"Fighting the pandemic!" Western Australian pharmacists' perspectives on COVID-19 vaccines: A qualitative study.

BACKGROUND: In Western Australia, community pharmacists are authorized to administer a range of vaccines without a prescription. Since mid-July 2021, pharmacists can also administer Coronavirus Disease 2019 (COVID-19) vaccines. Little is known about how pharmacists think and feel about giving and receiving COVID-19 vaccines and how they discuss it with patients. AIM: This study aimed to explore Western Australian pharmacists' perceptions on being vaccinated with, administering, and communicating about COVID-19 vaccines. METHODS: Semi structured interviews were conducted with 20 pharmacists from metropolitan and regional areas of Western Australia across a two-week period in July and early August 2021. Interview transcripts were coded using NVivo 20 and data was thematically analyzed using the framework method. RESULTS: Most pharmacists (n = 16, 80 %) had received at least one dose of a COVID-19 vaccine. Some expressed difficulty accessing the vaccine while two unvaccinated pharmacists were hesitant to receive it due to concerns about vaccine development. The majority of pharmacists spoke positively about administering the vaccines, discussing perceived facilitators such as designated vaccination days but also perceived barriers such as inadequate financial reimbursement compared to other healthcare providers. Many pharmacists obtained their information from Australian government sources and training modules. Pharmacists were only passively promoting COVID-19 vaccines, with conversations mostly initiated by patients. Most pharmacists specified they would highlight the common side effects when administering the vaccine and would provide patients with written information. CONCLUSION: The majority of pharmacists were willing to administer and be vaccinated with COVID-19 vaccines. Since pharmacists play an important role in increasing vaccine uptake, governments should provide equitable reimbursement to pharmacists in line with other vaccinators such as General Practitioners. We welcome the recent resources produced by governments and pharmacy professional organizations to help pharmacists actively promote the vaccines since this work was undertaken.

Oesophageal adenocarcinoma metastasis into a microcystic meningioma: a rare occurrence of tumour to tumour metastasis.

A 78-year-old male was admitted with a history of a fall following seizures. This occurred 2 years post-curative treatment (minimally invasive oesophagectomy with neo-adjuvant chemotherapy) for an oesophageal adenocarcinoma staged T3N0M0. On examination, patient had left-sided hemiparesis. A CT and magnetic resonance image (MRI) of the head confirmed a right frontotemporal meningioma with features suggestive of internal haemorrhage or calcification and mild local mass effect. A joint decision was made between the local neuro-surgical and neurology departments to manage this conservatively. However, due to progressive neurological deterioration and a concomitant increase in the size of the haemorrhagic lesion, emergent surgical intervention was indicated. The patient underwent a Simpson one complete resection (complete tumour resection including associated dura matter and abnormal underlying bone). Postoperative histology confirmed a rare case of metastatic oesophageal adenocarcinoma to a microcystic meningioma (World Health Organization Grade I). The meningioma was the only known site of distant metastasis for the oesophageal adenocarcinoma. Our case highlights the only documented case of the adenocarcinoma subtype of oesophageal tumour metastasizing to a meningioma. This case demonstrates the rare but well-documented occurrence of tumour to tumour metastasis. It highlights the importance played by imaging and clinical correlation when assessing progressively growing meningiomas in patients with a history of or underlying malignancy.