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Introduction: Receiving a diagnosis of young onset dementia is particularly distressing; the person under 65 years is often in employment, with financial commitments, young children, and an active social life. Some of the stress experienced by younger people experiencing cognitive changes can be reduced by an early and accurate diagnosis, but this is contingent on the timing of disclosure and a process which is sensitive and appropriate to the person. The study aim was to explore experiences of giving and receiving a diagnosis of young onset dementia, by triangulating the perspectives of the key parties involved. Methods: A qualitative design was employed, using semi-structured interviews. Participants (N = 47) included people with young onset dementia (n = 10), family members (n = 12), and health and social care professionals (n = 25). Thematic analysis and triangulation enabled identification of overall themes across different participant groups. Results: All participant groups agreed on key aspects of good disclosure practice, with two overarching themes: The optimal conditions for disclosure, and how best to disclose a diagnosis. Positive experiences of disclosure were prefaced on having the appropriate space and time; having a support person present; clearly labelling the diagnosis; providing appropriate information at the right pace. Other findings include recommendations for longer appointment times, offering additional support for young families, and for carers of people with atypical presentations (e.g. frontotemporal dementia). Conclusion: Many people with young onset dementia had unsatisfactory disclosure experiences. Health and social care professionals should provide a 'pre-disclosure' appointment, elicit the amount of information the person may want at the point of disclosure of the diagnosis, balance truth and hope, provide contact details for follow-up, and overall be mindful of the individual in front of them. While young onset dementia may be a life-altering diagnosis, a disclosure meeting which is sensitively undertaken can increase the person's agency, coping ability, and ultimately empower them to live well with their diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to review the entrepreneurial and educational innovations in technology-enabled distance education in practical legal education (PLE) accomplished by a unit "on the periphery" of a strong research-led university. It also aims to examine the learning organisation (LO) attributes associated with this initiative. Design/methodology/approach: This is a longitudinal case study based on interviews and reflective analysis, and reviewed using three "models" drawn from the literature: breaking the "iron triangle" (containing costs; widening access; enhancing quality); a tailored version of distance education appropriate for research-intensive universities; a strategy for successful adoption of disruptive technologies in higher education. Findings: Entrepreneurialism yielded growth (PLE student numbers went from 150 to 2,000 in 15 years) and diversification (two new programmes established). The PLE programme advanced in two "waves": the first centred on widening access and the second, on enhancing quality. Costs were contained. Both the presence and absence of LO attributes are identified at three different organisational levels. Research limitations/implications: Challenges to academic identity may act to inhibit educational change, especially in research-strong settings. Practical/implications: Business logic, and the creation and institutionalisation of educational development support--an "internal networking" group, were keys to success. "Organisational learning" in complex institutional environments such as universities involves understandably lengthy timescales (e.g. decades or more). Practical/implications Technology-enabled disruption in higher education appears relentless. While institutional and individual performance metrics favour research, proven cases of "how to do things differently" in education may well not get exploited, thus opening the market to alternative providers. Originality/value: This is the only empirical example of a tailored version of distance education appropriate for research-intensive universities that we know about.

Background Pharmacists are being increasingly employed as part of general practice teams globally, and their input has been associated with several clinical and economic benefits. However, there is a paucity of research focussing on general practitioners' (GPs') perceptions of pharmacist integration into practices in countries where this novel role for pharmacists is yet to become commonplace. Objective To explore GPs' perceptions of integrating pharmacists into general practices and to identify the behavioural determinants of GPs integrating pharmacists into practices. Methods Semistructured interviews were conducted with GPs practising in Ireland, who were sampled using a combination of purposive, convenience, and snowball sampling. Interviews were audio-recorded and transcribed verbatim , which then were analysed using conventional content analysis and directed content analysis employing the Theoretical Domains Framework (TDF). Results Seventeen GPs were interviewed between November 2021 and February 2022. Seven TDF domains were identified as predominant in influencing GPs' perceptions of pharmacist integration into general practices. These perceptions were mostly positive, especially regarding patient outcomes, cost savings, and improving access to care. However, there were concerns about funding the role, affecting others' workloads, and pharmacists' training needs to work in practices. Conclusion This study's theory-informed insight provides a deeper understanding of GPs' perceptions of pharmacists working in general practice and behaviours which can be targeted to help optimize integration. These findings should be utilized in future service development to preempt and address GPs' concerns ahead of pharmacist integration, as well as to inform the development of general practice-based pharmacist roles going forward. [ABSTRACT FROM AUTHOR]

Background: People with young onset dementia face unique challenges. Notably, at time of symptom presentation, many people affected by young onset dementia are still employed with significant financial obligations. The aim of this study was to explore the specific impact that young onset dementia has on continued employment and finances and to identify ways to optimise post-diagnostic approaches in this regard. Methods: Purposive sampling, with a maximum variation technique, was used to recruit a small but diverse range of people with young onset dementia in Ireland. In-depth semi-structured interviews were conducted, and data were analysed using Reflexive Thematic Analysis. In total, 22 interviews were conducted with 10 people with young onset dementia and 12 spouses and children. Two themes were constructed: impact of young onset dementia on (I) employment and (II) finances. Findings: Participants' lived accounts showed the devastating effect of a diagnosis of young onset dementia on working life, and the resultant financial, social, and psychological consequences. Participants reported having to leave paid employment early, reported losing contracts and retiring on medical grounds. There were financial implications caused by loss of income, and many additional expenses owing to dementia were incurred. In some families, spouses had to take up employment at the same time as a caring role to mitigate the loss of income, and young children were anxious at the resultant occupational and financial tensions. Conclusion: People diagnosed with young onset dementia encounter significant challenges associated with employment, and individual and family finances. There is a need for more specific information and guidance from healthcare professionals around employment rights, income support and welfare benefits and the pension status for this group of people. Additionally, healthcare professionals should be cognisant of the additional financial burden people face in young onset dementia when advising on services which incur out-of-pocket costs. [ABSTRACT FROM AUTHOR]

Background: Pharmacist services in general practice are expanding worldwide, with evidence to show pharmacists' presence in general practice has financial, workload, and clinical benefits. Yet, little is known globally about general practitioners' (GPs') views on their presence in general practice.Objective: To synthesize the qualitative research evidence on GPs' views of pharmacist services in general practice.Methods: Qualitative evidence synthesis; 8 electronic databases were searched from inception to April 2021 for qualitative studies that reported the views of GPs regarding pharmacist services in general practice. Data from included studies were analyzed using thematic synthesis. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach was used to assess the confidence in individual review findings.Results: Nineteen studies were included, which captured the views of 159 GPs from 8 different countries. Four analytical themes describing the factors that should be considered in the development or optimization of pharmacist services in general practice, based on the views of GPs, were developed from the coded data and descriptive themes: (i) optimal environment for a pharmacist, (ii) the ideal pharmacist characteristics, (iii) complex stakeholder relationships, and (iv) benefits of an effective pharmacist.Conclusion: Based on the synthesis of GPs' views, we have created a conceptual model of factors that should be considered by policymakers, GPs, pharmacists, and other relevant stakeholders when developing or optimizing pharmacist services in general practice going forward. [ABSTRACT FROM AUTHOR]