Understanding literature and AI: how to choose and conduct the right assessment for your research question.

This masterclass was presented on the 30th October 2023 at the 2023 ESCP Aberdeen symposium. Building on previous successful editions, this Masterclass provided an overview of each of the different types of literature review, narrative, scoping and systematic, and help design research question and stepwise protocol relevant to researchers own interests while also spending some time to critically reflect on the future use of AI in the scientific writing process. Summarising, evaluating and critically analysing the vast body of available scientific literature to further their research and practice, poses numerous challenges for healthcare researchers, professionals, and early career researchers. For example, a vast range of scientific literature exists on each topic using different research designs, underpinning theory, sampling strategies and sampling sizes. In addition, several different types of literature reviews exist (narrative, scoping and systematic), so choosing the correct approach to answer research question can be challenging. In addition, we are now seeing the advent of artificial intelligence (AI) tools that can achieve a literature review in a fraction of the time, seemingly short-circuiting this laborious process

It is the future. Clinical pharmaceutical care simply has to be a matter of course: community pharmacy clinical service providers' and service developers' views on complex implementation factors.

Background: While there is a lot of documented evidence about the clinical and cost effectiveness of pharmacists' role extensions there is an inherent gap between service development and implementation. Objective(s): This study aims to better understand the complex factors that influence the implementation of clinical pharmacy services from both the perspective of the community pharmacy service providers and service developers. Methods: A prospective qualitative interview study using purposive sampling of twelve service developers and twelve community pharmacy service providers from across all nine Federal States of Austria. The validated and piloted interview guide contained questions and prompts on role perceptions, attitudes, experience, implementation barriers, training needs and measures identified to strengthen clinical pharmacy provision in community pharmacy. Verbatim quotes were independently mapped to the Framework for the Implementation of Services in Pharmacy (FISpH) by two researchers. Results: 24 Interviews were carried out. Data saturation was achieved. There is a great deal of enthusiasm to develop the remit of clinical pharmacy services. It is seen as important to ensure the future survival of the profession. Service developers are more positive and confident in the implementation success and pharmacists' skills than providers. Clear mandates for politics, academia and individual pharmacists have been discussed to affect change. Conclusions: Austrian pharmacists are facing the same well documented challenges as many other healthcare systems only with more urgency. The development of a clinical pharmacy service framework; education accreditation standard and a well-supported continuous professional development system are considered key to bring about the necessary culture shift

Investigation of hypoxia and hyperglycaemia mediated DNA damage in human endothelial cells.

Chronic complications of diabetes mellitus are a pathological consequence of unregulated levels of blood glucose leading to disorders of the vascular system. When investigating the vascular complications the changes in the endothelium are of particular significance as they are central to vascular function. The endothelium actively regulates vascular function by regulating permeability, vascular tone and inflammatory responses. Certain endothelium derived molecules, such as nitric oxide, act as vasodilators as well as exhibiting anti-platelet, anti-proliferative, permeability decreasing and anti-inflammatory properties (Kawashima et al. 2004). Changes to the molecular processes or injury to the endothelium lead to endothelial dysfunction and the initiation and progression of certain diseases such as the development of atherosclerosis as well as micro and macro-angiopathy (De Caterina et al. 2000). In the present study, we examine the effect of glucose and oxygen on endothelial DNA damage derived within 24h of incubation and the cytoprotective effect of the flavonoid antioxidant, silymarin, and two of its constituents, taxifolin and silibinin. Results show a significant increase in endothelial DNA damage in response to glucose and hypoxia which appears to be additive. These findings are supported by a significant rise in mitochondrial ractive oxygen species (ROS) production within 6h of exposure, while mitochondrial number, morphology and HUVEC size stay the same. A change in superoxide radical production in hypoxic conditions alone emphasises the important contribution of hypoxia in the pathogenesis of endothelial damage. Further investigation reveals a role for HIF-1a in the development of endothelial DNA damage which is hypoxia-dependent. Attempts to counteract the observed cytotoxicity to endothelial cells using the flavonoid antioxidant, silymarin, revealed that silymarin is a potent cytoprotective agent for hypoxia-induced DNA damage. This appears to be due to its strong mitochondrial radical scavenging activity. Further analysis into the mechanism of silymarin reveals that the impurity, taxifolin, possesses more potent cytoprotective activity than the formerly known active component silibinin. Taken together, the results strongly emphasise the important contribution of hypoxia in the early development of endothelial changes, which have the potential to accumulate to vascular complications in diabetes since its cytotoxic effect appears to be additive to that of glucose. Flavonoid antioxidants, such as silymarin and taxifolin, show promising potential to prevent or slow the progression of these changes

Reaching consensus on mechanisms of change to support implementation of medication reviews in community pharmacies.

Since 2022 patients with 5 or more medicines can receive a medication review (MR) in a community pharmacy remunerated by the German health system. However, implementation is slow, and few pharmacies are currently providing MRs. Stakeholders' input is necessary to generate and prioritise mechanisms of change through which a successful implementation strategy will achieve implementation outcomes

Hospital discharge information communication and prescribing errors: a narrative literature overview.

Objectives - To provide a narrative overview of the literature on discharge information communication and medicines discharge prescribing error rate in the UK and other similar healthcare systems. Methods - A narrative review of the peer reviewed literature (2000-2014) on communication of discharge information from hospitals to general practitioners. Databases included were MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index and Abstracts, and International Pharmacy Abstracts database. Results - The search yielded 673 results with 15 papers satisfying all inclusion criteria. Direct comparison of studies was not feasible due to differences in study populations and outcome measures. No studies reported post Hospital Electronic Prescribing and Medicine Administration (HEPMA) implementation. Studies (n=6) investigating handwritten discharge communication systems demonstrated medicine information inaccuracy ranging from 0.81 errors per patient to 17.5% medicines with errors and 67% letters missing medicines change information; with 77% assessed as legible. Studies (n=4) comparing interim electronic solutions with traditional showed variable results: improved, unchanged or decreased medicine information accuracy. Studies researching solely interim electronic solutions (n=5) with one including prescribing error rate assessment at 8.4% of prescribed items and identification of a new electronic system-related error type. Conclusion - Implementation of interim electronic discharge solutions resulted in complete legibility but did not eradicate information and prescribing errors. A paucity of information is available about HEPMA implementation impact on discharge information communication and prescribing error rates. There is urgent need for formal evaluation in this area

Hospital electronic prescribing system implementation impact on discharge information communication and prescribing errors: a before and after study.

The study aimed to test the hypothesis that hospital electronic prescribing and medicine administration (HEPMA) system implementation impacted patient discharge letter quality, and the nature and frequency of prescribing errors. A quasi experimental before and after retrospective case note review was conducted in one United Kingdom district general hospital. The total sample size was 318 (random samples of 159 before and after implementation), calculated to achieve a 10% error reduction with a power of 80% and p < 0.05. Adult patients discharged after ≥24 hour inpatient stay were assessed for discharge information documentation quality using a modified validated discharge document template. Prescribing errors were classified as medicine omissions, commissions, incorrect dose/frequency/ duration, drug interactions, therapeutic duplications or missing/inaccurate allergy information. Post-implementation assessments were undertaken four months after HEPMA implementation. Error severity was determined by a multidisciplinary panel consensus using the Medications at Transitions and Clinical Handoffs (MATCH) study validated scoring system. There were no statistically significant differences in patient demographics between the pre and post-implementation groups. Discharge information documentation quality improved; allergy documentation increased from 11 to 159/159 (p < 0.0001). The number of patients with prescribing errors reduced significantly from 158 to 37/159 (p < 0.001).Prescribing error category incidence identified in preimplementation patients was reduced (e.g. omission incidence from 66 to 18/159 (p < 0.001)), although a new error type (sociotechnical [errors caused by the system]) was identified post-implementation (n=8 patients). Post-implementation prescribing errors severity rating identified 8/37 as likely to cause potential patient harm. In conclusion, HEPMA implementation was associated with improved discharge documentation quality, statistically significant prescribing error reduction and prescribing error type alteration. There remains a need to be alert for potential prescribing errors

Patients' and doctors' experiences with medication reviews: a literature review using the CFIR.

Medication reviews (MRs) aim at optimising medicines use and improving health outcomes. Despite encouraging literature reports, their implementation differs between countries. Ultimately, the only interventions that will succeed are those that are accepted by all involved stakeholders. Identifying stakeholders' experiences with and attitudes towards MRs can inform further implementation of MRs in community pharmacies. The aim of this study was to critically appraise, synthesize and present the evidence on patients' and doctors' experiences with and attitudes towards MRs in community pharmacies, using the Consolidated Framework for Implementation Research (CFIR). This literature review is part of a larger systematic review of four databases (MEDLINE, Scopus, CINAHL, IPA), which was conducted with key search terms related to: implementation, pharmacy, medication reviews, facilitators and barriers. The search included primary research items published in English, Spanish or German and dating from 2004 onward. Mappy against the CFIR was carried out by two independent researchers and the synthesis of the findings was presented according to the CFIR constructs. The study found that CFIR provided a clear structure for experiences, barriers and facilitators to MR-implementation. Despite general appreciation of MRs and the perceived patient benefit, issues persist with encouraging the positive engagement of both patients and doctors. Further research is needed to explore the reasons for this and to develop strategies for overcoming these barriers

Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation.

Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation produced perceptions of patient safety improvement. TDF use enabled behaviour change analysis due to implementation, for example, staff adoption of behaviours to ensure general practitioners receive good quality discharge information

Interprofessional student-run primary health clinics: implications for pharmacy education in Scotland.

Introduction Interprofessional student run primary health care clinics have been a flagship model of health professional education in Canada for many years. The purpose of this study was to determine if there is support for implementing this educational model in the United Kingdom and to highlight the implications for pharmacy education in Scotland. Method A cross-sectional postal survey of 3000 randomly selected citizens of Aberdeen city and shire, Scotland, aged 18 years and over. Results Out of the 824 questionnaires that were returned (response rate 27.5%) over half of respondents (62.4%; n=514) would consider accessing healthcare from a student led, walk in service. The range of services they expect to see include general health checks (60%; n=494); help for sexually transmitted diseases (57.5%; n=474); weight management (56.8%; n=468); smoking cessation (54.4%; n=448) and drug misuse services (47.2%; n=387). Concerns raised pertained to student ability; suitability for children and accessibility. Many comments pertained to the improvement of the current system by offering after-hours care. Discussion The positive response from the general public towards an interprofessional student run primary health care clinic in Aberdeen, suggest that this Canadian model of interdisciplinary health professional education would likely be a successful addition to the pharmacy curriculum in Scotland