Conscientious objection - a cross-sectional, vignette-based, mixed methods exploration of Australian pharmacists' perspectives.

Background: Conscientious objection (CO) in healthcare is a controversial topic. Some perceive CO as freedom of conscience, others believe their professional duty-of-care overrides personal-perspectives. There is a paucity of literature pertaining to pharmacists' perspectives on CO. Aim: To explore Australian pharmacists' decision-making in complex scenarios around CO and reasons for their choices. Method: A cross-sectional, qualitative questionnaire of pharmacists' perspectives on CO. Vignette-based questions were about scenarios related to medical termination, emergency contraception, IVF surrogacy for a same-sex couple and Voluntary Assisted Dying (VAD) Results: Approximately half of participants (n = 223) believed pharmacists have the right to CO and most agreed to supply prescriptions across all vignettes. However, those who chose not to supply (n = 20.9%), believed it justifiable, even at the risk of patients failing to access treatment. Strong self-reported religiosity had a statistically significant relationship with decisions not to supply for 3 of 4 vignettes. Three emergent themes included: ethical considerations, the role of the pharmacist and training and guidance. Conclusion: This exploratory study revealed perspectives of Australian pharmacists about a lack of guidance around CO in pharmacy. Findings highlighted the need for future research to investigate and develop further training and professional frameworks articulating steps to guide pharmacists around CO.

Professional stigma towards clients with methamphetamine use disorder - a qualitative study.

Background: Methamphetamine use disorder (MUD) is associated with poor health outcomes. Pharmacists play a role in delivery of substance use treatment, with several studies having examined their attitudes to people with opioid use disorder, but little is known about their attitude towards people with MUD. This study aimed to explore pharmacists' perspectives on the provision of services to clients with MUD. Methods: A convenience sampling strategy was used to recruit community pharmacists across Sydney, Australia. Semi structured interviews examined views and ideas of pharmacists surrounding the treatment and management of MUD, followed by coding of transcribed interview data by all members of the research team. Results: Nineteen pharmacists completed the interviews. The main theme identified was stigma held by healthcare professionals. The almost unanimous perception amongst pharmacists was fear and apprehension towards people with MUD, including underlying assumptions of criminality, misinformation regarding people with MUD, and lack of education and knowledge surrounding MUD. Conclusion: A substantial amount of stigma towards people with MUD was found in this study. Negative attitudes by healthcare professionals can perpetuate healthcare disparities and impede the accessibility of future treatment programs for people with MUD. Appropriate educational interventions on MUD for pharmacists are needed.

A Qualitative Evaluation of the Australian Community Pharmacy Agreement.

The Australian Federal Government's Community Pharmacy Agreement (Agreement), initiated in 1990 and renegotiated every five years with a pharmacy owners' organisation, is the dominant policy directing community pharmacy. We studied the experience with the Agreements of 38 purposively selected individual pharmacists and others of diverse backgrounds, using in-depth, semi-structured interviews. Although perceived to lack transparency in negotiation and operation, as well as paucity of outcome measures, the Agreements have generally supported the viability of community pharmacies and on balance, contributed positively to the public's access to medicines. There were, however, contradictory opinions regarding the impact of the policy's regulation of pharmacy locations, including the suggestion that they provide existing owners with an undue commercial advantage. A reported shortcoming of the Agreements was their impact on pharmacists' abilities to expand their scopes of practice and assist patients to make better use of medicines, in part due to the funding being almost totally focused on supply-related functions. The support for programs such as medication management services was perceived to be limited, and opportunities for diversification in pharmacy practice appeared constrained. Future pharmacy policy developed by the government could be more inclusive of a diverse range of stakeholders, seek to better utilise pharmacists' expertise, and have a greater focus on health outcomes.

Examining pharmacists' anti-doping knowledge and skills in assisting athletes to avoid unintentional use of prohibited substances.

OBJECTIVES: To explore the knowledge and skills of pharmacists practicing in Sydney, Australia, in preventing the use of prohibited medications by athletes. METHODS: Using a simulated-patient study design, the researcher (an athlete and pharmacy student herself) contacted 100 Sydney pharmacies by telephone requesting advice about taking a salbutamol inhaler (a WADA-prohibited substance with conditional requirements), for exercise-induced asthma, following a set interview protocol. Data were assessed for both clinical and anti-doping advice appropriateness. KEY FINDINGS: Appropriate clinical advice was provided by 66% of pharmacists in the study, appropriate anti-doping advice was provided by 68%, and 52% provided appropriate advice across both aspects. Of the respondents, only 11% provided both clinical and anti-doping advice at a comprehensive level. Identification of accurate resources was made by 47% of pharmacists. CONCLUSIONS: Whilst most participating pharmacists had the skills to deliver assistance regarding the use of prohibited substances in sports, many lacked core knowledge and resources to enable them to deliver comprehensive care to prevent harm and protect athlete-patients from anti-doping violations. A gap was identified regarding advising/counselling athletes, indicating the need for additional education in sport-related pharmacy. This education would need to be coupled with the incorporation of sport-related pharmacy into current practice guidelines to enable pharmacists to uphold their duty of care and for athletes to benefit from their medicines-related advice.

A grounded theory approach to exploring the experiences of community pharmacists in Lebanon to a triple whammy of crises: The Lebanese financial crisis, COVID-19 pandemic, and the Beirut port explosion.

Background: Community pharmacists like other health care professionals in Lebanon have been grappling with a series of multifaceted, country-wide and ongoing challenges that have formed the impetus for this research. We aimed to explore experiences of community pharmacists in Beirut, Lebanon, during three concurrent crises in 2020: the Lebanese financial crisis, COVID-19 pandemic and the Beirut Port explosion. Methods: A qualitative approach using a constructivist grounded theory methodology was employed. Between October 2020 and February 2021, semi-structured interviews were conducted with purposefully recruited community pharmacists working in Beirut. All interviews were conducted virtually, and data collected were analysed using inductive reasoning, with open coding and concept development. Results: Thirty-five participants (63% female, mean age 30) were interviewed online. Emergent categories and theoretical concepts included 1. painting the picture - pharmacists describing the context/setting; 2. impact of the crises - on community pharmacists, the profession, patients and the system; 3. response to the crises - of community pharmacists, the profession (+ practice), patients and the system; and 4. need for advocacy and leadership. A theory was developed about "unsustainable resilience" in the scheme of ongoing crises. Conclusions: The findings revealed a shared sense of futility and despair among pharmacists collectively as a profession, as well as a sense of unsustainable healthcare systems in Lebanon, and environments impacting on the resilience of pharmacists at an individual level. A call for action is needed for urgent sustainable structural and financial reforms, advocacy and planning for future resilient systems, as well as a resilient pharmacy profession and protection of pharmacists' wellbeing and livelihood.

Comparing comprehensibility of standard and enhanced prescription medicine labels: a randomized simulation.

OBJECTIVES: The objective of this study is to develop and user-test the comparative effectiveness of two enhanced label designs to improve comprehension of patients with low English proficiency versus a standard label representative of the pharmacist-affixed medicine labels currently used in practice. METHODS: Using a randomized two-group study design, 66 participants from Sydney, Australia were allocated to view a set of standard labels followed by a set of enhanced labels named 'linguistically enhanced labels' or 'linguistically and graphically enhanced labels'. Each set of labels depicted medicine directions of three levels of complexity, which participants viewed consecutively. The 'enhanced labels' incorporated several features documented in the literature as improving understanding of low-health-literate/linguistically compromised individuals such as translated directions in a language the person is more proficient in, numeric presentations of numbers/counts, carriage returns and graphic depiction of directions. A user-testing questionnaire relating to comprehensibility was conducted after each label was viewed. Differences in comprehensibility were assessed using a generalized linear model, Cochran-Mantel-Haenszel test for trend and a chi-square test. KEY FINDINGS: Results indicated significant improvements in comprehensibility with both types of enhanced labels compared with standard labels (P < 0.0001). The 'linguistically and graphically enhanced label' improved comprehensibility of the most complex directions to a greater extent than the 'linguistically enhanced label' (P < 0.0001). CONCLUSIONS: This study has highlighted the scope for improvement of existing pharmacist-affixed prescription medicine labels to ensure better understanding by individuals with low English proficiency. The enhanced labels trialled presented a means with which this may be achieved through the incorporation of key design elements, such as simpler, translated and graphically supported directions.

Pharmacists supporting athletes: a scoping review exploring the knowledge, role and responsibilities of pharmacists in preventing the unintentional use of prohibited substances by athletes.

BACKGROUND: Following the establishment of the World Anti-Doping Agency in 1999, the International Pharmacy Federation (FIP) published guidelines - The Role of the Pharmacist in the Fight against Doping in Sport (2014) - intended for implementation into national standards of practice, to clarify pharmacists' roles in supporting athletes. Despite 7 years since the publication of these guidelines, the extent of practice and knowledge regarding sport pharmacy remains unclear. OBJECTIVES: To explore the literature to ascertain knowledge held by pharmacists and pharmacy students regarding anti-doping and to determine current/potential roles and responsibilities for pharmacists in the dissemination of information about, and the reduction in unintentional use of, prohibited substances by athletes. METHOD: A literature search of five databases utilising terms such as athlete, performance-enhancing and pharmacist was undertaken. Relevant articles published since 1999 were searched for knowledge, roles and responsibilities of pharmacists. KEY FINDINGS: We identified 16 research studies outlining knowledge, as well as roles and responsibilities of pharmacists in assisting athletes. Pharmacists reportedly had limited knowledge of anti-doping organisations and prohibited substances. Roles identified included counselling, education, advice about prohibited substances and dispensing. Responsibilities included medication review and assisting athletes to avoid unintentional ingestion of prohibited substances. CONCLUSION: Pharmacists, by training, can play a role in providing accurate medication-related information to athletes to avoid prohibited substances. Key barriers identified were pharmacists' lack of knowledge and the absence of guidelines articulating specific roles and responsibilities for pharmacists, highlighting the need for educational programmes and inclusion of specific responsibilities in national guidelines.

Implementing and evaluating a course in professional ethics for an undergraduate pharmacy curriculum: A feasibility study.

BACKGROUND: Pharmacy practice today mandates "patient-centered care", thereby assigning higher levels of professional responsibility for pharmacists leading to ethical challenges. These challenges often involve ethical principles, institutional, personal, or other constraints that can pull practitioners in incompatible opposite directions, creating "ethical dilemmas" in many circumstances. Pharmacists are expected to handle challenges competently and in the best interest of patients. Literature underlines the positive impact of educational interventions focusing on ethical awareness and competence, and that "gaps" existed in pharmacy training/curricula for Jordanian pharmacists. The objective of this study was to develop, implement, and evaluate the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian university. EDUCATIONAL ACTIVITY AND SETTING: Fifth-year pharmacy students attending summer school at a university in Jordan from July to September 2020 were invited to participate in an educational intervention (suite of didactic online lectures and skills-based workshops). This study was delivered in four parts, with a pretest administered immediately before and a posttest survey immediately after the educational intervention, the educational intervention (three phases), and focus-group discussions to elicit students' feedback. FINDINGS: Findings indicated enhanced levels of confidence in students' decision-making. The development of students' moral reasoning and decision-making skills were also observed to be improved. SUMMARY: This study highlighted the importance of the implementation of an ethics course in pharmacy undergraduate curricula. It emphasized the positive impact this course made on the students' learning experiences and provided a strong environment for discussion and group learning.

Asthma patients in Saudi Arabia - preferences, health beliefs and experiences that shape asthma management.

Objectives: The aim of this study was to explore the experience of Saudi participants in managing their asthma and their perspectives about using future pharmacy-based services for asthma management. METHODS: Semi-structured interviews were conducted with adult Saudis with asthma or those who were a carer of a child with asthma. Participants were recruited from medical practices and community centres in Riyadh, Saudi Arabia. Verbatim transcribed interviews were inductively analysed using thematic analysis. RESULTS: Twenty-three Saudi participants with asthma or caring for those with asthma took part in interviews which lasted on average for 25 min. Most participants did not have well-controlled asthma. Thematic analyses of the interview transcripts highlighted four key emergent themes: participants experience of asthma, participants' beliefs and perceptions about health and medicines, perception of health professionals and advocacy and social support. Many participants expressed an emotional burden in their lived experience of asthma. Lack of self-management skills were evident in participants' reluctance to make decisions in emergency situations. Some participants had strong beliefs about using herbal medicines rather than western medicines. Using social media or consulting with their family members with asthma was a common preference, rather than consulting healthcare professionals. Participants' were rather unclear about pharmacy asthma care services and reported not having experienced such services in their pharmacies. CONCLUSION: Inadequate self-management behaviours may affect the level of asthma control in people with asthma in Saudi Arabia. Improved primary care models with extensive focus on asthma education are needed to relieve the over-reliance on tertiary care help-seeking models that are currently the norm. Current evidence-based information also needs to be prepared in patient friendly formats and disseminated widely. Community pharmacists would need to be trained and skilled inpatient engagement and would have to win the public trust for viable asthma services provision.

Pharmacists' experiences serving culturally and linguistically diverse patients in the Australian community pharmacy setting.

Background There has been no in depth published study to date reporting on community pharmacists' current experiences and their future practice needs relating to providing culturally competent pharmaceutical care to Australian culturally and linguistically diverse patients with low English proficiency. Objective To explore community pharmacists' experiences serving culturally and linguistically diverse patients who have low English proficiency. Setting Community pharmacists in Australia. Method Focus group discussions with practising community pharmacists were conducted. Participants were recruited from metropolitan Sydney. Discussion centred around their current experiences and practice changes needed to enhance the provision of culturally competent pharmaceutical care. Thematic analysis using the constant comparison method within a grounded theory approach was performed on the data collected. Main outcome measure Participants' experiences in providing culturally competent care to culturally and linguistically diverse patients with low English proficiency. Results Thirty community pharmacists participated in six focus group discussions. Inadequate provision of culturally competent care was found to be primarily due to the issue of language incongruence between pharmacist and patient. Participants proposed various means with which such care may be provided to ensure patient safety. Conclusion Pharmacist participants expressed being inadequately equipped to provide culturally competent care in the community setting and identified potential means by which such care may be delivered. Addressing identified barriers that hinder community pharmacists' capacity to engage in culturally competent practice can potentially improve provision of pharmaceutical care to culturally and linguistically diverse patients with low English proficiency.

Cardiovascular disease risk prevention services by pharmacists in Saudi Arabia: what do policymakers and opinion leaders think?

BACKGROUND: Cardiovascular disease (CVD) is an emerging contributor to national morbidity and mortality in Saudi Arabia. CVD risk prevention services are limited, particularly with an over-utilised public health sector and an under-utilised and under-resourced primary care sector. Globally, there is evidence that community pharmacists can play a key role in CVD prevention within primary care. However, the perspectives of policymakers and opinion leaders are critical to successful translation of evidence into practice. Thus, the aim was to engage policymakers and professional leaders in discussions about implementing high-quality CVD risk prevention services in community pharmacy. METHODS: Qualitative semi-structured interviews were conducted, audio-recorded and transcribed verbatim. All transcripts were thematically analysed. RESULTS: A total of 23 participants (87% male) from government and non-government sectors were interviewed. Of these, almost 65% had pharmacy qualifications. Limited provision of CVD risks preventative services in primary care was acknowledged by most participants and building community pharmacists' capacity to assist in preventive health services was viewed favourably as one way of improving the status quo. The data yielded four key themes: (1) future pharmacy CVD health service models; (2) demonstrable outcomes; (3) professional engagement and advocacy; and (4) implementability. CVD health services roles (health screening, primary and secondary prevention services), pragmatic factors and tiered models of care (minimal, medium, and comprehensive pharmacist involvement) were discussed. The need for humanistic, clinical, and cost effectiveness outcomes to be demonstrated and active involvement of professional bodies were deemed important for such services to be sustainable. Professional pharmacy governance to develop pharmacy careers and workforce, pharmacy curricular reform and ongoing education were posed as key success factors for novel pharmacy roles. Practice policies, standards, and guidelines were seen as required to adhere to stringent quality control for future pharmacy services provision. Participant's implementation vision for such services included scalability, affordability, access, adoption and health system reform. Most discussions focused on the need for structural improvement with limited input regarding processes or outcomes required to establish such models. CONCLUSIONS: Most participants favoured pharmacy-based CVD risk prevention services, despite the variability in proposed service models. However, prior to developing such services, support structures at the health system and health professional level are needed as well as building public support and acceptability for pharmacy services.

Physicians' views on cardiovascular disease risk prevention services by pharmacists and potential for collaboration.

Background: Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. Early identification and management of modifiable CVD risk factors are highly effective in preventing disease onset and/or improving outcomes in CVD. As highly accessible primary health professionals, pharmacists can assume a role in screening and risk factor management in collaboration with physicians; however, such prevention services are not established practice in Saudi pharmacies. Therefore, the aim was to explore physicians' perceptions about the utility of a role in CVD risk screening and management for Saudi pharmacists. Methods: Qualitative semi-structured interviews were conducted, audio-recorded and transcribed verbatim in Arabic or English. All transcripts were thematically analyzed in an inductive approach after translation into English if required. Results: A total of 26 physicians recruited from public hospitals and primary healthcare centers were interviewed. Most were unaware of pharmacists' potential to undertake a role in CVD risk prevention. Although there was broad support for the concept, they recommended physician-pharmacist collaborative models, extensive provider pharmacist training, and strict oversight by the Saudi Ministry of Health (MoH)/other official authorities to ensure service quality and sustainability, should implementation occur. Healthcare system reform was considered key to expanding private sector (i.e., community pharmacy) involvement in healthcare, as was incentivizing providers and 'marketing' for patient acceptance. Conclusion: Physicians were positive about setting up a collaborative community pharmacist-physician CVD risk screening and management service model with the help of an authorized body within the Saudi Arabian healthcare system.

Do medicines commonly used by older adults impact their nutrient status?

Background: Chronic health conditions and polypharmacy are common among the older population and associated with increased risks of adverse events, medicine-interactions, geriatric syndromes, falls and mortality. Poor nutrition is also common in older people. Causal associations between medication use and older people's nutrient status is seldom discussed. Objectives: The objectives of this review were to summarise the literature reporting associations between medicines commonly prescribed to older adults and nutrient deficiencies, and to discuss the clinical implications and management. Methods: Medicine information resources (n = 5) were searched for information about nutrient deficiencies associated with common medicines used by older people and listed within the top 50 medicines prescribed by volume on the Australian Pharmaceutical Benefits Scheme. This was followed by a search for clinical studies published on PubMed from inception to April 2020. Data was extracted, tabulated and summarised with clinical information relevant to pharmacists and clinicians involved in the care of older people taking medicines. Results: A total of 23 clinical studies were identified reporting medicine-induced nutrient deficiencies in older adults. Vitamin B12, sodium, magnesium were identified as the 3 main nutrients susceptible to deficiency by medicines used to treat cardiovascular disease, neurological conditions, gastrointestinal conditions, and diabetes. The coenzyme CoQ10 was depleted by statins.Conclusion: Certain medicines commonly prescribed to older adults are associated with nutrient deficiencies that may be clinically significant. Given the high prevalence of comorbidities and polypharmacy it is possible that some of these individual drug-induced nutrient deficiencies are compounded, warranting both clinical and research attention.

A mixed-method simulated patient approach to explore implicit bias in health care: A feasibility study in community pharmacy.

BACKGROUND: Implicit bias is prejudice shown towards an individual or group without consciously meaning to do so. This bias may occur due to age, race, and gender among other factors. Implicit bias has been examined and identified in a variety of health care professionals, primarily using Implicit Association Tests. To date, literature has not examined implicit bias using covert simulated patients in a naturalistic setting, or in practicing community pharmacists. OBJECTIVE: To develop and pilot a novel method for exploring and reporting on implicit racial bias by community pharmacists in their practice setting. METHODS: Four female actors of different racial and ethnic backgrounds (Caucasian Australian, East Asian, Middle Eastern, South Asian) completed simulated patient visits at eight community pharmacies in Sydney, Australia between February-March 2019. Actors provided scripted requests for assistance with symptoms or products relating to women's health ailments (cystitis, dysmenorrhea, emergency contraception, vaginal thrush) at a rate of one visit per pharmacy per week. Visits were audio-recorded. Semi-structured interviews were conducted with actors immediately post-visit. Transcriptions of visits and interviews were analyzed through discourse analysis. RESULTS: Thirty-two vists were completed. Discourse analysis identified 3 discursive frames of 'caring', 'neutral, and 'abrupt' and enabled identification of potential differences between pharmacists when responding to actors of different racial and ethnic backgrounds. Consultation length, number of products sold, and number of questions asked did not significantly differ between visits. CONCLUSIONS: This novel method proved feasible and future work could adapt this method to different practitioners and simulated patient demographics to explore different types of implicit bias in a number of naturalistic settings.

Pharmacists' experience of asthma management in culturally and linguistically diverse (CALD) patients.

BACKGROUND: In Australia, one of the world's significantly multicultural nations, asthma is one of the most common chronic conditions. A significant level of health disparities have been observed in many countries with a culturally and linguistically diverse demography. Previous studies have identified that language and culture affect health care provision, this is why culturally competent care is crucial when managing chronic conditions in diverse populations. OBJECTIVE: The purpose of this study was to explore Australian community pharmacists' experience and perspective about providing care for CALD people with asthma. METHODS: Qualitative semi-structured interviews were used as the method of choice to fulfil the study objective. Participants were recruited purposively from suburbs of relative diversity in two Australian cities: Melbourne and Sydney. Interviews with consenting pharmacist were conducted using an interview guide. Verbatim transcripts of interviews were then thematically analysed. RESULTS: Thirty-two interviews resulted in five emergent themes 1) Pharmacists' attitudes towards CALD patients and Cultural Competence; 2) Barriers and facilitators; 3) Clinical issues; 4) Cultural barriers; 5) Workarounds. It was evident that language and to a smaller extent, cultural barriers were experienced regularly by pharmacists managing CALD patients; pharmacists had mostly adapted with a range of methods to work around these barriers. Although pharmacists had a positive attitude, there seemed to be a need for enhanced cultural competence skills; reflections from pharmacists supported the need for further training and pharmacy specific resources. CONCLUSIONS: There is a significant gap in cultural awareness among Australian pharmacists. Future direction suggests obligatory training in cultural competence for health professionals in order to be able to provide cultural proficient care.

The provision of care provided by the pharmacy workforce in relation to complementary medicines in Australia.

BACKGROUND: The use of complementary medicines (CMs) is prevalent across the world. Some CMs, such as St John's Wort, when taken with specific pharmaceutical medicines, may cause drug-herb interactions. In this context, pharmacists have the opportunity to play an important role in preventing harm to patients. OBJECTIVE: The aim of this study was to explore real-life pharmacy practice in relation to CMs in New South Wales, Australia. METHODS: The study design involved 'pseudo-patient' pharmacy visits while posing as a patient's relative requesting St John's Wort and using a standardized set of questions to document details of the interaction with a range of pharmacy staff. RESULTS: Of the 110 metropolitan pharmacy visits made, the pharmacy workforce who were involved in assisting the pseudo-patient's request included 51 pharmacists (46.4%), 57 pharmacy assistants (51.8%) and 1 naturopath (0.9%). Advice that may have resulted in harm to the patient, was offered by pharmacists in 11.8% (n = 13) of the encounters, and 20.9% (n = 23) by pharmacy assistants. Conversely, advice that prevented harm was provided by only 17.3% (n = 19) pharmacists and 10.9% (n = 12) pharmacy assistants. History-taking was not attempted by 84 pharmacy staff. CONCLUSION: The majority of pharmacy staff involved in this study did not manage a request for a CM with known drug-herb interactions in a way that would prevent harm. These findings highlight the need for the pharmacy workforce to engage in education and training in CMs, with a focus on how to consult evidence-based resources regarding interactions in the interest of patient safety.

Stakeholders' Perceptions of Factors Influencing the Use of Take-Home-Naloxone.

BACKGROUND AND AIMS: Opioid associated death and overdose is a growing burden in societies all over the world. In recent years, legislative changes have increased access to naloxone in the take-home setting for use by patients with a substance use disorder and bystanders, to prevent opioid overdose deaths. However, few studies have explored the factors influencing the uptake by its multiple stakeholders. The aim of this scoping review was to explore the factors influencing the use of take-home naloxone from the perspectives of different stakeholders. METHODS: A scoping review methodology was adopted with a systematic search of databases EMBASE, MEDLINE and PubMed. A variation of the search words "naloxone", "opioid" and "overdose" were used in each database. The articles were screened according to the predetermined inclusion/exclusion criteria and categorized based on their key perspective or target population. RESULTS: The initial database search yielded a total of 1483 articles. After a series of screening processes, 51 articles were included for analysis. Two key stakeholder perspectives emerged: patients and bystanders (n = 36), and healthcare professionals (n = 15). Within the patient and bystander group, a strong consensus arose that there were positive outcomes from increased access to take-home naloxone and relevant training programs. Despite these positive outcomes, some healthcare professionals were concerned that take-home naloxone would encourage high-risk opioid use. CONCLUSION: Take-home naloxone is slowly being introduced into community practice, with a sense of enthusiasm from patients and bystanders. There are still a number of barriers that need to be addressed from healthcare professionals' perspective. Future research should be aimed at emergency care professionals outside of the US, who are most experienced with naloxone and its potential impact on the community.

End-of-life treatment decisions in adult Muslims: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to explore the empirical evidence on the range of treatment decisions made by adult Muslims at the end of life. INTRODUCTION: Relief of pain and suffering is a human right; however, ethnic, racial, and religious minorities do not receive optimum end-of-life care. Several factors have been identified as impacting on the decision-making of minority populations. These patients have been found to access palliative care to a lesser degree, receive inadequate pain management, prefer aggressive care, and die in a place other than their place of preference. Muslims remain an under-represented community in end-of-life studies, with little known about their care preferences and decisions in their final stage of life. INCLUSION CRITERIA: This review will include studies whose participants are adults (≥18 years) facing end-of-life decision-making who identify as Muslim while residing in a non-Muslim-majority country. The participants may be healthy volunteers with a view on the subject, or patients and their caregivers facing end-of-life decision-making. Quantitative and qualitative studies will be included, with the exclusion of theoretical and opinion-based articles. METHODS: The three-step search strategy for the proposed scoping review will follow JBI methodology. Databases to be searched include MEDLINE via OvidSP, PsycINFO via OvidSP, Embase via OvidSP, Scopus (Elsevier), CINAHL via EBSCO, and ProQuest Dissertations and Theses Global. Studies in English published since database inception will be considered. The results will be extracted and charted by two independent reviewers. Data will be presented in tabular form and a narrative summary provided.

Exploring Ethical Pharmacy Practice in Jordan.

Patient-centered pharmacy practice involves increased pharmacist engagement in patient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists' practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with 30 Jordanian registered pharmacists. The transcribed interviews were thematically analysed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious values; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists' personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists' understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternalism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists' literacy in professional ethics.