bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased synaptic microtubules and altered synapse development in Drosophila sec8 mutants
Authors: Liebl Faith LW , Chen Kaiyun , Karr Julie , Sheng Qi , Featherstone David E
Published: December 2005

Background

Sec8 is highly expressed in mammalian nervous systems and has been proposed to play a role in several aspects of neural development and function, including neurite outgrowth, calcium-dependent neurotransmitter secretion, trafficking of ionotropic glutamate receptors and regulation of neuronal microtubule assembly. However, these models have never been tested in vivo. Nervous system development and function have not been described after mutation of sec8 in any organism.

Results

We identified lethal sec8 mutants in an unbiased forward genetic screen for mutations causing defects in development of glutamatergic Drosophila neuromuscular junctions (NMJs). The Drosophila NMJ is genetically malleable and accessible throughout development to electrophysiology and immunocytochemistry, making it ideal for examination of the sec8 mutant synaptic phenotype. We developed antibodies to Drosophila Sec8 and showed that Sec8 is abundant at the NMJ. In our sec8 null mutants, in which the sec8 gene is specifically deleted, Sec8 immunoreactivity at the NMJ is eliminated but immunoblots reveal substantial maternal contribution in the rest of the animal. Contrary to the hypothesis that Sec8 is required for neurite outgrowth or synaptic terminal growth, immunocytochemical examination revealed that sec8 mutant NMJs developed more branches and presynaptic terminals during larval development, compared to controls. Synaptic electrophysiology showed no evidence that Sec8 is required for basal neurotransmission, though glutamate receptor trafficking was mildly disrupted in sec8 mutants. The most dramatic NMJ phenotype in sec8 mutants was an increase in synaptic microtubule density, which was approximately doubled compared to controls.

Conclusion

Sec8 is abundant in the Drosophila NMJ. Sec8 is required in vivo for regulation of synaptic microtubule formation, and (probably secondarily) regulation of synaptic growth and glutamate receptor trafficking. We did not find any evidence that Sec8 is required for basal neurotransmission.
AIDS, conflict and the media in Africa: risks in reporting bad data badly
Authors: Lowicki-Zucca Massimo , Spiegel Paul , Ciantia Filippo
Published: December 2005

Background

Conflict, poverty and HIV disproportionately affect people in sub-Saharan Africa. The manner in which governments, national and international organisations and the media report on the HIV epidemic in situations of conflict, post-conflict and reconstruction can have unintended and negative consequences for those affected populations. The media in particular has a huge influence on how the world observes and reacts to the HIV epidemic among conflict-affected and displaced populations.

Discussion

Three case studies focused on Sudan, Uganda and Guinea describe what the media reported and why the reports were incomplete, misleading or incorrect. The exploration of possible ways to ensure that the media do not unwittingly inflame delicate and complicated situations of HIV among conflict-affected and displaced populations is then undertaken using epidemiological and journalistic principles. The discussion is divided into four sections: 1) Avoid stigmatising statements and ensure a balanced view; 2) Avoid accurate but misleading statements; 3) Avoid inaccurate statements by clearly stating sources and verifying their credibility; and 4) Do not repeat data and conclusions from other news sources without checking their accuracy. The aim of this manuscript is to stimulate awareness and debate among persons and organisations working on HIV/AIDS as well as the media in order to improve dialogue and ultimately to reduce stigma and discrimination amongst an already vulnerable group – conflict-affected and displaced persons.

The media and humanitarian organisations have published misleading and inaccurate HIV data and statements on conflict-affected and displaced populations in Sudan, Uganda and Guinea. Given the unique characteristics of the HIV epidemic and conflict-affected and displaced populations, the media have a special obligation to report in a balanced and non-discriminatory manner that may go beyond the accepted standards of journalism. The media may wish to have the HIV data and their interpretation reviewed by technical experts before going to press. Specific training for reporters and editors regarding ethical issues and basic epidemiological methods may help them to better understand the complexity of the situation and report more accurately; similar training for media watch groups and human rights organisations may improve the monitoring of such situations and possibly reduce misreporting and subsequent discrimination. More rigorous HIV biological and behavioural surveillance should be undertaken in situations of conflict and displacement and humanitarian guidelines should be integrated with guidance on media relations and reporting responsibilities of humanitarian agencies. Finally, humanitarian agencies must ensure the data they release are sound and that any biases are clearly stated. Improved communication with the media will help to ensure more accurate reporting and interpretation.
The shrinking lung syndrome in systemic lupus erythematosus: improvement with corticosteroid therapy
Authors: Oud K T.M , Bresser P , Berge R J M ten , Jonkers R E
Published: December 2005

Respiratory manifestations of systemic lupus erythematosus (SLE) are frequent. The ‘shrinking lung syndrome’ (SLS) represents a rare complication of SLE. The pathogenesis and therapy of the SLS remains controversial. We report a series of five consecutive cases with the SLS of which we provide a detailed description of the extent and dynamics of the response to corticosteroid therapy.
Lupus in Baltimore: evidence-based ‘clinical pearls’ from the Hopkins Lupus Cohort
Authors: Petri M
Published: December 2005

The Hopkins Lupus Cohort is supported by RO1 AR 43727 and by the Outpatient General Clinical Research Center M01-RR00052. Received 6 June 2005; accepted 23 June 2005 The Hopkins Lupus Cohort is a prospective longitudinal study of lupus activity, organ damage, and quality of life in SLE patients. It is balanced between Caucasian and African-American SLE patients. This review highlights major findings from the cohort with implications for clinical care.
Male systemic lupus erythematosus in a Latin-American inception cohort of 1214 patients
Authors: Garcia M A , Marcos J C , Marcos A I , Pons-Estel B A , Wojdyla D , Arturi A , Babini J C , Catoggio L J , Alarcon-Segovia D
Published: December 2005

The objective of the study was to evaluate the influence of the male gender in the clinical presentation and outcome of systemic lupus erythematosus in a prospective inception cohort of Latin-American patients. Of the 1214 SLE patients included in the GLADEL cohort, 123 were male. Demographic characteristics as well as clinical manifestations, laboratory profile, activity and damage scores were evaluated at onset and during the course of the disease and compared with female patients. The median age at onset of the male patients was 27 and that at diagnosis 29.2 years. Delay to diagnosis was shorter in males (134 versus 185 days, P = 0.01). At onset, men more frequently showed fever (42.3 versus 27.0%, P = 0.001) and weight loss (23.6 versus 11.8%, P = 0.001). During disease course the incident of symptoms was: fever, 67.8 versus 55.6%, P = 0.012; weight loss, 47.2 versus 24.3%, P = 0.001; arterial hypertension, 37.4 versus 25.8%, P = 0.007; renal disease (persistent proteinuria and/or cellular casts), 58.5 versus 44.6%, P = 0.004); and hemolytic anemia, 19.5 versus 10.9%, P = 0.008. The laboratory results showed that: men more frequently had IgG anticardiolipin antibodies (68.2 versus 49%, P = 0.02) and low C3 (61.3 versus 48.1%, P = 0.03); 5/123 men died (4%) compared with 29/1091 women (2.7%). In conclusion, 10% of GLADEL’s cohort patients were male. They showed a distinctive profile with shorter delay to diagnosis, higher incidence of fever, weight loss, arterial hypertension, renal disease, hemolytic anemia, IgG anticardiolipin antibodies and low C3. Although not statistically significant, mortality was higher in men.
Angiotensin inhibition or blockade for the treatment of patients with quiescent lupus nephritis and persistent proteinuria
Authors: Tse K C , Li F K , Tang S , Tang C S-O , Lai K N , Chan T M
Published: December 2005

Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) reduces proteinuria and the rate of renal function deterioration in diabetic nephropathy and other glomerular diseases, but its role in quiescent lupus nephritis has not been established. We conducted a retrospective study to investigate the effects of ACEI/ARB on proteinuria and renal function in patients with persistent proteinuria (>1 g/day) despite resolution of acute lupus nephritis following immunosuppressive treatment. Fourteen out of 92 patients were included. The duration of treatment with ACEI/ARB was 52.1 ± 35.7 months. The levels of proteinuria, serum albumin, serum creatinine, systolic and diastolic blood pressure were 1.10 to 6.90 g/day, 35.8 ± 3.6 g/L, 102.54 ± 34.48 μmol/L, 137.6 ± 10.9 and 81.9 ± 9.2 mmHg at baseline. Proteinuria and serum albumin showed significant sustained improvements after 6 and 24 months of treatment. Comparison of slopes for serial proteinuria, albumin and reciprocal of serum creatinine before and after treatment showed significant improvements in six (43%), eight (57%) and two patients, respectively. At last follow-up proteinuria remained significantly lower (0.36 g/day, P = 0.043) and albumin higher (41.3 ± 2.2 g/L, P = 0.023). Eleven (78.6%) patients had proteinuria improved by >50%, and five had insignificant proteinuria at last follow-up. Systolic blood pressure was significantly reduced from 6 months onwards, but this did not correlate with proteinuria reduction. Diastolic blood pressure, serum creatinine, creatinine clearance, anti-dsDNA, C3 and haemoglobin were not altered. We conclude that ACEI/ARB effectively reduces proteinuria and improves serum albumin in patients with persistent proteinuria despite quiescent lupus nephritis.
Complement-fixing activity of anticardiolipin antibodies in patients with and without thrombosis
Authors: Shinzato M M , Bueno C , Viana V S Trindade , Borba E F , Gonçalves C R , Bonfá E
Published: December 2005

We have analysed in vitro the complement-fixing activity of anticardiolipin antibodies (C-fix aCL) from patients with persistent and moderate/high titres IgG aCL antibodies: 21 with thrombosis and 11 without thrombosis. Titre and C-fix ability of aCL were measured by ELISA. APS and non-APS patients were similar with regard to mean levels of IgG aCL (46 ± 24 versus 51 ± 30 GPL, P = 0.7), frequency of IgM aCL ( P = 0.7) and a comparable predominance of IgG2 aCL reactivity on ELISA (95% versus 100%, respectively, P = 1.0 ). Remarkably, a high frequency of C-fix aCL (71% versus 92%, P = 0.35) was observed in both groups. Similarly, no difference was observed in the mean level of C-fix aCL in APS and non-APS patients (7 ± 6 versus 9 ± 8 SDunits, P = 0.3). Analysis of 10 primary and 11 secondary APS also revealed a comparable IgG aCL mean titre (57 ± 29 versus 37 ± 11, P = 0.06), frequency of IgM aCL ( P = 0.6) and of C-fix aCL (70% versus 73%, P = 0.99). Among APS patients six had exclusive arterial events and seven exclusive venous events. The IgG aCL mean titre (36 ± 10 versus 36 ± 11 GPL, P = 0.9) and the frequency of IgM aCL antibodies ( P = 0.56) in these subgroups of patients were comparable. There was a trend of higher frequency of C-fix aCL in patients with exclusive venous events (100%) compared to 50% of those with exclusive arterial events (p = 0.07). Importantly, C-fix aCL titre was higher in the former group compared to the later one (8 ± 5 SDunits versus 2 ± 2 SDunits, P = 0.016). Our data support the notion of a high frequency of C-fix aCL in APS. Although it does not discriminate those patients without thrombotic events with persistent moderate/high levels of aCL, this property seems to be more relevant in venous events and may provide the basis for further understanding the distinct pathogenic mechanisms underlying arterial and venous occlusive disorders of APS.
Pharmacists' perceptions regarding their contribution to improving the public's health: a systematic review of the United Kingdom and international literature 1990–2001
Authors: Anderson Claire , Blenkinsopp Alison , Armstrong Miriam
Published: December 2005

Objective

To systematically review, summarise and evaluate the published evidence from 1990–2001 relating to pharmacists' attitudes towards and perceptions of their role in improving the public's health.

Methods

Electronic databases searched were MEDLINE, EMBASE, Cochrane Library and International Pharmaceutical Abstracts. Hand searches were undertaken of a number of relevant journals and conference abstracts. Studies on pharmacy and health education, health promotion, public health, smoking cessation, diet, body weight, and coronary heart disease were identified. All relevant studies with an English language abstract were included. Two of the authors separately examined the lists of titles and abstracts of papers from the searches and then compared inclusion/ exclusion lists and resolved any differences by discussion. Two approaches were used to assess the quality of the evidence and each study was allocated an evidence grade. Data were abstracted into a matrix and a narrative report constructed to synthesise the evidence.

Key findings

The search identified 12 studies (nine from the UK and three from other countries), all of which involved community pharmacists. Pharmacists attach a high degree of importance to health improvement activities. They are more comfortable with activities that are related to medicines and need support to extend their range of health-related work. Pharmacists' advice is more likely to be reactive than proactive; their concerns about being “intrusive” in offering potentially unwelcome health advice predisposes to a reactive stance. While dispensing duties were widely reported by pharmacists as a key barrier to greater involvement in activities that improve the public's health, the review of the evidence showed that perceptions and attitudes are also key to pharmacists' behaviour in relation to these activities.

Conclusion

Community pharmacists' activities in improving the public's health centre around medicines. This is unsurprising, as dispensing and sale of medicines constitute a pharmacist's core business, and are the areas that they are perceived to be expert in and in which they have received the most training. If pharmacists are to contribute to wider public health activities, ways need to be found of extending their sphere of activity. The review findings have implications for those involved in education and training of pharmacists at undergraduate and postgraduate levels.
Views and practices of community pharmacists regarding services for people with type 2 diabetes
Authors: Abduelkarem Abduelmula R , Sackville Mike A , Morgan Rae M , Sackville Margaret P , Hildreth Anthony J
Published: December 2005

Objective

To describe the views and practices of community pharmacists regarding services for people with type 2 diabetes.

Method

A cross-sectional questionnaire survey of a convenience sample of 317 community pharmacists in the North East of England. The 26-item questionnaire covered the setting of the pharmacy, dispensing medication, and the pharmacist's role in the primary prevention of diabetes, detecting undiagnosed diabetes and prevention of complications.

Key findings

There was a 51% response rate. More than 80% of respondents reported that they saw patients with diabetes “very often” or “often” when they collected their prescriptions, but three-quarters reported that they “never/rarely” or only “sometimes” advised patients what to expect from their medication and gave information to help them have a better understanding of their disease. More than 90% of the pharmacists believed that a healthy lifestyle is important, but the majority were “never/rarely” or only “sometimes” involved in its promotion. Around 10 per cent of the respondents reported that they “often” or “very often” promoted regular eye examinations. Home blood glucose monitoring was promoted by 50% of the respondents. The majority reported that they checked prescriptions for drug interactions.

Conclusion

This study found that community pharmacists' advice and services to people with type 2 diabetes fell short of the standards and objectives set out in the National Service Framework for Diabetes. Our findings can be used to promote discussion in the profession and with stakeholders about the future role of the community pharmacist in diabetes care.
Community pharmacists' identification of natural health product/drug interactions in older persons
Authors: Grymonpre Ruby E , McKechnie Meghan , Briggs Colin
Published: December 2005

Objective

To document the prevalence and significance of potential natural health products (NHPs)/prescribed drug interactions in a sample of older adults; to determine whether community pharmacists detected these drug interactions; and to characterise users and non-users of NHPs.

Setting

The project involved 15 community pharmacists providing pharmaceutical care to 213 non-institutionalised older adults.

Method

The study was a subanalysis of a prospective, non-randomised, before-and-after trial of the provision of pharmaceutical care. Pharmacists documented each time medication-specific information or advice was provided to subjects. The numbers and types of NHPs that clients reported taking and the number of potentially significant NHP/prescribed drug interactions were determined. Whether pharmacists identified such drug interactions and made the necessary interventions were also documented.

Results

Forty-two NHPs were reported 96 times by 49 (23%) clients, most commonly glucosamine (n = 10), garlic (n = 10), prune juice (n = 9), and Ginkgo biloba (n = 6). There was a total of 446 possible NHP/prescribed drug combinations in the 49 clients, of which 53 (12%) were considered to be of potential clinical significance. Of these 53 combinations, three pharmacists identified four (8%) potential interactions in three different patients. Although gender, mean age and number of reported medical conditions did not differ between users and non-users of NHPs, users reported taking fewer prescribed drugs compared with non-users (5.0 ± 3.2 vs 6.0 ± 2.9, respectively, P = 0.043) and more non-prescribed drugs (4.2 ± 2.5 vs 2.1 ± 2.0, respectively, P < 0.0001).

Conclusion

The reported prevalence of NHP and the potential for NHP/prescribed drug interactions in our sample of older adults were high. Pharmacists providing pharmaceutical care did not commonly identify potentially significant NHP/prescribed drug interactions.
Assessment of patient satisfaction with pharmaceutical services in a Nigerian teaching hospital
Authors: Oparah Azuka C , Enato Ehijie F O , Akoria Obehi A
Published: December 2005

Objective

To assess patients' satisfaction with pharmaceutical services using an“ideal referent” model, and to further explore the validity of an existing patient satisfaction instrument.

Method

A cross-sectional survey was conducted with a sample of 500 outpatients recruited consecutively at the University of Benin teaching hospital, Nigeria. A self-completion questionnaire that employed a Likert-type scale was used. Data were used to calculate scores on a scale that ranged from 20 to 100, with an assumed midpoint of 60. Descriptive statistics on the sample characteristics and questionnaire items were computed including means, standard deviations and frequency distributions. Varimax rotation with Kaiser normalisation was employed in principal factor analysis. Student's t-test and one-way ANOVA were used for inferential statistics.

Key findings

The instrument reliability was determined to be 0.9641 and was comparable to the reference study. Nearly half of the patients (46%) rated the amount of time the pharmacist offered to spend with them as poor. About one-third rated promptness of prescription service as poor. Only 49% felt satisfied with the pharmaceutical services. Overall, pharmacy services received a satisfaction rating of 56.04±24.49, below the midpoint. Perceived satisfaction was significantly higher in “friendly explanation” than in “managing therapy” (t=3.916; P<0.0001).

Conclusion

The study provides evidence that patients experience low satisfaction with current pharmaceutical services at the study hospital. The sociodemographic characteristics of patients were not associated with their level of satisfaction. We further confirm the validity of the patient satisfaction questionnaire in a Nigerian practice setting.
An evaluation of the contribution of the medical admissions pharmacist at a London teaching hospital
Authors: Brady Deirdre , Franklin Bryony Dean
Published: December 2005

Objective

To evaluate the contribution of the medical admissions pharmacist (MAP) at a London teaching hospital.

Method

A descriptive study using quantitative methods to compare the activities of former non-designated pharmacists with that of the currently employed MAP in relation to interventions made regarding the drug therapy of patients in one medical admissions ward in a London hospital. The outcome measures were numbers of pharmacist interventions made and their clinical significance. A multi-disciplinary panel assessed clinical significance using an adapted form of a previously validated method.

Key findings

Overall, significantly more interventions were made per day after appointment of the MAP (P= 0.003). In particular, interventions relating to drug administration/route, choice, dose, medication history and need for drug therapy significantly increased. Interventions made by the MAP were found to be of greater clinical significance when compared with those made by the non-designated pharmacists (P= 0.005). In a separate assessment of medication history accuracy, 12% of the patients' regular medicines were unintentionally omitted and 6% of prescriptions unintentionally changed. All unintentional omissions and discrepancies identified resulted in an intervention by the MAP. The majority of these interventions were found to be of moderate clinical significance.

Conclusions

The MAP made more interventions than the previous non-designated ward pharmacists and, overall, the interventions were of greater clinical significance. The research demonstrates the potential contribution of an MAP on post-admission ward rounds to ensure the safe and appropriate prescribing of medicines on the medical admissions ward. Confirming medication histories was shown to be important in ensuring appropriate prescribing of patients' regular medicines on admission to hospital.
Cross-sectional survey of medication used for headache in a general population
Authors: Boardman Helen F , Thomas Elaine , Millson David S , Croft Peter R
Published: December 2005

Objective

To determine the level and types of medication used to treat headache in the general population and to compare this with current recommendations.

Methods

Cross-sectional survey to an adult general population sample. A questionnaire gathered information on occurrence, characteristics of, and medication use for headaches in the previous three months.

Setting

Patients aged 18 years and over registered with five general practices in North Staffordshire, England.

Key findings

The response rate was 56%. Eighty-five per cent of headache sufferers (60% of all questionnaire respondents) reported using medication for their headaches in the three months prior to the survey. Medication use was more likely to be reported by women, respondents aged 36 to 50 years, those reporting more painful and more disabling headaches, those experiencing at least five associated symptoms, and those whose untreated headaches lasted 4 to 24 hours. Paracetamol was by far the most widely used medication, with 74% of medication users taking it in the three-month period. Fifty-eight per cent of acute medication users took only one single therapy for their headaches. Only a small number of medication users (3%) took their headache medication before the pain began, with most (63%) taking it when the pain started and the remainder waiting until the pain was unbearable. Half of medication users (47%) reported that the medication completely relieved their headache, 51% obtained partial relief and 2% did not obtain relief.

Conclusion

Medication use for headache appears to be appropriate for most patients. Although only a minority used combination therapy, the high prevalence of headache means that this translates to substantial numbers in the population as a whole. Some headache sufferers might benefit from advice to make better use of the treatments available.
Alternative delivery methods for pharmacy services
Authors: Phul Sharon , Bessell Tracey , Cantrill Judith A
Published: December 2005

In many developed countries, the provision of pharmacy services is no longer restricted to the traditional “walk-in” or face-to-face approach. This paper examines whether alternative delivery methods provide patients with pharmacy services that meet their medication and related information needs, and discusses professional issues and the implications for practice. Although not appropriate for everyone, studies show that many patients do accept the alternative means of service delivery examined here. For some patients, such as those with mobility problems or who live in remote areas, technology-driven alternatives may be preferred. Health care professionals must take steps to address legitimate concerns about the protection of patient safety and confidentiality. To increase patient choice, the pharmacy profession needs to look closely at the positive aspects of these alternatives, as they can be incorporated in “traditional” pharmacy practice.
Are customers requesting medicines by name less likely to be advised or referred? Provision of over-the-counter H2-receptor antagonists and alginate products from pharmacies
Authors: John David Neale , Krska Janet , Hansford Denise
Published: December 2005

Objectives

To identify selected factors which may influence the provision of over-the-counter alginate and H2-receptor antagonist (H2RA) products, advice and referral from community pharmacies, and to establish if referrals of customers with dyspepsia made by pharmacy staff were in line with published referral guidelines.

Setting

Customers supplied with over-the-counter alginates or H2RAs by 39 community pharmacies in Scotland and Wales in a six-month period.

Method

A structured questionnaire was issued to customers provided with an alginate or H2RA from community pharmacies, with one reminder sent to non-responders.

Key findings

A total of 608 completed questionnaires were returned (79 per cent response): 523 customers (86 per cent) stated they requested the product they were supplied with by name, with previous use being the most frequently cited reason. Customers who requested a product by name were less likely to receive advice about the supplied medicine, less likely to be referred to a medical practitioner (GP) and also less likely to receive lifestyle advice than customers who did not request a named product. Overall, only 30 per cent of patients who met criteria for referral to a GP were referred.

Conclusion

The findings of this study suggest that more emphasis should be placed on referrals by pharmacy staff and on the provision of lifestyle and product-specific advice, particularly when products are requested by name. The acceptability of these actions to pharmacy customers is not known.
The influence of education on the interpretation of pharmaceutical pictograms for communicating medicine instructions
Authors: Dowse Ros , Ehlers Martina Sabrina
Published: December 2005

Objective

To assess the influence of formal education on the interpretation of pharmaceutical pictograms.

Method

A total of 46 pictograms were used: 23 were extracted directly from the USP-DI, and 23 with corresponding meanings were designed in accordance with the local culture (local pictograms). One hundred and thirty Xhosa respondents, who ranged from having no formal education to tertiary level education, were interviewed with the aid of an interpreter. Demographic data were collected, a literacy test was conducted and respondents were tested for their interpretation of all 46 pictograms. Preference for either the USP-DI or the local pictogram was determined.

Setting

Respondents were interviewed in primary health care clinics, a variety of work settings or in their homes in Grahamstown, South Africa.

Key findings

Standard of education had a significant influence on the interpretation of 24 of the 46 pictograms. Generally, significant differences in interpretation were apparent between those with only primary school education and those who had completed at least some senior school education (P < 0.05). The group with tertiary education was significantly better than the other groups (P < 0.05). Only 15 of the 46 pictograms met the American National Standards Institute (ANSI) 85% correct criterion.

Conclusion

Interpretation was dependent on education and the development of visual literacy skills, but potential for misinterpretation in all educational groups was noted. These results suggest that pictograms should only be used as a communication aid in combination with text or verbal information from the health care provider.
Prescribing errors on medical wards and the impact of clinical pharmacists
Authors: Dale Ms Alison , Copeland Richard , Barton Roger
Published: December 2005

Objectives

To assess the incidence of prescribing errors, predict patient outcome from clinical pharmacists' recommendations made in response to identified prescribing errors, and evaluate the influence of clinical pharmacists on recommendation implementation.

Method

Clinical pharmacy activities were conducted on two wards, one of which had an existing clinical pharmacy service (intervention ward) while the other did not (control ward). For the control ward, prescribing errors were documented but not followed up unless a potentially life-threatening problem was identified. Prescribing errors were identified and recommendations made by pharmacists. A consultant physician and pharmacist conducted an independent, blinded assessment of these recommendations to predict the impact on patient outcome if implemented. Recommendations were communicated to medical staff or implemented by the pharmacist on the intervention ward only. The proportion of recommendations implemented for intervention and control group patients were recorded.

Setting

Two medical wards in a UK district general hospital. The study was carried out over 12 weeks.

Key findings

There were 740 errors recorded for 235 patients. Fourteen recommendations could not be assessed. For all recommendations, the consultant and pharmacist predicted patient outcomes with life-saving (one consultant vs three pharmacist), major (186 vs 318), minor (328 vs 324), neutral (211 vs 85) or harmful (five vs five) impact respectively. For the intervention group, 79% of recommendations were implemented, including 81 of 92 (88%) predicted by the consultant to have major impact on patient outcomes. In the control group, only 18% of recommendations were spontaneously implemented, including only 10 of 94 (11%) recommendations predicted by the consultant to have major impact.

Conclusion

Ward-based clinical pharmacists identified large numbers of prescribing errors and made clinically significant recommendations. Implementation of recommendations was predicted to improve the outcome of patient care. Further research, specifically assessing the outcome of pharmacists' recommendations on patient care, is warranted.
Novel provision of pharmacy services to a deprived area: a pharmaceutical needs assessment
Authors: Porteous Terry , Bond Christine
Published: December 2005

Objective

To conduct a pharmaceutical services needs assessment in a deprived area of Aberdeen and to inform the development of an innovative provision of these services, addressing local needs, to be delivered within an agreed budget.

Method

A systematic consultation with a wide range of stakeholders. Preliminary content setting interviews informed the development of questionnaires which were mailed to residents (n = 300) randomly selected from the electoral roll, and professionals (n = 117). A nominal group of stakeholders (17 invitees) was used to prioritise the services identified from the questionnaire and identify barriers to their implementation.

Setting

The setting was a deprived community in the city of Aberdeen, Scotland.

Key findings

Questionnaire response rates were 53% and 74% for residents and professionals respectively. The majority of residents reported receiving a prescription from their GP at least annually (81%) and purchased over-the-counter (OTC) medicines (78%). The top five services required by residents were advice on minor illnesses and the use of OTC medicines, sales of first aid products and OTC medicines, and collection of prescribed medicines. The professionals additionally favoured advice on prescribed medicines and sales of baby products instead of collection of medicines and sales of first aid products. The nominal group was attended by nine people. Benefits of a pharmacy service in the area were identified as convenience and access to advice. There was concern about duplication of services with the established nurse practitioner. Concerns were also raised about security, particularly if drug misuse services were provided.

Conclusion

The feasibility of using a systematic approach to identify services to address local need was demonstrated.
Adverse drug reaction reporting in Australian hospitals
Authors: Nita Yunita , Plumridge Richard J , Batty Kevin T
Published: December 2005

Objective

To determine the status of adverse drug reaction (ADR) reporting in Australian hospitals. Method Postal questionnaire to all 299 directors of pharmacy in Australian hospitals.

Key findings

The response rate was 49.5%. Hospitals of different size were well represented: <100 beds (23%), 100–199 beds (35%) and 200–499 beds (30%). ADR policies were reported by 67% of pharmacy departments. In most hospitals, doctors or pharmacists were responsible for ADR submissions to the Australian ADR Advisory Committee (ADRAC). Follow-up action included reports to Drug and Therapeutics Committees (57%) and drug bulletins (37%). Advice on ADRs was forwarded to the patient, the general practitioner (GP) and the community pharmacist by 96%, 89% and 11% of hospitals. Methods of informing patients were verbal (91%), card (17%) or letter (13%). Methods used to notify GPs included discharge summary (70%), letter (26%) or via the patient (15%). Data from ADRAC indicated a median 2.5 (range 0–362) reports from participating hospitals in 2000. The median ADR reporting rate was 0.02% (range 0–1.09) of patient admissions. There was no association between ADR reporting rates and the existence of an ADR policy or a centralised ADR reporting system. There was an association between hospital ADR reporting rates and provision of feedback or a reward for ADR reporting (P<0.001).

Conclusions

Procedures or policies for ADR reporting are available in most Australian hospitals but this has no direct effect on ADR reporting rates. These findings suggest a gap between policy and implementation of ADR reporting. Strategies to improve ADR reporting could include improved feedback and electronic submissions to ADRAC from a centralised service.
Managing independent prescribing: the influence of primary care trusts on community nurse prescribing
Authors: Hall Jason , Cantrill Judith , Noyce Peter
Published: December 2005

Background

Community nurses have been prescribing in the United Kingdom from the Nurse Prescribers' Formulary (NPF) since 1994. Most prescribing for the items included in the NPF is still carried out by general practitioners, although the proportion attributed to nurses is increasing.

Objective

To describe the methods that primary care trusts (PCTs) have used to influence the prescribing practices of community nurses and to explore the views of nurse prescribers regarding these methods.

Method

Semi-structured interviews with a purposive sample of 22 community nurse prescribers and five PCT prescribing leads. The transcripts were analysed using the framework method.

Key findings

PCTs used formularies and guidelines, education and training, individual prescriber feedback and directives to varying degrees to influence nurse prescribing. Some nurse prescribers considered formularies and guidelines to be restrictive. There were few instances of feedback or training being given to prescribers following their initial training as a prescriber, despite a majority wishing to receive both of these. Directives were used to restrict prescribing in a limited number of specific areas.

Conclusion

Influencing nurse prescribing did not appear to be a priority for PCTs despite this being part of the National Health Service's clinical governance agenda. PCTs will need to engage with nurse prescribers to determine ways to influence prescribing that are in the best interests of patients, nurses, doctors and the Trust.
Needle exchange services: a profile of service users in community pharmacies and other settings
Authors: Cameron Jacqui , Gilchrist Gail , Roberts Kay
Published: December 2005

Objective

To compare client profiles and activity data from the pharmacy needle exchanges (PNEXs) with other needle exchanges (NEXs) in a UK city.

Method

Routinely collected data from four types of needle exchange services were used to analyse levels of activity and user profiles. Simple descriptive statistics with 95% confidence intervals (95% CI) were calculated.

Setting

In Glasgow, Scotland, at the time of the study NEX was provided at four key facilities: (1) PNEXs; (2) drug treatment service sites (Glasgow Drug Problem Service, GDPS); (3) a drop-in service for female prostitutes (Base 75); and (4) a service based in a 24-hour crisis assessment and treatment centre (Glasgow Drug Crisis Centre, GDCC).

Key findings

A total of 1074 455 needles/syringes were issued during the study period. Over half of all needles and syringes were issued from PNEXs (52%; 558 176) compared with 15% (162431) from GDPS, 5% (59 348) from the Base 75 exchange and 27% (294 500) from the GDCC. The return rate at PNEXs was 86% (95% confidence interval (CI) 85.90–86.10%) and was significantly higher than both GDCC (70%, 95% CI 69.80–70.19%) and Base 75 (25%, 95% CI 24.31–25.69%). A significantly greater proportion of needles and syringes were returned to the GDPS (94%, 95% CI 93.88–94.12%) than to PNEXs (86%). A significantly greater proportion of female clients attended GDCC (30%, 95% CI 27.41–32.59%) than the PNEXs (25%, 95% CI 23.80–26.20%).

Conclusion

PNEXs attract large numbers of injectors to use the service and have a high return rate of needles and syringes issued. A diverse population uses PNEXs. In order to meet the needs of different groups of injecting drug users, a variety of NEX facilities is needed, including out of hours services and exchanges for women, especially those in crisis or involved in prostitution.
Can in-depth research interviews have a ‘therapeutic’ effect for participants?
Authors: Morecroft Charles , Cantrill Judy , Tully Mary P
Published: December 2005

Objective

The study's objective was to explore whether there was any discernible ‘therapeutic’ effect upon participants after an in-depth research interview, which focused upon their experiences of hypertension and its management.

Method

A questionnaire comprising 13 questions (open and closed) was posted to patients with hypertension (n = 30), three to eight months after participating in face-to-face in-depth interviews, which explored their experiences of chronic illness and its management.

Key findings

The data from 25 respondents (83%) suggested that in-depth research interviews could have a therapeutic benefit for some participants. This benefit was described by some as encouraging them to take more control over their lifestyle; specifically, consideration of their diet and/or increasing the time involved in regular exercise or relaxation. For others, it was the recognition of the need for both additional information on hypertension and the available treatment options, and for healthcare professionals to talk with them and to discuss their condition and its management.

Conclusions

Participating in an in-depth interview can have a therapeutic effect. This effect may encompass not only changes in the interviewee's perceptions and behaviour, but also the possible development of a more meaningful appreciation and understanding of their condition.
A pharmacist-led information and advice service based within a voluntary sector drugs service
Authors: Scott Jennifer , Bond Christine M , Winfield Arthur J , Kennedy Emily J
Published: December 2005

Objectives

To explore the role of an information pharmacist within a voluntary sector drugs service, to establish a pharmacist-led information and advice service within the drugs service and to describe the nature of the use of the pharmacist's service.

Method

An intervention study.

Setting

A voluntary sector drug dependency agency in Aberdeen, UK.

Key findings

The pharmacist service was utilised by staff and service users, making 77 contacts and processing 87 enquiries in 26 weeks. Forty-five of the contacts were with agency staff and 32 were with agency service users. The nature of the 87 enquiries was analysed and defined by 11 distinct categories. These are described in the paper.

Conclusions

Pharmacists are increasingly specialising in drug misuse as members of addictions teams, but no study of information provision in this capacity could be found. The success of this service highlights the important role pharmacists can play in providing information and advice to professionals and drug misusers. It also supports the expansion of the pharmacist's role as part of the multidisciplinary team within the voluntary sector.
Improved periconceptional use of folic acid after patient education in pharmacies: promising results of a pilot study in the Netherlands
Authors: Meijer Willemijn M , de Smit Denhard J , Jurgens Renate A , van den Berg Lolkje T W de Jong
Published: December 2005

Objective

Although most Dutch women plan their pregnancy, less then half begin using folic acid supplements before they become pregnant. The objective of this study was to assess the effect of the provision of unsolicited information through community pharmacies on the knowledge, attitudes and behaviour towards folic acid of women receiving oral contraceptives on prescription.

Method

Seven of nine community pharmacies (four intervention and three ‘reference’ pharmacies) in a small Dutch city participated in the study. A sample of 880 women (600 from intervention and 280 from reference pharmacies) receiving oral contraceptives on prescription were sent a postal questionnaire. The questions covered knowledge of, attitude towards and future intentions to take folic acid. Women were also asked whether they had received a sticker and leaflet about folic acid (the interventions) during the previous year, and about sources of information on folic acid. Demographic information requested included age and any previous pregnancies.

Key findings

Three-quarters of women in the intervention group reported receiving a sticker about folic acid and 48.4% said they had received a leaflet. Women who received information about folic acid with their oral contraceptives knew more about folic acid and there were differences in attitudes towards and intended use of folic acid in relation to women in the reference group. Some of the differences were statistically significant and were particularly evident among women who had not previously had a child (nulligravidae) and those who were intending to become pregnant within the next 12 months.

Conclusion

This study showed that providing information about folic acid from pharmacies to women using oral contraceptives has the potential to increase awareness and use of folic acid among women planning to become pregnant.
Pharmaceutical care services: a systematic review of published studies, 1990 to 2003, examining effectiveness in improving patient outcomes
Authors: Roughead E E , Semple S J , Vitry A I
Published: December 2005

Objective

To systematically review the evidence for the effect of pharmaceutical care practice on patient outcomes.

Setting

Community and outpatient setting.

Method

Randomised controlled trials (RCTs) published in English between 1990 and 2003 were identified through a systematic literature search. To be included, studies had to assess the effect of a pharmaceutical care intervention, defined as a one-to-one consultation between each patient and a pharmacist with a focus on managing health or resolving drug-related problems, development of a care plan and follow-up.

Key findings

Twenty-two RCTs met the review criteria. Studies targeted general patient populations at risk of drug-related problems, disease-specific target groups or patients with risk factors including hypertension and raised cholesterol. While a number of trials have been undertaken, the variability in the application of endpoints utilised means the evidence for effectiveness of single endpoints apart from quality of life is generally limited to one or two controlled trial results. Collectively, the studies provide evidence that the service improves signs and symptoms for people with asthma, surrogate endpoints such as blood pressure, cholesterol levels and glycosylated haemoglobin and medication use, but do not provide evidence supporting improved health-related quality of life. One study showed an improvement in combined all-cause mortality and non-fatal heart failure-related events in patients with heart failure.

Conclusion

Pharmaceutical care services are effective in improving medication use and surrogate endpoints, but improvement in other outcomes is less conclusive. Given that the focus of the service is to resolve medication-related problems, consideration should be given to the use of adverse drug events and resolution of medication-related problems as an outcome measure in future studies.