Louise Smith

BACKGROUND: Community pharmacy Common Ailments Services can ease the considerable workload pressures on primary and secondary care services. However, evidence is needed to determine whether there are benefits of extending such services beyond their typically limited scope. This study therefore aimed to evaluate a new community pharmacy model of a service for patients with ear, nose and throat (ENT) and eye conditions who would otherwise have had to seek primary care appointments or emergency care. METHODS: People with specified ENT or eye conditions registered with General Practitioners in Staffordshire or Shropshire who presented at participating community pharmacies were offered a consultation with a pharmacist trained to provide the service. The service included provision of relevant self-care advice and, where clinically appropriate, supply of non-prescription medicines or specified prescription-only medicines (POMs), including antibiotics, under Patient Group Directions. Patients received a follow up telephone call from the pharmacist five days later. Data were collected on the characteristics of patients accessing the service, the proportion of those who were treated by the pharmacist without subsequently seeing another health professional about the same condition, and patient reported satisfaction from a questionnaire survey. RESULTS: A total of 408 patients accessed the service, of whom 61% received a POM, 15% received advice and medicine supplied under the common ailments service, 9% received advice and purchased a medicine, 10% received advice only and 5% were referred onwards. Sore throat accounted for 45% of diagnoses where a POM was supplied, 32% were diagnosed with acute otitis media and 15% were diagnosed with acute bacterial conjunctivitis. The number of patients successfully followed up was 309 (76%), of whom 264 (85%) had not seen another health professional for the same symptoms, whilst 45 (15%) had seen another health professional, usually their GP. The questionnaire was completed by 259 patients (response rate 63%) of whom 96% reported being very satisfied or satisfied with the service. CONCLUSIONS: The study demonstrates that pharmacists can effectively diagnose and treat these conditions, with a high degree of patient satisfaction. Wider adoption of such service models could substantially benefit primary care and emergency care services.

PURPOSE: The purpose of this article is to provide an overview of relevant clinical issues including pathophysiology, clinical presentation, assessment/diagnosis, and treatment strategies regarding depression in the heart failure (HF) patient. This information was synthesized to create a clinical protocol to guide the practitioner in identifying, diagnosing, and treating depression in adult HF patients. This protocol was designed for use in the primary care or HF clinic setting. DATA SOURCES: PubMed and CINAHL were utilized to search for articles pertaining to HF and depression. CONCLUSIONS: The presence of depression in HF is associated with a worsening prognosis, increased risk of death, rehospitalization, and functional decline. The practitioner must identify predisposing factors for depression and evaluate symptoms. Self-rated screening instruments can assist the practitioner in identifying those with depression. Evidence is lacking regarding the treatment of depression in HF but selective serotonin reuptake inhibitors are likely the best option. IMPLICATIONS FOR PRACTICE: Understanding depression as it occurs in patients with HF is critical. If depression is identified and properly managed it may lead to better patient outcomes.

T lymphocytes oxidized with the mitogen sodium periodate undergo a proliferative response when cultured in the presence of Ia+ accessory cells. However, the exact role(s) the accessory cells play in such a response has not been clearly defined. We have evaluated the role of Ia and the requirement for interleukin 1 (IL 1) in periodate mitogenicity by using the Ia+ cloned tumor cell lines P388AD (Ia+, IL 1 inducible) and P388NA (Ia+, IL 1 noninducible) as accessory cells. P388AD but not P388NA was able to supply accessory cell function to periodate-treated T cells, suggesting that Ia expression alone was not sufficient to reconstitute a response. Monoclonal anti-I-Ad and anti-I-Ed antibody blocked the accessory cell function of P388AD. In addition, monoclonal antibody GK 1.5, directed against the T cell determinant L3T4a, blocked the P388AD/periodate-treated T cell interaction, confirming that this interaction was restricted by class II molecules. Although Ia expression was required, the response was not major histocompatibility complex (MHC) restricted, because allogeneic as well as syngeneic macrophages were capable of supplying accessory cell function to periodate-treated T cells. Exogenous IL 1 alone was able to trigger periodate-treated T cells, suggesting that Ia was required for the induction of IL 1 synthesis by the accessory cells. Furthermore, purified IL 2, devoid of IL 1 activity, was able to fully reconstitute the proliferative response of accessory cell-depleted oxidized T cells to a level equal to that of whole spleen accessory cells or P388AD. These data suggest that periodate-treated T cells can proliferate with IL 1 alone and that Ia+ accessory cells in periodate-mediated T cell mitogenicity may function in the release of IL 1 and the induction of IL 2 synthesis by the T cells.

OBJECTIVES: To investigate rates of uptake of lateral flow testing and reporting of test results in England and Scotland, and the psychological, contextual, and socio-demographic factors associated with testing.
\nDesign: Series of four fortnightly online cross-sectional surveys.
\nSetting: Data collected 19 April to 2 June 2021. PARTICIPANTS: People who lived in England and Scotland, aged 18 years or over, excluding people who reported their most recent test was a polymerase chain reaction (PCR) test (n=6646, n≈1,600 per wave).
\nMAIN OUTCOME MEASURES: Having completed at least one lateral flow test (LFT) to see whether you have COVID-19 in the last seven days. RESULTS: We used binary logistic regressions to investigate psychological, contextual and socio-demographic factors associated with lateral flow testing at least once in the last week. Increased uptake of testing was associated with being younger, female, living with a dependent child, being employed and being vaccinated. Work- and study-related factors such as having been out to work in the last week, working in a sector that adopted LFT early, and being a student were also associated with increased uptake. People who reported COVID-19 symptoms in the last week were more likely to have taken a test, as were those who had heard more about regular LFT, knew they were eligible to receive regular LFT, and agreed that LFTs were accurate and an effective way to prevent the spread of COVID-19. Factors associated with not taking a test included agreeing that you do not need to test for COVID-19 unless you have come into contact with a case, and that people who have been vaccinated do not need to be tested regularly. CONCLUSIONS: These data indicate that uptake of lateral flow testing is low. Encouraging testing and making testing easy through workplaces and places of study are likely to increase uptake, although care should be taken not to pressurise employees and students. Increasing knowledge that everyone is eligible for regular asymptomatic testing may drive uptake, as should communications that testing is important regardless of whether people think they have come into contact with a COVID-19 case and that people who have been vaccinated should still test regularly.

Cultivating curiosity about our patients can make all the difference to their care Asking questions that elicit who a patient is, and not just their diagnosis and symptoms, leads to more compassionate care, says Louise Smith Louise Smith senior lecturer in clinical skillsMy mother lay there, day after day, waiting for the time to come.She had cancer and was terminally ill, with only a few days left to live.She was unconscious and cachexic, the toll of the disease evident.At 83 years old, she had grey hair as she could no longer visit the hairdresser.Before this illness, nothing would have got in the way of her weekly hair appointments that she had enjoyed for so many years.