Jane Portlock

Safety of chiropractic manipulation of the cervical spine: a prospective national survey

Study Design. Prospective national survey. Objective. To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors. Summary of Background Data. The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations. Methods. We studied treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as “referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity,” and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment. Results. Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse ≈1 per 10,000 treatment consultations immediately after cervical spine manipulation, ≈2 per 10,000 treatment consultations up to 7 days after treatment and ≈6 per 100,000 cervical spine manipulations. Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse ≈16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse ≈4 per 100, numbness/tingling in upper limbs in, at worse ≈15 per 1000 and fainting/dizziness/light-headedness in, at worse ≈13 per 1000 treatment consultations. Conclusion. Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.

Increasing seasonal influenza vaccination uptake using community pharmacies: experience from the Isle of Wight, England.

Influenza vaccination rates achieved by general medical practice on the Isle of Wight, England, have been consistently lower than regional and national averages despite practices pursuing an active programme of patient engagement. The objective of this work was to determine whether inclusion of community pharmacies in an influenza vaccination programme improves vaccination rates and is acceptable to patients.

The impact of a supplementary medication review and counselling service within the oncology outpatient setting

The impact on the care of breast cancer patients, of a pharmacy technician-led medication review and counselling clinic, provided in an outpatient setting, was investigated using a controlled randomised study. Compared to the controls, clinic patients showed a significantly improved level of understanding of their chemotherapy support medication (95% CI for difference in mean knowledge rating scores=2.165–2.826, P<0.001) and a significant reduction in the median number of support items required (two compared to five in the control, P<0.001). This resulted in a significant reduction in mean medication expenditure per patient (£26.70 vs £10.20, 95% CI for the mean difference in cost £6.72–£26.26, P<0.001). The clinic was also associated with significant reductions in chemotherapy delays (P<0.001) and dose reductions due to side effects (P=0.003). Other benefits from the clinic were a reduction in pharmacy dispensing time and a highly significant reduction in pharmacy time spent resolving post-clinic prescription queries (P<0.001). Taking into account the initial technician training cost, the scheme represented an annual saving to the Trust of over £15 000. The clinic serves as a model for those wishing to improve outpatient services to breast cancer patients.

A systematic review of the role of community pharmacies in improving the transition from secondary to primary care

AIM We set out to determine the potential contribution of community pharmacists to improve the transfer of care of patients from secondary to primary care settings. METHOD We systematically reviewed the literature on interventions that involved community pharmacy post-discharge. We considered all relevant studies, including both randomized and non-randomized controlled trials, irrespective of patient population. Our primary outcome was any impact on patient and medication outcomes, while the secondary outcome was to identify intervention characteristics that influenced all reported outcomes. RESULTS We retrieved 14 studies that met our inclusion criteria. There were four studies reporting outcomes relating to the identification and rectification of medication errors that were significantly improved with community pharmacy involvement. Other patient outcomes such as medication adherence and clinical control were not unanimously positively or negatively influenced via the inclusion of community pharmacy in a transfer of care post-discharge intervention. Some inconsistencies in implementation and process evaluation of interventions were found across the reviewed studies. This limited the accuracy with which true impact could be considered. CONCLUSIONS There is evidence that interventions including a community pharmacist can improve drug related problems after discharge. However, impact on other outcomes is not consistent. Further studies are required which include process evaluations to describe fully the context of the intervention so as to determine better any influencing factors. Also applying more stringent controls and closer adherence to protocols in both intervention and control groups would allow clearer correlations to be made between the intervention and the outcomes.

Delivering domiciliary pharmaceutical care from a health centre pharmacy

Aim — To develop and administer a pharmacist domiciliary visiting programme from a community pharmacy based in a health centre.

Can automated dispensing decrease prescription turn-around time and alter staff work patterns?

□ Prescription assembly was automated

Investigation of student views on industrial pharmacy

Aims: To identify the key reasons why few pharmacy students opt for a career in the pharmaceutical industry. Methods: A 17 item questionnaire was developed and distributed to final year undergraduates in UK schools of pharmacy. Respondents gave views on possible career choices using structured and open questions and a five point Likert scale. Results: Questionnaires were returned from 219 final year pharmacy undergraduates. Seventy-one students expressed an interest in industrial pharmacy. Key attractions of the industry included a wide range of job opportunities and a research environment; key detractors included lack of patient contact and a perception that work would be dull, difficult and laboratory based. Conclusion: Undergraduates do not have enough information concerning industrial pharmacy to be able to make informed judgements concerning opportunities in this sector.

Teaching safe prescribing to medical Students: perspectives in the UK

Prescribing is a characteristic role of a medical practitioner. On graduating from medical school, students are presumed to have acquired the necessary pharmacology knowledge underpinning the therapeutics and developed their personal skills and behaviors in order to write a safe and effective prescription (The Four Ps). However, there are reports of errors in medical prescribing and dissatisfied feedback from recent graduates, which evidence potential flaws in the current training in the practice of prescribing. We examine the Four Ps from a systems approach and offer scope for educators and curriculum designers to review and reflect on their current undergraduate teaching, learning, and assessment strategies in a similar manner. We also adopt a national framework of common competencies required of all prescribers to remain effective and safe in their area of practice as a more objective layer to the broader learning outcomes of the General Medical Council Tomorrow’s Doctors 2009. This exercise demonstrates where standard, recognized competencies for safe prescribing can be accommodated pedagogically within existing medical curricula.

Strategies enhancing the public health role of community pharmacists: a qualitative study

This study interviewed healthcare professionals to identify strategies enhancing the public health role of community pharmacists in the UK.

Foundation Degree Learning: An Educational Journey of Personal Development.

The foundation degree is an intermediate-level qualification designed to widen participation in higher education while providing work-related skills and knowledge. It has a vocational focus and a pedagogic approach that integrates academic and work-based learning. Research into opportunities and the process of learning within foundation degrees is limited, particularly that which looks in depth at personal development occurring within these courses. This study contributes to the literature in this area, reporting on the results of a case study of the foundation degree in medicines management (University of Portsmouth). A key finding of this work was that knowledge was gained within a community of practice, and led to students’ development as individuals. Motivation, learning to learn and guidance and feedback, alongside peer learning within the course, were central aspects of this process. The learning and personal development taking place resulted in increased awareness, confidence and empowerment in students, which was reported to influence their work and personal lives. However, the development of specialist work-related skills and knowledge was found to be limited, questioning the fitness for purpose of the course researched. While key aspects of the subject investigated have been described in this work, further research is needed to understand this complex phenomenon.