A Scoping Review of Patient and Public Involvement (PPI) in Empirical Stroke Research.

BACKGROUND: Impactful, evidence-based solutions in surveillance, prevention, acute care, and rehabilitation for stroke survivors are required to address the high global burden of stroke. Patient and Public Involvement (PPI), where patients, their families, and the public are actively involved as research partners, enhances the relevance, credibility, and impact of stroke-related research. AIMS: This scoping review, adhering to the PRISMA Scoping Review guidelines, aims to identify and summarize how PPI is currently implemented and reported in empirical stroke research using a participatory approach. SUMMARY OF REVIEW: A comprehensive search strategy was developed and implemented across Medline, CINAHL, EMBASE, PsynchINFO and Cochrane electronic databases, supplemented by grey literature searches. Empirical stroke research papers in the English language, published from 2014 up to 2023 and documenting PPI activity were included. Of the 18,143 original papers identified, 2,824 full text manuscripts matching from this time window were screened. Only 2% (n=72) of these directly reported embedded PPI activity in empirical research. The majority were qualitative in design (60%) and were conducted in high-income countries (96%). Only one included study originated from a developing country, where the burden of stroke is highest. Most studies (94%) provided some information about the activities carried out with their PPI partners, mainly centered on the study design (57%) and management (64%), with only 4% of studies integrating PPI across all research cycle phases from funding application through to dissemination. When studies were examined for compliance with the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) short form checklist, only 11% of included studies were 100% compliant. Twenty-one studies (29%) reported barriers and facilitators to including PPI in stroke research. Organization, authentic partnership and experienced PPI representatives were common facilitators and identified barriers reflected concerns around adequate funding, time required and diversity in perspectives. A positive reporting bias for PPI impact was observed, summarized as keeping the patient perspective central to the research process, improved care of study participants, validation of study findings, and improved communication / lay-summaries of complex research concepts. CONCLUSIONS: PPI is underutilised and inconsistently reported in current empirical stroke research. PPI must become more widely adopted, and notably in low- and middle-income countries. Consensus-driven standards for inclusion of PPI by funding organisations and publishers is required to support its widespread adoption.

Production, isolation, and shipment of clinically relevant quantities of astatine-211: A simple and efficient approach to increasing supply.

The alpha emitter astatine-211 (211At) is a promising candidate for cancer treatment based on Targeted Alpha (α) Therapy (TAT). A small number of facilities, distributed across the United States, are capable of accelerating α-particle beams to produce 211At. However, challenges remain regarding strategic methods for shipping 211At in a form adaptable to advanced radiochemistry reactions and other uses of the radioisotope. PURPOSE: Our method allows shipment of 211At in various quantities in a form convenient for further radiochemistry. PROCEDURES: For this study, a 3-octanone impregnated Amberchrom CG300M resin bed in a column cartridge was used to separate 211At from the bismuth matrix on site at the production accelerator (Texas A&M) in preparation for shipping. Aliquots of 6 M HNO3 containing up to ≈2.22 GBq of 211At from the dissolved target were successfully loaded and retained on columns. Exempt packages (<370 MBq) were shipped to a destination radiochemistry facility, University of Texas MD Anderson Cancer Center, in the form of a convenient air-dried column. Type A packages have been shipped overnight to University of Alabama at Birmingham. MAIN FINDINGS: Air-dried column hold times of various lengths did not inhibit simple and efficient recovery of 211At. Solution eluted from the column was sufficiently high in specific activity to successfully radiolabel a model compound, 4-(4,4,5,5-tetramethyl-1,3,2-dioxaborolan-2-yl)aniline (1), with 211At. The method to prepare and ship 211At described in this manuscript has also been used to ship larger quantities of 211At a greater distance to University of Alabama at Birmingham. PRINCIPAL CONCLUSIONS: The successful proof of this method paves the way for the distribution of 211At from Texas A&M University to research institutions and clinical oncology centers in Texas and elsewhere. Use of this simple method at other facilities has the potential increase the overall availability of 211At for preclinical and clinical studies.

Complexation of Astatine(III) with Ketones: Roles of NO3- Counterion and Exploration of Possible Binding Modes.

Ketones have been proven effective in extracting astatine(III) from aqueous solvents. Previous theoretical studies suggested a mechanism where the "sp2" lone pair on the carbonyl oxygen donates electron density into the π system of the AtO+ molecular cation to form a dative-type bond. In this study, co-extraction of NO3- as AtO(NO3)·(O═CR1R2) species into the organic phase appears to be a key factor. Adjusting the electronic properties of the ketone, by having an aryl group instead of an alkyl group in the alpha position of the ketone, increased the electron density on C═O, increased the bond strength between the ketone and AtO+, and in turn increased the extraction of 211At into the organic phase. Extraction with diketones shows dependence on the bridging distance between the two carbonyl moieties, where a C3 or longer bridge results in a 10-fold increase in extraction into the organic phase. DFT calculations show the longer bridge allows for the chelation of AtO(NO3) by either the second carbonyl or the phenyl ring.

Decomposition of Chemical Warfare Agent Simulants Utilizing Pyrolyzed Cotton Balls as Wicks.

A simple method to improve the thermal decomposition of chemical warfare agent simulants is reported. Utilizing pyrolyzed cotton balls as a substrate for the delivery of an incendiary agent into a bulk volume of chemical warfare agent simulants, significant enhancements in the burning rates were achieved with respect to either other wicks or the incendiary agent by itself. To perform the decomposition experiments and follow the reaction in real time, while still addressing the important safety considerations related to experiments involving chemical warfare agent simulants and incendiary agents, a simple instrument was assembled in a laboratory hood, where all experiments were performed. Under ambient conditions, this method was able to enhance the decomposition of simulants for both sulfur mustard (HD) and sarin (GB) chemical warfare agents. Overall, the proposed approach represents one of the simplest and more cost-effective ways to improve the decomposition of these dangerous substances, presenting options for field expedient and low-cost processes that could be applied in the near future to the safe destruction of an actual CWA.

Ethical challenges in nephrology: a call for action.

The American Society of Nephrology, the European Renal Association-European Dialysis and Transplant Association and the International Society of Nephrology Joint Working Group on Ethical Issues in Nephrology have identified ten broad areas of ethical concern as priority challenges that require collaborative action. Here, we describe these challenges - equity in access to kidney failure care, avoiding futile dialysis, reducing dialysis costs, shared decision-making in kidney failure care, living donor risk evaluation and decision-making, priority setting in kidney disease prevention and care, the ethical implications of genetic kidney diseases, responsible advocacy for kidney health and management of conflicts of interest - with the aim of highlighting the need for ethical analysis of specific issues, as well as for the development of tools and training to support clinicians who treat patients with kidney disease in practising ethically and contributing to ethical policy-making.

Addressing the distribution of proteins spotted on µPADs.

Adsorption is the most common approach to immobilize biorecognition elements on the surface of paper-based devices. Adsorption is also the route selected to coat the substrate with albumin, therefore minimizing the interaction of other proteins. While similar in nature, the structure of the selected proteins as well as the conditions selected from the immobilization have a significant effect on the amount and distribution of the resulting composites. To illustrate these differences and provide general guidelines to efficiently prepare these devices, this article explores the interaction (adsorption and desorption) of BSA with 3MM chromatography paper. The experimental conditions investigated were the protein concentration, the interaction time, the number of times the protein was spotted, the pH of buffer solution, and the ionic strength of the buffer solution. The proposed approach mimics the steps involved in the fabrication (adsorption) and use (rinsing induced by the sample) of paper-based microfluidic devices. To identify the protein location following the rinsing step, the protein was fixed by dehydration in a convection oven and then stained using Coomassie Blue. The color intensity, which was found to be proportional to the amount of protein immobilized, was determined using a desktop scanner. To highlight the importance of understanding the adsorption process to the rational development of µPADs, results were complemented by experiments performed with lysozyme and immunoglobulin G.

Adoption of nitrogen-efficient technologies by u.s. Corn farmers.

Anthropogenically introduced nitrogen (N) has compromised environmental quality, but it is an essential element for crop production, particularly corn production. Increasing N use efficiency by adopting eco-innovations such as N soil testing, plant tissue testing, and N transformation inhibitors can ameliorate this problem. Data from the 2010 USDA Agricultural Resource Management Survey of corn producers was used to examine the factors affecting adoption of these practices. Twenty-one percent of the 1840 corn farmers had adopted N soil testing, 3% had adopted plant tissue testing, and 10% had adopted N inhibitors. A multivariate probit regression found significant results for each category of explanatory variable that was examined. Among the findings was the importance of information source for N recommendations. Farmers who did not obtain external recommendations were less likely to adopt all three practices than farmers who received recommendations from a crop consultant. Those who received recommendations from fertilizer dealers were less likely to adopt N soil testing and plant tissue testing. All regions were more likely to adopt N soil testing than the Midwest, and warmer regions were less likely to adopt B transformation inhibitors. Those who adopted conservation tillage were more likely to adopt plant tissue testing and N inhibitors, and those who received conservation payments were more likely to adopt N soil testing and plant tissue testing. Adoption of conservation tillage was also associated with the adoption of several other technologies. Implications for research and educational programs are discussed.

Development and application of medication appropriateness indicators for persons with advanced dementia: a feasibility study.

BACKGROUND: No studies have been conducted in the UK context to date that categorise medications in terms of appropriateness for patients with advanced dementia, or that examine medication use in these vulnerable patients. OBJECTIVES: The objectives of this study were to categorise the appropriateness of a comprehensive list of medications and medication classes for use in patients with advanced dementia; examine the feasibility of conducting a longitudinal prospective cohort study to collect clinical and medication use data; and determine the appropriateness of prescribing for nursing home residents with advanced dementia in Northern Ireland (NI), using the categories developed. METHODS: A three-round Delphi consensus panel survey of expert clinicians was used to categorise the appropriateness of medications for patients with advanced dementia [defined as having Functional Assessment Staging (FAST) scores ranging from 6E to 7F]. This was followed by a longitudinal prospective cohort feasibility study that was conducted in three nursing homes in NI. Clinical and medication use for participating residents with advanced dementia (FAST scores ranging from 6E to 7F) were collected and a short test of dementia severity administered. These data were collected at baseline and every 3 months for up to 9 months or until death. For those residents who died during the study period, data were also collected within 14 days of death. The appropriateness ratings from the consensus panel survey were retrospectively applied to residents' medication data at each data collection timepoint to determine the appropriateness of medications prescribed for these residents. RESULTS: Consensus was achieved for 87 (90 %) of the 97 medications and medication classes included in the survey. Fifteen residents were recruited to participate in the longitudinal prospective cohort feasibility study, four of whom died during the data collection period. Mean numbers of medications prescribed per resident were 16.2 at baseline, 19.6 at 3 months, 17.4 at 6 months and 16.1 at 9 months. Fourteen residents at baseline were taking at least one medication considered by the consensus panel to be never appropriate, and approximately 25 % of medications prescribed were considered to be never appropriate. Post-death data collection indicated a decrease in the proportion of never appropriate medications and an increase in the proportion of always appropriate medications for those residents who died. CONCLUSIONS: This study is the first to develop and apply medication appropriateness indicators for patients with advanced dementia in the UK setting. The Delphi consensus panel survey of expert clinicians was a suitable method of developing such indicators. It is feasible to collect information on quality of life, functional performance, physical comfort, neuropsychiatric symptoms and cognitive function for this subpopulation of nursing home residents with advanced dementia.

A patient perspective of pharmacist prescribing: 'crossing the specialisms-crossing the illnesses'.

BACKGROUND: The drive for non-medical prescribing has progressed quickly since the late 1990s and involves a range of healthcare professionals including pharmacists. As part of a commissioned research project, this qualitative element of a larger case study focused on the views of patients of pharmacist prescribers. OBJECTIVE: The aim of this study was to explore patients' perspectives of pharmacists as prescribers. METHODS: Three pharmacists working as independent prescribers in the clinical areas of (i) hypertension, (ii) cardiovascular/diabetes management, (iii) anticoagulation were recruited to three case studies of pharmacist prescribing in Northern Ireland. One hundred and five patients were invited to participate in focus groups after they had been prescribed for by the pharmacist. Focus groups took place between November 2010 and March 2011 (ethical/governance approvals granted) were audio taped, transcribed verbatim, read independently by two authors and analysed using constant comparative analysis. RESULTS: Thirty-four patients agreed to participate across seven focus groups. Analysis revealed the emergence of one overarching theme: team approach to patient care. A number of subthemes related to the role of the pharmacist, the role of the doctor and patient benefits. There was an overwhelming lack of awareness of pharmacist prescribing. Patients discussed the importance of a multidisciplinary approach to their care and recognized limitations of the current model of prescribing. CONCLUSION: Patients were positive about pharmacist prescribing and felt that a team approach to their care was the ideal model especially when treating those with more complex conditions. Despite positive attitudes, there was a general lack of awareness of this new mode of practice.

"They come with multiple morbidities": a qualitative assessment of pharmacist prescribing.

This paper presents qualitative findings from a larger sequential mixed methods study which sought to provide an in-depth understanding of pharmacist prescribing from the perspective of pharmacist prescribers, medical colleagues and key stakeholders in Northern Ireland. Transcriptions were analyzed using thematic analysis as the interviews progressed and emergent themes were identified and coded (along with supporting quotes) independently and by consensus of the research team. Three major themes emerged in relation to pharmacist prescribing: the effect on patient care; challenges facing pharmacist prescribers and the importance of the interprofessional team (where two or more different professions with varied, yet complementary experience work together with a common purpose). Pharmacist prescribing may have the potential to reduce the medication burden for patients (as reported by pharmacists) as pharmacists tend to provide a more comprehensive medication review than doctors; the additional time for consultations made this possible. Further research is required on how interprofessional team working can be maximized in the context of pharmacist prescribing, particularly in relation to the management of multi-morbidity.

Pharmacist prescribing in Northern Ireland: a quantitative assessment.

OBJECTIVE: Health care in the United Kingdom (UK) has undergone a significant change in terms of the range of professionals who are permitted to prescribe medications. This study aimed to capture information on pharmacist prescribing in Northern Ireland (NI). SETTING: Primary and secondary care in NI. METHOD: A structured self-administered questionnaire was developed and sent to all pharmacists who were identified as qualified prescribers in NI (n = 105), although only 100 respondents provided details of their prescribing status i.e. currently prescribing, previous prescribers and those who had never prescribed. Three versions of the questionnaire were developed to accommodate each category of prescriber. The questionnaire, which sought information on clinical areas/practice settings of prescribers, their working arrangements and barriers to prescribing was distributed by mail on two occasions to maximise response rates. Descriptive analyses were used as appropriate, together with Chi-squared tests or Fisher exact tests to evaluate associations between responses and demographic information, with significance set a priori at P < 0.05. Qualitative data (from the free text response section) were analysed for recurring themes using content analysis. RESULTS: A response rate of 76.0% (n = 76) was achieved. There were more female respondents (73.7%) than males (26.3%). Nearly 50% of respondents were currently prescribing (n = 36; 47.4%), 46.1% (n = 35) had never prescribed and 6.6% (n = 5) had prescribed in the past. There were perceived benefits in terms of patient care and perception of the pharmacist within the health care team. A number of barriers to pharmacist prescribing were reported. Independent prescribing was viewed as the way forward, although pharmacists expressed reluctance to prescribe without a diagnosis or beyond the team setting. CONCLUSION: Pharmacy prescribing has yet to fully embedded in routine practice. This study has shown that the number of qualified prescribers in NI is relatively small and not all have taken up prescribing responsibilities. Well recognised barriers were reported as reasons as to why qualified prescribers were unable to use their prescribing skills. Further research should provide an in-depth understanding of pharmacy prescribing in NI and examine patients' experiences of this form of practice.

A self-reported work-sampling study in community pharmacy practice: a 2009 update.

OBJECTIVE: Using a self-reported work sampling methodology this study investigated how community pharmacists utilised their time, and quantified how much time pharmacists devoted to specific activities. SETTING: Community pharmacies (n = 30) in the Greater Belfast area. METHOD: A classification system was developed to define all activities (professional, semi-professional, and non-professional tasks) which could potentially be performed by a community pharmacist in the course of a normal working day (from 9.00 to 6.00 pm). A random bleeper device was used which was programmed to bleep randomly approximately 13 times per day (over 12 days) at which time the pharmacist recorded their precise activity (using the classification system) at that time on a proforma. All completed data sheets for each pharmacy were entered into an Excel spreadsheet, where the number of observations for each activity was expressed as a proportion of the total number of observations per day. Statistical analysis was carried out in SPSS, comparing these data to similar data which had been collected in 1998. RESULTS: Pharmacists in this study were found to spend approximately 49% of their time engaged in professional activities, 31% in semi-professional activities and 20% involved in non-professional activities which was similar to that reported in 1998. Most time was spent on assembly and labelling of products, whilst staff training occupied the least amount of pharmacists' time. Pharmacists with a prescription volume of less than 1,499 per month spent significantly more time counselling patients on OTC medicines and responding to symptoms than those dispensing 1,500 items/month or more (P = 0.027). Pharmacists who employed a pre-registration student apportioned less time to the assembly and labelling of products compared to those without a student (P = 0.08). Pharmacists with three or more staff spent less time on coding and endorsing of prescriptions compared to those with less staff (P = 0.086). CONCLUSION: Pharmacists in this study are spending more time checking prescriptions (essential component of pharmaceutical care) and are still managing to spend only 20% of their time on non-professional activities. However, there had been relatively little change in the way in which pharmacists in this sample spent their time compared to a previous study.

Assessing job satisfaction and stress among pharmacists in Northern Ireland.

OBJECTIVE AND SETTING: The pharmacy profession in Northern Ireland (NI) is currently experiencing major changes in practice development. The aim of this study was to determine the levels of job satisfaction and stress in pharmacists in NI in the context of these changes. METHOD: A questionnaire was adapted from one previously used in the United States (US). Following minor amendments and piloting, the survey was distributed by mail on two occasions (January/February 2007) to all registered community and hospital pharmacists in NI (n = 1,965). Data were entered into SPSS (version 15) and analysed using descriptive statistics, t-test and regression analysis. The significance level was set at P < 0.05. RESULTS: The overall response rate was 39% (n = 766). Of the potentially highest stress score of 165, overall mean scores were significantly higher for community than hospital pharmacists (P < 0.05). Both groups found interruptions, excessive workload, and inadequate staffing to be the most stressful aspects of their employment. Just over 30% (n = 178) of community pharmacists and half of all hospital pharmacists cited feeling often or frequently stressed because of imminent changes in contractual or organisational arrangements. Regression analysis indicated that sector of work (community or hospital) appeared to account for differences in self-reported stress. CONCLUSION: Any developments in professional practice need to be considered in the context of the well-being of the health professionals who implement, and are affected by, the changes. Unless stress in pharmacy is recognised and reduced, pharmacists and patients may be at risk.

An exploration of work-related stress in Northern Ireland community pharmacy: a qualitative study.

OBJECTIVES: The aim of this study was, through qualitative methodology, to explore the factors which contribute to job-related stress in community pharmacy in Northern Ireland. METHODS: All community pharmacists in Northern Ireland were invited to participate in one-to-one semi-structured interviews. Interview schedules explored pharmacists' attitudes to job-related stress and the situations that may contribute to stress. All interviews took place at participants' work sites between December 2007 and April 2008, were audio-taped, transcribed verbatim, read independently by the authors and analysed using thematic analysis. KEY FINDINGS: Seventeen pharmacists participated in the interviews. The main themes that emerged in relation to job-related stress were workplace issues, issues regarding professional expansion, recognition and responsibility, and a demanding public. Although there was general support for development in community pharmacy, this was tempered by concerns as to how expectations would be met and how all services would be delivered. CONCLUSIONS: The themes that emerged from this work reflect what was reported from a survey conducted in 2007 and reinforce the tension between developments in practice and the ability to deliver. Developments in professional practice can be positive; however, commissioners and policy-makers need to consider whether community pharmacists have the infrastructure in terms of environment, personnel and multi-professional support to deliver what is required of them.