BackgroundNHS policy emphasises shared decision-making during labour and birth. There is, however... more BackgroundNHS policy emphasises shared decision-making during labour and birth. There is, however, limited evidence concerning how decision-making happens in real time.ObjectivesOur objectives were as follows – create a data set of video- and audio-recordings of labour and birth in midwife-led units; use conversation analysis to explore how talk is used in shared decision-making; assess whether or not women’s antenatal expectations are reflected in experiences and whether or not the interactional strategies used (particularly the extent to which decisions are shared) are associated with women’s postnatal satisfaction; and disseminate findings to health-care practitioners and service users to inform policy on communication in clinical practice.DesignThis was a mixed-methods study. The principal method was conversation analysis to explore the fine detail of interaction during decision-making. Derived from the conversation analysis, a coding frame was developed to quantify interactions...
International Journal of High Dilution Research - ISSN 1982-6206, 2021
When Samuel Hahnemann devised homoeopathy he constructed multiple arguments that both vehemently ... more When Samuel Hahnemann devised homoeopathy he constructed multiple arguments that both vehemently supported his new system and criticized the conventional medical practice of his day. At the end of the 19th century when homeopathy had grown within Britain and America, homeopaths failed to make use of some of Hahnemann’s most successful arguments. Instead, homeopaths found themselves lose significant cognitive ground to their long time conventional rivals with the dawn of the 20th century, a ground they have not yet recovered. This paper uses the theoretical framework of Berger and Luckmann to analyse the dynamics of the arguments used against homeopathy and suggests that homeopaths failed to adopt a universalizing medical explanation that was available to them: the reverse action of drugs. Had they used this argument homoeopaths could have explained conventional medicine successes within their own universe of meaning and thus neutralized the impact of conventional on...
Background An unlicensed medicine is defined as a medicinal product for which there is no marketi... more Background An unlicensed medicine is defined as a medicinal product for which there is no marketing authorisation granted by the Medicines Healthcare and Regulatory Agency (MHRA)1. Unlicensed medicines are widely used within the UK and there are many guidance documents which exist to support their use. However, each guidance document is published for individual organisations and there has never been an analysis of the different approaches these documents take nor an evaluation of their quality. Aims and Objectives To analyse the content and quality of unlicensed medicines guidance documentation in use in the UK. Methods A systematic search of the published literature was conducted between April and June 2015. Databases used to identify published guidance included Medline, Embase, ISI Web of Knowledge, Google Scholar, PubMed and International Pharmaceutical Abstracts. Search terms included ‘unlicensed medicine’ or ‘specials’ combined with; guideline, policy, framework, standardized o...
An unlicensed medicine (ULM) is a product which does not have a marketing authorisation from the ... more An unlicensed medicine (ULM) is a product which does not have a marketing authorisation from the MHRA. ULMs include Specials, food supplements and imported medicines. They have not undergone the same regulatory processes as licensed medicines, including rigorous assessment of safety and efficacy. How and why prescribers choose to initiate these medicines, pharmacists source them and patients use them has never been explored. Aim and objectives • To explore the use of unlicensed medicines across primary and secondary care from the perspectives of prescribers, pharmacists and patients – To conduct an analysis of guidance documentation designed to support the use of unlicensed medicines – To describe experiences of prescribing, dispensing and taking ULMs – To explore perceptions of risks and benefits associated with ULMs – To identify concerns around use of ULMs – To discover any perceived improvements to ULM use in the NHS
Problem An unlicensed medicine (ULM) is a product which does not have a marketing authorisation f... more Problem An unlicensed medicine (ULM) is a product which does not have a marketing authorisation from the MHRA. ULMs include Specials, food supplements and imported medicines. There has never been an evaluation of the quality of ULM guidelines or analysis of their content. Approach A search of published guideline documentation was conducted using peer-reviewed electronic databases. Search terms included ‘unlicensed medicine’ or ‘specials’ combined with; guideline, policy, framework, standardized operating procedure, standard operating procedure or recommendation. Internal documentation was acquired using a ‘call for guidance’ which was distributed both locally and nationally across healthcare settings. The quality of the guidelines was assessed using the AGREE II tool alongside a thematic analysis of the content. Findings A total of 52 guidance documents were included in the analysis. The quality of the guidance documentation was good for the domains ‘Scope and Purpose’ (70.6%) and ‘...
Problem An unlicensed medicine (ULM) is a product which does not have a marketing authorisation f... more Problem An unlicensed medicine (ULM) is a product which does not have a marketing authorisation from the MHRA. They include Specials, food supplements and imported medicines. Areas that have not been explored include: • How and why prescribers choose to initiate them • How and where pharmacists source them • Patient use and awareness of ULM • Perceptions of use Approach Semi-structured face-to-face interviews were conducted with prescribers (n=11), pharmacists (n=10) and patients (n=7) sampled from both primary and secondary care in the North East of England. Interviews were audio recorded and transcribed verbatim. Grounded theory analysis led to the development of themes and informed the selection of subsequent participants. Findings Several themes were identified across the data by healthcare professionals and patients in primary and secondary care, including: • Healthcare professionals’ awareness of when they were using an ULM and their definition of an ULM • Perceptions of safet...
The 19th century saw the development of an eclectic medical marketplace in both the United Kingdo... more The 19th century saw the development of an eclectic medical marketplace in both the United Kingdom and the United States, with mesmerists, herbalists and hydrotherapists amongst the plethora of medical ‘sectarians’ offering mainstream (or ‘allopathic’) medicine stiff competition. Foremost amongst these competitors were homoeopaths, a group of practitioners who followed Samuel Hahnemann (1982[1810]) in prescribing highly dilute doses of single-drug substances at infrequent intervals according to the ‘law of similars’ (like cures like). The theoretical sophistication of homoeopathy, compared to other medical sectarian systems, alongside its institutional growth after the mid-19th-century cholera epidemics, led to homoeopathy presenting a challenge to allopathy that the latter could not ignore. Whilst the subsequent decline of homoeopathy at the beginning of the 20th century was the result of multiple factors, including developments within medical education, the Progressive movement, a...
The International journal of pharmacy practice, Jan 30, 2018
There is widespread use of unlicensed medicines within primary and secondary care but little info... more There is widespread use of unlicensed medicines within primary and secondary care but little information is available around how these medicines are used. This analysis examines and evaluates the content and quality of relevant guidance documentation currently in use within the UK. Guidance documents were identified through a literature search as well as email requests to pharmacy organisations throughout the UK. Unlicensed medicine documentation suitable for inclusion in the analysis underwent thematic analysis and quality assessment using the AGREE II tool. Thematic analysis of 52 guidelines revealed four parent themes: (1) Professional responsibility (2) Usage practicalities (3) Risk versus benefit (4) Controlling use. There was variability in scores across the AGREE II domains with areas covering Scope and Purpose and Clarity of Presentation scoring well. Conversely, an area needing attention was Rigour of Development. Healthcare organisations would benefit from agreeing a '...
Background There is a growing need to involve patients in the development of patient safety inter... more Background There is a growing need to involve patients in the development of patient safety interventions. Mental health services, despite their strong history of patient involvement, have been slow to develop patient safety interventions, particularly in inpatient settings. Methods A systematic search was undertaken of both academic and grey literature. Whilst no lay member of the team worked directly on the review, they were part of the project steering group which provided oversight throughout the review process. This included people with lived experience of mental health services. From a research perspective the main focus for lay members was in co-producing the digital technology, the key project output. Smits et al.’s (Res Involv Engagem 6:1–30, 2020) Involvement Matrix was used to taxonomise levels of patient involvement. Studies were included if they were set in any inpatient mental health care context regardless of design. The quality of all selected studies was appraised u...
Background: The role of the pharmacist is changing. One example of this is the potential for phar... more Background: The role of the pharmacist is changing. One example of this is the potential for pharmacists in primary care to be involved in the administration and monitoring of cancer patients receiving oral chemotherapy. However, little is known about whether pharmacists feel they have sufficient communication skills training to conduct consultations with cancer patients. Aims: To ascertain undergraduate pharmacy students’ attitudes towards developing the communication skills required to conduct consultations with cancer patients in pharmacy practice. Methods: Qualitative and quantitative methods were used for the study. A questionnaire focusing on the communication skills required to care for cancer patients was administered to all four year groups of an undergraduate pharmacy degree at a United Kingdom School of Pharmacy. Key emerging issues were then explored through a focus group, which were analysed using a thematic content analysis. Results: Several themes emerged from the qua...
Journal of Reproductive and Infant Psychology, 2021
OBJECTIVE To investigate any association between expressions of parents' continuing bond with... more OBJECTIVE To investigate any association between expressions of parents' continuing bond with their stillborn baby and bereavement adaptation. BACKGROUND Continuing bonds theory suggests that bereaved parents adapt to the loss of their child by sharing and transforming mental representations of the child, allowing them to be integrated into parents' everyday lives. Little is known about the mental health benefits of expressing continuing bonds following stillbirth. This study examined any association between aspects of parents' relationship with their stillborn baby, social support for the relationship, and bereavement adaptation. METHODS Cross-sectional questionnaire study. Parents of stillborn babies (N=170) completed an online questionnaire examining engagement in continuing bonds expressions; characteristics of parents' relationship with their stillborn baby and their experience of sharing it; social support, and meaning-making. Measures of mental health were included to quantify bereavement adaptation. RESULTS Regression analyses showed that time since death, meaning-making, engaging with nature, and legacy building are positively linked to bereavement adaptation. Risk factors included inadequate social support for the relationship, a greater desire to share it more freely, an increased sense of integration with baby, and societal pressure to move on. CONCLUSION Key aspects of parents' ongoing relationship with their stillborn baby and the social context are related to bereavement adaptation.
BackgroundNHS policy emphasises shared decision-making during labour and birth. There is, however... more BackgroundNHS policy emphasises shared decision-making during labour and birth. There is, however, limited evidence concerning how decision-making happens in real time.ObjectivesOur objectives were as follows – create a data set of video- and audio-recordings of labour and birth in midwife-led units; use conversation analysis to explore how talk is used in shared decision-making; assess whether or not women’s antenatal expectations are reflected in experiences and whether or not the interactional strategies used (particularly the extent to which decisions are shared) are associated with women’s postnatal satisfaction; and disseminate findings to health-care practitioners and service users to inform policy on communication in clinical practice.DesignThis was a mixed-methods study. The principal method was conversation analysis to explore the fine detail of interaction during decision-making. Derived from the conversation analysis, a coding frame was developed to quantify interactions...
International Journal of High Dilution Research - ISSN 1982-6206, 2021
When Samuel Hahnemann devised homoeopathy he constructed multiple arguments that both vehemently ... more When Samuel Hahnemann devised homoeopathy he constructed multiple arguments that both vehemently supported his new system and criticized the conventional medical practice of his day. At the end of the 19th century when homeopathy had grown within Britain and America, homeopaths failed to make use of some of Hahnemann’s most successful arguments. Instead, homeopaths found themselves lose significant cognitive ground to their long time conventional rivals with the dawn of the 20th century, a ground they have not yet recovered. This paper uses the theoretical framework of Berger and Luckmann to analyse the dynamics of the arguments used against homeopathy and suggests that homeopaths failed to adopt a universalizing medical explanation that was available to them: the reverse action of drugs. Had they used this argument homoeopaths could have explained conventional medicine successes within their own universe of meaning and thus neutralized the impact of conventional on...
Background An unlicensed medicine is defined as a medicinal product for which there is no marketi... more Background An unlicensed medicine is defined as a medicinal product for which there is no marketing authorisation granted by the Medicines Healthcare and Regulatory Agency (MHRA)1. Unlicensed medicines are widely used within the UK and there are many guidance documents which exist to support their use. However, each guidance document is published for individual organisations and there has never been an analysis of the different approaches these documents take nor an evaluation of their quality. Aims and Objectives To analyse the content and quality of unlicensed medicines guidance documentation in use in the UK. Methods A systematic search of the published literature was conducted between April and June 2015. Databases used to identify published guidance included Medline, Embase, ISI Web of Knowledge, Google Scholar, PubMed and International Pharmaceutical Abstracts. Search terms included ‘unlicensed medicine’ or ‘specials’ combined with; guideline, policy, framework, standardized o...
An unlicensed medicine (ULM) is a product which does not have a marketing authorisation from the ... more An unlicensed medicine (ULM) is a product which does not have a marketing authorisation from the MHRA. ULMs include Specials, food supplements and imported medicines. They have not undergone the same regulatory processes as licensed medicines, including rigorous assessment of safety and efficacy. How and why prescribers choose to initiate these medicines, pharmacists source them and patients use them has never been explored. Aim and objectives • To explore the use of unlicensed medicines across primary and secondary care from the perspectives of prescribers, pharmacists and patients – To conduct an analysis of guidance documentation designed to support the use of unlicensed medicines – To describe experiences of prescribing, dispensing and taking ULMs – To explore perceptions of risks and benefits associated with ULMs – To identify concerns around use of ULMs – To discover any perceived improvements to ULM use in the NHS
Problem An unlicensed medicine (ULM) is a product which does not have a marketing authorisation f... more Problem An unlicensed medicine (ULM) is a product which does not have a marketing authorisation from the MHRA. ULMs include Specials, food supplements and imported medicines. There has never been an evaluation of the quality of ULM guidelines or analysis of their content. Approach A search of published guideline documentation was conducted using peer-reviewed electronic databases. Search terms included ‘unlicensed medicine’ or ‘specials’ combined with; guideline, policy, framework, standardized operating procedure, standard operating procedure or recommendation. Internal documentation was acquired using a ‘call for guidance’ which was distributed both locally and nationally across healthcare settings. The quality of the guidelines was assessed using the AGREE II tool alongside a thematic analysis of the content. Findings A total of 52 guidance documents were included in the analysis. The quality of the guidance documentation was good for the domains ‘Scope and Purpose’ (70.6%) and ‘...
Problem An unlicensed medicine (ULM) is a product which does not have a marketing authorisation f... more Problem An unlicensed medicine (ULM) is a product which does not have a marketing authorisation from the MHRA. They include Specials, food supplements and imported medicines. Areas that have not been explored include: • How and why prescribers choose to initiate them • How and where pharmacists source them • Patient use and awareness of ULM • Perceptions of use Approach Semi-structured face-to-face interviews were conducted with prescribers (n=11), pharmacists (n=10) and patients (n=7) sampled from both primary and secondary care in the North East of England. Interviews were audio recorded and transcribed verbatim. Grounded theory analysis led to the development of themes and informed the selection of subsequent participants. Findings Several themes were identified across the data by healthcare professionals and patients in primary and secondary care, including: • Healthcare professionals’ awareness of when they were using an ULM and their definition of an ULM • Perceptions of safet...
The 19th century saw the development of an eclectic medical marketplace in both the United Kingdo... more The 19th century saw the development of an eclectic medical marketplace in both the United Kingdom and the United States, with mesmerists, herbalists and hydrotherapists amongst the plethora of medical ‘sectarians’ offering mainstream (or ‘allopathic’) medicine stiff competition. Foremost amongst these competitors were homoeopaths, a group of practitioners who followed Samuel Hahnemann (1982[1810]) in prescribing highly dilute doses of single-drug substances at infrequent intervals according to the ‘law of similars’ (like cures like). The theoretical sophistication of homoeopathy, compared to other medical sectarian systems, alongside its institutional growth after the mid-19th-century cholera epidemics, led to homoeopathy presenting a challenge to allopathy that the latter could not ignore. Whilst the subsequent decline of homoeopathy at the beginning of the 20th century was the result of multiple factors, including developments within medical education, the Progressive movement, a...
The International journal of pharmacy practice, Jan 30, 2018
There is widespread use of unlicensed medicines within primary and secondary care but little info... more There is widespread use of unlicensed medicines within primary and secondary care but little information is available around how these medicines are used. This analysis examines and evaluates the content and quality of relevant guidance documentation currently in use within the UK. Guidance documents were identified through a literature search as well as email requests to pharmacy organisations throughout the UK. Unlicensed medicine documentation suitable for inclusion in the analysis underwent thematic analysis and quality assessment using the AGREE II tool. Thematic analysis of 52 guidelines revealed four parent themes: (1) Professional responsibility (2) Usage practicalities (3) Risk versus benefit (4) Controlling use. There was variability in scores across the AGREE II domains with areas covering Scope and Purpose and Clarity of Presentation scoring well. Conversely, an area needing attention was Rigour of Development. Healthcare organisations would benefit from agreeing a '...
Background There is a growing need to involve patients in the development of patient safety inter... more Background There is a growing need to involve patients in the development of patient safety interventions. Mental health services, despite their strong history of patient involvement, have been slow to develop patient safety interventions, particularly in inpatient settings. Methods A systematic search was undertaken of both academic and grey literature. Whilst no lay member of the team worked directly on the review, they were part of the project steering group which provided oversight throughout the review process. This included people with lived experience of mental health services. From a research perspective the main focus for lay members was in co-producing the digital technology, the key project output. Smits et al.’s (Res Involv Engagem 6:1–30, 2020) Involvement Matrix was used to taxonomise levels of patient involvement. Studies were included if they were set in any inpatient mental health care context regardless of design. The quality of all selected studies was appraised u...
Background: The role of the pharmacist is changing. One example of this is the potential for phar... more Background: The role of the pharmacist is changing. One example of this is the potential for pharmacists in primary care to be involved in the administration and monitoring of cancer patients receiving oral chemotherapy. However, little is known about whether pharmacists feel they have sufficient communication skills training to conduct consultations with cancer patients. Aims: To ascertain undergraduate pharmacy students’ attitudes towards developing the communication skills required to conduct consultations with cancer patients in pharmacy practice. Methods: Qualitative and quantitative methods were used for the study. A questionnaire focusing on the communication skills required to care for cancer patients was administered to all four year groups of an undergraduate pharmacy degree at a United Kingdom School of Pharmacy. Key emerging issues were then explored through a focus group, which were analysed using a thematic content analysis. Results: Several themes emerged from the qua...
Journal of Reproductive and Infant Psychology, 2021
OBJECTIVE To investigate any association between expressions of parents' continuing bond with... more OBJECTIVE To investigate any association between expressions of parents' continuing bond with their stillborn baby and bereavement adaptation. BACKGROUND Continuing bonds theory suggests that bereaved parents adapt to the loss of their child by sharing and transforming mental representations of the child, allowing them to be integrated into parents' everyday lives. Little is known about the mental health benefits of expressing continuing bonds following stillbirth. This study examined any association between aspects of parents' relationship with their stillborn baby, social support for the relationship, and bereavement adaptation. METHODS Cross-sectional questionnaire study. Parents of stillborn babies (N=170) completed an online questionnaire examining engagement in continuing bonds expressions; characteristics of parents' relationship with their stillborn baby and their experience of sharing it; social support, and meaning-making. Measures of mental health were included to quantify bereavement adaptation. RESULTS Regression analyses showed that time since death, meaning-making, engaging with nature, and legacy building are positively linked to bereavement adaptation. Risk factors included inadequate social support for the relationship, a greater desire to share it more freely, an increased sense of integration with baby, and societal pressure to move on. CONCLUSION Key aspects of parents' ongoing relationship with their stillborn baby and the social context are related to bereavement adaptation.
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