'What does good look like'-exploring access to healthcare for the homeless population in Gateshead, England.

BACKGROUND: individuals who are homeless encounter extreme health inequalities and as a result often suffer poor health. This study aims to explore ways in which access to healthcare could be improved for individuals who are homeless in Gateshead, UK. METHODS: twelve semi-structured interviews were conducted with people working with the homeless community in a non-clinical setting. Transcripts were analysed using thematic analysis. RESULTS: six themes were identified under the broad category of 'what does good look like', in terms of improving access to healthcare. These were: facilitating GP registration; training to reduce stigma and to provide more holistic care; joined-up working in which existing services communicate rather than work in isolation; utilising the voluntary sector as support workers could actively support access to healthcare and provide advocacy; specialised roles such as specialised clinicians, mental health workers or link workers; and specialised bespoke services for the homeless community. CONCLUSIONS: the study revealed issues locally for the homeless community accessing healthcare. Many of the proposed actions to facilitate access to healthcare involved building upon good practice and enhancing existing services. The feasibility and cost-effectiveness of interventions suggested requires further assessment.

Incidence, Population Density, and Spatial Heterogeneity of Plant-Parasitic Nematodes in Corn Fields in Ohio.

Soil samples were collected from 425 corn fields in 28 Ohio counties between growth stages V3 and V6 during the 2013 and 2014 growing seasons. Ten morphological groups of plant-parasitic nematodes, namely spiral, lesion, lance, dagger, stunt, pin, ring, stubby-root, cyst, and "tylenchids" (several genera morphologically similar to members of the subfamily Tylenchinae [NCBI Taxonomy] including Cephelenchus, Filenchus, Malenchus, and Tylenchus) were identified. Eight species belonging to six of these groups were characterized. Spiral, tylenchids, lesion, pin, lance, stunt, and dagger nematodes were detected in 94, 96, 80, 57, 48, 48, and 37% of the fields, respectively, whereas the stubby-root, cyst, and ring nematodes were present in fewer than 14% of the samples. Averaged across fields, the spiral, tylenchids, and pin nematodes had the highest mean population densities. For all groups, incidence and population density varied among counties, and in some cases, among soil regions and cropping practices. Both population parameters were heterogeneous at multiple spatial scales, with the lowest heterogeneity among soil regions and the highest among fields within county and soil region. Estimated variances at the soil region level were not significantly different from zero for most of the nematodes evaluated. Stunt and lance were two of the most variable groups at all tested spatial scales. In general, the population densities were significantly more heterogeneous at the field level than at the county level. Findings from this study will be useful for developing sampling protocols and establishing on-farm trials to estimate losses and evaluate nematode management strategies.

Helpful advice and hidden expertize: pharmacy users' experiences of community pharmacy accessibility.

Background: In recent years community pharmacies have emerged as strategically important settings to deliver services aimed at promoting public health. In order to develop evidence-based approaches to public health interventions that exploit the unique accessibility of community pharmacies, it is important to determine how people experience care in this context. This study, therefore, aimed to describe how care is perceived and experienced in community pharmacies with particular focus on community pharmacy access. Methods: In-depth semi-structured interviews were used to explore the perceptions and experiences' of people using community pharmacies. Results: A total of 30 participants were interviewed. Themes specifically emerged in relation to community pharmacy access; these fell into four main categories: relationships; time; lack of awareness; and empowerment. Conclusions: The experience of developing a trusting relationship with the pharmacist is an important consideration in the context of community pharmacy accessibility. This could be an important consideration when a person uses a community pharmacy to access a public health service. There is also a perceived lack of awareness among the general public about the extended role of community pharmacy; this is a potential barrier toward people using them.

Effects of Row Spacing and Nitrogen Rate on Wheat Grain Yield and Profitability as Influenced by Diseases.

In Ohio, changes in nitrogen (N) fertilizer application rates and row spacing in combination with fungicide applications have been proposed as possible strategies for increasing wheat productivity and profitability. Field experiments were conducted in 2013, 2014, and 2015 to evaluate the benefits of increasing row spacing and N rates in soft red winter wheat as influenced by diseases. Combinations of narrow (19 cm) and wide (38 cm) row spacings, N rates ranging from 34 to 180 kg ha-1, and the fungicide prothioconazole + tebuconazole applied at flag leaf emergence, boot, or early anthesis represented different management programs. Linear mixed model analyses were performed to evaluate the effects of N, row spacing, and fungicide timing on leaf rust, Fusarium head blight (FHB), and deoxynivalenol (DON), and to quantify relationships among leaf rust, N, grain yield (YLD), and test weight (TW). YLD, TW, grain prices and price discounts, as well as input costs were used to estimate net cash income (NCI) for each management program. Wide row wheat had statistically higher mean FHB and DON, and lower mean yield and test weight than narrow row wheat in 2014 and 2015 but not in 2013. There were significant positive linear relationships between leaf rust and N as well as YLD and TW with N. Differences in FHB and DON among N rates were not statistically significant. Leaf rust severity was consistently lower in treated plots, with efficacy influenced by N rate and application timing. Programs with narrow row spacing and treated with the fungicide generally resulted in the highest mean YLD and TW across N rates. Price discounts due to high FDK and DON, and low TW were higher, and consequently, NCIs were lower in 2014 and 2015 than in 2013. The highest NCIs were obtained for programs with the highest YLD and lowest price discounts, consequently programs with wide row spacing, a fungicide treatment, and high N rates were only economically beneficial when FHB levels were low and grain prices were high.

The challenges for primary caregivers of adolescents with disruptive behavior disorders.

Adolescents with disruptive behavior disorders (DBD), including oppositional defiant disorder and conduct disorder, present unique challenges for their families. Although, most empirically supported treatments for DBD are family-based, the emphasis is typically on the behavior of the child rather than on the life challenges and resultant distress experienced by the family members. Fifteen families of adolescents with DBD were recruited from a large publicly funded Community Mental Health Center. For this report, data from in-depth interviews with the adolescents' primary caregivers were analyzed by standard content analytic procedures to describe the challenges they experienced living with and caring for the adolescents. The primary caregivers reported that the challenges were overwhelming, demanding, and unrelenting. The two most salient challenges were (a) managing the adolescents' aggressive, defiant, and deceitful behaviors, and (b) interacting frequently with a number of child-serving agencies. A number of clinical implications are drawn from these findings.

A qualitative exploration of the barriers and enablers to supporting informal and familial carers within community pharmacies.

OBJECTIVES: There are approximately 5.3 million informal carers in the United Kingdom, many of whom support family in their health despite being unpaid and often unsupported. Many visit pharmacies to collect medicines and look for advice. This work explores informal carer support within community pharmacies (CP). METHODS: Semi-structured video interviews exploring perspectives on the role of CP in supporting carers were conducted in autumn 2022. The study received institutional ethical approval. Interviews were audio-recorded, transcribed verbatim, and analysed using a reflexive thematic approach. KEY FINDINGS: In total 25 interviews were conducted with 13 carers and 12 pharmacy staff. Three themes were identified:-What support do carers need through CP?-medicines management, navigating services, and carers health and wellbeing.-Barriers to CP better supporting carers-relationships with CP, carer needs, identification as a 'carer'.-Enablers to CP better supporting carers-support is a team effort, and CP as a community 'hub'. CONCLUSIONS: There is a trusted relationships between carers and pharmacy staff which can contribute to establishing pharmacies as a safe space of support, this includes medicines-specific support and navigating services, but also carer health and wellbeing support. Pharmacy staff may need to reconsider approaches to identifying and supporting carers and not just treating them as an extension of supporting a patient. In making this support accessible, relationships with pharmacy staff are important, as well as embracing CP as a 'community hub', although pharmacy staff may need training and information to facilitate them in this role.

Pharmacy Students' Lived Experiences With Atopic Dermatitis Inform Perceptions of Learning in the Curriculum.

OBJECTIVE: To explore the impact of lived experiences of pharmacy students with atopic dermatitis (AD) on perceptions of learning in pharmacy curriculum. METHODS: An exploratory qualitative study was conducted with pharmacy students in the United Kingdom to understand how their lived experiences affect their perception of AD in pharmacy curriculum. Semistructured interviews were conducted, and a thematic analysis method was followed. Firstly, codes were created, and then relevant codes were combined to identify themes. RESULTS: Thirteen pharmacy students were interviewed. Study findings showed pharmacy students support teaching with a holistic approach to management and patient-centered care in AD in pharmacy curriculum. Although students had empathy and moral support for patients, they also described a need for teaching on the mental health effects of AD in pharmacy education. CONCLUSION: This brief report explores the role of lived experience of pharmacy students in considering the provision of holistic, patient-centered care in AD teaching in pharmacy education. Participants also suggest the need within the pharmacy curriculum for training to provide mental health advice to patients with AD.

Factors influencing pharmacists' roles in preventing prescription and over-the-counter opioid misuse: a systematic review and narrative synthesis.

BACKGROUND: The prescribing rate of opioids is increasing and is a main contributor to opioid misuse. Community pharmacists can help reduce opioid misuse rates by carrying out prescription and over-the-counter (OTC) opioid misuse prevention services. Understanding the barriers and facilitators to community pharmacists' involvement has the potential to improve these services. OBJECTIVE: To review the literature on the barriers and facilitators of community pharmacists' involvement in prescription and OTC opioid misuse prevention. METHODS: A systematic review of primary research was carried out in MEDLINE, Embase, Scopus, Web of Science, CINAHL, and APA PsycINFO from January 2022 to March 2022. Narrative synthesis underpinned by the COM-B model was used to analyse findings from the included articles. Studies were included if they used qualitative or mixed methods; published in English and focussed on OTC or prescription opioids. RESULTS: Ten studies were included in the review. Barriers and facilitators were grouped into individual, environmental, and system-level factors. Based on the COM-B model, these factors were classified as capabilities (knowledge and skill), opportunities (e.g. relationship with prescribers, time), and motivation (pharmacists' attitude). CONCLUSION: Improving pharmacists' capabilities and opportunities might improve pharmacists' motivation to offer opioid misuse services. This could improve pharmacists' behaviour, that is, their role in preventing prescription and OTC opioid misuse. The findings of this review were based on information obtained from primary evidence from qualitative studies; However. further empirical work is needed to identify how pharmacists can be supported.

"You don't get side effects from social prescribing"-A qualitative study exploring community pharmacists' attitudes to social prescribing.

OBJECTIVES: Social prescribing is an approach that enables the referral of patients to non-clinical support and places a focus on holistic care. This study explored views of community pharmacists regarding social prescribing in pharmacies. STUDY DESIGN: A qualitative phenomenological approach was used. METHODS: A convenience sample of eleven community pharmacists from Northern England were recruited via social media (Twitter, Facebook) and took part in a semi-structured, one-to-one qualitative interviews that asked about their knowledge of social prescribing, the advantages of community pharmacist involvement and any barriers they predicted to its implementation. Interviews were transcribed verbatim and thematically analysed. RESULTS: The sample included largely male pharmacists (63.3%) with less than five years' experience (45.5%) and included pharmacists working as employees (63.6%), locums (27.3%) and owners (9%) in both chain (36%) and independent stores (54.5%). The main findings indicate an enthusiasm for but limited understanding of social prescribing. Factors which appeared to influence involvement were training requirements and time available to complete an additional service in busy pharmacies. Opportunities centred on the broader pharmacy team's role to optimise health outcomes. CONCLUSIONS: The findings indicate pharmacists may be an underused resource due to a poor understanding of the full scale and scope of social prescribing beyond health promotion, lifestyle interventions. Further work is needed to explore the transferability of the findings to the broader pharmacy workforce to understand how social prescribing can be positioned within pharmacy practice.

Problem-solving intervention for caregivers of children with mental health problems.

UNLABELLED: Building Our Solutions and Connections (BOSC) focused on enhancing problem-solving skills (PSS) of primary caregivers of children with mental health problems. Aims were determining feasibility, acceptability, and effect size (ES) estimates for depression, burden, personal control, and PSS. METHODS: Caregivers were randomized to BOSC (n=30) or wait-list control (WLC) groups (n=31). Data were collected at baseline, post-intervention, and 3 and 6 months post-intervention. RESULTS: Three-months post-intervention, ES for burden and personal control were .07 and .08, respectively. ES for depressed caregivers for burden and personal control were 0.14 and 0.19, respectively. CONCLUSIONS: Evidence indicates that the intervention had desired effects.

The role of pharmacists in supporting service users to optimise antipsychotic medication.

Pharmacists have a contribution to make in improving optimising medication use for people on antipsychotic medication. The rates of prescribing antipsychotics have increased in England with an 18% rise from 2015 to 2020. People on antipsychotic medication are not treated as equal partners in conversations about their medications. This can leave people to make decisions about their antipsychotic medications without input from their prescribers which can have significant consequences for individuals. Involving people in the decision-making process, as experts on their own condition, has the potential to improve treatment outcomes. The evidence suggests that involving pharmacists in supporting people with serious mental illnesses will lead to improved clinical outcomes. Key areas for pharmacist involvement are providing information, education and counselling on antipsychotic medication and the side effects and reducing polypharmacy especially when antipsychotics are prescribed off license.

Practices and Perceptions of Community Pharmacists in the Management of Atopic Dermatitis: A Systematic Review and Thematic Synthesis.

Understanding the contributions of community pharmacists as first-line health providers is important to the management of atopic dermatitis, though little is known about their contribution. A systematic review was carried out to examine practices and perceptions of the role of community pharmacists. A literature search was conducted in five different databases. Full-text primary research studies, which involved practices and perceptions of the role of community pharmacists in the management of atopic dermatitis, previously published in peer reviewed journals were used. Critical appraisal of included studies was performed using the Mixed Methods Appraisal Tool. Data were extracted and thematically synthesized to generate descriptive and analytical themes. The confidence of the findings of the included studies was assessed via either GRADE or CERQual. Twenty-three studies were included. Findings showed that community pharmacists lacked knowledge of the uses of topical corticosteroids. The recommendations of other treatments were limited. Pharmacists generally undertook dermatology training after graduation. Analytical themes indicated that the practices of community pharmacists were poor and misled patients. Inappropriate education in initial training was identified as a potential reason for their poor practices. This systematic review reveals a gap between patients' needs in practice and dermatological education provided to community pharmacists. Novel approaches regarding education and training should be explored to improve pharmacists' dermatological knowledge and skills.

A systematic review and thematic synthesis exploring the role of pharmacists in supporting better sleep health and managing sleep disorders.

BACKGROUND: Sleep is an essential part of mental and physical well-being. Sleep disorders may lead to psychiatric and physical conditions that contribute to morbidity and mortality. They lead to severe health and economic consequences across high-, intermediate- and low-income countries. Little is known about how pharmacists manage sleep disorders for patients in high, intermediate and low-income countries. METHOD: Four databases were systematically searched, and titles, abstracts, and full texts were screened to detect relevant studies. Data were extracted from literature and thematically synthesised to identify descriptive and analytical themes. RESULTS: Thirty-four studies met the inclusion criteria. Most studies were from high-income countries (n = 33) and based in community pharmacy settings (n = 17). Four descriptive themes were identified: (1) how pharmacists manage sleep disorders, (2) the impact of pharmacists' interventions on sleep, (3) barriers to managing sleep by pharmacists and (4) inappropriate sleep disorders management by pharmacists. Three analytical themes were synthesised from extracted data that identified the pharmacists have roles as (1) de-prescribers, (2) collaborators and (3) educators in sleep management services. CONCLUSION: Pharmacists have three clear roles in sleep disorder management; deprescribing, collaboration with other healthcare professionals and educators. However, most of the literature is from high-income countries; therefore, further work is needed to explore these roles in low and middle-income countries.

Community pharmacies as a place for informal carer support in mental health and wellbeing.

There are 5.3 million informal carers in the United Kingdom who take on caring responsibilities for family and friends. Informal carers can be forgotten patients within health and care services, yet because of carer burden, they are at risk of deterioration in health and wellbeing. There are higher levels of anxiety, depression, burnout and low self-esteem amongst carers but, to our knowledge work to date has mainly focused on supporting carers to provide better care for their family member, and less on carers' health and wellbeing. There is increasing interest in social prescribing as a method of linking patients with community-based services to improve health and wellbeing. Initiatives have included social prescribing via community pharmacies which are already recognized to be accessible for support and signposting. The coming together of community pharmacy services and social prescribing could represent a framework to better support carers in their mental health and wellbeing.

The role of pharmacists in deprescribing benzodiazepines: A scoping review.

Background: Polypharmacy can increase the risk of adverse drug events, hospitalisation, and unnecessary healthcare costs. Evidence indicates that discontinuing certain medications, such as benzodiazepines, can improve health outcomes, by resolving adverse drug effects. This scoping review aims to explore the pharmacists' role in deprescribing benzodiazepines. Method: A scoping review has been conducted to distinguish and map the literature, discover research gaps, and focus on targeted areas for future studies and research. A systematic search strategy was conducted to identify relevant studies from PubMed, Medline, and EMBASE databases. The eligibility criteria involved studies that focused on the role of pharmacists in benzodiazepine deprescribing, quantitative and qualitative studies conducted in humans, full-text articles published in English. Results: Twenty studies were identified, revealing three themes: 1) pharmacists' involvement in benzodiazepine deprescribing, 2) the impact of their involvement, and 3) obstacles impeding the process. Pharmacists involved in deprescribing procedures, mainly through completing medication reviews, collaborative work with other healthcare providers, and education. Pharmacists' involvement in benzodiazepine deprescribing intervention led to better health and economic outcomes. Withdrawal symptoms after medication discontinuation, dependence on medication, and lack of time and guidelines were identified in the literature as barriers to deprescribing. Conclusion: Pharmacists' involvement in deprescribing benzodiazepines is crucial for optimizing medication therapy. This scoping review examines the pharmacists' role in benzodiazepine deprescribing. The findings contribute to enhancing healthcare outcomes and guiding future research in this area.

Intersectional Identities: Making Sense of Skill Development on Clinical Placements.

OBJECTIVE: Little is known about the influence of personal experiences on learners' trajectories toward mastery. Newell's theory of constraints articulates the relationship between environmental, individual, and task-related factors for skill development. This study explores how undergraduate pharmacy students experience skill development on placements and what the barriers and facilitators are within Newell's framework. METHODS: Year 3 undergraduate pharmacy students were invited to take part in focus groups exploring Newell's theory relative to skill development. Verbatim transcripts were analyzed using an interpretive phenomenological approach. RESULTS: Five focus groups were conducted with 16 students. The placement task provided structure through entrustable professional activities (EPAs). The resulting skill development varied but included EPA expected behaviors and also skills for mastery, eg, self-reflection. Students' personal identities acted as both barriers and facilitators. For example, expecting or experiencing racial microaggressions limited participation; having a local accent facilitated rapport with patients. Students worked toward integration into the community of practice (the ward), where the staff was critical to inclusion. Where students had barriers related to their identities, they found it more difficult to access the community of practice. CONCLUSION: Factors related to the community of practice (environment), students' identities (individual), and the EPA behaviors (task) can influence skill development during placement. For some students, these factors will be more prevalent, and elements of their identities may intersect and conflict, acting as both barriers and facilitators to skill development. Educators can consider the influence of intersectionality on student identity when designing and preparing new placements and assessing students.

Biochar as a negative emission technology: A synthesis of field research on greenhouse gas emissions.

Biochar is one of the few nature-based technologies with potential to help achieve net-zero emissions agriculture. Such an outcome would involve the mitigation of greenhouse gas (GHG) emission from agroecosystems and optimization of soil organic carbon sequestration. Interest in biochar application is heightened by its several co-benefits. Several reviews summarized past investigations on biochar, but these reviews mostly included laboratory, greenhouse, and mesocosm experiments. A synthesis of field studies is lacking, especially from a climate change mitigation standpoint. Our objectives are to (1) synthesize advances in field-based studies that have examined the GHG mitigation capacity of soil application of biochar and (2) identify limitations of the technology and research priorities. Field studies, published before 2022, were reviewed. Biochar has variable effects on GHG emissions, ranging from decrease, increase, to no change. Across studies, biochar reduced emissions of nitrous oxide (N2 O) by 18% and methane (CH4 ) by 3% but increased carbon dioxide (CO2 ) by 1.9%. When biochar was combined with N-fertilizer, it reduced CO2 , CH4 , and N2 O emissions in 61%, 64%, and 84% of the observations, and biochar plus other amendments reduced emissions in 78%, 92%, and 85% of the observations, respectively. Biochar has shown potential to reduce GHG emissions from soils, but long-term studies are needed to address discrepancies in emissions and identify best practices (rate, depth, and frequency) of biochar application to agricultural soils.

Beyond the numbers: Utilising existing textual data for qualitative research in pharmacy and health services research.

INTRODUCTION: Qualitative research is a well-established branch of scientific enquiry that draws insights from experiences.1, 2Within social and administrative pharmacy research, interview and focus group methods are a mainstay of collecting data. However, other disciplines such as sociology, psychology and anthropology, use existing data that is routinely to provide a substance for qualitative inquiry. Drawing on our experiences of using interdisciplinary research methods, this paper presents three case studies where textual data was qualitatively analysed and critically examines the strengths and weaknesses of these method in relation to pharmacy practice. METHODS: Three case studies were selected that access different types of existing, routinely collected data from pharmacy practice. This included 1) a study utilising boardroom meeting minutes, 2) a study using incident reports and 3) a study using WhatsApp messages as data. Each case study is described and critically examined. The strengths and weaknesses of this approach are based on our own reflections of completing the studies. RESULTS: Relationships between people, products and organisations can be examined in documents, records and text that is routinely collected. Existing data can also provide insights into culture, working patterns, education and errors. Practical advantages of using existing data include faster data collection and access to first-hand, accounts of experiences of human relationship with pharmaceutical products and practice. Drawbacks of using existing data are that some data may be missing, participants may no longer be accessible for participant checking and the context of language may have changed. CONCLUSION: This paper critically examined the use of methods rarely used in pharmacy practice research which draw on existing, routinely collected data. Adopting a wider range of data collection methods may will provide new understanding and insights into social and clinical pharmacy practice.

Investigating community pharmacists' perceptions of delivering chlamydia screening to young people: a qualitative study using normalisation process theory to understand professional practice.

OBJECTIVES: Some community pharmacies in England provide free chlamydia testing to young people, yet testing activity in the setting is low. This study aims to increase understanding of why that is, by investigating community pharmacists' perceptions of barriers to delivering the service, and the reasons why some do not offer testing. METHODS: Semi-structured interviews were conducted with 22 community pharmacists in North East England between November 2018 and May 2019. The sample comprised both those who provided and did not provide chlamydia testing at the time of the interview. Data were subjected to thematic analysis, utilising the constructs of the normalisation process theory. KEY FINDINGS: Pharmacists found it challenging to sustain delivery of chlamydia testing, as very few young people either requested the test or accepted it when it was offered during consultations on other sexual health services. Pharmacists were cautious about offering the test, having concerns about making clients feel uncomfortable. They identified the value of training to enable them to communicate confidently with clients about testing. Pharmacists supported the suggestion that treatment for chlamydia be offered as part of a 'test and treat' package, as they felt that it aligned to their role in the provision of medicines advice. CONCLUSIONS: Community pharmacies are well-placed to deliver chlamydia testing but are not operating as effectively as they might do. The provision of training on communicating with young people, integrating testing with more sexual health services, and providing 'test and treatment' for chlamydia could contribute to greater testing activity.