Factors influencing PRN medication use in nursing homes

Objective: To identify determinants of PRN ( as needed) drug use in nursing homes. Decisions about the use of these medications are made expressly by nursing home staff when general medical practitioners (GPs) prescribe medications for PRN use. Method: Cross-sectional drug use data were collected during a 7-day window from 13 Australian nursing homes. Information was collected on the size, staffing-mix, number of visiting GPs, number of medication rounds, and mortality rates in each nursing home. Resident specific measures collected included age, gender, length of stay, recent hospitalisation and care needs. Main outcome measures: The number of PRN orders prescribed per resident and the number of PRN doses given per week averaged over the number of PRN medications given at all in the seven-day period. Results: Approximately 35% of medications were prescribed for PRN use. Higher PRN use was found for residents with the lower care needs, recent hospitalisation and more frequent doses of regularly scheduled medications. With increasing length of stay, PRN medication orders initially increased then declined but the number of doses given declined from admission. While some resident-specific characteristics did influence PRN drug use, the key determinant for PRN medication orders was the specific nursing home in which a resident lived. Resident age and gender were not determinants of PRN drug use. Conclusion: The determinants of PRN drug use suggest that interventions to optimize PRN medications should target the care of individual residents, prescribing and the nursing home processes and policies that govern PRN drug use.

Paediatric telecardiology services in Queensland: a review of three years' experience

Videoconferencing at 384 kbit/s for the transmission of echocardiograms has proved useful for the assessment of children with suspected cardiac disease, in regional areas of Queensland. A retrospective review of patient and management outcomes was conducted on cardiac teleconsultations performed at two regional hospitals during the period November 2000 to February 2004, inclusive. There were 106 echo studies. A subset of 72 cardiac teleconsultations performed between May 2001 and February 2004 was reviewed in detail. The median age of patients at the time of consultation was 3 months (range 1 day-17 years). Sixteen per cent of teleconsultations were classified as urgent and were conducted on the same day as referral. Following the videoconference, 90% of patients could be managed locally and reviewed by the paediatrician or visiting paediatric cardiologist during an outreach clinic. Six children (8%) had significant cardiac lesions that were initially managed locally, with subsequent elective transfer at the appropriate time for treatment. Only one child (1%) required urgent transfer to the tertiary centre for specialist care and surgery. Telecardiology was effective in accurately identifying congenital heart disease. Paediatric telecardiology is an evolving modality of assessment and communication, and is likely to result in continued improvements in patient care, patient outcomes and parental satisfaction, in provincial centres removed from the tertiary cardiac centre.

Promoting physical activity in Australian general practices: a randomised trial of health promotion advice versus hypertension management

A randomised controlled trial was conducted to determine if physicians' advice to promote physical activity to patients was more effective if the advice was tailored to the management of hypertension, compared with more general health promotion advice. Participants included inactive 40- to 70-year-old patients visiting the physicians' during study recruitment period. Physicians provided verbal physical activity advice and written materials, both tailored to either general health promotion messages or specifically as a means for treating or managing hypertension. Seventy-five physicians and 98% (767/780) of screened eligible patients participated in the study. Differences between intervention and control groups self-reported physical activity were assessed over 6 months. Follow-up response rates were 92 and 84% at the 2- and 6-month assessments. There were no consistent, significant differences between groups at the 2- or 6-month assessments. Thus, neither intervention strategy resulted in significant changes in patients self-reported physical activity, regardless of the whether the advice was tailored to hypertension management or general health promotion advice. (c) 2004 Elsevier Ireland Ltd. All rights reserved.

Exploring the usefulness of a consumer activity index in the sponsorship-linked marketing context

Despite the now well developed use of sponsorship-linked marketing, there have been few methodological advances in the measurement of sponsorship constructs and outcomes. This paper offers a preliminary development of an activity index for use in the sponsorship marketing context. The activity index seeks to capture the consumer's extended experience with sport (rugby) and considers the relationship of this overall experience to sponsorship-related outcomes of interest. Initial development of the index, based on a convenience sample of 108 people visiting a sports centre, shows promise.

Medication management at home: medication risk factor prevalence and inter-relationships

Background and objective: Patients can have medication-related risk factors associated with poor health outcomes that become evident through visiting them in their homes. These medication-related risk factors may not be apparent in pharmacy and general practitioner (GP) records. The aim was to determine the prevalence and inter-relationships of medication-related risk factors for poor patient health outcomes identifiable through 'in-home' observations. Methods: The design was a cross-sectional study of 204 general practice patients living in their own homes and at risk of medication-related poor health outcomes. Medication-related risk factors were identified in the patients' homes by community pharmacists and GPs. Results and discussion: The prevalence of risk factors varied from 8.3% (multiple medication storage locations) to 55.9% (confused by generic and trade names). There were many relationships observed between the medication-related risk factors, with expired medication having the most relationships with other risk factors followed by therapeutic duplication and poor adherence (9, 6 and 6 relationships respectively). Conclusion: Visiting patients' homes may identify medication-related risk factors not otherwise apparent through patient visits to the health practitioner when medications may be brought for review (i.e. 'brown bag' reviews).

Using special events to motivate visitors to attend art galleries

The contemporary directions of art galleries worldwide are changing as social patterns and demands, as well as visitor expectations of their experiences at art galleries, change. New programs and strategies are being developed in galleries to make these institutions more appealing to people who would not normally visit them, and one such strategy is the staging of special events. However, because galleries are staging an increasing number of special events, the factors motivating visitors to attend these institutions are changing. Visitors hope to have different experiences and encounters in the gallery during special events. This paper presents the findings from a study in Australia about visitors’ motivations to attend special events in galleries. It highlights the different factors that motivate visitors to attend the gallery specifically for a special event in comparison to visiting the gallery's permanent collections.

The evaluation of marketing strategies for the sale of sports goods in Europe

The objectives of this thesis are to examine and evaluate the process of marketing as practiced by an established and successful company in the sports trade, Dunlop Sports Company Ltd. (D.S.C.). In particular the field of strategy formulation for exporting is considered in an operational context, and compared with existing literature and theory on the subject. Market intelligence has been gathered by visiting European territories and pursuing available sources in the United Kingdom. The data now available is intended to act as a base for developing a more effective market research function within D.S.C. At various stages reports have been submitted on specific topics to the Company and this thesis represents the culmination of these reports and an outline for future policies which are open to D.S.C. The thesis chooses certain aspects of marketing and examines the way in which the marketing strategy of the Company appears to act upon these. In particular the topics of Pricing, Distribution and Market Research are considered. Initially a series of alternative market postures are postulated and assessed within the European strategy of D.S.C. Where no explicit strategy is available an implied strategy is identified and evaluated. In chapters on Pricing and Distribution some of the problems being encountered are given detailed consideration and preferred policies arc suggested. In the final chapter the major strengths and weaknesses of of the Company are brought together and the various recommendations summarised in the context of a marketing strategy which would meet some o:f the current difficulties. The emphasis tliroughout is on the effect of strategy formulation, whether or not this appears adequate, and how each of the various operational elements of the marketing mix depend upon this.

Intercultural transfer and artistic innovation:German musicians in Victorian Britain

Throughout the nineteenth century, German classical music production was an aesthetic point of reference for British concert audiences. As a consequence, a sizeable number of German musicians were to be found in Britain as performers, conductors, teachers, musicologists and managers. They acted as agents of intercultural transfer, disseminating performance and organisational practices which had a transformative effect on British musical life. This article moves away from a focus on high-profile visiting artists such as Mendelssohn Bartholdy or Wagner and argues that the extent to which transfer took place can be better assessed by concentrating on the cohort of those artists who remained permanently. Some of these are all but forgotten today, but were household names in Victorian Britain. The case studies have been selected for the range of genres they represent and include Joseph Mainzer (choral singing), Carl Rosa (opera), August Manns, Carl Hallé and Julius Seligmann (orchestral music), and Friedrich Niecks (musicology). On a theoretical level, the concept of ‘intercultural transfer’ is applied in order to determine aspects such as diffusion, adaptation or sustainability of artistic elements within the new cultural context. The approach confirms that ‘national’ cultures do not develop indigenously but always through cross-national interaction. Während des neunzehnten Jahrhunderts war die klassische Musikszene Deutschlands ästhetischer Bezugpunkt für das britische Konzertpublikum. Dies hatte zur Folge, dass vermehrt Deutsche als Musiker, Dirigenten, Lehrer, Musikwissenschaftler und Manager in Großbritannien tätig wurden. Sie fungierten als Vermittler interkulturellen Transfers, indem sie aufführungs- und organisationstechnische Praktiken verbreiteten und damit zu einer Transformation des britischen Musiklebens beitrugen. Vorliegender Artikel konzentriert sich weniger auf bekannte Künstler mit kurzfristigen Engagements (z. B. Mendelssohn Bartholdy, Wagner), und argumentiert vielmehr, dass sich das Ausmaß des Transfers besser über solche Musiker feststellen lässt, die sich längerfristig ansiedelten. Einige davon waren allgemein bekannte Persönlichkeiten im Königreich, sind heute aber vergessen. Die Auswahl der Fallstudien gibt einen Überblick über verschiedene Gattungen und beinhaltet Joseph Mainzer (Chorgesang), Carl Rosa (Oper), August Manns, Carl Hallé und Julius Seligmann (Orchestermusik), sowie Friedrich Niecks (Musikwissenschaft). Auf der Theorieebene wird das Konzept des ‘interkulturellen Transfers’ herangezogen, um Aspekte wie Diffusion, Anpassung oder Nachhaltigkeit künstlerischer Elemente im neuen kulturellen Kontext zu beleuchten. Der Ansatz bestätigt, dass sich ‘nationale’ Kulturen nicht indigen entwickeln sondern immer im Austausch mit anderen Kulturen

The management of ocular allergy in community pharmacies in the United Kingdom

Background Ocular allergies frequently present in pharmacy practices. However, research into the actual management of ocular allergy in pharmacies is lacking. Objective To determine and quantify history and symptom questioning of a patient with presumed allergic conjunctivitis and management strategies employed by pharmacy staff in the UK. Method A mystery shopper technique was used to simulate an episode of allergic conjunctivitis in 100 community pharmacies across the UK. Results The mean number of questions asked by pharmacy staff to the patient was 3.5 ± 2.6, with a range of 0-10. The most common question was whether the patient had a history of allergies (45 %).Ninety-one percent advised on treatment, with the remaining 9 % directly referring to the patient's general practitioner (n = 4) or pharmacist(n = 4), but only two to their optometrist. The most common treatment suggested was sodium cromoglycate 2 % (50 %). However, many pharmacies advising treatment did not ask the patient's age (37 %), if they wore contact lenses (43 %), or gave dosage advice (43 %). Only 5 % of pharmacies advised follow up and 14 % suggested visiting a general practitioner and 1 % an optometrist if symptoms did not resolve with treatment. Conclusion There is a need for improved ophthalmological training for pharmacy staff with respect to the management of allergic conjunctivitis. © Springer Science+Business Media Dordrecht 2012.

Impact of suspected food allergy on emotional distress and family life of parents prior to allergy diagnosis

Background: Food allergy is associated with psychological distress in both child and parent. It is unknown whether parental distress is present prior to clinical diagnosis or whether experiences at clinic can reduce any distress present. This study aimed to assess anxiety and depression in parents and the impact of suspected food allergy on the lives of families before and after a visit to an allergy clinic. Methods: One hundred and twenty-four parents visiting an allergy clinic for the first time to have their child assessed for food allergy completed a study-specific questionnaire and the Hospital Anxiety and Depression Scale; 50 parents completed these 4-6 wk later in their own home. Results: Most parents (86.4%) reported suspected food allergy had an impact on their family life prior to clinic attendance; 76% had made changes to their child's diet. 32.5% of parents had mild-to-severe anxiety before their clinic visit; 17.5% had mild-to-moderate depression. Post-clinic, 40% had mild-to-severe anxiety; 13.1% had mild-to-moderate depression. There were no significant differences in anxiety (p = 0.34) or depression scores (p = 0.09) before and after the clinic visit. Conclusions: Anxiety and depression is present in a small proportion of parents prior to diagnosis of food allergy in their child and this does not reduce in the short term after the clinic visit. Identification of parents at risk of suffering from distress is needed and ways in which we communicate allergy information before and at clinic should be investigated to see if we can reduce distress. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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.

Stability of Supporting and Exposing Elements of Convex Sets in Banach Spaces

* This work was supported by the CNR while the author was visiting the University of Milan.

Sufficient Conditions of Optimality for Control Pproblem Governed by Variational Inequalities

* This work was completed while the author was visiting the University of Limoges. Support from the laboratoire “Analyse non-linéaire et Optimisation” is gratefully acknowledged.

Paronyms for Accelerated Correction of Semantic Errors

* Work done under partial support of Mexican Government (CONACyT, SNI), IPN (CGPI, COFAA) and Korean Government (KIPA Professorship for Visiting Faculty Positions). The second author is currently on Sabbatical leave at Chung-Ang University.

Work placements in doctoral research training in the humanities:eight cases from translation studies

Research cooperation between academic and nonacademic institutions tends not to concern the humanities, where mutual financial rewards are mostly not in evidence. The study of eight nonacademic placements of doctoral researchers working on interlingual translation nevertheless indicates some degree of success. It is found that the placements lead to ongoing cooperation when the following conditions are met: 1) the nature of the placement is understood and relations of trust are established; 2) mutual benefits are envisaged; and 3) there are prior arrangements for receiving visiting researchers. A placement can be successful even when one of the last two factors is missing. Further, the measure of success for placements in the humanities should concern social and symbolic benefits, in addition to financial profits.