Provision of pharmaceutical care by community pharmacists:a comparison across Europe

Objective To investigate the provision of pharmaceutical care by community pharmacists across Europe and to examine the various factors that could affect its implementation. Methods A questionnaire-based survey of community pharmacies was conducted within 13 European countries. The questionnaire consisted of two sections. The first section focussed on demographic data and services provided in the pharmacy. The second section was a slightly adapted version of the Behavioral Pharmaceutical Care Scale (BPCS) which consists of three main dimensions (direct patient care activities, referral and consultation activities and instrumental activities). Results Response rates ranged from 10–71% between countries. The mean total score achieved by community pharmacists, expressed as a percentage of the total score achievable, ranged from 31.6 (Denmark) to 52.2% (Ireland). Even though different aspects of pharmaceutical care were implemented to different extents across Europe, it was noted that the lowest scores were consistently achieved in the direct patient care dimension (particularly those related to documentation, patient assessment and implementation of therapeutic objectives and monitoring plans) followed by performance evaluation and evaluation of patient satisfaction. Pharmacists who dispensed higher daily numbers of prescriptions in Ireland, Germany and Switzerland had significantly higher total BPCS scores. In addition, pharmacists in England and Ireland who were supported in their place of work by other pharmacists scored significantly higher on referral and consultation and had a higher overall provision of pharmaceutical care. Conclusion The present findings suggest that the provision of pharmaceutical care in community pharmacy is still limited within Europe. Pharmacists were routinely engaged in general activities such as patient record screening but were infrequently involved in patient centred professional activities such as the implementation of therapeutic objectives and monitoring plans, or in self-evaluation of performance.

Crisis communication and social media : the changing environment for natural disaster response

Over the past two years there have been several large-scale disasters (Haitian earthquake, Australian floods, UK riots, and the Japanese earthquake) that have seen wide use of social media for disaster response, often in innovative ways. This paper provides an analysis of the ways in which social media has been used in public-to-public communication and public-to-government organisation communication. It discusses four ways in which disaster response has been changed by social media: 1. Social media appears to be displacing the traditional media as a means of communication with the public during a crisis. In particular social media influences the way traditional media communication is received and distributed. 2. We propose that user-generated content may provide a new source of information for emergency management agencies during a disaster, but there is uncertainty with regards to the reliability and usefulness of this information. 3. There are also indications that social media provides a means for the public to self-organise in ways that were not previously possible. However, the type and usefulness of self-organisation sometimes works against efforts to mitigate the outcome of the disaster. 4. Social media seems to influence information flow during a disaster. In the past most information flowed in a single direction from government organisation to public, but social media negates this model. The public can diffuse information with ease, but also expect interaction with Government Organisations rather than a simple one-way information flow. These changes have implications for the way government organisations communicate with the public during a disaster. The predominant model for explaining this form of communication, the Crisis and Emergency Risk Communication (CERC), was developed in 2005 before social media achieved widespread popularity. We will present a modified form of the CERC model that integrates social media into the disaster communication cycle, and addresses the ways in which social media has changed communication between the public and government organisations during disasters.

Crisis communication and social media:the changing environment for natural disaster response

Over the past two years there have been several large-scale disasters (Haitian earthquake, Australian floods, UK riots, and the Japanese earthquake) that have seen wide use of social media for disaster response, often in innovative ways. This paper provides an analysis of the ways in which social media has been used in public-to-public communication and public-to-government organisation communication. It discusses four ways in which disaster response has been changed by social media: 1. Social media appears to be displacing the traditional media as a means of communication with the public during a crisis. In particular social media influences the way traditional media communication is received and distributed. 2. We propose that user-generated content may provide a new source of information for emergency management agencies during a disaster, but there is uncertainty with regards to the reliability and usefulness of this information. 3. There are also indications that social media provides a means for the public to self-organise in ways that were not previously possible. However, the type and usefulness of self-organisation sometimes works against efforts to mitigate the outcome of the disaster. 4. Social media seems to influence information flow during a disaster. In the past most information flowed in a single direction from government organisation to public, but social media negates this model. The public can diffuse information with ease, but also expect interaction with Government Organisations rather than a simple one-way information flow. These changes have implications for the way government organisations communicate with the public during a disaster. The predominant model for explaining this form of communication, the Crisis and Emergency Risk Communication (CERC), was developed in 2005 before social media achieved widespread popularity. We will present a modified form of the CERC model that integrates social media into the disaster communication cycle, and addresses the ways in which social media has changed communication between the public and government organisations during disasters.

Community pharmacist perceptions of the loss of resale price maintenance

Focal points: This study was designed to elicit the views of community pharmacists on any perceived business and professional changes following the loss of resale price maintenance (RPM)A piloted, 22-point self-completion questionnaire containing open, closed and scaled response questions was distributed to 35 independent (<10 stores), 13 multiple group and three supermarket-based pharmacies, and 40 responses were obtained (29 independent, eight multiple and three supermarket)Theme analysis indicated that 20 respondents felt that an increased range of services was now provided, 27 reported a decreased sales potential and 25 thought that patients now purchased more medicinesThe average price at which eight common over-the-counter medicines were offered was found to be £4.34 in independents, £4.37 in multiples and £4.22 in the supermarket pharmacies, compared with an average standard list price of £4.32There are indications that removal of RPM may have instigated changes in community pharmacy

The Ecumenical movement and the making of the European Community

The European Community has largely been considered a predominantly secular project, bringing together the economic and political realms, while failing to mobilise the public voice and imagination of churchmen and the faithful. Drawing on a wide range of archival sources, this is the first study to assess the political history of religious dialogue in the European Community. It challenges the widespread perception that churches started to engage with European institutions only after the 1979 elections to the European Parliament, by detailing close relations between churchmen and high-ranking officials in European institutions, immediately after the 1950 Schuman Declaration. Lucian N. Leustean demonstrates that Cold War divisions between East and West, and the very nature of the ecumenical movement, had a direct impact on the ways in which churches approached the European Community. He brings to light events and issues which have not previously been examined, such as the response of churches to the Schuman Plan, and the political mobilisation of church representations in Brussels, Strasbourg and Luxembourg. Leustean argues that the concept of a 'united Europe' has been impeded by competing national differences between religious and political institutions, having a long-standing legacy on the making of a fragmented European Community.

Understanding knowledge coordination dynamics in traditional and fast-response IT organizations

This research takes a dynamic view on the knowledge coordination process, aiming to explain how the process is affected by changes in the operating environment, from normal situations to emergencies in traditional and fast-response organizations, and why these changes occur. We first conceptualize the knowledge coordination process by distinguishing between four dimensions - what, when, how and who - that together capture the full scope of the knowledge coordination process. We use these dimensions to analyze knowledge coordination practices and the activities constituting these practices, in the IT functions of traditional and fast-response (military) organizations where we distinguish between "normal" and "emergency" operating conditions. Our findings indicate that (i) inter-relationships between knowledge coordination practices change under different operating conditions, and (ii) the patterns of change are different in traditional and fast-response organizations.

Stress, burnout and coping strategies in the emergency and intensive care hospital departments

Doctors and nurses working at the accident and emergency (A&E), and intensive care departments are at risk of burnout. They often spend substantial time in intense interactions with other people, centered on patients? health problems (physical, psychological and social) that may lead to feelings of anger, anxiety and frustration, and eventually to burnout. Burnout is a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment (Maslach & Jackson, 1981) The purpose of this chapter is to assess work stressors, burnout and stress-coping mechanisms among doctors and nurses at the A&E and intensive care departments. A quantitative design using the survey approach was used to collect data from a sample of 200 participants with a response rate of 71% (n=154) Work stressors were associated with burnout in both doctors and nurses. Workload was the most salient work stressor in the sample. Nurses experienced more stress (M=1.5, SD=0.4) than doctors (M=1.2, SD=0.4) in all the work stressor variables examined. The A&E department was reported as more stressful than the intensive care department. Avoidance-oriented and task-oriented coping were the most and the least frequently reported coping strategies respectively. Additionally, only emotion-oriented coping strategy was significantly different between doctors and nurses, and this strategy was also significantly positively correlated with all the variables in the adapted nursing stress scale, and the three burnout variables. Death and dying was most strongly correlated with emotion-oriented coping. This chapter provides an assessment of stress, burnout and coping experienced by both doctors and nurses within the A&E and intensive care departments. Methods that may mitigate stress in these environments may be adequate staffing, supportive management, stress management programs, as well as improvement in communication strategies between doctors and nurses.

Discovering biomarkers for antidepressant response:protocol from the Canadian biomarker integration network in depression (CAN-BIND) and clinical characteristics of the first patient cohort

Background: Major Depressive Disorder (MDD) is among the most prevalent and disabling medical conditions worldwide. Identification of clinical and biological markers ("biomarkers") of treatment response could personalize clinical decisions and lead to better outcomes. This paper describes the aims, design, and methods of a discovery study of biomarkers in antidepressant treatment response, conducted by the Canadian Biomarker Integration Network in Depression (CAN-BIND). The CAN-BIND research program investigates and identifies biomarkers that help to predict outcomes in patients with MDD treated with antidepressant medication. The primary objective of this initial study (known as CAN-BIND-1) is to identify individual and integrated neuroimaging, electrophysiological, molecular, and clinical predictors of response to sequential antidepressant monotherapy and adjunctive therapy in MDD. Methods: CAN-BIND-1 is a multisite initiative involving 6 academic health centres working collaboratively with other universities and research centres. In the 16-week protocol, patients with MDD are treated with a first-line antidepressant (escitalopram 10-20 mg/d) that, if clinically warranted after eight weeks, is augmented with an evidence-based, add-on medication (aripiprazole 2-10 mg/d). Comprehensive datasets are obtained using clinical rating scales; behavioural, dimensional, and functioning/quality of life measures; neurocognitive testing; genomic, genetic, and proteomic profiling from blood samples; combined structural and functional magnetic resonance imaging; and electroencephalography. De-identified data from all sites are aggregated within a secure neuroinformatics platform for data integration, management, storage, and analyses. Statistical analyses will include multivariate and machine-learning techniques to identify predictors, moderators, and mediators of treatment response. Discussion: From June 2013 to February 2015, a cohort of 134 participants (85 outpatients with MDD and 49 healthy participants) has been evaluated at baseline. The clinical characteristics of this cohort are similar to other studies of MDD. Recruitment at all sites is ongoing to a target sample of 290 participants. CAN-BIND will identify biomarkers of treatment response in MDD through extensive clinical, molecular, and imaging assessments, in order to improve treatment practice and clinical outcomes. It will also create an innovative, robust platform and database for future research. Trial registration: ClinicalTrials.gov identifier NCT01655706. Registered July 27, 2012.

The MG Rover closure and policy response: an evaluation of the Task Force model in the UK

In recent years there have been a number of high-profile plant closures in the UK. In several cases, the policy response has included setting up a task force to deal with the impacts of the closure. It can be hypothesised that task force involving multi-level working across territorial boundaries and tiers of government is crucial to devising a policy response tailored to people's needs and to ensuring success in dealing with the immediate impacts of a closure. This suggests that leadership, and vision, partnership working and community engagement, and delivery of high quality services are important. This paper looks at the case of the MG Rover closure in 2005, to examine the extent to which the policy response to the closure at the national, regional and local levels dealt effectively with the immediate impacts of the closure, and the lessons that can be learned from the experience. Such lessons are of particular relevance given the closure of the LDV van plant in Birmingham in 2009 and more broadly – such as in the case of the downsizing of the Opel operation in Europe following its takeover by Magna.

A multi-organisational approach for disaster preparedness and response:the use of optimisation and GIS for facility location, stock pre-positioning, resource allocation and relief distribution

From 1992 to 2012 4.4 billion people were affected by disasters with almost 2 trillion USD in damages and 1.3 million people killed worldwide. The increasing threat of disasters stresses the need to provide solutions for the challenges faced by disaster managers, such as the logistical deployment of resources required to provide relief to victims. The location of emergency facilities, stock prepositioning, evacuation, inventory management, resource allocation, and relief distribution have been identified to directly impact the relief provided to victims during the disaster. Managing appropriately these factors is critical to reduce suffering. Disaster management commonly attracts several organisations working alongside each other and sharing resources to cope with the emergency. Coordinating these agencies is a complex task but there is little research considering multiple organisations, and none actually optimising the number of actors required to avoid shortages and convergence. The aim of the this research is to develop a system for disaster management based on a combination of optimisation techniques and geographical information systems (GIS) to aid multi-organisational decision-making. An integrated decision system was created comprising a cartographic model implemented in GIS to discard floodable facilities, combined with two models focused on optimising the decisions regarding location of emergency facilities, stock prepositioning, the allocation of resources and relief distribution, along with the number of actors required to perform these activities. Three in-depth case studies in Mexico were studied gathering information from different organisations. The cartographic model proved to reduce the risk to select unsuitable facilities. The preparedness and response models showed the capacity to optimise the decisions and the number of organisations required for logistical activities, pointing towards an excess of actors involved in all cases. The system as a whole demonstrated its capacity to provide integrated support for disaster preparedness and response, along with the existence of room for improvement for Mexican organisations in flood management.

The roles of community pharmacists and other pharmacy staff:public perceptions

Introduction: The focus of the community pharmacist’s (CP’s) activities continues to move away from traditional dispensing activities towards the provision of health services. Current functions of CPs cover a combination of roles including prescription matters, counselling and service provision. These expanding roles, along with raised prescription volume, have increased CP workload. Therefore, it has become commonplace to delegate certain activities to other pharmacy staff (PS). This research aimed to examine public perceptions of CPs and other PS functions. Methodology: A self-completion postal questionnaire was sent to a random sample of 9769 members of the general public in England. Participants were asked to indicate which functions they believed CPs and other PS perform. Data were imported into SPSS 22 for analysis. Results: A response rate of 15.7% (n = 1537) was achieved. The roles most commonly attributed to CPs were monitoring prescription appropriateness (90.4%, n = 1390) and counselling patients on prescribed medicines (90.4%, n = 1389). The role most commonly attributed to other PS was sales transactions (92.4%, n = 1420). Similar numbers of responders agreed that the delivery of health services was the role of both CPs and other PS (58.9%, n = 906; 57.0%, n = 876). Conclusion: Despite a move towards more service based practice, the public still primarily associate the CP’s role with activities centred on dispensing. The provision of health services was seen to be equally carried out by CPs and other PS. As the CP’s service-based activities continue to develop, promotional activities may be required to ensure developments in CP functions are recognised by the public