A qualitative exploration of the implementation of the Prescribing course Designated Prescribing Practitioner role in community pharmacy

Introduction: To alleviate NHS workload pressures Scottish Government wish to train more pharmacist independent prescribers (IPs) for community pharmacy (1). A critical aspect for IP training is the role of Designated Prescribing Practitioner (DPP) for the period of learning in practice. A paucity of work has focussed on implementation of the DPP role with a recent cross-sectional survey (2) indicating that further qualitative exploration is warranted. Aim(s): To explore the implementation of the DPP role in Scottish Community Pharmacy (CP). Method(s): Following a survey (2) participants opted in to qualitative semi-structured online mini-focus groups. This included key stakeholders likely be involved in the implementation of the DPP role (e.g Directors of Pharmacy, Prescribing Leads, Education and Training leads, IP qualified CPs). The topic guide was informed by the survey key findings, Royal Pharmaceutical Society DPP Framework and the Consolidated Framework for Implementation Research and piloted with academic and practice-based stakeholders. All focus groups were conducted using Zoom, recorded, transcribed, and independently analysed thematically, by two researchers, using the Framework Approach. Data generation continued until data saturation. Result(s): Data were generated from six mini-focus groups with 12 key stakeholders across Scottish Health Boards. Key themes derived related to: views on the DPP role, characteristics of potential DPPs, facilitators and barriers to implementation. Participants supported DPP implementation and noted benefits of pharmacists training pharmacists. They noted that potential DPPs need to be confident and competent and be active prescribers. Facilitators for implementation included: new contracted services (e.g. NHS Pharmacy First Plus), growing need for more IPs, and the impact of COVID-19. Barriers included: limited time, capacity, resources, and support to take on the DPP role. Pharmacists were also considered risk averse which could influence role uptake. Conclusion(s): This theory-based work involved a range of key stakeholders and highlights that there is a need to further consider interventions to overcome barriers related to capacity and resource related issues. A limitation relates to the dyadic nature of some focus groups that may have affected data collection. Future research should focus on further theory-based work evaluating structures, processes, and outcomes of DPP role implementation.

Fetal effects of mild maternal COVID-19 infection: metabolomic profiling of cord blood.

INTRODUCTION: The impact of maternal coronavirus disease 2019 (COVID-19) infection on fetal health remains to be precisely characterized. OBJECTIVES: Using metabolomic profiling of newborn umbilical cord blood, we aimed to investigate the potential fetal biological consequences of maternal COVID-19 infection. METHODS: Cord blood plasma samples from 23 mild COVID-19 cases (mother infected/newborn negative) and 23 gestational age-matched controls were analyzed using nuclear magnetic spectroscopy and liquid chromatography coupled with mass spectrometry. Metabolite set enrichment analysis (MSEA) was used to evaluate altered biochemical pathways due to COVID-19 intrauterine exposure. Logistic regression models were developed using metabolites to predict intrauterine exposure. RESULTS: Significant concentration differences between groups (p-value < 0.05) were observed in 19 metabolites. Elevated levels of glucocorticoids, pyruvate, lactate, purine metabolites, phenylalanine, and branched-chain amino acids of valine and isoleucine were discovered in cases while ceramide subclasses were decreased. The top metabolite model including cortisol and ceramide (d18:1/23:0) achieved an Area under the Receiver Operating Characteristics curve (95% CI) = 0.841 (0.725-0.957) for detecting fetal exposure to maternal COVID-19 infection. MSEA highlighted steroidogenesis, pyruvate metabolism, gluconeogenesis, and the Warburg effect as the major perturbed metabolic pathways (p-value < 0.05). These changes indicate fetal increased oxidative metabolism, hyperinsulinemia, and inflammatory response. CONCLUSION: We present fetal biochemical changes related to intrauterine inflammation and altered energy metabolism in cases of mild maternal COVID-19 infection despite the absence of viral infection. Elucidation of the long-term consequences of these findings is imperative considering the large number of exposures in the population.

Vaccination rates in Europe are not associated with online media intensity

To map the public information about COVID-19 vaccines and vaccine trials in Europe, we have compiled an inventory of online communication materials from official sources (e.g., governments, public agencies, and NGOs) via directed online research. While information for the general public was abundant across Europe, we found a large variation in number, type and target audiences among countries. Little or no information was found for population groups that are typically underrepresented in vaccine clinical trials. Materials about clinical trials and trial participation were also limited.Interestingly, higher number of media materials was not reflected in higher national vaccination rates.

Anglican cathedrals and implicit religion: Softening the boundaries of sacred space through innovative events and installations

High profile (and controversial) events and installations, like the Helter-Skelter in Norwich and the Crazy Golf Bridges in Rochester, have drawn attention to innovation and public engagement within Anglican cathedrals. The present study contextualised these innovations both empirically and conceptually. The empirical framework draws on cathedral websites to chronicle the wide and diverse range of events and installations hosted by Anglican cathedrals in England and the Isle of Man between 2018 and 2022. The conceptual framework draws on Edward Bailey’s theory of implicit religion to classify and to explore these events and installations. Two insights from the theory of implicit religion emerged as of particular significance. First, the notion of implicit religion softens the boundaries between the sacred and the secular. This was exemplified by eight categories of events: scientific exhibitions, festivals, musical events, art exhibitions, theatre, markets, community events and installations. Second, the notion of implicit religion draws attention to the themes and activities that generate meaning and purpose. This was exemplified by seven themes: social justice and social conscience, violence and reconciliation, remembrance, migration and sanctuary, COVID-19 and lockdowns, personal well-being and nature and environment. Contribution: Situated within the science of cathedral studies, this article identifies the range of innovative events and installations hosted by Anglican Cathedrals in England and the Isle of Man and assesses the significance of these events and installations through Edward Bailey’s lens of implicit religion, discussing first the softening of boundaries between the sacred and the secular and then the generation of meaning and purpose through the core themes raised by these events and installations. © 2022. The Authors.

Fetal Effects of Mild Maternal COVID-19 Infection: Metabolomic profiling of cord blood (preprint)

Introduction: The impact of maternal coronavirus disease 2019 (COVID-19) infection on fetal health remains to be precisely characterized.Objectives: Using metabolomic profiling of newborn umbilical cord blood, we aimed to investigate the potential fetal biological consequences of maternal COVID-19 infection.Methods: Cord blood serum samples from 23 mild COVID-19 cases (mother infected/ newborn negative) and 23 gestational age-matched controls were analyzed using nuclear magnetic spectroscopy and liquid chromatography coupled with mass spectrometry. Metabolite set enrichment analysis (MSEA) was used to evaluate altered biochemical pathways due to COVID-19 intrauterine exposure. Logistic regression models were developed using metabolites to predict intrauterine exposure.Results: Significant concentration differences between groups (p-value <0.05) were observed in 19 metabolites. Elevated levels of glucocorticoids, pyruvate, lactate, purine metabolites, phenylalanine and branched chain amino acids of valine and isoleucine were discovered in cases while ceramide subclasses were decreased. The top metabolite model including cortisol and ceramide (d18:1/23:0) achieved an Area under the Receiver Operating Characteristics curve (95% CI) = 0.841 (0.725 - 0.957) for detecting fetal exposure to maternal COVID-19 infection. MSEA highlighted steroidogenesis, pyruvate metabolism, gluconeogenesis, and Warburg effect as the major perturbed metabolic pathways (p-value < 0.05). These changes indicate fetal increased oxidative metabolism, hyperinsulinemia, and inflammatory response. Conclusion: We present fetal biochemical changes related to intrauterine inflammation, altered energy metabolism in cases of mild maternal COVID-19 infection despite the absence of viral infection. Elucidation of the long-term consequences of these findings is imperative considering the large number of exposures in the population.

Increased levels of circulating neurotoxic metabolites in patients with mild Covid19 (preprint)

SARS-CoV-2 corona virus causes a multi-faceted and poorly defined clinical and pathological phenotype involving hyperinflammation, cytokine release. And long-term cognitive deficits, with an undefined neuropathological mechanism. Inflammation increases the activity of the kynurenine pathway, which is linked to neurodegenerative and psychiatric disorders. We sought to determine whether the kynurenine pathway is impacted in patients with mild COVID-19, leading to elevated neurotoxic metabolites in blood, and whether such changes are associated with pro-inflammatory cytokines. Serum samples were taken from 150 patients and analyzed by ELISA and ultra-high performance liquid chromatography (UHPLC). The data were analyzed using multiple linear regression models adjusted for age and sex. We found increased levels of kynurenine, quinolinic acid and 3-hydroxykynurenine in serum from patients with mild COVID-19, together with increased levels of IL-6, ICAM-1, VCAM-1 and neopterin. The levels of neurotoxic metabolites were significantly associated with key inflammatory cytokines including IL-6 and TNF. The COVID-19 risk-factor hypertension was associated with the highest levels of neurotoxic metabolites in plasma. These neuroactive metabolites could be part of the pathological mechanisms underlying cognitive impairment during and post-COVID and should be explored as potential biomarkers for long-COVID symptoms.

When Will Immersive Virtual Reality Have Its Day? Challenges to IVR Adoption in the Home as Exposed in Studies with Teenagers, Parents, and Experts

In response to the pandemic, many countries have had multiple lockdowns punctuated by par tial freedoms limiting physically being together. In 2020–2021, during the COVID-19 pandemic, parents were stressed and exhausted by the challenges of work, home schooling, and barriers to typical childcare arrangements. Children were missing one another, their social lives, and the variety of experiences that the world beyond the home brings. Immersive Vir tual Reality (IVR) offers tried and tested ways to enable children to maintain beyond-household family activities and dynamics. However, it is not viewed as a solution. Instead, as demonstrated through a multiple method study involving a Rapid Evidence Assessment, workshops with 91 teenagers, interviews with 15 exper ts, a Delphi study with 21 exper ts, 402 parent questionnaires pre-pandemic, 232 parent questionnaires during the pandemic, and longitudinal interviews with 13 parents during the first UK lockdown in 2020, IVR is not viewed as having value in the home beyond gaming. Results highlight limited consideration of IVR as a way to enhance family life or the home, with a lack of evidence and direction from current research, innovation, and policy. The ar ticle empirically demonstrates that exper ts, teenagers, and parents have limited expectations for VR. Fur ther, with parental resistance to adoption and a lack of ideas or innovations in how IVR could be used, the likelihood of VR-headset adoption remains low as does its potential as a means of educating, enter taining, and socially engaging children and teenagers. © 2021 by the Massachusetts Institute of Technology.

COVID-19 and children, in the North and in the South

This paper aims to document the likely direct and indirect impacts of the COVID-19 crisis in developed and developing countries. It also aims to identify potential urgent measures to alleviate such impacts on children. Thirty-three years after the UNICEF report, 'Adjustment with a Human Face', the authors warn of the effects of the pandemic which are likely to be considerable and comparable to the recession and debt crisis of the 1980s. The heavy costs for children can only be avoided with systematic and concerted efforts on the part of governments and the international community, to provide extensive financial and social support for the poor, and to invest in the health and education systems, in order to offset the negative impact of the virus-induced recession.

Blood and marrow transplantation during the emerging COVID-19 pandemic: the Seattle approach.

On January 20, 2020, the first patient with coronavirus disease 2019 (COVID-19) in the United States of America was diagnosed in Washington state, which subsequently experienced rapidly increasing numbers of COVID-19 cases, hospitalizations, and deaths. This placed the Seattle Blood and Marrow Transplant Program at Fred Hutchinson Cancer Research Center (Fred Hutch) in the national epicenter of this pandemic. Here, we summarize the experience gained during our rapid response to the COVID-19 pandemic. Our efforts were aimed at safely performing urgent and potentially life-saving stem cell transplants in the setting of pandemic-related stresses on healthcare resources and shelter-in-place public health measures. We describe the unique circumstances and challenges encountered, the current state of the program amidst evolving COVID-19 cases in our community, and the guiding principles for recovery. We also estimate the collateral impact of directing clinical resources toward COVID-19-related care on cancer patients in need of stem cell transplantation. Although our experience was influenced by specific regional and institutional factors, it may help inform how transplant programs respond to COVID-19 and future pandemics.

Managing Cancer Care During the COVID-19 Pandemic: Agility and Collaboration Toward a Common Goal.

The first confirmed case of coronavirus disease 2019 (COVID-19) in the United States was reported on January 20, 2020, in Snohomish County, Washington. At the epicenter of COVID-19 in the United States, the Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, and University of Washington are at the forefront of delivering care to patients with cancer during this public health crisis. This Special Feature highlights the unique circumstances and challenges of cancer treatment amidst this global pandemic, and the importance of organizational structure, preparation, agility, and a shared vision for continuing to provide cancer treatment to patients in the face of uncertainty and rapid change.