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Why you should read this article: • To recognise the potential benefits and risks associated with remote prescribing • To understand the main principles of effective practice in remote consultations and prescribing • To consider how you could enhance the use of remote patient consultations in your area of practice. There has been a rapid increase in remote patient consultations, including remote prescribing – partly in response to the coronavirus disease 2019 (COVID-19) pandemic, but also as part of the move towards a ‘digital first’ NHS. There are various benefits associated with remote prescribing, such as convenience for patients and judicious use of healthcare resources. However, it is also associated with several risks, for example the use of inappropriate medicines or doses if the prescriber does not have full access to the patient’s records. This article considers some of the benefits and challenges of remote prescribing, and discusses the main principles of effective practice in relation to patient safety, informed consent and documentation. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the classification and assigned schedules of controlled drugs • To understand the legal framework that underpins the prescribing of medicines • To be aware of the areas that need to be considered when prescribing controlled drugs. There are multiple acts of law and case law that govern UK prescribing practice. This article examines three important topics for nurses: the classification and prescribing of controlled drugs, including the meaning of medicine classes and schedules; the prescribing of unlicensed medicines, including the difference between unlicensed and off-license medicines; and negligence in prescribing practice. The article outlines the acts of law that are relevant to each topic and provides examples of significant case law or other legal rulings to demonstrate how the law is relevant to nurses’ clinical practice. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the physiological principles of gas exchange • To enhance your understanding of the use of different types of oxygen delivery devices • To recognise the need to support patients using oxygen delivery devices. Many nurses will care for a patient who requires oxygen therapy, either to treat an acute respiratory condition, such as a lung infection, or a chronic condition, such as chronic obstructive pulmonary disease. This article discusses the physiology of gaseous exchange and provides an overview of some of the main respiratory conditions that may result in the need for oxygen therapy. The author also describes the oxygen delivery devices commonly used in clinical practice, such as simple face masks and nasal cannulas, to assist nurses in selecting the most appropriate device. [ABSTRACT FROM AUTHOR]

The article discusses how nurses can identify and effectively manage adverse drug reactions (ADR) to promote medicines adherence and safety. Topics include the potential effects of ADRs on people's quality of life and therapeutic results, the Royal Pharmaceutical Society (RPS) principles of medicines optimisation, and the types of ADRs like types A, B and C.

Why you should read this article: • To enhance your understanding of the skin barrier function • To familiarise yourself with the mode of action of emollients and how they can improve dry skin conditions • To understand the optimal methods of emollient application The role of emollients in the treatment of dry skin conditions is often underestimated. Emollients promote optimal skin health and prevent skin breakdown, and their use can improve patients' quality of life. However, when advising patients on emollient use, nurses must consider the challenges involved such as the extensive choice of products and the necessity of regular applications. This article explores the development of dry skin conditions and outlines the role of emollients in maintaining the skin barrier function. The author also details optimal nursing practice in areas such as emollient prescribing and application. [ABSTRACT FROM AUTHOR]

The article offers screening insights before prescribing presbyopia-correcting drops. Topics discussed include case instances of retinal detachment (RD), retinal tears, or vitreomacular traction among patients, and safety measures like performing a thorough eye examination before a topical prescription, and examining possible histories of retinal problems and risk factors for dissatisfaction. Also noted is the recommended one week drops trial for patients before deciding if it is beneficial.

The article focuses on the disparity in hepatitis C virus (HCV) treatment outcomes among people who inject drugs (PWID), despite the high efficacy of direct-acting antivirals (DAAs), and discusses the OPPORTUNI-C trial, which evaluated the efficacy of treatment of HCV infection among hospitalized PWID. Topics include the challenges faced by PWID in accessing HCV treatment, the outcomes of the OPPORTUNI-C trial, and the barriers to implementing opportunistic treatment in clinical practice.

The article discusses an American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry study which shows that Dextenza delivery to the ocular surface ensures safe adherence to a corticosteroid course after cataract surgery as of 2023. Topics covered include the insert's help to patients with dexterity issues in eyedrop use, and its likely receipt by patients with preexisting dry eye disease. Also noted is the need for further study of Dextenza use in patients with glaucoma.

It is the privilege of nurses to be present at the beginning and the end of life, says RCN professional lead for community and end of life care Carolyn Doyle. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To understand the principles of pharmacogenomic testing • To be aware of how pharmacogenomic testing can inform prescribing decisions • To familiarise yourself with the role of nurses in pharmacogenomic testing When making prescribing decisions, it is important for healthcare professionals to remember that individual patients may respond differently to medicines. For example, some patients may experience a therapeutic benefit while others may experience an adverse drug reaction. The aim of personalised medicine is to tailor treatment based not only on a patient's clinical factors, but also on their genetic profile. Pharmacogenomics is a branch of personalised medicine that is concerned with how differences in people's genomes affect their response to medicines. Pharmacogenomic testing, which recently has become less expensive and increasingly available, can inform nurses' prescribing decisions and improve patient outcomes. This article discusses personalised medicine and pharmacogenomics, including how pharmacogenomic testing can optimise medicine prescribing, and explains the role of nurses in the process. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To improve your understanding of the mechanisms of medicine absorption • To explore the numerous pharmacokinetic factors that affect medicine absorption • To understand the safety parameters of the prescription and administration of medicines The speed and extent of medicine absorption in the human body are affected by numerous interrelated pharmacokinetic factors. To maximise therapeutic benefit and ensure patient safety, nurses require an optimal understanding of these factors. The Royal Pharmaceutical Society has established four principles of medicines optimisation that healthcare professionals should follow. This article discusses the pharmacokinetic factors that affect medicine absorption. It also examines the four principles of medicines optimisation and how nurses can use these to ensure the safe and effective use of medicines. [ABSTRACT FROM AUTHOR]

Problem/Condition: In 2017, a total of 70,237 persons in the United States died from a drug overdose, and 67.8% of these deaths involved an opioid. Historically, the opioid overdose epidemic in the United States has been closely associated with a parallel increase in opioid prescribing and with widespread misuse of these medications. National and state policy makers have introduced multiple measures to attempt to assess and control the opioid overdose epidemic since 2010, including improvements in surveillance systems. Period Covered: 2010-2016. Description of System: The Prescription Behavior Surveillance System (PBSS) was created in 2011. Its goal was to track rates of prescribing of controlled substances and possible misuse of such drugs using data from selected state prescription drug monitoring programs (PDMP). PBSS data measure prescribing behaviors for prescription opioids using multiple measures calculated from PDMP data including 1) opioid prescribing, 2) average daily opioid dosage, 3) proportion of patients with daily opioid dosages ≥90 morphine milligram equivalents, 4) overlapping opioid prescriptions, 5) overlapping opioid and benzodiazepine prescriptions, and 6) multiple-provider episodes. For this analysis, PBSS data were available for 2010-2016 from 11 states representing approximately 38.0% of the U.S. population. Average quarterly percent changes (AQPC) in the rates of opioid prescribing and possible opioid misuse measures were calculated for each state. Results and Interpretation: Opioid prescribing rates declined in all 11 states during 2010-2016 (range: 14.9% to 33.0%). Daily dosage declined least (AQPC: -0.4%) in Idaho and Maine, and most (AQPC: -1.6%) in Florida. The percentage of patients with high daily dosage had AQPCs ranging from -0.4% in Idaho to -2.3% in Louisiana. Multiple-provider episode rates declined by at least 62% in the seven states with available data. Variations in trends across the 11 states might reflect differences in state policies and possible differential effects of similar policies. Public Health Actions: Use of PDMP data from individual states enables a more detailed examination of trends in opioid prescribing behaviors and indicators of possible misuse than is feasible with national commercially available prescription data. Comparison of opioid prescribing trends among states can be used to monitor the temporal association of national or state policy interventions and might help public health policymakers recognize changes in the use or possible misuse of controlled prescription drugs over time and allow for prompt intervention through amended or new opioid-related policies. [ABSTRACT FROM AUTHOR]

The article offers information on the second annual Current, Relevant, Useful Eye Symposium to be held at the Silverado resort and Spa in Napa Valley, California from November 10 to 12, 2023, which will focus on subjects related to eye care, such as glaucoma, anterior segment disease and myopia management.

The article discusses the increasing incidence of opioid misuse in Great Brtain. According to data, 23 million prescriptions for opioid drugs had been issued in 2018. More patients have used opioid drugs to treat their chronic pain. The Organisation for Economic Co-operation and Development (OECD) has provided suggestions for reducing opioid addiction, including more medication-assisted therapy and specialized services for infectious disease management.

Deprescribing is the term used to describe the discontinuation of medicines. It can be either 'reactive', for example in response to an adverse event or therapeutic failure, or 'proactive', when the prescriber and patient decide to discontinue the medicine because its future benefits no longer outweigh its potential for harm. At present, there is a limited amount of proactive deprescribing activity in primary and secondary care. This article provides the rationale for increasing proactive deprescribing activity, lists the medicines this relates to, identifies the barriers and enablers to its implementation, and describes the potential role of the nurse in this process. [ABSTRACT FROM AUTHOR]

The article discusses a 2018 study which shows that eye care providers drove higher branded medication claims than all other providers. Topics covered include bases for branded preferences for optimized patient outcomes, reviewing the evidence on equivalence of efficacy and tolerability between generic and brand name medications, and encounters with patients who develop problems with generic prescriptions. Also noted is the less than automatic translation of generics into costs savings.

The article reports on a study by Yoshihiro Yonekawa which analyzed opioid prescription patterns of retina specialists in the U.S. Based on data from the 2019 American Society of Retina Specialists directory Yonekawa found that male members were more likely to prescribe opioids but as a whole, members prescribe the drug at a lower rate. Between 201 and 2016, it was observed that there is a downward trend overtime. The highest prescriptions were written in Texas, Okalhoma, Idaho, among others.

Antimicrobial resistance is a significant public health issue and a major threat to global health. The solutions are multifactorial, and include: a reduction in the unnecessary use of antibiotics; public health campaigns; the use of systems approaches by healthcare organisations; and involving the knowledge and responsibilities of individual nurses. This article examines the challenge of antimicrobial resistance and explores the concept of antimicrobial stewardship in addressing this issue. It also discusses how nurses can contribute to a systems approach in primary and secondary care to support antimicrobial stewardship initiatives. [ABSTRACT FROM AUTHOR]

Polypharmacy refers to the prescribing of many medicines for one individual. Polypharmacy is increasingly common as a result of the rise in multimorbidity, use of evidence-based clinical guidelines and care pathways, and a focus on disease prevention. Polypharmacy can be justified and appropriate, but it may also be inappropriate and associated with suboptimal health outcomes and mortality. Polypharmacy is associated with adverse drug events such as drug-drug interactions and adverse drug reactions (ADRs). Taking multiple medicines can adversely affect adherence, resulting in lost opportunities for health gain and wasted medicines. Older people, and particularly those who are frail, are susceptible to the adverse effects of polypharmacy. Medication reviews should be undertaken regularly in older people with polypharmacy. Medicines management systems, research, and education are essential to improve safe practice in the management of polypharmacy. [ABSTRACT FROM AUTHOR]

The article presents the author's views on the modern methods of risk analysis and calculating risk based on the recommendation in ICH Q9 document, and his query on the practical value of its inclusion in European Union (EU) general medical practice (GMP) guideline.

Problem/Condition: Drug overdose is the leading cause of injury death in the United States. The death rate from drug overdose in the United States more than doubled during 1999-2013, from 6.0 per 100,000 population in 1999 to 13.8 in 2013. The increase in drug overdoses is attributable primarily to the misuse and abuse of prescription drugs, especially opioid analgesics, sedatives/ tranquilizers, and stimulants. Such drugs are prescribed widely in the United States, with substantial variation by state. Certain patients obtain drugs for nonmedical use or resale by obtaining overlapping prescriptions from multiple prescribers. The risk for overdose is directly associated with the use of multiple prescribers and daily dosages of > 100 morphine milligram equivalents (MMEs) per day. Period Covered: 2013. Description of System: The Prescription Behavior Surveillance System (PBSS) is a public health surveillance system that allows public health authorities to characterize and quantify the use and misuse of prescribed controlled substances. PBSS began collecting data in 2012 and is funded by CDC and the Food and Drug Administration. PBSS uses standard metrics to measure prescribing rates per 1,000 state residents by demographic variables, drug type, daily dose, and source of payment. Data from the system can be used to calculate rates of misuse by certain behavioral measures such as use of multiple prescribers and pharmacies within specified time periods. This report is based on 2013 de-identified data (most recent available) that represent approximately one fourth of the U.S. population. Data were submitted quarterly by prescription drug monitoring programs (PDMPs) in eight states (California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio, and West Virginia) that routinely collect data on every prescription for a controlled substance to help law enforcement and health care providers identify misuse or abuse of such drugs. Results: In all eight states, opioid analgesics were prescribed approximately twice as often as stimulants or benzodiazepines. Prescribing rates by drug class varied widely by state: twofold for opioids, fourfold for stimulants, almost twofold for benzodiazepines, and eightfold for carisoprodol, a muscle relaxant. Rates for opioids and benzodiazepines were substantially higher for females than for males in all states. In most states, opioid prescribing rates peaked in either the 45--54 years or the 55--64 years age group. Benzodiazepine prescribing rates increased with age. Louisiana ranked first in opioid prescribing, and Delaware and Maine had relatively high rates of use of long-acting (LA) or extended-release (ER) opioids. Delaware and Maine ranked highest in both mean daily opioid dosage and in the percentage of opioid prescriptions written for > 100 MMEs per day. The top 1 % of prescribers wrote one in four opioid prescriptions in Delaware, compared with one in eight in Maine. For the five states whose PDMPs collected the method of payment, the percentage of controlled substance prescriptions paid for in cash varied almost threefold, and the percentage paid by Medicaid varied sixfold. In West Virginia, for 1 of every 5 days of treatment with an opioid, the patient also was taking a benzodiazepine. Multiple-provider episode rates were highest in Ohio and lowest in Louisiana. Interpretation: This report presents rates of population-based prescribing and behavioral measures of drug misuse in the general population that have not been available previously for comparison among demographic groups and states. The higher prescribing rates for opioids among women compared with men are consistent with a higher self-reported prevalence of certain common types of pain, such as lower back pain among women. The trend in opioid prescribing rates with age is consistent with an increase in the prevalence of chronic pain with age, but the increasing prescribing rates of benzodiazepines with age is not consistent with the fact that anxiety is most common among persons aged 30^4 years. The variation among states in the type of opioid or benzodiazepine of choice is unexplained. Most opioid prescribing occurs among a small minority of prescribers. Most of the prescriptions by top-decile prescribers probably are written by general, family medicine, internal medicine, and midlevel practitioners. The source of payment varied by state, for reasons that are unclear. Persons who are prescribed opioids also are commonly prescribed benzodiazepine sedatives despite the risk for additive depressant effects. Public Health Actions: States can use their prescription drug monitoring programs to generate population-based measures for the prescribing of controlled substances and for behaviors that suggest their misuse. Comparing data with other states and tracking changes in these measures over time can be useful in measuring the effect of policies designed to reduce prescription drug misuse. [ABSTRACT FROM AUTHOR]

An interview with University of Oregon's Master's Program in Communication Disorders and Sciences director McKay Moore Sohlberg is presented. She talks about how she became interested in acquired brain injury rehabilitation. She explains why she is interested in assisting patients regain attention, memory and executive function. She discusses the best strategies in cognitive rehabilitation.

In the article, the author discusses the factors in the cataract surgery process that could improve the patient experience and satisfaction. Also cited are the survey they conducted to determine the patients' perspective of their cataract surgical process, their postcataract surgery drop regimen like antibiotics, nonsteroidal anti-inflammatory agents, and steroids, and their use of dexamethasone opthalmic insert from Ocular Therapeutix to eliminate the need for postoperative steroid drop.

The article focuses on a survey conducted to analyze the economic growth of group medical practitioners and solo medical practitioners. The survey was conducted on 30,000 optometrists and the data was collected through electronic mails. According to the results, annual income for solo doctors was 144,125 U.S. dollars and group doctors were 191, 195 U.S. dollars.

Information on issues discussed at the International Workshop on Meibomiam Gland Dysfunction (MGD) on dry eye syndrome is presented. Topics include clinical insights on the underdiagnosis and prevalence of MGD in clinical practice, its testing methods and classification, and conventional therapies such as LipiFlow®. The workshop featured several physicians including Edward Holland, Alan Carlson, and Donald Korb.

The article discusses the ICD-9 diagnostic codes for glaucoma in the U.S. The codes are implemented by the Centers for Medicare & Medicaid Services to address physician profiling in which an insurance company examines how much one's services are costing the company. The use of staging codes are provided depending on the type of dignosis made for glaucoma. It is considered that the use of the diagnostic codes can help ophthalmologists to analyze resource use in their practice.

The article presents essays from several optometrists based on their respective experiences while under a residency training. Featured optometrists include Jordan Keith, assistant Professor of Optometry in Illinois College of Optometry, Sarah A. Hetu-Radny at HealthDrive in Nashua, New Hampshire, and Ben L. Larson of the Advanced Eye Care in Sanford, Florida. They have shared their experiences, particularly on their lessons learned from their practice of optometry while at a residency training.

The article offers information on the medical practice of optometrists from refraction to medical care. These include the assessment of optometrist's diagnosis and treatment skills to know the level of competency and to improve each field. Another one is equipping the office with the proper tools for diagnosis and management of eye disease which includes appropriate diagnostic and treatment pharmaceuticals. Last is the proper coding for medical procedures including billing and coding.

This article presents a brief history of national and regional changes in pre-registration nurse education together with an overview of how these were adopted in Wales. The development and functions of the practice facilitator role are described and the results of a small-scale audit are discussed. The audit sought to elicit if the training and support given to mentors via the practice facilitators were effective and how this strengthened the credibility of the assessment process of students in practice. [ABSTRACT FROM AUTHOR]

This article describes the author's first experience of learning from reflection on the practice of administering intramuscular injections, using critical incident analysis. The value of effective mentoring on the learning experience is also explored. [ABSTRACT FROM AUTHOR]

The article offers tips for ophthalmologists on how to manage the transition stage from an academic or hospital environment to private practice. The author discusses understanding how ophthalmologists fit into their new practice situation, their relationship with medical staff, and using senior doctors as a source for knowledge. Furthermore, ophthalmologists should know how to manage their patients and clinical time. INSETS: Your Chance to Shine;Defuse the Difficult Patient;When You Break Bad News.

The article discusses clinical informations in patient care which can be helpful for optometric practice. It includes concepts on synechia which results from delay in seeking eye care and acne rosacea-associated with ocular problem. It is stated that the patients with lattice degeneration of the retina are at risk for subsequent retinal tears or breaks.

The reader is encouraged to investigate what is involved in the practice-based assessment of students and to consider how it might be improved. The author suggests that students should be assessed on their performance during episodes of care rather than by continuous assessment. [ABSTRACT FROM AUTHOR]

This article describes how the authors helped practitioners to develop their action planning skills in conjunction with a practice development strategy in an acute hospital, using an approach called concept analysis, embellished by a systematic literature review. As a result of this, two tools were developed to help practitioners become more effective in action planning. This article describes the process and the tools that resulted, and illustrates the impact and benefits of using these tools in practice. It concludes that action planning, when undertaken rigorously and effectively, is a key skill for changing the workplace culture from one where the action plan belongs to one person to one where everyone takes responsibility for action. [ABSTRACT FROM AUTHOR]

The article offers suggestions for effective patient and staff education. INSET: Use Animated Videos to Educate Patients.

AIM: To explore approaches to the promotion of evidence-based practice from academic and clinical perspectives by visiting acute stroke units and collaborating centres of the Joanna Briggs Institute, an international network of academic centres. METHOD: A semi-structured interview schedule was developed, piloted and used to guide interviews with academic and clinical staff in five state capital cities in Australia. Data were analysed and findings reviewed by clinical and academic participants. FINDINGS: Four distinct but not mutually exclusive models and common but variously applied pathways for translation of evidence into clinical practice were identified. Key influential factors included context and local culture, the nature of evidence and role of clinical expertise. Implementation and change management strategies were recognised as emerging priorities. CONCLUSION: A range of methods to advance research synthesis, dissemination and knowledge transfer into clinical practice were demonstrated and may warrant consideration for the UK. [ABSTRACT FROM AUTHOR]

The article offers guides to optimal, most effective and reasonable intraocular pressure (IOP) lowering glaucoma medications. Topics include insight from Dr. Janet Serle of the Icahn School of Medicine on finding the right balance surrounding the number of anti-glaucoma medications that take into considerations various factors including regimen complexity, cost, side effects, physical and mental status of patient. Also discussed are past treatment practices by ophthalmologists for glaucoma.

Provides steps on how to improve primary care ophthalmic practice. Incorporation of automated phone system to facilitate more patient; Benefits of spending more time with patients; Alternative measures to be taken to ensure patient satisfaction.

For reflection to become a transferable skill that is used in practice, practitioners need to learn how to combine this skill with critical thinking. This article provides practical guidance to mentors, clinical supervisors and preceptors on how this might be encouraged. [ABSTRACT FROM AUTHOR]

Reports on issues related to modern optics for the contact lens practitioner in the U.S. Implications for the application of wavefront technology on contact lenses; Role of understanding optical aberrations in harnessing the technology for ophthalmic lenses; Capability of clinicians to apply the theoretical in a practical way.

In this article the author offers useful tips on safe practice for general practitioners (GP). The effectiveness and safety of clinical management decisions depend on the quality of information gathered. GP should make sure his or her advice is appropriate to patients' circumstances, or they will begin to doubt competence and understanding of GP. The responsibility of GP does not end once the referral has been made, no matter how long the waiting list. Written notes that are neither in date order nor summarised can spell disaster. Although succinct notes can be a virtue in general practice, there are times when it is wise to record negative findings.

Discusses the benefits of physician practice in small groups. Growth in the number of physicians working in small groups in the United States; Details on several cases of physicians who shifted to practicing in small groups; Failure of physician management companies.

The article discusses the development of Preferred Practice Pattern (PPP) guidelines to help ophthalmologists not specialized to identify primary open-angle glaucoma (POAG) as of 2021. Topics covered include the recommendation of a periodic genioscopy to document angle status, the low gonioscopy patient adherence rates, and identification of patient adherence if one underwent the procedure within 12 months of initial POAG diagnosis. Also noted is a demographic chart on gonioscopy adherence.

The article discusses the U.S. Food and Drug Administration's (FDA) approval of the artificial intelligence (AI) system (IDx-DR) for the automated detection of diabetic retinopathy (DR) without human oversight, or diabetic macular edema, as of February 1, 2019. Topics covered include its changing of healthcare delivery and increase in patient access to early DR detection, the minimal training required for operating the AI system, and the common standard for deciding DR severity.