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Background: With increasing demands on the National Health Service (NHS), Scottish Government-led pharmacy strategy has prioritised the development and expansion of outpatient services. Pharmacist-led outpatient clinics have been shown to reduce hospital admissions and improve patient outcomes. However, expanding these contemporary models of care has proved challenging, and there are few qualitative data about the factors affecting the provision of these.Aim: This study aimed to explore the enablers and barriers to hospital pharmacists providing outpatient clinics within the largest health authority in Scotland, NHS Greater Glasgow & Clyde (NHSGGC).Method: Between August and October 2020, one-to-one semi-structured interviews were conducted virtually using the videoconferencing platform Microsoft Teams®, with NHSGGC hospital pharmacists who did or did not provide clinics. Audio- and video-recordings of the interviews were transcribed verbatim and underwent thematic analysis.Results: 16 hospital pharmacists were interviewed; 50% were clinic providers and 50% were not. Analysis generated seven themes: clinical or service need, individual factors, clinic structure and processes, additional clinical skills and training, competing priorities, macro-level pharmacy working, and external stakeholder relationships. Many of these were interdependent and had the potential to be an enabler or a barrier to clinic provision, depending on the context or individual.Conclusion: The enablers and barriers to hospital pharmacists providing outpatient clinics are multifaceted, incorporating individual, systematic and professional factors. The implementation of new national professional curricula may help address many of these factors, however prospective research needs to accompany this vision. [ABSTRACT FROM AUTHOR]

Objective: To identify what matters to clinicians and patients when discussing cancer medicines' impact on health-related quality of life (HRQoL). Methods: A framework of HRQoL domain/domain elements was developed, informed by analysis of published patient reported outcome measures (PROMs), applicable to prostate cancer. Using mixed methods (eDelphi, Nominal Group Technique and questionnaire), prostate cancer clinicians and patients attending prostate cancer clinics and support groups were asked which domains/domain elements would be important to them when discussing the impact prostate cancer medicines have on their HRQoL. Results: Twenty-one clinicians and 71 patients participated from the West of Scotland. Clinicians and patients identified 53/62 domain elements across seven domains as important, of which 32 (60%) were common to both groups. Clinicians placed more importance than patients on Mood & Emotion; in contrast, patients placed importance on a broader range of Symptoms & Side Effects, being informed about their care, and having effective healthcare professional collaboration. Conclusion: This study provides insight into the similarities and differences between what clinicians and patients think is important when discussing the impact of cancer medicines on HRQoL. Future research should involve exploring the potential for consistency of medicines PROMs across different cancer types to support patient-clinician communication and drive improvements in care. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus (COVID-19) pandemic has impacted healthcare worldwide. It has altered service delivery and posed challenges to practitioners in relation to workload, well-being and support. Within primary care, changes in physicians' activities have been identified and innovative work solutions implemented. However, evidence is lacking regarding the impact of the pandemic on pharmacy personnel who work in primary care. Aim: To explore the impact of the pandemic on the working practice (including the type of services provided) and job satisfaction of pharmacists and pharmacy technicians within Scottish general practice. Due to the stressful nature of the pandemic, we hypothesise that job satisfaction will have been negatively affected. Methods: An online questionnaire was distributed in May–July 2021, approximately 15 months since initial lockdown measures in the UK. The questionnaire was informed by previous literature and underwent expert review and piloting. Analysis involved descriptive statistics, non-parametric statistical tests and thematic analysis. Results: 180 participants responded (approximated 16.1% response rate): 134 pharmacists (74.4%) and 46 technicians (25.6%). Responses indicated greater involvement with administrative tasks and a reduction in the provision of clinical services, which was negatively perceived by pharmacists. There was an increase in remote working, although most participants continued to have a physical presence within general practices. Face-to-face interactions with patients reduced, which was negatively perceived by participants, and telephone consults were considered efficient yet less effective. Professional development activities were challenged by increased workloads and reduced support available. Although workplace stress was apparent, there was no indication of widespread job dissatisfaction. Conclusion: The pandemic has impacted pharmacists and technicians, but it is unknown if changes will be permanent, and there is a need to understand which changes should continue. Future research should explore the impact of altered service delivery, including remote working, on patient care. [ABSTRACT FROM AUTHOR]

Objectives: Left ventricular systolic dysfunction (LVSD) is common following myocardial infarction (MI). Pharmacological management of secondary prevention is known to be sub-optimal. Integration of pharmacists into clinical teams improves prescribing and quantitative outcomes. Few data have been published on patient views of pharmacist input. We aimed to explore patient experiences of attending a dedicated pharmacist independent prescriber (PIP)-led clinic. Methods: Semi-structured face-to-face interviews. Participants were aged =18 years with new incident MI and echocardiographically confirmed LVSD. Patients were recruited from three pharmacistled clinics at point of clinic discharge. Interviews were transcribed verbatim. Thematic analysis was undertaken. Key findings: Twelve patients were recruited, median age 67.5 years and ten male. Six core themes were identified: multidisciplinary working; satisfaction; confidence in the pharmacist; comparative care; prescribing behaviours; and monitoring. Pharmacist clinics complemented other established post-MI services, and participants perceived benefits obtained through effective inter-professional working. Participants welcomed dedicated appointment time, the opportunity to ask questions and address problems. Pharmacist explanations of condition and medicines, prescribing at the point of care and monitoring were beneficial and reduced patient stress. Conclusions: This study demonstrates that a PIP-led post-MI LVSD clinic delivers a positive initial patient experience. More research is needed to understand the longer-term patient experiences, the impact of such models on medication taking behaviours and the experiences of carers and other members of the multidisciplinary team. [ABSTRACT FROM AUTHOR]

Background: As clinical trials are often highly selective with patient recruitment, there has been increasing interest in recent years in the use of real-world evidence (RWE). RWE may improve understanding of outcomes in patient groups often excluded from trials and the long-term safety and efficacy of medicines.1 Much has been done globally to generate RWE in oncology. For example, the Cancer Medicines Outcomes Programme (CMOP), which uses routinely collected NHS data to describe outcomes in cancer patients in Scotland.2 Clinician support is essential to ensure that the generation of RWE translates into a meaningful impact on patient care. However, limited work has been done to determine clinicians’ views of RWE or how it is utilised in practice. Aims: To understand the views and experiences of medical, nursing and pharmacy staff in cancer services in Scotland on RWE use, including evidence generated through CMOP, in routine practice. Method: An online survey was sent via email to medical, nursing and pharmacy staff working in cancer services in Scotland in February 2022, and was life for 4 weeks. Prior to dissemination, the survey was piloted by a consultant oncologist and specialist oncology pharmacist. Descriptive statistics were generated for the quantitative data. Qualitative data was analysed by a combination of content and thematic analyses. Results: 127 respondents took part in the survey; 57% stated they use RWE in their practice. The results from thematic and content analyses of responses to free-text questions on the use and views of RWE are presented in Table 1. A total of 47 (37%) respondents were aware of CMOP prior to the survey. Most respondents became aware of CMOP through presentations by CMOP team members and word of mouth. Eighteen respondents were aware of specific findings from CMOP studies and, of those, five stated they had used CMOP-generated evidence in their practice. Those clinicians stated the evidence was beneficial and was primarily used in treatment decisions and patient discussions. Discussion: This is the first study to explore the experiences of Scottish Cancer clinicians on RWE use and the value clinicians see in RWE. However, as a voluntary sampling method was used, the views of the respondents may not represent all Scottish cancer clinicians. As seen in a previous European survey, there is concern about the reliability of RWE and the quality of data from real-world sources.3 CMOP is not widely known across Scottish Cancer Services, however, where data generated by CMOP has been used, the evidence has contributed positively towards patient care. As awareness of CMOP grows nationally, it is hoped CMOP data will be utilised more commonly in routine practice. The results of this study may be of interest to other groups developing RWE, across the UK and internationally, on how their results may be applied in practice. Conclusion: RWE is a moderately utilised source of evidence in cancer care in Scotland and clinicians believe it adds value to patient-centred care. Initiatives to generate RWE, through programmes like CMOP, can lead to more informed decision-making for clinicians and patients. [ABSTRACT FROM AUTHOR]

The article reports that United Nations General Assembly received its first report from the new Special Rapporteur of the Human Rights Council on extrajudicial, summary or arbitrary executions Agnes Callamard. It mentions report focuses on the unlawful deaths of refugees and migrants, identifying a ‘human rights and humanitarian crisis' characterized by ‘mass casualties'. It also mentions international legal obligations deduced from international human rights law.

The author presents her reply to the article "Humanity as the &alha; and ω of Sovereignty," by Anne Peters. She claims that the current discourse on state protection of foreign nationals have affirmed the movement from right to obligation within the domestic field. She refutes the notion that a humanization of the law transform individuals as international agents by reiterating that states have remained the core of the international order.

Introduction: In 2016, Children's Health Queensland (CHQ) launched its new organisational values; respect, integrity, care and imagination, as well as pursuing a more integrated approach to service delivery. Delivering paediatric healthcare across the continuum in a state as diverse as Queensland presents many inherent challenges. Through a successful Integrated Care Innovation Fund grant for CHQ to deliver telementoring to general practitioners in Attention Deficit Hyperactivity Disorder, the first paediatric hub in Australasia for Project ECHO® launched in May 2017. This was a successful example of fostering a strategic, sustainable, and mutually-beneficial relationship with a dynamic and dedicated consumer. Change implemented: By living the organisation's commitment to its new values and integrated care agenda, the medical lead and project manager engaged a consumer who identified as a mother of four children with behavioural health needs. Consultation occurred with the consumer to identify how the project could acknowledge the value-add that consumers bring to implementation science, and how CHQ could benefit to consumers outside of enhanced clinical service delivery resulting from the project implementation. While caring for four children, participating on a project steering committee, weekly teleECHO clinics and completing undergraduate human services studies, the consumer was supported by the project team to design a student placement plan that would expose the consumer to frontline project management in a large-scale, multi-site health service, while maintaining objectivity as an advocate for families, and maintaining compliance to objectives of the undergraduate course. The project manager coordinated a comprehensive onboarding and networking agenda, including weekly full-day project management supervision for the duration of the semester placement. This included providing coaching and debriefing for the consumer to maintain the 'real life' experience and reflective element of how CHQ engages with consumers to enhance the implementation of the Project ECHO® hub. With this support infrastructure in place, the medical lead could test the efficacy of the project's implementation, with consistent focus on effects impacting the families. Target population and stakeholders: Consumers, advocates, patients, families, clinicians, hospital executives and GPs. Timeline: Two years, with an evaluation to be completed in June 2018. Highlights: Consumer co-design at all stages of the project lifecycle to implement the ECHO® hub. Consumer achieved a High Distinction for her placement. Consumer empowerment to apply university study with real-life experience and co-designing innovative new models of service. Mutual benefit, recognition and trust built between stakeholders. Enhanced value in new service models by GP audiences. Pairing traditional project management methodology with organisational values to empower consumers to be key partners of co-designing innovation. Sustainability and transferability: This consumer engagement approach, and value-add of codesign is directly sustainable and transferable to other project contexts. Through delivering innovative new models of service, health services can empower and inspire consumer representatives to become professionals, formally acknowledged and accepted for their lived experience and academic pursuits. Conclusions: CHQ has successfully launched the ECHO® hub, and continues to foster a positive and mutually-beneficial consumer developmental relationship. Participating clinicians and management have unanimously accepted the ongoing consumer participation to continue innovating. [ABSTRACT FROM AUTHOR]

Background: To meet emergent healthcare needs, innovations need to be implemented into routine clinical practice. Community pharmacy is increasingly considered a setting through which innovations can be implemented to achieve positive service and clinical outcomes. Small-scale pilot programmes often need scaled up nation-wide to affect population level change. This systematic review aims to identify facilitators and barriers to the national implementation of community pharmacy innovations.Methods: A systematic review exploring pharmacy staff perspectives of the barriers and facilitators to implementing innovations at a national level was conducted. The databases Medline, EMBASE, PsycINFO, CINAHL, and Open Grey were searched and supplemented with additional search mechanisms such as Zetoc alerts. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis.Results: Thirty-nine studies were included: 16 were qualitative, 21 applied a questionnaire design, and 2 were mixed methods. Overarching thematic areas spanning across the CFIR domains were pharmacy staff engagement (e.g. their positive and negative perceptions), operationalisation of innovations (e.g. insufficient resources and training), and external engagement (e.g. the perceptions of patients and other healthcare professionals, and their relationship with the community pharmacy). Study participants commonly suggested improvements in the training offered, in the engagement strategies adopted, and in the design and quality of innovations.Conclusions: This study's focus on national innovations resulted in high-level recommendations to facilitate the development of successful national implementation strategies. These include (1) more robust piloting of innovations, (2) improved engagement strategies to increase awareness and acceptance of innovations, (3) promoting whole-team involvement within pharmacies to overcome time constraints, and (4) sufficient pre-implementation evaluation to gauge acceptance and appropriateness of innovations within real-world settings. The findings highlight the international challenge of balancing the professional, clinical, and commercial obligations within community pharmacy practice. A preliminary theory of how salient factors influence national implementation in the community pharmacy setting has been developed, with further research necessary to understand how the influence of these factors may differ within varying contexts.Trial Registration: A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42016038876 ). [ABSTRACT FROM AUTHOR]