A patient perspective of pharmacist prescribing: 'crossing the specialisms-crossing the illnesses'

Background: The drive for non-medical prescribing has progressed quickly since the late 1990s and involves a range of healthcare professionals including pharmacists. As part of a commissioned research project, this qualitative element of a larger case study focused on the views of patients of pharmacist prescribers. 

Objective: The aim of this study was to explore patients' perspectives of pharmacists as prescribers. 

Methods: Three pharmacists working as independent prescribers in the clinical areas of (i) hypertension, (ii) cardiovascular/diabetes management, (iii) anticoagulation were recruited to three case studies of pharmacist prescribing in Northern Ireland. One hundred and five patients were invited to participate in focus groups after they had been prescribed for by the pharmacist. Focus groups took place between November 2010 and March 2011 (ethical/governance approvals granted) were audio taped, transcribed verbatim, read independently by two authors and analysed using constant comparative analysis. 

Results: Thirty-four patients agreed to participate across seven focus groups. Analysis revealed the emergence of one overarching theme: team approach to patient care. A number of subthemes related to the role of the pharmacist, the role of the doctor and patient benefits. There was an overwhelming lack of awareness of pharmacist prescribing. Patients discussed the importance of a multidisciplinary approach to their care and recognized limitations of the current model of prescribing. 

Conclusion: Patients were positive about pharmacist prescribing and felt that a team approach to their care was the ideal model especially when treating those with more complex conditions. Despite positive attitudes, there was a general lack of awareness of this new mode of practice.

Crossing the Threshold: Mysticism, Liminality, and Remedios Varo’s Bordando el manto terrestre (1961–2)

In this article we propose to take up the question of the painter’s work in connection with liminality more explicitly. We will argue that the limen Varo’s heroines cross is a psychological one that takes them through a process culminating in a rebirth of the self, and that to the extent they are in-between identities and involved in a process of initiation, they can be considered liminars (Turner). We will also argue that in order to develop this theme, which culminates in her most autobiographical work, the triptych Bordando el manto terrestre (1961–2), the artist needed to find a way conceptually to bridge surrealism and her interest in mysticism. She would have found a sympathetic approach in Jung, one of the founders of psychoanalysis, who turned explicitly to the question of religion in the troubled thirties, though, as we shall see, she revised his androcentric approach. We will suggest that Jung’s writing helped the artist make a transition from surrealism to esoteric spirituality.

Shooting for the Moon or Flying Too Near the Sun? Crossing the Value Rubicon in Precision Cancer Care

In his last two State of the Union addresses, President Barack Obama has focused on the need to deliver innovative solutions to improve human health, through the Precision Medicine Initiative in 2015 and the recently announced Cancer Moonshot in 2016. Precision cancer care has delivered clear patient benefit, but even for high-impact medicines such as imatinib mesylate (Glivec) in chronic myeloid leukaemia, the excitement at the success of this practice-changing clinical intervention has been somewhat tempered by the escalating price of this 'poster child' for precision cancer medicine (PCM). Recent studies on the costs of cancer drugs have revealed significant price differentials, which are a major causative factor behind disparities in the access to new generations of immunological and molecularly targeted agents. In this perspective, we will discuss the benefits of PCM to modern cancer control, but also emphasise how increasing costs are rendering the current approaches to integrating the paradigm of PCM unsustainable. Despite the ever increasing pressure on cancer and health care budgets, innovation will and must continue. Value-based frameworks offer one of the most rational approaches for policymakers committed to improving cancer outcomes through a public health approach.

Identification of Road Irregularities via Vehicle Accelerations

A periodic monitoring of the pavement condition facilitates a cost-effective distribution of the resources available for maintenance of the road infrastructure network. The task can be accurately carried out using profilometers, but such an approach is generally expensive. This paper presents a method to collect information on the road profile via accelerometers mounted in a fleet of non-specialist vehicles, such as police cars, that are in use for other purposes. It proposes an optimisation algorithm, based on Cross Entropy theory, to predict road irregularities. The Cross Entropy algorithm estimates the height of the road irregularities from vehicle accelerations at each point in time. To test the algorithm, the crossing of a half-car roll model is simulated over a range of road profiles to obtain accelerations of the vehicle sprung and unsprung masses. Then, the simulated vehicle accelerations are used as input in an iterative procedure that searches for the best solution to the inverse problem of finding road irregularities. In each iteration, a sample of road profiles is generated and an objective function defined as the sum of squares of differences between the ‘measured’ and predicted accelerations is minimized until convergence is reached. The reconstructed profile is classified according to ISO and IRI recommendations and compared to its original class. Results demonstrate that the approach is feasible and that a good estimate of the short-wavelength features of the road profile can be detected, despite the variability between the vehicles used to collect the data.

Gaze behavior of the visually impaired during street crossing.

PURPOSE:

This study explored the gaze patterns of fully sighted and visually impaired subjects during the high-risk activity of crossing the street.

METHODS:

Gaze behavior of 12 fully sighted subjects, nine with visual impairment resulting from age-related macular degeneration and 12 with impairment resulting from glaucoma, was monitored using a portable eye tracker as they crossed at two unfamiliar intersections.

RESULTS:

All subject groups fixated primarily on vehicles and crossing elements but changed their fixation behavior as they moved from "walking to the curb" to "standing at the curb" and to "crossing the street." A comparison of where subjects fixated in the 4-second time period before crossing showed that the fully sighted who waited for the light to change fixated on the light, whereas the fully sighted who crossed early fixated primarily on vehicles. Visually impaired subjects crossing early or waiting for the light fixate primarily on vehicles.

CONCLUSIONS:

Vision status affects fixation allocation while performing the high-risk activity of street crossing. Crossing decision-making strategy corresponds to fixation behavior only for the fully sighted subjects.