Patients' Opinions towards the Services of Pharmacists Based in General Practice.

Pharmacists have been included in general practice teams to provide non-dispensing services for patients. In Australia, pharmacists' role in general practice has been slowly expanding. However, there is a paucity of research to explore patients' opinions toward pharmacist-led services in general practice. This study aimed to assess patient awareness, perceived needs, and satisfaction with these services. A cross-sectional survey was conducted with a purposeful sample of patients who visited six general practices in the Australian Capital Territory that included pharmacists in their team. The survey was informed by the literature and pre-tested. The survey was distributed to two samples: patients who had seen a pharmacist and those who had not seen a pharmacist. Of 100 responses received, 86 responses were included in the analysis: patients who had seen a pharmacist (n = 46) and patients who had not seen a pharmacist (n = 40). Almost all the patients who utilised pharmacist-led services were highly satisfied with those services. Among patients who had not seen a pharmacist, 50% were aware of the existence of general practice pharmacists. Patients who had visited the pharmacist rated higher scores for perceived needs. Patient satisfaction towards the pharmacist-led services in general practices was very high, and patients supported the expansion of these services. However, awareness of the availability of general practice pharmacist services could be improved.

Monoclonal antibody therapy in cancer: When two is better (and considerably more expensive) than one.

WHAT IS KNOWN AND OBJECTIVE: It is 20 years since the US Food and Drug Administration approved the first successful monoclonal anticancer antibody, trastuzumab. The therapeutic utility of monoclonal antibodies in cancer is often limited by partial clinical responses and the development of tumour resistance. An expanding strategy, to be reviewed here, to overcome the limited response and resistance to monotherapy utilizes concurrent treatment with two synergistic monoclonal antibodies. COMMENT: Key examples include two monoclonal antibodies, each engaging a distinct site of human epidermal growth factor receptor 2 (HER2), in the treatment of breast cancer and a combination of antibodies to two distinct T-cell antigens for the treatment of melanoma. Here, we provide an overview of the rationale and evidence for using selected monoclonal antibodies in combination for treating some cancers, along with potential hazards, especially autoimmune-related toxicities. WHAT IS NEW AND CONCLUSION: Thorough research, the development of panels of biomarkers and individualization of therapy will be necessary to optimize the use of these combinations and minimize the substantial risk of overstimulating the immune system.

"HAND ME AN ISOBAR": a pilot study of an evidence-based approach to improving shift-to-shift clinical handover.

OBJECTIVE: To develop, using an evidence-based approach, a standardised operating protocol (SOP) and minimum dataset (MDS) to improve shift-to-shift clinical handover by medical and nursing staff in a hospital setting. DESIGN, SETTING AND PARTICIPANTS: A pilot study conducted in six clinical areas (nursing and medical handovers in general medicine, general surgery and emergency medicine) at the Royal Hobart Hospital between 1 October 2005 and 30 September 2008. Data collection and analysis involved triangulation of qualitative techniques; 120 observation sessions and 112 interviews involving nurses and junior medical officers were conducted across the six clinical areas; information on more than 1000 individual patient handovers was analysed. RESULTS: We developed an overarching four-step SOP and MDS for clinical handover, summarised by the acronym "HAND ME AN ISOBAR". This standardised solution supports flexible adaptation to local circumstances. CONCLUSION: A standardised protocol for clinical handover can be developed and validated across professional and disciplinary boundaries. It is anticipated that our model will be transferable to other sites and clinical settings.

Does high blood glucose mean more insulin? Type 1 diabetes management in children and adolescents.

BACKGROUND: The growth and development occurring in children and adolescents with type 1 diabetes contributes to many medical and nonmedical factors that may affect diabetic control. OBJECTIVE: This article discusses the assessment of high blood sugar levels in children and adolescents with type 1 diabetes. DISCUSSION: Traditionally, diet, exercise and insulin dose are seen as the determinants of blood glucose levels in type 1 diabetic patients. While these factors are important, other practical, medical and psychosocial factors need to be considered. Appropriate management requires more than just alteration of insulin dose. Insulin injection technique, adherence to insulin and management regimens in general, psychosocial issues, the role of intercurrent infections and the development of other medical problems need to be considered. Children and adolescents may only be seen by specialist physicians at three monthly intervals. Exploring these issues with patients during routine general practitioner consultations is likely to allow early identification of treatable problems and improve long term glucose control.