Investigating practice integration of independent prescribing by community pharmacists using normalization process theory: a cross-sectional survey.

Independent prescribing (IP) has not been extensively investigated in community pharmacy (CP). Normalization Process Theory (NPT) constructs help explain how interventions are integrated into practice and include: 'coherence' (understanding), 'cognitive participation' (what promotes engagement), 'collective action' (integration with existing systems), 'reflexive monitoring (evaluation). The aim of this study was to use NPT to investigate the integration of pharmacist IP in CP. NHS Scotland Pharmacy First Plus (PFP) is a community pharmacy IP service. Questionnaire items were developed using the NPT derived Normalisation MeAsure Development (NoMAD) tool for an online survey of all PFP IP pharmacists. Demographic data were analysed descriptively and scale scores (calculated from item scores for the 4 NPT constructs) were used for inferential analysis. There was a 73% (88/120) response rate. Greater than 90% 'strongly agreed' / 'agreed' to NoMAD items relating to most NPT constructs. However, responses to 'collective action' items were diverse with more participants answering 'neither agree nor disagree' or 'disagree'. A statistically significant difference in NPT construct scale scores with significant p-values (ranging from p<0.001 to p=0.033) was shown on all the NPT constructs for the variable 'On average, how often do you consult with patients under the PFP service?'. This theory-based work offers perspectives on IP integration within CP. Despite its geographic focus this work offers insights relevant to wider contexts on IP integration. It shows 'collective action' focused 'organisation' and 'group process' challenges with a need for further work on staff training, resource availability and utilisation, working relationships, communication and management

Belief-Propagation for Weighted b-Matchings on Arbitrary Graphs and its Relation to Linear Programs with Integer Solutions

We consider the general problem of finding the minimum weight \bm-matching on arbitrary graphs. We prove that, whenever the linear programming (LP) relaxation of the problem has no fractional solutions, then the belief propagation (BP) algorithm converges to the correct solution. We also show that when the LP relaxation has a fractional solution then the BP algorithm can be used to solve the LP relaxation. Our proof is based on the notion of graph covers and extends the analysis of (Bayati-Shah-Sharma 2005 and Huang-Jebara 2007}. These results are notable in the following regards: (1) It is one of a very small number of proofs showing correctness of BP without any constraint on the graph structure. (2) Variants of the proof work for both synchronous and asynchronous BP; it is the first proof of convergence and correctness of an asynchronous BP algorithm for a combinatorial optimization problem.Comment: 28 pages, 2 figures. Submitted to SIAM journal on Discrete Mathematics on March 19, 2009; accepted for publication (in revised form) August 30, 2010; published electronically July 1, 201

Evaluation of the 2019 ACTp Pilot [Final Report]

In 2019, the first Additional Cost of Teaching Pharmacy (ACTp) funded experiential learning (EL) was piloted across Scotland. These pilots ran alongside existing EL in all years of the MPharm in two Scottish Schools of Pharmacy. Sixty undergraduate MPharm students participated in the pilot: 29 Robert Gordon University (RGU); 31 University of Strathclyde (UoS). A total of 41 sites hosted students, including 18 general practices, 10 community pharmacies, 10 community/specialist hospitals (e.g. mental health, prison service), NHS 24 (two sites) and one ‘combined package’. Two community pharmacies had extended opening and the eight remaining community pharmacies were in remote and rural locations. The sites were distributed across most of the Scottish Health Boards. This evaluation explored stakeholder opinions and experiences of the pilots and identified areas for future improvement

The international literature underpinning collaborative practice within practice based experiential learning for the initial education of student pharmacists : a scoping review

Abstract Introduction Interprofessional team working within healthcare [1] enables the use of complementary areas of expertise. Collaborative practice (CP) builds on this and enhances recognition and respect for such expertise which facilitates professional synergy. Development of CP needs to be built into initial education programmes and there is global progress. [2] Further, a WHO Framework highlighted the importance of courses developing CP in experiential learning (EL) environments. [1] There is need to develop both CP and EL within pharmacy courses to meet governmental and regulatory aspirations around the clinical and prescribing roles of pharmacists. Aim The aim of this part of a scoping review was to describe the different characteristics of the international literature around the development, implementation and evaluation of CP within practice based EL for initial education of student pharmacists. Methods The six-stage Arksey and O'Malley framework and the PRISMA extension for Scoping Reviews for reporting were followed. Eligibility criteria were defined (Table 1) and electronic searches of relevant databases (Medline, IPA, CINAHL and Google Scholar) conducted from inception to April 2020. MeSH terms and other relevant subject headings and text words were used. First stage involved screening titles / abstracts and second stage involved review of full text articles. A charting tool was developed and used to extract data on: country, study design, methods of evaluation, sector of practice, stage of students, professional groups involved, monitoring and assessment and scope for development. Findings were presented as a descriptive narrative summary. All steps involved independent checks by two of the review team. Results Twenty-eight papers were included with most from the USA (16 papers), with the remainder from Australia (5 papers), UK (5 Papers), Canada and the Netherlands (1 paper each). The majority of papers described quantitative methods using a wide variety of published (some validated) scales (20 scales including RIPLS, SPICE, CPAT) and a number of bespoke survey tools. The main focus was at 'Kirkpatrick model of educational evaluation' level 3 – with 13 papers focussing on changes to professional behaviours. Papers focussed on either hospital (12 papers) or primary care initiatives (12 papers) with the remaining four describing cross-sectoral settings. Only 6 papers stated that they focussed on specific healthcare specialities and the remainder were in general medical facilities. The nature of initiatives and activities varied with a predominance of focus to include later years of study. Only 3 papers included only pharmacy and medicine students.. Detailed information was lacking on methods of student assessment: some reported this involved reflection, with limited reporting of tools to assess competencies. A wide array of further research proposals was articulated. Conclusion This scoping review highlights the range of work already carried out. The diversity highlights the need for consideration of commonality in the nature of activity and tools to evaluate outcomes to ensure transferability to practice. There are many challenges influencing further development and implementation of CP. Facilitating matters by using the evidence base to add to existing placements without restructuring curricula across courses / institutions has been proposed by some authors

Exploration of inter-professional learning in experiential learning for student pharmacists in Scotland : a qualitative study

Abstract Introduction Additional Cost of Teaching for Pharmacy (ACTp) funding from Scottish Government supports the development of experiential learning (EL) placements for student pharmacists [1]. Interprofessional learning (IPL) has been built into initial education for many healthcare professionals [2]. In 2019, a National Pharmacy EL Stakeholder event recommended exploring the further development of IPL within EL for the MPharm. Aim To scope existing IPL in EL and explore the feasibility for further development within the MPharm in Scotland Methods Online qualitative interviews were conducted with key stakeholders from Schools of Pharmacy, NHS Education for Scotland, EL sites, and Scottish health boards. All were involved in the development/delivery of these activities. The interview schedule was developed by the research team, reviewed for face and content validity, piloted prior to use, and modified based on early interviews. All interviews were audio-recorded, transcribed, and independently thematically analysed by two researchers. Interviews continued until data saturation and good representation from all settings were achieved. All ethical approvals were sought prior to the interviews. Results Twenty interviews were conducted with three key themes emerging; (1)current IPL within EL activities, (2)future developments, and (3)perceptions of enablers and barriers to developing/delivering IPL within EL. There were limited examples of existing IPL within EL activities including: a pilot pharmacy longitudinal clerkship and hospital-based pharmacy/medical student IPL week. Some stakeholders indicated that current IPL involves mainly campus-based activities but other EL based initiatives were planned but not yet implemented. Respondents indicated that future developments should be carefully planned in collaboration with other stakeholders and tailored to students’ stage of study to ensure their success. There was significant support for incorporating IPL within EL initiatives as part of the MPharm course to complement traditional ways of teaching. “I think if we don't do it, we're missing a big trick… Doing something in a classroom or doing something within a small tutorial is a very false way of learning, whereas in practice, where they're going to end up working together, it seems ideal.” Many enablers were highlighted mainly relating to the expected benefits of such activities on students, facilitators, patients, and the healthcare system. Logistics and planning difficulties were perceived to be barriers to implementation of IPL within EL. “We've tried to do it, it was with the medical school and they were receptive to it, but the logistics just didn't work out… when you've got two very different timetables to try and bring together, it is very, very difficult to do.” Conclusion Pharmacy stakeholders highlighted that the majority of IPL currently undertaken in Scotland is not based in EL settings but they supported developing it. Enablers and barriers articulated highlight the need for careful planning of these activities. A strength of this study is it involved a broad range of key stakeholders from across Scotland ensuring representativeness of views and ideas. A limitation may be that, given the Scottish focus, findings may lack direct transferability to other countries. Future research should focus on designing a framework for developing and implementing IPL within EL in Scotland. References 1. NHS Education for Scotland, 2020. Experiential learning for student pharmacists in Scotland. [online]. Edinburgh: NHS Education for Scotland. Available from: https://www.nes.scot.nhs.uk/our-work/experiential-learning-for-student-pharmacists-in-scotland/ [Accessed 07/10/2020]. 2. Barr H. Interprofessional Education-The Genesis of Global Movement. 2015. https://www.caipe.org/resources/publications/barr-h-2015-interprofessional-education-genesis-global-movement. [Accessed 4 Aug 2020

A Novel Visual Word Co-occurrence Model for Person Re-identification

Person re-identification aims to maintain the identity of an individual in diverse locations through different non-overlapping camera views. The problem is fundamentally challenging due to appearance variations resulting from differing poses, illumination and configurations of camera views. To deal with these difficulties, we propose a novel visual word co-occurrence model. We first map each pixel of an image to a visual word using a codebook, which is learned in an unsupervised manner. The appearance transformation between camera views is encoded by a co-occurrence matrix of visual word joint distributions in probe and gallery images. Our appearance model naturally accounts for spatial similarities and variations caused by pose, illumination & configuration change across camera views. Linear SVMs are then trained as classifiers using these co-occurrence descriptors. On the VIPeR and CUHK Campus benchmark datasets, our method achieves 83.86% and 85.49% at rank-15 on the Cumulative Match Characteristic (CMC) curves, and beats the state-of-the-art results by 10.44% and 22.27%.Comment: Accepted at ECCV Workshop on Visual Surveillance and Re-Identification, 201

Pheochromocytoma presenting with arterial and intracardiac thrombus in a 47-year-old woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pheochromocytoma is a rare cause of hypertension but it could have severe consequences if not recognized and treated appropriately. The association of pheochromocytoma and thrombosis is even rarer but significantly increases management complexity, morbidity and mortality. To the best of our knowledge, this is the first report of a patient with pheochromocytoma presenting with left axillary arterial and intracardiac thrombus.</p> <p>Case presentation</p> <p>A 47-year-old Caucasian woman with a past medical history of hypertension presented for medical attention with left arm numbness. Doppler ultrasound showed an obstructing thrombus in her left axillary artery. She had symptom resolution after stent placement in her left axillary artery. A subsequent echocardiogram demonstrated a large intracardiac mass and abdominal computed tomography revealed a 7 cm mass between her spleen and left kidney. Labile blood pressure was noted during admission and she had very high levels of plasma and 24-hour urine catecholamines and metanephrines tests. A (123)I- metaiodobenzylguanidine scan showed intense uptake in the left abdominal mass. After adequate alpha blockage with phenoxybenzamine, laparoscopic tumor resection was performed without complications. She had normal metanephrines and complete symptom resolution afterwards. The intracardiac mass also disappeared with anticoagulation. All other endocrine laboratory abnormalities returned to normal after surgery.</p> <p>Conclusion</p> <p>Arterial and ventricular thrombosis occurring in patients with pheochromocytoma is rare. A multi-disciplinary approach is necessary in caring for this type of patient. Catecholamines likely contributed to the development of thrombosis in our patient. Early recognition of pheochromocytoma is the key to improving outcome.</p