, there was general appreciation of the benefit of CP services to patients, professionals and wider healthcare system. Potential barriers to uptake and use included: accessibility, resource availability, lack of awareness, and privacy and confidentiality issues related to information-sharing. Several participants felt the uptake of such services should be improved. CONCLUSION: There was alignment between the review and qualitative study about high patient acceptance, appreciation and satisfaction with primary care services post-discharge. Barriers to the use of CP post-discharge services identified from interviews resonated with the existing literature; this is despite developments in pharmacy practice in recent times towards clinical and public health services

Optimizing time of use (ToU) electricity pricing in regulated market

Time-of-Use (ToU) electricity price for residential consumers is receiving lots of attention lately with the increment of smart meters usage among residential customers. ToU prices reflect the actual electricity cost and the rate is commonly set base on market price of electricity. Implementing ToU pricing system on a regulated electricity system such as in Malaysia is complicated due to non existence of electricity market. The electrical utility company or the regulator will need to determine the optimum ToU prices that would give the correct price signal so that customers will react accordingly. Many factors need to be considered such as impact on electricity generation cost, load profile, load elasticity and customers’ satisfaction. This paper presents an optimization method to estimate the optimum ToU prices for given electricity demand profile and demand elasticity. The presented method able to reduce the gap between peak and off-peak demand and ensure the estimated ToU prices are fairly proportionate among hours i.e. summation of rate increments (from the fixed price) is equal to the summation of rate decrements. A simple system is used as a case study to demonstrate the application of the optimization method presented

A Dynamic Collusion Analysis Framework Considering Generation and Transmission Systems Maintenance Constraints

Capacity withholding of generation companies is an important issue in market monitoring procedures. The capacity withholding can be intensified in the transmission and generation constrained system. The strategic maintenance of market participants can impose multiple constraints on the system and changes the wholesale electricity market prices. The strategic maintenance of transmission and generation facilities is known as dynamic capacity withholding (DCW) and all of the market-monitoring units need algorithms to detect and reduce DCW. In this paper, a new dynamic capacity withholding index is presented. The method is analyzed on the IEEE 30, 57-bus test system. The numerical results show the effectiveness of the proposed index.©2020 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.fi=vertaisarvioitu|en=peerReviewed

Demand Response Program Integrated With Electrical Energy Storage Systems for Residential Consumers

This article presents a distributed resilient demand response program integrated with electrical energy storage systems for residential consumers to maximize their comfort level. A dynamic real-time pricing method is proposed to determine the hourly electricity prices and schedule the electricity consumption of smart home appliances and energy storage systems commitment. The algorithm is employed in normal and emergency operating conditions, taking into account the comfort level of consumers. In emergency conditions, the power outage of consumers is modeled for different hours and outage patterns. To evaluate the applicability of the proposed model, real samples of Southern California households are considered to model the smart homes and their appliances. Further, a sensitivity analysis is performed to assess the impacts of the number of households and number of persons per household on the output results. The results showed that the proposed model reduced the costs of utility in normal and emergency conditions by about 33.77% and 30.92%, respectively. The values of total payments of consumers in normal and emergency conditions were decreased by about 34.26% and 31.31%, respectively. Further, the consumers comfort level for normal and emergency conditions increased by about 146.78% and 110.2%, respectively. Finally, the social welfare for normal and emergency conditions increased by about 46% and 49.06%, respectively.© 2022 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.fi=vertaisarvioitu|en=peerReviewed

Risky Driving Behaviours among Medical Students in Erbil, Iraq

Objectives: This study aimed to assess risky driving behaviours among medical students in Erbil, Iraq, and to explore the relationship between risky driving behaviours and perceptions of risky driving. Methods: This self-administered questionnaire-based survey was conducted from January to May 2014 among a random sample of 400 medical students at Hawler Medical University in Erbil. The questionnaire was designed to assess the frequency of engagement in 21 risky driving behaviours, the perceived risk of each behaviour and the preference for each behaviour as ranked on a 5-point scale. Results: A total of 386 students responded to the survey (response rate: 96.5%). Of these, 211 reported that they currently drove a vehicle (54.7%). Drivers most frequently engaged in the following behaviours: playing loud music (35.9%), speeding (30.4%), allowing front seat passengers to not wear seat belts (27.9%) and using mobile phones (27.7%). Least frequent driving behaviours included not stopping at a red light (3.9%), driving while sleepy (4.4%), driving after a mild to moderate intake of alcohol (4.5%) and drunk driving (6.4%). Mean risky driving behaviour scores were significantly higher among males (P <0.001) and those who owned a car (P = 0.002). The mean risk perception score was higher among >20-year-olds (P = 0.028). There was a significant positive relationship between the preference for risky behaviours and risky driving behaviours (beta = 0.44; P <0.001). Conclusion: Medical students in Erbil reported high frequencies of several serious risky driving behaviours. The preference for risky behaviours was found to be an important predictor of risky driving behaviours among medical students in Erbil

Relative condition factor and food and feeding of Jones’ pony fish Eubleekeria jonesi (James, 1971) from Mandapam waters, Tamil Nadu, India

The relative condition factor (Kn) based on length-weight relationship and food and feeding habits of Jones’ pony fish Eubleekeria jonesi  (James, 1971) off Mandapam waters was studied during December 2016 - April 2018. The Kn values showed variations on a monthly basis with maximum value during September (1.23) for male and March (1.53) for female. Analysis of fullness of stomach of 961 samples within the size range of 51-130 mm revealed 40.87% fishes as actively fed, 36.19% as moderately fed and remaining 22.94% as poorly fed. The monthly mean fullness index (FI) was highest during September for both sexes. Highest gonadosomatic index (GSI), vacuity index (VI) and Kn value were observed during March-April in females, probably indicating a spawning peak and hence meagre feeding, which resulted in lowest fullness index (FI). Fishes of smallest length group (51-70 mm) had highest FI and minimum VI and vice versa. The values of index of relative importance (IRI) indicated that the species was planktivorous as well as detritivorous, with top priority towards crustaceans (27.6%) followed by bivalves (23.6%), foraminifera (15.4%), phytoplankton (12.5%), gastropods (9.1%) and nematodes (8.3%) in the gut contents. Diet did not show significant variation either sex-wise or size-wise

Neoplasia in oil sardine from Palk Bay

During a routine fishery survey programme at Irumeni fishing village, Palk Bay on 03rd December 2016, a single specimen of oil sardine Sardinella longiceps with neoplasia, measuring 163 mm in total length (TL) and weighing 119 gram was collected from the gillnet landings. The specimen was a female with empty stomach

Female genital mutilation among Iraqi Kurdish women: a cross-sectional study from Erbil city

BACKGROUND: Iraqi Kurdistan region is one of the areas where female genital mutilation is reportedly widely practiced but inadequately studied. The aim of this study was to determine (i) the prevalence of female genital mutilation among Muslim Kurdish women in Erbil city, (ii) the patterns and types of female genital mutilation, (iii) the factors associated with this practice and (iv) women’s knowledge and attitudes towards this practice. METHODS: A cross-sectional study was conducted in the primary health care centers and the Maternity Teaching Hospital in Erbil city, involving 1987 women aged 15–49 years. Data were obtained about female genital mutilation status and knowledge and perception towards this practice. The participants were clinically examined to verify the self-reported female genital mutilation status. RESULTS: The self-reported prevalence of female genital mutilation was 70.3%, while it was 58.6% according to clinical examination of the women’s genitalia. The most common type of female genital mutilation was type I (99.6%) and the most common age at which mutilation was performed was 4–7 years (60.2%). This practice was mostly performed by traditional birth attendants (72.5%). Only 6.4% of mutilated women reported having complications after mutilation, most commonly bleeding (3.6%). The practice was more reported among housewives (OR = 3.3), those women whose mothers were mutilated (OR = 15.1) or with unknown mutilation status (OR = 7.3) and those women whose fathers were illiterate (OR = 1.4) or could only read and write (OR = 1.6). The common reasons for practicing female genital mutilation were cultural tradition (46.7%) and dictate of religion (38.9%). Only 30% of the participants were aware about the health consequences of female genital mutilation. More than one third (36.6%) of the women support the practice and 34.5% have intention to mutilate their daughters. CONCLUSIONS: Prevalence of female genital mutilation among Muslim Kurdish women in Erbil city is very high; although, most cases are of type I. There is clear lack of knowledge about the health consequences of female genital mutilation and a relatively important segment of women support this practice. Custom or tradition and dictate of religion are the main reasons for this practice that need further in-depth exploration

Women's Health and Status in the Kurdistan Region of Iraq: A Review

Women in the Kurdistan region of Iraq suffer from various health, social and cultural problems. The poor reproductive health of many women is primarily related to inadequate access and utilization of health services. The maternal mortality rate in Iraq has remained high, and its attributes such as early marriage and childbearing, inadequate birth spacing and high cesarean section rates are constant problems in the region. Women also suffer from different aspects of gender discrimination and women's rights abuse such as domestic violence, female genital mutilation, self-mutilation, and honor killing. Many of these problems are deeply rooted in the culture, and the efforts against them face many challenges. Improvement of women's health in the Kurdistan region of Iraq needs an integrated approach that takes into consideration the physical and mental health of women, their families and societies in a holistic way. Interventions should address the cultural and traditional issues sensitively. The strategies to ban harmful behavior, including female genital mutilation and violence against women, need active engagement of the community and educating its members