Post discharge medicines use review (dMUR) service for older patients: Cost-savings from community pharmacist interventions

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Community pharmacist perceptions of delivering post-hospital discharge Medicines Use Reviews for elderly patients

Background The UK’s Department of Health has recommended that formal communication channels between hospital and community pharmacy should be established so that post discharge Medicines Use Reviews (dMUR) become an integral part of the medicines pathway. Objective To investigate the perspective of community pharmacists on the usefulness of dMUR referrals from hospital, the suitability of patients referred and overall views on the service. Method Self-completed survey distributed to 21 community pharmacists who had received referrals from the hospital during a 9-month randomized controlled feasibility study. Results Nineteen pharmacists (90.4%) returned the survey. Seven (36.8%) felt that it was hard to engage patients with dMURs. Failure or inability of patients to attend the pharmacy were the most common barriers. Reasons for medication changes (n=5) and indications for new medicines (n=4) were the most common examples of extra information that would be useful on referral. Community pharmacists held positive opinions on the dMUR service and could see the benefit to patients. Pharmacists wanted more referrals but reported performing few dMURs outside this study. Conclusion This study highlights the need to improve communication between hospital and community pharmacies and to overcome barriers to performing dMURs outside the pharmacy premises in this patient group. Impact of Findings on Practice • Referral of elderly patients from hospital to community pharmacy for a Medicines Use Review is well received by community pharmacists and is feasible • Reasons for medication changes and indications for new medicines started in hospital would be welcomed with the referral • Difficulty in patients leaving home to attend the pharmacy was the most common barrier to completion of the reviews • Contractual restrictions placed on UK community pharmacists limit their ability to provide the service to housebound patient

Total or Partial Knee Arthroplasty Trial - TOPKAT : study protocol for a randomised controlled trial

Peer reviewedPublisher PD

The Knee Arthroplasty Trial (KAT) : design features, baseline characteristics and two-year functional outcomes after alternative approaches to knee replacement

Background: The aim of continued development of total knee replacement systems has been the further improvement of the quality of life and increasing the duration of prosthetic survival. Our goal was to evaluate the effects of several design features, including metal backing of the tibial component, patellar resurfacing, and a mobile bearing between the tibial and femoral components, on the function and survival of the implant. Methods: A pragmatic, multicenter, randomized, controlled trial involving 116 surgeons in thirty-four centers in the United Kingdom was performed; 2352 participants were randomly allocated to be treated with or without a metal backing of the tibial component (409), with or without patellar resurfacing (1715), and/or with or without a mobile bearing (539). Randomization to more than one comparison was allowed. The primary outcome measures were the Oxford Knee Score (OKS), Short Form-12, EuroQol-5D, and the need for additional surgery. The results up to two years postoperatively are reported. Results: Functional status and quality-of-life scores were low at baseline but improved markedly across all trial groups following knee replacement (mean overall OKS, 17.98 points at baseline and 34.82 points at two years). Most of the change was observed at three months after the surgery. Six percent of the patients had additional knee surgery within two years. There was no evidence of differences in clinical, functional, or quality-of-life measures between the randomized groups at two years. Conclusions: Patients have substantial improvement following total knee replacement. This is the first adequately powered randomized controlled trial, of which we are aware, in which the effects of metal backing, patellar resurfacing, and a mobile bearing were investigated. We found no evidence of an effect of these variants on the rate of early complications or on functional recovery up to two years after total knee replacement. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.NIHR Health Technology Assessment Programme (Project Number 95/10/01); Howmedica Osteonics; Zimmer; DePuy, a Johnson and Johnson company; Corin Medical; Smith and Nephew Healthcare. Biomet Merck; and Wright CremascoliPeer reviewe

First Measurement of Monoenergetic Muon Neutrino Charged Current Interactions

We report the first measurement of monoenergetic muon neutrino charged current interactions. MiniBooNE has isolated 236 MeV muon neutrino events originating from charged kaon decay at rest ($K^+ \rightarrow \mu^+ \nu_\mu$) at the NuMI beamline absorber. These signal $\nu_\mu$-carbon events are distinguished from primarily pion decay in flight $\nu_\mu$ and $\overline{\nu}_\mu$ backgrounds produced at the target station and decay pipe using their arrival time and reconstructed muon energy. The significance of the signal observation is at the 3.9$\sigma$ level. The muon kinetic energy, neutrino-nucleus energy transfer ($\omega=E_\nu-E_\mu$), and total cross section for these events is extracted. This result is the first known-energy, weak-interaction-only probe of the nucleus to yield a measurement of $\omega$ using neutrinos, a quantity thus far only accessible through electron scattering.Comment: 6 pages, 4 figure

Measures for the integration of health and social care services for long-term health conditions: a systematic review of reviews

Abstract: Background: As people are living longer with higher incidences of long-term health conditions, there is a move towards greater integration of care, including integration of health and social care services. Integrated care needs to be comprehensively and systematically evaluated if it is to be implemented widely. We performed a systematic review of reviews to identify measures which have been used to assess integrated care across health and social care services for people living with long-term health conditions. Methods: Four electronic databases (PUBMED; MEDLINE; EMBASE; Cochrane library of systematic reviews) were searched in August 2018 for relevant reviews evaluating the integration of health and social care between 1998 and 2018. Articles were assessed according to apriori eligibility criteria. A data extraction form was utilised to collate the identified measures into five categories. Results: Of the 18 articles included, system outcomes and process measures were most frequently identified (15 articles each). Patient or carer reported outcomes were identified in 13 articles while health outcomes were reported in 12 articles. Structural measures were reported in nine articles. Challenges to measuring integration included the identification of a wide range of potential impacts of integration, difficulties in comparing findings due to differences in study design and heterogeneity of types of outcomes, and a need for appropriate, robust measurement tools. Conclusions: Our review revealed no shortage of measures for assessing the structures, processes and outcomes of integrated care. The very large number of available measures and infrequent use of any common set make comparisons between schemes more difficult. The promotion of core measurement sets and stakeholder consultation would advance measurement in this area

Measuring the benefits of the integration of health and social care: qualitative interviews with professional stakeholders and patient representatives

Abstract: Background: Integrated care has the potential to ease the increasing pressures faced by health and social care systems, however, challenges around measuring the benefits for providers, patients, and service users remain. This paper explores stakeholders’ views on the benefits of integrated care and approaches to measuring the integration of health and social care. Methods: Twenty-five semi-structured qualitative interviews were conducted with professional stakeholders (n = 19) and patient representatives (n = 6). Interviews focused on the benefits of integrated care and how it should be evaluated. Data was analysed using framework analysis. Results: Three overarching themes emerged from the data: (1) integrated care and its benefits, with stakeholders defining it primarily from the patient’s perspective; (2) potential measures for assessing the benefits of integration in terms of system effects, patient experiences, and patient outcomes; and (3) broader considerations around the assessment of integrated care, including the use of qualitative methods. Conclusions: There was consensus among stakeholders that patient experiences and outcomes are the best measures of integration, and that the main measures currently used to assess integration do not directly assess patient benefits. Validated health status measures are readily available, however, a substantial shift in practices is required before their use becomes commonplace

Measurement of Muon Antineutrino Quasi-Elastic Scattering on a Hydrocarbon Target at E_{\nu} ~ 3.5 GeV

We have isolated muon anti-neutrino charged-current quasi-elastic interactions occurring in the segmented scintillator tracking region of the MINERvA detector running in the NuMI neutrino beam at Fermilab. We measure the flux-averaged differential cross-section, d{\sigma}/dQ^2, and compare to several theoretical models of quasi-elastic scattering. Good agreement is obtained with a model where the nucleon axial mass, M_A, is set to 0.99 GeV/c^2 but the nucleon vector form factors are modified to account for the observed enhancement, relative to the free nucleon case, of the cross-section for the exchange of transversely polarized photons in electron-nucleus scattering. Our data at higher Q^2 favor this interpretation over an alternative in which the axial mass is increased.Comment: 8 pages, 5 figures. Added correlation between neutrino and anti-neutrino results in ancillary text files (CSV

Predictors of activity and participation across neurodegenerative conditions: a comparison of people with motor neurone disease, multiple sclerosis and Parkinson’s disease

Background: Comparisons between neurological conditions have the potential to inform service providers by identifying particular areas of difficulty experienced by affected individuals. This study aimed to identify predictors of activity and participation in people with motor neurone disease (MND), people with multiple sclerosis (MS) and people with Parkinson’s Disease (PD). Methods: The Oxford Participation and Activities Questionnaire (Ox-PAQ) and Medical Outcomes Study 36-Item Short Form Survey (MOS SF-36) were administered by postal survey to 386 people with a confirmed diagnosis of MND, MS or PD. Data analyses focused on stepwise regression analyses in order to identify predictors of activity and participation in the three conditions assessed. Results: Three hundred and thirty four participants completed the survey, a response rate of 86.5%. Regression analyses identified multiple predictors of activity and participation dependent on Ox-PAQ domain and disease group, the most prominent being social and physical functioning as measured by the MOS SF-36. Conclusions: Results indicate that the physical and social consequences of neurological illness are of greatest relevance to people experiencing the conditions assessed. Whilst the largely inevitable physical implications of disease take hold, emphasis should be placed on the avoidance of social withdrawal and isolation, and the maintenance of social engagement should become a significant priority