New roles in pharmacy - learning from the All Wales Common Ailments Scheme.

OBJECTIVES: The objective of this study was to explore the perceptions of stakeholders on a national pilot of a new service, the 'Choose Pharmacy' Common Ailments Service (CAS) in Wales. METHODS: Methods used were semi-structured interviews with stakeholders involved in development and delivery of the CAS. Snowball sampling was employed and invites were extended to eight of 13 pharmacies offering CAS in Cwm Taf LHB, the practice managers at two associated general practitioner surgeries and two local and national level commissioners. KEY FINDINGS: The benefits of encouraging self-care by patients were widely recognised in terms of their impact on patients, health professionals and wider society. Although some challenges of introducing a new service were identified, these did not appear to be insurmountable. CONCLUSIONS: CAS was welcomed by stakeholders in terms of its potential benefits. Results are therefore encouraging for policy makers involved in the implementation of other new roles within community pharmacy in the UK and beyond.

Intestinal SR-BI does not impact cholesterol absorption or transintestinal cholesterol efflux in mice.

Reverse cholesterol transport (RCT) can proceed through the classic hepatobiliary route or through the nonbiliary transintestinal cholesterol efflux (TICE) pathway. Scavenger receptor class B type I (SR-BI) plays a critical role in the classic hepatobiliary route of RCT. However, the role of SR-BI in TICE has not been studied. To examine the role of intestinal SR-BI in TICE, sterol balance was measured in control mice and mice transgenically overexpressing SR-BI in the proximal small intestine (SR-BI(hApoCIII-ApoAIV-Tg)). SR-BI(hApoCIII-ApoAIV-Tg) mice had significantly lower plasma cholesterol levels compared with wild-type controls, yet SR-BI(hApoCIII-ApoAIV-Tg) mice had normal fractional cholesterol absorption and fecal neutral sterol excretion. Both in the absence or presence of ezetimibe, intestinal SR-BI overexpression had no impact on the amount of cholesterol excreted in the feces. To specifically study effects of intestinal SR-BI on TICE we crossed SR-BI(hApoCIII-ApoAIV-Tg) mice into a mouse model that preferentially utilized the TICE pathway for RCT (Niemann-Pick C1-like 1 liver transgenic), and likewise found no alterations in cholesterol absorption or fecal sterol excretion. Finally, mice lacking SR-BI in all tissues also exhibited normal cholesterol absorption and fecal cholesterol disposal. Collectively, these results suggest that SR-BI is not rate limiting for intestinal cholesterol absorption or for fecal neutral sterol loss through the TICE pathway.

Introducing a nationally shared electronic patient record: case study comparison of Scotland, England, Wales and Northern Ireland.

AIM: To compare the experience of the four UK countries in introducing nationally accessible electronic summaries of patients' key medical details, intended for use in emergency and unscheduled care episodes, and generate transferable lessons for other countries. METHOD: Secondary analysis of data collected previously on all four schemes; cross-case comparison using a framework derived from diffusion of innovations theory. MAIN FINDINGS: Whilst all four programmes shared a similar vision, they differed widely in their strategy, budget, implementation plan, approach to clinical and public engagement and approach to evaluation and learning. They also differed, for various reasons, in stakeholder alignments, the nature and extent of resistance to the programme and the rate at which records were created. A nationally shared, widely accessible electronic record has powerful symbolic meaning; it may or may not be perceived as improving the quality and safety of care or (alternatively) as threatening patient confidentiality or the traditional role of the doctor or nurse. 'Hard' project management oriented to achieving specific milestones and deadlines sometimes appeared counterproductive when it cut across the 'softer' aspects of the programmes. CONCLUSION: When designing and implementing complex technologies with pervasive implications, policymakers must consider not only technical issues but also the personal, social and organisational aspects of the programme. A judicious blend of 'hard' and 'soft' management appears key to managing such programmes.