Influences on general practitioner prescribing with particular reference to community pharmacy

Influences on general practitioner prescribing of drugs continue to be of interest and importance as cost containment becomes central to Government health policy. This thesis employs a plurality of research methods including quantitative and qualitative survey techniques for example, questionnaires, interviews and prescription analyses to investigate some of the factors which may influence GP prescribing such as information sources, hospital consultants and in particular the community pharmacist. When the use and influence of drug information sources by GPs was examined, the community pharmacist was given a relatively low rating as a source but a high rating, similar to that of the consultant, for helpfulness. Influences are needed to improve prescribing and reduce the incidence of iatrogenic disease for the benefit of the patient. The education and expertise of pharmacists and their familiarity with local prescribing habits places them in a unique position to meet the needs of local GPs. As 96.5% of the public always or nearly always take their prescriptions to the same pharmacy, patient medication records, now kept by 77.5% of pharmacies, provide a valuable check on the appropriateness and safety of patients' medication. The barriers to the pharmacist's greater involvement were shown to be suspicion by GPs of pharmacists' motivation, isolation of many community pharmacists, difficulties in leaving the pharmacy for domiciliary visits, residential home care and GP practice meetings. These barriers must be lowered if the pharmacist is to have a greater influence and involvement. It was concluded that changes are necessary in pharmaceutical education, staff training, organisation and remuneration. Some changes in the targeting of remuneration to the pharmaceutical care services provided and registration of patients with pharmacies would contribute greatly to these aims.

Problems with formative and higher-order reflective variables

Cadogan and Lee (this issue) discuss the problems inherent in modeling formative latent variables as endogenous. In response to the commentaries by Rigdon (this issue) and Finn and Wang (this issue), the present article extends the discussion on formative measures. First, the article shows that regardless of whether statistical identification is achieved, researchers are unable to illuminate the nature of a formative latent variable. Second, the study clarifies issues regarding formative indicator weighting, highlighting that the weightings of formative components should be specified as part of the construct definition. Finally, the study shows that higher-order reflective constructs are invalid, highlights the damage their use can inflict on theory development and knowledge accumulation, and provides recommendations on a number of alternative models which should be used in their place (including the formative model). © 2012 Elsevier Inc.

Transdisciplinarity and reflective practice in sustainable development learning

Using various extracts from the reflective commentaries of MSc students, this article explores how transdisciplinarity and reflective practice operate in the programme. It shows how learners managed the uncertainties of sustainable development through regular critical and evaluative reflections. Students were able to apprehend the several worlds making up the sustainable development project and their own personal learning journey through the various competing, complementary and occasionally contradictory perspectives, modes of learning, sources of knowledge and information. One conceptual device facilitating this process was offering an understanding of sustainable development as constituting a ‘dialogue of values’, an approach that effectively invites students to square the metaphorical circle - i.e. broadly reconciling (ecological) sustainability with (economic) development.

Genie:supporting the model driven development of reflective, component-based adaptive systems

Engineering adaptive software is an increasingly complex task. Here, we demonstrate Genie, a tool that supports the modelling, generation, and operation of highly reconfigurable, component-based systems. We showcase how Genie is used in two case-studies: i) the development and operation of an adaptive flood warning system, and ii) a service discovery application. In this context, adaptation is enabled by the Gridkit reflective middleware platform.

Your students have excellent knowledge and skills but they don’t think about them...:a reflective learning project

This paper describes two phases of a project set up to encourage students to be more reflective about their studies and their career goals. it takes as its starting point a discussion with employers about the Jack of reflection that they observed in otherwise highly skilled management graduates. The project.examin!ld.a number of processes, including mentoring, logbooks and learning style questionnaires to gauge which was the most effective in inspiring students to be reflective. Having identified the best methods the project entered a second phase which involved rolling out the findings to large numbers of students. The challenges of doing this are analysed in the paper.

Role, function and responsibilities of the safety practitioner in the United Kingdom

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A comparison of the provision of the My Choice Weight Management Programme via general practitioner practices and community pharmacies in the United Kingdom

This study aimed to assess the effectiveness of a novel, community-based weight management programme delivered through general practitioner (GP) practices and community pharmacies in one city in the United Kingdom. This study used a non-randomized, retrospective, observational comparison of clinical data collected by participating GP practices and community pharmacies. Subjects were 451 overweight or obese men and women resident in areas of high socioeconomic deprivation (82% from black and minority ethnic groups, 86% women, mean age: 41.1 years, mean body mass index [BMI]: 34.5 kg m−2). Weight, waist circumference and BMI at baseline, after 12 weeks and after 9 months were measured. Costs of delivery were also analysed. Sixty-four per cent of participants lost weight after the first 12 weeks of the My Choice Weight Management Programme. There was considerable dropout. Mean percentage weight loss (last observation carried forward) was 1.9% at 12 weeks and 1.9% at final follow-up (9 months). There was no significant difference in weight loss between participants attending GP practices and those attending pharmacies at both 12 weeks and at final follow-up. Costs per participant were higher via community pharmacy which was attributable to better attendance at sessions among community pharmacy participants than among GP participants. The My Choice Weight Management Programme produced modest reductions in weight at 12 weeks and 9 months. Such programmes may not be sufficient to tackle the obesity epidemic.

Reflective journals:can they be used to identify struggling students?

The ability to identify early failure in knowledge accquisition amongst students is important because it enables tutors to put in place suitable interventions to help struggling students. We hypothesised that if a reflective learning journal is a useful learning tool, there ought to be relationship between the type of journal entries and the depth of knowledge acquisition. Our research question is: can reflectiuve journals be used to identify struggling students? Previous work with reflective journals has not related the level of reflection with module outcomes obtained by the student. In our study, we have classified journal entries written by first year students in a foundationalprogramming module based on the SOLO taxonomy and compared this against the outcomes of two module assessments. Our results suggest that there is potential for using reflective journals to identify struggling stuidents in first year programming.

On the Relationships Among Quantified Autoepistemic Logic, its Kernel, and Quantified Reflective Logic

A Quantified Autoepistemic Logic is axiomatized in a monotonic Modal Quantificational Logic whose modal laws are slightly stronger than S5. This Quantified Autoepistemic Logic obeys all the laws of First Order Logic and its L predicate obeys the laws of S5 Modal Logic in every fixed-point. It is proven that this Logic has a kernel not containing L such that L holds for a sentence if and only if that sentence is in the kernel. This result is important because it shows that L is superfluous thereby allowing the ori ginal equivalence to be simplified by eliminating L from it. It is also shown that the Kernel of Quantified Autoepistemic Logic is a generalization of Quantified Reflective Logic, which coincides with it in the propositional case.

Representing Reflective Logic in Modal Logic

The nonmonotonic logic called Reflective Logic is shown to be representable in a monotonic Modal Quantificational Logic whose modal laws are stronger than S5. Specifically, it is proven that a set of sentences of First Order Logic is a fixed-point of the fixed-point equation of Reflective Logic with an initial set of axioms and defaults if and only if the meaning of that set of sentences is logically equivalent to a particular modal functor of the meanings of that initial set of sentences and of the sentences in those defaults. This result is important because the modal representation allows the use of powerful automatic deduction systems for Modal Logic and because unlike the original Reflective Logic, it is easily generalized to the case where quantified variables may be shared across the scope of the components of the defaults thus allowing such defaults to produce quantified consequences. Furthermore, this generalization properly treats such quantifiers since all the laws of First Order Logic hold and since both the Barcan Formula and its converse hold.

On the Relationship between Quantified Reflective Logic and Quantified Default Logic

Reflective Logic and Default Logic are both generalized so as to allow universally quantified variables to cross modal scopes whereby the Barcan formula and its converse hold. This is done by representing both the fixed-point equation for Reflective Logic and the fixed-point equation for Default both as necessary equivalences in the Modal Quantificational Logic Z. and then inserting universal quantifiers before the defaults. The two resulting systems, called Quantified Reflective Logic and Quantified Default Logic, are then compared by deriving metatheorems of Z that express their relationships. The main result is to show that every solution to the equivalence for Quantified Default Logic is a strongly grounded solution to the equivalence for Quantified Reflective Logic. It is further shown that Quantified Reflective Logic and Quantified Default Logic have exactly the same solutions when no default has an entailment condition.

Integrating service user and practitioner expertise within a web-based system for collaborative mental-health risk and safety management

Objectives: To develop a decision support system (DSS), myGRaCE, that integrates service user (SU) and practitioner expertise about mental health and associated risks of suicide, self-harm, harm to others, self-neglect, and vulnerability. The intention is to help SUs assess and manage their own mental health collaboratively with practitioners. Methods: An iterative process involving interviews, focus groups, and agile software development with 115 SUs, to elicit and implement myGRaCE requirements. Results: Findings highlight shared understanding of mental health risk between SUs and practitioners that can be integrated within a single model. However, important differences were revealed in SUs' preferred process of assessing risks and safety, which are reflected in the distinctive interface, navigation, tool functionality and language developed for myGRaCE. A challenge was how to provide flexible access without overwhelming and confusing users. Conclusion: The methods show that practitioner expertise can be reformulated in a format that simultaneously captures SU expertise, to provide a tool highly valued by SUs. A stepped process adds necessary structure to the assessment, each step with its own feedback and guidance. Practice Implications: The GRiST web-based DSS (www.egrist.org) links and integrates myGRaCE self-assessments with GRiST practitioner assessments for supporting collaborative and self-managed healthcare.