What is the new medicines use review ‘patient survey’ attempting to capture in the context of existing patient satisfaction with pharmacy questionnaires and a new conceptual framework?

The community pharmacy service medicines use review (MUR) was introduced in 2005 ‘to improve patient knowledge, concordance and use of medicines’ through a private patient–pharmacist consultation. The MUR presents a fundamental change in community pharmacy service provision. While traditionally pharmacists are dispensers of medicines and providers of medicines advice, and patients as recipients, the MUR considers pharmacists providing consultation-type activities and patients as active participants. The MUR facilitates a two-way discussion about medicines use. Traditional patient–pharmacist behaviours transform into a new set of behaviours involving the booking of appointments, consultation processes and form completion, and the physical environment of the patient–pharmacist interaction moves from the traditional setting of the dispensary and medicines counter to a private consultation room. Thus, the new service challenges traditional identities and behaviours of the patient and the pharmacist as well as the environment in which the interaction takes place. In 2008, the UK government concluded there is at present too much emphasis on the quantity of MURs rather than on their quality.[1] A number of plans to remedy the perceived imbalance included a suggestion to reward ‘health outcomes’ achieved, with calls for a more focussed and scientific approach to the evaluation of pharmacy services using outcomes research. Specifically, the UK government set out the main principal research areas for the evaluation of pharmacy services to include ‘patient and public perceptions and satisfaction’as well as ‘impact on care and outcomes’. A limited number of ‘patient satisfaction with pharmacy services’ type questionnaires are available, of varying quality, measuring dimensions relating to pharmacists’ technical competence, behavioural impressions and general satisfaction. For example, an often cited paper by Larson[2] uses two factors to measure satisfaction, namely ‘friendly explanation’ and ‘managing therapy’; the factors are highly interrelated and the questions somewhat awkwardly phrased, but more importantly, we believe the questionnaire excludes some specific domains unique to the MUR. By conducting patient interviews with recent MUR recipients, we have been working to identify relevant concepts and develop a conceptual framework to inform item development for a Patient Reported Outcome Measure questionnaire bespoke to the MUR. We note with interest the recent launch of a multidisciplinary audit template by the Royal Pharmaceutical Society of Great Britain (RPSGB) in an attempt to review the effectiveness of MURs and improve their quality.[3] This template includes an MUR ‘patient survey’. We will discuss this ‘patient survey’ in light of our work and existing patient satisfaction with pharmacy questionnaires, outlining a new conceptual framework as a basis for measuring patient satisfaction with the MUR. Ethical approval for the study was obtained from the NHS Surrey Research Ethics Committee on 2 June 2008. References 1. Department of Health (2008). Pharmacy in England: Building on Strengths – Delivering the Future. London: HMSO. www. official-documents.gov.uk/document/cm73/7341/7341.pdf (accessed 29 September 2009). 2. Larson LN et al. Patient satisfaction with pharmaceutical care: update of a validated instrument. JAmPharmAssoc 2002; 42: 44–50. 3. Royal Pharmaceutical Society of Great Britain (2009). Pharmacy Medicines Use Review – Patient Audit. London: RPSGB. http:// qi4pd.org.uk/index.php/Medicines-Use-Review-Patient-Audit. html (accessed 29 September 2009).

A retrospective audit of medicines use review forms

The medicines use review (MUR) service was introduced in England and Wales in 2005 to improve patients’ knowledge and use of medicines through a private, patient–pharmacist consultation. The pharmacist completes a standard form as a record of the MUR consultation and the patient receives a copy. The 2008 White Paper, Pharmacy in England[1] notes some MURs are of poor or questionable quality and there are anecdotal reports that pharmacists elect to conduct ‘easy’ MURs with patients on a single prescribed medicine only.[2] In 2009, the Royal Pharmaceutical Society of Great Britain (RPSGB) launched a multi-disciplinary audit template to review the effectiveness of MURs and improve their quality.[3] Prior to this, we conducted a retrospective MUR audit in a 1-month period in 2008. Our aims were to report on findings from this audit and the validity of using MUR forms as data for audit.

Evaluating canalside hedgerows to determine future interventions

This paper describes a project undertaken during 2001/2002 which developed a method for valuing hedgerows adjacent to the inland waterway network of Great Britain. The method enables the landowner, British Waterways, to manage their valuable environmental asset to achieve a good level of biodiversity and robust habitat balanced against the heavy amenity use the 3000 km canal network endures. Valuation techniques were developed using a combination of new and existing ecological indices for components of biodiversity, hedgerow structure and amenity, and synthesised into an index in an innovative combined approach. The resultant index was then applied to a sample 20 km section of hedge alongside the Grand Union Canal in Southeast England. The results obtained reflect the hedgerows' present value, and highlight factors that might improve or limit their future increase in value. The results from the case study application also demonstrate that there is a positive relationship between hedgerow structure and biodiversity, and that hedgerows in urban areas are less biodiverse and structurally sound than those in rural areas. Furthermore, there is a zone within rural areas influenced by the adjacent urban areas and/or higher amenity use. The paper concludes with an assessment of the approaches' strengths and weaknesses with a view to its compatibility with other hedgerow evaluations, such as HEGS, its use by other agencies or landowners, and to aid hedgerow management and future development. (C) 2004 Elsevier Ltd. All rights reserved.

Determinants of biosecurity behaviour of British cattle and sheep farmers: a behavioural economics analysis

The paper analyses the impact of a priori determinants of biosecurity behaviour of farmers in Great Britain. We use a dataset collected through a stratified telephone survey of 900 cattle and sheep farmers in Great Britain (400 in England and a further 250 in Wales and Scotland respectively) which took place between 25 March 2010 and 18 June 2010. The survey was stratified by farm type, farm size and region. To test the influence of a priori determinants on biosecurity behaviour we used a behavioural economics method, structural equation modelling (SEM) with observed and latent variables. SEM is a statistical technique for testing and estimating causal relationships amongst variables, some of which may be latent using a combination of statistical data and qualitative causal assumptions. Thirteen latent variables were identified and extracted, expressing the behaviour and the underlying determining factors. The variables were: experience, economic factors, organic certification of farm, membership in a cattle/sheep health scheme, perceived usefulness of biosecurity information sources, knowledge about biosecurity measures, perceived importance of specific biosecurity strategies, perceived effect (on farm business in the past five years) of welfare/health regulation, perceived effect of severe outbreaks of animal diseases, attitudes towards livestock biosecurity, attitudes towards animal welfare, influence on decision to apply biosecurity measures and biosecurity behaviour. The SEM model applied on the Great Britain sample has an adequate fit according to the measures of absolute, incremental and parsimonious fit. The results suggest that farmers’ perceived importance of specific biosecurity strategies, organic certification of farm, knowledge about biosecurity measures, attitudes towards animal welfare, perceived usefulness of biosecurity information sources, perceived effect on business during the past five years of severe outbreaks of animal diseases, membership in a cattle/sheep health scheme, attitudes towards livestock biosecurity, influence on decision to apply biosecurity measures, experience and economic factors are significantly influencing behaviour (overall explaining 64% of the variance in behaviour).

English Contract Law and the Great War: the development of a doctrine of frustration

This article examines changes that occurred in English contract law as a result of the demands made upon Great Britain by the Great War. The focus is on the development of the doctrine of frustration in English law. In particular, it is argued that the development of the doctrine of frustration was fashioned from internal legal forces in the form of both existing case law and emergency legislation in response to the demands placed upon the nation by a global war. The way in which the doctrine of frustration developed during the Great War arose as a direct result of the way in which Britain chose to meet the logistical demands created by the way it fought the Great War.

Exercising the self : On the Role of Exercise, Gender and Culture in Physical Self-Perceptions

In modern society, individuals constantly pass judgments on their own body and physical competence as well as that of other people. All too often, the verdict is less favourable. For the person, these physical self-perceptions (PSP) may negatively affect global self-esteem, identity, and general mental well being. The overall aim of this thesis is to examine primarily the role that exercise, but also the roles that gender and culture, play in the formation of PSP. In Study I, using confirmatory factor analyses, strong support for the validity of a first-order, and a second-order hierarchical and multidimensional model of the Physical Self-Perception Profile (PSPP: Fox & Corbin, 1989) was found across three national samples (Great Britain, Sweden and Turkey) of university students. Cross-cultural differences were detected, with the British sample demonstrating higher latent means on all PSPP subdomains except for the physical condition subdomain (Condition), than the Swedish and Turkish samples. In Study II, a higher self-reported exercise frequency was associated with more positive PSP (in particular for Condition) and more importance attributed to PSP in Swedish university students. Males demonstrated higher overall PSPP-scores than females. In Study III, a true-experimental design with randomisation into an intervention and a control group was adopted. Strong support for the effects of an empowerment-based exercise intervention programme on PSP and social physique anxiety (SPA) over six months for adolescent girls was found. The relations of exercise, gender and culture with PSP, SPA and self-esteem are discussed from the standpoints of a variety of theoretical models (the EXSEM-model), and frameworks (self-presentation and objectification theory). The two theories of self-enhancement and skill-development are examined with regard to the direction of the exercise-physical self relationship and motivation for exercise. Arguments for the relevance of exercise and PSP for practitioners in promoting general mental well-being and preventing modern-day diseases are outlined.

The gap between recognition and the 'compensation business' : the claim against Britain for compensation by Kenya's former Mau Mau fighters

During the first Kibaki administration (2002-2007), a movement by the former Mau Mau fighters demanded recognition for the role that they had played in the achievement of independence. They began to demand, also, monetary compensation for past injustices. Why had it taken over 40 years (from independence in 1963) for the former Mau Mau fighters to initiate this movement? What can be observed as the outcome of their movement? To answer these questions, three different historical currents need to be taken into account. These were, respectively, changing trends in the government of Kenya, progress in historical research into the actual circumstances of colonial control, and a realization, based on mounting experience, that launching a legal action against Britain could turn out to be a lucrative initiative. This paper concludes that, regardless of the actual purpose of the legal case, neither of their objectives was certain to be achieved. Two inescapable realities remain: the doubts cast on the reputation of the government by its decision to lift the Mau Mau‟s outlaw status – a decision that was widely seen as a latter-day example of the „Kikuyu favouritism‟ policy followed by the first Kibaki administration – and the popular interpretation of the involvement of Leigh Day, well known in Kenya ever since the unexploded bombs case for its success in obtaining substantial compensation payments, as a vehicle for squeezing large amounts of money from the British government for the benefit of the Kikuyu people.

Reviews

Contiene: Jussawalla, Feroza (2003): Chiffon Saris. Toronto: TSAR Publications, 92 pages / Reviewed by Silvia Caporale Bizzini; Fernández Álvarez; M. Pilar and Antón Teodoro Manrique (2002): Antología de la literatura nórdica antigua. Salamanca: Ediciones Universidad / Reviewed by José R. Belda; Schwarlz, Anja (2001). The (im)possibilities of machine translation. Peter Lang. Frankfurt am Main. 323 pages / Reviewed by Silvia Borrás Giner; Terttu Nevalainen and Helena Raumolin-Brunberg (2003): Historical Sociolinguistics: Language Change in Tudor and Stuart England. Great Britain: Pearson Education, 260pages / Reviewed by Sara Ponce Serrano.Contiene: Jussawalla, Feroza (2003): Chiffon Saris. Toronto: TSAR Publications, 92 pages / Reviewed by Silvia Caporale Bizzini; Fernández Álvarez; M. Pilar and Antón Teodoro Manrique (2002): Antología de la literatura nórdica antigua. Salamanca: Ediciones Universidad / Reviewed by José R. Belda; Schwarlz, Anja (2001). The (im)possibilities of machine translation. Peter Lang. Frankfurt am Main. 323 pages / Reviewed by Silvia Borrás Giner; Terttu Nevalainen and Helena Raumolin-Brunberg (2003): Historical Sociolinguistics: Language Change in Tudor and Stuart England. Great Britain: Pearson Education, 260pages / Reviewed by Sara Ponce Serrano.

A catechism geographical, historicall and chronologicall

Notebook of unlined pages holding a handwritten copy of Tutor Flynt's "Catechism" copied by Harvard student Hull Abbot (1702-1774, Harvard AB 1720). The volume lists questions and accompanying answers on various academic subjects.

A catechism geographicall, historical and chronologicall 1719

Notebook of unlined pages with paper marbled cover holding a handwritten copy of Tutor Flynt's "Catechism" likely copied by Harvard student John Wolcott in 1719. The volume lists questions and accompanying answers on various academic subjects. On the last page, the inscription "John Wolcott [the name is crossed over] his geography, 1719" indicates Wolcott (1702-1747), a member of the Harvard class of 1721, copied the book.

Letter book : manuscript, 1764-1771

Tryon's official letter book containing copies of letters and documents relating to his work as colonial governor of North Carolina; with references concerning drawing a boundary between North Carolina and South Carolina; talks with the Cherokee Indians; the establishment of a postal service; working with the Propagation of the Gospels in Foreign Parts; establishing the Church of England in North Carolina; strengthening the defenses of the colony; maintaining better communication with Great Britain; and other events.

Mathematical notebook, and commonplace book, circa 1689-1769

Manuscript notebook, possibly kept by Harvard students, containing 17th century English transcriptions of arithmetic and geometry texts, one of which is dated 1689-1690; 18th century transcriptions from John Ward’s “The Young Mathematician’s Guide”; and notes on physics lectures delivered by John Winthrop, the Hollis Professor of Mathematics and Natural Philosophy at Harvard from 1738 to 1779. The notebook also contains 18th century reading notes on Henry VIII, Tudor succession, and English history from Daniel Neal’s “The History of the Puritans” and David Hume’s “History of England,” and notes on Ancient history, taken mainly from Charles Rollin’s “The Ancient History of the Egyptians, Carthaginians, Assyrians, Babylonians, Medes and Persians, Macedonians and Grecians.” Additionally included are an excerpt from Plutarch’s “Lives” and transcriptions of three articles from “The Gentleman’s Magazine, and Historical Chronicle,” published in 1769: “A Critique on the Works of Ovid”; a book review of “A New Voyage to the West-Indies”; and “Genuine Anecdotes of Celebrated Writers, &.” The flyleaf contains the inscription “Semper boni aliquid operis facito ut diabolus te semper inveniat occupatum,” a variation on a quote of Saint Jerome that translates approximately as “Always good to do some work so that the devil may always find you occupied.” In the seventeenth and eighteenth centuries, Harvard College undergraduates often copied academic texts and lecture notes into personal notebooks in place of printed textbooks. Winthrop used Ward’s textbook in his class, while the books of Hume, Neal, and Rollin were used in history courses taught at Harvard in the 18th century.