What is the new medicines use review ‘patient survey’ attempting to capture in the context of existing patient satisfaction with pharmacy questionnaires and a new conceptual framework?

The community pharmacy service medicines use review (MUR) was introduced in 2005 ‘to improve patient knowledge, concordance and use of medicines’ through a private patient–pharmacist consultation. The MUR presents a fundamental change in community pharmacy service provision. While traditionally pharmacists are dispensers of medicines and providers of medicines advice, and patients as recipients, the MUR considers pharmacists providing consultation-type activities and patients as active participants. The MUR facilitates a two-way discussion about medicines use. Traditional patient–pharmacist behaviours transform into a new set of behaviours involving the booking of appointments, consultation processes and form completion, and the physical environment of the patient–pharmacist interaction moves from the traditional setting of the dispensary and medicines counter to a private consultation room. Thus, the new service challenges traditional identities and behaviours of the patient and the pharmacist as well as the environment in which the interaction takes place. In 2008, the UK government concluded there is at present too much emphasis on the quantity of MURs rather than on their quality.[1] A number of plans to remedy the perceived imbalance included a suggestion to reward ‘health outcomes’ achieved, with calls for a more focussed and scientific approach to the evaluation of pharmacy services using outcomes research. Specifically, the UK government set out the main principal research areas for the evaluation of pharmacy services to include ‘patient and public perceptions and satisfaction’as well as ‘impact on care and outcomes’. A limited number of ‘patient satisfaction with pharmacy services’ type questionnaires are available, of varying quality, measuring dimensions relating to pharmacists’ technical competence, behavioural impressions and general satisfaction. For example, an often cited paper by Larson[2] uses two factors to measure satisfaction, namely ‘friendly explanation’ and ‘managing therapy’; the factors are highly interrelated and the questions somewhat awkwardly phrased, but more importantly, we believe the questionnaire excludes some specific domains unique to the MUR. By conducting patient interviews with recent MUR recipients, we have been working to identify relevant concepts and develop a conceptual framework to inform item development for a Patient Reported Outcome Measure questionnaire bespoke to the MUR. We note with interest the recent launch of a multidisciplinary audit template by the Royal Pharmaceutical Society of Great Britain (RPSGB) in an attempt to review the effectiveness of MURs and improve their quality.[3] This template includes an MUR ‘patient survey’. We will discuss this ‘patient survey’ in light of our work and existing patient satisfaction with pharmacy questionnaires, outlining a new conceptual framework as a basis for measuring patient satisfaction with the MUR. Ethical approval for the study was obtained from the NHS Surrey Research Ethics Committee on 2 June 2008. References 1. Department of Health (2008). Pharmacy in England: Building on Strengths – Delivering the Future. London: HMSO. www. official-documents.gov.uk/document/cm73/7341/7341.pdf (accessed 29 September 2009). 2. Larson LN et al. Patient satisfaction with pharmaceutical care: update of a validated instrument. JAmPharmAssoc 2002; 42: 44–50. 3. Royal Pharmaceutical Society of Great Britain (2009). Pharmacy Medicines Use Review – Patient Audit. London: RPSGB. http:// qi4pd.org.uk/index.php/Medicines-Use-Review-Patient-Audit. html (accessed 29 September 2009).

Understanding construction consortia: Theory, practice and opinions

Firms form consortia in order to win contracts. Once a project has been awarded to a consortium each member then concentrates on his or her own contract with the client. Therefore, consortia are marketing devices, which present the impression of teamworking, but the production process is just as fragmented as under conventional procurement methods. In this way, the consortium forms a barrier between the client and the actual construction production process. Firms form consortia, not as a simple development of normal ways of working, but because the circumstances for specific projects make it a necessary vehicle. These circumstances include projects that are too large or too complex to undertake alone or projects that require on-going services which cannot be provided by the individual firms inhouse. It is not a preferred way of working, because participants carry extra risk in the form of liability for the actions of their partners in the consortium. The behaviour of members of consortia is determined by their relative power, based on several factors, including financial commitment and ease of replacement. The level of supply chain visibility to the public sector client and to the industry is reduced by the existence of a consortium because the consortium forms an additional obstacle between the client and the firms undertaking the actual construction work. Supply chain visibility matters to the client who otherwise loses control over the process of construction or service provision, while remaining accountable for cost overruns. To overcome this separation there is a convincing argument in favour of adopting the approach put forward in the Project Partnering Contract 2000 (PPC2000) Agreement. Members of consortia do not necessarily go on to work in the same consortia again because members need to respond flexibly to opportunities as and when they arise. Decision-making processes within consortia tend to be on an ad hoc basis. Construction risk is taken by the contractor and the construction supply chain but the reputational risk is carried by all the firms associated with a consortium. There is a wide variation in the manner that consortia are formed, determined by the individual circumstances of each project; its requirements, size and complexity, and the attitude of individual project leaders. However, there are a number of close working relationships based on generic models of consortia-like arrangements for the purpose of building production, such as the Housing Corporation Guidance Notes and the PPC2000.

Comparing nurses’ and doctors’ views of nurse prescribing: a questionnaire survey

Nurses have successfully adopted the role of prescriber in numerous health care settings in the UK. Existing research has not addressed how Nurse Independent and Nurse Supplementary Prescribers compare with doctors in terms of the perceived advantages and disadvantages of nurse prescribing, nor has the perceived importance of nurses providing patients with an explanation about their medicines been established. The current study utilized a random sample of 31 qualified Nurse Independent and Nurse Supplementary Prescribers and 30 general practitioners who self-completed a written questionnaire in an independent groups design. The study establishes nurses’ and doctors’ perceptions of the advantages and disadvantages of independent and supplementary nurse prescribing and provides some indication of the importance that nurses and doctors place on nurses providing an explanation about medicines, and the categories of information perceived to be important.

Milk and meat in our diet: good or bad for health?

Foods derived from animals are an important source of nutrients in the diet but there is considerable uncertainty about whether or not these foods contribute to increased risk of various chronic diseases. For milk in particular there appears to be an enormous mismatch between both the advice given on milk/dairy foods items by various authorities and public perceptions of harm from the consumption of milk and dairy products, and the evidence from long-term prospective cohort studies. Such studies provide convincing evidence that increased consumption of milk can lead to reductions in the risk of vascular disease and possibly some cancers and of an overall survival advantage from the consumption of milk, although the relative effect of milk products is unclear. Accordingly, simply reducing milk consumption in order to reduce saturated fatty acid (SFA) intake is not likely to produce benefits overall though the production of dairy products with reduced SFA contents is likely to be helpful. For red meat there is no evidence of increased risk of vascular diseases though processed meat appears to increase the risk substantially. There is still conflicting and inconsistent evidence on the relationship between consumption of red meat and the development of colorectal cancer, but this topic should not be ignored. Likewise, the role of poultry meat and its products as sources of dietary fat and fatty acids is not fully clear. There is concern about the likely increase in the prevalence of dementia but there are few data on the possible benefits or risks from milk and meat consumption. The future role of animal nutrition in creating foods closer to the optimum composition for long-term human health will be increasingly important. Overall, the case for increased milk consumption seems convincing, although the case for high-fat dairy products and red meat is not. Processed meat products do seem to have negative effects on long-term health and although more research is required, these effects do need to be put into the context of other risk factors to long-term health such as obesity, smoking and alcohol consumption.

Teaching assistants and pupils' academic and social engagement in mainstream schools: insights from systematic literature reviews

The last 20 years have seen a huge expansion in the additional adults working in classrooms in the UK, USA, and other countries. This paper presents the findings of a series of systematic literature reviews about teaching assistants. The first two reviews focused on stakeholder perceptions of teaching assistant contributions to academic and social engagement. Stakeholders were pupils, teachers, TAs, headteachers and parents. Perceptions focused on four principal contributions that teaching assistants contribute to: pupils’ academic and socio-academic engagement; inclusion; maintenance of stakeholder relations; and support for the teacher. The third review explored training. Against a background of patchy training provision both in the UK and the USA, strong claims are made for the benefits to TAs of training provided, particularly in building confidence and skills. The conclusions include implications for further training and the need for further research to gain an in-depth understanding as to precisely the manner in which TAs engage with children.

Conceptualizing change in the Portuguese footwear industry: regional voices and cognitive spaces of agency

Expanding national services sectors and global competition aggravate current and perceived future market pressures on traditional manufacturing industries. These perceptions of change have provoked a growing intensification of geo-political discourses on technological innovation and ‘learning’, and calls for competency in design among other professional skills. However, these political discourses on innovation and learning have paralleled public concerns with the apparent ‘growth pains’ from factory closures and subsequent increases in unemployment, and its debilitating social and economic implications for local and regional development. In this respect the following investigation sets out to conceptualize change through the complementary and differing perceptions of industry and regional actors’ experiences or narratives, linking these perceptions to their structure-determined spheres of agent-environment interactivity. It aims to determine whether agents’ differing perceptions of industry transformation can have a role in the legitimization of their interests in, and in sustaining their organizational influence over the process of industry-regional transformation. It argues that industry and regional agent perceptions are among the cognitive aspects of agent-environment interactivity that permeate agency. It stresses agents’ ability to reason and manipulate their work environments to preserve their self-regulating interests in, and task representative influence over the multi-jurisdictional space of industry-regional transformation. The contributions of this investigation suggest that agents’ varied perceptions of industry and regional change inform or compete for influence over the redirection of regional, industry and business strategies. This claim offers a greater appreciation for the reflexive and complex institutional dimensions of industry planning and development, and the political responsibility to socially just forms of regional development. It positions the outcomes of this investigation at the nexus of intensifying geo-political discourses on the efficiency and equity of territorial development in Europe.

Sudden onset stuttering in an adult: Neurogenic and psychogenic perspectives

A healthy 33 year old man with no previous history of speech language problems was referred to speech language therapy services following an episode which left him with a pronounced stutter, and which worsened over the next ten days. A range of neurological and psychological assessments failed to find any abnormality, as did MRI testing, and a diagnosis of psychogenic stuttering was made. This client was seen for three sessions of fluency therapy without significant improvement, after which he ceased attending. This paper considers the relationship between psychogenic and neurogenic stuttering generally, then more specifically in regard to this client, and the treatment he received. The paper concludes by considering problems in differentially diagnosing neurogenic from psychogenic stuttering.

The status of literature: English teaching and the condition of literature teaching in schools

Although the curriculum subject of English is continually reviewed and revised in all English speaking countries, the status of literature is rarely questioned i.e. that it is of high cultural value and all students should be taught about it. The concerns of any review, in any country, are typically about what counts as literature, especially in terms of national heritage and then how much of the curriculum should it occupy. This article reports on three inter-related pieces of research that examine the views of in-service, and pre-service, English teachers about their experiences of teaching literature and their perceptions of its ‘status’ and significance at official level and in the actual classroom; it draws attention to how England compares to some other English speaking countries and draws attention to the need to learn from the negative outcomes of political policy in England. The findings suggest that the nature of engagement with literature for teachers and their students has been distorted by official rhetorics and assessment regimes and that English teachers are deeply concerned to reverse this pattern.

Towards effective water reuse: drivers, challenges and strategies shaping the organisational management of reclaimed water in Jordan

Treated wastewater or reclaimed water is gaining recognition as a valuable water resource around the world. To assess why, where and how water reuse takes place in Jordan, semi-structured interviews were conducted with representatives of 29 key organisations in 2008. The analysis reveals that water scarcity is a key driver for water reuse. However, despite such recognition, reuse was described positively by only a small proportion of the interviewees (n = 6). Negative and neutral perceptions regarding reuse dominated and the research found that this was related to two underlying challenges: (i) the requirement for more intensive management when using reclaimed water compared with freshwater and (ii) concern over societal acceptance of water reuse. These factors were found to be associated with the risks posed to humans and their environments, combined with negative emotional and cultural responses to human waste and its applications. Numerous strategies are identified that are employed by organisations to overcome these challenges. Wastewater treatment, regulation, monitoring, the mixing of treated effluent with freshwater and limited public discussion of water reuse are all employed to achieve maximum use of reclaimed water. Each strategy presents benefits of sort, but some may paradoxically also inhibit optimal use of reclaimed water. Careful modifications to the existing strategies of Jordanian agencies, such as more open discussion of reuse, could lead to greater social, economic and environmental gains.

On climate change and cultural geography: farming on the Lizard Peninsula, Cornwall, UK

Climate change as a global problem has moved relatively swiftly into high profile political debates over the last 20 years or so, with a concomitant diffusion from the natural sciences into the social sciences. The study of the human dimensions of climate change has been growing in momentum through research which attempts to describe, evaluate, quantify and model perceptions of climate change, understand more about risk and assess the construction of policy. Cultural geographers’ concerns with the construction of knowledge, the workings of social relations in space and the politics and poetics of place-based identities provide a lens through which personal, collective and institutional responses to climate change can be evaluated using critical and interpretative methodologies. Adopting a cultural geography approach, this paper examines how climate change as a particular environmental discourse is constructed through memory, observation and conversation, as well as materialised in farming practices on the Lizard Peninsula, Cornwall, UK

An exploration of the role duality experienced by HR professionals as both implementers and recipients of HR practices: evidence from the Indian railways

This study provides an innovative perspective on empirically assessing HR by focusing on the duality of HR professionals’ experiences as both implementers and recipients or internal customers of HR practices given that they are also employees of the organization. We hypothesize that HR professionals experience HR practices more favorably from an implementer perspective as compared to an internal customer perspective. These differences in experiences are likely to be influenced by HR professionals’ hierarchical position in the HR department. Our analyses of 1,271 HR professionals employed by Indian Railways revealed a number of differences between the two types of experience. Some practices (recruitment and selection, training, and employee welfare) were viewed more negatively from the implementer perspective, whereas others (compensation, benefits, and employment relations) were rated more negatively from the internal customer perspective. Those holding more senior HR positions reported more positive experiences of training and employment relations from an internal customer perspective. Overall our contributions draw on the attribution theory and concepts of intraorganizational power and voice, and have implications concerning the effectiveness of HR practices. © 2015 Wiley Periodicals, Inc.

Unpicking antecedents of CRM adoption: a two-stage model

Most CRM work focuses on consumer applications. This paper addresses the operational adoption issues facing the organisation deploying CRM practices. There are a plethora of challenges facing organisations when adopting CRM. Previous research is limited to either examining the CRM adoption process at an individual/employees level or an organisational level. Hence, in this paper the myriad of organisational, marketing and technical antecedents that seem to impinge upon employee perceptions and organisational implementation of CRM are structured in a two-stage model. Using a stratified sample of ten organisations across four sectors, seven hypotheses are tested on data collected from 301 practitioners. A two-stage model is analysed using structural equation modelling. Findings reveal that CRM implementation relates to employee perceptions of CRM. This paper deepens our understanding of organisational practices to adopt CRM, so as an organisation properly profits from the expected benefits of CRM.

A Conceptual Model for Group Support Systems in Local Councils

This paper proposes a conceptual model of a context-aware group support system (GSS) to assist local council employees to perform collaborative tasks in conjunction with inter- and intra-organisational stakeholders. Most discussions about e-government focus on the use of ICT to improve the relationship between government and citizen, not on the relationship between government and employees. This paper seeks to expose the unique culture of UK local councils and to show how a GSS could support local government employer and employee needs.

Partnering in flight: From being to becoming

Current literature offers little understanding about how procurement methods are enacted in practice. Developments in procurement are often viewed as the result of responding to recommendations from particular constituents within the sector. The research seeks to remove itself from such deterministic leaning, counselling instead that procurement should not be viewed in static terms, but dynamically manifesting over time within a complex web of interconnections between various actors, their situated context and the broader industrial structure. Attention is given to how a client and construction firm engaged in a collusive interaction to realise an innovative procurement method that derived its legitimacy from a backcloth of initiatives promoted by various commentators. A case study of a medium-size regional contractor demonstrates how the first partnering arrangement was enacted within the UK affordable housing maintenance sector in the UK. The case study finds that the enactment of new procurement methods strongly relies on iterative learning between clients and contractors. It is further suggested that construction firms need to initiate new procurement in order to remain competitive within the sector. The findings point towards a pro-active initiative by the contractor and client to enact a ‘procurement first’. Encouragement may be drawn from this example by other contractors seeking to offer more than simply responsive procurement solutions.

A conceptual model for group support systems in local councils

This paper proposes a conceptual model of a context-aware group support system (GSS) to assist local council employees to perform collaborative tasks in conjunction with inter- and intra-organisational stakeholders. Most discussions about e-government focus on the use of ICT to improve the relationship between government and citizen, not on the relationship between government and employees. This paper seeks to expose the unique culture of UK local councils and to show how a GSS could support local government employer and employee needs.