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Background: Non-adherence to prescribed medicines is linked to adverse health outcomes in people living with chronic health conditions (CHCs). Multiple factors are known to contribute to non-adherence to medicines including polypharmacy, demographic features and disease and health systems. Both non-prescription and prescription medicines contribute to polypharmacy; however, there is limited data on the influence of non-prescription medicines to non-adherence. Aim: Therefore, the aim of the study was to investigate the influence of non-prescription medicines to non-adherence in an Australian population. Methods: Data from the 2016 National Survey of a random sample of Australian adult residents were utilised in this study to investigate factors associated with non-adherence. Descriptive statistics, chi(2), regression and generalised linear models were used to assess the relationships between variables of interest. Narrative response and comments were used to provide further insight. Results: This study recruited 1217 participants to explore factors associated with non-adherence to medicines. Weak but statistically significant correlations were identified showing the number of CHCs, patient's age, number of prescription medicines, number of non-prescription medicines and total number of medicines associated with non-adherence. Discussion: The findings suggest that people living with CHCs and taking multiple medicines, including non-prescription medicines, are likely to be non-adherent to prescription medicines. This study shows the possible involvement of non-prescription medicines in contributing to non-adherence in an Australian population and suggests that future studies with a broader demographic are warranted.

Metformin (MET), a biguanide oral hypoglycaemic agent, recently has been shown to be effective in various conditions other than type-2 diabetes including cancer, stroke, weight reduction, and polycystic ovarian syndrome, to name a few. MET has also possessed antioxidant and antiinflammatory properties by activation of AMPK . This study was aimed at evaluating the effects of MET on lipopolysaccharide (LPS)-induced systemic and neuroinflammation, oxidative stress, and behavioural changes. The study consisted of six groups, where three selected doses of MET (100, 200, and 300 mg/kg) were employed in male Swiss albino mice, with one group of imipramine (IMI), saline, and LPS each. Systemic inflammation was induced by injecting LPS (1.5 mg/kg) by intraperitoneal route. A battery of behavioural tests including open field, forced swim, and tail suspension tests were employed to assess the impact of systemic inflammation on exploratory behaviour and learned helplessness. LPS induced significant immobility with profound symptoms of sickness behaviour. Furthermore, LPS led to significant increase in serum and brain proinflammatory cytokines TNF-α and IL-6; and also increased lipid peroxidation with reduced glutathione levels. Pretreatment of the animals with 100 and 200 mg/kg of MET significantly reduced both systemic and central inflammatory markers along with protecting against LPS-induced oxidative stress. The higher dose, 300 mg/kg of MET was not effective against most of LPS-induced biochemical changes. Our preliminary results from this study suggest the antiinflammatory and neuroprotective effects of MET in LPS-induced model of sickness behaviour and neuroinflammation.

Accumulating data links inflammation, oxidative stress and immune system in the pathophysiology of major depressive disorders. Sickness behaviour is a set of behavioural changes that develop during infection, eventually leading to decrease in mobility and depressed behaviour. Lipopolysaccharide (LPS) induces a depression-like state in animals that mimics sickness behaviour. Caffeic acid, a naturally occurring polyphenol, possesses antioxidant and anti-inflammatory properties. The present study was designed to explore the potential of caffeic acid against LPS-induced sickness behaviour in mice. Caffeic acid (30 mg/kg) and imipramine (15 mg/kg) were administered orally one hour prior to LPS (1.5 mg/kg) challenge. Behavioural assessment was carried out between 1 and 2 h and blood samples were collected at 3 h post-LPS injection. Additionally, cytokines (brain and serum) and brain oxidative stress markers were estimated. LPS increased the systemic and brain cytokine levels, altered the anti-oxidant defence and produced key signs of sickness behaviour in animals. Caffeic acid treatment significantly reduced the LPS-induced changes, including reduced expression of inflammatory markers in serum and whole brain. Caffeic acid also exerted an anti-oxidant effect, which was evident from the decreased levels of oxidative stress markers in whole brain. Our data suggests that caffeic acid can prevent the neuroinflammation-induced acute and probably the long term neurodegenerative changes.

Poor surgical assistance has been identified as a major stressor in surgeons, making the ability to provide effective surgical assistance an important skill which will have a lifelong impact on the surgical patient. Knowledge and technical ability are clearly important, but strong personal qualities are more so in the long run. This applies to all who provide assistance either as a surgical first assistant or surgical care practitioner. These skills and attributes are needed to provide a safe service that meets the expectations of both the professional regulatory authorities and surgical Royal Colleges. Advice is given in this article as to how non-medical practitioners may acquire these skills.

Montelukast is a cysteinyl leukotriene (CysLT) receptor antagonist with efficacy against a variety of diseases, including asthma and inflammation-related conditions. However, various neuropsychiatric events (NEs) suspected to be related to montelukast have been reported recently, with limited understanding on their association and underlying mechanisms. This study aimed to investigate whether montelukast can induce neuroinflammation and neurotoxicity in microglial HAPI cells and neural SH-SY5Y cells. The present study also compared the effects of montelukast with a 5-lipoxygenase inhibitor (zileuton) and a cyclooxygenase-2 inhibitor (celecoxib) to better understand modulation of related pathways. HAPI or SH-SY5Y cells were treated with the indicated drugs (3.125 μM–100 μM) for 24 h to investigate drug-induced neuroinflammation and neurotoxicity. Montelukast induced cytotoxicity in HAPI cells (50–100 μM), accompanied with caspase-3/7 activation, prostaglandin E2 (PGE2) release, and reactive oxygen species (ROS) production. Whilst both montelukast and zileuton down-regulated CysLT release in HAPI cells, zileuton did not significantly affect cell viability or inflammatory and oxidative factors. Celecoxib decreased HAPI cell viability (6.25–100 μM), accompanied with increasing caspase-3/7 activation and ROS production, but in contrast to montelukast increased CysLT release and decreased PGE2 production. Similar to observations in HAPI cells, both montelukast and celecoxib (50–100 μM) but not zileuton produced toxicity in SH-SY5Y neuroblastoma cells. Similarly, CM from HAPI cells treated with either montelukast or zileuton produced toxicity in SH-SY5Y cells. The results of the current study show the capability of montelukast to directly induce toxicity and inflammation in HAPI cells, possibly through the involvement of PGE2 and ROS, and toxicity in undifferentiated SH-SY5Y neuroblastoma cells. The current study highlights the importance of consideration between benefit and risk of montelukast usage and provides references for future investigation on decreasing montelukast-related NEs.

Background An individualized approach using shared decision-making (SDM) and goal setting is a person-centred strategy that may facilitate prioritization of treatment options. SDM has not been adopted extensively in clinical practice. An interprofessional approach to SDM with tools to facilitate patient participation may overcome barriers to SDM use. The aim was to explore decision-making experiences of health professionals and people with diabetes (PwD), then develop an intervention to facilitate interprofessional shared decision-making (IP-SDM) and goal-setting. Methods This was a multi-phased study. 1) Feasibility: Using a descriptive qualitative study, individual interviews with primary care physicians, nurses, dietitians, pharmacists, and PwD were conducted. The interviews explored their experiences with SDM and priority-setting, including facilitators and barriers, relevance of a decision aid for priority-setting, and integration of SDM and a decision aid into practice. 2) Development: An evidence-based SDM toolkit was developed, consisting of an online decision aid, MyDiabetesPlan, and implementation tools. MyDiabetesPlan was reviewed by content experts for accuracy and comprehensiveness. Usability assessment was done with 3) heuristic evaluation and 4) user testing, followed by 5) refinement. Results Seven PwD and 10 clinicians participated in the interviews. From interviews with PwD, we identified that: (1) approaches to decision-making were diverse and dynamic; (2) a trusting relationship with the clinician and dialog were critical precursors to SDM; and, (3) goal-setting was a dynamic process. From clinicians, we found: (1) complementary (holistic and disease specific) approaches to the complex patient were used; (2) patient-provider agendas for goal-setting were often conflicting; (3) a flexible approach to decision-making was needed; and, (4) conflict could be resolved through SDM. Following usability assessment, we redesigned MyDiabetesPlan to consist of data collection and recommendation stages. Findings were used to finalize a multi-component toolkit and implementation strategy, consisting of MyDiabetesPlan, instructional card and videos, and orientation meetings with participating patients and clinicians. Conclusions A decision aid can provide information, facilitate clinician-patient dialog and strengthen the therapeutic relationship. Implementation of the decision aid can fit into a model of team care that respects and exemplifies professional identity, and can facilitate intra-team communication. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015.

Coffee, a popular beverage throughout the world, has been shown to have numerous beneficial health effects, including reducing the risk of developing depression. This effect has only been shown with the consumption of caffeinated coffee and not decaffeinated coffee or caffeine alone and one of many hypotheses attributes this to the loss of key constituents during the decaffeination process. The aim of this study was to investigate whether any of the key bioactive coffee constituents with known anti-oxidant and anti-inflammatory effects are lost during the decaffeination process. The analysis of nine caffeinated and nine decaffeinated samples of various brands and batches of commonly consumed coffee in Australia using HPLC analysis found that, with the exception of caffeine, there were no significant differences in the quantity of other key bioactive coffee constituents in caffeinated and decaffeinated coffee. These results suggest that there may be an alternative explanation for the observed inverse correlation between caffeinated coffee consumption and the risk of developing depression.

The stimulant properties of caffeine are often promoted in pre-workout supplements (PWS) to assist with training, reduce the perception of fatigue, and for some brands, assist body fat loss. While manufacturers of PWS often indicate the inclusion of significant amounts of caffeine, no independent verification of the caffeine content of these products exists. The aim of this investigation was to independently assess the caffeine content of popular PWS in Australia and compare these values to nutrition information panel data. Fifteen PWS were tested for their caffeine content (both within and between batches of the same product). The caffeine content of selected PWS ranged from 91 to 387 mg·serve-1 . Only 6 of the 15 PWS nutrition information panels included details on caffeine content. The percent of caffeine present ranged from 59% to 176% of packaging claims. All but one PWS contained a variation of caffeine within and between batches that was considered "practically" significant (ie, ≥40 mg·serve-1 variation). Consumers are likely to be exposed to large and variable caffeine doses if ingesting PWS. Product information panels do little to improve consumer awareness of likely caffeine intakes.

Pain is the most frequent complication of cancer and an important reason for out-of-hours (OOH) primary care contacts by patients with established cancer. Existing quantitative data give little insight into the reason for these contacts. Exploring such encounters of care could highlight ways to improve anticipatory cancer care and communication between daytime and OOH primary care services.To explore the experiences, views, and opinions of patients and their caregivers who have used OOH primary care for help with managing cancer pain.A semi-structured interview study with patients and caregivers who have utilised an OOH primary care service in Grampian, Scotland, because of pain related to cancer.Semi-structured interviews with 11 patients and four caregivers (n = 15), transcribed verbatim and analysed using framework analysis and, to a lesser extent, inductive thematic analysis.Six key themes emerged: making sense of pain and predicting its likely course; beliefs about analgesics; priority daytime access; the importance of continuity of care and communication between all involved; barriers and facilitators to seeking help in the OOH period; and satisfaction/dissatisfaction with OOH care. Three prominent sub-themes were: patient knowledge; the influence of a caregiver on decision-making; and the benefits of having a palliative care summary.Effective daytime and anticipatory care can positively influence OOH care. Interventions that aid patients in understanding cancer pain, communicating about pain, utilising analgesics effectively, and seeking appropriate and timely help may improve cancer pain management.

Coffee is a widely consumed beverage containing numerous biologically active constituents predominantly belonging to the polyphenol and alkaloid classes. It has been established that coffee has a beneficial effect on numerous disease states including depression. A number of prospective and retrospective cohort studies have assessed the effects of coffee consumption on the relative risk of developing major depressive disorder in humans. These studies have identified an inverse relationship between the consumption of caffeinated coffee and the risk of developing depression. Caffeine, chlorogenic acid, ferulic acid and caffeic acid, all important constituents of coffee, have been shown to possess biological activities that highlight a possible mechanistic link to the pathology of depression. This review aims to assess the evidence from the biological evaluation of these constituents of coffee on markers of inflammation associated with depression in in vitro and in vivo models of inflammation, neuroinflammation and depression. The ability of bioactive coffee constituents to modulate the parameters of neuroinflammation has been shown with caffeine having strong antioxidant properties in vitro, chlorogenic acid and caffeic acid having strong anti-inflammatory and antioxidant properties in vitro and ferulic acid having activities in in vivo animal models of depression.

This second article in the series Spotlight on Research focuses on qualitative research, its applications, principles and methodologies. It provides an insight into how this approach can be used within the perioperative setting and gives advice for practitioners looking to undertake a qualitative research study.

Pyocyanin (PCN) is a virulence factor secreted by Pseudomonas aeruginosa (P. aeruginosa) that has been shown to have numerous toxic effects in both in vitro and in vivo studies. Such toxicities include pro-inflammatory and pro-oxidant mediated responses. It is hypothesized that PCN can cross biological membranes and reach the systemic circulation, but no previous studies have investigated this. The aim of this study was, therefore, to quantify PCN in plasma and assess if systemic responses were occurring after localized intranasal administration in C57BL/6 J mice. This was achieved through the plasma quantification of PCN and assessment of changes to behavior using two commonly used tests, the forced swimming test and the open field test. Furthermore, evidence of systemic oxidative stress and inflammation was measured using malondialdehyde (MDA) and TNF-α post PCN exposure. PCN was found to cross into systemic circulation but in a variable manner. Furthermore, significant increases in plasma TNF-α and MDA (both p

BACKGROUND: Melanoma incidence is rising rapidly worldwide among white populations. Defining higher-risk populations using risk prediction models may help targeted screening and early detection approaches. OBJECTIVES: To assess the feasibility of identifying people at higher risk of melanoma using the Williams self-assessed clinical risk estimation model in U.K. primary care. METHODS: We recruited participants from the waiting rooms of 22 general practices covering a total population of > 240 000 in three U.K. regions: Eastern England, North East Scotland and North Wales. Participants completed an electronic questionnaire using tablet computers. The main outcome was the mean melanoma risk score using the Williams melanoma risk model. RESULTS: Of 9004 people approached, 7742 (86%) completed the electronic questionnaire. The mean melanoma risk score for the 7566 eligible participants was 17·15 ± 8·51, with small regional differences [lower in England compared with Scotland (P = 0·001) and Wales (P < 0·001), mainly due to greater freckling and childhood sunburn among Scottish and Welsh participants]. After weighting to the age and sex distribution, different potential cut-offs would allow between 4% and 20% of the population to be identified as higher risk, and those groups would contain 30% and 60%, respectively of those likely to develop melanoma. CONCLUSIONS: Collecting data on the melanoma risk profile of the general population in U.K. primary care is both feasible and acceptable for patients in a general practice setting, and provides opportunities for new methods of real-time risk assessment and risk stratified cancer interventions.

Chemotherapy is an important treatment modality for malignancy but is limited by significant toxicity and it susceptibility to numerous drug interactions. While the interacting effects with medications are well known, there is limited evidence on the interaction with commonly consumed food and natural products. The aim of this study was to evaluate the bioactive constituents of coffee (caffeine and chlorogenic acid) on the cytotoxicity of doxorubicin, gemcitabine, and paclitaxel in vitro. Pretreatment with caffeine (100 nM and 10 μM) sensitized SH-SY5Y cells to doxorubicin-induced toxicity and increased apoptosis and sensitized PC3 cells to gemcitabine-induced toxicity. Pretreatment with 10 μM caffeine decreased total cell reactive oxygen species (ROS) production but increased mitochondrial ROS production. In contrast, caffeine (10 nM and 10 μM) protected cells against gemcitabine-induced toxicity and apoptosis. Similarly, 1 μM and 10 μM caffeine protected cells against paclitaxel-induced toxicity and mitochondrial ROS production. Chlorogenic acid had no effect on chemotherapy-induced toxicity in SH-SY5Y cells. In conclusion, this study provides preliminary evidence that caffeine, not chlorogenic acid, modulates the cytotoxicity of doxorubicin, gemcitabine, and paclitaxel in SH-SY5Y cells via different mechanisms.

Combining an exercise and nutritional intervention is arguably the optimal method of creating energy imbalance for weight loss. This study sought to determine whether combining exercise and caffeine supplementation was more effective for promoting acute energy deficits and manipulations to substrate metabolism than exercise alone. Fourteen recreationally active participants (mean ± SD body mass index: 22.7 ± 2.6 kg/m2) completed a resting control trial (CON), a placebo exercise trial (EX), and a caffeine exercise trial (EX+CAF, 2 × 3 mg/kg of caffeine 90 min before and 30 min after exercise) in a randomized, double-blinded design. Trials were 4 h in duration with 1 h of rest, 1 h of cycling at ∼65% power at maximum O2 consumption or rest, and a 2-h recovery. Gas exchange, appetite perceptions, and blood samples were obtained periodically. Two hours after exercise, participants were offered an ad libitum test meal where energy and macronutrient intake were recorded. EX+CAF resulted in significantly greater energy expenditure and fat oxidation compared with EX (+250 kJ; +10.4 g) and CON (+3,126 kJ; +29.7 g) ( P < 0.05). A trend for reduced energy and fat intake compared with CON (−718 kJ; −8 g) ( P = 0.055) was observed. Consequently, EX+CAF created a greater energy deficit ( P < 0.05). Caffeine also led to exercise being perceived as less difficult and more enjoyable ( P < 0.05). Combining caffeine with exercise creates a greater acute energy deficit, and the implications of this protocol for weight loss or maintenance over longer periods of time in overweight/obese populations should be further investigated.

It is over a century now since the importance of the knowledge and skills of the surgeon's assistant were first considered (Brickner 1907). More recently both the Royal College of Surgeons of England (RCSE 1999, 2011) and the Perioperative Care Collaborative (PCC 2007) have reviewed the role of the non-medically qualified surgical assistant. In 2012, the PCC published their review of the surgical first assistant (SFA) role in response to a call by the RCSE for greater clarity in relation to the plethora of titles afforded to non-medical surgical assistants (RCSE 2011).

People living with colorectal cancer are at risk of anxiety and depression. We investigated what factors were most highly associated with these. Four hundred and ninety-six people with colorectal cancer completed the Hospital Anxiety and Depression Scale (HADS). Data on functioning, symptoms, illness perceptions and social difficulties were collected by questionnaire. Case-note-identified disease, treatment and co-morbidity data were recorded. Multiple logistic regression identified factors independently predictive of anxiety and depression caseness. Self-reported history of anxiety/depression predicted anxiety but not depression caseness. Depression caseness predicted anxiety caseness (p = 0.043), as did poorer self-reported cognitive functioning (p = 0.001), dyspnoea (p = 0.015) or diarrhoea (p = 0.021), reporting a high negative life and emotional impact (p

South Africa’s Choice on Termination of Pregnancy Act of 1996 implicitly expresses the attitude that the prenatal detection of foetal abnormality justifies selective abortion, even at a stage when abortion is in general morally prohibited. It will be argued that this attitude is logically incompatible with a simultaneous commitment to non-discrimination against persons with disabilities, in that the Act makes allowance for the subjection of beings that are considered to be morally significant, but that exhibit disabling characteristics, to worse treatment than their non-disabled counterparts, despite the fact that this differential treatment is not always justified by the presence of impairment.

INTRODUCTION Interprofessional education (IPE) interventions lack clarity regarding development and implementation, impeding a clear understanding of their role and effectiveness. The aim of this study was to identify whether and how an outreach program targeting interprofessional health care teams can improve self-efficacy and interprofessional collaboration (IPC). METHODS A cohort study was conducted to explore the effect of the program on individual self-efficacy and perceived IPC and investigate factors affecting interprofessional learning and collaboration. The program was a two-year IPE program consisting of workshops, educational materials, and interworkshop support. Participants were physicians, nurses, dietitians, pharmacists, and social workers at two primary care teams in Toronto. Self-efficacy and team function were measured five times throughout the program. We used analysis of variance and t-tests to compare between teams and used Pearson correlations to estimate the relationship between self-efficacy and team function. One-on-one interviews investigated factors affecting IPC and the program's effect on IPC. RESULTS Team function improved as the program progressed (P = .02); although it did not affect self-efficacy, there was an increasing correlation between self-efficacy and team function as the program progressed (P < .01 for workshop 5). Interviews revealed that trust, liability concerns, and geographic proximity were mediators of IPC. The workshops were perceived to enable trust building by increasing knowledge and allowing nonphysician team members to showcase their expertise. DISCUSSION Our findings demonstrate that an IPE workshop, through role clarification, cultivation of trust, and a community of practice, can promote these elements. Trust in team members and geographic proximity are potential facilitators to IPC developed during an interprofessional program.

Purpose Preparing residents for future practice, knowledge, and skills in quality improvement and safety (QI/S) is a requisite element of graduate medical education. Despite many challenges, residency programs must consider new curricular innovations to meet the requirements. We report the effectiveness of a primary care QI/S curriculum and the role of the chief resident in quality and patient safety in facilitating it. Method Through the Veterans Administration Graduate Medical Education Enhancement Program, we added a position for a chief resident in quality and patient safety, and 4 full-time equivalent internal medicine residents, to develop the Primary Care Interprofessional Patient-Centered Quality Care Training Curriculum. The curriculum includes a first-or second-year, 1-month block rotation that serves as a foundational experience in QI/S and interprofessional care. The responsibilities of the chief resident in quality and patient safety included organizing and teaching the QI/S curriculum and mentoring resident projects. Evaluation included prerotation and postrotation surveys of self-assessed QI/S knowledge, abilities, skills, beliefs, and commitment (KASBC); an end-of-the-year KASBC; prerotation and postrotation knowledge test; and postrotation and faculty surveys. Results Comparisons of prerotation and postrotation KASBC indicated significant self-assessed improvements in 4 of 5 KASBC domains: knowledge (P Conclusions Our primary care QI/S curriculum was associated with improved and persistent resident self-perceived knowledge, abilities, and skills and increased knowledge-based scores of QI/S. The chief resident in quality and patient safety played an important role in overseeing the curriculum, teaching, and providing leadership.

A first-generation energy sorghum hybrid with enhanced photoperiod sensitivity and long growth duration accumulated more than twice as much biomass as grain sorghum. The energy sorghum produced more leaves (~45 vs 17–20), longer stems (~4 vs 1.5 meters) and had a higher stem-to-leaf biomass ratio than grain sorghum. At the end of the season, energy sorghum stems represented 83% of the plant's shoot biomass. The greater biomass accumulation was due to longer growth duration, a higher leaf area index, greater radiation interception, and higher radiation use efficiency. When grown under dryland or limited irrigation conditions, the rate of biomass accumulation by the energy sorghum hybrid was reduced in mid-season. This decrease was most apparent in August due to summer water deficit; however plants recovered when rain occurred in September. Crop growth modeling and biomass accumulation rates measured under optimal field conditions show that energy sorghum, like other C4 energy grasses, has excellent biomass yield potential. The greenhouse gas offset values of energy sorghum hybrids, grown in large and small field plots, and under fully irrigated and dryland conditions, ranged from 63–78% for cellulosic ethanol production and 88–95% for power generation. This study shows that drought-tolerant, annual energy sorghum hybrids have the genetic yield potential to contribute significantly to bioenergy production. Sorghum is a genetically tractable, diverse species with a good genomics platform, making energy sorghum a promising genetic model for the design of C4 grass energy crops. © 2012 Society of Chemical Industry and John Wiley & Sons, Ltd

Background: Asthma action plans (AAPs), which decrease hospitalizations and improve symptom control, are recommended in guidelines, but are seldom delivered to patients. Existing AAPs have been developed by experts, without the inclusion of all stakeholders (such as patients with asthma) and without specifically addressing usability and visual design. Objective: Our objective was to develop a more usable AAP by involving all stakeholders and considering design preferences. Methods: We created a Wiki-based system for multiuser AAP development. Pulmonologists, primary care physicians, asthma educators and patients used the system to collaboratively compile a single AAP by making multiple online selections over 1 week. We combined common elements from 3 AAPs developed in this way into 1, optimized visual design features and tested face validity in focus groups. Results: A total of 41 participants averaged 646 selections/week over a login-time of 28.8 h/week. Of 35 participants, 28 (80%) were satisfied with the final AAP and 32 (91%) perceived that they would be able to use it. The plans created by the 3 groups were very similar, with a unanimous or majority agreement in the handling of 100/110 (91%) AAP options. Conclusions: Inclusion of multiple stakeholders and focus on design preferences predict enhanced usability and uptake of medical tools. The validity of our AAP is further supported by the similarity between the AAPs created by each group, user engagement and satisfaction with the plan and agreement with existing validity criteria proposed by experts. This AAP can be implemented in care with a concurrent measurement of uptake and health impact.

Background The University of Utah began an interdisciplinary experience for students of the health sciences professions in order to improve communication and experience teamwork. Process Students from different health professions interviewed standardized patients then worked in teams to develop a care plan. Results Students' evaluations of the experience were positive. Students felt more at ease in their communications with other disciplines after the experience. They saw the value of teamwork in giving optimal patient care. Conclusions Interdisciplinary team experiences, such as the one described here, are valuable tools for exposure to the healthcare teamwork needed to improve patient outcomes.

The regulation of healthcare professionals is far from new. It continues to evolve, responsive to changes in the professional workforce and the needs of society.

Changes affecting surgical training, together with the implementation of the European Working Time Directive, have necessitated increased reliance on non-medically qualified assistants. Such assistance must be performed by suitably educated personnel. The RCS, The Perioperative Care Collaborative (PCC) and The Association for Perioperative Practice (AfPP) all play a role in ensuring high standards of patient care. In so doing, they have determined the circumstances and the level at which such assistance may be given by three grades of perioperative personnel. It is essential that surgeons understand and support such non-medically qualified colleagues in adhering to these standards.

Objective To investigate the attitudes of pharmacists to the provision of needle-exchange services (NES) at community pharmacies and, if barriers exist, explore means by which they may be overcome. Setting Twenty-one community pharmacies across Grampian in North East Scotland during May and June 2005. Method Semi-structured face-to-face interviews conducted with 24 pharmacists. Key findings Newly identified barriers included the negative influence of security staff, a local policy against NES provision and a lack of awareness of other services available for drug users. Conclusion Training packages for all health professionals working with drug users and awareness training for security staff are required if the identified barriers are to be overcome. ‘Hands-on’ training and experience of NES for pharmacists and their staff should be available. Suggestions made by pharmacists for NES provision in general practitioner surgeries or community hospitals and the development of automated services should be considered.

Dissertations have become common inclusions to postgraduate degrees in healthcare. To the novice researcher, undertaking an extensive project of this kind can appear daunting. In this final article in the series ‘ Spotlight on Research’, Julie Quick and Susan Hall advise perioperative practitioners on how to plan, produce and write a research dissertation. Guidance is also given on disseminating the results from research studies.

Background: Following surgery for melanoma, there is a high risk of recurrence and it is recommended that patients perform regular total skin self-examination (TSSE) to complement physician follow-up. However practice is sub-optimal and reported barriers to TSSE include lack of training, waning motivation and the time required. The Achieving Self-directed Integrated Cancer Aftercare (ASICA) intervention was developed based on behaviour change theory [Information-Motivation-Behavioural skills model (IMB) and Control Theory]. Aims: This study assessed acceptability and feasibility of ASICA. Methods: The intervention involves text message prompts from the nurse-lead (N), information and TSSE demonstration by tablet, monitoring of TSSE, photographing any skin changes and sending to N via tablet, feedback and follow-up by N. Interviews were conducted with 21 people previously treated for cutaneous melanoma. The intervention was piloted with 20 people treated for melanoma. Results: Interviewees were positive about the use of technology to remind and instruct on TSSE, conducting it in their homes and getting feedback quickly. Pilot participants were strongly positive; 15 adhered well to the intervention, 4 intermittently and one withdrew. Symptoms were reported by seven and two had further surgery, one with a recurrent melanoma. Several practical issues were identified. Participants’ intention and self-efficacy increased. Conclusions: The ASICA intervention was acceptable to most patients and feasible following small technical adjustments. It is now proposed to evaluate the intervention in a randomised controlled trial.

The previous articles in this series have explored the need for perioperative practitioners to select a research approach that supports the aims of the study to be undertaken (Quick & Hall 2015a, b). The quantitative approach is considered by some authors to be ‘the epitome of the scientific approach’ (Meadows 2003) and this article, the third in a series, aims to give an overview of this model.

The number and types of applications for Information and Communications Technology (ICT) in the health-care field is constantly increasing and diversifying, from the incorporation of ICT solutions within medical devices to the use of broadband in order to deliver sophisticated patient care remotely and in real time. While legal analysis to date of ICT in healthcare has tended to focus on the issues relating to patient data confidentiality, this article looks at a wider range of concerns, including the need to define the patient/professional relationship differently in a remote care context, questions about who the actual health-carer provider is, and the identification of who has primary care responsibility where health-care is delivered by means of a distributed, multi-site model facilitated by ICT.

In the 25 years since the Oxford Heart Centre in England appointed the first British nurse to be formally trained as a non-medically qualified surgical assistant, the number of nurses and allied health professionals (AHPs) undertaking advancing surgical roles has increased in order to backfill the deficit of a surgical workforce(Quick and Hall 2014). Despite initial concerns over nurses and AHPs undertaking roles and responsibilities which were previously performed solely by doctors, the role of non-medical surgical assistants has been shown to maintain surgical services, provide an additional career route for nurses, and enhance patient care (Abraham 2011, Quick 2013, Jones et al 2012). In the early days however, a lack of role specific regulation, practice guidelines and a variety of educational standards led to variances in job titles and role responsibilities for nurses and AHPs performing surgical assistance (Box 1).

Healthcare providers are challenged to efficiently achieve evidence-based care for patients and their families. Clinical decision support tools are being introduced to facilitate knowledge transfer to care providers. Order sets are one of the tools. Using the realist review methodology and focus group of interview participants, this paper retrospectively explored relationships that lead to successful order set adoption. Findings demonstrate the need for regular review of clinical context. Technology can offer some enhancements but also introduces complex challenges. Ongoing software development is needed to improve delivery formats as well as incorporate effective tools for efficient continuous quality improvement.

Background Competing health concerns present real obstacles to people living with diabetes and other chronic diseases as well as to their primary care providers. Guideline implementation interventions rarely acknowledge this, leaving both patients and providers feeling overwhelmed by the volume of recommended actions. Interprofessional (IP) shared decision-making (SDM) with the use of decision aids may help to set treatment priorities. We developed an evidence-based SDM intervention for patients with diabetes and other conditions that was framed by the IP-SDM model and followed a user-centered approach. Our objective in the present study is to pilot an IP-SDM and goal-setting toolkit following the Knowledge-to-Action Framework to assess (1) intervention fidelity and the feasibility of conducting a larger trial and (2) impact on decisional conflict, diabetes distress, health-related quality of life and patient assessment of chronic illness care. Methods/Design A two-step, parallel-group, clustered randomized controlled trial (RCT) will be conducted, with the primary goal being to assess intervention fidelity and the feasibility of conducting a larger RCT. The first step is a provider-directed implementation only; the second (after a 6-month delay) involves both provider- and patient-directed implementation. Half of the clusters will be assigned to receive the IP-SDM toolkit, and the other will be assigned to be mailed a diabetes guidelines summary. Individual interviews with patients, their family members and health care providers will be conducted upon trial completion to explore toolkit use. A secondary purpose of this trial is to gather estimates of the toolkit’s impact on decisional conflict. Secondary outcomes include diabetes distress, quality of life and chronic illness care, which will be assessed on the basis of patient-completed questionnaires of validated scales at baseline and at 6 and 12 months. Multilevel hierarchical regression models will be used to account for the clustered nature of the data. Discussion An individualized approach to patients with multiple chronic conditions using SDM and goal setting is a desirable strategy for achieving guideline-concordant treatment in a patient-centered fashion. Our pilot trial will provide insights regarding strategies for the routine implementation of such interventions in clinical practice, and it will offer an assessment of the impact of this approach. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0797-8) contains supplementary material, which is available to authorized users.

Institutions vary widely in the implementation and administration of Electronic Theses/Dissertations (ET/D) programs. Differences are found in the range of personnel involved in ET/D administration, university policy regarding mandatory or optional participation, the provision of student services, and key contacts for student inquiries as well as instruction and resources made available. Initial planning for the start-up phases in ET/D programs is influenced by a number of institutional factors and varied models exist for ET/D initiatives. A survey was conducted of selected academic institutions in the U.S. to identify these factors for consideration, and to present an array of potential strategies for successful implementation of ET/D initiatives.

As research libraries investigate digital storage options for theses and dissertations, a range of new service issues emerge. At the outset, staffing these projects creates a challenge. Library roles are changing with regard to handling theses and dissertations, meeting new demands beyond traditional binding, cataloging, and shelving. In some cases, the functions and services provided to graduate students by academic departments, graduate schools, and libraries are reconfigured as electronic publishing services. The authors present an overview of library program responses that assist graduate students in completing theses and dissertations. A review of the literature and discussion of staff configurations is given. From the few university libraries engaged in electronic theses and dissertations (ET/D) projects, information is discerned as to library roles in ET/D services, the relative number of electronic documents published, details on Web sites for contact information and staff, and the level ...