Validity and reliability of the kidney disease questionnaire in patients receiving continuous ambulatory peritoneal dialysis

□ No specific health‐elated quality of life (HRQL) measure exists for patients receiving continuous ambulatory peritoneal dialysis (CAPD) □ This study assessed evaluated the use of the kidney disease questionnaire (KDQ) which has been specifically designed for haemodialysis patients in those undergoing CAPD □ Confirmatory factor analysis was used to assess the validity and reliability of the KDQ which was administered by interview to 41 CAPD patients □ Many of the items in the five dimensions of the KDQ demonstrated high factor loadings, thus indicating good representation of the associated dimension; good reliability scores were also reported □ The KDQ may be a useful measure of HRQL in CAPD patients     

SIGN guidelines and the management of sore throat in community pharmacy

□ Scottish Intercollegiate Guidelines Network guidance on the management of sore throat recommends analgesia and refer to the role of the community pharmacist in advising symptomatic relief □ Advice given to 749 patients from 65 community pharmacies; 49 patients (6.5 per cent) were referred to their general practitioner □ Paracetamol, drug of choice from SIGN guideline, was recommended to 219 patients (29 per cent); a preparation for symptomatic relief either alone or in combination with an analgesic was advised for 590 patients (79 per cent) and of these, 315 patients (42 per cent) were recommended lozenges with anaesthetic and antibacterial action □ Compliance with SIGN guidelines was observed regarding choice of analgesic □ Evidence is required for choice of symptomatic relief.     

Gender and age influences on prescription and consultation frequency for multiple sclerosis patients

□ The study aimed to examine whether gender and age affects the burden of disease in secondary care in terms of number of prescribed drugs and number of consultations with the general practitioner (GP) for multiple sclerosis and control patients □ Anonymised data for 1996 was obtained for all patients (patient years at risk = 220,538) from 24 GP practices in the GP Morbidity Database who had a Read code of MS at some point from 1993 to 1996 and a randomly selected age, gender and surgery matched control group □ A total of 216 cases was identified, giving a prevalence of 97.9 per 105 (based on patient years at risk in the database for 1996; n=220,538). Sixty‐seven per cent (145/216) of cases were female. The mean age was 46.7 (range 17 to 84 years) □ Gender differences for the MS patients, but not controls were found. For example, although females in both the control and MS population had significantly more consultations than the corresponding males, only the control females had more items prescribed than control males (p=0.033) □ This study warrants further work to elucidate whether specific therapeutic areas or MS‐treated symptoms are influenced by gender     

Medianes management and the individual patient

□ For medicines management to fulfil its aim of partnership with patients, the individual patient's perspective needs to be examined □ Study uses discursive analysis of in depth interviews of hypertensive patients to highlight individual patients' experience of hypertension □ Findings suggest that patients may consider condition and care differently than health care professional □ Evaluation of medication may not be completely explained by the clinical paradigm of risk/benefit □ Concordance may be more difficult to achieve in the early stages of treatment.     

Patients' perspectives on medicines and pharmacy: views of patients with Type 2 diabetes

□ The study was conducted to inform the design of pharmaceutical care support to patients with Type 2 diabetes – a recognised health care priority and a target for new pharmacy initiatives □ Interviews in an outpatient clinic revealed an apparent lack of patient‐pharmacist communication and low patient expectations □ Some patients felt a lack of feedback about the results of clinic checks and what they meant for disease control □ Patient information leaflets were not consistently seen as meeting patients' needs for information and advice □ Patients' experiences can be used to develop the role of community pharmacy services within the health care team effort     

Compliance,concordance and the revolving door of care: caring for elderly people with mental health problems

□ The project involved community pharmacists receiving specialised training, becoming integrated into the community mental health teams and providing pharmaceutical care when making joint domiciliary visits with the key workers. □ Community pharmacists, psychiatrists and key workers all wanted the project to develop into a service and had similar views about the general benefits of the study. However, they had contrasting expectations of the project, based on their own perspectives on compliance, concordance and models of care □ The key workers valued the provision of monitored dosage systems for patients with confusion or memory problems. But the pharmacists felt that they were being expected to organise compliance aids; they recognised that it was their role to assess complaince and that other measures could be taken before organising an MDS □ The psychiatrists stated that involuntary non‐compliance with medication, arising from confusion, memory and physical problems, was a major issue and the project had made improvements in this area; they wanted to keep patients in the community and particularly valued reductions in morbidity, relapses and the “revolving door of care”     

Futile and inappropriate prescribing: an assessment of the issue in a series of patients admitted to a specialist palliative care unit

□ Palliative care patients are often subjected to polypharmacy, some of which is futile or inappropriate □ Rationalisation of medication does not occur due to patients being seen by several specialists and prescribers fearing the reaction of a patient whose drug rationalisation may remind the patient of his/her own mortality □ Patients raised no objections to having medication withdrawn after the reasons why had been carefully communicated to them □ Health care professionals need to do regular medication review as part of their role to achieve favourable outcomes for patients     

Perceptions of CPD within the pharmacy profession

□ A questionnaire was used to determine current perceptions of continuing professional development within the pharmacy profession in Northern Ireland □ Although the majority of respondents understood the concept, few pharmacists currently practise this method of professional development □ Almost 90 per cent of responding pharmacists agreed/strongly agreed that it was essential for all practising pharmacists to participate in continuing professional development □ Lack of time, remuneration and locum cover, location and type of courses provided, and lack of understanding about continuing professional development were all identified as barriers to participation     

A novel approach for teaching aseptic processing to pharmacy undergraduates

□ Aseptic processing is a fundamental skill required of pharmacy graduates □ Traditional one‐to‐one teaching is not possible with the expanding numbers of undergraduates □ An original computer‐aided learning package was written to aid teaching aseptic processing to pharmacy undergraduates □ The students valued the CAL package as an aid in preparation for practical exercises, but would have preferred more feedback on the questions asked □ Funds have been secured to enable improvements in the CAL package, allowing assessment of questions and better interactivity.     

Pharmaceutical information exchange between primary and secondary health care professionals and cancer patients

□ No single professional takes overall responsibility for the pharmaceutical aspects of cancer patient care □ Information given to cancer patients by health care professionals (HCPs) varies depending on the priority of the professional □ Cancer patients primarily approach primary care HCPs for help and advice for their medication □ Training and support must be available to enable HCPs to address individual cancer patients' information needs.     

Compliance and adherence as pragmatic concepts: a study of TB in rural Pakistan

□ Urine tests highlight fewer non‐compliant tuberculosis (TB) patients than do tablet counts □ Face‐to‐face interview techniques are of limited use for the purposes of investigating adherence and compliance issues □ Clinic attendance would need to have been measured for a much greater time duration to reflect compliance □ DOTS (directly observed treatment – short course) and combination formulations seem to improve compliance □ Patients who default or die while being treated have better attendance rates than those discharged (cured, resistant or sick)     

Laxative prescribing during pregnancy in primary care

□ Hormonal changes, mechanical pressure and concurrent medication all contribute to altered bowel habit during pregnancy □ It has been suggested that pregnant women are more likely to receive laxatives than the baseline population □ A retrospective case control study using a primary care prescribing database was undertaken to compare laxative prescribing before and during pregnancy with that in matched controls □ Prescribing rate of laxatives increased during pregnancy compared with before becoming pregnant but this was not different to controls □ Pregnant women were more likely to receive a laxative if they were using antibacterials, preparations for haemorrhoids or drugs for nausea and vertigo.     

Variation in the management of PONV and pain in day case surgery: implications for evidence based practice

□ This study aimed to provide information on the variation in perioperative anaesthetic care for principal types of day case adult and paediatric procedures including the use of intraoperative analgesia and the treatment of post‐operative nausea and vomiting □ A structured postal survey comprising closed questions was sent to consultant anaesthetists involved in anaesthetising patients for day case surgery in United Kingdom National Health Service trusts □ This survey found wide variation in the selection of intraoperative analgesics and treatment anti‐emetics for the potential management of patients having three common day surgery procedures □ It is likely that the wide variation in practice seen in this, and previous studies, is due to uncertainty about effectiveness □ The lack of consensus about the preferred choice of analgesia and anti‐emetics provides a challenge to pharmacists and clinicians in the development of evidence based guidelines.     

Identification of the need for pharmaceutical care within the prevention strategy of CHD: a study in acute MI patients

□ Aspirin use in primary prevention candidates overall was only 11% □ Of those patients with a CHD risk of 30% or more and a total cholesterol of mmol/L or more, only 10% were receiving a statin □ Statin use in secondary prevention was only 47% of candidates □ The use of aspirin, ß-blockers and angiotensin converting enzyme inhibitors in secondary prevention was 65, 44 and 36%, respectively □ The gaps in provision of CHD prevention are highlighted when seen among those destined to suffer AMI; they call for pharmacists to be part of local initiatives to improve standards of CHD prevention     

Cost implications of the use of troponin I (cTnI) measurement to diagnose heart conditions

□ The measurement of cTnI provides a sensitive test for the diagnosis of myocardial infarction and also improves risk stratification in patients with unstable angina □ The use of cTnI analyses was introduced in the study site hospital on 1 January 1999 to help diagnose heart conditions □ The use of cTnI decreased the total cost of hospitalisation in the low risk acute coronary insufficiency (ACI) diagnostic subgroup     

From compliance to concordance: meeting the needs of patients?

□ Compliance has come under increasing criticism as a means by which to organise health care interactions and interest has been expressed in a new model termed concordance □ This research set out to explore the relevance of compliance and concordance to a group of Pakistani people with Type 2 diabetes and the health professionals involved in their care □ Both patients and health professionals remained wedded, to some degree, to traditional notions of compliance with health care instructions □ However, some patients expressed a desire for greater understanding of the practical problems of living with Type 2 diabetes and integrating the regimen into their lives □ On the basis of these findings, it may be more appropriate to link concordance to an approach which seeks to sensitively elicit patients narratives as a basis for shared understanding.     

Working alongside nursing staff to review medication in nursing homes

□ Pharmacists performed medication reviews in nursing homes using the nursing staff as a source of information □ Lack of access to medical records did hamper the review but was not the main reason for non‐implementation □ The recommendations were more likely to be implemented if further clinical information was supplied to the general practitioner □ All of the pharmacists, all of the nursing staff responding and a majority of the GPs who responded wished to see the project continue □ Future training of community pharmacists should focus on “how to review”.     

Patient self‐eports of potential adverse drug reactions

□ A systematic questionnaire was found to be a feasible method of facilitating patients to report symptoms they perceived to be potential adverse effects of drugs □ Although 89 per cent of patients who had taken tramadol and venlafaxine reported at least one symptom in questionnaires, only 58 per cent of these claimed to have reported their symptoms to their doctor □ Only 22 per cent of symptoms reported by a sample of patients were found to be recorded in medical records and only 23 yellow card reports were submitted to the CSM for the same period □ Low reporting rates to GPs and low recording rates would appear to be contributory factors to low rates of reporting to the CSM.