Provision of primary care to patients with chronic cough in the community pharmacy setting

BACKGROUND: Community pharmacies are at the forefront of primary care providers and have an important role in the referral of patients to a medical practitioner for review when necessary. Chronic cough is a common disorder in the community and requires medical assessment. The proficiency of community pharmacy staff to refer patients with chronic cough is currently unknown. OBJECTIVE: To assess the ability of community pharmacy staff to recognize and medically refer patients with a chronic nonproductive cough. METHODS: Following ethics approval, a simulated patient study of 156 community pharmacies in Perth, Western Australia, was conducted over a 3-month period. Simulated patients presented to the pharmacy requesting treatment for a cough. The simulated patient required a referral based on a designated scenario. Demographic details, assessment questions, and advice provided were recorded by the simulated patient immediately postvisit. A logistic regression analysis was performed, with referral for medical assessment as the dependent variable. RESULTS: Of the 155 community pharmacies included in the analysis, 38% provided appropriate medical referral. Cough suppressants were provided as therapy in 72% of all visits. Predictors of medical referral were assessment of symptom duration, medical history, current medications being taken, frequency of reliever use, and the position of the pharmacy staff member conducting the consultation. A third of community pharmacies provided appropriate primary care by recommending medical referral advice to patients with chronic cough. The majority of pharmacy staff members acquired information from the patient that suggested a need for medical referral, yet did not provide referral advice. CONCLUSIONS: Appropriate medical referral is more likely when adequate assessment is undertaken and when a pharmacist is directly involved in the consultation. This highlights the need for pharmacies to ensure that processes are in place for patients to access the pharmacist.

Health promotion for chronic obstructive pulmonary disease

Peter, a 45 year old male, enters the pharmacy and asks, 'do you have something to stop a cough?' On questioning you find out that Peter has an irritating cough that has been off and on for the past few weeks since winter started. He coughs up phlegm every now and then, mostly upon waking. He has tried some cough mixture that he bought at the supermarket but is looking for something stronger. He states that he does not have any medical history or allergies and does not take any medication. He does feel that he can't exercise as much as he used to as he gets more breathless these days.

Illness perceptions predict reassurance following a negative exercise stress testing result

Many patients are not reassured after receiving normal results following cardiac investigations. While previous studies have shown anxiety to be a contributing factor, little research has investigated the influence of patients’ illness perceptions on reassurance. In this study we investigated whether illness perceptions predicted patients’ reassurance following normal exercise stress test results. Sixty-two chest pain patients without prior diagnosed cardiac pathology completed questionnaires assessing anxiety and illness perceptions prior to exercise stress testing. Patients completed a reassurance questionnaire immediately following their appointment and again one month later. Illness perceptions (consequences, timeline, identity, illness concern, and emotional effect) but not anxiety, significantly predicted reassurance immediately following testing. We found both state anxiety and illness perceptions to predict reassurance one month later. After controlling for anxiety, longer timeline and lower treatment control beliefs predicted lower reassurance. The results suggest that an intervention targeting patients who have high anxiety and negative illness perceptions prior to testing may improve reassurance and decrease disability and the subsequent use of medical care.

Connecting a sociology of childhood perspective with the study of child health, illness and wellbeing:introduction

This chapter focuses on concepts and theoretical points of departure found in child health and wellbeing studies. Firstly, seeing children as a social group draws attention to the ways this group is placed and perceived in the structures of societies. Children as a social group need to be understood in relation to other social groups. Secondly, understanding children as social agents and as co-constructors of their social worlds is fundamental to studying their experiences and ways of dealing with health and wellbeing in everyday life. Thirdly, in recent years, there has been a turn towards seeing children as beings. The chapter discusses the child health issues and concerns in contemporary society. Children are diagnosed with an increasing range of conditions and are subject to more and more elaborate child health and welfare interventions, reflecting a medical perspective on the changing panorama of illness and health risks in the 21st century.

Identifying the scope for savings at inpatient episode level:an illustration applying DEA to chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by a largely irreversible obstruction of the airways, and is one of the leading causes of chronic morbidity and mortality worldwide. This paper illustrates the use of Data Envelopment Analysis (DEA) to assess the potential for cost savings at COPD inpatient episode level. The analysis uses the length of stay of each episode as a surrogate for expenditure on that episode while allowing for the medical condition of the patient and the quality of care received. We find substantial possible reductions in length of stay which would translate to cost savings. The paper also explores differences both between hospitals and between care teams within hospitals so that cost efficient protocols of treatment can be identified and disseminated.

Cost of illness in benign prostatic hyperplasia: A review

The paper provides a systematic review on the cost-of-illness studies in an age-associated condition with high prevalence, benign prostatic hyperplasia (BPH), published in Medline between 2005 and 2015. Overall 11 studies were included, which were conducted in 8 countries. In the US, the annual direct medical costs per patient ranged from $255 to $5,729, while in Europe from €253 to €1,251. In 2008, in the UK total annual direct medical costs of BPH were £180.8 million at national level. In the US, overall costs of BPH management in the private sector were estimated at $3.9 billion annually, of which $500 million was attributable to productivity loss (year 1999). Due to demographic factors and possible surgical innovations in the field of urology, the costs of BPH are likely to increase in the future. Over the next decade the age of retirement is projected to rise, consequently, the indirect costs related to aging-associated conditions such as BPH are expected to soar. To promote the transparent and cost-effective management of BPH, development of rational clinical guidelines would be essential that may lead to significant improvement in quality of care as well as reduction in healthcare expenditure.

Relation of health related hardiness to health perception and psychosocial adaptation in adult hispanics with chronic hepatitis C

The purpose of this study was to investigate the role of hardiness in health perception and psychosocial adaptation in adult hispanics with chronic hepatitis C (n = 32). The Health Related Hardiness Scale and the Psychosocial Adaptation to Illness Scale were administered to 32 adult hispanics diagnosed with chronic heptitis C at a gastroenterology center. The results indicate that a comparison of subjects with low and high hardiness scores did not reveal significant differences on any of the PAIS domains (health care orientation, sexual relationships, psychological distress, vocational, domestic and social environments). Furthermore, hardiness subscales of control and committment did not have any influence on patient's psychosocial adaptation nor in its domains. However, a comparison of subjects with low and high challenge scores indicates that those with low challenge had lower total psychosocial adaptation scores (M = 5.55, SD = 2.13) than subjects with high challenge scores (M = 4.24, SD = .67) ,t = (1, 30) = 2.34, p < 0.05. Differences were also found for the domains of health care orientation, psychological distress, social and vocational environment. Lastly, there were significant differences on perceived health rating (poor, fair, and good) for the total hardiness score (F = (2,29) =5.49, p < 0.05), control (F =(2,29) = 4.09, p < 0.05), committment (F=(2,29) = 3.76, p < 0.05) and challenge (F=(2,29)= 4.92, p < 0.05). Thus, those patients who rated their health as poor had lower hardiness levels. Findings have implications for promoting hardiness for better health perception and in certain aspects of psychosocial adaptations in adult hispanics with chronic hepatitis C.

A crença sobre a morte e o coping religioso-espiritual em pacientes internados com doenças crônicas

The human being is understood as an integral being, complex, which has multiple dimensions: social, biological, psychological, anthropological, spiritual and others. As its biological dimension, the man presents the possibility of physical illness, which means that the body requires care. The sick away from humans in health and safety conditions, approaching them directly from the finitude and vulnerability condition, leading us to contact the major uncertainties of life: suffering of disease and death. Religiosity and spirituality are important coping strategy for human when faced with borderline situations. When people turn to religion to cope with stress is the religious and spiritual coping. The objective of this research was to evaluate the relationship between the views on death and the religious-spiritual coping in patients with chronic diseases hospitalized. The study included ten patients hospitalized for chronic disease complications Medical Clinic Unit of a public hospital in the city of Uberlândia/MG. two psychological scales were used: Scale Religious-Spiritual Coping Brief (CRE-Brief Scale) and Scale Brief Diverse Perspectives of Death and a structured interview (audiogravada) on the subject of death and religious and spiritual coping. The results indicated that 80% of the sample (N = 8) consisted of patients hospitalized due to chronic diseases, while 20% accounted for patients with AIDS complications. Analyzing the results of scale CRE-Brief, it emphasizes the use of strategies of religious and spiritual coping by participants as compared to CRE Total, all study participants had average or high scores for this index, with a low utilization CRE negative and average utilization CRE Positive. Regarding views on death, the results obtained by the Different Perspectives Quick Scale on Death suggest that this sample agrees with the view death as something that is part of the natural cycle of life (M8 - Death as a natural end) and features the prospect of death as uncertainty, mystery and ignorance (M4 - death as Unknown). The correlations between the measures the factors and items of CRE-Bref and dimensions of Short scales on different perspectives of Death notes the prevalence of correlations of M4 dimensions - Death as unknown and M8 - Death as a natural order to the creditor scale soon. In the interview analysis revealed a positive influence of religion/ spirituality on health, from the perspective of the respondent, highlighting the protection promoted by religion. It also noticed the use of prayer as a coping strategy of hospitalization and illness. Regarding the interview about the topic of death, there was a predominance of issues related to "afterlife", "unknown" and "abandonment", which are associated with the visions of death and mystery and death as a natural end. In the interviews there belief clues about death as a terrifying mystery connected, so the unknown and the feeling of fear on the same. The experience of illness can therefore be considered as a source of vulnerability, since it is present personal perception of danger (external) - own illness and possible death, especially in those patients undergoing ICU - and where control is insufficient for the sense of security, since the hospital providing care to the patient are delegated to third parties and patients assume a passive role. This fact is important and relevant to health professionals who deal daily with patients hospitalized for chronic diseases, since the recourse to religion and spirituality as a coping strategy that psychic movement was not constituted in a form of negative distance or even denial of health condition. On the contrary, it refers to a movement in search of comfort and security provided by the religion and spirituality.

Prevalence of chronic pain in the UK : a systematic review and meta-analysis of population studies

Acknowledgements The authors are grateful for the input of Professor Blair Smith (University of Dundee): his counsel early in the project, and his advice and comments regarding the search strategy; and Professor Danielle van der Windt (Keele University) for helpful advice and comments. Funding The British Pain Society provided financial assistance to AF with the costs of this project. PC was partly supported by an Arthritis Research UK Primary Care Centre grant (reference: 18139).

Looking to the future : Predicting renal replacement outcomes in a large community cohort with chronic kidney disease

Peer reviewed

Looking to the future : Predicting renal replacement outcomes in a large community cohort with chronic kidney disease

Peer reviewed

Decreased Cell Wall Galactosaminogalactan in Aspergillus nidulans Mediates Dysregulated Inflammation in the Chronic Granulomatous Disease Host

Author Disclosure Statement No competing financial interests exist.

Is alcohol consumption related to likelihood of reporting chronic widespread pain in people with stable consumption? : Results from UK Biobank

Acknowledgements This research has been conducted using the UK Biobank resource, and was funded by the University of Aberdeen. The authors have no conflicts of interest to declare.

Chronic pelvic pain in women of reproductive and post-reproductive age : a population-based study

Abimbola Ayorinde’s PhD funded by the Medical Research Council. This study was funded by the British Pain Society (Mildred Clulow Award) and preparatory work by National Health Service Grampian.

Historical cohort study examining comparative effectiveness of albuterol inhalers with and without integrated dose counter for patients with asthma or chronic obstructive pulmonary disease

This study was supported financially by an unrestricted grant from Teva Pharmaceuticals, Frazer, PA, USA. The authors thank Jenny Fanstone of Fanstone Medical Communications Ltd., UK, and Elizabeth V Hillyer for medical writing support, funded by Research in Real-Life. We acknowledge with gratitude Dr Ruchir Parikh for his review of and contributions to the manuscript.