The concept of burnout has been ascribed several meanings over the years, and concerns have been raised about the lack of clarity and consensus in the defining criteria. However, the most popular definition to emerge is the multidimensional description by Maslach where burnout is a syndrome of emotional exhaustion, depersonalisation and reduced personal accomplishment that can occur among individuals who do people work of some kind. Burnout can result from prolonged periods of stress or excessive workload. The aim of this research was to describe burnout and job engagement in a sample population of community pharmacists. Methods: A mixed method approach of quantitative and qualitative methods was used; both these methods are widely used within organisational psychology. The study was composed of two discrete but overlapping parts, each using a different but complementary methodology: a quantitative first part informing a qualitative second part. A self-administrated questionnaire was posted to all pharmacists in residing in the Local Practice Forum covering Dorset, Hampshire and the Isle of Wight (n=1170). Respondents completed a questionnaire pack comprising the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Utrecht Work Engagement Scale (UWES-9) together with questions of demographic characteristics, both survey instruments have been widely used in job burnout and engagement studies. A letter was also included inviting respondents to take part in the qualitative part of this study and ethical approval was granted by the Bioscience Research Ethics Committee at the University of Portsmouth. The MBI-Human Services Survey (MBI-HSS) measures the three sub-scales of burnout, "emotional exhaustion," "depersonalization" and "personal accomplishment." The survey consists of 22 items designed to assess the three dimensions of burnout and the items are scored on a seven-point Likert scale ranging from zero (never) to 6 (every day), indicating the frequency of feelings and attitudes experienced. The Utrecht Work Engagement Scale (UWES) measures the three constituting dimensions of work engagement: vigour, dedication, and absorption, and consists of 9 items designed to measure the three dimensions. All items are scored on a 7-point frequency rating scale ranging from 0 (never) to 6 (everyday). Quantitative data were analysed using descriptive statistics (means, standard deviations, skewness and kurtosis) and calculated for all scales and subscales. Non-parametric tests were performed as the data was not normally distributed, and analysed using SPSS V 18.0. Regression analysis was performed to investigate the relative contribution of the different stressors and demographic variables to the variance in burnout and engagement. Internal consistency of the three subscales of MBI-HSS and UWES-9 was computed using Cronbach‟s alpha. Qualitative data were obtained using a combination of focus group, semi-structured interviews and electronic interviews and transcribed verbatim. Template analysis was used to develop a hierarchical list of codes representing themes and the relationship between themes. Results/Discussion: A total of 702 questionnaires were returned from a sample population of 1170 pharmacists residing in the Wessex LPF, giving an overall response rate 60%. Out of which 72.36% (n= 508) indicated that community pharmacy was their main job role. Demographic data of respondents was compared to previous workforce data and showed that 63.2% (n=321) were female and 36.4 %(n=185) were male. Respondents showed high scores on the Emotional Exhaustion scale (Mean 35.28, SD 12.10), high levels of depersonalisation (Mean 14.23, SD 6.48) and Low levels of Personal Accomplishment (Mean 42.86, SD 8.14).This gives an overall picture of a high degree of burnout within the sample population. Regarding engagement the mean score of 4.64,SD 3.74 indicates that the sample population has average levels of job engagement. Qualitative data results combined focus group (n=5), semi-structured interviews (n=9), telephone (n=5) and electronic interviews (n=5) and themed into positive/negative work and patient related events. Qualitative data indicated that community pharmacists are finding that paperwork/administration, skill mix, responsible pharmacist regulations, availability of dispensing stock and the demands of patients being factors that might contribute to burnout levels. Possible signs of job engagement included enjoyable patient events such as helping a patient and appreciation of a job well done by line management. Conclusions: This research has several implications for community pharmacy practice and service development. A significant proportion of pharmacists in this sample population suffered from burnout, and if this data were extrapolated to all community pharmacists and if those pharmacists were unable to detect and acknowledge the signs of burnout, disillusionment with the profession might follow. Employers, professional bodies and employees should become aware of the causes and symptoms of burnout and if possible monitor burnout levels on a regular basis, this could help them become aware of their own and others levels of burnout.

Background and aims: Endothelial dysfunction, vascular inflammation and oxidative stress have been integrally linked to the pathogenesis of both type 2 diabetes and cardiovascular disease. Aged Garlic Extract (AGE), a potent antioxidant, has been shown in previous studies to attenuate these novel risk factors in a non-diabetic population. Aims: This study tested the hypothesis that AGE may improve endothelial function , oxidative stress, vascular inflammation and insulin resistance in high risk cardiovascular subjects with type 2 diabetes (defined as >30% Cardiovascular risk over 10 yrs). Methods: A double blind, placebo controlled cross-over study was performed in 26 type 2 diabetic patients who received 1200mg of AGE or placebo daily for 4 weeks with a 4 week washout period. Plasma HsCRP was measured as a marker of inflammation. TAOS,GSH/GSSG and LHP were measured as markers of oxidative stress/anti-oxidant defence. Insulin resistance was measured using the HOMA-IR method. Endothelial function was measured using change in the reflective index (RI) post salbutamol using digital photoplethysmography and urinary albumin/creatinine ratio was measured as a biochemical surrogate. Measurements were taken at baseline and after intervention with AGE or placebo. Results: Of the 26 patients studied (Male 17, Female 9), mean age was 61 ± 8 yrs, HbA1c 7.2 ± 1.1%, BP 130/75 ± 15.9/9.8 mmHg, total cholesterol 4.2 ± 0.81 mmol/l, triglyceride 2.11 ± 1.51 mmol/l, HDL-cholesterol 1.04 ± 0.29 mmol/l. The majority of patients were being treated with metformin (59%), aspirin (50%) and statin (96%) therapy. 36% were treated with an ACEI. There were no changes in these therapies throughout the study. Treatment with AGE had no significant effect upon the above metabolic parameters including insulin resistance. Systolic blood pressure pre AGE 130 ± 15mmHg vs post AGE 130± 14mmHg. Total cholesterol pre AGE 4.2 ± 0.9 mmol/l vs post AGE 4.2 ± 0.8 mmol/l. Triglycerides pre AGE 1.4 IQ range 0.7 mmol/l vs post AGE 1.4 IQ range 0.8 mmol/l. HDL cholesterol pre AGE 1.0 ± 0.3 mmol/l vs post AGE 1.0 ± 0.3mmol/l. In addition, no statistically significant difference was found in plasma HsCRP (pre AGE: median 2.0mg/l, IQ range 0.8-2.7 vs post AGE: median 1.83mg/l, IQ range 1.1-3.2, p = 0.89) or urinary albumin/creatinine ratio (pre AGE: 0.55, IQ range 0.4-1.65 vs post AGE: 0.6, IQ range 0.47-1.5, p = 0.43) endothelial function (change in RI pre AGE: 6.5%, IQ range 2.75-11 vs post AGE: 6.5%, IQ range 2.75-13, p = 0.95) with AGE or placebo. Conclusion: In this group of type 2 diabetic patients at high cardiovascular risk, 4 weeks treatment with AGE did not significantly improve endothelial function, vascular inflammation, oxidative stress or insulin resistance.

Towards the development of a drug delivery vehicle for the nasal delivery of insulin, N-trimethyl chitosan has been co-formulated with poly(ethylene glycol) and glycerophosphate into a thermosensitive hydrogel structure, the sol-to-gel transition properties of which occur at physiologically relevant temperatures over optimally brief timescales. In vitro experiments mimicking those of the nasal environment have indicated the dual capability of the formulation to affect the opening of tight junctions and to release its therapeutic content in a controlled manner, while spectroscopic and analytical investigations have indicated the structural integrity of the incorporated insulin. The in vivo potential of this in situ thermogelling nasal formulation to act as a once-a-day dosage form for the intranasal delivery of insulin has been demonstrated in the diabetic rat model.

Lectures have been used as a teaching method for many centuries and remain a standard on most university courses. More than twice as many teaching hours are devoted to lectures on the MPharm course at the University of Portsmouth than to all other teaching methods. Lecturers frequently express concern however, at low levels of attendance at lectures and, during 2007-8, registers were taken at approximately 15% of MPharm lectures. The aims of the research were to ascertain whether any correlation existed between lecture attendance and exam performance, and to investigate both lecturers’ and students’ attitudes towards and opinions of lectures as a method of teaching. A Scoping Exercise was used to put the work into context with other UK Schools of Pharmacy (SoPs).

Introduction It has been said that through monitoring of drug safety, pharmacovigilance (PV) systems have been instrumental in assisting regulatory decisions on product safety. However, there has been no, systematic, in-depth study of this role. This thesis reports such a study conducted in the UK. On the basis of the results, suggestions are made on how PV data might be produced and used more effectively. Methods In Phase 1, a scoping study was conducted to document all changes made to UK product labelling on safety grounds over a 10 year period (September 1st 1995 to August 31st 2005). In Phase 2, all product withdrawals and major labelling changes made during the 10 year study above, were investigated in depth to determine the therapeutic group, source of ADR data cited as the reason for the change; and product survival probability, using Kaplan-Meier modelling. Phase 3, informed by Phases 1 and 2, used a web-based survey (150 respondents) and structured interviews (13 subjects) with healthcare professionals and scientists with a PV role in the NHS, pharmaceutical companies and the UK regulator, to gain views on the current procedures for handling safety issues in the UK and how these might be improved. Inferences were drawn using interpretative henomenological analysis with NVivo 8 software. Key findings Phases 1 and 2 revealed the fragmentary nature of information in the public domain and the difficulties of obtaining unpublished information. Based on public information, Phase 1 showed that 2,630 safety notices were issued affecting 688 individual products. The two main safety notice categories were drug interactions (841;32%) and side effects (537;20%). The rank order of the four most common therapeutic areas in which safety notices occurred was: CNS (23.5%)> anti-infectives (21.6%) > cardiovascular (15.2%) > cancer chemotherapy (10.8%). The ratio of Type A : Type B side effects (ADRs) was 1:3.3. Phase 2 found that of 518 eligible products launched during the study period, 9 (1.7%) were licensed and withdrawn for safety reasons. The ten-year Kaplan-Meier probability of adverse drug reactions causing the withdrawal of a new product, postmarketingwas 2.2%. All decisions were based on more than one safety data type and all involved UK yellow cards. One decision considered prescription event monitoring (PEM) data. A total of 164 important safety notices affecting 818 individual products were identified. Of 518 products launched during the study period, 56 experienced at least one major labelling change for safety reasons. The ten-year Kaplan-Meier risk of a product experiencing at least one major labelling change on safety grounds was 13.8%. As with product withdrawals, safety decisions were based on a wide range of data sources of variable quality and quantity. Variation in dissemination of the new safety information was observed. Only one fifth of safety notices warranting a ‘Dear Healthcare Professional’ letter or a monograph in ‘Current Problems in Pharmacovigilance’, were accompanied by a boxed warning in the BNF, representing an important inconsistency in notifying prescribers. As with interview participants, respondents to the on-line questionnaire had difficulties placing the yellow card reports in a formal hierarchy of evidence whilst acknowledging that the data were valuable in the decision making process. Suggested ways of improving the quality of such reports included making the reporting more accessible and training all those eligible to report. PEM studies were cited by the majority of respondents as a means of generating credible safety data and raising the general quality of the drug safety database. In terms of dissemination and education about ADRs, Drug Safety Updates (which replaced the ‘Current Problems’ publication from the MHRA in August 2007) were highly thought of; they appeared to be more popular than ‘Dear Healthcare Professional’ letters and because they were web-based, ought to be accessible by a wider audience. Conclusions Safeguarding public health is of utmost importance when making a decision whether or not to withdraw a product or amend its labelling upon the emergence of new safety data. Labelling changes should be made only on the best evidence available at the time and appropriate risk management strategies should be instigated where feasible; not only when a safety signal arises post-marketing, but when a drug is first granted a marketing authorisation. There is no general consensus on what constitutes ‘best evidence’ and rating evidence using traditional hierarchies is problematic, The GRADE hierarchy may be an exception. Improving ADR reporting should lead to improved data bases from which to draw safety conclusions. Methods of improving reporting include early instigation and enforcement of risk management plans by the regulator, education of all those eligible to report, greater transparency of regulatory decisions and better and more rapid dissemination of safety change information.

Background The discharge summary is a critically important form of communication when a patient is discharged from hospital. It has been shown in numerous studies that discharge summaries often lack sufficient information, with deficiencies in completeness and accuracy, and may not be received by the GP surgery before the patient’s first postdischarge contact. Poor quality medicines-related information can result in unintentional changes to the patient’s medication after discharge. Increasingly discharge summaries are being prepared and transmitted electronically; but research into the quality of medicinesrelated information in the electronic discharge summary was scant and not UK based. Aims To list and describe the content of medicines-related information in the electronic discharge summary, and evaluate the quality of information for completeness, accuracy and timeliness. To evaluate the quality of information about medication changes in the electronic discharge summary for completeness and accuracy. Method Prospective content analysis of medicines-related information in a sample of the electronic discharge summaries generated over a two month period at a 400 bed general hospital. A stratified random sample of 10% of the electronic discharge summaries were further analysed to evaluate the quality of information about medication changes; by identifying if medication changes had occurred, and whether they were listed and the reasons for changes stated completely and accurately. Results The majority of electronic discharge summaries were prepared by junior doctors, and in a timely manner in 97% of the sample of 1306 summaries. They contained medicinesrelated information categorised as allergies, discharge medications, and medication notes. Allergies data and discharge medication lists were complete and accurate in 96% and 89% of the summaries respectively; medication notes were written in 73%, most frequently about medication changes. Medication changes occurred, between admission and discharge, in 96% of cases; new medications were started (87%) more frequently than admission medications were changed (59%). Information about these medication changes were present in 69% of summaries, and were complete and accurate in 22% and 16% respectively. Complete and accurate information about all medication changes were shown in only 13% of summaries. Conclusion Electronic discharge summaries make an important contribution to patient safety in generating legible and timely information about allergies and discharge medications; but do not completely eliminate the risk of inaccurate or incomplete information. Documentation of information about medication changes in the electronic discharge summary was frequently incomplete or inaccurate. There was a gap between the need for, and provision of, information about medication changes in the discharge summary.

Current clinical practice relies on sufficiently low haemoglobin (HB) level, low serum ferritin (SF), low serum iron concentration and an elevated total iron binding capacity (TIBC) to identify iron deficiency (ID) and iron deficiency anaemia (IDA). However, these parameters are sometimes not reliable in assessing iron status in patients with underlying conditions like chronic diseases, malignancies and inflammation. Growing evidence indicates the appropriate inclusion of reticulocyte haemoglobin content (RET-He) and red cell haemoglobin content (RBC-He) into the iron studies investigation could improve the early diagnosis. The aim of this study were to evaluate the extent to which RET-He and RBC-He values could improve the assessment of iron status in chronic disease and inflammation, and to evaluate if the inclusion could be used to preclude the need for further biochemical assessment in iron status. A total of 800 samples (89 normal, 611 patients and 100 haemochromatosis) were obtained and analysed for biochemical and haematological iron indicators. RET-He and RBC-He were added to the full blood counts parameters on the Sysmex XE2100TM, and C-reactive protein was added to indicate inflammation. The inclusion criteria were based on symptomatic and asymptomatic cases, such as gastroenterological, cancer and rheumatoid arthritis. Children and pregnant women were excluded from participating in the study. Stability of RET-He, RBC-He, HB, mean cell volume (MCV) and mean cell haemoglobin (MCH) were evaluated to determine if there was significant shift in the result over 96 h and at varying temperature 40C, 200C and 300C. RET-He and RBC-He were also added to the haematological iron assessment in the follow up monitoring of haemochromatosis patients to evaluate their usefulness. The serial measurement shows reasonable stability for MCH, HB, RET-He and RBC-He for up to 96 h. Elevated shift were recorded for MCV on all the samples in the same time frame. Receiver operating characteristic (ROC) analysis was used to obtain sensitivity and specificity of the biochemical and haematological iron indices measured in the study. Female patients were classified into ID using SF ≤ 20 ng/mL. The area under the curve (AUC) in this group were (SF = 0.99 versus RET-He and RBC-He = 0.72). RET-He has (sensitivity, 89.6% and specificity, 58.0%), and RBC-He, (sensitivity 88.6% and specificity 57.0%) in detecting ID. Female patients with IDA were classified using HB ≤ 11.5 g/dL. The AUC were (HB = 0.99; versus RET-He = 0.87 and RBC-He = 0.86). RET-He has (sensitivity, 84.0% and specificity, 72.0%) and RBC-He (sensitivity 82.0% and specificity 71.0%) versus HB (sensitivity, 100.0% and specificity, 99.9%) in detecting IDA. In male patients with ID, SF < 20 ng/mL was used for classification, AUC were (SF = 1.00 versus RET-He = 0.78 and RBC-He = 0.79). RET-He has (sensitivity, 78.4% and specificity, 66.0%) and RBC-He (sensitivity 80.0% and specificity 61.2%), against SF (sensitivity, 100.0% and specificity, 100.0%) in detecting ID. In male patients with IDA, HB <13.5 g/dL was used for classification, AUC were (HB = 0.99 versus RET-He = 0.89 and RBC-He = 0.87). RET-He has (sensitivity, 88.6% and specificity, 83.0%) and RBC-He (sensitivity 83.8% and specificity 80.0%) in detecting IDA in male patients. Diagnostic plots were used to assess the ability of RET-He and RBC-He in comparison to other biochemical and haematological parameters, RET-He and RBC-He emerged as possible predictors of ID and IDA in inflammations and chronic diseases. The results of RET-He and RBC-He when measured with the other haematological parameters in the follow up treatment of haemochromatosis patients, shows 99% agreement with HB, MCV and MCH. In conclusion, the inclusion of RET-He and RBC-He into the iron studies investigation may improve the identification of ID and IDA in chronic disease and inflammation, and can possibly detect changes in the cohort of cells with inadequate haemoglobinisation. Therefore, both indices hold promise as an alternative to biochemical iron studies especially, in patients with acute phase response and chronic diseases.

The overall aims of my PhD research project were to identify which particular gamma-amino butyric acid A receptor (GABAAR) subunits are expressed by neurochemically defined cell-types of the enteric nervous system (ENS) of the mouse colon, and what effect the pharmacological activation of specific receptor subtypes had on colonic contractility, as well as assessing whether two key determinants of gastrointestinal (GI) plasticity, namely stress and ageing, altered such GABAAR expression and functional phenotypes in the colon.

M. Tech. / Complementary and alternative therapies (CAM) have become increasingly widespread in countries throughout the world in recent years. Alternative medications, including homoeopathic, are now commonly available for purchase from pharmacies, health shops and even supermarkets in South Africa. Due to this, pharmacists particularly, as the point of first contact for members of the public, have an increased responsibility towards their patients to have a certain working knowledge of these products. However, pharmacists receive little training of this nature during their formal education. Their consequent lack of understanding about homoeopathy may be detrimental to the optimal health management of patients by pharmacists, as well as to the growth of the homoeopathic and alternative medicine industries in South Africa (Montagne, 1997). The aim of this research was to establish the perceptions of homoeopathy among professional pharmacists and qualified pharmacists' assistants in the Greater Johannesburg area. The information gained is intended to provide valuable baseline information about how homoeopathy is viewed by these professionals and to provide a framework for further research in other geographic areas of South Africa. This information may also be helpful in the development of future homoeopathic education programmes for the pharmaceutical industry. A sample group of 50 pharmacists and pharmacists' assistants working in retail pharmacies in the Greater Johannesburg area were randomly invited to complete a written survey regarding their personal and professional perceptions of homoeopathy. Twenty seven fully qualified pharmacists and 23 pharmacists' assistants completed the survey between the 25 October 2007 and the 16 January 2008. The results indicated that in some respects there are differences of opinion between pharmacists and pharmacy assistants with regard to issues surrounding homoeopathy, as well as between people who have been qualified for different lengths of time. The results however, reflect a general trend toward acceptance and interest in homoeopathy in the pharmacy profession. There was little statistical difference between the answers given by male and female participants, or participants from different racial groups.

No description available.