Nitroxide-mediated polymerization is now a mature technique, at 35 years of age. During this time, several variants have been developed: electron spin capture polymerization (ESCP), photoNMP (NMP2), ...chemically initiated NMP (CI-NMP), spin label NMP (SL-NMP), and plasmon-initiated NMP (PI-NMP). This mini-review is devoted to the features and applications of these variants.
Background
Medication-related harm is a major problem in healthcare. New models of integrated care are required to guarantee safe and efficient use of medication.
Aim
To prevent medication-related ...harm by integrating a clinical pharmacist in the general practice team. This best practice paper provides an overview of 1. the development of this function and the integration process and 2. its impact, measured with quantitative and qualitative analyses.
Setting
Ten general practices in the Netherlands.
Development and implementation of the (pragmatic) experiment
We designed a 15-month workplace-based post-graduate learning program to train pharmacists to become clinical pharmacists integrated in general practice teams. In close collaboration with general practitioners, clinical pharmacists conduct clinical medication reviews (CMRs), hold patient consultations for medication-related problems, carry out quality improvement projects and educate the practice staff. As part of the Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT) intervention study, ten pharmacists worked full-time in general practices for 15 months and concurrently participated in the training program. Evaluation of this integrated care model included both quantitative and qualitative analyses of the training program, professional identity formation and effectiveness on medication safety.
Evaluation
The integrated care model improved medication safety: less medication-related hospitalisations occurred compared to usual care (rate ratio 0.68 (95% CI: 0.57–0.82)). Essential hereto were the workplace-based training program and full integration in the GP practices: this supported the development of a new professional identity as clinical pharmacist. This new caregiver proved to align well with the general practitioner.
Conclusion
A clinical pharmacist in general practice proves a feasible integrated care model to improve the quality of drug therapy.
The ESCP is featured as a written procedure, wherein the oral hearing is granted limited space. The reason stems from the fact that oral hearing in cross-border litigations takes significantly longer ...time and its worth seems to be – notably in civil matters such as those included in the ESCP scope – inversely related with the case value (the smaller the value, the lesser the worth). Such a discipline gives rise to a number of significant issues, concerning its consistency with the procedural fundamental «right to be heard»; the correlative margin of discretion the court may rely on in deciding whether a hearing shall be scheduled or not; not least the role played by the modern communication technologies in this respect. The Author deals with such issues in their multiple features and connections, trying thence to offer proper answers thereto. The overall Author’s view is that the ESCP Regulation’s restrictive approach to oral hearing is reconciliable with the right to be heard and that the broad discretion conferred to the court in this respect is justified as well.
Background
Patient delays at the point of their discharge account for more than half a million additional bed days every year in Scotland, United Kingdom. Bottlenecks in discharge medication ...dispensing contribute to such delays.
Aim
To test whether the discharge process could be made more time-efficient by utilising community pharmacy supply of medicines on the day of discharge, rather than hospital pharmacy supply.
Setting
Glasgow Royal Infirmary, Scotland.
Development
Local community pharmacy staff received training and communication about each patient discharge. Pharmacies could access an immediate discharge letter (IDL) on a shared electronic record. The existing pandemic law allowed medication dispensing from this IDL, without a prescription.
Implementation
The programme was implemented from June to November 2020, across three Plan-Do-Study-Act (PDSA) cycles. Comparisons were made between the new community pharmacy model and standard hospital model.
Evaluation
Across three PDSA cycles, in total 335 patients had community pharmacy supply compared to 376 patients eligible for hospital pharmacy supply. The median time taken from creation of the IDL to final completion was significantly lower in the new community pharmacy model compared to the hospital pharmacy model; 154 min (interquartile range (IQR) 82–272 min) vs 296 min (IQR 197–1281 min)
p
value < 0.000
Conclusion
A community pharmacy supply model compared to a standard hospital pharmacy model resulted in a median time saving of 142 min per patient. Such a time saving has the potential to deliver a transformational change in patient flow and free up hospital pharmacy staff to deliver other clinical interventions.
Background
Standard concentration infusions and ‘smart-pumps’ are recognised as best practice in the paediatric setting. Implementation rates in European hospitals remain low. Children’s Health ...Ireland (CHI) developed a paediatric ‘smart-pump’ drug library using standardised concentrations. At time of development, other Irish hospitals continued to use traditional pumps and weight-based paediatric infusions.
Aim
To expand best paediatric infusion practices by nationalising use of the CHI drug library.
Setting
Tertiary paediatric, maternity and general acute hospitals, and associated transport services in Ireland.
Development
The CHI drug library was first developed for paediatric intensive care and then adapted over a 10-year period for use in emergency departments, general paediatric wards, neonatal units, adult intensive care and transport services. The original library (42 drug lines, 1 ‘care-unit’) was substantially expanded (223 drug lines, 6 ‘care-units’). A neonatal sub-library was created.
Implementation
Executive support, dedicated resources and governance structures were secured. Implementation and training packages were developed. Implementation has occurred across CHI, in paediatric and neonatal transport services, 58% (n = 11) of neonatal units, and 23% (n = 6) of paediatric sites.
Evaluation
A before and after study demonstrated significant reductions in infusion prescribing errors (29.0% versus 8.4%,
p
< 0.001). Direct observation of infusions (n = 1023) found high compliance rates (98.9%) and low programming errors (1.6%). 100% of nurses (n = 132) surveyed 9 months after general ward implementation considered the drug library had enhanced patient safety.
Conclusion
Strategic planning and collaboration can standardise infusion practices. The CHI drug library has been approved as a National Standard of Care, with implementation continuing.
Background
Clinical activities provided by pharmacists are increasing worldwide, including in Europe. However, an overview of clinical pharmacy education and practice is needed.
Aim
To map clinical ...pharmacy (CP) education and practice among European countries.
Method
A cross-sectional web-based survey led by the Education Committee of the European Society of Clinical Pharmacy (ESCP) was conducted. The survey comprised three domains focusing on: undergraduate education, postgraduate education, and practice. A multi-phased validation process was undertaken, attributing levels of evidence according to the number of information sources for each country. Triangulation was used to seek within country consensus. Main outcome measures included the number of hours of education in CP; existence of a specialization in CP and activities delivered in practice.
Results
Data from 40 European countries were included (response rate 95.2%). Most respondents (86.8%) agreed with the ESCP definition of CP. Almost every country (94.9%) reported CP topics at the undergraduate level median number = 65 h/semester (IQR: 2.0–5.6), including practical teaching median = 30.0% (IQR: 17.0–42.0). At postgraduate level, 92.5% of countries reported PhD programmes including CP and 65.0% mentioned the existence of specific CP master/diploma degrees. Continuous professional development (CPD) courses were also reported by 63.9% of respondents. More than half the countries (52.5%;
n
= 21) recognized CP as an area of specialization, which for 60.0% of participants was applied solely in the hospital setting.
Conclusion
Although CP is embedded in education and practice in European countries, there is wide variability in education and practice patterns.
The EU ODR platform was created with the objective of offering better access to justice for the consumer, especially for cross-border disputes. The recognition and enforcement of cross-border ODR ...outcomes in the EU is however a complex procedure, and not always possible under the current EU legal framework. This article therefore questions whether a digitalised ESCP procedure is a better alternative to the enforcement of consumer redress for cross-border electronic-based small claims procedures.
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