Inpatient and outpatient cognitive behavioural pain management programmes for mixed chronic pain patients were compared. Patients were randomly allocated to the 4 week inpatient programme or to the 8 half day per week outpatient programme, or to a waiting list control group. Staff, teaching materials, and setting were the same for the two treatment groups. Patients were assessed pre-treatment, and at 1 month after discharge, and treated patients also at 6 months and 1 year after discharge, by assessors blind to treatment group; assessments included physical, functional and psychological measures, and medication use. In total, 121 mixed chronic pain patients (mean age 50 years; mean chronicity 8.1 years) were included in the study, following medical examination to ensure that no further medical treatment was appropriate. There was no change in the control group; inpatients and outpatients, comparable before treatment, both made significant improvements in physical performance and psychological function, and reduced medication use. Inpatients made greater gains, and maintained them better at 1 year; they also used less health care than outpatients. There were no outstanding predictors of improvement other than treatment group.

Drop-out from treatment and attrition from follow-up present problems for generalizing results from pain management programmes. Predictors of drop-out and of attrition were sought from a range of psychological and physical variables. Of 239 patients admitted to an in-patient pain management programme, 24 (10 percent) dropped out, 12 (5 percent) did not attend one month follow-up and 65 (26 percent) did not attend six month follow-up. Comparisons were made of personal, medical, psychological, physical and pain measures, taken before admission, on discharge and at one month follow-up. Drop-out was best predicted by the combination of low self-efficacy and poor physical performance. Before treatment, future non-attenders at six month follow-up reported more distress due to pain and more frequent catastrophic thinking. Although they improved during treatment, at one month follow-up future non-attenders at six month follow-up scored significantly worse on almost all physical and psychological measures. Frequency of catastrophic thoughts at one month follow-up was the best predictor of attrition at six month follow-up.

The aim of this study was to investigate the factors that contribute to the stress reported by nurses and patients. Thirty-four nurses in a London teaching hospital completed the nurse stress index and the Spielberger state trait anxiety inventory, and attitudes towards the ward and nursing care were measured in 52 patients. Nurses in the sample reported significantly greater problems than the norm in dealing with stress (as measured by the nurse stress index). In particular, they expressed difficulty in dealing with patients and their relatives, with conflict between home and work, and with and pressure resulting from problems concerning confidence and competence in the role. Patients were generally satisfied with the health care they received. There was a positive relationship between the time that patients spent talking to nurses and the degree to which nurses were perceived as helpful. Results are discussed in terms of possibilities for further research and implications for the design of future intervention programmes aimed at reducing job-related stress in hospitals.

Provision of adequate information is well established as an important determinant of patient compliance with taking medication. Elderly patients, who constitute a large proportion of patients discharged from hospital on medication, may be particularly at risk of unintentional noncompliance due to inadequate or forgotten information. This study demonstrates that counselling provided to the elderly by a clinical pharmacist significantly improved knowledge about medication and, therefore, the opportunity for compliance at home.

Introduction Elderly care is becoming increasingly complex due to the increasing age of the population leading to higher disease burden. The British Geriatric Society (BGS), defines frailty as a ‘distinctive health state related to the ageing process in which multiple body systems gradually lose built in reserves’ (1). Patients included in this study were both male and female selected at random. Age included those over the age of 65 with a frailty score over 0.25 to include moderately and severely frail. Aim To identify frail patients at The Mill Medical Practice and assess the appropriateness of their prescribed medication using statistically validated medication review tools. This included looking at STOP/START interventions, anti-cholinergic burden and frailty index. Methods Moderately and severely frail patients were categorised using the electronic frailty index within the emis system at the GP surgery. 20% of patients from each group were chosen at random to have their medication assessed using the review tools. The tools included: STOPP/START, Anticholinergic burden calculator, PrescQIPP falls risk, NICE guidelines, and adapted RiO scoring tool. Results In total, the medications of 113 patients were assessed using the review tools. 38% of patients had a STOPP intervention and 63% had a START intervention. The most commonly inappropriately prescribed medicine was Furosemide for both patient groups. It has an anticholinergic burden score of 1 and moderate falls risk. Overall, 16% of patients had a drop of one in anticholinergic burden score. Also, an increase in 23% of patients having a score of zero. Conclusion This study was successful in identifying those patients that could have changes made to their medication to improve quality of care. Anticholinergic burden can have detrimental effects in those frail patients leading to physical and cognitive changes. Decreasing anticholinergic burden in frail patients is clinically important due to the risk of these adverse effects such as confusion, dizziness which could result in injury. Even a small increase in in anticholinergic burden score can have serious effects for these frail patients resulting in a hospital admission (2). By decreasing the medicine burden on frail patient this can reduce issues associated with anticholinergic burden and other medicine related issues in turn improving quality of life. Despite the use of medication review tools which try to prevent inappropriate prescribing, this is still an occurrence within the frail population and primary care. This could be due to: lack of time, limited resources available, patients not wanting to change, prescriber willingness to change medication and availability of healthcare professionals to do medicine reviews. Future work could include looking in depth at the ideas explored in this study such as anticholinergic burden and the long terms effects of this on patients. References 1. British Geriatrics Society [BGS]. Introduction to Frailty, Fit for Frailty part 1. 2014. URL: https://www.bgs.org.uk/resources/introduction-to-frailty [25 November 2019]. 2. Ruxton K, Woodman RJ, Mangoni AA. Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis. Br J Clin Pharmacol. 2015;80(2):209–220.