1,721,003 research outputs found
Pharmacist educational interventions for patients with advanced cancer pain living in the community
Full text linkBackground: At the end of life, patients living in their own homes experience significantly more pain than those who die in either hospital or hospice care (Office for National Statistics, 2015). With an increasing prevalence of this, person-centred medicines optimisation is essential.
Aim: To investigate the feasibility of community pharmacist medicines optimisation services for patients living with advanced cancer pain in community settings.
Methods: Mixed methods were used, adopting a pragmatic stance and approach. Qualitative interviews, a systematic review and meta-analysis and a proof-of-concept study were undertaken.
Results: Patients with advanced cancer pain need support with their medicines which could be provided by a pharmacist. Patients experienced a significant number of medicines related problems, even those already receiving specialist palliative care. Most problems were addressed by pharmacist advice with the remainder being referred for additional prescribing.
Care for patients with cancer pain is currently not person-centred and the current medicines optimisation model is unsuitable for this patient group. An enhanced model of medicines optimisation is therefore presented for patients with advanced cancer and this model can be amended and adopted for other patient groups.
Conclusions: An enhanced medicines optimisation model (MOCAP) has been created to inform person-centred medicines optimisation for patients with advanced cancer pain. Feasibility and acceptability were also confirmed and it can be adapted for further clinical use. This model contributes to the goals of the NHS agenda of choice and control of care as proposed in the NHS Long Term Plan (NHS, 2019b)
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Medicines Management after Hospital Discharge: Patients’ Personal and Professional Networks
Full text linkImproving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.University of Bradford studentshi
A mixed-methods exploration of the potential use of pharmacogenomics with patients and healthcare professionals
No full textThis research explores the potential of pharmacogenomic (PGx)-guided care for older patients in secondary care. Using a mixed methods approach, the study demonstrates the efficacy of PGx-guided care for patients aged 65 and above, identifies behaviour change techniques for healthcare professionals to successfully adopt PGx-guided medicines optimisation, and paves the way for future implementation strategies. The research adopted a convergent parallel design, comprised of a systematic review, secondary data analysis of hospital admissions data for older patients and a qualitative interview study with older patients and healthcare professionals. This research provides a proof-of-concept for the use of PGx testing in medicines optimisation, leading to a potential decrease in hospitalisations. Notably, the research showed that 22% of medicines that older hospitalised patients use are PGx-influenced, and exposure to such medicines can help predict the length of hospital stay, unplanned admission and repeat hospitalisation, especially among highly frail patients. The study identified factors critical for implementing PGx, including knowledge, role identity, optimism, intentions, context, and capability beliefs. It highlighted prioritised change techniques such as information about health consequences, behaviour instruction, social support, and outcome goal review as essential guides for PGx champions driving implementation efforts in hospital settings. These findings significantly enhance the understanding of PGx's role in geriatric medicine, providing strategies to overcome potential barriers and suggesting necessary alterations to facilitate its implementation. The study underscores the potential of PGx-guided care to enhance medicines optimisation for older individuals, offering valuable insights to shape policy, practice, and direct future research in this field
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
From hospital to home: a mixed methods exploration of post-discharge medicines management for older people living with long-term conditions
Full text linkThere are numerous threats to medication safety at care transitions, which are
heightened for older people, because they live with multiple long-term
conditions as well as polypharmacy, and have frequent hospital admissions.
Whilst evidence of the severity and scale of these medicines-related problems
exists, there is insufficient detail about the lived experience of post-discharge
medicines management, in particular what helps or what hinders, and how
better support could be enabled. This thesis, underpinned by the Medicines
Research Council framework for complex intervention design, aimed to find
acceptable intervention components, which would enhance patient
experience.
This research followed a sequential, mixed method design to: establish the
evidence base through critical literature review, develop theory using an
interview study grounded in behaviour change theory, and finally to model
potential intervention components by expert consensus. Interviews revealed
that there were gaps in current service provision, which impacted on
participants’ knowledge of and capabilities with their medicines. Despite these
challenges, some participants took actions to safeguard from problems after
discharge. The literature review found that effective components of trialled
interventions were self-management advice, post-discharge telephone follow up and medicines reconciliation. Further behaviour change techniques from
the literature, alongside expert consensus and theory-driven analysis of interview findings resulted in final selection of eight potential components.
Real-world implementation of these must be coupled with key changes to
current healthcare practices and policy, including better engagement with patients and carers, as well as pro-active post-discharge follow-up. Future work must carefully explore how these components can be tested pragmatically
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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