GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland

Objective. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.
Methods. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.
Results. There was an overall response rate of 17.7% (897 respondents—554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.
Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.

Length-weight relationship of benthic bivalves of the Andoni Flats, Niger Delta, Nigeria

The length weight relationship of three benthic bivalves namely, Senilia (= Anadara) senilis (bloody cockle), Tagelus adansonii (knife clam), Tellina nymphalis (soft shell clam) from the Andoni Flats were determined. The bivalves which are of ecological importance were obtained from the intertidal areas of the Andoni Flats. Shell lengths of the bivalves were measured and corresponding dry weight measurements were also taken. The data obtained were then subjected to regression analysis using the FAO-ICLARM Fish Stock Assessment Tools (FiSAT). The length weight relationships obtained from the FiSAT analysis indicated isometric growth for Senilia (= Anadara) senilis, with slope (b) value of 2.942; positive allometric growth for Tagelus adansonii, with a ‘b’ value of 3.395 and negative allometric growth for Tellina nymphalis with ‘b’ value of 2.633. KEYWORDS: bivalves, length-weight, isometric growth, allometric growth, cockle, clam.

THE TERMINATION PHASE: THERAPISTS’ PERSPECTIVE ON THE THERAPEUTIC RELATIONSHIP AND OUTCOME

The termination phase of treatment is recognized as a significant aspect of the therapy process and yet remains vastly understudied in psychotherapy literature. In the present study, therapists’ perspectives were used to examine how three elements of the therapy relationship (working alliance, real relationship and transference) during the termination phase relate to perceived client sensitivity to loss, termination phase evaluation and overall treatment outcome. Self-report data was gathered from 233 therapists, recruited from two Divisions of the American Psychological Association. Therapists completed measures for their work with a client with whom they could identify a termination phase of treatment. Results revealed that the working alliance and real relationship during the termination phase related positively to termination phase evaluation and overall treatment outcome, whereas negative transference during the termination phase related negatively to overall treatment outcome. Therapists’ perceptions of client sensitivity to loss related positively to both negative and positive transference during the termination phase. Post-hoc analyses revealed only the working alliance during the termination phase uniquely predicted overall treatment outcome in a model with the three therapy relationship elements examined together. On the other hand, all three therapy relationship variables during the termination phase uniquely predicted termination phase evaluation, when examined together. Limitations and implications of these findings are discussed, and recommendations for future study are suggested.

Influence of pharmacists expertise on physicians prescription decisions

Purpose: To explore the influence of pharmacist factors on prescription decisions of physicians. Methods: A survey of literature was carried out across online databases and 12 relevant articles were identified. The influence of pharmacist factors on physician prescription decisions was identified in the articles. A conceptual model for investigating pharmacist factors that influence physicians’ prescription decisions was then developed. Results: The main factors identified were pharmacist expertise, pharmacist – physician collaboration, and trust between physician and pharmacist. There was no direct evidence of influence of pharmacist expertise on prescription, but some studies indicated that pharmacist recommendation is in tandem with the prescribing behaviour of physicians. One study reported that pharmacist–physician collaboration positively influenced physicians’ prescribing decision, while others found no relationship between these. Conclusion: Existing literature on the influence of pharmacist factors on prescription behaviour of physicians are limited and debatable. There is no consistency in these studies. Moreover, studies that reported a strong connection between the trustworthiness and pharmacist–physician collaboration in drug prescription lack hard evidence.

Exposure to pesticides, ill health and averting behaviour : costs and determining the relationship

Farmers' exposure to pesticides is high in developing countries. As a result many farmers suffer from ill-health, both short and long term. Deaths are not uncommon. This paper addresses this issue. Field survey data from Sri Lanka are used to estimate farmers' expenditure on defensive behavior (DE) and to determine factors that influence DE. The avertive behavior approach is used to estimate costs. Tobit regression analysis is used to determine factors that influence DE. Field survey data show that farmers' expenditures on DE are low. This is inversely related to high incidence of ill health among farmers using pesticides.

Visitor Relationship Management (VRM) - Repeat Visitation Opportunities for Destination Marketing Organisations

In competitive tourism markets the consumer-traveller is spoilt by choice of available destinations. Successfully differentiating a destination and getting noticed at decision time is arguably the focus of activities by destination marketing organisations (DMOs). In pursuit of differentiation, three emergent themes in the marketing literature during the past decade have been branding, integrated marketing communications (IMC), and customer relationship management (CRM) a fundamental goal of each being stimulating customer loyalty. However there has been little attention given to destination loyalty in the tourism literature. The purpose of this paper is to report an exploratory investigation of visitor relationship management (VRM) by DMOs. Based on interviews with the management of 11 regional tourism organisations (RTO) in Queensland, Australia, the opportunities for, and immediate challenges of, VRM are discussed. While each RTO recognised the potential for VRM, none had yet been able to develop a formal approach to engage in meaningful dialogue with previous visitors from their largest market.