Public health qualifications, motivation, and experience of pharmacy professionals: exploratory cross-sectional surveys of pharmacy and public health professionals.

BACKGROUND: Pharmacy professionals (pharmacists and pharmacy technicians; PPs) are recognised for delivering public health interventions (micro level). There is increased policy focus on population health management, but limited knowledge regarding the role of PPs within UK's public health meso and macro levels. This study aimed to explore UK PPs' public health qualifications, specialisations, and motivations and barriers to pursuing advanced public health practice. METHODS: In this cross-sectional study, we developed and piloted two surveys, and we disseminated them separately via email to UK pharmacy and public health networks and social media, between June 19, and Oct 26, 2021. PPs with an interest or experience in public or population health were invited to participate in the study. We asked PPs questions about public health qualifications, specialisations, motivations, and barriers, and we also asked PHPs for opinions regarding the value of specialist public health skills for PPs. Numerical data were summarised, and responses collated into themes. NHS Health Research Authority tool identified ethics approval not required; and the questionnaire included consent request. FINDINGS: 128 PPs (85% pharmacists) and 54 PHPs responded. Of the PPs who responded, 90 (70%) were female and 35 (27%) were male; 62 (48%) were White British, 19 (14%) were Asian or Asian British, 14 (12%) were Black or Black British. They worked in primary care (34%, n=43), secondary care (26%, n=33), Community Pharmacy (13%, n=16), and public health bodies (13%, n=16). Overall, 34 (27%) of 128 PPs (32 pharmacists; 2 pharmacy technicians) possessed public health qualifications (MPH, PhD). Motivations for these qualifications were ambition to work as PP in public health PP (31%; 17/55 respondents), public health as alternative career (29%; 16/55), general interest (27%; 15/55) recommended or required for current role (11%; 6/55). Themes of barriers included limited training opportunities and poor career pathways. For the PHP survey, 36 (67%) of 54 were female and 16 (30%) were male. They worked as Consultants or Directors (28%, n=15), Registrars (24%, n=13), Practitioners (15%, n=8). 45 (87%) of 52 PHP respondents agreed that specialist PPs in public health would be beneficial to public health; 13 (45%) of 29 respondents recommended a public health Master's degree, eight (27%) recommended experience or postgraduate modules in health economics and health inequalities, three (10%) recommended credentialing for PPs to specialise. INTERPRETATION: Findings suggest responding PPs are motivated to advance in public health practice, despite barriers. Collaboration with PHPs and development of communities of practice might address barriers identified and contribute to advanced public health practice for PPs, supporting the increased focus on population health management in the UK. Limitations include the exploratory nature of the study, and the fact that PPs responding to public health surveys might be more motivated to advance in public health practice than those not responding. FUNDING: NHS England and UK Health Security Agency.

Criteria to achieve safe antimicrobial intravenous-to-oral switch in hospitalised adult populations: a systematic rapid review.

OBJECTIVES: This rapid review aimed to assess and collate intravenous-to-oral switch (IVOS) criteria from the literature to achieve safe and effective antimicrobial IVOS in the hospital inpatient adult population. DESIGN: The rapid review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES: OVID Embase and Medline databases. ELIGIBILITY CRITERIA: Articles of adult populations published globally between 2017 and 2021 were included. DATA EXTRACTION AND SYNTHESIS: An Excel spreadsheet was designed with specific column headings. IVOS criteria from UK hospital IVOS policies informed the framework synthesis. RESULTS: IVOS criteria from 45/164 (27%) local IVOS policies were categorised into a five-section framework: (1) timing of IV antimicrobial review, (2) clinical signs and symptoms, (3) infection markers, (4) enteral route and (5) infection exclusions. The literature search identified 477 papers, of which 16 were included. The most common timing for review was 48-72 hours from initiation of intravenous antimicrobial (n=5, 30%). Nine studies (56%) stated clinical signs and symptoms must be improving. Temperature was the most frequently mentioned infection marker (n=14, 88%). Endocarditis had the highest mention as an infection exclusion (n=12, 75%). Overall, 33 IVOS criteria were identified to go forward into the Delphi process. CONCLUSION: Through the rapid review, 33 IVOS criteria were collated and presented within five distinct and comprehensive sections. The literature highlighted the possibility of reviewing IVOS before 48-72 hours and of presenting heart rate, blood pressure and respiratory rate as a combination early warning score criterion. The criteria identified can serve as a starting point of IVOS criteria review for any institution globally, as no country or region limits were applied. Further research is required to achieve consensus on IVOS criteria from healthcare professionals that manage patients with infections. PROSPERO REGISTRATION NUMBER: CRD42022320343.

Development of National Antimicrobial Intravenous-to-Oral Switch Criteria and Decision Aid.

INTRODUCTION: Antimicrobial stewardship (AMS) strategies, such as intravenous-to-oral switch (IVOS), promote optimal antimicrobial use, contributing to safer and more effective patient care and tackling antimicrobial resistance (AMR). AIM: This study aimed to achieve nationwide multidisciplinary expert consensus on antimicrobial IVOS criteria for timely switch in hospitalised adult patients and to design an IVOS decision aid to operationalise agreed IVOS criteria in the hospital setting. METHOD: A four-step Delphi process was chosen to achieve expert consensus on IVOS criteria and decision aid; it included (Step One) Pilot/1st round questionnaire, (Step Two) Virtual meeting, (Step Three) 2nd round questionnaire and (Step 4) Workshop. This study follows the Appraisal of Guidelines for Research and Evaluation II instrument checklist. RESULTS: The Step One questionnaire of 42 IVOS criteria had 24 respondents, 15 of whom participated in Step Two, in which 37 criteria were accepted for the next step. Step Three had 242 respondents (England n = 195, Northern Ireland n = 18, Scotland n = 18, Wales n = 11); 27 criteria were accepted. Step Four had 48 survey respondents and 33 workshop participants; consensus was achieved for 24 criteria and comments were received on a proposed IVOS decision aid. Research recommendations include the use of evidence-based standardised IVOS criteria. DISCUSSION AND CONCLUSION: This study achieved nationwide expert consensus on antimicrobial IVOS criteria for timely switch in the hospitalised adult population. For criteria operationalisation, an IVOS decision aid was developed. Further research is required to provide clinical validation of the consensus IVOS criteria and to expand this work into the paediatric and international settings.

Influence of factors commonly known to be associated with health inequalities on antibiotic use in high-income countries: a systematic scoping review.

INTRODUCTION: Inappropriate antibiotic use contributes to antimicrobial resistance. High-income countries have high rates of antibiotic use, with a prevalence of health inequalities amongst populations. OBJECTIVES: To understand the influence of factors commonly known to be associated with health inequalities on antibiotic use in high-income countries. METHODS: Factors commonly known to be associated with health inequalities were defined as protected characteristics under UK's Equality Act (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race/ethnicity, religion or belief, sex, sexual orientation), socioeconomic characteristics (income, insurance, employment status, deprivation, education), geography (urban versus rural, region) and vulnerable groups. The study followed PRISMA-ScR and, PRISMA-E statements. RESULTS: Fifty-eight of 402 identified studies met inclusion criteria. Fifty of those papers (86%) included one or more protected characteristics, 37 (64%) socioeconomic characteristics, 21 (36%) geography and 6 (10%) vulnerable groups. Adults in older age groups, especially those in residential care, had the highest antibiotic use. The influence of race or ethnicity and antibiotic use was particular to country context. Areas of high deprivation had higher antibiotic use compared with areas of no or low deprivation, and geographical variation existed within countries. When faced with health system barriers, migrants relied on alternative routes of antibiotic supply other than prescription. RECOMMENDATIONS FOR FUTURE RESEARCH: To investigate how factors and wider social determinants of health interplay and impact antibiotic use, using frameworks/approaches to reduce health inequalities such as England's Core20PLUS approach. Antimicrobial stewardship initiatives should equip healthcare professionals to review patients at the highest risk of antibiotic use.

Knowledge and Attitudes about Antibiotics and Antibiotic Resistance of 2404 UK Healthcare Workers.

BACKGROUND: Using the COM-B model as a framework, an EU-wide survey aimed to ascertain multidisciplinary healthcare workers' (HCWs') knowledge, attitudes and behaviours towards antibiotics, antibiotic use and antibiotic resistance. The UK findings are presented here. METHODS: A 43-item questionnaire was developed through a two-round modified Delphi consensus process. The UK target quota was 1315 respondents. RESULTS: In total, 2404 participants responded. The highest proportion were nursing and midwifery professionals (42%), pharmacists (23%) and medical doctors (18%). HCWs correctly answered that antibiotics are not effective against viruses (97%), they have associated side effects (97%), unnecessary use makes antibiotics ineffective (97%) and healthy people can carry antibiotic-resistant bacteria (90%). However, fewer than 80% correctly answered that using antibiotics increases a patient's risk of antimicrobial resistant infection or that resistant bacteria can spread from person to person. Whilst the majority of HCWs (81%) agreed there is a connection between their antibiotic prescribing behaviour and the spread of antibiotic-resistant bacteria, only 64% felt that they have a key role in controlling antibiotic resistance. The top three barriers to providing advice or resources were lack of resources (19%), insufficient time (11%) and the patient being uninterested in the information (7%). Approximately 35% of UK respondents who were prescribers prescribed an antibiotic at least once in the previous week to responding to the survey due to a fear of patient deterioration or complications. CONCLUSION: These findings highlight that a multifaceted approach to tackling the barriers to prudent antibiotic use in the UK is required and provides evidence for guiding targeted policy, intervention development and future research. Education and training should focus on patient communication, information on spreading resistant bacteria and increased risk for individuals.

Metal exposure causes rDNA copy number to fluctuate in mutation accumulation lines of Daphnia pulex.

Ribosomal (r)DNA is a highly dynamic, conserved, multigene family whose sequence homogeneity is thought to be maintained by intra- and interchromosomal recombination, which are capable of changing rDNA copy number. It is generally not known how environmental stress such as sublethal exposure to environmentally relevant concentrations of metals impacts rDNA copy number. To determine how chronic metal exposure affects rDNA, we measured copy number of the 18S rRNA gene in 355 copper and nickel-exposed samples and 132 metal-free samples derived from 325 mutation accumulation (MA) lines of two genetically distinct Daphnia pulex lineages. The MA lines were sampled at four time points over 100+ generations of clonal propagation. The copy number of rDNA was also measured in 15 individuals sampled from a metal-free non-MA control population established from the same progenitor as one of the MA lineages. We found that mean rDNA copy number fluctuated across lines exposed to metals with a tendency to decrease over time. In contrast, mean rDNA copy number in the metal-free control lines and the non-MA population remained stable over time. It is generally accepted that extreme rDNA loss results in the loss of organism fitness. Thus, fluctuations in rDNA copy number, including losses, could affect the long-term viability of natural populations of Daphnia in metal-contaminated habitats.

The use of actor-based immersive health and safety inductions: Lessons from the Thames Tideway Tunnel megaproject.

Health and safety inductions are ubiquitous in construction but tend to be poorly designed and suffer low levels of worker engagement. In this paper we report on the evaluation of an innovative, full day, actor-based health and safety induction called EPIC, currently being used on London's Thames Tideway Tunnel megaproject. As of March 2019, more than 14,000 individuals had attended EPIC. This evaluation examines the impact of EPIC from the perspective of participants and other stakeholders, and considers the utility of actor-based immersive health and safety inductions for use more widely, in both construction and other sectors. Using a mixed-method, longitudinal approach to data collection, EPIC is evaluated against Kirkpatrick's (1959) 'four levels' framework of reactions, learning, behaviour change and results. This paper discusses factors which support and hinder actor-based inductions, and the challenges involved in assessing the impact of inductions on subsequent behaviour and health and safety outcomes.

An Integrated Dyspepsia Module for First-year Pharmacy Students.

Objective. To design an integrated dyspepsia module for first year pharmacy students that combines clinical and professional practice with fundamental sciences in five different science subject areas. Methods. The approaches used in designing this module are described with emphasis on strategies adopted to integrate science and practice, and the new ways of working adopted by the design team. Students' views and experiences of the module and its integration were explored using questionnaires. Results. A high proportion of students reported positive views and experiences of the module, the integration and its impact (as self-reported) on their learning and practice. The assessment of student performance indicated learning and attainment was at an appropriate level for a first-year module. Both the student grades and research results indicate a positive student learning experience. Conclusion. The dyspepsia module provides a flexible and effective template for the integration of science and practice in theme-based modules, with students reporting positively about the integration, including their perception of its contribution to improving their learning and understanding. New and more collaborative ways of working are required when designing integrated modules.

Beyond ConCA: Rethinking causality and construction accidents.

The construction industry takes an orthodox approach to safety: Finding root causes, quantifying risk, and often blaming frontline workers. However, safety has reached a plateau and the limitations of this approach are starting to be acknowledged. A sociotechnical systems approach (as applied in the ConCA model) presents new opportunities to understand accident causation by linking immediate accident circumstances with the distal shaping and originating influences. 32 construction safety managers, consultants, and experts contributed their views regarding the hazards of construction (both human and physical) and the difficulties managing these. The findings provide an insight into the work of construction safety managers and their decision making which is influenced by industry-wide pressures and worker attributes over physical hazards. Construction suffers from a wide range of pressures; a combination of both top-down, from the client, and bottom-up challenges from the workforce it attracts. The original ConCA model has been revised to reflect the findings. By applying systems thinking, the relationships between negative perceptions of workers' risk-taking and these challenges can be crystallised. The results support integrating safety into primary activities to increase engagement, learning legacies to transfer knowledge between projects, multi-disciplinary teams to raise risk awareness, empowerment to combat their feelings of dissatisfaction and disloyalty, and collaboration in risk management to incorporate workers' expertise and ensure they feel valued.