Em busca de consensos em homeopatia: perspectivas em 2023 / In search of consensus in homeopathy: perspectives in 2023

Consenso também pode ser entendido como anuência, aprovação, licença, concessão e acordo. A comunidade de praticantes da clínica da similitude sempre apresentou uma generosa variedade metodológica em seus procedimentos. Muitas das discussões concentraram-se em aspectos considerados filosóficos encontrados nos textos canônicos da homeopatia, enquanto outras enfocaram os aspectos terapêuticos dos procedimentos clínicos. Diante deste quadro entendemos que se tornou necessário construir um processo dialógico entre os médicos. O desejo é encontrar bases corroborativas que nos permita estabelecer limites e alcances para definir o estado da arte. Nesta procura por consensos mínimos a partir da coleta de informações obtidas através de um formulário, adotou-se a escala de Likert com quatro alternativas para resposta às afirmações contidas em cada questão. Os resultados, junto com dados demográficos da comunidade homeopática brasileira encontram-se representados neste artigo. Esperamos aumentar a representatividade destes acordos durante uma nova consulta nas atividades que serão realizadas na Cidade de São Paulo durante o 36º Congresso Brasileiro de Homeopatia.

Consensus can also be understood as consent, approval, license, concession, and agreement. The similitude clinic's community of practitioners has always displayed generous methodological variety in its procedures. Many of the discussions focused on aspects considered philosophical found in canonical homeopathy texts, while others focused on the therapeutic aspects of clinical procedures. Faced with this situation, we understand that it has become necessary to build a dialogic process between physicians. The desire is to find corroborative bases that allow us to establish limits and scope to define the state of the art. In this search for minimum consensus from the collection of information obtained through a form, the Likert scale was adopted with four alternatives to answer the statements contained in each question. The results, along with demographic data of the Brazilian homeopathic community are represented in this article. We hope to increase the representativeness of these agreements during a new consultation in the activities that will be carried out in São Paulo, during the 36th Brazilian Congress of Homeopathy.

A comparative study of PhD and DNP nurses in an integrated health care system.

BACKGROUND: A vast literature exists on doctorally-prepared RNs in academia, but little is known about those in practice settings. PURPOSE: The purpose of this study was to explore demographic, educational, and employment characteristics, as well as practice patterns and professional accomplishments of doctorally-prepared RNs in one practice setting. METHODS: Survey of approximately 100 doctorally-prepared RNs in an integrated health system were surveyed. DISCUSSION: Doctors of Nursing Practice (DNPs) outnumber PhDs three to one in the institution. Several statistically significant differences exist between them: DNPs are younger and most likely hold advanced practice nursing positions; PhDs are 10 years older and more likely hold administrative or leadership positions. Little evidence exists that neither nurses nor administrators understand the skills and knowledge that doctorally-prepared RNs bring to the organization. This is particularly true for DNPs who predominantly hold clinical positions also held by master's-prepared RNs. CONCLUSION: Advocates for continued growth of DNPs in academia and practice should partner more closely to clarify the skills and talents that doctorally-prepared nurses bring to clinical settings.

Antifungal susceptibility testing practices in mycology laboratories in France, 2018.

A survey of mycology laboratories for antifungal susceptibility testing (AFST) was undertaken in France in 2018, to better understand the difference in practices between the participating centers and to identify the difficulties they may encounter as well as eventual gaps with published standards and guidelines. The survey captured information from 45 mycology laboratories in France on how they perform AFST (number of strains tested, preferred method, technical and quality aspects, interpretation of the MIC values, reading and interpretation difficulties). Results indicated that 86% of respondents used Etest as AFST method, with a combination of one to seven antifungal agents tested. Most of the participating laboratories used similar technical parameters to perform their AFST method and a large majority used, as recommended, internal and external quality assessments. Almost all the participating mycology laboratories (98%) reported difficulties to interpret the MIC values, especially when no clinical breakpoints are available. The survey highlighted that the current AFST practices in France need homogenization, particularly for MIC reading and interpretation.

Diabetes Healthcare Professionals Use Multiple Continuous Glucose Monitoring Data Indicators to Assess Glucose Management.

BACKGROUND: Continuous glucose monitoring (CGM) offers multiple data features that can be leveraged to assess glucose management. However, how diabetes healthcare professionals (HCPs) actually assess CGM data and the extent to which they agree in assessing glycemic management are not well understood. METHODS: We asked HCPs to assess ten de-identified CGM datasets (each spanning seven days) and rank order each day by relative glycemic management (from "best" to "worst"). We also asked HCPs to endorse features of CGM data that were important in making such assessments. RESULTS: In the study, 57 HCPs (29 endocrinologists; 28 diabetes educators) participated. Hypoglycemia and glycemic variance were endorsed by nearly all HCPs to be important (91% and 88%, respectively). Time in range and daily lows and highs were endorsed more frequently by educators (all Ps < .05). On average, HCPs endorsed 3.7 of eight data features. Overall, HCPs demonstrated agreement in ranking days by relative glycemic control (Kendall's W = .52, P < .001). Rankings were similar between endocrinologists and educators (R2 = .90, Cohen's kappa = .95, mean absolute error = .4 [all Ps < .05]; Mann-Whitney U = 41, P = .53). CONCLUSIONS: Consensus in the endorsement of certain data features and agreement in assessing glycemic management were observed. While some practice-specific differences in feature endorsement were found, no differences between educators and endocrinologists were observed in assessing glycemic management. Overall, HCPs tended to consider CGM data holistically, in alignment with published recommendations, and made converging assessments regardless of practice.

[Exploratory study on spinal musculoskeletal health of osteopathy students]. / Étude exploratoire de la santé musculo-squelettique du rachis d'étudiants en ostéopathie.

BACKGROUND: During their training, students in osteopathy regularly undergo spinal manipulation exercises. This exposes the students' spine to unskilled gestures performed by their colleagues learning spinal manipulation. Discomfort, muscle soreness or moderate pain following spinal manipulations lasting two or three days are commonly reported. In addition, some students may have ongoing spinal musculoskeletal disease (SMSD) during their studies. The purpose of this study was to evaluate the prevalence of SMSDs and their maximum intensity in a population of osteopathy students and to determine whether individual differences exist. METHOD: An exploratory cross-sectional study took place over three years. Data were collected by means of a self-administrated standardised questionnaire screening for MSD: the Nordic questionnaire. RESULTS: There were 733 exploitable questionnaires, giving an average response rate of 91.5%. Average prevalence of SMSD was 98.4% during the last 12 months. Average maximum intensity perceived was 6/10 and 45% of students experienced an intense SMSD (scored between 7 and 10/10). Variation of the maximum intensity of SMSD between "before osteopathy studies" and "the last 12 months" was 1.2/10. This variation was influenced by the number of days students were manipulated during a week (p<0.0001). On average, students underwent manipulation three days a week. CONCLUSION: This study confirms the important prevalence of SMSD among osteopathy students. This result led us to carry out a qualitative study for exploring students' conceptions in health and spinal manipulative practices.

Speech and language therapy for primary progressive aphasia across the UK: A survey of current practice.

BACKGROUND: Primary progressive aphasia (PPA) describes a heterogeneous group of language-led dementias. People with this type of dementia are increasingly being referred to speech and language therapy (SLT) services. Yet, there is a paucity of research evidence focusing on PPA interventions and little is known about SLT practice in terms of assessment and provision of intervention. AIMS: To survey the practices of SLTs in the areas of assessment and intervention for people with PPA. METHODS & PROCEDURES: A 37-item, pilot-tested survey was distributed electronically through the Royal College of Speech and Language Therapists (RCSLT), Clinical Excellence Networks (CENs) and social media networks. Survey items included questions on care pathways, assessment and intervention approaches, and future planning. Analysis was conducted using descriptive statistics and thematic analysis. OUTCOMES & RESULTS: A total of 105 SLTs completed the survey. Respondents reported more frequently using formal assessment tools designed for stroke-related aphasia than for dementia. Informal interviews were reportedly always used during assessment by almost 80% of respondents. Respondents were significantly more likely to use communication partner training than impairment-focused interventions. Goal attainment was the most commonly used outcome measure. Respondents provided 88 goal examples, which fell into six themes: communication aid; conversation; functional communication; impairment focused; specific strategy; and communication partner. Additionally, respondents reported addressing areas such as future deterioration in communication and cognition, decision-making and mental capacity, and driving. Ten (9.4%) respondents reported the existence of a care pathway for people with PPA within their service. CONCLUSIONS & IMPLICATIONS: This survey highlights the range of current PPA assessment and intervention practices in use by the respondents. Communication partner training is commonly used by the surveyed SLTs, despite the lack of research evidence examining its effectiveness for PPA. There is a need to develop evidence-based care pathways for people with PPA in order to advocate for further commissioning of clinical services.

Beliefs, practices and knowledge of community pharmacists regarding complementary and alternative medicine: national cross-sectional study in Lebanon.

INTRODUCTION: Pharmacists are uniquely positioned to provide patients with evidence-based information in order to ensure effective and safe use of Complementary and alternative medicine (CAM) products. OBJECTIVE: Assess beliefs, practices and knowledge related to CAM products among community pharmacists in Lebanon. DESIGN, METHODS AND SETTING: Using stratified random sampling, a nationally representative survey was conducted among community pharmacists in Lebanon. Through face-to-face interviews, pharmacists completed a multicomponent questionnaire consisting of four sections: (1) sociodemographic characteristics; (2) beliefs related to regulation of CAM products, role of media in promoting their safe use, availability of resources and continuing education; (3) practices including selling CAM products, providing advice for patients and reporting adverse effects and (4) knowledge about specific CAM products, their uses, side effects and interactions. RESULTS: A total of 341 pharmacists agreed to participate (response rate: 86%). Only pharmacists with complete data were included in this study (n=310). Pharmacists agreed that CAM products are effective (63.8%) and that they should be exclusively sold in pharmacies (80.3%), but disagreed that commercially marketed CAM products are well regulated (63.5%) and that media plays a positive role in educating users about these products (55.8%). As for practices, 64.5% of pharmacists were always or often advising patients on safe use; however, 74.2% of participants rarely or never reported adverse effects. Regarding knowledge, although the majority of pharmacists were aware of the uses of CAM products, fewer knew about their side effects and their interactions with drugs. After adjustment for covariates, receiving education/training on CAM products during university was the sole predictor of higher knowledge score (ß=0.68, 95% CI 0.29 to 1.07). CONCLUSIONS: This study revealed positive beliefs of pharmacists in Lebanon towards CAM products and indicated important gaps in their practice and knowledge. Deliberate efforts to enhance the education of pharmacists are warranted to ensure the safe integration and use of CAM products in Lebanon.

Evaluating the Strength of the Association Between Industry Payments and Prescribing Practices in Oncology.

BACKGROUND: Financial relationships between physicians and the pharmaceutical industry are common, but factors that may determine whether such relationships result in physician practice changes are unknown. MATERIALS AND METHODS: We evaluated physician use of orally administered cancer drugs for four cancers: prostate (abiraterone, enzalutamide), renal cell (axitinib, everolimus, pazopanib, sorafenib, sunitinib), lung (afatinib, erlotinib), and chronic myeloid leukemia (CML; dasatinib, imatinib, nilotinib). Separate physician cohorts were defined for each cancer type by prescribing history. The primary exposure was the number of calendar years during 2013-2015 in which a physician received payments from the manufacturer of one of the studied drugs; the outcome was relative prescribing of that drug in 2015, compared with the other drugs for that cancer. We evaluated whether practice setting at a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, receipt of payments for purposes other than education or research (compensation payments), maximum annual dollar value received, and institutional conflict-of-interest policies were associated with the strength of the payment-prescribing association. We used modified Poisson regression to control confounding by other physician characteristics. RESULTS: Physicians who received payments for a drug in all 3 years had increased prescribing of that drug (compared with 0 years), for renal cell (relative risk [RR] 1.81, 95% confidence interval [CI] 1.58-2.07), CML (RR 1.22, 95% CI 1.08-1.39), and lung (RR 1.69, 95% CI 1.58-1.82), but not prostate (RR 0.97, 95% CI 0.93-1.02). Physicians who received compensation payments or >$100 annually had increased prescribing compared with those who did not, but NCI setting and institutional conflict-of-interest policies were not consistently associated with the direction of prescribing change. CONCLUSION: The association between industry payments and cancer drug prescribing was greatest among physicians who received payments consistently (within each calendar year). Receipt of payments for compensation purposes, such as for consulting or travel, and higher dollar value of payments were also associated with increased prescribing. IMPLICATIONS FOR PRACTICE: Financial payments from pharmaceutical companies are common among oncologists. It is known from prior work that oncologists tend to prescribe more of the drugs made by companies that have given them money. By combining records of industry gifts with prescribing records, this study identifies the consistency of payments over time, the dollar value of payments, and payments for compensation as factors that may strengthen the association between receiving payments and increased prescribing of that company's drug.

How do pharmacists in English general practices identify their impact? An exploratory qualitative study of measurement problems.

BACKGROUND: In England, there is an ongoing national pilot to expand pharmacists' presence in general practice. Evaluation of the pilot includes numerical and survey-based Key Performance Indicators (KPIs) and requires pharmacists to electronically record their activities, possibly by using activity codes. At the time of the study (2016), no national evaluation of pharmacists' impact in this environment had been formally announced. The aim of this qualitative study was to identify problems that English pharmacists face when measuring and recording their impact in general practice. METHODS: All pharmacists, general practitioners (GPs) and practice managers working across two West London pilot sites were invited, via e-mail, to participate in a focus group study. Appropriately trained facilitators conducted two audio-recorded, semi-structured focus groups, each lasting approximately 1 h, to explore experiences and perceptions associated with the KPIs. Audio-recordings were transcribed verbatim and the data analysed thematically. RESULTS: In total, 13 pharmacists, one GP and one practice manager took part in the study. Four major themes were discerned: inappropriateness of the numerical national KPIs ("whether or not we actually have positive impact on KPIs is beyond our control"); depth and breadth of pharmacists' activity ("we see a huge plethora of different patients and go through this holistic approach - everything is looked at"); awareness of practice-based pharmacists' roles ("I think the really important [thing] is that everyone knows what pharmacists in general practice are doing"); and central evaluation versus local initiatives ("the KPIs will be measured by National Health Service England regardless of what we think" versus "what I think is more pertinent, are there some local things we're going to measure?"). CONCLUSIONS: Measures that will effectively capture pharmacists' impact in general practice should be developed, along with a set of codes reflecting the whole spectrum of pharmacists' activities. Our study also points out the significance of a transparent, robust national evaluation, including exploring the needs/expectations of practice staff and patients regarding pharmacists' presence in general practice.

[The Professional Practice of Midwives in Home-based Postnatal Care: A Literature Analysis]. / Die berufliche Praxis von Hebammen in der ambulanten Wochenbettbetreuung: eine Literaturanalyse.

Due to the reduction of the length of stay in hospital, postnatal care today takes place primarily in the ambulant sector. Midwives provide the health care and support young families. This literature study examines home-based postnatal care from the perspectives of midwives with the aim of exploring how midwives provide postnatal care and what influencing factors exist. A systematic literature search was conducted. Studies that integrated the perceptions of midwives during their work in home-based postpartum care were included. A thematic analysis of the selected articles was undertaken. Besides monitoring the health and well-being of mother and child, the focus of postnatal care is on psychosocial aspects and on support and advice on issues concerning the new situation and structural changes in the family. However, midwives do not always feel sufficiently prepared for dealing with complex psychosocial issues and require extra knowledge and better access to information. Besides temporal limitations of midwives, continuity of care as well as different care approaches are also relevant. Home-based postnatal care constitutes complex professional procedures during an important period of life of women and their families. Besides ensuring continuity of care, appropriate knowledge resources and midwifery skills are required. The development of theory-guided concepts, improved training and further training programmes as well as a clearly defined provider contract can support the professional behaviour patterns of midwives.

Prevalence and correlates of vaccine hesitancy among general practitioners: a cross-sectional telephone survey in France, April to July 2014.

This article sought to estimate the prevalence of vaccine hesitancy (VH) among French general practitioners (GPs) and to study its demographic, professional and personal correlates. We conducted a cross-sectional telephone survey about GPs' vaccination-related attitudes and practices in 2014 in a national panel of 1,712 GPs in private practice, randomly selected from an exhaustive database of health professionals in France. A cluster analysis of various dimensions of VH (self-reported vaccine recommendations, perceptions of vaccine risks and usefulness) identified three clusters: 86% of GPs (95% confidence interval (CI): 84-88) were not or only slightly vaccine-hesitant, 11% (95% CI: 9-12) moderately hesitant and 3% (95% CI: 3-4) highly hesitant or opposed to vaccination. GPs in the latter two clusters were less frequently vaccinated and reported occasional practice of alternative medicine more often than those in the first cluster; they also described less experience with vaccine-preventable diseases and more experience with patients who they considered had serious adverse effects from vaccination. This study confirms the presence of VH among French GPs but also suggests that its prevalence is moderate. Given GPs' central role in vaccination, these results nevertheless call for a mobilisation of stakeholders to address VH among GPs.

Predictors of nurses' and midwives' intentions to provide maternal and child healthcare services to adolescents in South Africa.

BACKGROUND: Adolescent mothers are at a much higher risk for maternal mortality compared to mothers aged 20 years and above. Newborns born to adolescent mothers are also more likely to have low birth weight, with the risk of long-term effects such as early onset of adult diabetes than newborns of older mothers. Few studies have investigated the determinants of adequate quality maternal and child healthcare services to pregnant adolescents. This study was conducted to gain an understanding of nurses' and midwives' intentions to provide maternal and child healthcare and family planning services to adolescents in South Africa. METHODS: A total of 190 nurses and midwives completed a cross-sectional survey. The survey included components on demographics, knowledge of maternal and child healthcare (MCH) and family planning (FP) services, attitude towards family planning services, subjective norms regarding maternal and child healthcare and family planning services, self-efficacy with maternal and child healthcare and family planning services, and intentions to provide maternal and child healthcare and family planning services to adolescents. Pearson's correlation analysis was conducted to determine the association between knowledge, attitude, subjective norms, self-efficacy, and intention variables for FP and MCH services. A 2-step linear regression analysis was then conducted for both FP and MCH services to predict the intentions to provide FP and MCH services to adolescents. RESULTS: Self-efficacy to conduct MCH services (ß = 0.55, p < 0.01) and years of experience as a nurse- midwife (ß = 0.14, p < 0.05) were associated with stronger intentions to provide the services. Self-efficacy to provide FP services (ß = 0.30, p < 0.01) was associated with stronger intentions to provide FP services. CONCLUSIONS: Self-efficacy has a strong and positive association with the intentions to provide both MCH and FP services, while there is a moderate association with attitude and norms. There is a need to improve and strengthen nurses' and midwives' self-efficacy in conducting both MCH and FP services in order to improve the quality and utilization of the services by adolescents in South Africa.

Human tissue models for a human disease: what are the barriers?

Asthma represents an area of significant unmet medical need, with few new drugs making it to the clinic in the past 50 years. Much asthma research is currently carried out in non-human models. However, as asthma is a uniquely human condition, it is difficult to translate findings from these models to efficacious therapies. Based on the results of a survey of the UK asthma research community carried out jointly between the NC3Rs, Asthma UK, the UK Respiratory Research Collaborative and the Human Tissue Authority, we propose that more emphasis be placed on the use of human tissue studies to provide more relevant models that better translate to the clinic and which reduce the reliance of the asthma community on less predictive animal models.

[The INSuLa Project: the knowledge survey of company physicians]. / Progetto INSuLa: I'indagine conoscitiva sui medici competenti.

The technological advancements, the occurrence of new emerging occupational risks and diseases, and the changes in the regulatory framework for occupational health and safety induce a constant evolution of occupational medicine. Consequently, the skills and training needs of the occupational physicians should be periodically revalued and upgraded in order to identify technical and operational issues and problems of this discipline. In this context, the aim of this national survey, carried out using a self-administered questionnaire submitted to a sample of 1,237 occupational physicians, has been to gain helpful information to ensure a continuous improvement of the quality and effectiveness of measures aimed at protecting the health and safety of workers. The questionnaire, that consists of 43 questions divided into 5 different areas (personal and professional information, training and updating needs of occupational physicians, professional activities and relationships with the corporate prevention system, relationships with the supervisory board of the Local Health Authority, relationships with the National Health Service), allowed to obtain personal and professional data, to assess the training needs and demands of occupational physicians and to evaluate their relationships with the other stakeholders of the Italian prevention system and with the National Health Service. The preliminary results of this survey appear extremely important. In fact, this findings, highlighting the current problems of occupational physician, constitute the starting point to identify, develop and implement management methodologies, operative procedures and training programs that are effective and modern.

Chiropractic Observation and Analysis Study (COAST): providing an understanding of current chiropractic practice.

OBJECTIVES: COAST (Chiropractic Observation and Analysis Study) aimed to describe the clinical practices of chiropractors in Victoria, Australia. DESIGN: Cross-sectional study using the BEACH (Bettering the Evaluation and Care of Health) methods for general practice. SETTING AND PARTICIPANTS: 180 chiropractors in active clinical practice in Victoria were randomly selected from the list of 1298 chiropractors registered on Chiropractors Registration Board of Victoria. Twenty-four chiropractors were ineligible, 72 agreed to participate, and 52 completed the study. MAIN OUTCOME MEASURES: Each participating chiropractor documented encounters with up to 100 consecutive patients. For each chiropractor-patient encounter, information collected included patient health profile, patient reasons for encounter, problems and diagnoses, and chiropractic care. RESULTS: Data were collected on 4464 chiropractor-patient encounters from 52 chiropractors between 11 December 2010 and 28 September 2012. In most (71%) encounters, patients were aged 25-64 years; 1% of encounters were with infants (age < 1 year; 95% CI, 0.3%-3.2%). Musculoskeletal reasons for encounter were described by patients at a rate of 60 per 100 encounters (95% CI, 54-67 encounters) and maintenance and wellness or check-up reasons were described at a rate of 39 per 100 encounters (95% CI, 33-47 encounters). Back problems were managed at a rate of 62 per 100 encounters (95% CI, 55-71 encounters). The most frequent care provided by the chiropractors was spinal manipulative therapy and massage. CONCLUSIONS: A range of conditions are managed by chiropractors in Victoria, Australia, but most commonly these conditions are musculoskeletal-related. These results can be used by stakeholders of the chiropractic profession in workforce development, education and health care policy.

Anaemia management in patients with inflammatory bowel disease: routine practice across nine European countries.

BACKGROUND AND OBJECTIVES: Anaemia and iron deficiency (ID) are common complications in inflammatory bowel disease (IBD). In patients undergoing iron therapy, intravenous iron supplementation is recommended in preference to oral therapy. This study evaluated routine practice in the management of IBD-associated anaemia and ID to verify implementation of international treatment guidelines. MATERIALS AND METHODS: Gastroenterologists from nine European countries (n=344) were surveyed about their last five IBD patients treated for anaemia (n=1404). Collected information included tests performed at anaemia diagnosis, haemoglobin (Hb) levels and iron status parameters, the anaemia treatment given and, if applicable, the iron administration route. RESULTS: Selection of diagnostic tests and treatment for IBD-associated anaemia varied considerably across Europe. Anaemia and iron status were mainly assessed by Hb (88%) and serum ferritin (75%). Transferrin saturation was only tested in 25% of patients. At diagnosis of anaemia, 56% presented with at least moderate anaemia (Hb<10 g/dl) and 15% with severe anaemia (Hb<8 g/dl). ID (ferritin<30 ng/ml) was detected in 76%. Almost all patients (92%) received iron supplementation; however, only 28% received intravenous iron and 67% oral iron. Management practice was similar in 2009 and 2011. CONCLUSION: In clinical practice, most IBD patients received oral iron even though this administration route may aggravate the disease, and despite international guidelines recommending intravenous administration as the preferred route. The high frequency of ID suggests insufficient monitoring of iron status in IBD patients. There is a need to increase awareness and implementation of international guidelines on iron supplementation in patients with IBD.

[Knowledge and attitudes of medical personnel in blood transfusion in Bamako, Mali]. / Connaissances et attitudes du personnel médical en matière de transfusion sanguine au Mali.

PURPOSE OF THE STUDY: We undertook a study to determine the level of knowledge and practice of medical staff personnel on transfusion medicine in Mali at Bamako and Kati. PATIENTS AND METHODS: The study was conducted from January to April 2010 in the three main teaching hospitals of Bamako and Kati and in the six referral health centers of the district of Bamako. Medical staff knowledge and practice were assessed using a questionnaire. The study population consisted of specialized practitioners (15%), general practitioners (21.4%), nurses (41.6%), and midwives (22%). RESULTS: Overall, 70.9% of the staff did not receive any training in blood transfusion since their graduation. The general knowledge about blood transfusion was insufficient in 53.9% of staff and excellent in 46.1%. Only 42.9% of medical staff has a good basic knowledge of blood products, their indications, and related accidents. CONCLUSION: Our study showed weaknesses in the transfusion system in Bamako, with insufficient knowledge of the medical staff in blood transfusion and little experience.

Pharmacist provision of primary health care: a modified Delphi validation of pharmacists' competencies.

BACKGROUND: Pharmacists have expanded their roles and responsibilities as a result of primary health care reform. There is currently no consensus on the core competencies for pharmacists working in these evolving practices. The aim of this study was to develop and validate competencies for pharmacists' effective performance in these roles, and in so doing, document the perceived contribution of pharmacists providing collaborative primary health care services. METHODS: Using a modified Delphi process including assessing perception of the frequency and criticality of performing tasks, we validated competencies important to primary health care pharmacists practising across Canada. RESULTS: Ten key informants contributed to competency drafting; thirty-three expert pharmacists replied to a second round survey. The final primary health care pharmacist competencies consisted of 34 elements and 153 sub-elements organized in seven CanMeds-based domains. Highest importance rankings were allocated to the domains of care provider and professional, followed by communicator and collaborator, with the lower importance rankings relatively equally distributed across the manager, advocate and scholar domains. CONCLUSIONS: Expert pharmacists working in primary health care estimated their most important responsibilities to be related to direct patient care. Competencies that underlie and are required for successful fulfillment of these patient care responsibilities, such as those related to communication, collaboration and professionalism were also highly ranked. These ranked competencies can be used to help pharmacists understand their potential roles in these evolving practices, to help other health care professionals learn about pharmacists' contributions to primary health care, to establish standards and performance indicators, and to prioritize supports and education to maximize effectiveness in this role.

Exploring knowledge and attitudes towards counselling about vitamin supplements in Jordanian community pharmacies / Explorando el conocimiento y actitudes hacia el asesoramiento sobre suplementos vitamínicos en farmacias comunitarias jordanas

The use of multivitamins within a pharmaceutical setting has been the subject of considerable debate. Objective: This research aimed to provide a platform for assessing and evaluating knowledge, attitudes and professional practices of Jordaninan community pharmacists in counselling patients about the safe consumption of vitamins. Methods: A cross-sectional study was conducted between October 2009 and May 2010. Data collection was carried out using a 44-item semistructured self-administrated questionnaire. Setting: Community pharmacies in Amman with target sample of 400 pharmacists. Results: A total of 388 pharmacists participated in this study. The majority (77.8%) of pharmacists believed that a balanced diet is more achievable by eating healthily than by vitamins supplements. 78.1% of participants believed that vitamins deficiency would not shorten life spans, while 80.7% agreed that vitamin supplements could be toxic or might contain unlabelled harmful ingredients. Less than half of pharmacists were aware that some antioxidant vitamins have been verified to be of unproven value, or may even cause cancer. While over 80% of pharmacists would recommend vitamins on a regular basis without prescription, the majority agreed that counselling on vitamin supplements is part of their role in pharmaceutical care (93.3%), in addition to providing relevant information to other healthcare professionals (78.4%). Moreover, responses to specific knowledge questions, such as the interactions of vitamins with drugs or the recommended dietary allowance of vitamins for infants, children, and pregnant women, were negative. Furthermore, only a minority of pharmacists would recheck the accuracy of dose regimens in prescriptions and symptoms of true vitamins deficiency or would follow up patients to record any consequences of vitamins consumption. Conclusion: The questionnaire revealed satisfactory awareness of community pharmacists about their role in counselling; however, further programmes to update their knowledge are mandatory to emphasise the importance of vitamin supplements as part of complementary medicine, and their exclusion from being considered as merely over the counter (OTC) products (AU)

El uso de multivitamínicos en la Farmacia ha estado sujeto a considerable debate. Objetivo: Esta investigación trato de proporcionar una plataforma evaluar el conocimiento, actitudes y práctica profesional de los farmacéuticos comunitarios de Jordania hacia el asesoramiento de pacientes sobre el consume seguro de vitaminas. Métodos: Se realizó un estudio transversal entre octubre 2009 y mayo 2010. La recogida de datos se hizo usando un cuestionario semi-estructurado y auto-administrado de 44 ítems. Entorno: Farmacias comunitarias de Amman, con un objetivo de muestreo de 400 farmacéuticos. Resultados: Un total de 388 farmacéuticos participaron en el estudio. La mayoría de los farmacéuticos (77,8%) creía que era más fácil conseguir una dieta equilibrada comiendo sano que con suplementos vitamínicos. El 78,1% de los participantes creía que las deficiencias de vitaminas no acortarían los intervalos de vida, mientras que el 80,7% aceptó que los suplementos vitamínicos podrían ser tóxicos o podrían contener ingredientes no declarados peligrosos. Menos de la mitad de los farmacéuticos eran conocedores de que algunas vitaminas antioxidantes eran de valor no demostrado o podrían incluso producir cáncer. A su vez, más del 80% de los farmacéuticos recomendaría vitaminas de forma regular sin prescripción, la mayoría aceptó que el asesoramiento sobre suplementos vitamínicos es parte de su papel en cuidados farmacéuticos (93,3%), además de proporcionar información relevante a otros profesionales de la salud (78,4%). Las respuestas a preguntas específicas de conocimiento, tales como interacciones de las vitaminas con medicamentos, o las recomendaciones diarias de ingesta de vitaminas para bebés, niños y embarazadas, fueron negativas. Sólo una minoría de farmacéuticos verificaría la certeza de la dosis de regímenes prescritos y los síntomas de verdaderas deficiencias vitamínicas, o seguiría a los pacientes para registrar las consecuencias del consumo de vitaminas. Conclusión: El cuestionario reveló un conocimiento satisfactorio de los farmacéuticos comunitarios sobre su papel en asesoramiento; sin embargo, son necesarios nuevos programas para actualizar sus conocimientos y para enfatizar la importancia de los suplementos vitamínicos como parte de la medicina complementaria, y el abandono de considerar que son meramente productos OTC (AU)