Licensing Status Research Articles

Unlicensed "Special" Medicines: Using the Pillar Integration Model to Understand Stakeholder Perspectives Across Care Settings.

The use of unlicensed medicines has been associated with safety concerns, availability and accessibility issues, and lack of integrated care across care settings. To understand the interaction between the views and experiences of those who prescribe, those who supply and those who receive unlicensed "special" medicines, so that factors affecting the patient journey and successful treatment can be identified and used to inform areas for change. A qualitative, phenomenological approach was adopted, with semi-structured interviews with prescribers, community pharmacy staff and patients. A combination of stratified, purposive, snowball and convenience sampling was used to identify participants. Interviews were analysed using reflexive thematic analysis and the findings were integrated using an adapted model of the Pillar Integration Process. Three pillars were constructed after synthesising results from interviews with patients (n=4), prescribers (n=5) and pharmacy staff (n=6): the awareness of licensing status; perceptions of patient care and acceptability of unlicensed medicine use; and challenges associated with the accessibility of unlicensed medicines. The varying levels of awareness when unlicensed medicines are prescribed and the varying perceptions of responsibility and acceptability of the use of unlicensed medicines help to explain the challenges faced by participants across the patient journey, Challenges identified included understanding what unlicensed medicines are, awareness of the licensing status when unlicensed medicines are prescribed, managing care across care settings to ensure the patient is effectively treated and ensuring continuity of care for patients in the community. The results highlight a clear need for more integrated care and support for prescribers to reduce the chances of delays between care settings, and more patient-centred care to ensure that any delays when accessing medicines do not lead to treatment disruption for the patient. The new national guidelines informed by findings of this study can support policy-makers across the globe.

Driving License Management System Using Finger Print Sensors with Seat Belt Monitoring System

The finger print based driving license management is an advanced technology that is designed for security purposes. This system consists of a fingerprint sensor, which is used to identify the status of the driver, whether he/she obtained a license or not. This is a very highly secured system. The driver's fingerprint is already stored in the system for comparison purposes. Nowadays, accidents are increasing day by day. In the recent days minor people are driving the vehicles without the license; this may cause future accidents. In order to conquer this, we proposed this system. This system not only checks the license status, and here a further IR sensor is used to check whether the seat belt wore or not. By using this system, there are tremendous advantages, like accidents will be reduced, high security, and reduced vehicle theft. Keywords: Finger print sensor, microcontroller, and IR sensor.

Fine Motor Impairment and Its Impact on Social Outcomes in Survivors of Pediatric Acute Lymphoblastic Leukemia: St. Jude Lifetime Cohort Study.

The impact of fine motor impairment among adult survivors of childhood acute lymphoblastic leukemia (ALL) on life after treatment is unknown. This study evaluated prevalence and utilized multivariate logistic regression to identify risk factors for fine motor impairment among survivors of ALL, and associations with educational attainment and social independence. Latent class analysis defined social independence (independent, moderately independent, dependent), using employment, independent living, personal care assistance, routine need assistance, driver's license status, and marital status inputs. Among 875 survivors who were ≥ 25years old (age when most adults achieve independence) and ≥ 5years from diagnosis (mean = 28.97years), 33.6% had fine motor impairment, with scores at or below the 10th percentile of the scores of community controls (n = 460) on fine motor components of the physical performance test and the grooved peg-board test. Survivors exposed to cranial radiation had more fine motor impairment than those without (45.8% vs 20.2%). Male sex (exposed: odds ratio [OR] = 2.55, 95% confidence interval [CI] = 1.65-3.92; unexposed: OR = 3.02, 95% CI = 1.69-5.38) and lower scores on the Wechsler abbreviated scale of intelligence (exposed: OR = 0.46, 95% CI = 0.36-0.58; unexposed: OR = 0.43, 95% CI = 0.31-0.58) were risk factors for neuropathy. A 1-point-higher total neuropathy score was associated with 8% (95% CI = 1%-17%) increased odds of fine motor impairment. Fine motor impairment was associated with less than a college education (less than high school: OR = 2.23, 95% CI = 1.20-4.14; high school diploma/general equivalency diploma: OR = 2.66, 95% CI = 1.65-4.30; vocational education: OR = 2.07, 95% CI = 1.38-3.13) and less social independence (moderately independent: OR = 1.80, 95% CI = 1.15-2.83; dependent: OR = 2.65, 95% CI = 1.25-5.64). Fine motor impairment in survivors of childhood ALL may interfere with optimal educational attainment and social independence. Early identification of survivors at risk for fine motor impairment, with timely intervention, may improve long-term outcomes.

Current Status of Licensing and Education of Acupuncture and Moxibustion for Physicians and Acupuncturists/Moxibustionists in Japan

Current Status of Licensing and Education of Acupuncture and Moxibustion for Physicians and Acupuncturists/Moxibustionists in Japan

Firearm Injuries in Children: Four-year Experience from a Rural Tertiary Care Centre of Northern India.

Firearm injuries (FAIs) continue to be a global public health problem possessing substantial emotional, physical and financial burdens on hospital resources. Although FAIs are rare in children, their incidence is gradually increasing. The aim of this study was to evaluate various aspects of FAI in children that were managed at a tertiary care centre located in the rural part of India. This clinical observational study of children <18 years of age, all due to FAI, was conducted at a tertiary care centre located in the rural part of India. Data of all children admitted with FAI over 4 years from January 2016 to December 2019 were collected. Recorded data included age, sex, motive (intentional/unintentional) and circumstances leading to injury, type and license status of firearm used, time of injury, pre-hospital care, mode of transport to hospital, duration between injury and arrival to hospital, body parts and organs injured, trauma scores, management, complications, length of hospital stay and outcomes. The recorded data were entered into a worksheet and analysed. Out of 283 cases of FAI admitted, only 24 were children with age <18 years (8.48%). The mean age was 12.66 years (male:female = 2.4:1). Sixteen were intentional (66.67%) and eight were unintentional (33.33%). The family feud was the most common reason in case of intentional FAI (43.75%), and mishandling was the most common reason in case of unintentional FAI. Country made gun was the most common firearm used (62.5%). The chest and upper back were the most common sites of injury (54.16%). Intercostal drainage tube insertion was the most common surgical procedure performed (33.33%). There were three mortalities (12.5%). The present study found that intentional FAIs in children were more common than unintentional FAIs with family feuds and mishandling being the most common causes, respectively. The unlicensed country-made gun was the most common firearm causing injury in children.

Correlation between organizational support, self-efficacy, and core competencies among long-term care assistants: a structural equation model.

Long-term care assistants are taking on more important roles in the healthcare system. The purpose of this study was to investigate what demographic factors influence the core competencies of nursing assistants, as well as to investigate the levels of organizational support, self-efficacy, and core competencies among nursing assistants in China, to explore the relationship between them. This is a cross-sectional study with prospective data collection based on a self-report questionnaire. A total of 320 long-term care assistants from two healthcare institutions. We collected socio-demographic characteristics and measured their perceived organizational support, self-efficacy, and core competency levels of the participants. Pearson correlation tests were conducted to examine the relationships among three variables, and a structural equation model was developed to test the interrelationships among these variables. The results indicated that age, employment type, licensing status, monthly income, pre-job training, and training methods were associated with core competency, with nursing knowledge identified as a weak area in core competencies. There were significant associations among each dimension of perceived organizational support, self-efficacy, and core competencies (p < 0.01). The structural equation model demonstrated good fit: X 2/df = 2.486, GFI = 0.974, CFI = 0.988, IFI = 0.988, TLI = 0.977, RMSEA = 0.068, SRMR = 0.013. The direct effect of organizational support on core competencies was 0.37, with self-efficacy mediating the relationship between organizational support and core competencies, yielding an indirect effect of 0.122 and a total effect coefficient of 0.492 (all p < 0.001). Training in core competencies should prioritize nursing knowledge. Enhanced perceived organizational support and self-efficacy among nursing assistants were associated with higher core competencies.

Epidemiological profile of polytrauma victims attended in a basic care hospital in the South of Brazil: retrospective cross-sectional study

Background: In the scope of public health, it is fundamental to comprehend the patterns and characteristics of the patients attended in hospitals for the guidance about prevention and intervention policies. In this perspective, the present study aims to evaluate the epidemiological profile of polytrauma victims who were assisted in a basic care hospital, located in the interior of Rio Grande do Sul, Brazil, during the period of January 1st to December 31th of 2022. The importance of studying the mechanism of trauma lies in the fact that it is the main cause of fatality in the population between 1 and 44 years old and represents a total of 5.8 million deaths annually in Brazil. Methods: The methodology consists of a retrospective cross-sectional study based on the analysis of hospital records, identifying patterns of gender, age, type of injury, modes of damage and outcome of the attended patients. Results: Based on the data collected, it was observed a predominance of the male gender among the polytrauma victims, with a significant incidence of assistance resulting from motor vehicle collisions, corroborating with previous epidemiological evidence. Conclusion: The epidemiological profile of polytraumatized patients is male, aged 41 and victims of traffic accidents. Therefore, urges the need to develop preventive and interventionist measures in relation to the causal factors of polytrauma, such as road infrastructure and alcohol use. In addition, the study was limited by the fact that it did not investigate the use of alcohol by the drivers, and the license status.

Quality of Essential Medicines from Different Sources in Enugu and Anambra, Nigeria.

This study investigated the quality of 13 essential medicines in the states of Enugu and Anambra, Nigeria. A total of 260 samples were purchased from licensed pharmaceutical manufacturers and wholesalers and from vendors in pharmaceutical markets with unclear licensing status. Samples were analyzed for identity, content, and dissolution according to the United States Pharmacopeia (USP) 42 monographs. Forty-five samples of this study could be examined for authenticity with the Mobile Authentication Service scheme of the Nigerian National Agency for Food and Drug Administration and Control. Out of all samples, 25.4% did not comply with the USP 42 specifications. Strikingly, 21 out of 22 dexamethasone tablet samples (95%) were out of specification (OOS). Nine out of 19 glibenclamide samples (47%) failed dissolution testing, and 7 out of 17 cotrimoxazole samples (41%) failed assay testing. Medicines against noncommunicable diseases showed a slightly higher percentage of OOS samples than anti-infectives (21.2% versus 17.6%). The rates of OOS samples were similar in medicines stated to be produced in Nigeria, India, and China but were very different between individual manufacturers from each of these countries of origin. Therefore, prequalification of products, manufacturers, and suppliers are very important for quality assurance in medicine procurement. Unexpectedly, the total proportions of OOS samples were similar from licensed vendors (25.2%) and from markets (25.5%). Four samples (1.5%), all collected in markets, were clearly falsified and did not contain the declared active pharmaceutical ingredients. The proportion of falsified medicines was found to be lower than frequently reported in the media for Nigeria.

Health care managers' perspectives on workforce licensing practice in Ethiopia: A qualitative study.

Professional licensing bodies are valuable sources for tracking the health workforce, as many skilled health-care providers require formal training, registration, and licensure. Regulatory activities in Ethiopia were not effectively implemented due to poor follow-up and gaps in skilled human resources, budget, and information technology infrastructure. The aim of this study was to explore and describe the lived experiences and challenges faced by health care managers in health professionals' licensure practices in Ethiopia. A cross-sectional study design with a phenomenological approach was employed between March 26 and April 30, 2021, to collect qualitative data. We conducted in-depth interviews with a total of 32 purposively selected health system managers. An interview guide was prepared in English, translated into Amharic, and then pretested. Audio recorded data was transcribed verbatim, translated, and analysed manually by themes and sub-themes. A member check was done to check the credibility of the result. The data revealed four major themes: awareness of licensing practices, enforcement of licensing practices, systems for assuring the quality of licensing practices, and challenges to licensing practices. Lack of awareness among managers about health workforce licensing was reported, especially at lower-level employers. Regulators were clear on the requirements to issue a licence to the health workforce if they are competent in the licensing exam, while human resource managers do not emphasise whether the employees have a licence or not during employment. As a result of this, non-licenced health workers were employed. Health care managers mentioned that they did not know any monitoring tools to solve the issue of working without a licence. Fraudulent academic credentials, shortage of resources (human resources, finance, equipment, and supplies), and weak follow-up and coordination systems were identified as main practice challenges. This study reported a suboptimal health professionals' licensing practice in Ethiopia, which is against the laws and proclamations of the country that state to employ all health workers only with professional licenses. Challenges for health professionals' licensing practice were identified as fraudulent academic credentials, a shortage of resources (HR, finance, equipment, and supplies), and a weak follow-up and coordination system. Further awareness of licensing practices should be created, especially for lower-level employers. Regulators shall establish a reliable digital system to consistently assure the quality of licensing practices. Health care managers must implement mechanisms to regularly monitor the licensing status of their employees and ensure that government requirements are met. Collaboration and regular communication between regulators and employers can improve quality practices.

Mixed methods evaluation of a jail diversion program: Impact on arrests and functioning.

This mixed methods study had two aims: (1) to examine the effectiveness of a jail diversion program in reducing recidivism and promoting educational and employment outcomes; and (2) to qualitatively explore mechanisms through which the program was effective. Participants were 17 individuals arrested for drug offenses who participated in an intensive, law enforcement-based jail diversion program, and 17 individuals in a comparison group. Arrests were extracted from police records, and education and employment were extracted from program data. Four intervention participants completed qualitative interviews. Arrest rates in the intervention group decreased significantly postintervention, and arrest rates in the intervention group were numerically lower than those in the comparison group. Participants experienced significant increases in employment and driver's license status. Participants also identified mechanisms through which the program was effective. This jail diversion program shows promise in reducing recidivism and promoting adaptive functioning. Jail diversion programs that include mentorship, peer support, and removal of barriers to success may be particularly effective.

Correlates of Bird Collection Compositions in Thai Zoos: Implications for Conservation and Management

Zoo collection management is increasingly driven by meeting global conservation needs. Many avian species have experienced population declines throughout Southeast Asia, underscoring the importance of ex situ conservation in these countries. We focus on Thailand, a bird diversity hotspot with a long tradition of keeping birds in captive settings. We aimed to understand what drives species acquisition and maintenance in Thai zoos. To that end, we surveyed 55 zoos, making a complete inventory of reptiles, birds, and mammals on display. We recorded 249 bird species, of which 149 are not native to Thailand. Bird species diversity was positively correlated with mammal species diversity but not with the entry ticket price, the Gross Domestic Product of the province in which the zoo was based, or the size of the zoo. Diversity did differ significantly between zoo types (accredited, government and private zoos). There was a clear difference in the proportion of native and non-native species between zoos, with private zoos containing the highest number of non-native species, which may be related to the licensing status of these zoos. The composition of bird species in Thai zoos appears to be largely driven by their availability, the legal status for keeping them and serendipity. The conservation status seems to be of minor importance, contradicting the typical role of a zoo. To be considered global conservation players, zoos in countries of high species diversity, such as Thailand, have the unique opportunity to provide breeding programmes for some of the rarest species, yet they must improve their collection management plans to focus on such aims.

Fall risk prediction ability in rehabilitation professionals: structural equation modeling using time pressure test data for Kiken-Yochi Training.

Falls occur frequently during rehabilitation for people with disabilities. Fall risk prediction ability (FRPA) is necessary to prevent falls and provide safe, high-quality programs. In Japan, Kiken Yochi Training (KYT) has been introduced to provide training to improve this ability. Time Pressure-KYT (TP-KYT) is an FRPA measurement specific to fall risks faced by rehabilitation professionals. However, it is unclear which FRPA factors are measured by the TP-KYT; as this score reflects clinical experience, a model can be hypothesized where differences between rehabilitation professionals (licensed) and students (not licensed) can be measured by this tool. To identify the FRPA factors included in the TP-KYT and verify the FRPA factor model based the participants' license status. A total of 402 participants, with 184 rehabilitation professionals (physical and occupational therapists) working in 12 medical facilities and three nursing homes, and 218 rehabilitation students (physical and occupational therapy students) from two schools participated in this study. Participant characteristics (age, gender, job role, and years of experience and education) and TP-KYT scores were collected. The 24 TP-KYT items were qualitatively analyzed using an inductive approach based on content, and FRPA factors were extracted. Next, the correction score (acquisition score/full score: 0-1) was calculated for each extracted factor, and an observation variable for the job role (rehabilitation professional = 1, rehabilitation student = 0) was set. To verify the FRPA factors associated with having or not having a rehabilitation professional license, FRPA as a latent variable and the correction score of factors as an observed variable were set, and structural equation modeling was performed by drawing a path from the job role to FRPA. The results of the qualitative analysis aggregated patient ability (PA), physical environment (PE), and human environment (HE) as factors. The standardized coefficients of the model for participants with or without a rehabilitation professional license and FRPA were 0.85 (p<0.001) for FRPA from job role, 0.58 for PA, 0.64 for PE, and 0.46 for HE from FRPA to each factor (p<0.001). The model showed a good fit, with root mean square error of approximation < 0.001, goodness of fit index (GFI) = 0.998, and adjusted GFI = 0.990. Of the three factors, PA and PE were common components of clinical practice guidelines for fall risk assessment, while HE was a distinctive component. The model's goodness of fit, which comprised three FRPA factors based on whether participants did or did not have rehabilitation professional licenses, was good. The system suggested that rehabilitation professionals had a higher FRPA than students, comprising three factors. To provide safe and high-quality rehabilitation for patients, professional training to increase FRPA should incorporate the three factors into program content.

Examination of Sportsmanship Behaviours of Physical Education And Sports Course on Students

The study group of the research consisted of 260 students, 143 females and 117 males, who voluntarily participated in the study and were attending Düzce Konuralp Middle School. The "Physical Education Class Sportsmanship Behavior Scale (PEC-SBS)" developed by Koç (2013) was used in the study. The scale is a 22-item 5-point Likert scale with two sub-dimensions: exhibiting appropriate behavior and avoiding inappropriate behavior. The effect of Physical Education and Sports classes on students' sportsmanship behaviors was examined in terms of some variables within the scope of the research. The obtained data was analyzed using the SPSS 20.0 package program. Although the normality test result showed that the data was not normally distributed, parametric tests were applied because the data had values between -1 and +1 according to the Kurtosis-Skewness test. ANOVA test was used for three or more variables, and the t-test was used for binary variables in the analysis. According to the results of the statistical analysis, significant differences were found in both sub-dimensions according to the Class variable, and in terms of gender, significant differences were found in the sub-dimensions. However, no significant difference was found in General Sportsmanship Behaviors. In terms of athlete license status variable, no statistically significant difference was observed in General Sportsmanship Behaviors. In terms of the variable of following sports channels, statistically significant differences were found in favor of those who answered "Yes" in both the Avoiding Inappropriate Behaviors sub-dimension and the General Sportsmanship Behaviors. In conclusion, it can be said that Physical Education and Sports class generally have a positive impact on middle school students' sportsmanship behaviors and are an important tool in helping them learn about the concept of sportsmanship

HPR79 Analysis of Newly FDA Approved Medicines and the Licensing Status By Titck in Turkiye

HPR79 Analysis of Newly FDA Approved Medicines and the Licensing Status By Titck in Turkiye

Examining the Driving Habits of Older Canadians as Captured by the COMPASS‐ND Study

AbstractBackgroundDriving is associated with a sense of autonomy and good quality of life in older adults. However, older adults often change their driving habits, such as regulating how often, how far, and under what conditions (e.g., time of day, weather) they drive, in part due to changes in cognition. Our study describes data from the first large‐scale Canadian cohort study to investigate differences in driving habits across cognitive groups, including cognitively healthy older adults (control), Subjective Cognitive Decline (SCD), Mild Cognitive Impairment (MCI), and Alzheimer’s Disease (AD).MethodWe analyzed data from the Comprehensive Assessment of Neurodegeneration and Dementia study (COMPASS‐ND, Chertkow et al., 2019), a population‐based study of Canadians with various cognitive and functional abilities (May 2021 Data Release). The final sample analyzed included 317 participants (55% Females, Meanage = ∼72). We report the responses for the following driving‐related questions: licensing status (no longer have license, drive with or without restrictions), driving frequency, driving distance, and driving restrictions (e.g., bad weather).ResultMost participants across all groups reported that they have a driver’s license without restrictions, including the AD group (AD: ∼61%, remaining groups: &gt;90%). The following analyses only included current drivers. In terms of the frequency of driving and the distance travelled, as expected, the AD group drove the least often and the shortest distances. The most frequent restriction types selected by all groups were bad weather and nighttime driving. The number of restriction types increased with the severity of cognitive decline. Interestingly, driving restrictions reported by the SCD group more closely approximated the cognitively impaired groups (MCI and AD) than the control group.ConclusionAlthough many of the AD group participants still had a license, they also reported the greatest number of driving restrictions. Further, the SCD group and MCI group were quite similar in their responses for several items, indicating that even SCD may be associated with differences in driving habits. Implications of driving‐related limitations include reduced independence, socialization, participation, and access to resources (e.g., medical care, groceries).

Associations Between State Practice Regulations and Access to Midwifery Care.

This study aimed to identify associations between state policies and access to midwifery care. Identifying policies that facilitate increased access to midwives will help policymakers determine the best methods for increasing access to midwives in their states. This cross-sectional study was conducted at the county level as a secondary analysis of National Vital Statistics data from the Natality online database. The unit of analysis was counties with populations of at least 100,000, and the outcome was the proportion of births attended by midwives in 2019. The potential predictors of increased access to midwifery care were independent midwife licensure, independent midwife prescribing, midwife access to hospital medical staff membership, and midwife Medicaid parity. Medicaid provider resources and state statutes verified Medicaid reimbursement rates and eligibility for hospital medical staff privileges. Each state was categorized as an independent or restricted licensure state according to data from the American College of Nurse-Midwives. Data for the control variable, the presence of a midwifery education program, were gathered from the Accreditation Commission for Midwifery Education. The analysis was conducted as a Poisson regression. There was no association between independent licensing and increased access among all states. Stratifying the analysis by independent licensing law revealed that all but one policy was related to higher rates of midwife attendance at birth. Maximum Medicaid reimbursement correlated with greater access regardless of licensing status. The rate of midwife-attended births in independent licensing states grew as the number of potential predictors in a county increased. Regulatory policies beyond independent licensing are associated with women's access to midwifery services. In independent licensing states, adopting additional policies favorable to midwives may strengthen access to midwifery. Policymakers and regulators can use these findings to identify strategies for accelerating the expansion of midwifery access in their states.

Labour market impacts of occupational licensing and delicensing: New evidence from China

AbstractWe examined the recent occupational regulation changes in China and their labour market impacts. Using data from the China Labor‐Force Dynamic Survey from 2014 to 2018, we found an earning premium of approximately 10 per cent, as well as more employment‐based benefits, for those with an occupational license compared to those without one. Licensed workers reported higher skill‐job task match than unlicensed workers. Our data cover the period of occupational regulation reform in China, when 70 per cent of occupations previously licensed or certified were deregulated. Over this period, the licensing status remained associated with positive earning and employment benefits premiums, and better skill‐job task match at the labour market level. However, delicensing led to a distributional shift in the earning dispersion, especially at the bottom of the earning distribution; earning premiums rose sharply for the 10th to 30th percentiles. Workers directly affected by the licensing reform reported a significant decrease in employment benefits and in subjective job quality measures (i.e. skill‐job task match and voice at work) after delicensing, relative to never‐licensed workers. We suggest that non‐wage compensation is lost in the short term because the signal of competency is no longer valued by employers after delicensing.

Intention to use private autonomous vehicles in developed and developing countries: What are the differences among the influential factors, mediators, and moderators?

This paper investigates the intention to use private autonomous vehicles (PAVs) in developed (i.e., the United States, Belgium, the United Kingdom, Italy, Portugal, and Hungary) and developing countries (i.e., Egypt, Iraq, Jordan, Lebanon, and Saudi Arabia). Self-efficacy, the attitude toward using PAV technology, and the trust in PAV constructs are integrated into an extended Unified Theory of Acceptance and Use of Technology (UTAUT2) model to increase the understanding of users’ perceptions of PAVs in developed and developing countries. The results of partial least squares structural equation modeling show the attitude toward using PAV technology to be the strongest predictor of the intention to use PAVs in developed and developing countries. Performance expectancy and trust in PAV are the strongest predictors of attitude toward using PAV technology in developed and developing countries, respectively. Effort-related constructs (i.e., effort expectancy and self-efficacy) do not directly affect the behavioral intention of the respondents from the developed countries while significantly affecting the behavioral intention of the respondents from the developing countries. The results of the mediation analysis show that the relationship between effort expectancy and behavioral intention is fully mediated by the attitude toward using PAV technology and performance expectancy for the respondents of the developed countries. Furthermore, the results of the multi-group moderation analysis show the relationship between performance expectancy and behavioral intention as well as social influence and the trust in PAV is not moderated by any of the moderators (i.e., age, gender, educational level, employment status, income level, car ownership status, and driving license status), neither for the developed countries nor for the developing countries.

SP3 Optimising prescribing of medicines to children by formulary interface pharmacists

ContextUnlicensed and off label drug use in children is common and leads to well recognised problems. It has been shown that there is an association between unlicensed drug use in children and particularly neonates, and increased risks of medication errors, due to prescribing, dispensing and administration.1Alongside this, the variation in strengths of oral liquid products, adds to the potential for harm to be caused to children due to a lack of awareness and education on these issues.Quality improvement initiativeA UK CCG funded two specialist paediatric pharmacist posts with the aim of rationalising, standardising, and optimising the prescribing of unlicensed medicines to children. The aim was that these pharmacists would create an interface link between primary and secondary care, to empower healthcare professionals to prescribe and supply medicines to children safely and effectively.Work undertaken ePACT2 prescribing data highlighting variation in strength, formulation and cost of unlicensed medicines supplied; feedback from colleagues across all sectors of healthcare; NPPG position statements and MHRA alerts were used to identify areas to focus interventions. Examples of the work undertaken includes:Led webinars on prescribing medicines to children to healthcare professionals across the CCGMet with ~70% of GP practices, either individually or as groups e.g. PCNs across the CCGInitiated standardisation of liquid strengths kept across 3 hospital trust and primary careIdentified areas for medication safety team work e.g. prescribing of multiple strengths of medicines to children, prescribing of alcohol–containing phenobarbital to childrenWorked with CCG Medication Safety Officers to provide a response, advice and information on MHRA alerts e.g. chloral hydrate prescribing to childrenWorked with medicines optimisation CCG teams on communication tools e.g. bulletinsCreated a paediatric guidelines and pathways section on the CCG webpageCreated a paediatric formulary pharmacist group with representatives across all 3 hospital trusts to meet monthly and foster collaborative working.Measure of improvementThrough regular feedback, meetings, and email communication it can be noted that the links between primary and secondary care have been strengthened. Praise has been received for the help and support provided and for the openness to amend and adjust work plans based on the priorities and needs of the CCG. Through monthly ePACT2 data in the form of excel specials dashboard the reduction in variation of strengths being supplied to children can be seen, with in most cases an accompanying reduction in spend.Lessons learnedAlthough much has been publicised on the importance of nationally standardising concentrations of liquid medicines2, this initiative has shown that there is still much work to be done. Dedicated pharmacists have been able to make progress in standardising the range of unlicensed medicines recommended in the local formulary and ensure that this is well communicated across both primary and secondary care. Interface links between care settings are vital if we are to achieve substantial harmonisation of medicines prescribed to children.ReferencesConroy S. Association between licence status and medication errors.Arch Dis Child2011;96:305-306.Rawlence E,et al. Is the provision of paediatric oral liquid unlicensed medicines safe?Arch Dis Child Educ Pract Ed.2018;103:310-3.

Application of the Theory of Planned Behavior to the Analysis of Variations in Attitudes toward Exclusive Motorcycle Lanes

The purpose of this paper was to test the differences in attitudes influencing motorcyclists' behavioural expressions of motorcycle lane use as classified by demographic data and attitude factors from an application of the Theory of Planned Behaviour (TPB) comprised of four factors: Attitude toward use, Subjective norms, perceived behavior control, and Behaviour intention. A questionnaire study of 1,004 motorcyclists in Nakhon Ratchasima province was conducted. Independent t-tests, One-Way ANOVA were used to analyze differences between motorcyclists' demographic data and components in the Theory of Planned Behavior. The findings revealed that different age groups and income levels had significantly different effects on perceived behavior control and behavior intention to use motorcycle lanes. While there were considerable differences in indications of attitude toward use and perceived norms across educational levels. Furthermore, perceived behavior control and behavior intention differed significantly across urban and rural areas, including driver's license status. Differences in location zone subjective norms, as well as attitudes toward the use of different driver's license statuses