Multiple studies have explored the implementation process and influences, however it appears there is no study investigating these influences across the stages of implementation. Community pharmacy ...is attempting to implement professional services (pharmaceutical care and other health services). The use of implementation theory may assist the achievement of widespread provision, support and integration. The objective was to investigate professional service implementation in community pharmacy to contextualise and advance the concepts of a generic implementation framework previously published.
Purposeful sampling was used to investigate implementation across a range of levels of implementation in community pharmacies in Australia. Twenty-five semi-structured interviews were conducted and analysed using a framework methodology. Data was charted using implementation stages as overarching themes and each stage was thematically analysed, to investigate the implementation process, the influences and their relationships. Secondary analyses were performed of the factors (barriers and facilitators) using an adapted version of the Consolidated Framework for Implementation Research (CFIR), and implementation strategies and interventions, using the Expert Recommendations for Implementing Change (ERIC) discrete implementation strategy compilation.
Six stages emerged, labelled as development or discovery, exploration, preparation, testing, operation and sustainability. Within the stages, a range of implementation activities/steps and five overarching influences (pharmacys' direction and impetus, internal communication, staffing, community fit and support) were identified. The stages and activities were not applied strictly in a linear fashion. There was a trend towards the greater the number of activities considered, the greater the apparent integration into the pharmacy organization. Implementation factors varied over the implementation stages, and additional factors were added to the CFIR list and definitions modified/contextualised for pharmacy. Implementation strategies employed by pharmacies varied widely. Evaluations were lacking.
The process of implementation and five overarching influences of professional services implementation in community pharmacy have been outlined. Framework analysis revealed, outside of the five overarching influences, factors influencing implementation varied across the implementation stages. It is proposed at each stage, for each domain, the factors, strategies and evaluations should be considered. The Framework for the Implementation of Services in Pharmacy incorporates the contextualisation of implementation science for pharmacy.
To explore approaches for developing and implementing interventions aimed at improving health literacy and health-related scientific literacy in disadvantaged groups.
A scoping review of literature ...published in 2012–2022 was conducted, followed by quality appraisal of eligible studies.
Interventions were conducted mainly in community settings, where the most popular venues were adult education facilities. The primary target groups were those with limited income or education, ethnic minorities, or immigrants. Programs were often held in-person using interactive and culturally appropriate methods. They were predominantly focused on functional and interactive health literacy dimensions rather than on critical and scientific ones. Evaluations measured knowledge, health literacy, behavioral and psychological outcomes using various quantitative and qualitative instruments.
The findings offer a comprehensive overview of the ways to design and evaluate health and scientific literacy interventions tailored to disadvantaged groups.
Future interventions should prioritize participatory designs, culturally appropriate materials, and shift focus to critical and scientific health literacy, as well as to program scalability in less controlled conditions.
•Improving health literacy in disadvantaged groups can reduce health disparities.•Most past programs targeted functional health literacy, not critical or scientific.•Diverse quantitative and qualitative tools were used for evaluation.•Using participatory designs and culturally appropriate interactive methods is key.•To increase applicability, future programs should focus on being scalable.
OBJECTIVE: To assess visual outcome and post-operative complications after silicone oil removal in pseudophakic vitrectomized patients. METHODS: This interventional case series study was conducted ...at Department of Ophthalmology, Medical Teaching Institution Lady Reading Hospital, Peshawar, Pakistan from February 2019 to January 2020. A total of 32 eyes of 32 patients were enrolled in the study after fulfilling inclusion and exclusion criteria using non-random consecutive sampling technique. All patients had pars plana vitrectomy with silicone oil done 6 months ago and were pseudophakic. Silicone oil removal was carried out in all patients and visual outcome and surgical complications assessed on 1st and 14th post-operative day. Final examination was done after six months. Statistical analysis was done by using Statistical Package for Social Sciences (version 21) by applying paired sample t-test. RESULTS: Amongst 32 patients, 20 (62.5%) were male and 12 (37.5%) were female. Age of the patients ranged from 16 to 60 years with a mean age of 35±13.97 years. Pre operatively mean best corrected visual acuity (BCVA) was 1.45±0.52 Log Mar. On the last post-operative follow up after six months mean BCVA was 1.21±0.55 Log Mar. Visual acuity improved in 24 (75%), remained stable in 3 (9.4%) and worsening in visual acuity was seen in five (15.6%) cases. Visual improvement was statistically significant (p-value 0.001) using paired t-test. Most common complications were retinal detachment (n=4: 12.5%), secondary glaucoma (n=4: 12.5%) and epi-retinal membrane (n=2; 6.3%). CONCLUSION: Vision improves in majority of pseudophakic patients after silicone oil removal.
OBJECTIVE: To compare the efficacy of Aloe vera (AV) gel versus Ferric Sulphate (FS) as a pulp medicament in vital pulpotomy of deciduous molars. METHODS: This randomized controlled trial was ...conducted at Peshawar Dental College, Peshawar, Pakistan. One hundred and fourteen patients were randomized into interventional group (A): who received AV gel & control group (B): who received as FS pulpotomy medicament. Deciduous molars of patients of both genders were selected for this study. Clinical signs & symptoms and radiological findings were then observed in both groups after a period of 6 months and then checked for their comparative efficacy. RESULTS: Out of 114 patients, 69 (60.5%) were males. Postoperative pain came out to be as no pain AV=44/57 (77.2%); FS=43/57 (75.4%), mild pain AV=07/57 (12.3%); FS=11/57 (19.3%), moderate pain AV=03/57 (5.3%); FS=01/57 (1.8%) and severe pain AV=03/57 (5.3%); FS=02/57 (3.5%). Periapical abscess was observed in total of 04/114 (3.5%) patients (AV=03/57; FS=01/57). Pathological tooth mobility was also present as mild/normal AV=52/57 (91.2%); FS=56/57 (98.2%), moderate AV=04/57 (7%); FS=01/57 (1.8%) and severe AV=01/57 (1.8%). Radiographic changes were found in total of 06/114 (5.3%) patients (AV=04/57; FS=02/57). Out of 114 patients, 51/57 (89.47%) cases remained successful in group A while in group B, 54/57 (94.73%) were successful. CONCLUSION: AV tends to prove favorable outcomes in terms of clinical signs and symptoms and radiological features comparable to ferric sulphate and could be a better & cheap alternative to other medicaments in future and can be used safely for pulpotomy.
OBJECTIVE: To find-out the association of dyslipidemia with anxiety and depression in patients with polycystic ovarian syndrome (PCOS). METHODS: This descriptive cross-sectional study was conducted ...at Mardan Medical Complex, Mardan, Pakistan from December-2019 to March-2020. One hundred & forty diagnosed cases of PCOS, ranging in age from 20-40 years, were selected through purposive sampling. Anxiety and depression were calculated using hospital anxiety and depression scale (HADS) score. Total cholesterol (TC), triglycerides, low-density-lipoproteins (LDL), high-density-lipoproteins (HDL) and testosterone were tested through fasting blood samples. RESULTS: Anxiety and depression were documented in 102 (72.9%) & 99 (70.7%) cases respectively. Primary infertility, oligomenorrhoea, Hirsutism & acne were present in 69 (49.3%), 111 (73.5%), 81 (57.9%) and 55 (39.3%) patients respectively. Twenty-two (15.7%) patients were overweight/obese. All patients had raised testosterone levels and polycystic ovaries on ultrasound. Raised triglyceride levels (≥150 mg/dl), Low levels of HDL (≤ 60mg/dl), raised levels of LDL (≥130 mg/dl), raised cholesterol levels (≥200 mg/dl) were reported in 71/99 (71.7%), 56/99 (56.6%), 38/99 (38.4%) & 10/99 (10.2%) cases with depression as compared to 27/41 (65.9%), 13/41 (31.7%), 21/41 (51.2%) & 14/41(34.1%) non-depressed patients respectively. Similarly raised triglyceride levels, low levels of HDL, raised levels of LDL, raised cholesterol levels were reported in 73/102 (71.6%), 58/102 (56.9%), 40/102 (39.2%) & 12/102 (11.76%) cases with anxiety as compared to 25/38 (65.8%), 11/38 (28.9%), 19/38 (50%) and 12/38 (31.6%) patients without anxiety respectively. CONCLUSION: Dyslipidemia, anxiety and depression are very common in PCOS. Dyslipidemia is associated with anxiety and depression in PCOS patients.
OBJECTIVE: To determine the effects of short inter delivery interval (IDI) on mode of delivery in patients with immediate previous one caesarean section (C-Section). METHODS: This is a retrospective ...chart review of 120 patients treated at Khyber Teaching Hospital, Peshawar, Pakistan from December 2017 to December 2019. Patients of previous one C-Section and with gestational age of >37 weeks were included in this study. Outcome variables were mode of delivery whether operative or vaginal delivery, maternal and fetal complications such as scar dehiscence or scar rupture and fetal distress. RESULTS: Mean age of the patients was 28.9±2 years. IDI was <18 months in 35/120 (29.2%) cases, 18-24 months in 54/120(45%) cases and >24 months in 31/120 (25.8%) cases. Out of 120, 102 (85%) patients underwent trial of labour after C-section (TOLAC). TOLAC was successful in 64 (62.7%) cases. Patient who underwent TOLAC with IDI of <18 months, 5/21 (23.8%) patients delivered vaginally and 16/21 (76.2%) patients had emergency C-Section while those with 18-24 months IDI, 38/51 (74.5%) patients delivered and 13/51 (25.4 %) patients had emergency C-Section. Main indications for emergency C-Section were scar tenderness and maternal tachycardia (n=16; 42.10%) and fetal distress (n=11, 28.9%). There were two cases of interauterine deaths. Uterine scar dehiscence was observed in 14.28% and 2.4% in short and normal IDI respectively. CONCLUSION: Patients with short IDI had high C-section and uterine scar dehiscence rate. IDI of >18 months is recommended to avoid the maternal and fetal morbidity and mortality.
Background
Patients with pre‐existing severe mental disorders are significantly less likely to receive guideline‐recommended cancer treatment and seems to have a significantly lower rate of cancer ...survival compared to patients with cancer without mental disorders.
Aim
To perform a systematic review on barriers at patient‐, provider‐ and system‐levels in cancer trajectories of patients with pre‐existing severe mental disorders.
Method
A systematic review was performed following the PRISMA guidelines (PROSPERO ID: CRD42022316020).
Results
Nine eligible studies were identified. Barriers at patient‐level included lack of self‐care and ability to recognize physical symptoms and signs. Provider‐level barriers included stigma from health care professionals on mental disorders, whereas system‐level barriers included fragmented health care and consequences of this.
Conclusion
This systematic review found that barriers at patient‐, provider‐ and system‐levels exist in cancer trajectories for patients with severe mental disorders, causing disparities in cancer care. Further research is needed to improve cancer trajectories for patients with severe mental disorder.
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