Search

Background and purpose: There is increasing demand for suitably trained pharmacists to undertake clinical roles in primary care general practices across the United Kingdom. This necessitates development of sustainable training opportunities to both better prepare future registrants for such roles and raise awareness of the new career pathway. Educational activity and setting: Hospital pre-registration trainee pharmacists undertook four or eight-week placements in general practice as part of their training year. Trainees attended an introductory session and received educational support tools six weeks prior to their placements. Each trainee had an allocated clinical supervisor in general practice and maintained communication with their hospital tutor. On completion of all placements, trainees and general practice staff were asked to share perceptions and outcomes via online questionnaires. Findings: Most trainees reported that the clinical supervision arrangements were satisfactory and found the placement workbook useful for guiding daily activities. Key benefits from the placements included enhanced understanding of the patient journey across healthcare sectors, increased confidence, and raised awareness of general practice as a career option. Main limitations included restricted opportunities to engage in patient-centred activities and lack of integration with general practice teams. All trainees stated that the presence of a general practice pharmacist was essential for learning support. Summary: This model demonstrated the feasibility of structured block placements of trainee pharmacists in general practice with identified benefits for trainees and pharmacy workforce requirements. Future research:Identified key limitations to this model need further investigation, to improve the design of future placements.

A newly introduced regulation renders the discarding of certain commercially important species illegal within the European waters progressively until 2019 (Article 15, EC Regulation 1380/2013). Thorough research is required in order to understand fishers’ perceptions and to achieve effective implementation of the regulation, as it is possible that certain implications might arise within the fishing industry and the associated communities after the shift to the new management regime. In this paper, fishers’ socio-economic behaviour is analyzed in relation to discarding practices under the “discrete choice” framework. Specifically, a variety of socioeconomic attributes, in the form of principal components that may affect the choices of the Greek bottom trawl fishers on three key discards’ drivers are analyzed to identify possible links between these. Utilizing the same attributes, eight hypothetical management tools that can be adopted for a smoother implementation of the discard ban are examined and the main results are discussed afterwards. Consistent patterns were revealed regarding fishers’ behaviour. An association of vessels’ efficiency with the probability to discard due to market limitations was evident, along with the association of different socioeconomic factors, such as the fishers’ age and the vessel’s crew size, with the incentives proposed regarding the introduction of awareness seminars. It is important to study these patterns carefully to understand the drivers and fishers’ motivation towards discarding. Their preferences on management tools that can be adopted by the EU member will also be considered, which can lead to a successful introduction of the regulation and a meaningful contribution into an effective management framework within which stakeholders can behave sustainably.

15 pages,3 figures, 3 tables, supplementary material https://www.frontiersin.org/articles/10.3389/fmars.2019.00594/full#supplementary-material, Aiming to end the practice of discarding unwanted catches back to the sea within European marine waters, an obligation to land the catches of all regulated commercial species was introduced with the Common Fisheries Policy, with required implementation by the first of January 2019. The implementation of this new fisheries regulation urges the definition of standard monitoring protocols to track potential changes in the European fisheries. Importantly, this framework needs to be multi-dimensional to capture the ecological, social and economic components of the fisheries system. Aiming to address this challenge, a set of 39 candidate indicators were identified by means of literature review and expert consultation. Experts in European fisheries were gathered to discuss the selection of a restricted set of indicators and later, a remote survey was completed by the experts to assess the adequacy of the indicators against pre-defined quality criteria and to identify expected direction of change. Based on survey results, the candidate indicators were ranked according to their adequacy for monitoring of the landing obligation (LO) potential effects. This ranking was dominated by indicators related to the exploited species, rather than the social or economic dimensions of the fisheries. Because the LO is not yet fully implemented, experts expressed uncertainty in the properties of many indicators, particularly related to ecosystem properties and social system properties, and had divergent opinions on the effect of the LO on discard numbers. The feasibility to operationalize a monitoring framework with the prioritized indicators was explored with data from a Spanish demersal otter-trawl fishery. This exercise evidenced that most indicators can be routinely collected and that it would be feasible to track these variables over time in the framework of a monitoring program. However, gaps exist in the time series of the studied indicators, especially for the period after the LO implementation. This study can provide valuable baseline information for any future monitoring program, as its objective was the development of a methodological approach that contributes to science-based policy making and to indicator selection for fisheries management reforms, This study was developed in the framework of MINOUW EU project (Project ID: 634495). SJ was funded by H2020-Marie Skłodowska-Curie Action MSCA-IF-2016 (Project ID: 743545)

The estimated impact of the EU Landing Obligation was investigated, which bans discards of regulated species, in South European fisheries through stakeholders’ perceptions with the intention to identify implementation shortcomings and practicalities that might lead to obstacles to enforcement. Structured interviews were conducted with 173 fishers in 4 countries practicing 4 generic fisheries (as typified by the dominant fishing gear) asking a total of 26 questions. Results show that fishers estimate that the full implementation of the discards ban will result in longer sorting times. Added to the limited space on board, especially in the more productive trawl and purse seine vessels, this may lead to practical difficulties in relation to compliance. Most of the respondents estimate that there are no realistic possibilities of utilizing the formerly discarded fish in the short term, because of the lack of adequate infrastructure on land Furthermore, the possible utilization types foreseen in the regulation will not help offset the costs of bringing former discards to land. The outcomes of this study have confirmed the implementation difficulties of the landing obligation, especially when the fishing industry cannot expect any medium to long-term benefits., This research has received funding from the European Commission's Horizon 2020 Research and Innovation Programme under Grant Agreement No. 634495 for the project Science, Technology, and Society Initiative to minimize Unwanted Catches in European Fisheries (MINOUW).

The debate concerning the biblical intertexts of Margaret Atwood’s The Handmaid's Tale has revolved around the question of the Bible’s role in the latter: as a tool for suppression and as a potential tool for subversion. The present article re-opens this crucial debate, shifting its focus and contributing to it in two interrelated ways. Whilst the explicit link between the theocracy of Atwood’s Gilead and its totalitarianism has been elaborated on, a specific analogy between Gilead and Nazi Germany drawn in the text remains underexplored in terms of its correlation with the novel’s biblical intertexts. This essay engages with the Gilead-Nazi Germany analogy in these terms, focusing – and this is its second contribution – on the novel’s intertextual entanglement with the story of the sacrificial lamb of the Passover, which still remains unexamined today, in 2015, the year that marks the thirtieth anniversary of the novel’s publication. Both the Passover sacrifice and Atwood’s novel, I will argue, present us with a figurative self-consumption that points to a politics of ‘auto-cannibalism’, which illuminates the parallel between Gilead and Nazi Germany whilst fleshing out its implications on Atwood’s treatment of the tripartite association between politics, sacrifice, and eating.

Summary Background Increased prevalence of psychological morbidities, including anxiety, depression and eating disorders, has been reported in women with polycystic ovary syndrome (PCOS) in comparison with normal ovulating, nonhyperandrogenemic women. Aim of the study To investigate the relationship between the degree of anxiety, depression and eating disorders via self-reported symptoms and the severity of hormonal and metabolic aberrations in women with PCOS. For this purpose, the PCOS cohort was subdivided into three subgroups according to the degree of anxiety. Methods One hundred and thirty women with PCOS of similar age and BMI were studied. In each subject, hormonal and metabolic status as well as psychological profile was assessed with the use of specific questionnaires. Specifically, anxiety (trait and state) was assessed with the use of STAI-T and STAI-S, while depression and eating disorders were evaluated with the use of the Beck Depression Inventory and the Eating Attitudes test, respectively. Results The subgroups did not differ in age and BMI. Subjects with the highest STAI-S compared with those with the lowest STAI-S displayed significantly higher the homeostasis assessment model-insulin resistance (HOMA-IR) and free androgen index values (P

Background PCOS is presented by a broad spectrum of menstrual irregularities appearing often at puberty or later on during the reproductive years in women suffering from this multifaceted syndrome. To our knowledge, there is no evidence to suggest whether the time of onset of menstrual irregularities (peri or post pubertal) indicates a differential metabolic and/or hormonal profile as well as ovarian ultrasonographic findings, in adulthood in women with PCOS. Aim of the study To compare anthropometric, hormonal-metabolic profile and ultrasound findings in PCOS women with peripubertal onset of menstrual disorders with the corresponding data obtained from PCOS patients with post pubertal onset of menstrual irregularities, matched for BMI and age. Patients-methods 89 PCOS women were evaluated cross-sectionally at the age of 25 years. In 49 subjects menstrual irregularities were present from menarche, whereas in 40 women the irregularities appeared at least 3 years post menarche. Results Anthropometric parameters were comparable between the 2 groups. The 2 groups did not differ on metabolic and hormonal profile as well as ovarian ultrasound findings. Conclusions These data indicate that the timing of menstrual irregularities, do not appear to have an impact, on hormonal/metabolic profile and ovarian ultrasound morphology in patients diagnosed with PCOS, later in life.

Hyperthyroidism is a common endocrine disorder affecting 2% of females and 0.5% of males worldwide and antithyroid drugs constitute the first line of treatment in the majority of cases. These agents may cause severe adverse effects and among them liver failure, although rare, is a potential lethal one. This case illustrates the sudden and abrupt deterioration of hepatic function due to antithyroid drug administration. This case along with a concise literature review is presented aiming to increase the awareness of endocrinologists of possible fatal complications from the everyday use of common agents such as antithyroid drugs.

Objectives The HOme-based MEdication Review (HOMER) trial investigated whether home-based medication review by pharmacists could decrease hospital re-admission in older people. This trial demonstrated that the intervention increased admissions by 30% (P=0.009). This unexpected finding provoked significant interest. This paper describes the intervention in detail and the process measures recorded by review pharmacists, and investigates whether results differed according to pharmacist characteristics. Method 437 patients were randomised to the intervention, which involved two pharmacist home visits within two and eight weeks of discharge, and 435 were randomised to usual care. An analysis was undertaken of the process measures and to determine whether admission rates differed within the intervention group according to the type of pharmacist performing the review. Setting Norfolk or Suffolk patients aged over 80 years discharged to their own home after an emergency admission (any cause), and taking two or more medications daily. Key findings Twenty-two pharmacists participated. The majority (68%) were experienced community pharmacists (mean age = 42 years), 71% had a postgraduate qualification. Pharmacists identified adverse drug reactions in 33% of patients and made a mean of 1.6 recommendations/comments per visit undertaken. At least 35% of these were enacted. Pharmacists reduced inappropriate drug storage from 7% to 2% of visited patients by their second visit (P = 0.04), and reduced hoarding of unnecessary drugs from 40% of visited patients to 19% (P < 0.001). Finally, the rate of admission within the intervention group did not vary significantly according to experience or type of pharmacist delivering the intervention. Conclusion The HOMER intervention was conducted in a similar way to interventions in many other medication review studies. Given the HOMER trial's counter-intuitive findings it is clear that there is an urgent need to refine this intervention, identify the most suitable location for its delivery, and develop training that can ensure it is delivered to best effect.

Objective: Higher frequency of subclinical atherosclerosis has been linked with androgen levels in postmenopausal women. Advanced glycation end-products (AGEs) are well-recognized atherogenic molecules. Therefore, we investigated the association of postmenopausal sex steroid and metabolic status with serum AGE levels. Methods: Serum sex hormones, fasting glucose, fasting insulin, and AGEs were assessed in 106 healthy postmenopausal women. Insulin resistance was estimated by using the homeostasis model assessment of insulin resistance (HOMA-IR). Results: Women in the highest testosterone quartile (Q4) had higher serum AGE levels (Q1, 5.22 IU/mL ± 0.50; Q2, 5.08 ± 0.53 IU/mL; Q3, 5.78 ± 1.10 IU/mL vs Q4, 7.35 ± 1.23 IU/mL; P < 0.0005) compared with women in the lowest testosterone quartiles. Accordingly, women in the highest free androgen index (FAI) quartile had higher serum AGE levels (Q1, 5.36 ± 0.59 IU/mL; Q2, 5.28 ± 0.72 IU/mL vs Q4, 6.68 ± 1.48 IU/mL; P < 0.0005) compared with women in the lowest FAI quartile. These findings remained significant after adjustment for age, body mass index, HOMA-IR, and fasting glucose and fasting insulin levels. A highly significant correlation was found for testosterone and FAI with AGEs and persisted after adjustment for age, body mass index, HOMA-IR, and fasting glucose and fasting insulin levels (r = 0.67, P < 0.0005) Conclusions: The data from the current study suggest that higher levels of AGEs are positively associated with higher androgen levels. This association, identified for the first time, may provide an additional insight into the pathophysiological mechanisms linking the described higher prevalence of cardiovascular events with higher androgen levels in postmenopausal women.

Objective To investigate the effects of oral natural micronized P on hormonal and metabolic parameters in patients with polycystic ovary syndrome (PCOS) and to answer the clinical question whether induction of withdrawal bleeding is a necessity for the comparison of hormonal and metabolic data in subjects with PCOS. Design Prospective clinical study. Setting Academic medical center. Patient(s) Twenty-eight reproductive-aged women with PCOS. Main Outcome Measure(s) Blood sampling was collected at baseline, after 7 days of oral natural micronized P (200 mg) administration, and after withdrawal bleeding. At these three stages hormonal parameters and homeostasis assessment model (HOMA-IR) index were assessed in all patients. Result(s) Oral natural micronized P administration did not alter significantly insulin sensitivity index and androgen levels; however, LH was decreased when postbleeding values were compared to baseline. Nevertheless, after oral natural micronized P administration, P and 17α-hydroxyprogesterone (17-OHP) concentrations were increased, and HOMA-IR was decreased, whereas androgens levels were not altered, in comparison with baseline. Conclusion(s) The induction of withdrawal bleeding, with this regimen, does not appear to be a necessity for the assessment of hormonal and metabolic profile in anovulatory women with PCOS.

Objective To determine whether home based medication review by pharmacists affects hospital readmission rates among older people. Design Randomised controlled trial. Setting Home based medication review after discharge from acute or community hospitals in Norfolk and Suffolk. Participants 872 patients aged over 80 recruited during an emergency admission (any cause) if returning to own home or warden controlled accommodation and taking two or more drugs daily on discharge. Intervention Two home visits by a pharmacist within two weeks and eight weeks of discharge to educate patients and carers about their drugs, remove out of date drugs, inform general practitioners of drug reactions or interactions, and inform the local pharmacist if a compliance aid is needed. Control arm received usual care. Main outcome measure Total emergency readmissions to hospital at six months. Secondary outcomes included death and quality of life measured with the EQ-5D. Results By six months 178 readmissions had occurred in the control group and 234 in the intervention group (rate ratio = 1.30, 95% confidence interval 1.07 to 1.58; P = 0.009, Poisson model). 49 deaths occurred in the intervention group compared with 63 in the control group (hazard ratio = 0.75, 0.52 to 1.10; P = 0.14). EQ-5D scores decreased (worsened) by a mean of 0.14 in the control group and 0.13 in the intervention group (difference = 0.01, -0.05 to 0.06; P = 0.84, t test). Conclusions The intervention was associated with a significantly higher rate of hospital admissions and did not significantly improve quality of life or reduce deaths. Further research is needed to explain this counterintuitive finding and to identify more effective methods of medication review.