Our objective was to identify and establish consensus on the most important safety features of GP computer systems, with a particular emphasis on medicines management. We used a two-round electronic Delphi survey, completed by a 21-member multidisciplinary expert panel, all from the UK. The main outcome measure was percentage agreement of the panel members on the importance of the presence of a number of different safety features (presented as clinical statements) on GP computer systems. We found 90% or greater agreement on the importance of 32 (58%) statements. These statements, indicating issues considered to be of considerable importance (rated as important or very important), related to: computerised alerts; the need to avoid spurious alerts; making it difficult to override critical alerts; having audit trails of such overrides; support for safe repeat prescribing; effective computer-user interface; importance of call and recall management; and the need to be able to run safety reports. The high level of agreement among the expert panel members indicates clear themes and priorities that need to be addressed in any further improvement of safety features in primary care computing systems.

Objective The present parallel randomised control trial evaluated the feasibility of a nurse‐led psycho‐educational intervention aimed at improving the self‐management of prostate cancer survivors. Methods We identified 305 eligible patients from a district general hospital, diagnosed 9–48 months previously, who completed radical treatment, or were monitored clinically (ineligible for treatment). Ninety‐five patients were recruited by blinded selection and randomised to Intervention (N = 48) and Control (N = 47) groups. Participant allocation was revealed to patients and researchers after recruitment was completed. For 36 weeks, participants received augmented usual care (Control) or augmented usual care and additional nurse support (Intervention) provided in two community hospitals and a university clinic, or by telephone. Results Data from 91 participants (Intervention, N = 45; Control, N = 46) were analysed. All feasibility metrics met predefined targets: recruitment rate (31.15%; 95% CI: 25.95%–36.35%), attrition rate (9.47%; 95% CI: 3.58%–15.36%) and outcome measures completion rates (77%–92%). Forty‐five patients received the intervention, with no adverse events. The Extended Prostate Cancer Index Composite can inform the minimum sample size for a future effectiveness trial. The net intervention cost was £317 per patient. Conclusions The results supported the feasibility and acceptability of the intervention, suggesting that it should be evaluated in a fully powered trial to assess its effectiveness and cost‐effectiveness.

Objective. To assess the prevalence of chronic postvasectomy testicular pain (CPTP) IntroductionChronic testicular pain after vasectomy is a recognised complication, with a reported incidence ranging from 0.9% to 54%. 1 Davies et al. 2 defined it as an intermittent or constant, unilateral or bilateral testicular pain, 3 months or longer in duration, which significantly interfered with the daily activities of the patient so as to prompt him to seek medical attention. McMahon et al. 3 in a postal questionnaire and telephone follow-up of 172 patients (68% response rate), 4 years after vasectomy, reported chronic testicular discomfort in 33% of patients, considered by 15% to be troublesome, but only nine of their patients had experienced pain severe enough to seek further medical help.Choe and Kirkemo 1 reported a 39% response rate (182/470) to a postal retrospective survey of postvasectomy patients. Chronic post-vasectomy testicular pain (CPTP) was shown to be the most common late complication, occurring in 18.7% (34 patients).In a review 4 concerning medico-legal aspects of fertility regulation, the prevalence of CPTP or scrotal pain was quoted to be as high as 30%, whereas in an earlier followup of 16 000 post-vasectomy patients regarding complication, no reference was made to chronic testicular pains. 5 Guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG) 6 gave chronic testicular pain a grade C recommendation in vasectomy counselling, meaning that in relation to the available evidence there is consensus among experts that it should be mentioned. However, we have been unable to find any studies giving the background prevalence of this symptom in men of similar age, social group and sexual activity, who have not had a vasectomy.This retrospective survey therefore aimed to assess the long-term morbidity related to chronic testicular pain from bilateral vasectomy, carried out in a community health centre under local anaesthetic, and to compare these results to a control population of men who had not had a vasectomy. The pain in our study was defined as intermittent or constant, unilateral or bilateral testicular pain occurring 6 weeks after vasectomy to allow time for any early post-operative complications to subside. The severity of pain was assessed in four categories as used by McMohan. 3 Methods Local ethical committee approval was obtained prior to commencement of the study. The study population comprised men who had undergone vasectomy in the Mancunian Community NHS Trust clinic. This runs once per week and performs about 250 operations per year, mainly on local residents from the area served by our community family planning clinics. 142A study to assess the prevalence of chronic testicular pain in post-vasectomy men compared to non-vasectomised men Key message pointsAt 3-4 years after their operation, vasectomy patients reported double the rate of occasional testicular discomfort at 47% compared to 23% in controls [95% confidence interval (CI) for a difference of 10%-3...

Background Changes in pharmacy models of care, services and funding have been occurring internationally, moving away from the traditional dispensing role to more extended patient-facing roles utilising pharmacists’ clinical skills. This study aimed to identify the extended services offered by community pharmacy in Aotearoa New Zealand and the barriers and facilitators to extended services provision. The study is unique in that it includes intern (pre-registration) pharmacists. Methods An online survey, conducted in 2018, of all pharmacists and intern (pre-registration) pharmacists working in a community pharmacy. Data were analysed using descriptive statistics and regression analyses. Results The results are based on replies from 553 community pharmacists and 59 intern pharmacists (response rate: 19 and 26% respectively). Both pharmacists (83%) and interns (85%) want to work at the top of their scope of practice. Wide variation exists in the specific services individual pharmacists offer. Most pharmacists were accredited to supply the emergency contraceptive pill (95%), sildenafil for erectile dysfunction (86%) and trimethoprim for uncomplicated urinary tract infection (85%). Fewer were able to immunise (34%) or to supply selected oral contraceptives (44%). Just under a quarter could provide a Medicines Use Review (MUR) or Community Pharmacy Anticoagulation Management Service (CPAMS). Of the pharmacists not already accredited, 85% intended to gain accreditation to supply selected oral contraceptives, 40% to become vaccinators, 37% to offer CPAMS and 30% MUR. Interns expressed strong interest in becoming accredited for all extended services. Poisson regression analyses showed key factors supporting the likelihood of providing extended services were owner and management support and appropriate space and equipment. Being excited about the opportunities in community pharmacy, having employer funding and time for training and sufficient support staff were also statistically significant. Conclusions Pharmacists need time and a supportive management structure to enable them to deliver extended services. Health policy with a greater strategic emphasis on funding services and pharmacist training, and developing technician support roles, will help to minimise or eliminate some of the barriers to role expansion both in Aotearoa New Zealand and internationally.

IntroductionProstate cancer is common and the incidence is increasing, but more men are living longer after diagnosis, and die with their disease rather than of it. Nonetheless, specific and substantial physical, sexual, emotional and mental health problems often lead to a poor quality of life. Urology services increasingly struggle to cope with the demands of follow-up care, and primary care is likely to play the central role in long-term follow-up. The present phase II trial will evaluate the feasibility and acceptability of a nurse-led, person-centred psychoeducational intervention, delivered in community or primary care settings.Methods and analysisProstate cancer survivors diagnosed in the past 9–48 months and currently biochemically stable will be identified from hospital records by their treating clinician. Eligible men would have either completed radical treatment, or would be followed up with prostate specific antigen monitoring and symptom reporting. We will recruit 120 patients who will be randomised to receive either an augmented form of usual care, or an additional nurse-led intervention for a period of 36 weeks. Following the health policy in Wales, the intervention is offered by a key worker, is promoting prudent healthcare and is using a holistic needs assessment. Outcome measures will assess physical symptoms, psychological well-being, confidence in managing own health and quality of life. Healthcare service use will be measured over 36 weeks. Feedback interviews with patients and clinicians will further inform the acceptability of the intervention. Recruitment, attrition, questionnaire completion rates and outcome measures variability will be assessed, and results will inform the design of a future phase III trial and accompanying economic evaluation.Ethics and disseminationEthics approval was granted by Bangor University and North Wales REC (13/WA/0291). Results will be reported in peer-reviewed publications, at scientific conferences, and directly through national cancer and primary care networks.Trial registration numberISRCTN 34516019.