Diabetes and mental illness are clinically managed by diverse pathways. However, an association between the two has been observed and evidence is growing that when poorly addressed, therapy adherence is low and outcomes are poor. To date, no intervention has been shown to provide sustained improvements in adherence, outcome, quality of life or provider cost savings. This literature review was undertaken as a foundation to a research project to examine whether there is an opportunity for current independent prescriber pharmacists, with or without further training, could as part of a primary care team, contribute their expertise to achieving better and sustainable outcomes for these conditions, where current treatment models are heavily medication-dependent. It reinforces the idea that these conditions are interlinked but by poorly understood mechanisms and suggests that a new approach is required in order to improve outcomes for this complex patient group.

Objective: Over 8.2 million people were affected by anxiety in the UK in 2013 and it is currently the world has most experienced mental health disorder. Previous research has indicated that a rising level of anxiety in higher education students is resulting in decreased academic success and progress. This research explores student’s perceptions of whether anxiety levels change throughout their course, whether it improves or worsens from the first year to the final year in the course and its effect on academic achievements. Methods: A survey-based approach was taken with questionnaires handed out to students in their 4th year of the MPharm programme at the University of Wolverhampton. Results: Fifty completed questionnaires were analysed by age, gender and ethnicity in order to identify patterns and trends. The results were in conformity with previous research findings that anxiety severity increases through education years and it is affecting educational performance and progress. There were68% of all students who participated stated they were currently experiencing anxiety and 86% of those stating their anxiety was now worse than it was in their sixth form years. On average, participants chose a minimum of four factors that triggered anxious episodes; 36% of participants stated that anxiety affected their grades all of the time and 44% were affected during written exams only. Conclusion: This study suggests further research into anxiety is needed to address this growing phenomenon and mechanisms are needed in order to accommodate the needs of students who are affected.

Objective: Pharmaceutical calculations are an essential aspect of learning for pharmacy students in order to avoid drug dose errors and maintain patient safety in future practice. Learning styles influence how lecturers approach the teaching-learning process. So far no specific learning preference is believed to be most appropriate for the pharmacy curricular; however certain learning styles are favoured by students as they improve their understanding of course material, knowledge and performance. Methods: 148Master of pharmacy participants from the second and third year were given a questionnaire to complete during a compulsory Individual Readiness Assurance Test session. Participants were restricted to just one option. Results: Workshops with a tutor was the most selected (36%) followed by 25% of participants favouring formative assessments, 28% selected workbooks alone, 37% for whole-class lecturers and videos option was the least selected. Reasons for the most and least preferred learning styles were highlighted and separated into advantages and disadvantages using themes. In the knowledge test; 92% of participants selected “unsure” or “didn’t know” the answer, 29% had a partially correct answer and 19% selected incorrect answers. The overall order of ranking arose in regards to the most beneficial learning style which enhances performance. The responses revealed a variety of advantages and disadvantages which were reflected between year groups and similar to views obtained from recent literature. Students reflected a lack of understanding on extemporaneous preparation (EPs) terms used in pharmaceutical compounding practices, thus the university should consider addressing the lack of awareness and consider the best teaching-learning style in doing so. Conclusion: Overall the findings suggested that the sample students have similar views on the learning styles used to deliver pharmaceutical calculations on their academic performance to that expressed by the authors from recent published literature.

Objective: It is commonly reported that medicines have side effects related to dermatological practice. However, it is extremely difficult to establish how commonly, or rarely skin-related medication side effects occur. Common dermatological side effects include rash, pruritus, and photosensitivity. Objective: To demonstrate the dermatological side-effects of the most commonly prescribed medications in the United Kingdom. Methods: This paper discusses dermatological side-effects of the commonly prescribed medications, including uncommon or rare manifestations such as angioedema and Stevens - Johnson syndrome (SJS). The list used for the most frequently prescribed drugs in the United Kingdom was created by nurses. This list was compared to the British National Formulary to demonstrate the reported frequency of occurrence of dermatological side-effects or complications. Conclusion: The top 100 prescribed medication cause a number of dermatological side effects that need to be considered when they are prescribed to patients who have pre-existing skin conditions. Additionally, when confronted with a common dermatological problem in any patient, clinicians should always consider the possibility of a drug adverse reaction.

<jats:p>Objective: Stress, depression and anxiety are common, estimated at 19.7% people showing symptoms of these diseases. Although, effective treatment for depression and anxiety is available, they are still under diagnosed and treated to avoid stigma.&#x0D; The study aims to explore the impact of pharmacist-led health promotion to increase the university local population awareness about stress, the causes and management.&#x0D; Methods: A questionnaire-based study which included 50 participants aged 18 and over from the University of Wolverhampton.&#x0D; Results: The findings revealed that stress has an impact on the individuals’ lives, but they understood the effects of stress. The results informed the different factors that cause stress amongst the participants of multiple demographics.&#x0D; Conclusion: Change is required to improve the mental well-being of the public. This study improved the University of Wolverhampton’s student’s knowledge and awareness of mental health. It provides in-depth knowledge for a future pharmacist to learn about stress management to help patients with more advanced services given in community pharmacies. Expanding knowledge within this area could assist millions of affected people to seek help.</jats:p>

Objective: Anecdotal evidence suggested that antibiotics are frequently used in the Emergency Treatment Units in Sri Lanka, mostly for the respiratory tract, soft tissue or urinary tract infections. This study aimed to describe the utilization patterns of antibiotics in terms of most common type, indication and associated direct cost in ETU at the Teaching Hospital Karapitiya, Sri Lanka. Methods: In this study, utilization patterns and the direct cost of antibiotics in an emergency treatment unit was evaluated by checking the bed-head tickets of all patients admitted to the unit from 1/5/16 to 15/5/16. Out of the 414 bed-head tickets checked 156 patients were receiving antibiotic treatment. Socio-demographic characteristics were analyzed. The prices of antibiotics in SriLankan government hospitals were taken from the hospital medical supply division price list. Data were analyzed by Microsoft Excel™. Results: In this study, 45.5% (out of 156 patients) were aged between 61-80years. The most used antibiotic was amoxicillin/clavulanic acid (18.1%) and clarithromycin (15.5%). Generic antibiotics were used for most patients (95.58%). Fixed-dose combinations were used in 18.5% of cases, including amoxicillin/clavulanic acid and piperacillin/tazobactam. The common indications for prescribing antibiotics were respiratory tract infections (31.2%) and soft tissues injuries (12.1%). Conclusion: This study revealed that there is apparent overuse of antibiotics and reveals that antibiotic stewardship programme could reduce antibiotic use, antibiotic resistance, and cost. Improved understanding of the rationale for antibiotic use would contribute optimising their use. Further studies are needed to establish the extent of sub-optimal prescribing of antibiotics in Sri Lankan hospitals.

Cytokines play an essential role in normal cell growth and the regulation of immune function. The emergence of Janus Kinase Enzyme inhibitors promises the start of a revolution in the treatment of several chronic diseases. Their efficacy and safety profile have been demonstrated in multiple trials and they have been licensed for the treatment of a number of diseases including RA and PsA. Moreover, the use of highly selective Janus Kinase Enzyme inhibitors is currently being studied aiming to reduce side effects compared with traditional JAKinibs, an example of that would be the recent FDA approved upadacitinib. The Janus Kinase Enzyme inhibitorsmay supplant the classical biologic agents in the treatment of autoimmune diseases, since they exhibitthe advantages of oral administration, simultaneous blockade of multiple cytokines, reversibility and the lack of immunogenicity.

<jats:p>This review aims to understand the co-existence of mental ill-health and heart failure and if this comorbidity affects patient self-care motivation and overall health outcomes. Databases searched were; PubMed®, Google® scholar and Science Direct® for studies related to heart failure, heart failure and mental health, depression and anxiety. Eleven articles were identified and reviewed. There were two studies disagreed with the theory that the mental ill-health and heart failure has disease modification and worsen patient health outcomes, three studies concluded that only anxiety has effect, five studies concluded that both anxiety and depression have effect, six studies concluded that depression only has effect but all eleven stated that more research is required. Recent theories on depression and cardiovascular disease comorbidity and the effect mental ill-health have on medication adherence in heart failure patients was discussed. People with long-term physical illnesses may suffer further complications to their health if they develop mental illness; increasing the cost of their care by an average of 45%, however, in the majority of these cases, the mental issues neither diagnosed nor treated. This review explored the link between cardiovascular disease (CVD) and mental ill health; and how comorbidity of the two conditions affects patients’ adherence to therapy behaviour. It was concluded that while the link between mental ill health and heart failure (HF) is recognized, studies that may be used as a basis of evidence to confirm this link are scarce.</jats:p>