Digital mental health and employment - Lessons from the Australian experience

Background and objectives: This paper reviews Australia's take-up of digital mental health interventions, including some specific reference to their application in relation to employment. Use of these interventions in Australia was already significant. Under COVID-19 they have exploded. The Australian experience offers useful lessons for European and other countries, and these are summarised.MethodsThis paper presents a narrative review of key texts, resources, policies and reports, from government and other sources. It also presents data reflecting the take-up of digital mental health services and the employment of people with a mental illness in Australia.ResultsWe present data showing the explosion in uptake of digital mental health services. There is very limited evidence about the impact of these services in improving employment outcomes for people with a mental illness in Australia. The Government has moved to make them a permanent feature of mental health care, in addition to traditional face-to-face care.ConclusionKey lessons emerge from the Australian experience, including the need for target clarity; the importance of blending digital services into broader frameworks of mental health care; the need for quality and safety standards to be developed and applied to digital services; and the need for better evaluation of the outcomes of digital interventions in the workplace.The digital mental health genie is out of the bottle. New capacity for evaluation of the outcomes of digital mental health services is vital to ensure value and quality of such investments. (AU)

International Tale on Gene Patents - between Medical and Legal Uncertainties / Cuento internacional sobre patentes genéticas: entre la incertidumbre médica y jurídica

This work is inspired by the international litigation chronicle of Myriad Genetics that remains of topical importance in the judicial and academic discourse regardless of the time that passed since. It discusses approaches of various jurisdictions to the problem of gene patenting as well as patenting of geneticdiagnostic testing. The article takes under scrutiny the judgments rendered in the U.S., Australia as well as the decisions by the European Patent Office and placesthem into interdisciplinary background of genetic science. The issue is significant, both theoretically and practically. Notwithstanding the expiration of patents that constituted the subject matter of the Myriad’s various lawsuits, the problem still remains currently relevant. Firstly, because the judgments in individual cases did not answer all the questions, but – in some way – only prepared a path for future decisions. Secondly, it is on account of new scientific breakthroughs in the area of human genetics. Consequently, the domain of genetic diagnostics is under continuous development and in the future may continue to reveal new scientific discoveries and (possibly) inventions. The lack of uniform and transparent rules in this field, and well-defined boundaries for potential monopolies constantly brings not only uncertainty for medical practitioners and scientists, but also real disadvantagesfor the patients. (AU)

Esta obra se inspira en la crónica del litigio internacional de Myriad Genetics, que sigue siendo de actualidad en el discurso judicial y académico a pesar del tiempotranscurrido desde entonces. En él se examinan los enfoques de diversas jurisdicciones sobre el problema de las patentes de genes, así como de las patentes de pruebas de diagnóstico genético. El artículo examina las sentencias dictadas en Estados Unidos y Australia, así como las decisiones de la Oficina Europea de Patentes, y las sitúa en el contexto interdisciplinario de la ciencia genética. La cuestión es importante, tanto desde el punto de vista teórico como práctico. A pesar de la expiración de las patentes que constituyeron el objeto de los diversos pleitos de Myriad, el problema siguesiendo de actualidad. En primer lugar, porque las sentencias dictadas en los casos individuales no respondieron a todas las preguntas, sino que –en cierto modo– sólo prepararon el camino para futuras decisiones. En segundo lugar, debido a los nuevosavances científicos en el ámbito de la genética humana. En consecuencia, el ámbito del diagnóstico genético está en continuo desarrollo y en el futuro puede seguirrevelando nuevos descubrimientos científicos y (posiblemente) invenciones. La falta de normas uniformes y transparentes en este ámbito y de límites bien definidos para los monopolios potenciales no sólo genera constantemente incertidumbre para losmédicos y científicos, sino también desventajas reales para los pacientes. (AU)

Multifocal contact lenses: A bibliometric study

Purpose: To analyze the state of scientific publications in multifocal contact lenses field through a bibliometric study.Methods: The database used to carry out the study was SCOPUS and contained the descriptors “multifocal contact lens”, “bifocal contact lenses”, “progressive contact lenses” and “presbyopia contact lenses”, limited to the fields of title, keywords and abstract. The indicators applied in this research were: doubling time and annual growth rate, Price’s transience index, Lotka’s law of scientific productivity, and Bradford’s zones.Results: A total of 346 articles were published between 1960 and 2019. The growth in the number of publications matches the exponential adjustment slightly better (R = 0.53). The duplication time was 13.2 years. The productivity level is focused on articles with an average number of authors of just 2.06 per article. The Bradford core was formed by two journals, Optometry and Vision Science and Eye and Contact Lens.Conclusions: Research on multifocal contact lenses has exponential growth, without evidence of having reached a saturation point. The main countries in scientific production in this field are the United States and Australia. (AU)

Home medicines reviews: a national survey of Australian accredited pharmacists’ health service time investment

Background: In Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists’ experiences of HMR time investment. Objective: This study aimed to explore accredited pharmacists’ experiences of HMR practice regarding time investment in the study’s defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient’s General Practitioner, including any liaison time). Methods: An electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment. Results: There was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed >100 HMRs (73%), were female (71%), and aged >40 years (60%). Regarding time investment for a typical instance of HMR, most spent: <30 minutes performing Stage 1 (46.7%), and 30-60 minutes performing Stage 2 (70.2%). In Stage 3, 40.0% invested 1-2 hours, and 27.1% invested 2-3 hours in HMR report collation and completion. Quantitative analysis revealed statistically significant (p=0.03) gender findings where females performed longer patient consultations than males (Stage 2) (AU)

Parto domiciliario: un fenómeno creciente con potenciales riesgos / Home births: A growing phenomenon with potential risks

El parto extrahospitalario es un tema controvertido que genera dudas a obstetras y pediatras sobre su seguridad. El nacimiento hospitalario fue la pieza clave en la reducción de la mortalidad materna y neonatal. Esta reducción en la mortalidad ha derivado en considerar el embarazo y el parto como fenómenos seguros, lo que, unido a una mayor conciencia social de la necesidad de humanización de estos procesos, ha conducido a un aumento en la demanda del parto domiciliario. Estudios en países como Australia, Holanda y Reino Unido muestran que el parto en casa puede aportar ventajas para la madre y el recién nacido, pero es necesario que se dote de los suficientes medios materiales, que sea atendido por profesionales formados y acreditados, y que se encuentre perfectamente coordinado con las unidades de obstetricia y neonatología hospitalarias, para poder garantizar su seguridad. En nuestro medio, no hay suficientes datos de seguridad ni evidencia científica que avalen el parto domiciliario en la actualidad

Home birth is a controversial issue that raises safety concerns for paediatricians and obstetricians. Hospital birth was the cornerstone to reduce maternal and neonatal mortality. This reduction in mortality has resulted in considering pregnancy and childbirth as a safe procedure, which, together with a greater social awareness of the need for the humanisation of these processes, have led to an increase in the demand for home birth. Studies from countries such as Australia, the Netherlands, and United Kingdom show that home birth can provide advantages to the mother and the newborn. It needs to be provided with sufficient material means, and should be attended by trained and accredited professionals, and needs to be perfectly coordinated with the hospital obstetrics and neonatology units, in order to guarantee its safety. Therefore, in our environment, there are no safety data or sufficient scientific evidence to support home births at present

Exploring Australian pharmacists' perceptions and attitudes toward codeine up-scheduling from over-the-counter to prescription only

OBJECTIVE: Explore the perceptions, attitudes and experiences of pharmacists relating to the up-scheduling of low dose codeine containing analgesics and the impact on pharmacy practice. METHODS: A mixed design method was used consisting of an anonymous online questionnaire survey to quantitatively capture broad pre-scheduling change perceptions paired with a series of in-depth post-scheduling semi-structured interviews to provide a qualitative picture of the impact of codeine up-scheduling on pharmacy practice in Australia. RESULTS: A total of 191 pharmacists completed the quantitative survey and 10 participated in the in-depth interview. The majority of respondents supported the decision to up-schedule over-the-counter combination products containing codeine to some degree. Three main themes emerged from the data: pharmacists' perceptions of the codeine up-scheduling decision, preparing for the up-schedule and impact of the up-schedule on pharmacy practice. Pharmacists were concerned about the impact of up-scheduling on the pharmacy business, patient access to pain relief and the diminishment of their professional role. CONCLUSIONS: There were diverse perceptions, preparedness and impact on practice regarding the up-scheduling of low dose codeine products. Further research should be conducted to gauge if and how these perceptions have changed over time and to identify whether pain is being managed more effectively post codeine up-scheduling

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Primary health care policy and vision for community pharmacy and pharmacists in Australia

There is evidence that the Australian Government is embracing a more integrated approach to health, with implementation of initiatives like primary health networks (PHNs) and the Government's Health Care Homes program. However, integration of community pharmacy into primary health care faces challenges, including the lack of realistic integration in PHNs, and in service and remuneration models from government. Ideally, coordinated multidisciplinary teams working collaboratively in the community setting are needed, where expanding skills are embraced rather than resisted. It appears that community pharmacy is not sufficiently represented at a local level. Current service remuneration models encourage a volume approach. While more complex services and clinical roles, with associated remuneration structures (such as, accredited pharmacists, pharmacists embedded in general practice and residential aged care facilities) promote follow up, collaboration and integration into primary health care, they potentially marginalize community pharmacies. Community pharmacists' roles have evolved and are being recognized as the medication management experts of the health care team at a less complex level with the delivery of MedChecks, clinical interventions and medication adherence services. More recently, vaccination services have greatly expanded through community pharmacy. Policy documents from professional bodies highlight the need to extend pharmacy services and enhance integration within primary care. The Pharmaceutical Society of Australia's Pharmacists in 2023 report envisages pharmacists practising to full scope, driving greater efficiencies in the health system. The Pharmacy Guild of Australia's future vision identifies community pharmacy as health hubs facilitating the provision of cost-effective and integrated health care services to patients. In 2019, the Australian Government announced the development of a Primary Health Care 10-Year Plan which will guide resource allocation for primary health care in Australia. At the same time, the Government has committed to conclude negotiations on the 7th Community Pharmacy Agreement (7CPA) with a focus on allowing pharmacists to practice to full scope and pledges to strengthen the role of primary care by better supporting pharmacists as primary health care providers. The 7CPA and the Government's 10-year plan will largely shape the practice and viability of community pharmacy. It is essential that both provide a philosophical direction and prioritize integration, remuneration and resources which recognize the professional contribution and competencies of community pharmacy and community pharmacists, the financial implications of service roles and the retention of medicines-supply roles

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Community pharmacists' recommendations for natural products for stress in Melbourne, Australia: a simulated patient study

BACKGROUND: Community pharmacists are often the first health professional approached to provide treatment for health issues, including the important mental health challenge, stress. Over-the-counter products for stress almost always are complementary and alternative medicines (CAM) and in Australia no protocol exists for their recommendation and sale in community pharmacies. OBJECTIVE: To assess the quality and relevance of community pharmacists' information gathering (questioning), counselling and product selection when interacting with customers requesting a CAM product for stress and consequently determine whether Australian pharmacy practice indicates the need for guidelines similar to those provided for 'pharmacy only' (S2) and 'pharmacist only' (S3) medicines. METHODS: A covert simulated patient was used to investigate the response of pharmacists to a request for a natural product for stress. The SPs documented the details of the pharmacist-simulated patient interaction immediately on leaving the pharmacy and then re-entered the pharmacy to debrief the pharmacist. The quality of the interaction was scored as a Total CARE (check, assess, respond, explain) Score, based on anticipated questions and counselling advice. The appropriateness of the product was scored as a Product Efficacy Score, based on evidence-based literature. RESULTS: Data from 100 pharmacies was provided. Information gathering illustrated by the questioning components Check and Assess (C and A) of the total CARE score by pharmacists was poor. The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), the average being 3.1 (SD 1.9). Provision of advice was generally better (a description of the suggested product was offered by 87 pharmacists) but was lacking in other areas (duration of use and side effects were explained by only 41 and 16 pharmacists respectively). The most common product suggested was B-group vitamins (57 pharmacists) followed by a proprietary flower essence product (19 pharmacists). A two-step cluster analysis revealed two sub-groups of pharmacists: one cluster (74 pharmacists) with a high Total CARE score provided an appropriate product. The other cluster (20 pharmacists) had a low total CARE score and provided an inappropriate product. CONCLUSIONS: The pharmacy visits revealed major shortcomings in questioning, counselling and product recommendation. There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending complementary and alternative medicine

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An investigation of the views and practices of Australian community pharmacists on pain and fever management and clinical guidelines

Background: Fever and pain are common conditions in the Australian healthcare setting. Whilst clinical guidelines provide important therapeutic recommendations, evidence suggests they are not always followed. Given that community pharmacy is one of the most frequently accessed primary healthcare services, it is important to understand the views and practices of community pharmacists in pain and fever. Objectives: To investigate the views and practices of Australian community pharmacists in pain and fever management, and their views on relevant clinical guidelines. Methods: A cross-sectional study of community pharmacists in Australia was conducted using a customised, anonymous, self-administered, online questionnaire between March and May 2018. To capture a broad range of demographics, pharmacists were recruited via local industry contacts and the Pharmaceutical Society newsletter, with further recruitment through snowball sampling. The main outcomes measured were pharmacists' views, practices and treatment recommendation of choice in pain and fever management, as well as views on clinical guidelines and training. Results: A total of 113 pharmacists completed the survey. In general, paracetamol (72%) was preferred as a recommendation over ibuprofen, and was the drug of choice for most mild to moderate pain and fever scenarios. Majority of pharmacists reported good knowledge of pain and fever management, however, only approximately half reported recent pain management training. Greater than 87% of pharmacists believe that clinical guidelines are useful in fever management, and 79% of pharmacists believe that following clinical guidelines is important in pain management. Conclusions: While most pharmacists recognise the importance of guidelines and demonstrated good pain and fever management, results suggests opportunities to promote additional education, upskilling, and research in this space to further optimise pain and fever management in the community

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A training program incorporating a diabetes tool to facilitate delivery of quality diabetes care by community pharmacists in Malaysia and Australia

Objectives: To assess a clinical training program on management of Type 2 Diabetes Mellitus (T2DM) incorporating a diabetes tool, the Simpler(TM) tool. Subsequently pharmacists' experience utilising the tool to deliver structured, consistent, evidence-based T2DM care was explored. Methods: Full-time non-credentialed diabetes pharmacists providing diabetes medication management services in community settings were purposively recruited. Participants had either face-to-face or online training on diabetes management using the tool which took about two hours and 20 minutes to complete. Their diabetes management knowledge was assessed pre- and post-training using quantitative methodology. They were then required to apply the tool in daily practice for one month. Feedback on both the training sessions and tool utilisation were obtained through semi-structured interviews and analysed using a qualitative approach. Results: Twelve pharmacists participated: Six from Australia and six from Malaysia. Before attending the training session, their median test score was 6.5/27, IQR 1.4 (1st marker) and 5.3/27, IQR 2.0 (2nd marker). After training, the scores doubled to 14.3/27, IQR 4.5 (1st marker) and 11.3/27, IQR 3.1 (2nd marker), showing significant improvements (p=0.002). Interview data identified perceived effectiveness factor through use of the tool. Participants found the content relevant, structured, concise and easy to understand; enabled comprehensive medication reviews; focused on achieving glycaemic improvement; facilitated documentation processes and pharmacists' role in T2DM management; and as a specific aid for diabetes management. Barriers included lack of accessibility to patients' laboratory data in Australia. Conclusions: The targeted training improved pharmacists' knowledge on diabetes management and supported the Simpler(TM) tool use in practice as a structured and beneficial method to deliver evidence-based T2DM care

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Consenso Victoria I: la cadena de supervivencia táctica civil ante incidentes de múltiples víctimas intencionados / A civilian tactical survival chain for incidents involving multiple intentionalinjury victims: the Victory I Consensus Report

Son múltiples las recomendaciones internacionales que aconsejan adaptar modelos asistenciales del entorno militar a incidentes de múltiples víctimas intencionados (IMVI) ocurridos en el entorno civil, bien por el tipo de patrón lesional, bien por aspectos de seguridad y autoprotección. Debido a la experiencia en Norteamérica, donde este tipo de situaciones son más frecuentes, casi toda la bibliografía y referencias existentes no se corresponden con un modelo de sistemas de emergencias médicas como el que existe en las distintas comunidades autónomas españolas, con sus diferentes medios y procedimientos tal y como viene estipulado por sus competencias exclusivas en esta materia. No obstante, se han detectado una serie de elementos comunes que pueden servir de referencia para elaborar un plan de respuesta a los IMVI, basados en la evidencia y utilizando principios de actuación dirigidos a una acción eficaz y eficiente. Pensamos que cada actor de los eslabones de esta cadena asistencial debe tener clara su misión, su rol y su función en las diferentes zonas de la escena, y así se intentan definir en este documento de consenso, desde un primer interviniente ocasional hasta la asistencia definitiva en los centros de referencia para pacientes traumatizados

International guidelines recommend adapting military health care protocols to emergencies involving multiple intentional-injury victims in civilian environments. Adaptations can reflect similarities in types of injuries or issues of provider safety and that arise in military and some civilian emergencies. Because more experience with such incidents has been gained in the United States, most of the literature on this topic discusses emergency medical systems that differ from the ones operating in the autonomous communities of Spain, where varying resources and procedures are mandated by local authorities charged with preparing for emergencies. However, common elements are present, offering a framework and principles to apply when drafting evidence-based plans for effective, efficient response to multiple-victim emergencies. We think that participants at each point in the chain of survival must have clear missions and understand the roles they play in the various zones that comprise the scene of an emergency. Therefore this consensus paper attempts to define the relevant principles and roles for participants at all levels, from occasional first responders up to staff at trauma referral centers

Expanding the role of Australian pharmacists in community pharmacies in chronic pain management - a narrative review

Chronic pain is a condition where patients continuously experience pain symptoms for at least 3 to 6 months. It is one of the leading causes of disabilities across the globe. Failure to adequately manage chronic pain often results in additional health concerns that may directly contribute to the worsening symptoms of pain. Community pharmacists are an important healthcare resource that contributes to patient care, yet their roles in chronic pain management are often not fully utilised. This review aimed to investigate and explore pharmacist-driven chronic pain educational and medication management interventions in community pharmacies on an international level, and thereby identify if there are potential benefits in modelling and incorporating these interventions in the Australian community. We found a number of studies conducted in Europe and the United States investigated the benefits of pharmacist-driven educational and medication management interventions in the context of chronic pain management. Results demonstrated that there were improvements in the pain scores, depression/anxiety scales and physical functionality in patient groups receiving the pharmacist driven-interventions, thereby highlighting the clinical benefit of these interventions in chronic pain. In conclusion, pharmacists are trustworthy and responsible advocates for medication reviews and patient education. There are currently very limited formal nationally recognised pharmacist-driven intervention programs dedicated to chronic pain management in Australian community pharmacies. International studies have shown that pharmacist-driven chronic pain interventions undertaken in community pharmacies are of benefit with regards to alleviating pain symptoms and adverse events. Furthermore, it is also clear that research around the application of pharmacist-led chronic pain interventions in Australia is lacking. Modelling interventions that have been conducted overseas may be worth exploring in Australia. The implementation of similar intervention programs for Australian pharmacists in community pharmacies may provide enhanced clinical outcomes for patients suffering from chronic pain. The recently implemented Chronic Pain MedsCheck Trial may provide some answers

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Management of allergic rhinitis in the community pharmacy: identifying the reasons behind medication self-selection

Background: Community pharmacists have a key role to play in the management of allergic rhinitis (AR). Their role is especially important because the majority of medications used to treat AR are available for purchase over-the-counter (OTC), allowing patients to self-select their own medications and bypass the pharmacists. Patients' self-selection often results in suboptimal treatment selection, undertreated AR and poor clinical outcomes. In order for pharmacists to optimise the care for AR patients in the pharmacy, pharmacists need to be able to identify patient cohorts who self-select and are at high risk of mismanagement. Objectives: This study aimed to compare the demographics, clinical characteristics and medication selected, between pharmacy customers who choose to self-select and those who speak with a pharmacist when purchasing medication for their AR in a community pharmacy and identify factors associated with AR patients' medication(s) self-selection behaviour. Methods: A cross-sectional observational study was conducted in a convenience sample of community pharmacies from the Sydney metropolitan area. Demographics, pattern of AR symptoms, their impact on quality of life (QOL) and medication(s) selected, were collected. Logistic regressions were used to identify factors associated with participants' medication self-selection behaviour. Results: Of the 296 recruited participants, 202 were identified with AR; 67.8% were female, 54.5% were >40 years of age, 64.9% had a doctor's diagnosis of AR, and 69.3% self-selected medication(s). Participants with AR who self-select were 4 times more likely to experience moderate-severe wheeze (OR 4.047, 95% CI 1.155-14.188) and almost 0.4 times less likely to experience an impact of AR symptoms on their QOL (OR 0.369, 95% CI 0.188-0.727). Conclusions: The factors associated with AR patients' self-selecting medication(s) are the presence of wheeze and the absence of impact on their QOL due to AR symptoms. By identifying this cohort of patients, our study highlights an opportunity for pharmacists to engage these patients and encourage discussion about their AR and asthma management

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Paediatric antimicrobial stewardship and safe prescribing: an assessment of medical staff knowledge and behaviour

Objective: Determine baseline knowledge of antimicrobial stewardship, and safe prescribing among junior medical officers, monitor their level of participation in interactive education during protected teaching time and assess day-to-day prescribing behaviours over the subsequent 3-month period. Methods: A voluntary and anonymous survey of all non-consultant level medical officers was conducted with the use of an audience response system during mandatory face-to-face orientation sessions at a tertiary paediatric hospital. Routine prescribing audits monitored compliance with national and locally derived quality use of medicines indicators. Results: Eighty-six percent of medical officers participated by responding to at least one question (171/200). Response rate for individual questions ranged between 31% and 78%. Questions that addressed adverse drug reactions, documentation and monitoring for empiric antibiotics and the error-prone abbreviations IU and U were correctly answered by over 90% of participants. Other non-standard and error-prone abbreviations were less consistently identified. In practice, 68% of patients had complete adverse drug reaction documentation (113/166). Error-prone abbreviations were identified on 5% of audited medication orders (47/976), approximately half included a documented indication and intended dose. Conclusions: Participants demonstrated a good understanding of safe prescribing and antimicrobial stewardship. Audits of prescribing identified potential discrepancies between prescribing knowledge and behaviours

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Health literacy and knowledge in a cohort of Australian patients taking warfarin

Objectives: To 1) characterise older patients taking warfarin, 2) assess these patients’ level of warfarin knowledge, and 3) describe their strengths and limitations in health literacy, and 4) explore relationships between participants’ characteristics, warfarin knowledge and health literacy. Methods: A warfarin knowledge questionnaire and Health Literacy Questionnaire (HLQ) were administered to older patients (aged >65 years, N=34) taking warfarin in an Australian general practice setting. Results: Key gaps in participant knowledge pertained to the consequences of an international normalized ratio (INR) being below the target INR range and safety issues such as when to seek medical attention. A limitation for participants with a lower level of health literacy was the ability to appraise health information. Patients who needed assistance in completing the HLQshad significantly lower warfarin knowledge scores (p=0.03). Overseas-bornparticipants and those taking 5 or more long-term medications had lower HLQ scores for specific scales (p<0.05).Conclusion: In this study warfarin knowledge gaps and a limitation of health literacy amongst a small sample of older patients were identified. The findings suggest that education and resources may need to be tailored to the needs of older patients taking warfarin and their carers to address these knowledge gaps and limitations in health literacy. Patients who may need greater support include those that need assistance in completing the HLQ, are overseas-born, or are taking 5or morelong-term medications (AU)

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The Introduction stage of Basketball players. A view from Basketball Experts / La etapa de introducción de los jugadores de baloncesto. Consideraciones de expertos de baloncesto / A fase de introdução dos jogadores de basquete. Uma visão de especialistas em basquete

This study aimed to examine the introduction stage of basketball participants in countries that are ranked within the top 20 basketball countries by FIBA. Through the use of semi structured interviews, data was collected from 16 technical experts from 6 countries. We analyzed the introductory phase determining: the age at which participants start in the programs; the different avenues or forms of entry in to the sport; the objectives defined and pursued in these stages; the structure of the competitive contests and the multi-sport involvement and specialization. The data revealed an age range of 5 to 12 years for the introduction of participants to basketball. Various settings for the introduction in the sport were found to exist. USA stands out with a maximum of 7 options. Regarding the main objectives in basketball introduction, the data revealed a balance between the three learning domains, with a slight increase of the affirmative and psychomotor over the cognitive. In terms of competition there is a common standard across countries that contests during the period of introduction are focused in enjoyment and stimulation. Several strategies are used in all countries, (e.g. reducing the size of the ball, number of players, height of the basket) are used to accommodate the game to the children abilities and to the objectives of the introductory stage. In terms of multi-sport participation and the ages at which specialization in basketball should occur, opinions are favorable to a multi-sport diversification, and the average age of specialization was 15 (AU)

Este estudio tuvo como objetivo examinar la etapa de presentación de los participantes de baloncesto de los países que se clasifican dentro de los 20 países de baloncesto superior por la FIBA. Mediante el uso de entrevistas semiestructuradas, se recogieron datos de 16 expertos técnicos de 6 países. Hemos analizado la fase de introducción determinando: la edad en que los participantes comienzan en los programas; las diferentes vías o formas de entrada en el deporte; los objetivos perseguidos y definidos en estas etapas; la estructura competitiva y la participación multe-deportiva y la edad de especialización. Los datos revelaron un rango de edad de 5 a 12 años para la presentación de los participantes al baloncesto. Se comprueba la existencia de varios parámetros para la introducción en el deporte. USA se destaca con un máximo de 7 opciones. En cuanto a los principales objetivos en la introducción de baloncesto, los datos revelaron un equilibrio entre los tres dominios de aprendizaje, con un ligero aumento de la afirmativa y psicomotor sobre el desarrollo cognitivo. En cuanto a la competición, hay un estándar común en los países definiéndose el disfrute y la estimulación como los objetivos principales. Varias estrategias se utilizan en todos los países, (por ejemplo, la reducción del tamaño de la bola, número de jugadores, la altura de la canasta) se utilizan para acomodar el juego de las habilidades de los niños y para los objetivos de la etapa de introducción. En cuanto a la participación del multe-deporte y las edades en las que la especialización en el baloncesto debe ocurrir, las opiniones son favorables a una diversificación multe-deporte, y la edad media de especialización fue de 15 anos (AU)

Este estudo teve como objetivo analisar a fase de introdução de participantes de basquete de países que são classificados dentro dos primeiros 20 países de basquete pela FIBA. Através do uso de entrevistas semiestruturados, os dados foram recolhidos a partir de 16 especialistas técnicos de 6 países. Analisou-se a fase introdutória determinando: a idade em que os participantes começam nos programas; os diferentes caminhos ou formas de entrada para a modalidade; os objetivos definidos e perseguidos nessa fase; a estrutura competitiva, o envolvimento multidesportivo e a especialização. Os dados revelaram uma faixa etária de 5 a 12 anos para a introdução de participantes para o basquete. Foram reveladas várias formas de introdução na modalidade. Os EUA destaca-se com um máximo de 7 opções. Em relação aos principais objetivos, os dados revelaram um equilíbrio entre os três domínios de aprendizagem, com um ligeiro aumento da afirmativa e psicomotor sobre o cognitivo. Em termos de competição há um padrão comum entre os países centrando-se os objetivos competitivos na diversão e estimulação. Várias estratégias são utilizadas em todos os países, (por exemplo, reduzindo o tamanho da bola, o número de jogadores, altura do cesto) para acomodar o jogo às capacidades crianças e aos objetivos da fase introdutória. As opiniões dos especialistas são favoráveis à participação multidesportiva e a idade em que a especialização deve ocorrer em basquetebol, foi em média de 15 anos (AU)

Purchasing Over-the-counter medicines from Australian pharmacy: what do the pharmacy customers value and expect?

Background: Over-the-counter medicines (OTC) are widely available and can be purchased without a prescription. Their availability means that a customer may choose to purchase them without the involvement of a pharmacy/pharmacist. It is important to understand customer OTC purchasing perceptions and behaviour from a pharmacy to better understand the needs and opportunities in this space. Objective: This study aimed to examine customers’ key expectations and what they value when purchasing OTC and how the effect of health status/stress and perceived risks/benefits of purchasing OTCs from a pharmacy may influence their OTC shopping behaviour. Methods: Customers from two metropolitan pharmacies across two different suburbs in Brisbane, Queensland, Australia completed a self-administered questionnaire. Data collection was conducted over a six-week period. The questionnaire examined demographics, current level of health and stress, as well as a range of questions (seven-point Likert-scale) examining perceived benefits and risks, what they value, trust and expect when purchasing OTC. Results: A total of 86 customers from a broad range of demographics were captured in this study. When asked about their current health state, 41% and 23% respectively indicated that they were stressed and tense when they arrived at the pharmacy but many were feeling well (38%). Most customers strongly agreed/agreed that trust in the advice from a pharmacy (96%), trust in the products (73%), and the altruistic approach of a pharmacy (95%) were critical to them. Further, 82% and 78% respectively disagreed that time pressures or costs were concerns, despite many feeling tense and stressed when they came in. When asked where they intend to buy their future OTC, 89% indicated pharmacy instead of a supermarket. Conclusions: High levels of trust, confidence and sense of altruism and care were key factors for customers buying OTC from a pharmacy, regardless of time pressures, costs or existing levels of stress and health (AU)

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Assessment and management of serotonin syndrome in a simulated patient study of Australian community pharmacies

Background: The incidence of serotonin syndrome is increasing due to the widening use of serotonergic drugs. Identification of serotonin syndrome is challenging as the manifestations are diverse. Misdiagnosis can lead to delay in care and inappropriate treatment. Objectives: The objectives of this study were to determine if staff of community pharmacies in Australia could identify the symptoms of serotonin syndrome in simulated patients and recommend an appropriate course of action. Methods: Agents acting on behalf of a simulated patient were trained on a patient scenario that reflected possible serotonin syndrome due to an interaction between duloxetine and recently prescribed tramadol. They entered 148 community pharmacies in Australia to ask for advice about a 60 year old male simulated patient who was ‘not feeling well’. The interaction was audio recorded and analysed for degree of access to the pharmacist, information gathered by pharmacy staff, management advice given and pharmacotherapy recommended. Results: The simulated patient’s agent was consulted by a pharmacist in 94.0% (139/148) of cases. The potential for serotonin syndrome was identified by 35.1% (52/148) of pharmacies. Other suggested causes of the simulated patient’s symptoms were viral (16.9%; 25/148) and cardiac (15.5%; 23/148). A total of 33.8% (50/148) of pharmacies recommended that the simulated patient should cease taking tramadol. This advice always came from the pharmacist. Immediate cessation of tramadol was advised by 94.2% (49/52) of pharmacists correctly identifying serotonin syndrome. The simulated patient was advised to seek urgent medical care in 14.2% (21/148) of cases and follow up with a doctor when possible in 68.2% (101/148) of cases. The majority of pharmacies (87.8%; 130/148) did not recommend non-prescription medicines. Conclusion: While not identifying the cause of the simulated patient’s symptoms in the majority of cases, community pharmacies recommended appropriate action to minimise the health impact of serotonin syndrome by advising to cease tramadol and/or referring to a doctor and not recommending non-prescription medicines to treat symptoms. Raising pharmacists’ awareness of the signs and symptoms of serotonin syndrome, and the importance of taking a comprehensive medication history when assessing a set of symptoms, may help community pharmacies further reduce serotonin syndrome toxicity (AU)

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Codificación sistemática de contenidos educativos de farmacia práctica / Systematic coding of pharmacy practice educational contents

Introducción: Los organismos internacionales farmacéuticos reclaman una educación farmacéutica más centrada en el paciente, que de apoyo a las funciones de la atención farmacéutica. Para ello, se han desarrollado marcos de competencias, que no siempre se han asociado a los correspondientes contenidos docentes. Objetivo: Identificación sistemática de los contenidos programáticos del área de farmacia práctica, mediante la creación de un árbol de codificación de contenidos. Método: Análisis cualitativo de los contenidos docentes de asignaturas del área de farmacia práctica de los planes de estudios de las facultades de farmacia de Australia, Canadá, Estados Unidos, y Nueva Zelanda. Los syllabus fueron obtenidos de las páginas web de las facultades de farmacia, excluyendo las que no tenían el plan de estudios completo disponible en inglés. Se solicitó a los responsables de las asignaturas información adicional por correo electrónico. Se creó un árbol de contenidos inicial a partir de directrices del Accreditation Council for Pharmacy Education. Se realizó un proceso iterativo de codificación dirigida, para obtener el árbol final de códigos que permitiese clasificar los contenidos docentes del área de farmacia práctica. Resultados: Se incluyeron 110 facultades (Australia=15; Canadá=5; Estados Unidos=89; y Nueva Zelanda=1), con 8733 asignaturas, de las que 1703 (19.5%) pertenecían al área de farmacia práctica y presentaban syllabus con información detallada. Se obtuvo respuesta con información adicional de 119 asignaturas. El análisis de contenido convirtió el árbol inicial de 39 categorías, en un árbol final de codificación con 3 niveles jerárquicos y 69 categorías. Conclusión: En los países del análisis, aproximadamente el 20% de las asignaturas pertenecen al área de farmacia práctica. Se ha conseguido un árbol de codificación y clasificación de los contenidos docentes de farmacia práctica. Futuros estudios deberían mapear las asignaturas actuales para determinar si los contenidos identificados están siendo enseñados

Introduction: International pharmaceutical institutions claim for a more patient-focused pharmacy education, which can support pharmaceutical care processes. Consequently, competencies frameworks have been developed, but they not always are associated with teaching contents. Objective: Systematic identification of pharmacy practice curricular contents, by means of creating a content codification tree. Method: Qualitative analysis of course contents of pharmacy practice disciplines from the curricular descriptions pharmacy schools from Australia, Canada, United States and New Zealand. Syllabuses were retrieved from pharmacy schools websites, excluding those without the complete program in English. Additional information was requested by email to course responsible. An initial content coding tree was created based on the Accreditation Council for Pharmacy Education standards. An iterative directed coding was done to obtain the final coding tree that would allow the complete codification of pharmacy practice educational contents. Results: A total of 110 schools were included (Australia=15; Canada=5; United States=89; y New Zealand=1), with 8733 courses, and 1703 (19.5%) corresponded to pharmacy practice area and presented syllabus with complete information. Additional information was obtained from 119 courses. Content analysis converted the initial tree with 39 categories to a final coding tree with 3 hierarchical levels and 69 categories. Conclusion: In countries under analysis, about 20% of courses fit in pharmacy practice area. A coding tree to classify pharmacy practice teaching contents was created. Future studies should map current courses to identify if these curricular contents are being taught

Implementing simulated learning modules to improve students' pharmacy practice skills and professionalism / Implantación de módulos de aprendizaje simulados para mejorar las habilidades de farmacia práctica y el profesionalismo en los estudiantes

Background: Effective communication enables healthcare professionals and students to practise their disciplines in a professional and competent manner. Simulated-based education (SBE) has been increasingly used to improve students’ communication and practice skills in Health Education. Objective: Simulated learning modules (SLMs) were developed using practice-based scenarios grounded in effective communication competencies. The effect of the SLMs on Pharmacy students’ (i) Practice skills and (ii) Professionalism were evaluated. Methods: SLMs integrating EXCELL competencies were applied in the classroom to study their effect on a number of learning outcomes. EXcellence in Cultural Experiential Learning and Leadership (EXCELL) Program is a schematic, evidence-based professional development resource centred around developing participants’ selfefficacy and generic communication competencies. Students (N=95) completed three hours of preliminary lectures and eight hours of SLM workshops including six scenarios focused on Pharmacy Practice and Experiential Placements. Each SLM included briefing, role-plays with actors, facilitation, and debriefing on EXCELL social interaction maps (SIMs). Evaluations comprised quantitative and qualitative survey responsed by students before and post-workshops, and post-placements, and teachers’ reflections. Surveys examine specific learning outcomes by using pharmacy professionalism and pharmacy practice effectiveness scales. Responses were measured prior to the commencement of SLMs, after completion of the two workshops and after students completed their block placement. Self-report measures enabled students to self-assess whether any improvements occurred. Results: Student responses were overwhelmingly positive and indicated significant improvements in their Pharmacy practice and professionalism skills, and commitment to professional ethics. Qualitative feedback strongly supported students’ improved communication skills and confidence. Teacher reflections observed ecological validity of SLMs as a method to enhance professionalism and communication skills, and suggested ways to improve this teaching modality. Conclusion: Inclusion of SLMs centred on practice and professionalism was evaluated as an effective, teaching strategy by students and staff. The integration of SIMs in SLMs has potential for wider application in clinical teaching (AU)

Antecedentes: La comunicación efectiva permite a los profesionales de la salud y estudiantes ejercer sus disciplinas de un modo profesional y competente. La educación basada en la simulación (SBE) se ha usado crecientemente para mejorar la comunicación de los estudiantes y las habilidades prácticas. Objetivo: Se desarrollaron módulos de aprendizaje simulados (SLM) usando escenarios basados en la práctica y apoyados en competencias de comunicación efectiva. Se evaluó el efecto de los SLM en (i) las habilidades prácticas y (ii) el profesionalismo de los estudiantes de farmacia. Métodos: Se utilizaron en clase SLM que integraban las competencias EXCELL para estudiar su efecto en varios resultados de aprendizaje. El programa EXCELL (EXcellence in Cultural Experiential Learning and Leadership) es un recurso de desarrollo profesional basado en la evidencia centrado en desarrollar la autoeficacia de los participantes y sus competencias genéricas de comunicación. Los estudiantes (N=95) completaron tres horas de sesiones teóricas y ocho horas de talleres SLM que incluían seis escenarios centrados en los lugares de prácticas tuteladas. Cada SLM incluía un resumen, role-plays con actores, facilitación y un resumen final con deliberación sobre mapas de interacción social (SIM) del EXCELL. Las evaluaciones contenían cuestionarios cualitativos y cuantitativos respondidos por los estudiantes antes y después de los talleres y después de las prácticas, y las reflexiones de los profesores. Los cuestionarios examinaban resultados de aprendizaje específicos usando escalas de profesionalismo en farmacia y de efectividad del ejercicio farmacéutico. Las respuestas se midieron antes del comienzo de los SLM, después de completar dos talleres, y después de que los estudiantes completasen su bloque de prácticas tuteladas. Las mediciones autocomunicadas permitieron a los estudiantes a auto-evaluar si existían mejoras. Resultados: Las respuestas de los estudiantes fueron extremamente positivas e indicaron mejoras significativas en su práctica y profesionalismo, y compromiso con la ética profesional. El feed-back cualitativo soportó fuertemente la mejora de habilidades de comunicación y confianza. Las reflexiones del profesor observaban una validez natural de los SLM como método para aumentar el profesionalismo y las habilidades de comunicación, y sugirieron modos de mejorar esta modalidad docente. Conclusión: La inclusión de SLM centrados en la práctica y el profesionalismo fue evaluada como una estrategia docente efectiva por los estudiantes y el personal. La integración de los SIM en los SLM tiene un potencial para otras aplicaciones en la docencia clínica (AU)