Ethical issues about shared medical records

Focal points: Patient views on pharmacists' access to medical records was studied using a self-completion questionnaire in medical practice and two community pharmacies There was some support for pharmacist access to records with a third of the sample being unsure There was a majority support when the purpose was clearly pharmacy related A clear majority was confident of confidentiality in the pharmacy

An investigation of medicines returned to general practitioners and community pharmacies

Focal points: All returned medicines were monitored in eight community pharmacies and five general medical practices over a four-week period Returns were analysed for the type, quantity, absolute cost of the medicines, original quantity and date dispensed together with the reason for return A total of 298 items was returned to pharmacists and the reason for the return was a change or stop of therapy in 56 per cent of cases; 66 per cent of these were prescribed in a quantity of one month or greater A total of 42 items was returned to GPs and the reason for the return involved a change or stop of the therapy in 54 per cent of cases; 69 per cent of these were prescribed in a quantity of one month or greater Measures to implement a procedure to limit prescribed quantities upon initiation of therapy should help to reduce medicines wastage

Teenage mothers' experiences of stigma and formal support services

This research has two focal points: experiences of stigma and experiences of formal support services among teenage mothers. Twenty teenage mothers were interviewed in depth, ten from a one-to-one support service, and ten from a group based support service. Contributions to knowledge consisted of the following. First, regarding experiences of stigma, this research integrated concepts from the social psychology literature and established the effects of stigma which are experienced by teenage mothers, offering reasons for the same. Additionally, further coping mechanisms in response to being stigmatized were discovered and grouped into two new headings: active and passive coping mechanisms. It is acknowledged that for a minority of participants, stigma does have negative effects, however, the majority experiences no such serious negative effects. Secondly, regarding experiences of support services, this research was able to directly compare one-to-one with group based support for teenage mothers. Knowledge was unearthed as to influential factors in the selection of a mode of support and the functions of each of the modes of support, which were categorised under headings for ease of comparison. It was established that there is indeed a link between these two research foci in that both the one-to-one and group based support services fulfil a stigma management function, in which teenage mothers discuss the phenomenon, share experiences and offer advice to others. However, it was also established that this function is of minor importance compared to the other functions fulfilled by the support services.

Die Behandlung englischen Kulturgutes im Wiener fin de siècle:am Beispiel von Hugo von Hofmannsthal, Hermann Bahr und Peter Altenberg

This study explores the fascination which English culture represented in turn-of-the-century Vienna. The writers that are going to be discussed are the renowned Anglophile Hugo von Hofmannsthal, the more ambivalent Hermann Bahr and the idealizing, but Janus-faced Peter Altenberg. With the more widely known poet, prose writer and playwright, Hofmannsthal, individual aspects of his engagement with English culture have already been well researched; the same, however, cannot be said in the case of Hermann Bahr, whose extensive literary oeuvre has now largely been forgotten, and who has, instead, come to be valued as a prominent figure in the culture life of modernist Vienna, and Peter Altenberg, whose literary fame rests mainly on his prose poems and who, a legend in his life-time, has in recent years also increasingly attracted research interest as a phenomenon and ‘embodiment’ of the culture of his time: while their engagement with French literature, for example, has long received its due share of attention, their debt to English culture has, until now, been neglected. This thesis, therefore, sets out to explore Hofmannsthal’s, Bahr’s and Altenberg’s perception and portrayal of English civilization – ranging from English character and stereotypes, to what they saw as the principles of British society; it goes on to investigate the impulses they derive from Pre-Raphaelite art (Rossetti, Burne-Jones, Whistler) and the art and crafts-movement centred around William Morris, as well as their inspiration by the art criticism of John Ruskin and Walter Horatio Pater. In English literature one of the focal points will be their reading and evaluation of aestheticism as it was reflected in the life and writings of the Dubliner Oscar Wilde, who was perceived, by these Austrian authors, as a predominant figure of London’s cultural life. Similarly, they regarded his compatriot George Bernard Shaw as a key player in turn-of-the-century English (and European) culture. Hermann Bhar largely identified with him. Hofmannsthal, on the other hand, while having some reservations, acknowledged his importance and achievements, whereas Peter Altenberg saw in Shaw a model to reassure him, as his writings were becoming more openly didactic and even more miniaturistic than they had already been. He turned to Shaw, too, to explain and justify his new goal of making his texts more intelligent to a wider circle of readers.

An assessment of the accuracy of electrolyte concentrations in neonatal parental nutrition

Focal points Over a six-week period in January and February 2002, 2ml samples were removed from all neonatal PN bags dispensed Samples were submitted for analysis of sodium, potassium and magnesium in triplicate by the hospital's clinical chemistry department using a Vitros Codac 950AT, dry slide, automated analyser Only 19.3, 7.1 and 30.4 per cent of measured sodium, potassium and magnesium concentrations respectively deviated by £5 per cent from stated bag concentrations The results indicate that it is possible that some electrolyte concentrations included in neonatal PN vary significantly from stated values

Are community pharmacists prepared to work extended opening hours?

Focal points: A 5 per cent cross-sectional sample of the Royal Pharmaceutical Society's membership was targeted with a self-completion questionnaire Community pharmacy respondents were asked questions on their views on current pharmacy opening hours and their willingness to work extended opening hours Around one fifth of the community pharmacists sampled believed that patients should have access to at least one community pharmacy 24 hours a day Only 3.4 per cent of community pharmacists sampled were prepared to work at any time over a 24-hour period With the introduction of more 24-hour health care services (eg, NHS Direct), there may need to be a change in the attitudes of community pharmacists towards working extended opening hours

Warfarin toxicity: do discharge ICD-10 codes and yellow cards accurately identify serious adverse drug reactions?

Focal points: ICD-10 codings and spontaneous yellow card reports for warfarin toxicity were compared retrospectively over a one-year period Eighteen cases of ICD-10 coded warfarin toxicity were identified from a total of 55,811 coded episodes More than three times as many ADRs to warfarin were found by screening ICD-10 codes as were reported spontaneously using the yellow card scheme Valuable information is being lost to regulatory authorities and as recognised reporters to the yellow card scheme, pharmacists are well placed to report these ADRs, enhancing their role in the safe and appropriate prescribing of warfarin

Set-up and maintenance of syringe drivers for subcutaneous drug administration in palliative care

Focal points: Details of syringe driver use were collected from 11 inpatient hospice units in the West Midlands and compared with predetermined standards set by a multidisciplinary group We recorded 294 syringe driver events which complied with standards for the choice of administration site, protection of the syringe driver from light and the reason for initiation of the infusion Issues of nurse training, variability in prescribing practices, provision of written information for patients, labelling and documentation of the diluent used were all identified as areas in which compliance with standards could be improved

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 extent and reasons for compliance failure with oral treatment regimens in haematology outpatients

Focal points: Self-completion questionnaires were used to determine issues with compliance surrounding the use of oral chemotherapy in haematology patients Forty-two patients were identified of which 40 responded over a two-month period Twenty-one respondents (52.5 per cent) indicated that they experienced difficulties in taking their medication Difficulties were not apparently related to the time of dosing; the size of dose units (hydroxyurea) and foil packed agents caused particular difficulties

Proton pump inhibitor prescribing following Endoscopic diagnosis in a district general hospital

Focal points: A systematic review of the use of proton pump inhibitors was conducted among patients undergoing diagnostic fibreoptic endoscopic examination of the upper gastrointestinal tract during the period July 2001 to February 2002 inclusive A total of 2,557 patients received a PPI following endoscopy and healing doses were prescribed to 75.3 per cent of these patients An “unknown indication” was stated as a diagnosis in 958 patients (37.5 per cent) of patients studied Although endoscopic diagnosis does not appear possible in all cases, the present study demonstrates that NICE guidance to employ the lowest appropriate dose of PPI is followed

Procedural justice in procurement management and inclusive interorganizational relations:An institutional perspective

This paper applies the concept of procedural justice to one of the most important focal points of interorganizational relations: the purchaser-supplier relationship. The few extant studies of the concept in the purchaser-supplier domain have overlooked an important aspect of this key relationship: that is, inclusiveness in procurement. This is despite the fact that interest in the specific empirical context of supply chain links between large purchasing organizations (LPOs) and ethnic minority suppliers (EMSs) from disadvantaged communities proceeds apace on both sides of the Atlantic. Institutional theory is used to examine the form that procedural justice takes in eight case studies of LPOs from the private and public sectors, which actively engage with inclusive procurement management initiatives in England. The guiding question is twofold: 'What may LPO approaches to installing procedural justice in procurement management entail?' and 'How are these approaches shaped?' This paper identifies specific approaches to installing procedural justice for inclusive procurement and submits theoretical propositions about how these are shaped. The study contributes to a macro-level assessment of procedural justice, i.e. interorganizational procedural justice, as a significant aspect of inclusive interorganizational relationships, which is a domain in need of theoretical development.

Superfocusing of high-M2 semiconductor laser beams:experimental demonstration

The focusing of multimode laser diode beams is probably the most significant problem that hinders the expansion of the high-power semiconductor lasers in many spatially-demanding applications. Generally, the 'quality' of laser beams is characterized by so-called 'beam propagation parameter' M2, which is defined as the ratio of the divergence of the laser beam to that of a diffraction-limited counterpart. Therefore, M2 determines the ratio of the beam focal-spot size to that of the 'ideal' Gaussian beam focused by the same optical system. Typically, M2 takes the value of 20-50 for high-power broad-stripe laser diodes thus making the focal-spot 1-2 orders of magnitude larger than the diffraction limit. The idea of 'superfocusing' for high-M2 beams relies on a technique developed for the generation of Bessel beams from laser diodes using a cone-shaped lens (axicon). With traditional focusing of multimode radiation, different curvatures of the wavefronts of the various constituent modes lead to a shift of their focal points along the optical axis that in turn implies larger focal-spot sizes with correspondingly increased values of M2. In contrast, the generation of a Bessel-type beam with an axicon relies on 'self-interference' of each mode thus eliminating the underlying reason for an increase in the focal-spot size. For an experimental demonstration of the proposed technique, we used a fiber-coupled laser diode with M2 below 20 and an emission wavelength in ~1μm range. Utilization of the axicons with apex angle of 140deg, made by direct laser writing on a fiber tip, enabled the demonstration of an order of magnitude decrease of the focal-spot size compared to that achievable using an 'ideal' lens of unity numerical aperture. © 2014 SPIE.