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The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.
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Educação Médica , Planetas , Currículo , Atenção à Saúde , Europa (Continente) , HumanosRESUMO
BACKGROUND: Extreme heat (EH) events are increasing in frequency and duration and cause more deaths in Australia than any other extreme weather event. Consequently, EH events lead to an increase in the number of patient presentations to hospitals. METHODS: Climatic observations for Hobart's region and Royal Hobart Hospital (RHH) emergency department admissions data were collected retrospectively for the study period of 2003-2010. A distributed lag non-linear model (DLNM) was fitted using a generalized linear model with quasi-Poisson family to obtain adjusted estimates for the relationship between temperature and the relative risk of being admitted to the RHH. RESULTS: The model demonstrated that relative to the annual mean temperature of 14°C, the relative risk of being admitted to the RHH for the years 2003-2010 was significantly higher for all temperatures above 27°C (P < 0.05 in all cases). The peak effect upon admission was noted on the same day as the EH event, however, the model suggests that a lag effect exists, increasing the likelihood of admission to the RHH for a further 14 days. CONCLUSIONS: To relieve the added burden on emergency departments during these events, adaptation strategies adopted by public health organizations could include preventative health initiatives.
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Calor Extremo , Austrália/epidemiologia , Serviço Hospitalar de Emergência , Calor Extremo/efeitos adversos , Hospitalização , Hospitais , Humanos , Estudos RetrospectivosRESUMO
OBJECTIVE: To explore community pharmacy consumers' knowledge and attitudes of mental illness, support services, and community pharmacists' role in supporting people living with mental illness (PLMI). METHODS: This survey was conducted in 15 community pharmacies between June and September 2019. Participants were aged 18 years or older without prior or ongoing history of mental illness and/or with close family members with mental illness. Open-ended responses to the anonymous questionnaire were analysed using content analysis. KEY FINDINGS: Majority of the 380 participants were female (57.4%) with a mean age 52.9 years and 33.7% having completed university. Most (70.3%) believed that people with mental illness had a negative image due to poor health literacy providing possible solutions of 'awareness campaigns', 'education and training', and 'increased government funding for mental health (MH) support services'. Only 33.7% and 63.7% of participants were aware of Mental Health Week and the R U OK? Campaign, respectively. Whilst 12.4% of participants had participated in MH campaigns, only 3.4% were aware of community pharmacists-led MH educational activities. There were significant differences between adults (<65 years) and older adults (≥65 years old) with the latter reporting a more negative image for mental illness (P < 0.05) and having less exposure and engagement with MH resources (P < 0.001) and campaigns (P < 0.01). CONCLUSION: Despite awareness, participants reported low engagement with MH campaigns. Additionally, older adults had lower MH literacy and exposure to resources and campaigns. This study highlighted that the community lacked awareness of what pharmacists can offer to support PLMIs.
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Serviços Comunitários de Farmácia , Transtornos Mentais , Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Farmacêuticos/psicologia , Saúde Mental , Transtornos Mentais/terapia , Promoção da Saúde , Atitude do Pessoal de Saúde , Percepção , Papel ProfissionalRESUMO
Background: Given the negative environmental impacts of pharmaceuticals, including their contribution to healthcare's carbon footprint, pharmacists have a role in responding to the climate and biodiversity crises. Knowledge and education are required to support transitions to environmentally sustainable pharmacy practice (ESPP). The aim of this study was to explore Australian undergraduate pharmacy students' knowledge and attitudes towards environmental sustainability and ESPP curriculum content. Methods: Participants were surveyed using an anonymous online questionnaire deployed using Qualtrics. The questionnaire comprised of two main sections: the 15-item New Ecological Paradigm (NEP) scale to determine participants' environmental attitude score, and section on students' perceptions and curricular experience of environmentally sustainable practice which was adapted from previously published surveys. The invitation with survey link was disseminated via social media, Australian pharmacy student organisations, and direct approach. Quantitative data were reported descriptively. Qualitative data from responses to open-ended questions were analysed thematically using a reflexive, recursive approach. Incomplete survey responses were excluded from the analysis. Results: Of the 164 complete responses, 99% had previously received information on environmental sustainability. However, only 10% were knowledgeable about ESPP and only 8.5% were aware of ESPP content in their pharmacy school curriculum. Importantly, 70% of respondents saw ESPP as relevant to their future pharmacy practice, and 94% believed the pharmacy profession has a responsibility to undertake sustainability initiatives in the delivery of pharmaceutical care. Conclusions: Australian pharmacy students lacked knowledge of ESPP and few reported having curricular exposure to ESPP content in their pharmacy degrees. Therefore, ESPP content is an important area for development in pharmacy curricula.
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OBJECTIVES: NHS England has set itself a target of net zero emissions by 2050. Therefore, to address this gap in the literature, this study aimed to explore engagement with NHS policy on carbon reduction (including awareness of the Sustainable Development Unit [SDU] and the Coalition for Sustainable Pharmaceuticals and Medical Devices [CSPM]) in NHS hospital pharmacists in England. METHODS: Semi-structured interviews were conducted with 23 pharmacists working in six NHS England hospitals across all hierarchical levels. Four interview questions elicited Yes/No responses and one generated qualitative data which were analysed by two methods - Leximancer and manual coding. KEY FINDINGS: Only five (5/23; 21.74%) had heard of the SDU and none knew its purpose. Those who did not wish to learn more about the SDU could not see its relevance to their clinical practice. Barriers identified to the inclusion of sustainability considerations in clinical decision-making were lack of knowledge of the environmental risk profiles for treatment options, lack of quality environmental evidence incorporated into clinical guidelines and lack of time to research for themselves. Many participants did not believe that environmental considerations were part of their job. CONCLUSIONS: For NHS England to successfully deliver on its target of net zero emissions by 2050, immediate action is required from all hospital staff, clinicians included. The challenge for the NHS will be engaging pharmacists and other clinicians with sustainable clinical practice and working with clinicians to reduce identified barriers. As these data were collected in 2016, further research is warranted to determine if pharmacists' attitudes towards sustainable practice are changing.
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Farmacêuticos , Medicina Estatal , Atitude do Pessoal de Saúde , Inglaterra , Hospitais , Humanos , Políticas , Pesquisa QualitativaRESUMO
OBJECTIVES: In the aftermath of a disaster, the services provided by pharmacists are essential to ensure the continued health and well-being of the local population. To continue pharmacy services, it is critical that pharmacists are prepared for disasters. A systematic literature review was conducted to explore pharmacists' and pharmacy students' preparedness for disasters and the factors that affect preparedness. METHODS: This review was conducted in April 2020 through electronic databases CINAHL, MEDLINE, Embase, PubMed, Scopus and PsycINFO, and two disaster journals. Search terms such as 'pharmacist*', 'disaster*' and 'prepared*' were used. The search yielded an initial 1781 titles. Articles were included if they measured pharmacists or pharmacy students' disaster preparedness. After screening and quality appraisal by two researchers, four articles were included in final analysis and review. Data were extracted using a data collection tool formulated by the researchers. Meta-analysis was not possible; instead, results were compared across key areas including preparedness ratings and factors that influenced preparedness. KEY FINDINGS: Three articles focused on pharmacy students' preparedness for disasters, and one on registered pharmacists' preparedness. Preparedness across both groups was poor to moderate with <18% of registered pharmacists found to be prepared to respond to a disaster. Factors that potentially influenced preparedness included disaster competency, disaster interventions and demographic factors. CONCLUSION: For pharmacists, the lack of research around their preparedness speaks volumes about their current involvement and expectations within disaster management. Without a prepared pharmacy workforce and pharmacy involvement in disaster management, critical skill and service gaps in disasters may negatively impact patients.
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Desastres , Assistência Farmacêutica , Farmácia , Estudantes de Farmácia , Humanos , FarmacêuticosRESUMO
Pharmaceuticals and their packaging have a significant negative impact on the environment providing a very strong argument for action on the part of pharmacists and pharmacy technicians to engage with pro-environmental behaviours (PEBs) in their workplaces. The aims of this research were therefore to investigate in hospital pharmacists and pharmacy technicians, 1) factors affecting engagement with workplace PEBs, and 2) determine if legislated carbon reduction targets in the UK influenced workplace PEBs in the UK compared with Australia which does not have legislated carbon reduction targets. The environmentally responsible disposal of pharmaceutical waste was the PEB of interest in this study. A mixed methods research design was utilised and a conceptual model (key variables: environmental attitude, concern, and knowledge, and organisational factors) was developed to identify factors influencing workplace PEBs. Participants were from five hospitals in Queensland, Australia and five NHS hospitals in England, UK. There was no statistically significant difference in environmental attitude or concern between the two groups-most had a mid-environmental attitude score and low levels of environmental concern. Participants lacked knowledge of the issue and the link between the environment and public health. Both Australian and UK participants reported recycling packaging waste was not a priority in the hospital pharmacy workplace (even in hospitals with recycling capability) as hospitals focused on compliance with clinical (contaminated) and confidential waste streams. Environmental attitude, knowledge, and concern therefore appeared to be weak influences on intention to perform workplace PEBs with workplace social norms (compliance due to audits) appearing to be a significant mediator of action. The key difference between the cohorts was that UK pharmacists felt waste was not in the scope of their role, and therefore not their responsibility. This study identified that legislated carbon reduction targets did not influence hospital pharmacy workplace PEBs-neither cohort reported engaging significantly in workplace PEBs. UK Government and NHS sustainability policy did not appear to have disseminated to pharmacy department level of UK public hospitals to any great extent.
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Carbono , Serviço de Farmácia Hospitalar , Adulto , Humanos , Farmácias , Reino UnidoRESUMO
INTRODUCTION: In a disaster aftermath, pharmacists have the potential to provide essential health services and contribute to the maintenance of the health and well-being of their community. Despite their importance in the health care system, little is known about the factors that affect pharmacists' disaster preparedness and associated behaviors. STUDY OBJECTIVE: The goal of this study was to determine the factors that influence disaster preparedness behaviors and disaster preparedness of Australian pharmacists. METHODS: A 70-question survey was developed from previous research findings. This survey was released online and registered Australian pharmacists were invited to participate. Multiple linear regression was used to determine the factors that influenced preparedness and preparedness behaviors among pharmacists. RESULTS: The final model of disaster preparedness indicated that 86.0% of variation in preparedness was explained by disaster experience, perceived knowledge and skills, colleague preparedness, perceived self-efficacy, previous preparedness behaviors, perceived potential disaster severity, and trust of external information sources. The final model of preparedness behaviors indicated that 71.1% of variation in previous preparedness behaviors can be explained by disaster experience, perceived institution responsibility, colleague preparedness, perceived likelihood of disaster, perceived professional responsibility, and years of practice as a pharmacist. CONCLUSION: This research is the first to explore the significant factors affecting preparedness behaviors and preparedness of Australian pharmacists for disasters. It begins to provide insight into potential critical gaps in current disaster preparedness behaviors and preparedness among pharmacists.
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Planejamento em Desastres , Desastres , Austrália , Estudos Transversais , Humanos , Farmacêuticos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Cyclones can significantly impact on communities and their healthcare services. Community members with chronic diseases, including opioid dependence, who rely on these healthcare services are placed at an increased risk of treatment disruption during a disaster event. Disruptions to the continuity of the opioid replacement therapy (ORT) service can potentially lead to relapse, withdrawal, and risky behaviours in clients with potential repercussions for the community. OBJECTIVE: To explore the effects of Queensland (QLD) cyclones on opioid treatment programs within Queensland community and hospital pharmacies from three perspectives. METHOD: Qualitative research methods were used. Participants comprised five community pharmacists, four Queensland opioid treatment program (QOTP) employees, and five public hospital pharmacists. Participants were identified as they had worked in Townsville, Rockhampton, Mackay, or Yeppoon in a community impacted by a cyclone and involved with ORT supply. Interviews were recorded and data were analysed by two methods - manual coding and the text analytics software Leximancer®. RESULTS: The two themes that emerged from the manual coding process were 'disaster preparedness' and 'continuity of service'. The key themes from the Leximancer® analysis aligned with the two manual coding themes with no new themes identified. Primary dosing site closures in disaster-affected areas led to increased pressures on hospitals and other community pharmacy dosing sites to supply ORT doses to clients. However, a lack of dosing information available to pharmacists and strict legislative requirements made continuity of ORT supply during these cyclones difficult. CONCLUSION: Continuation of ORT services during and in the aftermath of a cyclone event is complex. This research highlighted a need for a coordination of efforts and shared dosing information between QOTP employees, community pharmacists, and hospital pharmacists. To improve continuity of ORT services, it is essential that these stakeholders engage with each other in preparing for and responding to future events.
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Serviços Comunitários de Farmácia , Tempestades Ciclônicas , Analgésicos Opioides , Atitude do Pessoal de Saúde , Austrália , Humanos , Tratamento de Substituição de Opiáceos , Farmacêuticos , Papel Profissional , QueenslandRESUMO
Objective The aim of this study was to explore whether a relationship exists between the number of disasters a jurisdiction has experienced and the presence of disaster-specific pharmacy legislation. Methods Pharmacy legislation specific to disasters was reviewed for five countries: Australia, Canada, UK, US and New Zealand. A binary logistic regression test using a generalised estimating equation was used to examine the association between the number of disasters experienced by a state, province, territory or country and whether they had disaster-specific pharmacy legislation. Results Three of six models were statistically significant, suggesting that the odds of a jurisdiction having disaster-specific pharmacy legislation increased as the number of disasters increased for the period 2007-17 and 2013-17. There was an association between the everyday emergency supply legislation and the presence of the extended disaster-specific emergency supply legislation . Conclusions It is evident from this review that there are inconsistencies as to the level of assistance pharmacists can provide during times of crisis depending on their jurisdiction and location of practice. It is not a question of whether pharmacists have the skills and capabilities to assist, but rather what legislative barriers are preventing them from being able to contribute further to the disaster healthcare team. What is known about the topic? The contributing factors to disaster-specific pharmacy legislation has not previously been explored in Australia. It can be postulated that the number of disasters experienced by a jurisdiction increases the likelihood of governments introducing disaster-specific pharmacy legislation based on other countries. What does this paper add? This study compared five countries and their pharmacy legislation specific to disasters. It identified that as the number of disasters increases, the odds of a jurisdiction having disaster-specific emergency supply or disaster relocation or mobile pharmacy legislation increases. However, this is likely to be only one of many factors affecting the political decisions of when and what legislation is passed in relation to pharmacists' roles in disasters. What are the implications for practitioners? Pharmacists are well situated in the community to be of assistance during disasters. However, their ability to help patients with chronic disease management or providing necessary vaccinations in disasters is limited by the legislation in their jurisdiction. Releasing pharmacists' full potential in disasters could alleviate the burden of low-acuity patients on other healthcare services. This could subsequently free up other healthcare professionals to treat high-acuity patients and emergencies.
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Desastres/estatística & dados numéricos , Legislação Farmacêutica/estatística & dados numéricos , Farmacêuticos/legislação & jurisprudência , Medicamentos sob Prescrição , Austrália , Canadá , Serviços Comunitários de Farmácia , Humanos , Nova Zelândia , Papel Profissional , Reino Unido , Estados Unidos , Vacinação/legislação & jurisprudênciaRESUMO
INTRODUCTION: Human-induced climate change is increasing the likelihood and severity of wildfires across the globe. This has negative consequences for the health of affected communities through the loss of health systems' infrastructure and disrupted health services. Community pharmacies are a central hub between patients and the health care system and can provide continuity of care during wildfires. However, there is little in peer-reviewed literature about the impacts of wildfires on community pharmacy operations. STUDY OBJECTIVE: The aim of this study was therefore to explore the impacts of the 2018/2019 summer bushfires in Tasmania, Australia on community pharmacy operations in affected areas. METHODS: Semi-structured telephone interviews were conducted with four community pharmacists who were working in the affected region during the bushfires. Interviews were audio recorded and transcribed verbatim. Qualitative data were analyzed using two methods- manual coding utilizing NVivo software and Leximancer analysis. Inter-rater reliability was ensured by two researchers analyzing the data independently. Differences in coding were discussed and agreement reached through negotiation amongst the research team. RESULTS: From the manual coding analysis, five key themes emerged - communication and collaboration; support; patient health challenges; pharmacist experiences in delivering health care; and future planning. These aligned with the five themes that emerged from the Leximancer analysis - community; local; town; patients; and work. Participants described working during the wildfires as difficult, with multiple challenges reported including communication difficulties, operational barriers such as power cuts, legislative barriers, logistical issues with obtaining and storing medication supplies, and lack of preparation, support, and funding. They highlighted a lack of operational and financial support from the government and received most assistance from local council bodies and local branches of professional pharmacy organizations. CONCLUSION: During disasters, community pharmacies help reduce the burden on public hospitals by maintaining medication supplies and treating patients with minor ailments. However, increased support and inclusion in disaster management planning is needed to continue this role.
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Atitude do Pessoal de Saúde , Atenção à Saúde , Incêndios , Assistência Farmacêutica , Farmácias/organização & administração , Planejamento em Desastres , Humanos , TasmâniaRESUMO
BACKGROUND: In addition to the traditional logistics role, pharmacists are undertaking important new roles in disasters. Despite this, little is known about the level of acceptance of these activities by other providers. PROBLEM: The aim of this study was to determine the international opinion of disaster and health professionals regarding the emerging roles of pharmacists in disasters. METHODS: Delegates at the World Association for Disaster and Emergency Medicine's (WADEM; Madison, Wisconsin USA) 20th Congress in Toronto, Canada (April 2017) were invited to complete an anonymous survey posing eight questions regarding attitudes towards pharmacists' roles in disasters. Quantitative data were analyzed using IBM (IBM Corp.; Armonk, New York USA) SPSS statistical software version 23, and qualitative data were manually coded. RESULTS: Of the 222 surveys handed out, 126 surveys were completed yielding a 56.8% response rate. Of the respondents, 96.8% (122/126) believed pharmacists had a role in disasters additional to logistics. Out of 11 potential roles pharmacists could perform in a disaster, provided on a 5-point Likert scale, eight roles were given a rating of "Agree" or "Strongly Agree" by 72.4% or more of the participants. Lack of understanding of a pharmacist's roles and capabilities was the highest described barrier to pharmacists' roles in disaster management. CONCLUSIONS: This multi-disciplinary disaster health "community" agreed pharmacists have roles in disasters in addition to the established role in supply chain logistics. Participants accepted that pharmacists could possibly undertake numerous clinical roles in a disaster. Several barriers were identified that may be preventing pharmacists from being further included in disaster health management planning and response.WatsonKE, TippettV, SingletonJA, NissenLM. Disaster health management: do pharmacists fit in the team?Prehosp Disaster Med. 2019;34(1):30-37.
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BACKGROUND AND PURPOSE: Students find clinical pharmacokinetics and pharmacodynamics courses challenging, partly due to their mathematical nature. This study aimed to retrospectively evaluate the impact of "feedback quizzes" on the experiences and academic performance of undergraduate pharmacy students at an Australian university. EDUCATIONAL ACTIVITY AND SETTING: Formative paper-based quizzes were introduced into tutorials in an intermediate third-year pharmacokinetics course, and summative online quizzes were introduced into a subsequent advanced fourth-year course that included a pharmacokinetics component. Experience data were drawn from institutional student evaluation surveys, and academic performance was obtained from exam results. Student experiences and academic performance were compared pre- and post-intervention using the Test of Equal Proportions and Mann-Whitney-Wilcoxon, respectively. FINDINGS: A greater proportion of students in both quiz cohorts were satisfied with the overall course experience compared to the pre-curricular change cohort (intermediate: 87% vs. 78%; advanced: 63% vs. 50%). Students who received quizzes in both years performed better in the clinical pharmacokinetics component of the advanced course compared to a prior cohort who had no quizzes (85.7% vs. 77.8%). SUMMARY: Feedback quizzes, whether formative or summative, administered in-class or outside class, can enhance learning and performance and lead to improvements in student satisfaction with clinical pharmacokinetics courses. Scaffolding of feedback quizzes across year levels can provide students with added confidence when attempting assessment. Collaboration between research-focused and teaching-focused staff can lead to increased scholarship of teaching and learning activities.
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Desempenho Acadêmico/normas , Currículo/normas , Retroalimentação , Farmacocinética , Estudantes de Farmácia/psicologia , Desempenho Acadêmico/psicologia , Desempenho Acadêmico/estatística & dados numéricos , Adulto , Educação em Farmácia/métodos , Educação em Farmácia/normas , Educação em Farmácia/estatística & dados numéricos , Avaliação Educacional/métodos , Feminino , Humanos , Masculino , Aprendizagem Baseada em Problemas/métodos , Aprendizagem Baseada em Problemas/normas , Queensland , Estatísticas não Paramétricas , Estudantes de Farmácia/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The number of jurisdictions allowing access to medicinal cannabis has been steadily increasing since the state of California introduced legislation in 1996. Although there is a high degree of legislative heterogeneity across jurisdictions, the involvement of a health professional is common among all. This places health professionals at the forefront of therapy, yet no systematic review of literature has offered insight into the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis. METHODS: Using a predetermined study protocol, PubMed, EMBASE, PsycINFO, CINAHL, and Scopus databases were searched for studies indexed up to the 1st August 2018. Pre-defined inclusion and exclusion criteria were applied uniformly. Screening for relevancy, full-text review, data extraction, and risk of bias were completed by two independent investigators. Risk of bias was assessed using CASP criteria (qualitative) and a modified domain-based risk assessment tool (quantitative). RESULTS: Of the 15,775 studies retrieved, 106 underwent full-text review and of these, 26 were included. The overall risk of bias was considered low across all included studies. The general impression was that health professionals supported the use of medicinal cannabis in practice; however, there was a unanimous lack of self-perceived knowledge surrounding all aspects of medicinal cannabis. Health professionals also voiced concern regarding direct patient harms and indirect societal harms. CONCLUSION: This systematic review has offered a lens through which to view the existing literature surrounding the beliefs, knowledge, and concerns of health professionals regarding medicinal cannabis. These results are limited, however, by the implicit common-sense models of behaviour utilised by the included studies. Before strategies can be developed and implemented to change health professional behaviour, a more thorough understanding of the factors that underpin the delivery of medicinal cannabis is necessary.
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Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Abuso de Maconha/prevenção & controle , Maconha Medicinal/administração & dosagem , Cultura , HumanosRESUMO
INTRODUCTION: Pharmacists are uniquely placed in the community to be of assistance to disaster-affected patients. However, the roles undertaken by pharmacists in disasters are identified based on their own experiences and networks. There is currently no definition or acknowledgment of pharmacists' roles in disasters. OBJECTIVE: To acquire consensus from an expert panel of key opinion leaders within the field of disaster health on pharmacists' roles in disasters throughout the four disaster phases-prevention, preparedness, response, and recovery. METHODS: A Delphi study consisting of three rounds of online surveys was utilised. Twenty-four key opinion leaders were contacted, with 15 completing all three rounds. The 15 expert panellists were presented with 46 roles identified in the literature and asked to rank their opinions on a 5-point Likert scale. This study used an international, all-hazard, and multijurisdictional approach. Consensus was benchmarked at 80% and any role which did not reach consensus was re-queried in the subsequent round. The third round provided the results of the Delphi study and sought commentary on the acceptance or rejection of the roles. RESULTS: Of the 46 roles provided to the expert panel, 43 roles were accepted as roles pharmacists are capable of undertaking in a disaster. There were five roles for the prevention phase, nine for the preparedness phase, 21 for the response phase, and eight for the recovery phase. The experts were asked to prioritise the top five roles for each of the disaster phases. The three roles which did not make consensus were deemed to be specialised roles for disaster pharmacists and not generalisable to the broader pharmacy profession. CONCLUSION: This study identifies pharmacists' roles in disasters which have been accepted by the international disaster health community. The international key opinion leaders recommended that pharmacists could be undertaking 43 roles in a disaster, however, this is dependent on individual jurisdiction considerations. Pharmacy professional associations need to advocate to policymakers for legislative support and to ensure pharmacists are equipped with the training and education required to undertake these roles within specific jurisdictions.
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Desastres , Assistência Farmacêutica , Farmacêuticos , Consenso , Técnica Delphi , Humanos , Papel ProfissionalRESUMO
OBJECTIVE/S: The aim of this study was to explore Queensland hospital pharmacists' and pharmacy technicians' knowledge and understanding of the impact of pharmaceuticals on the environment and the handling of pharmaceutical waste. METHODS: This study followed a mixed methods research design. Purposive sampling techniques were used to recruit 64 hospital pharmacists and pharmacy technicians working in five public and private hospitals, in metropolitan and regional Queensland, Australia. Both quantitative and qualitative data were collected. Qualitative data were analysed using both the text analytics using descriptive statistics. KEY FINDINGS: Lack of environmental knowledge regarding the impact of pharmaceuticals on the environment and lack of understanding of systems thinking concepts (that all living things are part of the one environment or system, and therefore any negative impacts on the environment will ultimately have negative impacts on human health) were the key findings of this research. Interviewees expressed concern, but most expressed minimal personal concern, about the impact of pharmaceuticals entering the environment. Most interviewees were unsure as to best practice methods for the disposal of pharmaceutical waste, and by complying with hospital policy assumed appropriate disposal occurred. CONCLUSION: Before the pharmacy profession can take up a leadership role in the more sustainable use of pharmaceuticals, pharmacists and pharmacy technicians require environmental information regarding the negative impacts of pharmaceuticals on the environment, and education on systems thinking to enable them to understand that any negative impacts on the environment will ultimately have negative impacts on human health.
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Poluição Ambiental/prevenção & controle , Preparações Farmacêuticas , Serviço de Farmácia Hospitalar/organização & administração , Gerenciamento de Resíduos , Local de Trabalho/organização & administração , Atitude do Pessoal de Saúde , Serviços Comunitários de Farmácia , Feminino , Humanos , Liderança , Masculino , Farmacêuticos/organização & administração , Farmacêuticos/psicologia , Técnicos em Farmácia/organização & administração , Técnicos em Farmácia/psicologia , Papel Profissional , Pesquisa Qualitativa , Queensland , SoftwareRESUMO
BACKGROUND: The past decade has seen a rapid change in the climate system with an increased risk of extreme weather events. On and following the 3rd of January 2013, Tasmania experienced three catastrophic bushfires, which led to the evacuation of several communities, the loss of many properties, and a financial cost of approximately AUD$80 million. OBJECTIVE: To explore the impacts of the 2012/2013 Tasmanian bushfires on community pharmacies. METHOD: Qualitative research methods were undertaken, employing semi-structured telephone interviews with a purposive sample of seven Tasmanian pharmacists. The interviews were recorded and transcribed, and two different methods were used to analyze the text. The first method utilized Leximancer® text analytics software to provide a birds-eye view of the conceptual structure of the text. The second method involved manual, open and axial coding, conducted independently by the two researchers for inter-rater reliability, to identify key themes in the discourse. RESULTS: Two main themes were identified - 'people' and 'supply' - from which six key concepts were derived. The six concepts were 'patients,' 'pharmacists,' 'local doctor,' 'pharmacy operations,' 'disaster management planning,' and 'emergency supply regulation.' CONCLUSION: This study identified challenges faced by community pharmacists during Tasmanian bushfires. Interviewees highlighted the need for both the Tasmanian State Government and the Australian Federal Government to recognize the important primary care role that community pharmacists play during natural disasters, and therefore involve pharmacists in disaster management planning. They called for greater support and guidance for community pharmacists from regulatory and other government bodies during these events. Their comments highlighted the need for a review of Tasmania's three-day emergency supply regulation that allows pharmacists to provide a three-day supply of a patient's medication without a doctor's prescription in an emergency situation.
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Serviços Comunitários de Farmácia/organização & administração , Desastres , Incêndios , Farmacêuticos/organização & administração , Atitude do Pessoal de Saúde , Humanos , Entrevistas como Assunto , Variações Dependentes do Observador , Papel Profissional , Reprodutibilidade dos Testes , TasmâniaRESUMO
There is considerable interest in developing immunotherapeutic approaches to elicit tumor-specific CTL responses in cancer patients. Epitope-based approaches aim to deliver the antigenic peptides or epitopes recognized by CTLs rather than the intact tumor antigen. Many tumor-associated proteins are nonmutated self proteins for which the dominant peptide epitopes are usually poorly immunogenic. The subdominant epitopes, however, can elicit robust T cell responses if optimized for their ability to bind to class I MHC molecules. Only the epitopes for a few tumor antigens expressed in human cancers have been defined to this level, mainly for technical reasons. The means to rapidly screen and characterize the binding of epitopes derived from complex tumor-associated antigens is an important enabling technology. Here, we have used the high-throughput technology iTopia to identify those peptides derived from the tumor-associated antigen survivin that bind 8 class I alleles. A library of overlapping nonamers spanning the length of the survivin protein was initially screened for peptides capable of binding each allele. Nineteen HLA-A*0201, zero HLA-A*0101, seven HLA-A*0301, twelve HLA-A*1101, twenty-four HLA-A*2402, six HLA-B*0702, six HLA-B*0801, and eight HLA-B*1501 binding peptides were identified based on an arbitrary cutoff. Peptides capable of binding a given allele were further characterized by their affinity for MHC class I molecules and by the rate of dissociation of the complex. This information should help guide functional studies and future epitope-based immunotherapies.
Assuntos
Antígenos HLA/imunologia , Proteínas Associadas aos Microtúbulos/metabolismo , Proteínas de Neoplasias/metabolismo , Peptídeos/metabolismo , Alelos , Antígenos de Neoplasias , Antígenos HLA/genética , Humanos , Proteínas Inibidoras de Apoptose , Proteínas Associadas aos Microtúbulos/imunologia , Proteínas de Neoplasias/imunologia , Mapeamento de Peptídeos , Peptídeos/imunologia , Ligação Proteica , Survivina , Linfócitos T Citotóxicos/imunologiaRESUMO
776.1 is a murine IgG1 monoclonal antibody to the human ovarian cancer antigen CA 125 that has the unique property of having a clear preference for binding to the cell-associated form of the antigen. We have examined the tumor localization properties and efficacy of 776.1 in a subcutaneous OVCAR-3 xenograft mouse model of human ovarian cancer. Biodistribution experiments using (125)I-labeled 776.1 demonstrated a peak uptake in tumors at 72 hours postinjection, with an average of 17.7% of injected dose per gram localized to the tumor. Little uptake in other organs was observed. Further experiments using CA 125-transfected syngeneic tumors, as well as an immunoprecipitation assay using human chimeric 776.1, both clearly demonstrated that 776.1 localizes to the tumor in a CA 125-dependent manner. DOTA-776.1 (1,4,7,10-tetraazacyclododecane-N,N',N",N'" tetraacetic acid-conjugated 776.1) was labeled with (90)Y and used in efficacy studies. [(90)Y-DOTA]776.1 at a single dose of 150 microCi was able to mediate efficient reduction of tumor growth, with regression observed in a subset of animals for a period ranging from 3 to 48 days, equivalent to 3 weekly administrations of cisplatin at 6 mg/kg. No significant regression was observed in groups receiving [(90)Y-DOTA]MOPC-21 control antibody at any dose. These results suggest that 776.1 may be a promising radioimmunotherapeutic agent for the treatment of human ovarian cancer.