The aim of this study is to measure and evaluate the moral reasoning of undergraduate pharmacy students as they progress through a British university, and onward through the early years of their professional practice. This study utilizes version 2 of Rest's Defining Issues Test in a longitudinal design, evaluating a single cohort of future pharmacists, which started a 4-year Master of Pharmacy degree program in 2008-09, completed their preregistration training, and progressed through their early careers. The final dataset was collected in 2019. Both descriptive and inferential statistical analysis was subsequently carried out. The cohort experienced significant moral growth during the 4 years of their undergraduate degree, where they were exposed to an ethical education designed to engage students at the "plus one" level of moral reasoning. There is also evidence for work-based augmentation of moral development between graduation from university and qualification as pharmacists. The subjects underwent a marked increase in moral development as they progressed through their undergraduate studies, followed by another sizeable, though not statistically significant developmental progression during the preregistration year. The retrograde step in moral development observed between newly qualified level and established practitioner level requires further investigation: structured interviews with participants, which focus on changes to their experiences in practice and how these affected their moral agency are already underway.
{"title":"Measuring moral development in the pharmacy profession from undergraduate to established practitioner: a decadal longitudinal study.","authors":"Cathal T Gallagher, Waseeat O D Kareem-Alliu","doi":"10.1093/ijpp/riad059","DOIUrl":"10.1093/ijpp/riad059","url":null,"abstract":"<p><p>The aim of this study is to measure and evaluate the moral reasoning of undergraduate pharmacy students as they progress through a British university, and onward through the early years of their professional practice. This study utilizes version 2 of Rest's Defining Issues Test in a longitudinal design, evaluating a single cohort of future pharmacists, which started a 4-year Master of Pharmacy degree program in 2008-09, completed their preregistration training, and progressed through their early careers. The final dataset was collected in 2019. Both descriptive and inferential statistical analysis was subsequently carried out. The cohort experienced significant moral growth during the 4 years of their undergraduate degree, where they were exposed to an ethical education designed to engage students at the \"plus one\" level of moral reasoning. There is also evidence for work-based augmentation of moral development between graduation from university and qualification as pharmacists. The subjects underwent a marked increase in moral development as they progressed through their undergraduate studies, followed by another sizeable, though not statistically significant developmental progression during the preregistration year. The retrograde step in moral development observed between newly qualified level and established practitioner level requires further investigation: structured interviews with participants, which focus on changes to their experiences in practice and how these affected their moral agency are already underway.</p>","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":" ","pages":"633-637"},"PeriodicalIF":1.8,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10033649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1093/ijpp/riad074.019
E. Davidson, T. Jones, W. Baqir, K. Fenwick
Self-administration schemes can have significant impact on a patient’s management and treatment of specific diseases. Implementing the self-administration of insulin for inpatients is believed to increase patient’s knowledge, understanding, independence and confidence regarding medication to improve outcomes. This study identifies the limited knowledge and access to self-administration schemes for diabetes. The aim of this scoping review is to collect and review relevant literature surrounding inpatient insulin self-administration schemes and to identify the impact this scheme has on knowledge, confidence, independence, satisfaction, costs and workload for patients, hospitals and staff. This scoping review further aims to highlight the reported limitations regarding self-administration and identify the potential gaps in the evidence-base. Keywords were searched on MEDLINE (1946 to October Week 4 2022), EMBASE (1974 to 2022 Week 43), Scopus, Web of Science, CINAHL and Google Scholar from October 6th, 2022, to November 8th, 2022. The title, abstract and citations were initially screened using the inclusion and exclusion criteria. Included literature was then screened by a second reviewer. The identified literature described and evaluated inpatient insulin self-administration schemes and summarised according to author and study design. This scoping review did not require ethical approval as it was including information and studies freely available for public domain. Newcastle University Pharmacy Department. Among the 1,159 literature sources identified, 16 literature sources were included in the scoping review. A systematic review and meta-analysis was initially considered but yielded due to the heterogeneity of literature in study design. Nine quantitative and seven qualitative studies assessed individual patient and staff views. They were assessed in ranging time frames up to eight months. Literature evaluated the knowledge, understanding and compliance of patients relating to administration and drug regimens which were measured via questionnaires and interviews. Studies identified short-term costs to outweigh long-term benefits. The majority of patients and staff were significantly satisfied with the implementation of self-administration schemes. The implementation of insulin self-administration schemes for inpatients has shown to support patient health and safety, increasing knowledge and compliance. Literature continues to identify the need for extra support and maintenance from healthcare professionals to control diabetes. Self-administration schemes may continue to advance with increased support and engagement. Study limitations were identified to further acknowledged the advancements in time frames, support and sample size and selection for participants, supporting the advancements in self-administration schemes. 1. Wright J, Emerson A, Stephens M, Lennan E. Hospital inpatient self-administration of medicin
自我给药计划可对患者管理和治疗特定疾病产生重大影响。对住院病人实施胰岛素自我管理被认为可以增加病人对药物治疗的了解、理解、独立性和信心，从而改善治疗效果。本研究确定了糖尿病患者对自我管理计划的有限了解和获取途径。 本次范围界定审查旨在收集和审查有关住院患者胰岛素自我管理计划的相关文献，并确定该计划对患者、医院和员工的知识、信心、独立性、满意度、成本和工作量的影响。本次范围界定审查还旨在强调有关自我管理的报告局限性，并确定证据基础中的潜在差距。 自 2022 年 10 月 6 日至 2022 年 11 月 8 日，在 MEDLINE（1946 年至 2022 年 10 月第 4 周）、EMBASE（1974 年至 2022 年第 43 周）、Scopus、Web of Science、CINAHL 和 Google Scholar 上检索了相关关键词。根据纳入和排除标准对标题、摘要和引文进行初步筛选。然后由第二位审稿人对纳入的文献进行筛选。确定的文献对住院患者胰岛素自我管理方案进行了描述和评估，并根据作者和研究设计进行了总结。此次范围界定审查无需获得伦理批准，因为它包括了可在公共领域免费获取的信息和研究。纽卡斯尔大学药学系。 在已确定的 1,159 篇文献资料中，有 16 篇文献资料被纳入范围界定审查。最初考虑进行系统综述和荟萃分析，但由于研究设计方面的文献异质性而放弃。九项定量研究和七项定性研究对患者和员工的个人观点进行了评估。评估的时间范围最长为八个月。文献通过问卷调查和访谈的方式，评估了患者对用药和用药方案的了解、理解和依从性。研究发现，短期成本大于长期效益。大多数患者和医务人员对自我管理计划的实施非常满意。 对住院病人实施胰岛素自我管理计划已证明有助于患者的健康和安全，并能提高患者的知识水平和依从性。文献继续指出，控制糖尿病需要医护人员的额外支持和维护。随着支持和参与度的提高，自我管理计划可能会继续推进。研究局限性的确定进一步确认了时间框架、支持、样本大小和参与者选择方面的进步，支持了自我管理计划的进步。 1.Wright J, Emerson A, Stephens M, Lennan E. Hospital inpatient self-administration of medicine programs: a critical literature review.药学世界与科学》。2006;28(3):140. 2.Muhammad K, Khan T, Nisar Ur R, Khan Z, Subhan F. 《糖尿病患者对胰岛素自我管理的认识和态度：巴基斯坦开伯尔-普赫图赫瓦省一家教学医院的横断面研究》。药物与治疗展望》。2020;36(6):266-72. 3.Gangopadhyay KK, Ebinesan AD, Mtemererwa B, Marshall C, McGettigan AT, Cope A, et al：患者自行给药可能更安全。国际实用糖尿病》。2008;25(3):96-8.
{"title":"Does the implementation of self-administration policies for insulin improve patient safety in the hospital inpatient setting? A scoping review","authors":"E. Davidson, T. Jones, W. Baqir, K. Fenwick","doi":"10.1093/ijpp/riad074.019","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.019","url":null,"abstract":"Self-administration schemes can have significant impact on a patient’s management and treatment of specific diseases. Implementing the self-administration of insulin for inpatients is believed to increase patient’s knowledge, understanding, independence and confidence regarding medication to improve outcomes. This study identifies the limited knowledge and access to self-administration schemes for diabetes. The aim of this scoping review is to collect and review relevant literature surrounding inpatient insulin self-administration schemes and to identify the impact this scheme has on knowledge, confidence, independence, satisfaction, costs and workload for patients, hospitals and staff. This scoping review further aims to highlight the reported limitations regarding self-administration and identify the potential gaps in the evidence-base. Keywords were searched on MEDLINE (1946 to October Week 4 2022), EMBASE (1974 to 2022 Week 43), Scopus, Web of Science, CINAHL and Google Scholar from October 6th, 2022, to November 8th, 2022. The title, abstract and citations were initially screened using the inclusion and exclusion criteria. Included literature was then screened by a second reviewer. The identified literature described and evaluated inpatient insulin self-administration schemes and summarised according to author and study design. This scoping review did not require ethical approval as it was including information and studies freely available for public domain. Newcastle University Pharmacy Department. Among the 1,159 literature sources identified, 16 literature sources were included in the scoping review. A systematic review and meta-analysis was initially considered but yielded due to the heterogeneity of literature in study design. Nine quantitative and seven qualitative studies assessed individual patient and staff views. They were assessed in ranging time frames up to eight months. Literature evaluated the knowledge, understanding and compliance of patients relating to administration and drug regimens which were measured via questionnaires and interviews. Studies identified short-term costs to outweigh long-term benefits. The majority of patients and staff were significantly satisfied with the implementation of self-administration schemes. The implementation of insulin self-administration schemes for inpatients has shown to support patient health and safety, increasing knowledge and compliance. Literature continues to identify the need for extra support and maintenance from healthcare professionals to control diabetes. Self-administration schemes may continue to advance with increased support and engagement. Study limitations were identified to further acknowledged the advancements in time frames, support and sample size and selection for participants, supporting the advancements in self-administration schemes. 1. Wright J, Emerson A, Stephens M, Lennan E. Hospital inpatient self-administration of medicin","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":"57 5","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139196651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1093/ijpp/riad074.036
S. Lakhani, M. D. Allinson
The number of women in England prescribed HRT has increased dramatically in the last seven years.1 Meanwhile, from 2018, HRT product shortages have resulted in the release of Serious Shortage Protocols allowing community pharmacists to supply alternative HRT products where appropriate.2 Furthermore, in 2022, the first over-the-counter medication for vaginal atrophy in menopause was licensed.3 With so many recent changes, it seemed an opportune time to determine community pharmacists’ views on the topic. The aim of this study was to explore community pharmacists’ views around HRT and the menopause. A qualitative approach using semi-structured interviews was chosen to allow for exploration of views. A list of community pharmacies from Stoke-on-Trent and Staffordshire was obtained from the NHS website. They were grouped into independent and multiple pharmacies in both urban and rural areas. Twenty pharmacies were then randomly selected from across the lists, emailed and invited to participate in the study; a participant information sheet and consent form was attached. This was followed up with a telephone call one week later, and a day and time for interview was agreed. Telephone interviews were undertaken, with consent obtained verbally, and the interview digitally recorded. The interview guide was developed based on the literature review and aim of the study. The guide addressed experiences of patient queries regarding HRT and the menopause, views of the OTC vaginal tablet and their confidence in discussing menopause with patients. Interviews were transcribed verbatim and thematically analysed. Ethical approval was obtained from Keele School of Pharmacy and Bioengineering Ethics Committee. Nine interviews were undertaken in October 2022, lasting 10 to 15 minutes. Five interviewees were male, five from urban areas, all from different companies and experience ranged from 3 months to 45 years. Four themes emerged from the transcripts, namely: increase in queries; managing shortages; lack of knowledge on Gina®; and limited professional interest in the topic. Patients were found to rarely ask about menopausal symptoms, with most queries related to risks associated with HRT or advice on various formulations. All pharmacists found dealing with shortages to be time-consuming and potentially stressful. Many of the pharmacists had not heard of the new vaginal tablet and did not stock it. Those who did, felt it was expensive and unlikely to sell. All stated they would like further training on the menopause but only one would consider specialising as a future area of prescribing. This was a small study with relatively short interviews, due to the time constraints facing working pharmacists. Despite this, similarity in responses suggest that data saturation may have been reached. This study confirms previous reports of increasing queries relating to HRT, particularly around shortages, and the stress associated with dealing with them
1 同时，从 2018 年开始，HRT 产品短缺导致发布了《严重短缺协议》，允许社区药剂师在适当的情况下提供替代 HRT 产品。2 此外，2022 年，首个治疗更年期阴道萎缩的非处方药获得许可。 本研究的目的是探讨社区药剂师对 HRT 和更年期的看法。 研究选择了半结构化访谈的定性方法来探讨药剂师的观点。我们从英国国家医疗服务体系网站上获取了斯托克特伦特和斯塔福德郡的社区药房名单。这些药房被分为城市和农村地区的独立药房和综合药房。然后从这些药房名单中随机抽取了 20 家药房，通过电子邮件邀请它们参与研究；并随附了一份参与者信息表和同意书。一周后，我们又通过电话进行了跟进，并商定了访谈的日期和时间。在口头征得同意后进行了电话访谈，并对访谈进行了数码录音。访谈指南是根据文献综述和研究目的制定的。访谈指南涉及患者对更年期的疑问、对非处方药阴道片剂的看法以及与患者讨论更年期问题时的信心。对访谈内容进行了逐字记录和主题分析。基尔药学与生物工程学院伦理委员会批准了该访谈。 2022 年 10 月进行了九次访谈，每次持续 10-15 分钟。五位受访者为男性，五位来自城市地区，均来自不同的公司，工作经验从 3 个月到 45 年不等。访谈记录中出现了四个主题，即：询问增加；管理短缺；缺乏有关吉纳®的知识；以及专业人员对该主题的兴趣有限。患者很少询问有关更年期症状的问题，大多数询问都是关于与 HRT 相关的风险或各种配方的建议。所有药剂师都认为，处理药品短缺问题既耗时又可能造成压力。许多药剂师没有听说过这种新型阴道片剂，也没有库存。而那些有库存的药剂师则认为这种药物价格昂贵，不太可能畅销。所有药剂师都表示希望接受更年期方面的进一步培训，但只有一名药剂师考虑将其作为未来处方的一个专业领域。 由于在职药剂师面临时间限制，这是一项规模较小的研究，访谈时间相对较短。尽管如此，相似的回答表明数据可能已经达到饱和。这项研究证实了之前的报告，即与 HRT 有关的询问越来越多，尤其是与短缺有关的询问，以及与处理这些询问有关的压力。药剂师表示，他们希望得到有关该主题的进一步培训，尽管目前已有有关更年期的 CPPE 培训包。尽管 HRT 越来越受关注，处方也越来越多，但药剂师却很少有意愿专门从事这一领域的工作并开具处方。 1.Connelly D. 信息图表：HRT 的复苏。Pharm J [Internet] 2023 May 31 [cited 2023 Jun 02]; 310(7973)：Available from https://pharmaceutical-journal.com/article/feature/infographic-the-resurgence-of-hrt DOI:10.1211/PJ.2023.1.183280 2.Wickware C. 药剂师有权替代面临短缺的 HRT 产品。Pharm J [Internet] 2022 May 20 [cited 2023 Jun 02]; 308(7961)：Available from pharmaceutical-journal.com/article/news/pharmacists-given-powers-to-substitute-hrt-products-facing-shortages DOI:10.1211/PJ.2022.1.143779 3.电子药典》。[互联网] 吉娜 10 微克阴道片。[cited 2023 Jun 02]：Available from: https://www.medicines.org.uk/emc/product/13930
{"title":"Exploring community pharmacists’ views around HRT and the menopause","authors":"S. Lakhani, M. D. Allinson","doi":"10.1093/ijpp/riad074.036","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.036","url":null,"abstract":"The number of women in England prescribed HRT has increased dramatically in the last seven years.1 Meanwhile, from 2018, HRT product shortages have resulted in the release of Serious Shortage Protocols allowing community pharmacists to supply alternative HRT products where appropriate.2 Furthermore, in 2022, the first over-the-counter medication for vaginal atrophy in menopause was licensed.3 With so many recent changes, it seemed an opportune time to determine community pharmacists’ views on the topic. The aim of this study was to explore community pharmacists’ views around HRT and the menopause. A qualitative approach using semi-structured interviews was chosen to allow for exploration of views. A list of community pharmacies from Stoke-on-Trent and Staffordshire was obtained from the NHS website. They were grouped into independent and multiple pharmacies in both urban and rural areas. Twenty pharmacies were then randomly selected from across the lists, emailed and invited to participate in the study; a participant information sheet and consent form was attached. This was followed up with a telephone call one week later, and a day and time for interview was agreed. Telephone interviews were undertaken, with consent obtained verbally, and the interview digitally recorded. The interview guide was developed based on the literature review and aim of the study. The guide addressed experiences of patient queries regarding HRT and the menopause, views of the OTC vaginal tablet and their confidence in discussing menopause with patients. Interviews were transcribed verbatim and thematically analysed. Ethical approval was obtained from Keele School of Pharmacy and Bioengineering Ethics Committee. Nine interviews were undertaken in October 2022, lasting 10 to 15 minutes. Five interviewees were male, five from urban areas, all from different companies and experience ranged from 3 months to 45 years. Four themes emerged from the transcripts, namely: increase in queries; managing shortages; lack of knowledge on Gina®; and limited professional interest in the topic. Patients were found to rarely ask about menopausal symptoms, with most queries related to risks associated with HRT or advice on various formulations. All pharmacists found dealing with shortages to be time-consuming and potentially stressful. Many of the pharmacists had not heard of the new vaginal tablet and did not stock it. Those who did, felt it was expensive and unlikely to sell. All stated they would like further training on the menopause but only one would consider specialising as a future area of prescribing. This was a small study with relatively short interviews, due to the time constraints facing working pharmacists. Despite this, similarity in responses suggest that data saturation may have been reached. This study confirms previous reports of increasing queries relating to HRT, particularly around shortages, and the stress associated with dealing with them","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":"14 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139197294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1093/ijpp/riad074.024
S. A. Francis, S. Yardley, B. Franklin, M. Ogden, A. Kajamaa, K. Mattick
UK health policy documents are committed to improving personalised palliative care for people of all ages, prioritising access to coordinated care and health inequity. The UK Health and Care Act 2022 has stated it is a statutory requirement for Integrated Care Boards to commission palliative and end of life care services. Palliative care focuses on improving the quality of life of patients and families who are facing problems associated with life-limiting illness, and often involves medication for symptom control. Medication has been reported in 19% of NHS serious incident reports involving palliative patients, mostly occurring in patient homes, with half when specialists did not provide care.1 To document a model of existing evidence illustrating intended processes when palliative medications are prescribed for symptom control and used by adults at home, in hospital and hospice settings. We performed a scoping review using JBI methodology.2 Population (P): (i) adults in the last phase of life, (ii) informal carers supporting an adult as described above, (iii) healthcare professionals providing palliative care for symptom control. Concept (C): multistep processes for medication use for symptom control in palliative care. Context (C): care settings where palliative care may be anticipated, planned or happen. A systematic search were undertaken in Medline, CINAHL, Embase, plus Google scholar and Google images. There were no date limits; searches were confined to English language. Published and unpublished literature meeting the PCC framework were included. Screening and extraction of data were performed by two independent reviewers (SAF and SY). Studies were categorised inductively and results collated descriptively. Ethical approval was obtained from the NHS HRA and HCRW (ref: 21/LO/0459). 19,753 titles and abstracts were screened; 929 underwent full text review; 308 peer-reviewed articles and grey literature documents were retained to build the intended model. The majority of these papers (212; 69%) provided simple process steps involving expertise/judgement, supply chain/access, administration, prescribing/deprescribing, rationalisation, repurposing. The remaining 96 papers warranted richer thematic analysis. Most studies took place in the UK, Australia or USA in home/community settings. Analysis illuminated detail about ‘hidden work’ (participants’ actions in medication management), ‘hot spots’ (problematic areas e.g. out-of-hours care and the reliance on carers) and ‘cold spots’ (areas with less attention such as whose responsibility for keeping carers informed of changes and what is adequate support for safe medicines use at home). There is a growing interest in how best to work together across boundaries to enable getting the right medication to the right person at the right time and place. This scoping review documents the existing evidence of intended processes and a model of ideal prescribing and medication
英国的卫生政策文件致力于改善所有年龄段人群的个性化姑息关怀，优先考虑协调关怀的获取和健康不平等问题。英国《2022 年健康与护理法案》规定，综合护理委员会必须委托提供姑息关怀和生命末期关怀服务。 姑息关怀的重点是改善面临与局限生命的疾病相关问题的患者和家属的生活质量，通常涉及药物控制症状。 在涉及姑息关怀患者的英国国家医疗服务系统严重事故报告中，19% 的报告涉及药物治疗，其中大部分发生在患者家中，半数是在专科医生未提供护理的情况下发生的1。 2 研究对象（P）：(i) 处于生命最后阶段的成年人；(ii) 支持上述成年人的非正式照护者；(iii) 提供姑息关怀以控制症状的医护人员。概念（C）：在姑息关怀中使用药物控制症状的多步骤过程。背景（C）：可能预期、计划或发生姑息关怀的护理环境。 在 Medline、CINAHL、Embase 以及 Google scholar 和 Google images 中进行了系统搜索。没有日期限制；搜索仅限于英语。符合 PCC 框架的已发表和未发表的文献均被纳入。由两名独立审稿人（SAF 和 SY）负责筛选和提取数据。对研究进行归纳分类，并对结果进行描述性整理。 已获得英国国家医疗服务系统 HRA 和 HCRW 的伦理批准（编号：21/LO/0459）。 筛选了 19,753 篇标题和摘要；929 篇进行了全文审阅；保留了 308 篇同行评审文章和灰色文献，以建立预期模型。其中大部分论文（212 篇；69%）提供了简单的流程步骤，涉及专业知识/判断、供应链/获取、管理、处方/处方外、合理化、再利用。其余 96 篇论文需要进行更丰富的专题分析。大多数研究发生在英国、澳大利亚或美国的家庭/社区环境中。分析揭示了 "隐性工作"（参与者在用药管理方面的行动）、"热点"（存在问题的领域，如非工作时间护理和对护理人员的依赖）和 "冷点"（关注度较低的领域，如谁有责任让护理人员及时了解变化，以及什么是对在家安全用药的充分支持）方面的细节。 人们越来越关注如何以最佳方式开展跨部门合作，以便在正确的时间和地点为正确的人提供正确的药物。本范围界定综述记录了姑息关怀中症状控制的预期流程和理想处方与用药模式的现有证据。本研究仅限于成人姑息关怀服务。本研究的优势之一是采用了联合调查法。我们将利用人种学方法和活动理论的概念工具，通过对实践中发生的情况3 的研究来完善这一预期模式，从而建立一个有理论依据、有经验证明的姑息关怀用药管理模式。 1.Yardley I, Yardley S, Williams H, Carson-Stevens A, Donaldson L. 《姑息关怀中的患者安全》：严重事故国家数据库报告的混合方法研究。Pall Med 2018;32:1353-1362. 2.Joanna Briggs Institute.Joanna Briggs Institute Reviewers' Manual：2015 年版/补充：Joanna Briggs Institute Reviewers' Manual: 2015 edition / supplement: Methodology for JBI Scoping Reviews.澳大利亚阿德莱德：http://joannabriggs.org/assets/docs/sumari/Reviewers-Manual_Methodology-for-JBI-Scoping-Reviews_2015_v2.pdf 3.Yardley S, Francis SA, Dean Franklin B, Ogden M, Kajamaa A, Mattick K. Getting palliative medications right across the contexts of homes, hospitals and hospices: protocol to synthesize scoping review and ethnographic methods in an activity theory analysis.BMJ Open 2022 12:e061754.
{"title":"A model of intended and ideal prescribing and medication use in symptom control in palliative care: an international scoping review","authors":"S. A. Francis, S. Yardley, B. Franklin, M. Ogden, A. Kajamaa, K. Mattick","doi":"10.1093/ijpp/riad074.024","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.024","url":null,"abstract":"UK health policy documents are committed to improving personalised palliative care for people of all ages, prioritising access to coordinated care and health inequity. The UK Health and Care Act 2022 has stated it is a statutory requirement for Integrated Care Boards to commission palliative and end of life care services. Palliative care focuses on improving the quality of life of patients and families who are facing problems associated with life-limiting illness, and often involves medication for symptom control. Medication has been reported in 19% of NHS serious incident reports involving palliative patients, mostly occurring in patient homes, with half when specialists did not provide care.1 To document a model of existing evidence illustrating intended processes when palliative medications are prescribed for symptom control and used by adults at home, in hospital and hospice settings. We performed a scoping review using JBI methodology.2 Population (P): (i) adults in the last phase of life, (ii) informal carers supporting an adult as described above, (iii) healthcare professionals providing palliative care for symptom control. Concept (C): multistep processes for medication use for symptom control in palliative care. Context (C): care settings where palliative care may be anticipated, planned or happen. A systematic search were undertaken in Medline, CINAHL, Embase, plus Google scholar and Google images. There were no date limits; searches were confined to English language. Published and unpublished literature meeting the PCC framework were included. Screening and extraction of data were performed by two independent reviewers (SAF and SY). Studies were categorised inductively and results collated descriptively. Ethical approval was obtained from the NHS HRA and HCRW (ref: 21/LO/0459). 19,753 titles and abstracts were screened; 929 underwent full text review; 308 peer-reviewed articles and grey literature documents were retained to build the intended model. The majority of these papers (212; 69%) provided simple process steps involving expertise/judgement, supply chain/access, administration, prescribing/deprescribing, rationalisation, repurposing. The remaining 96 papers warranted richer thematic analysis. Most studies took place in the UK, Australia or USA in home/community settings. Analysis illuminated detail about ‘hidden work’ (participants’ actions in medication management), ‘hot spots’ (problematic areas e.g. out-of-hours care and the reliance on carers) and ‘cold spots’ (areas with less attention such as whose responsibility for keeping carers informed of changes and what is adequate support for safe medicines use at home). There is a growing interest in how best to work together across boundaries to enable getting the right medication to the right person at the right time and place. This scoping review documents the existing evidence of intended processes and a model of ideal prescribing and medication","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":" 9","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139197829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1093/ijpp/riad074.017
P. Crilly, S. Abdallah, J. Davey, I. Al-Saery
In the UK, medicines reclassification is the process of changing the legal classification of a medication, such as from a prescription-only medicine (POM) to a pharmacy (P) or general sales list (GSL) medicine.1 It is overseen by the Medicines and Healthcare products Regulatory Agency (MHRA). and improves patient access to certain medications while ensuring safeguards are in place for their safe and responsible use.2 A number of the most recent POM to P reclassifications have been for medications used in sexual and reproductive healthcare. To investigate community pharmacists' (CPs’) perceptions of POM to P medicine reclassifications for sexual and reproductive health: sildenafil citrate (Viagra Connect, for erectile dysfunction), desogestrel (Hana/Lovima, for contraception), and estradiol hemihydrate (Gina, for vaginal atrophy). The study population was all CPs in Greater London. The survey consisted of 59-questions in five sections. The first section was for general perceptions about the reclassification of medicines, while the other sections were specific to the medicines studied. The final section was demographics. Question types included multiple-choice, 5-point Likert scale, and free text. The recommended sample size was 340 (95% CI), therefore, 398 CPs, in 210 pharmacies, were approached. Ethical approval was obtained from the university ethics committee. Participants were posted a participant information sheet (PIS) one week before distribution of the survey as a hard copy. The survey was also available on Microsoft Forms. Data were analysed in Microsoft Excel and Statistical Package for Social Sciences (SPSS). Descriptive statistics were given in numbers and percentages. The response rate was 37.7% (N=150/398). Most CPs (88%) perceived that medication reclassification increased their role and provided greater access to medicines for the public. However, less than half (44%) had a good understanding of the reclassification process. Sildenafil was available to purchase in all of the visited pharmacies, however, desogestrel was only sold in 50% of them, and estradiol was sold in only 28%. Reasons cited for not selling desogestrel and/or estradiol included lack of public awareness about the availability of these products, and a lack of public interest in purchasing them. While the availability of sildenafil as a P medicine was seen as a positive for improving safe access, many CPs (86%) expressed concerns about the high risk of its misuse. In terms of training, the available training for sildenafil received higher ratings compared to that for desogestrel or estradiol. Most CPs (67%) indicated that having case studies incorporated into the training for POM to P switches helped them understand which patients could safely purchase these medications. CPs are positive about the availability of sexual and reproductive health medications over the counter. They do have concerns, however, about the potential of some of the
在英国，药品重新分类是改变药品法定分类的过程，例如从处方药 (POM) 变为药房药 (P) 或一般销售清单 (GSL) 药品。1 这项工作由药品和保健品监管局 (MHRA) 负责监督，在确保安全、负责任地使用药品的同时，还能提高患者获得某些药品的机会。 调查社区药剂师（CPs）对性保健和生殖保健药品从 POM 到 P 的重新分类的看法：枸橼酸西地那非（Viagra Connect，用于治疗勃起功能障碍）、去氧孕酮（Hana/Lovima，用于避孕）和半水合雌二醇（Gina，用于治疗阴道萎缩）。 研究对象为大伦敦地区的所有 CP。调查包括五个部分共 59 个问题。第一部分是对药品重新分类的总体看法，其他部分则针对所研究的药品。最后一部分是人口统计数据。问题类型包括多项选择、5 点李克特量表和自由文本。建议的样本量为 340 个（95% CI），因此共访问了 210 家药房中的 398 家 CP。研究获得了大学伦理委员会的伦理批准。在发放硬拷贝调查表一周前，向参与者张贴了参与者信息表 (PIS)。调查表也可在 Microsoft Forms 上下载。数据用 Microsoft Excel 和社会科学统计软件包 (SPSS) 进行分析。描述性统计以数字和百分比表示。 答复率为 37.7%（N=150/398）。大多数 CPs（88%）认为药物重新分类增加了他们的角色，并为公众提供了更多的药物。然而，只有不到一半的 CP（44%）对重新分类的过程有很好的了解。所有受访药店都有西地那非出售，但只有 50% 的药店出售去氧孕烯，只有 28% 的药店出售雌二醇。不出售去氧孕烯和/或雌二醇的原因包括公众对这些产品的供应缺乏了解，以及公众对购买这些产品缺乏兴趣。虽然西地那非作为 P 类药物的供应被视为改善安全获取的积极因素，但许多 CPs（86%）对其滥用的高风险表示担忧。在培训方面，与去氧孕烯或雌二醇的培训相比，西地那非的培训得到了更高的评价。大多数 CP（67%）表示，将案例研究纳入 POM 转 P 的培训有助于他们了解哪些患者可以安全地购买这些药物。 CPs 对非处方药的性健康和生殖健康药物的可获得性持肯定态度。不过，他们也对某些药物可能被滥用表示担忧，并认为需要提高人们对这些产品供应情况的认识。那些为重新分类药物编写培训材料的人应该将案例研究纳入其中，因为这些案例研究有助于做出处方药决策。本研究的局限性在于没有达到建议的样本量。 1.药品：重新分类您的产品[互联网]。2023 年 [2023 年 5 月 30 日引用]。见 https://www.gov.uk/guidance/medicines-reclassify-your-product#:~:text=The%20MHRA%20procedure%20is%20straightforward,%27me%2Dtoo%27%20reclassifications。 2.2. Blenkinsopp A, Bradley C. Over the Counter Drugs：2. Blenkinsopp A, Bradley C. Over Counter Drugs: Patients, Society, and the increase in self medication.BMJ [Internet].1996 Mar 9 [cited 2023 May 30];312(7031):629-32.可查阅： https://www.bmj.com/content/312/7031/629
{"title":"Community pharmacists' perceptions of the POM to P reclassification of medicines for sexual and reproductive health – A survey study","authors":"P. Crilly, S. Abdallah, J. Davey, I. Al-Saery","doi":"10.1093/ijpp/riad074.017","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.017","url":null,"abstract":"In the UK, medicines reclassification is the process of changing the legal classification of a medication, such as from a prescription-only medicine (POM) to a pharmacy (P) or general sales list (GSL) medicine.1 It is overseen by the Medicines and Healthcare products Regulatory Agency (MHRA). and improves patient access to certain medications while ensuring safeguards are in place for their safe and responsible use.2 A number of the most recent POM to P reclassifications have been for medications used in sexual and reproductive healthcare. To investigate community pharmacists' (CPs’) perceptions of POM to P medicine reclassifications for sexual and reproductive health: sildenafil citrate (Viagra Connect, for erectile dysfunction), desogestrel (Hana/Lovima, for contraception), and estradiol hemihydrate (Gina, for vaginal atrophy). The study population was all CPs in Greater London. The survey consisted of 59-questions in five sections. The first section was for general perceptions about the reclassification of medicines, while the other sections were specific to the medicines studied. The final section was demographics. Question types included multiple-choice, 5-point Likert scale, and free text. The recommended sample size was 340 (95% CI), therefore, 398 CPs, in 210 pharmacies, were approached. Ethical approval was obtained from the university ethics committee. Participants were posted a participant information sheet (PIS) one week before distribution of the survey as a hard copy. The survey was also available on Microsoft Forms. Data were analysed in Microsoft Excel and Statistical Package for Social Sciences (SPSS). Descriptive statistics were given in numbers and percentages. The response rate was 37.7% (N=150/398). Most CPs (88%) perceived that medication reclassification increased their role and provided greater access to medicines for the public. However, less than half (44%) had a good understanding of the reclassification process. Sildenafil was available to purchase in all of the visited pharmacies, however, desogestrel was only sold in 50% of them, and estradiol was sold in only 28%. Reasons cited for not selling desogestrel and/or estradiol included lack of public awareness about the availability of these products, and a lack of public interest in purchasing them. While the availability of sildenafil as a P medicine was seen as a positive for improving safe access, many CPs (86%) expressed concerns about the high risk of its misuse. In terms of training, the available training for sildenafil received higher ratings compared to that for desogestrel or estradiol. Most CPs (67%) indicated that having case studies incorporated into the training for POM to P switches helped them understand which patients could safely purchase these medications. CPs are positive about the availability of sexual and reproductive health medications over the counter. They do have concerns, however, about the potential of some of the","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":"18 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139201031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1093/ijpp/riad074.001
R. Abdelsalam Elshenawy, N. Umaru, Z. Aslanpour
The study highlights the urgency of combating rising multi-drug-resistant infections, projecting 10 million deaths annually by 2050. With over 1.2 million deaths in 2019, Antimicrobial Resistance (AMR) has become a significant public health issue. Antimicrobial Stewardship (AMS) promotes judicious antibiotic use1. 'The Five Rights of Antibiotic Safety' ensure appropriate usage. It encompasses the right patient, drug, dose, time, and duration2. The COVID-19 pandemic, causing around 6 million deaths by 2023, has intensified AMR challenges. The Royal Pharmaceutical Society's AMS policy advocates for maximising the use of pharmacists' expertise to promote prudent antibiotic use, strengthen stewardship, and reduce AMR3. This study aimed to evaluate AMS and adherence to the 'Five Rights of Antibiotic Safety' in antibiotic prescribing at an NHS Foundation Trust during 2019 and 2020 amidst the COVID-19 pandemic. This research study was conducted using a cross-sectional retrospective design and undertook an in-depth analysis of 640 patient records in 2019 and 2020. The study included adult patients aged 25 and above, immunocompromised and pregnant individuals, and those prescribed antibiotics for respiratory tract infections or pneumonia during 2019 and 2020. A validated data extraction tool facilitated data collection. This study was registered under ISRCTN number 14825813, receiving ethical approval from the University of Hertfordshire Ethics and Health Research Authority (HRA) (REC Reference number 22/EM/0161). The Citizens Senate reviewed the study protocol, ensuring public and patient involvement. The study evaluated inappropriate antibiotic prescribing, identifying a rise in inappropriate antibiotic prescribing with no indication from 16% in 2019 to 20% in 2020. Inappropriate routes of administration also increased from 33% to 36%. While inappropriate drug choice remained steady around 63-64%, inappropriate dosing rose from 13% to 18%. Interestingly, inappropriate duration reduced slightly from 70% to 66%. The study assessed AMS champions, pharmacists' participation increased from 19% to 21%, and doctors decreased from 19% to 12%. However, combined collaboration jumped from 58% to 71%. This study highlights the surge in incorrect antibiotic prescribing during the 2020 COVID-19 pandemic, stressing the necessity of the 'Five Rights of Antibiotic Safety.' Strict guideline adherence and increased professional education are pivotal. Progress in reducing improper duration was seen, indicating the significance of refining prescribing practices. This research highlights the critical role of pharmacists and doctors as AMS champions. It demonstrates that their collaborative efforts during the pandemic positively impacted patient outcomes, thus reaffirming the Royal Pharmaceutical Society's AMS policy on the importance of a multidisciplinary team in ensuring appropriate antibiotic use. This study reveals a worrying increase in inco
{"title":"Five Rights of Antibiotic Safety: Antimicrobial Stewardship at One NHS Foundation Trust in England Before and During the COVID-19 Pandemic","authors":"R. Abdelsalam Elshenawy, N. Umaru, Z. Aslanpour","doi":"10.1093/ijpp/riad074.001","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.001","url":null,"abstract":"The study highlights the urgency of combating rising multi-drug-resistant infections, projecting 10 million deaths annually by 2050. With over 1.2 million deaths in 2019, Antimicrobial Resistance (AMR) has become a significant public health issue. Antimicrobial Stewardship (AMS) promotes judicious antibiotic use1. 'The Five Rights of Antibiotic Safety' ensure appropriate usage. It encompasses the right patient, drug, dose, time, and duration2. The COVID-19 pandemic, causing around 6 million deaths by 2023, has intensified AMR challenges. The Royal Pharmaceutical Society's AMS policy advocates for maximising the use of pharmacists' expertise to promote prudent antibiotic use, strengthen stewardship, and reduce AMR3. This study aimed to evaluate AMS and adherence to the 'Five Rights of Antibiotic Safety' in antibiotic prescribing at an NHS Foundation Trust during 2019 and 2020 amidst the COVID-19 pandemic. This research study was conducted using a cross-sectional retrospective design and undertook an in-depth analysis of 640 patient records in 2019 and 2020. The study included adult patients aged 25 and above, immunocompromised and pregnant individuals, and those prescribed antibiotics for respiratory tract infections or pneumonia during 2019 and 2020. A validated data extraction tool facilitated data collection. This study was registered under ISRCTN number 14825813, receiving ethical approval from the University of Hertfordshire Ethics and Health Research Authority (HRA) (REC Reference number 22/EM/0161). The Citizens Senate reviewed the study protocol, ensuring public and patient involvement. The study evaluated inappropriate antibiotic prescribing, identifying a rise in inappropriate antibiotic prescribing with no indication from 16% in 2019 to 20% in 2020. Inappropriate routes of administration also increased from 33% to 36%. While inappropriate drug choice remained steady around 63-64%, inappropriate dosing rose from 13% to 18%. Interestingly, inappropriate duration reduced slightly from 70% to 66%. The study assessed AMS champions, pharmacists' participation increased from 19% to 21%, and doctors decreased from 19% to 12%. However, combined collaboration jumped from 58% to 71%. This study highlights the surge in incorrect antibiotic prescribing during the 2020 COVID-19 pandemic, stressing the necessity of the 'Five Rights of Antibiotic Safety.' Strict guideline adherence and increased professional education are pivotal. Progress in reducing improper duration was seen, indicating the significance of refining prescribing practices. This research highlights the critical role of pharmacists and doctors as AMS champions. It demonstrates that their collaborative efforts during the pandemic positively impacted patient outcomes, thus reaffirming the Royal Pharmaceutical Society's AMS policy on the importance of a multidisciplinary team in ensuring appropriate antibiotic use. This study reveals a worrying increase in inco","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":"174 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139208615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1093/ijpp/riad074.012
C. Brandish, N. Kamere, A. Iqbal, H. Rosado, V. Rutter
Antimicrobial resistance (AMR) is a global public health issue, which can be addressed through improved antimicrobial stewardship (AMS) knowledge and practice. The CwPAMS programme, launched in 2019, is funded by the UK aid Fleming Fund and managed by Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET).1,2,3 It expanded in 2021 to support 14 health partnerships to enhance AMS capacity by leveraging UK expertise between the UK and 8 Commonwealth countries: Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, Zambia. CwPAMS was supported by UK and LMIC volunteers. The aim of this study was to explore views and experiences of volunteers who took part in the CwPAMS Extension Programme. A cross-sectional survey was developed using Survey Monkey by CPA internal AMS experts and programme managers. The questions explored the key benefits to health organisations and professionals, including the development of AMS skills and competencies, barriers to AMS, and personal/professional development opportunities. Open-ended questions were included to gather further insights into volunteers' views and experiences of volunteering and participating in CwPAMS. The survey was emailed to the 14 health partnerships who took part in the CwPAMS programme between October 2021-May 2022 to be disseminated to all volunteers. Data were collected between 14 April-1 June 2022, transferred to Microsoft Excel and analysed thematically, with frequency counting where appropriate. As it was an internal CPA programme evaluation, no ethical approval was required. A total of 83 survey responses were received. The majority respondents were female (60%) and were pharmacists (54%). Volunteers recognised the programme’s positive impact on a personal/professional and organisational level, by fostering knowledge exchange and enhancing AMS practices. Amongst volunteers, 87% noted that their organisation had benefited through their participation in CwPAMS, with 72% stating they had increased AMS capacity in their team. Volunteers highlighted several areas where they applied their newly acquired skills and experiences from their participation in CwPAMS. The most frequently mentioned impactful areas were: 1) Leadership and project management: Volunteers reported improved competencies in establishing local expertise in AMS and infection management, strengthening stakeholder and partnership engagement and improved confidence in project leadership, monitoring, and evaluation. 2) Use of new tools (digital/virtual) for training and AMS use 3) Mentoring, teaching and sharing their knowledge and experiences to support others in their professional development. In addition, volunteers reported they had the opportunity to network and form international partnerships, fostering multidisciplinary collaborations. They also experienced personal development by acquiring leadership, communication, problem-solving, grant application writing, an
抗菌药耐药性（AMR）是一个全球性的公共卫生问题，可以通过提高抗菌药管理（AMS）知识和实践来解决。CwPAMS 计划于 2019 年启动，由英国援助弗莱明基金资助，由英联邦药剂师协会（CPA）和热带健康与教育信托基金（THET）管理。1,2,3 该计划于 2021 年扩大到支持 14 个卫生合作伙伴，通过在英国和 8 个英联邦国家之间利用英国的专业知识来提高 AMS 能力：加纳、肯尼亚、马拉维、尼日利亚、塞拉利昂、坦桑尼亚、乌干达和赞比亚。CwPAMS 得到了英国和 LMIC 志愿者的支持。 本研究旨在探讨参与 CwPAMS 推广计划的志愿者的观点和经验。 CPA 内部的 AMS 专家和项目经理使用 Survey Monkey 制作了一份横向调查问卷。问题探讨了对医疗机构和专业人员的主要益处，包括 AMS 技能和能力的发展、AMS 的障碍以及个人/专业发展机会。调查还包括开放式问题，以进一步了解志愿者对志愿服务和参与 CwPAMS 的看法和经验。调查问卷通过电子邮件发送给 2021 年 10 月至 2022 年 5 月期间参与 CwPAMS 计划的 14 个卫生合作机构，并分发给所有志愿者。数据收集时间为 2022 年 4 月 14 日至 6 月 1 日，数据已转入 Microsoft Excel，并进行了专题分析，适当时还进行了频率统计。由于这是一项内部的 CPA 计划评估，因此无需获得伦理方面的批准。 共收到 83 份调查回复。大多数受访者为女性（60%）和药剂师（54%）。志愿者们认为，通过促进知识交流和加强 AMS 实践，该计划对个人/专业和组织层面都产生了积极影响。在志愿者中，87% 的人指出，他们所在的组织通过参与 CwPAMS 项目受益匪浅，72% 的人表示他们提高了团队的 AMS 能力。 志愿者们强调了他们在参与 CwPAMS 过程中应用新获得的技能和经验的几个领域。最常提到的有影响的领域是1) 领导能力和项目管理：志愿者们报告说，他们在以下方面的能力得到了提高：建立 AMS 和感染管理方面的本地专业知识，加强利益相关者和合作伙伴的参与，提高对项目领导、监测和评估的信心。2) 使用新工具（数字/虚拟）进行培训和使用 AMS 3) 指导、教授和分享他们的知识和经验，以支持他人的专业发展。此外，志愿者们还报告说，他们有机会建立网络和国际伙伴关系，促进多学科合作。他们还通过学习领导、沟通、解决问题、撰写赠款申请和项目管理技能，获得了个人发展。 CwPAMS 为医疗合作伙伴中的志愿者提供了一个独特的个人和职业发展机会，同时也改善了他们所在组织中与 AMS 相关的医疗实践。我们将继续扩大该计划所取得的成就，加强志愿者的经验，如作为 CwPAMS 2 的一部分提供的非洲领导力奖学金--AMS，以提高 LMICs 中药剂师的技能并使他们能够发挥领导作用。此外，我们还致力于加强对 CwPAMS 的评估，以分别展示其对英国和低收入与中等收入国家的影响。 1.Commonwealth Pharmacists Association - CwPAMS: Commonwealth Partnerships for Antimicrobial Stewardship.见 https://commonwealthpharmacy.org/cwpams（2023 年 6 月 3 日访问）。 2.Ashiru-Oredope D, Langford BJ, Bonaconsa C, et al：All hands on deck.Antimicrob Steward Healthc Epidemiol, 2023; 3(1): e66.DOI: 10.1017/ash.2023.122. 3.Brandish C, Garraghan F, Ng BY, et al. Assessmenting the Impact of a Global Health Fellowship on Pharmacists' Leadership Skills and Consideration of Benefits to the National Health Service (NHS) in the United Kingdom.医疗保健（巴塞尔）2021；9（7）：890。DOI: 10.3390/healthcare9070890.
{"title":"Views and experiences of volunteers for the Commonwealth Partnerships for Antimicrobial Stewardship Extension Programme","authors":"C. Brandish, N. Kamere, A. Iqbal, H. Rosado, V. Rutter","doi":"10.1093/ijpp/riad074.012","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.012","url":null,"abstract":"Antimicrobial resistance (AMR) is a global public health issue, which can be addressed through improved antimicrobial stewardship (AMS) knowledge and practice. The CwPAMS programme, launched in 2019, is funded by the UK aid Fleming Fund and managed by Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET).1,2,3 It expanded in 2021 to support 14 health partnerships to enhance AMS capacity by leveraging UK expertise between the UK and 8 Commonwealth countries: Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, Zambia. CwPAMS was supported by UK and LMIC volunteers. The aim of this study was to explore views and experiences of volunteers who took part in the CwPAMS Extension Programme. A cross-sectional survey was developed using Survey Monkey by CPA internal AMS experts and programme managers. The questions explored the key benefits to health organisations and professionals, including the development of AMS skills and competencies, barriers to AMS, and personal/professional development opportunities. Open-ended questions were included to gather further insights into volunteers' views and experiences of volunteering and participating in CwPAMS. The survey was emailed to the 14 health partnerships who took part in the CwPAMS programme between October 2021-May 2022 to be disseminated to all volunteers. Data were collected between 14 April-1 June 2022, transferred to Microsoft Excel and analysed thematically, with frequency counting where appropriate. As it was an internal CPA programme evaluation, no ethical approval was required. A total of 83 survey responses were received. The majority respondents were female (60%) and were pharmacists (54%). Volunteers recognised the programme’s positive impact on a personal/professional and organisational level, by fostering knowledge exchange and enhancing AMS practices. Amongst volunteers, 87% noted that their organisation had benefited through their participation in CwPAMS, with 72% stating they had increased AMS capacity in their team. Volunteers highlighted several areas where they applied their newly acquired skills and experiences from their participation in CwPAMS. The most frequently mentioned impactful areas were: 1) Leadership and project management: Volunteers reported improved competencies in establishing local expertise in AMS and infection management, strengthening stakeholder and partnership engagement and improved confidence in project leadership, monitoring, and evaluation. 2) Use of new tools (digital/virtual) for training and AMS use 3) Mentoring, teaching and sharing their knowledge and experiences to support others in their professional development. In addition, volunteers reported they had the opportunity to network and form international partnerships, fostering multidisciplinary collaborations. They also experienced personal development by acquiring leadership, communication, problem-solving, grant application writing, an","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":"23 7","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139196680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1093/ijpp/riad074.032
Y. Jiao, J. Shenton
The National Health Service (NHS) is confronted with significant challenges in facilitating clinical research delivery.1 Clinical pharmacists were instrumental in ensuring patient safety while conducting urgent public health studies, such as the RECOVERY trial, during the COVID-19 pandemic.2 Numerous studies have reported the positive impact of pharmacy workforce in supporting clinical research delivery3. However, it remains unclear whether pharmacists are willing to take on this extra responsibility. To explore the opinions of UK clinical pharmacists towards facilitating the delivery of clinical research in secondary care. Objectives include understanding the level of knowledge of clinical research among clinical pharmacists; assessing levels of interest among clinical pharmacists towards supporting clinical research delivery; identifying clinical pharmacists’ perceived barriers and facilitators to supporting clinical research delivery; and developing recommendations to facilitate pharmacists’ engagement in research delivery. This study employed a qualitative research approach and utilised convenience sampling based on the researcher’s professional network. Eight pharmacists from two secondary care NHS Trusts participated. Individual semi-structured interviews were conducted using questions adapted from the Research Capacity and Culture (RCC) tool which was validated by two clinical trial pharmacists. Keele University Research Ethics Committee provided a favourable ethical opinion. Interview transcripts were analysed to identify emerging themes by using framework analysis. The findings revealed that participants possessed limited knowledge of clinical research in general. The key themes identified were categorised into three domains: individual, professional, and organisational, which corresponded with the RCC tool. In the individual domain, pharmacists demonstrated interest in clinical research delivery but lacked confidence. They acknowledged clinical research as contributing to evidence-based practice and enhancing professional development. However, they expressed concerns about patient harm resulting from trial interventions and poorly designed studies generating misleading data. Within the professional domain, pharmacists' capability to support clinical research delivery was limited by inadequate training in clinical research, their clinical skills, and their disease knowledge. They perceived internal and external barriers to participation. It has been suggested to improve the research culture within the profession and promote the role pharmacists can play in delivering research among other healthcare professionals. In the organisational domain, the workplace environment was perceived to present obstacles due to competing priorities and clinical research not being seen to be a core duty by managers. Additionally, awareness of clinical research opportunities was limited and exposure to clinical research-related activ
{"title":"To explore clinical pharmacists’ opinions, and their perceived barriers and facilitators, to supporting clinical research delivery in secondary care","authors":"Y. Jiao, J. Shenton","doi":"10.1093/ijpp/riad074.032","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.032","url":null,"abstract":"The National Health Service (NHS) is confronted with significant challenges in facilitating clinical research delivery.1 Clinical pharmacists were instrumental in ensuring patient safety while conducting urgent public health studies, such as the RECOVERY trial, during the COVID-19 pandemic.2 Numerous studies have reported the positive impact of pharmacy workforce in supporting clinical research delivery3. However, it remains unclear whether pharmacists are willing to take on this extra responsibility. To explore the opinions of UK clinical pharmacists towards facilitating the delivery of clinical research in secondary care. Objectives include understanding the level of knowledge of clinical research among clinical pharmacists; assessing levels of interest among clinical pharmacists towards supporting clinical research delivery; identifying clinical pharmacists’ perceived barriers and facilitators to supporting clinical research delivery; and developing recommendations to facilitate pharmacists’ engagement in research delivery. This study employed a qualitative research approach and utilised convenience sampling based on the researcher’s professional network. Eight pharmacists from two secondary care NHS Trusts participated. Individual semi-structured interviews were conducted using questions adapted from the Research Capacity and Culture (RCC) tool which was validated by two clinical trial pharmacists. Keele University Research Ethics Committee provided a favourable ethical opinion. Interview transcripts were analysed to identify emerging themes by using framework analysis. The findings revealed that participants possessed limited knowledge of clinical research in general. The key themes identified were categorised into three domains: individual, professional, and organisational, which corresponded with the RCC tool. In the individual domain, pharmacists demonstrated interest in clinical research delivery but lacked confidence. They acknowledged clinical research as contributing to evidence-based practice and enhancing professional development. However, they expressed concerns about patient harm resulting from trial interventions and poorly designed studies generating misleading data. Within the professional domain, pharmacists' capability to support clinical research delivery was limited by inadequate training in clinical research, their clinical skills, and their disease knowledge. They perceived internal and external barriers to participation. It has been suggested to improve the research culture within the profession and promote the role pharmacists can play in delivering research among other healthcare professionals. In the organisational domain, the workplace environment was perceived to present obstacles due to competing priorities and clinical research not being seen to be a core duty by managers. Additionally, awareness of clinical research opportunities was limited and exposure to clinical research-related activ","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":"50 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139198032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1093/ijpp/riad074.034
D. Kamdar, Y. El Kout Oustah, M. Elbashir
The United Kingdom (UK) has one of the lowest breastfeeding rates in Europe, with the last Infant Feeding Survey showing a reduction from 81% of mothers initiating breastfeeding to 0.5% still breastfeeding at 12 months.1 It provides multiple health benefits for mothers and infants, and promoting breastfeeding is an important public health strategy, impacting the future health of the population. Community pharmacists are accessible and trusted healthcare professionals, giving expert advice on medication use and public health. Previous research has found a lack of knowledge and training on medicines use during lactation and breastfeeding-related conditions, often leading to unnecessary cessation of breastfeeding.2 To explore breastfeeding knowledge, attitudes, and training amongst community pharmacists. Following ethical approval from Kingston University and a pilot study, a paper questionnaire comprising 24 mixed-style questions was distributed to community pharmacists in the London boroughs of Ealing and Brent. The Raosoft online calculator was used to calculate the sample size of 110 pharmacists at 95% confidence interval. Semi-structured interviews were conducted using a validated interview guide. Analyses were performed using SPSS software alongside thematic analysis for interview responses. Response rate was 75% (n=82/110) and 9 pharmacists participated in the interviews. 47.6% (n=39/82) pharmacists rated their current breastfeeding knowledge as neither poor nor good or lower. Only 11% (n=9/82) pharmacists stated the duration of breastfeeding should be greater than 2 years. 27.2% (n=12/44) pharmacists felt slightly or not confident providing over-the-counter medicines to breastfeeding patients compared to 61.4% (n=27/44) when making recommendations for breastfeeding-related conditions such as mastitis or nipple thrush. Thematic analysis highlighted the need for further research into medication use safety during lactation as pharmacists lacked confidence to make recommendations based on Summary of Product Characteristics (SPC). 50% (n=41/82) pharmacists stated their knowledge was obtained from personal experience. 100% (n=82/82) of participants agreed that more education and training must be provided, and thematic analysis showed pharmacists would prefer a spiralled approach starting at university level, through foundation year training and post-registration. The majority of pharmacists showed somewhat or high confidence advising patients about over-the-counter medication safety during lactation, but this was reversed when confronted with breastfeeding-related conditions, in contrast to findings from Byerley2 where the majority of pharmacists were not confident about medicines advice. Pharmacists have a positive attitude towards breastfeeding with all desiring further training. Changes to pharmacy education and training are needed to develop pharmacists’ understanding on breastfeeding generally and medicines safety
{"title":"Breast is best? A small-scale study exploring knowledge, attitudes, and training amongst community pharmacists about breastfeeding","authors":"D. Kamdar, Y. El Kout Oustah, M. Elbashir","doi":"10.1093/ijpp/riad074.034","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.034","url":null,"abstract":"The United Kingdom (UK) has one of the lowest breastfeeding rates in Europe, with the last Infant Feeding Survey showing a reduction from 81% of mothers initiating breastfeeding to 0.5% still breastfeeding at 12 months.1 It provides multiple health benefits for mothers and infants, and promoting breastfeeding is an important public health strategy, impacting the future health of the population. Community pharmacists are accessible and trusted healthcare professionals, giving expert advice on medication use and public health. Previous research has found a lack of knowledge and training on medicines use during lactation and breastfeeding-related conditions, often leading to unnecessary cessation of breastfeeding.2 To explore breastfeeding knowledge, attitudes, and training amongst community pharmacists. Following ethical approval from Kingston University and a pilot study, a paper questionnaire comprising 24 mixed-style questions was distributed to community pharmacists in the London boroughs of Ealing and Brent. The Raosoft online calculator was used to calculate the sample size of 110 pharmacists at 95% confidence interval. Semi-structured interviews were conducted using a validated interview guide. Analyses were performed using SPSS software alongside thematic analysis for interview responses. Response rate was 75% (n=82/110) and 9 pharmacists participated in the interviews. 47.6% (n=39/82) pharmacists rated their current breastfeeding knowledge as neither poor nor good or lower. Only 11% (n=9/82) pharmacists stated the duration of breastfeeding should be greater than 2 years. 27.2% (n=12/44) pharmacists felt slightly or not confident providing over-the-counter medicines to breastfeeding patients compared to 61.4% (n=27/44) when making recommendations for breastfeeding-related conditions such as mastitis or nipple thrush. Thematic analysis highlighted the need for further research into medication use safety during lactation as pharmacists lacked confidence to make recommendations based on Summary of Product Characteristics (SPC). 50% (n=41/82) pharmacists stated their knowledge was obtained from personal experience. 100% (n=82/82) of participants agreed that more education and training must be provided, and thematic analysis showed pharmacists would prefer a spiralled approach starting at university level, through foundation year training and post-registration. The majority of pharmacists showed somewhat or high confidence advising patients about over-the-counter medication safety during lactation, but this was reversed when confronted with breastfeeding-related conditions, in contrast to findings from Byerley2 where the majority of pharmacists were not confident about medicines advice. Pharmacists have a positive attitude towards breastfeeding with all desiring further training. Changes to pharmacy education and training are needed to develop pharmacists’ understanding on breastfeeding generally and medicines safety","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":"72 2 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139199425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1093/ijpp/riad074.070
S. Wilson, C. Tolley, R. Mc Ardle, E. Beswick, S. Slight
There has been substantial growth in research exploring use of digital health technologies (DHT) to improve global population health. Harnessing the potential of DHT for the early detection of neurodegenerative diseases is one such area.1 According to the National Institute for Health and Care Excellence, DHTs need to be credible for UK Healthcare Professionals (HCPs); HCPs should be involved in the development and implementation process of DHTs to ensure that their needs are met and to promote the successful adoption into healthcare systems.2 To explore HCPs’ perspectives on key considerations of developing and implementing DHT for the early detection of dementia causing diseases, such as Alzheimer’s, within the National Health Service (NHS). Ethical approval was granted from Newcastle University Ethics Committee. HCPs with patient-facing roles within primary or secondary care NHS settings were recruited through various online networks alongside a snowball sampling approach. Participants took part in a semi-structured audio-recorded interview exploring their experience of current diagnostic practices, opinions on the early detection of dementia causing diseases and the use of DHT to aid this approach, and the challenges of implementing such interventions into healthcare. The framework approach was used to thematically analyse the verbatim transcripts to identify core concepts and themes emerging within the interviews. A list of core concepts and themes was applied systematically to the whole data set using QSR N-Vivo (Version 1.6.1). The research team then used the ‘constant comparison’ technique to move backwards and forwards between these data and evolve explanations until a fit was made. Eighteen interviews were conducted with 11 primary and seven secondary care HCPs. Our analysis highlighted three core concepts, centring around considerations for healthcare service users, HCPs, and the DHT when developing and implementing DHT for the early detection of dementia causing diseases. HCPs recognised the potential benefits of providing an early detection of dementia causing diseases to healthcare services users, but only if a suitable intervention was available to allow individuals to potentially reduce their risk. Additionally, HCPs were concerned about the impact on health inequity, such as accessibility of this type of service to individuals who have disabilities or could be possibly digitally excluded. Many HCPs were also concerned about the impact on the healthcare system, with fears that it could overburden the NHS if sufficient resources and support were not provided for its implementation. In regard to the DHT, HCPs were positive about the possibility of a DHT to remotely capture real time data and felt it would be important to capture different modalities to help differentiate between dementia causing diseases. This study highlights the need to design a DHT for the early detection of dementia causing diseases t
利用数字健康技术（DHT）改善全球人口健康的研究有了长足的发展。1 根据英国国家健康与护理卓越研究所（National Institute for Health and Care Excellence）的研究，数字健康技术需要对英国医疗保健专业人员（HCPs）具有可信度；医疗保健专业人员应参与数字健康技术的开发和实施过程，以确保其需求得到满足，并促进其在医疗保健系统中的成功应用2。 纽卡斯尔大学伦理委员会颁发了伦理批准书。我们通过各种在线网络和滚雪球式抽样方法，招募了在初级或二级医疗保健系统（NHS）中担任面向患者角色的保健人员。参与者参加了半结构化录音访谈，探讨了他们对当前诊断方法的经验、对早期发现痴呆性疾病的看法、使用 DHT 来帮助这种方法的方法，以及在医疗保健中实施此类干预措施所面临的挑战。我们采用框架法对逐字记录稿进行了专题分析，以确定访谈中出现的核心概念和主题。使用 QSR N-Vivo（1.6.1 版）对整个数据集系统地应用了核心概念和主题列表。然后，研究小组使用 "不断比较 "技术，在这些数据之间进行前后移动，并不断演化解释，直到达成一致。 我们对 11 名初级保健和 7 名二级保健的保健医生进行了 18 次访谈。我们的分析强调了三个核心概念，分别围绕医疗服务用户、高级保健人员和痴呆症筛查系统在开发和实施痴呆症筛查系统以早期检测痴呆症疾病时的注意事项。医疗保健人员认识到，为医疗保健服务使用者提供致痴呆疾病的早期检测具有潜在的益处，但前提是必须提供适当的干预措施，使个人有可能降低风险。此外，保健医生还担心对健康不平等的影响，例如残疾人士或可能被数字技术排斥的人士能否获得此类服务。许多保健医生还担心对医疗系统的影响，担心如果不为其实施提供足够的资源和支持，可能会使国民保健服务体系不堪重负。关于 DHT，高级保健人员对 DHT 远程采集实时数据的可能性持肯定态度，并认为采集不同模式的数据非常重要，有助于区分导致痴呆的疾病。 这项研究强调，有必要设计一种用户可以使用的用于早期检测痴呆症的 DHT，以促进健康公平。本研究还强调了研究人员在国家医疗服务系统中实施 DHT 时可能遇到的障碍，但不能假设这些障碍是可能遇到的唯一障碍；开发人员需要考虑这一点，以便未来的 DHT 能够满足 HCP 的需求。 1.Frey AL, Karran M, Jimenez RC, Baxter J, Adeogun M, Bose N, Chan D, Crawford J, Dagum P, Everson R, Hinds C. Harnessing the Potential of Digital Technologies for the Early Detection of Neurodegenerative Diseases (EDoN). 2.国家卫生保健卓越研究所（NICE）。(2018, December 10).数字医疗技术证据标准框架（ECD7）. https://www.nice.org.uk/corporate/ecd7/resources/evidence-standards-framework-for-digital-health-technologies-pdf-1124017457605
{"title":"Key considerations when developing and implementing digital technology for early detection of dementia causing diseases: a qualitative study","authors":"S. Wilson, C. Tolley, R. Mc Ardle, E. Beswick, S. Slight","doi":"10.1093/ijpp/riad074.070","DOIUrl":"https://doi.org/10.1093/ijpp/riad074.070","url":null,"abstract":"There has been substantial growth in research exploring use of digital health technologies (DHT) to improve global population health. Harnessing the potential of DHT for the early detection of neurodegenerative diseases is one such area.1 According to the National Institute for Health and Care Excellence, DHTs need to be credible for UK Healthcare Professionals (HCPs); HCPs should be involved in the development and implementation process of DHTs to ensure that their needs are met and to promote the successful adoption into healthcare systems.2 To explore HCPs’ perspectives on key considerations of developing and implementing DHT for the early detection of dementia causing diseases, such as Alzheimer’s, within the National Health Service (NHS). Ethical approval was granted from Newcastle University Ethics Committee. HCPs with patient-facing roles within primary or secondary care NHS settings were recruited through various online networks alongside a snowball sampling approach. Participants took part in a semi-structured audio-recorded interview exploring their experience of current diagnostic practices, opinions on the early detection of dementia causing diseases and the use of DHT to aid this approach, and the challenges of implementing such interventions into healthcare. The framework approach was used to thematically analyse the verbatim transcripts to identify core concepts and themes emerging within the interviews. A list of core concepts and themes was applied systematically to the whole data set using QSR N-Vivo (Version 1.6.1). The research team then used the ‘constant comparison’ technique to move backwards and forwards between these data and evolve explanations until a fit was made. Eighteen interviews were conducted with 11 primary and seven secondary care HCPs. Our analysis highlighted three core concepts, centring around considerations for healthcare service users, HCPs, and the DHT when developing and implementing DHT for the early detection of dementia causing diseases. HCPs recognised the potential benefits of providing an early detection of dementia causing diseases to healthcare services users, but only if a suitable intervention was available to allow individuals to potentially reduce their risk. Additionally, HCPs were concerned about the impact on health inequity, such as accessibility of this type of service to individuals who have disabilities or could be possibly digitally excluded. Many HCPs were also concerned about the impact on the healthcare system, with fears that it could overburden the NHS if sufficient resources and support were not provided for its implementation. In regard to the DHT, HCPs were positive about the possibility of a DHT to remotely capture real time data and felt it would be important to capture different modalities to help differentiate between dementia causing diseases. This study highlights the need to design a DHT for the early detection of dementia causing diseases t","PeriodicalId":14284,"journal":{"name":"International Journal of Pharmacy Practice","volume":"24 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139199909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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