bluuebunny/crossref_metadata_2025 huggingface dataset:
North American Integration? Civil Society and Immigrant Health Policy Convergence
Authors: BARNES NIELAN
Published: February 2011

Post‐North American Free Trade Agreement and post‐9/11, increasing labor mobility combined with tightening security regimes and rising anti‐immigrant sentiment has negatively impacted the health of mobile transnational populations in North America. Public health and immigration researchers have documented the problems faced by migrants and immigrants, including lack of access to health services and increased risk of exposure to infectious disease, work‐related hazards, and violence. This article examines how civil society organizations that serve transnational populations act as drivers for health policy innovation and convergence. The methodology is a comparative case study that combines qualitative methods to analyze data across a range of knowledge domains. The article generates new knowledge about the role of nonstate actors on hemispheric integration and policy convergence.

Después del Tratado de Libre Comercio de América del Norte y 11/9, la movilidad laboral en aumento junto con el refuerzo de las medidas de seguridad y el creciente sentimiento anti‐inmigrante ha impactado negativamente la salud de la población trasnacional móvil en América del Norte. La salud pública y los investigadores de inmigración han documentado los problemas que enfrentan los migrantes y emigrantes, incluyendo la falta de acceso a los servicios de salud, un mayor riesgo de exposición a las enfermedades infecciosas, riesgos en el trabajo y violencia. Este artíclo examina cómo las organizaciones de la sociedad civil que atienden a las poblaciones transnacionales actúan como motor de la innovación y convergencia. La metodología es un estudio de caso comparativo que combina métodos cualitativos para analizar información a través de una serie de ámbitos del conocimiento. El artículo genera nuevo conocimiento acerca del rol de los actores no‐gubernamentales en la integración hemisférica y la convergencia de políticas.
Kumarangk (Hindmarsh Island) and the Politics of Natural Justice under Settler‐Colonialism
Authors: van Krieken Robert
Published: February 2011

This article examines the impact of the application of apparently impartial principles of procedural fairness and natural justice on the construction of “authentic” and “inauthentic” knowledge of Aboriginal culture. It discusses the progression of the Kumarangk (Hindmarsh Island) court cases and the legal construction of public participation in the making of political decisions affecting Aboriginal interests in land. In examining the politics of competing interests in land, this article reflects on the tension between Indigenous interests in land and settler developmentalism in relation to the Australian jurisprudence of procedural fairness and natural justice. The arguments running through the article concern the questions of the ways in which the liberal restraint on power is embodied in the impartial principles of administrative law, where that power creates rather than infringes upon rights, why it generates a particular legal construction of Aboriginal interests in land and cultural heritage, and the extent to which this plays a role in the maintenance of relations of settler‐colonial dispossession.
Libertarian Paternalism, Externalities, and the “Spirit of Liberty”: How Thaler and Sunstein Are Nudging Us toward an “Overlapping Consensus”. Richard H. Thaler, and Cass R. Sunstein. 2008 . Nudge: Improving Decisions about Health, Wealth, and Happiness . New Haven, CT: Yale University Press. Pp. x + 293. $26.00 cloth.
Authors: Desai Anuj C.
Published: February 2011

In their 2008 bookNudge: Improving Decisions about Health, Wealth, and Happiness, Richard Thaler and Cass Sunstein use research from psychology and behavioral economics to argue that people suffer from systematic cognitive biases. They propose that policy makers mitigate these biases by framing people's choices in ways that help people act in their own self‐interest. Thaler and Sunstein call this approach “libertarian paternalism,” and they market it as “the Real Third Way.” In this essay, I argue that the book is a brilliant contribution to thinking about policy making but that “choice architecture” is not just a solution to the problem of cognitive biases. Rather, it is a means of approaching any kind of policy making. I further argue that policy makers must take externalities into account, even when using choice architecture. Finally, I argue that libertarian paternalism can best be seen as motivated by what Sunstein has celebrated in his work on constitutional theory: a humility about the possibility of policy‐maker error embodied in Learned Hand's famous aphorism about the “spirit of liberty” and an attempt to reduce social conflicts by searching for what John Rawls called an “overlapping consensus.”
Extracellular Streptomyces vesicles: amphorae for survival and defence
Authors: Schrempf Hildgund , Koebsch Ilona , Walter Stefan , Engelhardt Harald , Meschke Holger
Published: February 2011

Blue‐pigmented exudates arise as droplets on sporulated lawns of Streptomyces coelicolor M110 grown on agar plates. Our electron microscopical and biochemical studies suggest that droplets contain densely packed vesicles with large assemblies of different protein types and/or the polyketide antibiotic actinorhodin. Frozen‐hydrated vesicles were unilamellar with a typical bilayer membrane, and ranged from 80 to 400 nm in diameter with a preferred width of 150–300 nm. By means of cryo‐electron tomography, three types were reconstructed three‐dimensionally: vesicles that were filled with particulate material, likely protein assemblies, those that contained membrane‐bound particles, and a vesicle that showed a higher contrast inside, but lacked particles. Our LC/MS analyses of generated tryptic peptides led to the identification of distinct proteins that carry often a predicted N‐terminal signal peptide with a twin‐arginine motif or lack a canonical signal sequence. The proteins are required for a range of processes: the acquisition of inorganic as well as organic phosphate, iron ions, and of distinct carbon sources, energy metabolism and redox balance, defence against oxidants and tellurites, the tailoring of actinorhodin, folding and assembly of proteins, establishment of turgor, and different signalling cascades. Our novel findings have immense implications for understanding new avenues of environmental biology of streptomycetes and for biotechnological applications.
De novo transcriptome characterization and development of genomic tools for Scabiosa columbaria L. using next‐generation sequencing techniques
Authors: ANGELONI F. , WAGEMAKER C. A. M. , JETTEN M. S. M. , OP den CAMP H. J. M. , JANSSEN‐MEGENS E. M. , FRANCOIJS K.‐J. , STUNNENBERG H. G. , OUBORG N. J.
Published: February 2011

Next‐generation sequencing (NGS) technologies are increasingly applied in many organisms, including nonmodel organisms that are important for ecological and conservation purposes. Illumina and 454 sequencing are among the most used NGS technologies and have been shown to produce optimal results at reasonable costs when used together. Here, we describe the combined application of these two NGS technologies to characterize the transcriptome of a plant species of ecological and conservation relevance for which no genomic resource is available, Scabiosa columbaria. We obtained 528 557 reads from a 454 GS‐FLX run and a total of 28 993 627 reads from two lanes of an Illumina GAII single run. After read trimming, the de novo assembly of both types of reads produced 109 630 contigs. Both the contigs and the >75 bp remaining singletons were blasted against the Uniprot/Swissprot database, resulting in 29 676 and 10 515 significant hits, respectively. Based on sequence similarity with known gene products, these sequences represent at least 12 516 unique genes, most of which are well covered by contig sequences. In addition, we identified 4320 microsatellite loci, of which 856 had flanking sequences suitable for PCR primer design. We also identified 75 054 putative SNPs. This annotated sequence collection and the relative molecular markers represent a main genomic resource for S. columbaria which should contribute to future research in conservation and population biology studies. Our results demonstrate the utility of NGS technologies as starting point for the development of genomic tools in nonmodel but ecologically important species.
Poland Welcomes a World of Socially Responsible Design
Authors: Bochińska Beata
Published: February 2011

For all kinds of reasons, historical and otherwise, the Baltic countries have a long tradition of what might be called democratic design—design that is affordable, as well as inclusive. In Poland, where the science of ergonomics began, that tradition has been joined by a great respect for sustainable design.
Getting the Balance Right: Five Guidelines for Sustainable Practice
Authors: Alviani Carl , Gabbert Nels
Published: February 2011

Businesses often think of CSR practices as an expensive and difficult add‐on, or as a quick way to convince customers to buy more stuff. In reality, practicing sustainability can not only save money; it can also be an essential part of long‐term brand‐building.
PREFACE AND ACKNOWLEDGMENTS
Authors: LARSEN JACK LENOR
Published: February 2011

Classification probably sounds like a dry concept, but it is not. Rather, it provides a skeleton on which to hang all other information. In making classifications, one also learns that one such system of order reveals a universe filled with parallel systems: there is a sensible logic to all we ever know.
Development and treatment of peritonitis in continuous ambulatory peritoneal dialysis
Authors: Mawhinney W M , Adair C G , Gorman S P
Published: February 2011

The main complication of continuous ambulatory peritoneal dialysis is peritonitis. This paper reviews its causes and treatment.
Audit of Pneumocystis carinii pneumonia prophylaxis in Bloomsbury health authority
Authors: West Deborah , Steel Sharon , Miller Robert
Published: February 2011

An audit of Pneumocystis carinü pneumonia prophylaxis used in HIV-infected patients within Bloomsbury health authority in 1989 was carried out. A total of 134 patients who were prescribed 167 courses of PCP prophylaxis, with a variety of different regimens, was included in the study. Fifty three patients were prescribed 60 courses of primary prophylaxis, 55 of which were given with concurrent zidovudine. Eighty two patients were prescribed 107 courses of secondary prophylaxis, 96 after one episode of PCP and 11 after two episodes.

Patients given primary prophylaxis, together with zidovudine, had a lower incidence of PCP than patients receiving no treatment. With secondary prophylaxis, a higher rate of relapse was seen with nebulised pentamidine than with co-trimoxazole (16 per cent compared with 4.5 per cent). The incidence of adverse effects with co-trimoxazole was higher in secondary than in primary prophylaxis. Compliance with nebulised pentamidine therapy was poor. Compliance with oral therapy was not monitored.
Total parenteral nutrition via a peripheral vein: A comparison of heparinised and non-heparinised regimens
Authors: Moclair A E , Moselhi M , Benjamin I S , Hecker J F
Published: February 2011

Administration of total parenteral nutrition solutions via a peripheral vein is an attractive concept. An ideal regimen would meet the requirements of moderately catabolic patients and would contain about 14g of nitrogen and 2200kcals. The feasibility of administering such a regimen was examined in a study at Hammersmith hospital, London. To prolong vein survival and minimise the risk of phlebitis, all patients had a glyceryl trinitrate patch and twice daily hydrocortisone cream applied to the infusion site. Patients were randomised to receive either heparinised or non-heparinised TPN at a concentration of 1 IU/ml. Sixteen patients were recruited to the study of whom nine received heparin in their TPN. The end point was determined as occurring when the cannula was removed electively or accidentally, or when phlebitis around the cannula site necessitated removal. Infusions ending in phlebitis or tissuing were counted as true failures while cannulae electively withdrawn or pulled out were treated as censored data. The median survival time of infusion sites receiving heparinised TPN was 69 hours while the median survival time of sites receiving TPN only was 31 hours. Life table analysis was carried out on the duration of patency of individual cannulation sites. Comparison of the two groups using the logrank test showed a significant difference (p=0.013). Thus, the addition of heparin at 1 IU/ml to TPN infusate produced a marked extension of the survival of the infusion sites. This technique warrants further investigation with other peripheral regimens.
The development of a computerised quality assurance system for clinical pharmacy
Authors: Cousins David , Hatoum Hind
Published: February 2011

New management arrangements which were initiated in National Health Service hospitals on April 1, 1990, required hospital pharmacists to draw up internal contracts for their services with clinical directorates/clinical speciality managers. There is an urgent requirement to be able to describe the work and benefits, both in terms of patient care and cost effectiveness of clinical pharmacy services.

This pilot study describes a system where clinical pharmacists' patient interventions were recorded, entered into a computer data base and analysed to show any quality of care and cost avoidance benefits.
A comparision of two devices for the continuous infusion of cytotoxic drugs in non-hospitalised patients
Authors: Summerhayes M , Fisher Z , Harper P G
Published: February 2011

The performance, cost and patient acceptability of two continuous infusion pumps, the Parker 2004 and the CADD-1, were compared in patients receiving continuous infusions of cytotoxic drugs. Eight patients used each pump for a minimum of four weeks. Questionnaires on both pumps were completed by each patient. All patients preferred the Parker pump in almost every respect.

Problems encountered with the pumps were recorded over 12 months and an estimate of running costs was made. Fourteen patients used the Parker pump for an average of 20.7 weeks and 11 patients used the CADD-1 pump for an average of 14.1 weeks. Eight patients used both pumps. Using either pump, it was possible to maintain outpatients on infusion therapy with few problems. The Parker pump is more economical to run in continuous operation but is less economical than the CADD-1 pump for giving short infusions.
Community pharmacists, injecting drug misusers and the reduction of HIV transmission
Authors: Harding G , Taylor K M G
Published: February 2011

The role of 268 community pharmacists in reducing human immunodeficiency virus (HIV) transmission by providing advice and injecting equipment to drug addicts was investigated. Postal questionnaires were issued to proprietors or managers of all (362) community pharmacies in two family health services authorities within the North West Thames regional health authority to determine their current activities concerning the reduction of HIV transmission between injecting drug misusers (IDMs). More than half of the pharmacists supplied injecting equipment to IDMs, most frequently as 1ml disposable insulin syringes. Eleven per cent of those pharmacies from which equipment was sold provided disposal facilities. More than half of those without disposal facilities failed to provide information regarding safe disposal when supplying injecting equipment. Virtually all the pharmacists surveyed did not supply accompanying health education literature when they sold injecting equipment
Wastage factor of intravenous infusions in a regional intensive care unit
Authors: Ferguson M I , Coppel D L
Published: February 2011

The use and wastage of infusions of propofol and atracurium were studied over an eight-week period in an intensive care unit. Four sources of wastage were apparent, three of which were avoidable. Cessation of therapy, often as a result of decisions made by medical staff on morning ward rounds, was the most important source of wastage (75.7 and 74.6 per cent of wastage of propofol and atracurium, respectively). Advance preparation of syringes was another source, particularly for atracurium, and intermittent short infusions accounted for 8.5 per cent of wastage of propofol. Alterations in unit practice for administration of propofol and atracurium could lead to financial savings (approximately 1.5 per cent of the annual expenditure on drugs by this unit) and greater financial savings would be expected if wastage reduction policies were applied to all infusions.
Rationalising the pharmacist's role
Authors: Noyce Peter
Published: February 2011

Pharmacists need a formulary, and health service patients in Britain should pay proportionately for their medicines
The nature and role of microbial biofilm in infections associated with prosthetic devices
Authors: Mawhinney W M , Adair C G , Gorman S P
Published: February 2011

An understanding of the role of microbial biofilm in infections associated with prosthetic devices is essential for the implementation of successful treatment regimens.
Liberalising medicines supply
Authors: Edwards Clive
Published: February 2011

A concerted and systematic effort to rationalise the deregulation of drugs from the prescription only category in the UK is needed
Prolonging the survival of peripheral infusion sites in neonates with low dose heparin
Authors: Moclair A E , Hecker J F , Willson A , Bates I P
Published: February 2011

The effect was studied of adding heparin to 10 per cent dextrose and to total parenteral nutrition (TPN) solutions infused into peripheral veins of premature babies. The median survival times of sites receiving 10 per cent dextrose and TPN solutions without heparin were 37 and 22 hours, respectively. Addition of 0. liu/ml heparin had little effect whereas adding 0.25iu/ml increased survival times to 48 and 32 hours, respectively. Adding 0.5iu/ml heparin increased survival times to 67 and 68 hours, and with liu/ml they rose further still, to 69 and 83 hours, respectively. These data suggest that 0.5iu/ml may be sufficient to prolong the survival of peripheral intravenous sites in premature babies.
CD4 lymphocyte count as predictor of drug expenditure in a cohort of anti-HIV seropositive haemophiliacs
Authors: Swaden Leonie , Sabin Caroline , Phillips Andrew , Farrell John , Janossy George , Lee Christine
Published: February 2011

The CD4 lymphocyte counts of 76 haemophilic patients who acquired HIV infection from unsterilised clotting factor concentrate were measured and the cost of all drugs used to treat each patient calculated. A rapid rise in drug costs was seen as patients' CD4 counts approached 0.2×109/L, the level at which zidovudine treatment and prophylaxis against Pneumocystis carinii are started. The relationship between decline in CD4 counts and cost of drugs was found to be linear. The authors conclude that it is possible to use CD4 counts to predict future drug costs.
A self medication scheme for elderly patients improves compliance with their medication regimens
Authors: Wood S I , Calvert R T , Acomb C , Kay E A
Published: February 2011

This study of elderly patients discharged from hospital looked at the effect of a self medication (SM) scheme on compliance with drug regimens. Patients from four medical wards for the elderly were recruited. Those from two wards participated in a SM scheme (18 subjects). Patients from the other wards (15) acted as controls. Two weeks after discharge, compliance was significantly better in the SM group. Only 6 per cent (one patient) made serious errors compared with 47 per cent of controls. After three months only 11 patients in each group remained in the study but compliance in SM patients was still better than in controls. The study highlighted the extremely poor ability of the elderly to manage their medicines at home. This was illustrated by problems cited by patients in the non-self medicating group.
Generic substitution by hospital pharmacists in Thailand
Authors: Charupatanapong N , Rascati K L
Published: February 2011

The generic substitution rate by hospital pharmacists in three university affiliated outpatient hospitals in Bangkok, Thailand, was examined and the cost savings from substitution were determined using a retrospective audit of prescription forms.

A total of 3,750 prescriptions was audited (1,250 from each hospital). Of the prescriptions studied, 51.2 per cent were written for generic products, 14.5 per cent were written for brand name products obtainable from a single source and 34.2 per cent were written for brand name products obtainable from multiple sources. For multiple source brand name prescriptions, pharmacists substituted generic products 15 per cent of the time. The mean price for the multiple source brand name product was US$5.2 and the mean price of the generic substitute was $2.5, an average saving of $2.7.

The substitution rate for regular (paying) patients was 9 per cent, while the substitution rate for government assistance (poor) patients was 40 per cent. Substitution rates for the three individual hospitals were 16 per cent, 21 per cent and 9 per cent.

The authors conclude that when substitution occurs savings are substantial, but that there is potential for additional substitutions to be made.
An evaluation of Enpharm, a computer assisted learning program for pharmacists
Authors: Mottram D R , Rowe P H , Stanley I M
Published: February 2011

Enpharm is a computer assisted learning program for pharmacists. It is based on case studies which occur in community practice. Pharmacists using the program respond to cases presented by free-text entry, then compare their input with that of a peer group of 76 community pharmacists.

There has been a high level of demand for the package. Many of the packages requested are used by pharmacists other than those making the original request. This paper presents an analysis of 100 evaluation questionnaires that were sent out with the package then returned to the authors. The analysis focused on the profile of users, when the program was used and pharmacists' perceptions of the value of Enpharm as a method of continuing education.

Pharmacists using the program were mainly in full-time community practice. Half used a work-based computer, the other half used a computer at home. Difficulties in loading the software were rare and were confined to incompatibilities with hardware or to corruption of software during transit. Patterns of use varied but the majority spent between 16 and 30 minutes, on average, per session. The case studies were perceived as being realistic to community practice and although, in general, no new ideas were evident, the cases provided a valuable refresher on the points raised.

Enpharm was judged overwhelmingly to be a form of continuing education which would be of benefit to other pharmacists.
Expert systems in pharmacy practice
Authors: Stork M W , Greene R J
Published: February 2011

This paper introduces expert systems and considers the advantages and disadvantages of their use in pharmacy. It describes how the future pharmacist is likely to be assisted by an expert system for diagnosis and patient management, and details a pharmacy system which accesses doctors' records and prescription databases, relieving the pharmacist of much clerical work and even some clinical activities. The provision of expert systems for public use and the potential for computer aided learning is also discussed. However, the legal aspects of expert system use remain to be clarified. Two prototype systems being developed at King's College, London, are described.
Pharmacist initiated therapy
Authors: Greeff Oppel B W
Published: February 2011

Pharmacists can no longer be the middle men
Identifying prediction factors for unplanned hospitalisation of an elderly population using classification and regression tree (CART) analysis
Authors: Passmore P R , Kailis S G , Marshall G A
Published: February 2011

Accurate prediction of those elderly people who are at a high risk of unplanned hospitalisation may assist pharmacists and other health care providers to target health care initiatives more specifically. A prospective study of 84 elderly persons, suffering from either ischaemic heart disease or obstructive airways disease, or both, was conducted to identify health-related factors that may be used to predict unplanned hospitalisation. Non-invasive factors, including the sickness impact profile (SIP) health status measure scores, drug consumption, demographic data, smoking history and disease/symptoms experience were determined. For hospitalised patients the overall SIP score was significantly higher (18.93) than for those non-hospitalised (10.54). The physical dimension score (20.76) and the psychosocial dimension score (16.74) were also both significantly higher in the hospitalised than the non-hospitalised group (10.85 and 9.44, respectively). The number of medicines used was higher (8.2) in the hospitalised group than in the non-hospitalised group (6.3). Logistic regression determined that the overall SIP score was highly predictive (P<0.01) of unplanned hospitalisation. Classification and regression tree (CART) analysis was used to determine the mix of health-related factors that could best classify subjects as being at either a high or low risk for unplanned hospitalisation within the six month prospective study period. A selected CART-generated decision protocol determined that the health-related parameters that enabled a useful prediction for unplanned hospitalisation were overall SIP score, the person's age, whether the person lived alone and smoking history. Seventy-nine per cent of those hospitalised and 91 per cent of those non-hospitalised had been correctly predicted. The results of this study show that it is possible to predict unplanned hospitalisation of elderly people in a retirement village setting by using previously measured non-invasive health related parameters in a decision protocol to determine their category of risk.
Referral of clients by community pharmacists in primary care consultations
Authors: Smith Felicity J
Published: February 2011

In responding to symptoms presented by clients, community pharmacists have a number of options open to them, including giving advice to seek the assistance of another health professional (ie, a referral). The objective of this study was to investigate the referral patterns of community pharmacists in primary care consultations. The analysis was performed on 716 tape-recorded consultations between pharmacists and clients collected in a random sample of community pharmacies in London. Fifteen per cent of clients were referred to another practitioner, usually their general medical practitioner. Information on the cases that pharmacists referred is provided. There was a wide variation in referral rates depending on the nature of the presenting symptoms. Pharmacists' referral patterns tended to be determined by the characteristics of the symptoms presented. A situation in which some pharmacists routinely refer a high proportion of clients irrespective of the nature of the symptoms was not apparent. The symptoms referred by pharmacists may or may not be those which other primary health carers feel they should see. A co-ordinated, safe and appropriate role as a filter to other practitioners could contribute to improvements in the effectiveness and efficiency of primary care.
Raising pharmacy standards
Authors: Pruce David
Published: February 2011

Health service purchasers are looking for value for money from community pharmacists
Junior doctors' satisfaction with the ward pharmacy service in the Hammersmith and Queen Charlotte's special health authority
Authors: Nicholls J , Batty R , Jacklin A
Published: February 2011

A questionnaire was drawn up to ascertain junior doctors' satisfaction with the ward pharmacy service in the Hammersmith and Queen Charlotte's special health authority, London. The questionnaire was designed for face to face interviews lasting not more than 10 minutes. The interviews were taped and the interviewer was not known to the doctors. The survey took place in January, 1992. Forty three out of 135 senior house officers, registrars and senior registrars employed by the special health authority were randomly selected for interview and 26 (60 per cent) of these were seen. Eighty five per cent of doctors thought the service was better than average and most doctors were satisfied with aspects of the service such as prescription monitoring, advice received from and friendliness of ward pharmacists. Only one doctor rated the service as worse than that in other hospitals in which he had worked. Fifteen doctors suggested increased liaison or contact between ward pharmacists and doctors would make the service better. A number of issues have been raised concerning the service which have been addressed and we intend to repeat the survey in the future.
Antiemetics in cancer chemotherapy
Authors: Stoner Nicola
Published: February 2011

Progress has been made in the prevention of chemotherapy-induced nausea and vomiting but it remains a major problem.
Prescribing patterns and drug costs: Effects of formulary recommendations and community pharmacists' information campaigns
Authors: Ekedahl Anders , Petersson Bengt-Åke , Eklund Per , Rametsteiner Gerhard , Melander Arise
Published: February 2011

In the health care districts of Lund and Orup (Lund-Orup) in southern Sweden, prescription recommendations for both primary and secondary health care are made by one local formulary committee. A revised formulary was introduced in 1989, and information on the most important changes was distributed to all prescribing physicians in the area with the new formulary. In an information campaign aimed only at district physicians (general practitioners) in Lund-Orup, community pharmacists initiated and maintained verbal discussions on the changed recommendations, particularly those concerning low-price brands of erythromycin, doxycycline, naproxen and combined amiloride/hydrochlorothiazide. One year and two years later they supplied feedback on compliance with the recommendations. Other prescribers in Lund-Orup received written information on the formulary changes but no verbal information.

Prescription surveys during that time indicated that the district physicians had rapidly accepted the new guidelines; compared with the other physicians they showed greater increases in prescription volume of the recommended low-price brands and higher compliance rates with the recommendations. The overall cost reduction for the four preparations during 1989–91 was approximately SEK3m,* of which almost 25 per cent (SEK700,000) was attributable to the extra savings due to the higher compliance rates among district physicians. Not only do these figures exceed the costs of the information campaign; there was a return in reduced costs of several times the investment. It appears that a verbal information campaign providing district physicians with data on formulary recommendations and savings is a realistic means of reducing drug expenditure.
Attitudes of pharmacists, medical practitioners and nurses towards the development of domiciliary and other community pharmacy services
Authors: Begley S , Livingstone C , Williamson V , Hodges N
Published: February 2011

Surveys were undertaken to determine both the current extent of provision of non-dispensing services by community pharmacists, and pharmacists' attitudes, together with those of medical practitioners and district/practice nurses, towards the development of domiciliary and other community pharmacy services. Five out of a list of 10 professional services were available on the premises in the majority of pharmacies. Approximately 65 per cent of pharmacists undertook prescription collection and medicine delivery and 43 per cent provided domiciliary patient counselling at least once a week. Medical practitioners and nurses expressed high levels of support for the majority of the established services; the exceptions were blood pressure testing and cholesterol monitoring for both of which only 30 per cent of each group were in favour. Most pharmacists were willing, in principle, to train for and to provide a domiciliary service which would include counselling on the use and storage of medicines and the supply or fitting of appliances; support for these services was high among medical practitioners and nurses (85–88 per cent). The proportions of pharmacists who were willing, after training, to provide domiciliary management of total parenteral nutrition, pain control and chemotherapy were 68, 85 and 36 per cent, respectively, but medical practitioners and nurses generally were not in favour of these extended roles. The length of professional registration and frequency of contact with pharmacists were both factors which significantly influenced the level of support by medical practitioners but not by nurses.
Performance based assessment in pharmacy education
Authors: Collett J H , Rees J A , Mylrea S , Crowther I
Published: February 2011

An objective structured procedure using simulated patients has been developed for assessing the abilities of pharmacy students to interview and counsel patients presenting ailments considered to be representative of those encountered in community pharmacy. Structured marking schedules have been used in the assessment. The results of the assessment can be used to determine the strengths and weaknesses of the students in patient interviewing skills. Results from semi-structured interviews and anonymously completed evaluation questionnaires have shown the procedure to be acceptable to students and examiners.
Effect of patient education in post-operative patients using patient controlled analgesia
Authors: Berwick S J , Lannigan N A , Ratcliff A
Published: February 2011

Patient controlled analgesia (PCA) is an effective method of postoperative pain control. Patients are required to operate the device in order to control their pain and it is therefore important that they receive an adequate explanation of its use.

This study compared a group of patients who received intensive pre- and postoperative counselling on the use of PCA with a group who received the usual explanation from anaesthetists.

No difference in pain control, as measured by nurse recorded pain scores, was detected but some evidence of a reduced incidence of side effects of therapy, particularly nausea and vomiting, was observed in the counselled group. Patients' overall satisfaction with post-operative pain relieving treatment was increased in the group who had been counselled.

The study indicates that improved patient education leads to a more satisfied patient who is less likely to have unanswered concerns about the use of PCA and who might be less likely to experience side effects associated with this therapy.
Stability of injections containing diamorphine and midazolam in plastic syringes
Authors: Allwood M C , Brown P W , Lee M
Published: February 2011

The stability of mixtures containing diamorphine hydrochloride, 10 or 500mg, and midazolam, 10 or 75mg, in 15ml water for injections, stored in three piece plastic syringes, was investigated using a stability-indicating HPLC method. Results indicated that diamorphine showed greater degradation than midazolam, which was relatively stable over the study period of 14 days at ambient temperature. Rates of degradation of diamorphine were estimated by linear regression analysis. The estimated values for the time to reach 10 per cent degradation in solutions containing 10 mg and 500mg diamorphine were 15.9 and 22.2 days, respectively. There was no evidence of physical incompatibility in any of these mixtures. It is recommended from these data that mixtures containing diamorphine hydrochloride and midazolam within the concentration ranges tested, and diluted in water for injections, may be assigned shelf lives of 14 days when stored at ambient temperature.
In their own words: Community pharmacists and their health education role
Authors: Benson M A , Cribb A
Published: February 2011

During the past decade, there has been much discussion about the role of the community pharmacist in health education. This paper is based upon interviews with a small sample of practising community pharmacists. It reports on their perceptions of the nature of their health education role, the practicalities of implementing this role and the obstacles that need to be overcome.

The pharmacists were clear about their health education role as it related to advice on prescribed medicines. However, they were uncertain about other aspects of the health education role. These uncertainties are related to their education in a biomedical and functionalist paradigm together with ethical concerns about interference in the lifestyles of patients. Both these aspects influence the manner in which pharmacists communicate.

The paper discusses the need for further advances towards patient orientated pharmacy, which is the essential direction for a health education role.
Book Reviews
Authors: Dingwall Robert , Hamilton Robert A
Published: February 2011

Book reviewed in this article:

Social pharmacy: ‘Social pharmacy: innovation and development’, edited by Geoff Harding, Sarah Nettle ton and Kevin Taylor

Literature evaluation: ‘Principles of drug information and scientific literature evaluation’, by Frank J. Ascione, Carol Colvin Manifold and Mary A. Parenti
Drugs prescribed for people aged 85 and over living in their own homes in an area of inner London
Authors: Smith Felicity J , Farquhar Morag , Bowling Ann P
Published: February 2011

This study investigated drugs prescribed for people aged 85 and over and living in their own homes in an area of inner London, and explored associations between drug use and other factors including use of general medical practitioner (GP) services, mobility, mortality and self-perceived health. Data were collected by structured interview of 630 participants in their own homes, with a follow-up interview of survivors three years later.

Respondents were taking a mean of 2.2 different drugs; 23 per cent were taking no prescribed drugs and 11 per cent were taking five or more. Of those on two or more drugs, 45 per cent were taking potentially interacting combinations. Although respondents on more drugs were more likely to have seen their GP recently, some on many different drugs had not. Nearly 15 per cent reported some sort of difficulty with their medication.

There was no significant difference between the mean number of drugs prescribed, at the begining of the study, for survivors and for non-survivors. However, there was an inverse relationship between prescribed medication and mobility, self-perceived health and satisfaction with other aspects of life. Very elderly people living in their own homes, like those in institutions, will frequently be on drug regimens that should be monitored regularly for drug-related problems. Because of rising numbers, the provision of a cost-effective service would require the identification of those most likely to experience problems with their medication.
Effect of caffeine-free beverages on elderly hospitalised patients
Authors: Stephens C M , Hankey C , Wynne H A
Published: February 2011

The objectives of the study were to determine whether, by providing caffeine-free tea and coffee, plasma caffeine concentrations would fall in elderly hospitalised patients, and whether, as a result, sleep profiles and urinary incontinence would be altered.

Twenty-eight patients in two wards of an elderly care hospital received caffeine-containing or caffeine-free tea and coffee for consecutive three week periods in a study which was blinded to patients, nurses and investigator. Median caffeine concentration (μg/ml) was stable between the run in period at 2.3 (range 0–5.8) and the caffeine-containing period at 1.6 (range 0.4–6.0), but fell significantly to 0 (range 0–0.7), during the caffeine-free period (P<0.001). In spite of significantly lowered caffeine concentrations, no change in sleep patterns or urinary incontinence was noted. Of 12 patients with sleep problems a benefit to sleep quality was reported by two individuals, one of whom was prescribed hypnotics from which she subsequently successfully withdrew.
Gentamicin dosing in neonates: evaluation of a dosing protocol
Authors: Lacey Ruth , Aldous Diane , Peterson Gregory , Cooper Gabrielle
Published: February 2011

A study was carried out to examine the dosing of gentamicin and to investigate some of the determinants of serum gentamicin concentrations in neonates at the Royal Hobart hospital, Tasmania, Australia, and to examine the appropriateness of the current dosing protocol (that of the Royal Children's hospital, Melbourne). Clinical and demographic data were retrospectively collected from the records of 39 neonates who had received therapy with gentamicin for suspected or proven septicaemia during the period May to September, 1993. Peak and trough serum concentrations of gentamicin were measured, at least 36 hours after starting therapy. The mean gestational age (± SD) of the sample was 32.3 ± 4.9 weeks, and 30 patients were male. The mean dosage of gentamicin was 4.0 ± 1.3mg/kg/day and the median duration of therapy was 4 days (range 2 to 22 days). Trough serum concentrations of gentamicin ranged from 0.6 to 6.0mg/L (mean 1.9 ± 1.0mg/L), with 35.9 per cent being 2.0mg/L or higher. Peak serum concentrations ranged from 4.3 to 12.9 mg/L (mean 6.1 ± 1.5 mg/L), with 89.7 per cent being between 5.0 and 8.0mg/L. The peak and trough serum concentrations were significantly related, while the total daily dosage of gentamicin and the resulting peak and trough serum concentrations were not significantly related. The trough serum concentration of gentamicin was significantly related to the serum creatinine concentration. Patients who had been dosed correctly according to the protocol were less likely to have a potentially toxic trough serum concentration of gentamicin. Those administered gentamicin every 12 hours tended to have higher serum trough concentrations of the drug than those who received it either 18- or 24-hourly.

This study has confirmed that excessive serum concentrations of gentamicin occur frequently in neonates, a situation which may be improved by greater usage of an 18-hourly dosing regimen and prompt adjustment of dosage according to renal function.
Verbal interactions between elderly people and community pharmacists about prescription medicines
Authors: Livingstone Carina
Published: February 2011

Tape recordings of verbal interactions between elderly patients (women aged 60 or over; men aged 65 or over) and community pharmacists about prescription medicines were made in four study pharmacies to determine the frequency with which information was provided and to elucidate communication issues relevant to this patient group. Overall, 65 per cent of elderly patients receiving prescribed medications had no verbal interaction at all with the pharmacist, speaking only to other pharmacy staff. The pharmacists provided verbal information to 12.5 per cent of elderly patients about their prescription medicines. It was generally limited to aspects of the dosage regimen and the most common number of items of information given was three. There was no obvious pattern in advice giving related to the estimated workload. However, the frequencies with which advice was provided at all the pharmacies were too low to draw definite conclusions. The mean length of interactions where information was provided was 71 seconds (range 8 to 335).

During 43 interactions studied, pharmacists asked 38 questions, nearly all of which were closed; patients asked 15 questions of which more than a third were open. As expected, the number of elderly patients visiting the pharmacies and the number of patient interactions showed marked intra- and inter-pharmacy variation. This is relevant to the development of realistic advice-giving protocols.
Referral of clients by community pharmacists: views of general medical practitioners
Authors: Smith Felicity
Published: February 2011

Community pharmacists have been shown to advise approximately 15 per cent of clients who present to them with minor ailments to consult another health professional, usually their general medical practitioner. The clients that pharmacists refer may or may not be those that GPs most wish to see. There may be other clients or symptoms that GPs believe should be referred to them. This study investigated GPs' views on community pharmacists' referral practices, looking at which symptoms they believed should be referred, the level of agreement between them and how their recommendations compared with the referral practices of community pharmacists established by the author in an earlier study.

Questionnaires were posted to a random sample of GPs in Greater London, asking them to indicate the referral advice they felt appropriate for each of 62 symptom groups, recommending either direct referral, no referral or referral only in some cases. The symptom groups were derived from the symptoms presented to the pharmacists in the earlier study.

Respondents were generally positive about the pharmacist's role, indicating that for many symptom groups they felt it appropriate for the pharmacist to be a first port of call. Although the variation between responses suggested that there should be local liaison regarding practice, on the whole the GPs' recommendations were in line with the pharmacists' existing practices.
Towards a model of pharmacy practice research
Authors: Harding Geoffrey , Taylor Kevin
Published: February 2011

A model defined by the methodologies of the social sciences and health services research
Work sampling observations of community pharmacists: a review
Authors: Emmerton Lynne , Jefferson Karyn
Published: February 2011

Activities undertaken by community pharmacists may be monitored in individual pharmacies to analyse the division of labour before and after changes in work practices, and for general insight into the current roles of pharmacists. Studies based in community pharmacies have used work sampling techniques, with activities recorded by observers at defined intervals. Sampling methods and the selection of observation periods have varied between studies, with activities recorded at one- to- five-minute intervals or at random. Differing classifications of activities also limit the comparison of findings. There exists a need for further research in this area to address sampling issues and limitations imposed by observers in pharmacies and to provide data relevant to present day practice. Self-reporting of activities using electronic bar code readers and reminders may be feasible for data collection from multiple-pharmacist pharmacies or larger samples of pharmacies.