A conceptual framework of patient satisfaction with a pharmacy adherence service

Background Patients do not adhere to their medicines for a host of reasons which can include their underlying beliefs as well as the quality of their interactions with healthcare professionals. One way of measuring the outcome of pharmacy adherence services is to assess patient satisfaction but no questionnaire exists that truly captures patients' experiences with these relatively new services. Objective Our objective was to develop a conceptual framework specific to patient satisfaction with a community pharmacy adherence service based on criteria used by patients themselves. Setting The study was based in community pharmacies in one large geographical area of the UK (Surrey). All the work was conducted between October 2008 and September 2010. Methods This study involved qualitative non-participant observation and semi-structured interviewing. We observed the recruitment of patients to the Medicines Use Review (MUR) service and also actual MUR consultations (7). We also interviewed patients (15). Data collection continued until no new themes were identified during analysis. We analysed interviews to firstly create a comprehensive account of themes which had significance within the transcripts, then created sub-themes within super-ordinate categories. We used a structure-process-outcome approach to develop a conceptual framework relating to patient satisfaction with the MUR. Favourable ethical opinion for this study was received from the NHS Surrey Research Ethics Committee on 2nd June 2008. Results Five super-ordinate themes linked to patient satisfaction with the MUR service were identified, including relationships with healthcare providers; attitudes towards healthcare providers; patients' experience of health, healthcare and medicines; patients' views of the MUR service; the logistics of the MUR service. In the conceptual framework, structure was conceptualised as existing relationships, environment, and time; process was conceptualised as related to recruitment and consultation stages; and outcome as two concepts of immediate patient outcomes and satisfaction on reflection. Conclusion We identified and highlighted factors that can influence patient satisfaction with the MUR service and this led to the development of a conceptual framework of patient satisfaction with the MUR service. This can form the basis for developing a questionnaire for measuring patient satisfaction with this and similar pharmacy adherence services. Impact of findings on practice * Pharmacists and researchers can access the relevant ideas presented here in relation to patient satisfaction with pharmacy adherence services. * Researcher can use the conceptual framework as a basis for measuring the quality of pharmacy adherence services. * Community pharmacists can improve the quality of healthcare they provide by realizing concepts relevant to patient satisfaction with adherence services.

Conceptual representation in bilinguals: the role of language specificity and conceptual change

Most prominent models of bilingual representation assume a degree of interconnection or shared representation at the conceptual level. However, in the context of linguistic and cultural specificity of human concepts, and given recent findings that reveal a considerable amount of bidirectional conceptual transfer and conceptual change in bilinguals, a particular challenge that bilingual models face is to account for non-equivalence or partial equivalence of L1 and L2 specific concepts in bilingual conceptual store. The aim of the current paper is to provide a state-of-the-art review of the available empirical evidence from the fields of psycholinguistics, cognitive, experimental, and cross-cultural psychology, and discuss how these may inform and develop further traditional and more recent accounts of bilingual conceptual representation. Based on a synthesis of the available evidence against theoretical postulates of existing models, I argue that the most coherent account of bilingual conceptual representation combines three fundamental assumptions. The first one is the distributed, multi-modal nature of representation. The second one concerns cross-linguistic and cross-cultural variation of concepts. The third one makes assumptions about the development of concepts, and the emergent links between those concepts and their linguistic instantiations.

Poetry on Pre-Raphaelite principles: science, nature and knowledge in William Michael Rossetti’s 'Fancies at Leisure' and 'Mrs. Holmes Grey'

This article demonstrates how early Pre-Raphaelite poetry worked according to the principle that art should be modelled on science theorised by the Pre-Raphaelites in their early essays. As the main theorists (rather than practitioners) of Pre-Raphaelite art, F. G. Stephens and William Michael Rossetti defined the Pre-Raphaelite project in terms of observation, investigation, experiment, the “adherence to fact” and the “search after truth”. In the hands of the early Pre-Raphaelite poets, and particularly Rossetti himself, poetry too becomes a mode of scientific enquiry into the natural world, the nature of observation, human psychology and medical practice.

The statistical downscaling model-decision centric (SDSM-DC): conceptual basis and applications

Regional climate downscaling has arrived at an important juncture. Some in the research community favour continued refinement and evaluation of downscaling techniques within a broader framework of uncertainty characterisation and reduction. Others are calling for smarter use of downscaling tools, accepting that conventional, scenario-led strategies for adaptation planning have limited utility in practice. This paper sets out the rationale and new functionality of the Decision Centric (DC) version of the Statistical DownScaling Model (SDSM-DC). This tool enables synthesis of plausible daily weather series, exotic variables (such as tidal surge), and climate change scenarios guided, not determined, by climate model output. Two worked examples are presented. The first shows how SDSM-DC can be used to reconstruct and in-fill missing records based on calibrated predictor-predictand relationships. Daily temperature and precipitation series from sites in Africa, Asia and North America are deliberately degraded to show that SDSM-DC can reconstitute lost data. The second demonstrates the application of the new scenario generator for stress testing a specific adaptation decision. SDSM-DC is used to generate daily precipitation scenarios to simulate winter flooding in the Boyne catchment, Ireland. This sensitivity analysis reveals the conditions under which existing precautionary allowances for climate change might be insufficient. We conclude by discussing the wider implications of the proposed approach and research opportunities presented by the new tool.

Poetry of social conscience, poetry of transition: Ann Hawkshaw's 'Introductory Stanzas' and 'The Mother to her Starving Child'

Through close readings of Ann Hawkshaw's poetry in the context of industrial Manchester in the 1840s, this article highlights the interaction of form and content in poetry that makes use of the idea of the past to question or complicate the politics of the present.

The aims of early years outdoor education in England: a conceptual and empirical investigation

This paper explores the place of aims in the early years foundation stage outdoor environment in England. Through examining the writing of academics, various themes are identified, and constructed into possible aims. These themes/aims are compared to an empirical study of early years teachers’ attitudes. Data was collected by questionnaire from schools within the University of Reading partnership. There was general agreement between experts and teachers as to the aims. While some respondents were able to explain what the aims of outdoor activity were, a significant number were unable to identify aims; further, a significant number did not distinguish between approach/practice and aims. A lack of understanding and agreement as to what the aims are may indicate teachers are unsure about the purpose of outdoor education for young children. A result of this study is to agree and make explicit the aims for outdoor education in the early years.

Speech acts, responsibility and commitment in poetry

Philosophy has tended to regard poetry primarily in terms of truth and falsity, assuming that its business is to state or describe states of affairs. Speech act theory transforms philosophical debate by regarding poetry in terms of action, showing that its business is primarily to do things. The proposal can sharpen our understanding of types of poetry; examples of the ‘Chaucer-Type’ and its variants demonstrate this. Objections to the proposal can be divided into those that relate to the agent of actions associated with a poem, those that relate to the actions themselves, and those that relate to the things done. These objections can be answered. A significant consequence of the proposal is that it gives prominence to issues of responsibility and commitment. This prominence brings philosophical debate usefully into line with contemporary poetry, whose concern with such issues is manifest in characteristic forms of anxiety.

Poetry, parables and codes: translating the letters of Indian soldiers

This chapter examines the role of translation in the work of the Indian Mail Censorship Department in France in the First World War, considering the position of the translator as an intermediary figure, and the implications for the military tasks of censorship and intelligence analysis of operating in this way from a foreign language.

Undying voices: the poetry of Roman Britain

An anthology (comprising introduction, text, translation, and notes) of Britain's most ancient (surviving) poetry (Latin/Greek, with an English translation).