An exploration of pharmacy-specific reasons for non-adherence to prescribed medicines in a socioeconomically deprived, ethnically diverse UK cohort

Methods - Ethical approval for the study was granted by both the local National Health Service (NHS) Research Ethics Committee (REC) and Aston University’s REC. Seven focus groups were conducted between October and December 2011 in medical or community settings within inner-city Birmingham (UK). Discussions were guided by a theme plan which was developed from key themes identified by a literature review and piloted via a Patient Consultation Group. Each focus group had between 3 and 7 participants. The groups were digitally recorded and subsequently transcribed verbatim. The transcriptions were then subjected to thematic analysis via constant comparison in order to identify emerging themes. Results - Participants recognised the pharmacist as an expert source of advice about prescribed medicines, a source they frequently felt a need to consult as a result of the inadequate supply of medicines information from the prescriber. However, an emerging theme was a perception that pharmacists had an oblique profit motive relating to the supply of generic medicines with frequent changes to the ‘brand’ of generic supplied being attributed to profit-seeking by pharmacists. Such changes had a negative impact on the patient’s perceived efficacy of the therapy which may make non-adherence more likely. Conclusions - Whilst pharmacists were recognised as medicines experts, trust in the pharmacist was undermined by frequent changes to generic medicines. Such changes have the potential to adversely impact adherence levels. Further, quantitative research is recommended to examine if such views are generalisable to the wider population of Birmingham and to establish if such views impact on adherence levels.

Living well to the end:a phenomenological analysis of life in extra care housing

OBJECTIVES: To understand older adults' experiences of moving into extra care housing which offers enrichment activities alongside social and healthcare support. DESIGN: A longitudinal study was conducted which adopted a phenomenological approach to data generation and analysis. METHODS: Semi-structured interviews were conducted in the first 18 months of living in extra care housing. Interpretative phenomenological analysis was used because its commitment to idiography enabled an in-depth analysis of the subjective lived experience of moving into extra care housing. Themes generated inductively were examined against an existential-phenomenological theory of well-being. RESULTS: Learning to live in an extra care community showed negotiating new relationships was not straightforward; maintaining friendships outside the community became more difficult as capacity declined. In springboard for opportunity/confinement, living in extra care provided new opportunities for social engagement and a restored sense of self. Over time horizons began to shrink as incapacities grew. Seeking care illustrated reticence to seek care, due to embarrassment and a sense of duty to one's partner. Becoming aged presented an ontological challenge. Nevertheless, some showed a readiness for death, a sense of homecoming. CONCLUSIONS: An authentic later life was possible but residents required emotional and social support to live through the transition and challenges of becoming aged. Enhancement activities boosted residents' quality of life but the range of activities could be extended to cater better for quieter, smaller scale events within the community; volunteer activity facilitators could be used here. Peer mentoring may help build new relationships and opportunities for interactive stimulation. Acknowledging the importance of feeling-empathic imagination-in caregiving may help staff and residents relate better to each other, thus helping individuals to become ontologically secure and live well to the end.

Reducing the time before consulting with symptoms of lung cancer:a randomised controlled trial in primary care

Background: Most individuals with lung cancer have symptoms for several months before presenting to their GP. Earlier consulting may improve survival. Aim: To evaluate whether a theory-based primary care intervention increased timely consulting of individuals with symptoms of lung cancer. Design and setting: Open randomised controlled trial comparing intervention with usual care in two general practices in north-east Scotland. Method: Smokers and ex-smokers aged ≥55 years were randomised to receive a behavioural intervention or usual care. The intervention comprised a single nurse consultation at participants' general practice and a self-help manual. The main outcomes were consultations within target times for individuals with new chest symptoms (≤3 days haemoptysis, ≤3 weeks other symptoms) in the year after the intervention commenced, and intentions about consulting with chest symptoms at 1 and 6 months. Results: Two hundred and twelve participants were randomised and 206 completed the trial. The consultation rate for new chest symptoms in the intervention group was 1.19 (95% confidence interval [CI] = 0.92 to 1.53; P = 0.18) times higher than in the usual-care group and the proportion of consultations within the target time was 1.11 (95% CI = 0.41 to 3.03; P = 0.83) times higher. One month after the intervention commenced, the intervention group reported intending to consult with chest symptoms 31 days (95% CI = 7 to 54; P = 0.012) earlier than the usual care group, and at 6 months this was 25 days (95% CI = 1.5 to 48; P = 0.037) earlier. Conclusion: Behavioural intervention in primary care shortened the time individuals at high risk of lung disease intended to take before consulting with new chest symptoms (the secondary outcome of the study), but increases in consultation rates and the proportions of consultations within target times were not statistically significant. © British Journal of General Practice.

CSR and the "underserving":a role for the state, civil society and business?

Purpose – The purpose of this paper is to demonstrate how the conceptual lens of corporate social responsibility (CSR), business and civil society can be used to explore “less popular causes” (in this case, a community-based public sector empirical study of initiatives with offenders) and, in particular, respond to the question used by Walzer “In which society can lives be best led?” Design/methodology/approach – This is a formative and summative evaluation study of a National Offender Management “community payback” offender scheme based in the UK using a mixed method, predominantly qualitative approach that integrates theory and practice. Findings – The paper finds that citizenship actions of front-line public sector employees, working in partnership with other agencies in the community, embody the essence of Walzer's notion of CSR and civil society by going beyond the call of duty to provide additional training and moral support for the community offenders. Originality/value – The paper contributes towards an understanding of how CSR and civil society debates can inform wider aspects of public policy and business through its application to areas of society that are perceived to be “challenging” and “undeserving”.

Managing radical ICT implementation and politics: A case study of cost-efficient wireless networks

This paper analyzes a case study of wireless network implementation in a politically sensitive environment and seeks to gain practical insights for IT managers in today’s networked economy. The case evolved around an urgent decision to implement wireless networks that were a radical replacement for the existing wired network infrastructure. Although the wireless network infrastructure was well calculated as being considerably cost-efficient, inexperienced administrators and IT department failed to consult various involved stakeholders. Consequently, unintended results of wireless network implementation entangled with the cost efficiency of technology outcome and in turn undermined the objectives and achievement of the initial project plan. Drawing from social perspectives, this case study challenges traditionally dominant perspectives of technology efficiency and summarizes several lessons that could help IT managers and policy makers to better strategize ICT in general, and wireless networks in particular.

Editorial

Welcome to the latest issue of Contact Lens and Anterior Eye. In this issue, Kuldeep Razaida provides a fascinating look at fitting prosthetic lenses to patients in India. I had the good fortune of visiting his clinic in August 2006 at the LV Prasad Eye Institute in Hyderabad, India and was humbled by the vast expertise within the one building. The institute started in 1987 and is the brainchild of the infamous Professor Rao. I think there are few such places in the world where the clinicians work so passionately in treating such interesting patients (for details regarding the LV Prasad Eye Institute see www.lvpei.org). I was in Hyderabad courtesy of IACLE (see issue 29:5 for an editorial by Judith Morris and Sonja Cronje about IACLE) and was able to share ideas with contact lens educators from across the world (for more information on IACLE see www.iacle.org). The issue contains some regular contact lens type papers too; with our aging population readers will be particularly interested in a paper by Mike Freeman and Neil Charman looking at modified monovision with diffractive bifocal lenses. There is an article looking at visual problems with video display terminal use and a study looking at the effects of surface treatment of silicone hydrogel contact lenses. There is an interesting piece from Dr Aisling Mann of Aston University looking at tear protein analysis; this article contains one CET point too for readers who complete the attached multiple choice questions before the relevant deadline. Also, congratulations to the BCLA members who successfully undertook the Fellowship of the BCLA at this year's BCLA conference in Manchester. If you are interested in undertaking the Fellowship please look at the details on the BCLA web page (http://www.bcla.org.uk/fellowship.asp). Amongst the case reports in this issue of CLAE you will notice one from Andrew Elder-Smith, this particular case report was presented as part of his successful Fellowship submission in 2006 and was thought to be of particular good quality by the examiners who asked Andrew to kindly submit it for publication to Contact Lens and Anterior Eye as an example for potential candidates. Finally, it is my sad duty to report the death of Howard Gee earlier this year, a past council member of the BCLA. Our thoughts and prayers are with his family and friends.

Patients' and health professionals' views on primary care for people with serious mental illness:focus group study

Objective: To explore the experience of providing and receiving primary care from the perspectives of primary care health professionals and patients with serious mental illness respectively. Design: Qualitative study consisting of six patient groups, six health professional groups, and six combined focus groups. Setting: Six primary care trusts in the West Midlands. Participants: Forty five patients with serious mental illness, 39 general practitioners (GPs), and eight practice nurses. Results: Most health professionals felt that the care of people with serious mental illness was too specialised for primary care. However, most patients viewed primary care as the cornerstone of their health care and preferred to consult their own GP, who listened and was willing to learn, rather than be referred to a different GP with specific mental health knowledge. Swift access was important to patients, with barriers created by the effects of the illness and the noisy or crowded waiting area. Some patients described how they exaggerated symptoms ("acted up") to negotiate an urgent appointment, a strategy that was also employed by some GPs to facilitate admission to secondary care. Most participants felt that structured reviews of care had value. However, whereas health professionals perceived serious mental illness as a lifelong condition, patients emphasised the importance of optimism in treatment and hope for recovery. Conclusions: Primary care is of central importance to people with serious mental illness. The challenge for health professionals and patients is to create a system in which patients can see a health professional when they want to without needing to exaggerate their symptoms. The importance that patients attach to optimism in treatment, continuity of care, and listening skills compared with specific mental health knowledge should encourage health professionals in primary care to play a greater role in the care of patients with serious mental illness.

Duties and discretions in banking law

Duties owed in banker customer relationships, with reference to Greenwood duty, duty to inform customers of new accounts and services, duty of confidentiality, drawing cheques on insufficient funds and restricting lender's discretion.

The availability of proprietary restitution in cases of mistaken payments

This article is concerned with the availability of “proprietary restitution” in cases of mistaken payments. It is argued that the mistake of the claimant is an insufficient justification for proprietary restitution, however a close analysis of the case law demonstrates that the presence of additional factors can justify the availability of proprietary restitution in specific circumstances. The basis of proprietary restitution is to be found in the breach of a duty which arises separately from the claim for unjust enrichment. The significant contribution of this article is the analysis that knowledge merely creates a duty to maintain the fund until restitution is made, and that knowledge cannot establish the breach of this duty. Importantly, breach of this duty is established by a second condition which is demonstrated by the wilful misconduct of the recipient. It is this conduct which justifies the imposition of the constructive trust. By adopting this analysis, the proprietary claim in the context of mistaken transfers can be classified as forming part of the law of wrongs, rather than the law of unjust enrichment.

Traffic based energy consumption optimisation to improve the lifetime and performance of ad hoc wireless sensor networks

Ad hoc wireless sensor networks (WSNs) are formed from self-organising configurations of distributed, energy constrained, autonomous sensor nodes. The service lifetime of such sensor nodes depends on the power supply and the energy consumption, which is typically dominated by the communication subsystem. One of the key challenges in unlocking the potential of such data gathering sensor networks is conserving energy so as to maximize their post deployment active lifetime. This thesis described the research carried on the continual development of the novel energy efficient Optimised grids algorithm that increases the WSNs lifetime and improves on the QoS parameters yielding higher throughput, lower latency and jitter for next generation of WSNs. Based on the range and traffic relationship the novel Optimised grids algorithm provides a robust traffic dependent energy efficient grid size that minimises the cluster head energy consumption in each grid and balances the energy use throughout the network. Efficient spatial reusability allows the novel Optimised grids algorithm improves on network QoS parameters. The most important advantage of this model is that it can be applied to all one and two dimensional traffic scenarios where the traffic load may fluctuate due to sensor activities. During traffic fluctuations the novel Optimised grids algorithm can be used to re-optimise the wireless sensor network to bring further benefits in energy reduction and improvement in QoS parameters. As the idle energy becomes dominant at lower traffic loads, the new Sleep Optimised grids model incorporates the sleep energy and idle energy duty cycles that can be implemented to achieve further network lifetime gains in all wireless sensor network models. Another key advantage of the novel Optimised grids algorithm is that it can be implemented with existing energy saving protocols like GAF, LEACH, SMAC and TMAC to further enhance the network lifetimes and improve on QoS parameters. The novel Optimised grids algorithm does not interfere with these protocols, but creates an overlay to optimise the grids sizes and hence transmission range of wireless sensor nodes.

Apodisation of photo-induced waveguide gratings using double-exposure with complementary duty cycles

We present a novel apodisation scheme for photo-induced waveguide gratings. The apodisation is implemented with double exposures that have reversely varying duty cycles. We have successfully applied the proposed scheme to remove the sidelobes of long period gratings (LPGs). We also observed for the first time super strong sidelobes in LPGs when creating them with only a single varying-duty-cycle exposure. The strong sidelobes can be well explained with a Mach-Zehnder interference model.

Data analysis methods in optometry Part 4: an introduction to analysis of variance (ANOVA)

In any investigation in optometry involving more that two treatment or patient groups, an investigator should be using ANOVA to analyse the results assuming that the data conform reasonably well to the assumptions of the analysis. Ideally, specific null hypotheses should be built into the experiment from the start so that the treatments variation can be partitioned to test these effects directly. If 'post-hoc' tests are used, then an experimenter should examine the degree of protection offered by the test against the possibilities of making either a type 1 or a type 2 error. All experimenters should be aware of the complexity of ANOVA. The present article describes only one common form of the analysis, viz., that which applies to a single classification of the treatments in a randomised design. There are many different forms of the analysis each of which is appropriate to the analysis of a specific experimental design. The uses of some of the most common forms of ANOVA in optometry have been described in a further article. If in any doubt, an investigator should consult a statistician with experience of the analysis of experiments in optometry since once embarked upon an experiment with an unsuitable design, there may be little that a statistician can do to help.

Apodisation of photo-induced waveguide gratings using double-exposure with complementary duty cycles

We present a novel apodisation scheme for photo-induced waveguide gratings. The apodisation is implemented with double exposures that have reversely varying duty cycles. We have successfully applied the proposed scheme to remove the sidelobes of long period gratings (LPGs). We also observed for the first time super strong sidelobes in LPGs when creating them with only a single varying-duty-cycle exposure. The strong sidelobes can be well explained with a Mach-Zehnder interference model.

The development of an expert system for the identification anodic coating process defects as a contribution to the dissemination of anodizing technology

Initially this thesis examines the various mechanisms by which technology is acquired within anodizing plants. In so doing the history of the evolution of anodizing technology is recorded, with particular reference to the growth of major markets and to the contribution of the marketing efforts of the aluminium industry. The business economics of various types of anodizing plants are analyzed. Consideration is also given to the impact of developments in anodizing technology on production economics and market growth. The economic costs associated with work rejected for process defects are considered. Recent changes in the industry have created conditions whereby information technology has a potentially important role to play in retaining existing knowledge. One such contribution is exemplified by the expert system which has been developed for the identification of anodizing process defects. Instead of using a "rule-based" expert system, a commercial neural networks program has been adapted for the task. The advantages of neural networks over 'rule-based' systems is that they are better suited to production problems, since the actual conditions prevailing when the defect was produced are often not known with certainty. In using the expert system, the user first identifies the process stage at which the defect probably occurred and is then directed to a file enabling the actual defects to be identified. After making this identification, the user can consult a database which gives a more detailed description of the defect, advises on remedial action and provides a bibliography of papers relating to the defect. The database uses a proprietary hypertext program, which also provides rapid cross-referencing to similar types of defect. Additionally, a graphics file can be accessed which (where appropriate) will display a graphic of the defect on screen. A total of 117 defects are included, together with 221 literature references, supplemented by 48 cross-reference hyperlinks. The main text of the thesis contains 179 literature references. (DX186565)

Enhanced spectral sensitivity of fibre long period gratings to refractive index of aqueous solutions utilising copper patterned coatings

A set of long period grating devices have been fabricated in photosensitive single mode fibre coated with a series of copper rings (period of 380μm, 50% duty cycle and length of 4cm). The long period gratings were inscribed with a uniform UV-laser exposure across the entire length of the copper ring patterned coating. The devices ranged in copper thickness from 0.5μm to 1.5μm. In addition, a control long period grating was fabricated in the same type of fibre with the same period for comparison. The refractive index and temperature spectral sensitivity of these devices were investigated and it was found that the index and temperature sensitivity is a function of the thickness of the copper rings, as supported by theoretical modelling. Furthermore, the index sensitivity of these devices in the 1.333 index region is greater than the control long period grating. The patterned 0.5μm coated long period grating gave a sensitivity of Δλ/Δn = -74 nm leading to a resolution of 1.4×10-3 compared to the control which had a sensitivity of Δλ/Δn = -32 nm with a resolution of 3.2×10-3 in the index region of 1.320 to 1.380 (aqueous solution regime). This demonstrates a two fold increase in the sensitivity. This novel fibre long period grating device shows potential for increasing the resolution of measurements of the index of aqueous solutions.