scholarly journals Task Shifting, Midwifery Empowerment and the Nascence of Clinical Pharmacy

2020 ◽  
pp. 103-127
Author(s):  
Louise Ackers ◽  
Gavin Ackers-Johnson ◽  
Joanne Welsh ◽  
Daniel Kibombo ◽  
Samuel Opio
Keyword(s):  
Clinical Pharmacy ◽  
Task Shifting ◽  
Structural Impact ◽  
Laboratory Results ◽  
Hospital Policies ◽  
Prescribing Behaviour ◽  
The Impact ◽  
Optimal Change ◽  
Multi Disciplinary Team ◽  
Procurement Planning

AbstractThis chapter addresses the role that the intervention has played in shaping professional engagement within the multi-disciplinary team. The existence of laboratory results has triggered the emergence of clinical pharmacy roles. The chapter traces the impact of this on prescribing behaviour and on procurement planning and hospital policies. Whilst celebrating the progress made and viability of the model, it describes the structural impact that access to antibiotics and IPC supplies has on the realisation of optimal change.

scholarly journals COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic Referrals

2020 ◽  
Vol 47 (5) ◽  
pp. 693-696 ◽  
Author(s):  
Maria Bres Bullrich ◽  
Sebastian Fridman ◽  
Jennifer L. Mandzia ◽  
Lauren M. Mai ◽  
Alexander Khaw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Stroke Prevention ◽  
Stroke Unit ◽  
Emergency Department Visits ◽  
Related Factors ◽  
Hospital Policies ◽  
The Government ◽  
Stroke Center ◽  
The Impact ◽  
Prevention Clinic

Abstract:We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.

Diabetes: The Impact of Clinical Pharmacy Services Integrated into Medical Homes on Diabetes-Related Clinical Outcomes

2010 ◽  
Vol 44 (12) ◽  
pp. 1877-1886 ◽  
Author(s):  
Kathleen A Johnson ◽  
Steven Chen ◽  
I-Ning Cheng ◽  
Mimi Lou ◽  
Paul Gregerson ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Pharmacy ◽  
Pharmacy Services ◽  
Clinical Pharmacy Services ◽  
Medical Homes ◽  
The Impact

The measurement of groundwater temperature in shallow piezometers and standpipes

2005 ◽  
Vol 42 (5) ◽  
pp. 1377-1390 ◽  
Author(s):  
Matthew D Alexander ◽  
Kerry TB MacQuarrie
Keyword(s):  
Finite Element ◽  
Statistical Analysis ◽  
Transport Model ◽  
Shallow Groundwater ◽  
Subsurface Temperature ◽  
Groundwater Temperature ◽  
Monitoring Well ◽  
Laboratory Results ◽  
The Impact

Accurate measurements of in situ groundwater temperature are important in many groundwater investigations. Temperature is often measured in the subsurface using an access tube in the form of a piezometer or monitoring well. The impact of standpipe materials on the conduction of heat into the subsurface has not previously been examined. This paper reports on the results of a laboratory experiment and a field experiment designed to determine if different standpipe materials or monitoring instrument configurations preferentially conduct heat into the shallow sub surface. Simulations with a numerical model were also conducted for comparison to the laboratory results. Statistical analysis of the laboratory results demonstrates that common standpipe materials, such as steel and polyvinylchloride (PVC), do not affect temperature in the subsurface. Simulations with a finite element flow and heat transport model also confirm that the presence of access tube materials does not affect shallow groundwater temperature measurements. Field results show that different instrument configurations, such as piezometers and water and air filled and sealed well points, do not affect subsurface temperature measurements.Key words: groundwater temperature, temperature measurement, conduction, piezometers, piezometer standpipes, thermal modelling.

Laboratory investigation results influence Physician’s Global Assessment (PGA) of disease activity in SLE

2020 ◽  
pp. annrheumdis-2019-216753 ◽  
Author(s):  
Cynthia Aranow ◽  
Anca Askanase ◽  
Shereen Oon ◽  
Molla Huq ◽  
Alicia Calderone ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Global Assessment ◽  
Intraclass Correlation ◽  
Physician Global Assessment ◽  
Systemic Lupus ◽  
Laboratory Test Results ◽  
Laboratory Results ◽  
The Impact

ObjectiveTo evaluate the impact of laboratory results on scoring of the Physician Global Assessment (PGA) of disease activity in systemic lupus erythematosus.MethodsFifty clinical vignettes were presented via an online survey to a group of international lupus experts. For each case, respondents scored the PGA pre and post knowledge of laboratory test results (pre-lab and post-lab PGAs). Agreement between individual assessors and relationships between pre-lab and post-lab PGAs, and PGAs and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) were determined. Respondents were also asked about factors they incorporate into their PGA determinations.ResultsSixty surveys were completed. The inter-rater PGA reliability was excellent (pre-lab intraclass correlation coefficient (ICC) 0.98; post-lab ICC 0.99). Post-lab PGAs were higher than pre-lab PGAs: median (IQR) pre-lab PGA 0.5 (1.05), post-lab PGA 1 (1.3) (p<0.001), with a median (IQR) difference of 0.2 (0.45). In general, all abnormal labs including elevated anti-double stranded DNA antibody level (dsDNA) and low complement impacted PGA assessment. Cases with weakest correlations between pre-lab and post-lab PGA were characterised by laboratory results revealing nephritis and/or haematological manifestations. Both pre-lab and post-lab PGAs correlated with SLEDAI-2K. However, a significantly stronger correlation was observed between post-lab PGA and SLEDAI-2K. Multiple factors influenced PGA determinations. Some factors were considered by an overwhelming majority of lupus experts, with less agreement on others.ConclusionsWe found excellent inter-rater reliability for PGAs in a group of international lupus experts. Post-lab PGA scores were higher than pre-lab PGA scores, with a significantly stronger correlation with the SLEDAI-2K. Our findings indicate that PGA scoring should be performed with knowledge of pertinent laboratory results.

A qualitative literature review exploring the drivers influencing antibiotic over-prescribing by GPs in primary care and recommendations to reduce unnecessary prescribing

2019 ◽  
Vol 141 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Joanna Rose ◽  
Michelle Crosbie ◽  
Antony Stewart
Keyword(s):  
Primary Care ◽  
Antibiotic Resistance ◽  
Literature Review ◽  
External Factors ◽  
Working Environment ◽  
Antibiotic Prescribing ◽  
Main Theme ◽  
Prescribing Behaviour ◽  
The Impact ◽  
Qualitative Literature

Aims: This qualitative literature review aims to critically assess and analyse published literature to determine drivers influencing over-prescribing by general practitioners (GPs) in primary care, exploring their views and opinions, and also to determine how antibiotic prescribing can be improved and unnecessary prescribing reduced, thus reducing the threat to public health from antibiotic resistance. It is intended to develop new thinking in this area and add to existing knowledge concerning GPs’ antibiotic prescribing behaviour. Methods: Thematic analysis following Braun and Clarke’s 2006 framework was used to analyse 17 qualitative studies chosen from EBSCOhost databases, focusing on GPs’ views of antibiotic prescribing in primary care, with specific search strategies and inclusion criteria to ensure study quality and trustworthiness. Results: Three main themes and nine sub-themes were generated from the studies. The first main theme discussed GP factors related to over-prescribing, the main drivers being GP attitudes and feelings and anxiety/fear concerning prescribing. The second theme highlighted external factors, with pressures from time and financial issues as the main drivers within this theme. The final theme marked patient pressure, demand and expectation with lack of patient education as the major drivers affecting GP over-prescribing. Conclusion: The findings of this research show GPs’ antibiotic prescribing in primary care is complex, being influenced by many internal and external factors. A multifaceted approach to interventions targeting the drivers identified could significantly reduce the level of antibiotic prescribing thus minimising the impact of antibiotic resistance and promoting a more efficient working environment for GPs and patients alike.

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