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Dissertation Topics and Titles
What are the most efficacious pharmacological strategies to incorporate into patient’s acute asthma action plans to prevent premature mortality?
Asthma is a highly prevalent chronic respiratory disease that affects more than five million adults and children in the UK and is associated with acute exacerbations that are responsible for an estimated 1000 premature deaths per year (Mukherjee et al., 2016). Notably, most of these deaths are considered preventable with optimal management regimes and stringent adherence to pharmacological agents (Torjesen, 2014). This has been recognised in a recent confidential enquiry into UK asthma deaths, where major contributing factors were found to be inappropriate prescribing and a lack of asthma action plans (Levy, 2015). In a small but significant proportion of cases, 3-10% of patients have severe asthma, who observe a more severe disease course with greater disability and impaired quality of life (D'Amato et al., 2016). After observation of a patient admitted to the Emergency Department with near fatal asthma, the role of acute management using a range of pharmacological interventions was fundamental to preventing death from respiratory failure. Given that UK hospitals receive a high proportion of patients with acute asthma exacerbations, this represents an opportunity to not only apply acute pharmacological strategies, but to also review and optimise patient’s regular asthma medications and acute management options, in order to promote more desirable outcomes. The focus of the dissertation be upon the medications used in the self-management of acute asthma and their evidence base and effects upon outcomes.
Other useful sources:
Pharmacotherapeutics of bronchodilators: (Cazzola et al., 2012)
Standard pharmacological therapy: (Patel and Shaw, 2015)
Severe and difficult-to-treat asthma: (Israel and Reddel, 2017)
What are the most effective education strategies for patients requiring long-term oral anticoagulation and overcoming the barriers to achieving therapeutic anticoagulation?
Anticoagulants are required for thromboprophylaxis in a range of diseases and conditions, which if left untreated, can lead to the development of thromboembolic complications and excess morbidity and mortality (Yeh et al., 2015). However, the use of conventional anticoagulants with narrow therapeutic indices, such as warfarin, are associated with considerable adverse effects, such as haemorrhage or sub-therapeutic concentrations, leaving patients vulnerable to complications (Harter et al., 2015). It is estimated that anticoagulants are responsible for 10% of all medication incidents causing severe harm or death, and efforts to promote safety rely upon effective patient education strategies (Fattah, 2013). Notably, in recent times the emergence of novel oral anticoagulants with more favourable pharmacological profiles, such as dabigatran and rivaroxaban, has seen reductions in adverse effects and requirements for drug level monitoring, however, problems such as limited reversal agents, among other reasons, mean that continued use of warfarin is required to protect patients future wellbeing (Arepally and Ortel, 2015). This dissertation will focus upon the education strategies that can be applied by pharmacists or other health professionals and reviewing the evidence base to evaluate their efficacy in preventing adverse effects and complications, as well as how they can help to overcome the barriers to achieving therapeutic anticoagulation.
Other useful sources:
Patient education on oral anticoagulation: (Hawes, 2018)
Pharmacist-provided counselling: (Moore et al., 2015)
Patient knowledge of warfarin: (Winans et al., 2010)
Systematic review of education strategies for warfarin: (Wofford et al., 2008)
What are the most efficacious and safe pharmacological interventions that should be considered for patients presenting with insomnia in primary care settings?
In the last decade, studies from around the world have shown that there have been increases in insomnia and insomnia-related symptoms, particularly among persons of working age (Kronholm et al., 2016). In a cross-sectional study in the UK, Calem et al. (2012) found that the prevalence of insomnia had increased over the past 15 years among the general population, despite not observing changes in the reasons for sleep disturbances during this period. It is estimated that insomnia affects 10% of the adult population but almost half of the population will experience insomnia symptoms during their lifetime (Morgan and Sharman, 2017). Notably, insomnia can adversely impact on quality of life but effective management using pharmacological agents has been shown to confer benefits to physical, social and emotional functioning (Kyle et al., 2010). Moreover, the effects of acute and chronic sleep insufficiency have received growing attention, due to evidence reporting its negative impact upon cardiovascular and metabolic health and all-cause mortality (Kurina et al., 2013). Recent research discussing topical issues related to the de-pharmaceuticalisation of insomnia through the negative influence of media has led to patients being more reluctant to seek or obtain pharmacological options (Gabe et al., 2017). Thus, this dissertation will involve exploring the evidence base regarding the most effective and safe drugs that can be recommended for use in primary care settings.
Other useful sources:
Novel pharmacotherapeutics for insomnia: (Neubauer, 2014)
Hypnotics and their risks: (Kripke, 2016)
Long term hypnotic use: (Shahid et al., 2012)
References
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