Promoting breastfeeding in women with gestational diabetes mellitus in high-income settings: an integrative review.

BACKGROUND: Breastfeeding provides many short- and long-term health benefits for mothers and their infants and is a particularly relevant strategy for women who experience Gestational Diabetes Mellitus (GDM) during pregnancy. However, breastfeeding rates are generally lower amongst this group of women than the general population. This review's objective is to identify the factors that influence breastfeeding by exploring the experiences and outcomes of women in in high-income health care contexts when there is a history of GDM in the corresponding pregnancy. METHODS: A comprehensive search strategy explored the electronic databases Medline, CINAHL, Web of Science and Scopus for primary studies exploring breastfeeding practices for papers published between January 2011 and June 2023. All papers were screened independently by two researchers with included papers assessed using the Crowe Critical Appraisal tool. Findings were analysed using a narrative synthesis framework. RESULTS: From an initial search result of 1037 papers, 16 papers representing five high-income nations were included in this review for analysis - the United States of America (n = 10), Australia (n = 3), Finland (n = 1), Norway (n = 1), and Israel (n = 1). Fifteen papers used a quantitative design, and one used a qualitative design. The total number of participants represented in the papers is 963,718 of which 812,052 had GDM and 151,666 did not. Women with an immediate history of GDM were as likely to initiate breastfeeding as those without it. However, they were more likely to have the first feed delayed, be offered supplementation, experience delayed lactogenesis II and or a perception of low supply. Women were less likely to exclusively breastfeed and more likely to completely wean earlier than the general population. Maternity care practices, maternal factors, family influences, and determinants of health were contextual and acted as either a facilitator or barrier for this group. CONCLUSION: Breastfeeding education and support need to be tailored to recognise the individual needs and challenges of women with a history of GDM. Interventions, including the introduction of commercial milk formula (CMF) may have an even greater impact and needs to be very carefully considered. Supportive strategies should encompass the immediate and extended family who are major sources of influence.

Healthy eating blog readership: A cross-sectional survey in Australian adults.

AIMS: To investigate whether members of the public read blogs for the purpose of accessing healthy eating information; examine demographic predictors of healthy eating blog readership, specifically education, gender, age, body mass index, and residential location; and explore the reasons for reading, and not reading, healthy eating blogs. METHODS: This study used a cross-sectional online self-reported survey design collected over three time points (round 1: December 2017-March 2018, round 2: August 2018-December 2018, round 3: December 2021-March 2022). The total sample of participants comprised of 238 respondents with a mean age of 46 years old, who mostly reported gender as female (82%), being educated with a university degree (69%), and predominantly resided in urban and city areas (84%). RESULTS: Fifty-one percent of respondents reported reading healthy eating blogs, suggesting that consumers were proactively seeking healthy eating information through this avenue. Participants who identified as female were 3.2 times more likely to read healthy eating blogs. Commonly, healthy eating blogs were read to receive practical information that aligned with current food choices. The main reason participants reported not reading healthy eating blogs was not thinking about using them (29%). CONCLUSIONS: Understanding who is seeking healthy eating information through blogs, and their reasons doing so, is important to continue research into the potential effectiveness of blogs as a platform to communicate healthy eating and nutrition messages. This study provides direction for further investigation into how dietetics professionals could effectively use blogs to disseminate healthy eating information and positively influence consumer food choices and dietary intake.

Prophylactic Cefazolin Dosing in Obesity-a Systematic Review.

Currently, there is no consensus on whether a standard 2-g prophylactic cefazolin dose provides sufficient antimicrobial coverage in obese surgical patients. This systematic review analysed both outcome and pharmacokinetic studies, aiming to determine the appropriate cefazolin dose. A systematic search was conducted using 4 databases. In total, 3 outcome and 15 pharmacokinetic studies met the inclusion criteria. All 3 outcome studies concluded that there is no need for increased dose. Also, 9 pharmacokinetic studies reached this conclusion; however, 6 pharmacokinetic studies recommended that 2-g dose is insufficient to achieve adequate plasma or tissue concentrations. The stronger body of evidence supports that 2-g dose of cefazolin is sufficient for surgery lasting up to 4 h; however, large-scale outcome studies are needed to confirm this evidence.

Defining and unpacking the core concepts of pharmacology education.

Pharmacology education currently lacks a research-based consensus on which core concepts all graduates should know and understand, as well as a valid and reliable means to assess core conceptual learning. The Core Concepts in Pharmacology Expert Group (CC-PEG) from Australia and New Zealand recently identified a set of core concepts of pharmacology education as a first step toward developing a concept inventory-a valid and reliable tool to assess learner attainment of concepts. In the current study, CC-PEG used established methodologies to define each concept and then unpack its key components. Expert working groups of three to seven educators were formed to unpack concepts within specific conceptual groupings: what the body does to the drug (pharmacokinetics); what the drug does to the body (pharmacodynamics); and system integration and modification of drug-response. First, a one-sentence definition was developed for each core concept. Next, sub-concepts were established for each core concept. These twenty core concepts, along with their respective definitions and sub-concepts, can provide pharmacology educators with a resource to guide the development of new curricula and the evaluation of existing curricula. The unpacking and articulation of these core concepts will also inform the development of a pharmacology concept inventory. We anticipate that these resources will advance further collaboration across the international pharmacology education community to improve curricula, teaching, assessment, and learning.

Identifying the core concepts of pharmacology education.

Pharmacology education currently lacks an agreed knowledge curriculum. Evidence from physics and biology education indicates that core concepts are useful and effective structures around which such a curriculum can be designed to facilitate student learning. Building on previous work, we developed a novel, criterion-based method to identify the core concepts of pharmacology education. Five novel criteria were developed, based on a literature search, to separate core concepts in pharmacology from topics and facts. Core concepts were agreed to be big ideas, enduring, difficult, applicable across contexts, and useful to solve problems. An exploratory survey of 33 pharmacology educators from Australia and New Zealand produced 109 terms, which were reduced to a working list of 26 concepts during an online workshop. Next, an expert group of 12 educators refined the working list to 19 concepts, by applying the five criteria and consolidating synonyms, and added three additional concepts that emerged during discussions. A confirmatory survey of a larger group resulted in 17 core concepts of pharmacology education. This list may be useful for educators to evaluate existing curricula, design new curricula, and to inform the development of a concept inventory to test attainment of the core concepts in pharmacology.

The P.O.S.T Guidelines for Nutrition Blogs: A Modified e-Delphi Study.

BACKGROUND: Blogs are being used increasingly to disseminate nutrition information to consumers, including by registered dietitians (RDs). Guidelines in authoring blogs are important for dietetics professionals so that they effectively communicate evidence-based nutrition information in this format. OBJECTIVE: The aim of this study was to obtain consensus from experts comprising RDs with active blog-writing experience on a set of guidelines for use by RDs when authoring a healthy eating or nutrition information blog. DESIGN: A modified e-Delphi technique with a consensus-based approach was used in this study undertaken between June and October 2019. The purpose-built, pilot-tested e-Delphi survey was informed by a literature review and included statements from 3 domains comprising blog readers and communication; purpose and healthy eating messages; and structure, voice, and tone. Expert participants were identified purposively and via snowballing. In each survey round, statements that achieved 80% consensus were accepted. PARTICIPANTS/SETTING: A total of 19 experts consented to participate. Experts resided in the United States, Australia, and United Kingdom. Experts were mainly women aged between 30 and 49 years and working in private practice and/or research or teaching areas of nutrition and dietetics. RESULTS: Across 3 domains, a total of 33 statements were accepted, comprising a final set of guidelines named the P.O.S.T (purpose, community, structure, and tone) Guidelines for Nutrition Blogs. CONCLUSIONS: Consensus from a panel of dietetics experts resulted in the P.O.S.T Guidelines for Nutrition Blogs, which can support RDs in authoring healthy eating blogs. This will ensure that evidence-based nutrition messages provided to consumers are engaging and effective.

Exploring pharmacists' views on an in-pharmacy medication review program in Australia using a mixed-methods design.

Background MedsCheck is an in-pharmacy medication review program funded by the Australian Government. It is intended to improve patient understanding of medicines and resolve adherence issues. Objective To explore MedsCheck from the community pharmacists' perspective, focusing on the perceived effectiveness of the program, barriers to its optimal delivery, and the integration with other services. Setting Individual interviews in one territory and a national online survey of Australian community pharmacists. Method Using a mixed-method triangulation design, the interviews and the survey were conducted concurrently. The interviews were semi-structured, transcribed verbatim and thematically analysed. The survey, comprising closed and open-ended questions, was quantitatively and thematically analysed. The findings were first analysed separately and finally integrated by searching for convergence, complementarity, and discrepancy. Main outcome measure Pharmacists' perceptions of the effectiveness and barriers of MedsCheck. Results Eight interviews were conducted, and 232 survey responses collected. In the interviews, themes related to perceived benefits (appreciation, reduced confusion, and strengthening relationships), barriers (lack of controls, lack of staff, lack of awareness, and lack of understanding of scope of services), and the integration with other services (strong link with dose administration aids) emerged, which mostly correlated with the survey's results. Ten percent of surveyed respondents did not provide the MedsCheck service; their main reason being insufficient staffing. Of the pharmacists offering the service, 76% strongly agreed that patients were benefitting. MedsCheck reviews were usually initiated by pharmacy staff. Fifty-three percent of respondent pharmacists never or only sometimes reported the review outcomes to the patient's general practitioner. Conclusion The pharmacists believed that MedsCheck is useful to improve patients' understanding and management of their medicines. However, there are currently barriers to the effective delivery of the service, including workload issues, lack of patient awareness, and the service's integration with the broader care of the patient. If these were appropriately addressed, the in-pharmacy medication review program could help pharmacists to better engage with patients and general practitioners and enhance understanding of medication and adherence.

Understanding medication safety and Charcot-Marie-Tooth disease: a patient perspective.

Background Charcot-Marie-Tooth disease is a common inherited neuropathy where patients may be sensitive to adverse effects of certain medicines; however, information about medication safety in this group of people is limited. Objective This study aimed to investigate the experience of Australian individuals with Charcot-Marie-Tooth disease in using medications, including perceived impact of drug-induced adverse effects. Secondarily, it aimed to determine whether individuals with Charcot-Marie-Tooth disease feel adequately supported to make decisions about medication safety. Setting Focus groups and interviews (face-to-face or telephone) of individuals with Charcot-Marie-Tooth disease in Australia. Method A mixed methods qualitative study was conducted between September 2015 and August 2016 using semi-structured interviews. Thematic analysis of interview transcripts was conducted independently by two researchers using inductive coding until concept saturation was achieved. Main outcome measure Perceptions of medicines safety in people with Charcot-Marie-Tooth disease, including barriers to making informed decisions about medication safety. Results Twenty-four adults with Charcot-Marie-Tooth disease participated. Anaesthetics (18%) and pregabalin (15%) were the medications most frequently reported as impacting on Charcot-Marie-Tooth symptoms. Participants sought medication information primarily from general practitioners or neurologists. The main barriers identified by participants were a perceived poor understanding in non-specialist health professionals about Charcot-Marie-Tooth disease and lack of attention to medication safety concerns in people with Charcot-Marie-Tooth disease; this resulted in dissatisfaction about the advice provided. Many individuals who faced uncertainty in obtaining and understanding medicines information turned to internet resources, peer groups, and use of complementary and alternative medicines to self-manage Charcot-Marie-Tooth exacerbations. Conclusion Participants reported drug-related adverse effects and a difficulty in obtaining safety information about medication. This study highlights the need for improved evidence about medication safety in people with Charcot-Marie-Tooth disease. Development of evidence-based resources, increased awareness amongst health professionals about Charcot-Marie-Tooth disease and a team-based care approach could facilitate shared decisions about medication use for people with Charcot-Marie-Tooth disease.

Pharmacist-led medication reviews in aged care residents with dementia: A systematic review.

OBJECTIVES: To evaluate outcomes associated with pharmacist-led medication reviews in residential aged care facility (RACF) residents with dementia. METHODS: Six scientific databases were searched. All study designs investigating pharmacist-led medication reviews in RACF residents with dementia were considered. The protocol was registered with PROSPERO (CRD42019121681). RESULTS: One randomised controlled trial (RCT) and five observational studies were identified. Two studies reported reductions in medication usage per resident, and one study reported improved appropriateness of psychotropic use following reviews as part of multi-faceted, collaborative interventions. In three studies, reviews undertaken as an isolated intervention or by a visiting pharmacist with minimal collaboration with physicians were associated with low implementation rates of recommendations to alter therapy. CONCLUSION: Pharmacist-led medication reviews, when conducted collaboratively, may improve the use of medicines in RACF residents with dementia. However, robust conclusions cannot be drawn, largely due to the low quality of evidence available, including only one RCT.

Residential Aged Care Pharmacist: An Australian Pilot Trial Exploring the Impact on Quality Use of Medicines Indicators.

BACKGROUND: This pilot study aimed to assess whether an on-site pharmacist could influence indicators of quality use of medicines in residential aged care. Methods: A pharmacist was embedded in a residential aged care home for six months. A similar control site received usual care. Polypharmacy, drug burden index, antipsychotic and benzodiazepine use, hospital admission rates and length of stay, and emergency department presentation rates were outcomes used to indicate medication use quality. Data were extracted from participating resident health records. Results: Fifty-eight residents at the study site and 39 residents at the control site were included in the analysis. There was a reduction in the proportion of residents at the study site who had at least one hospital admission at follow-up (28% to 12%, p < 0.01), but no significant difference in other outcomes. Conclusions: This pilot study suggests that a residential care pharmacist may positively influence indicators of medication use quality in aged care; however, further research is needed to expand on these findings.

The role of a residential aged care pharmacist: Findings from a pilot study.

OBJECTIVE: To explore the feasibility of integrating a residential care pharmacist and describe the activities they subsequently undertake in an established residential aged care facility. METHODS: A residential care pharmacist was integrated part-time (15 hours per week) into a 104-bed residential aged care facility in the Australian Capital Territory, for 6 months. The pharmacist documented all activities performed during the study period. RESULTS: The residential care pharmacist documented 335.3 hours performing 284 activities. The two broad classes of activities were as follows: (1) organisation-oriented, which were system-level interventions to improve medication safety, and (2) resident-oriented, which were clinical interventions conducted at the individual level. The activities most frequently performed were pharmaceutical opinion, quality improvement and comprehensive medication review. The stakeholder and organisational demand for these activities indicated feasibility for the role. CONCLUSION: Pharmacists working collaboratively as part of a multidisciplinary aged care team can perform a range of clinically and operationally beneficial activities.

Canaries in the coalmine: Stakeholder perspectives of medication management reviews for residents with dementia.

BACKGROUND: Residential medication management reviews (RMMRs) are the primary strategy enabling collaborative and individualised medication reviews in Australian residential aged care homes (RACHs). Residents with dementia often have complex health needs and care goals, which makes them a useful benchmark of health service efficacy. OBJECTIVE: To analyse perspectives of pharmacists, general practitioners (GPs) and nurses on the suitability and delivery of the current RMMR model for residents with dementia; and to identify scope for improvement in medication review service delivery. METHODS: Electronic surveys were distributed to the included health professions via professional agencies. Descriptive statistics and non-parametric tests were used to summarise quantitative variables. Qualitative data obtained from open-text responses underwent iterative thematic analysis. Two researchers independently conducted the thematic categorisation; data within responses was inductively coded, then codes were linked to identify emergent themes that described the data content. In a triangulated exploratory mixed method approach, the qualitative findings were used to explain the quantitative findings. RESULTS: None of the participants agreed that the current program recommendation of a single RMMR every 24 months was suitable for the residents' needs. Participants were more likely to use written, rather than verbal, means of communication during RMMRs. RMMRs were perceived to have minimal benefit if there was minimal face-to-face interaction between stakeholders. Individualised medicine management in relation to resident goals of care was the key benefit of RMMRs. Insufficient remuneration was the primary barrier to effective face-to-face collaboration and delivery of individualised resident care. CONCLUSIONS: Increasing support for stakeholder participation in face-to-face interactions during medication reviews may enable delivery of a more patient-centred service for residents with dementia and improve health professional satisfaction and engagement.

Reframing healthy food choices: a content analysis of Australian healthy eating blogs.

BACKGROUND: Blogs are widely being used by health professionals and consumers to communicate and access nutrition information. There are numerous benefits for dietitians to establish and contribute to healthy eating blogs. In particular, to disseminate evidence-based nutrition information to promote healthier dietary practices. The aim of this study was to explore characteristics of popular healthy eating blogs and inform the provision of healthy eating information in the Australian context. METHODS: A content analysis approach was used to identify characteristics of popular Australian healthy eating blogs. A purposive and snowball sampling approach was used to identify healthy eating blogs from search engines including Google, Bing and Yahoo. Blogs were deemed eligible if: (1) the author self-identified as a health professional; (2) the blog was written by a single author; (3) the blog was written by an Australian author; (4) the blog had a minimum of one post per month, and (5) the blog focused on communicating healthy eating information to the general adult population. RESULTS: Five popular blogs were followed over a three-month period (December 2017-March 2018), with 76 blog posts included for analysis. Characteristics of these popular blogs were examined and four main features were identified: (i) clearly conveying the purpose of each post; (ii) developing a strong understanding of the reader base and their preferences; (iii) employing a consistent writing style; use of vocabulary and layout; and (iv) communicating healthy eating information in a practical manner. These findings reveal important insight into the features that promote effective nutrition communication within this context. CONCLUSION: Findings from this study highlight common characteristics of popular healthy eating blogs. Future research into the development of blog guidelines which incorporate the characteristics identified in this study can support dietitians in establishing or contributing to the successful provision of evidence-based nutritional information through blogs.

What is healthy eating? A qualitative exploration.

OBJECTIVE: The present study aimed to explore how healthy food choices are translated into everyday life by exploring definitions of healthy food choices, perceptions of own food choice, and healthy food choice drivers (facilitators) and barriers. DESIGN: An exploratory qualitative study design was employed using semi-structured face-to-face interviews. Convenience sampling was used to recruit participants. Interviews were audio-recorded, transcribed verbatim and cross-checked for consistency. Thematic analysis was used to identify patterns emerging from the data. SETTING: Canberra, Australia, October 2015-March 2016. PARTICIPANTS: A total of twenty-three participants aged 25-60 years were interviewed. The mean age was 38 years and the mean BMI was 29·1 kg/m2. All male participants (n 4) were within the healthy weight range compared with 58 % of female participants, with 26 % being overweight and 16 % being obese. RESULTS: (i) Healthy food choices are important but are not a daily priority; (ii) healthy eating information is known but can be difficult to apply into everyday life; (iii) popular diets are used in attempts to improve healthy eating; and (iv) social media inspires and connects people with healthy eating. CONCLUSIONS: Social media facilitates healthy food choices by providing access to healthy eating information. In addition to Facebook and Instagram, healthy eating blogs were highlighted as a source of nutrition information. Research should consider exploring the use of healthy eating blogs and whether these blogs can be used as a tool by dietitians to communicate procedural healthy eating information more effectively in the future.

The effect of a residential care pharmacist on medication administration practices in aged care: A controlled trial.

WHAT IS KNOWN AND OBJECTIVE: With the ageing of the population also comes increasing comorbidities and the use of multiple medications and administration methods, along with greater susceptibility to adverse drug reactions. Dosage form modification to facilitate drug administration in older adults can be potentially problematic as altering the original licensed formulation can affect medication safety and efficacy. The reporting of adverse drug reactions and medication incidents is a key strategy in avoiding preventable adverse drug events for aged care residents. This study evaluated the effect of an on-site clinical pharmacist on reducing inappropriate dosage form modification and staff time spent on medication administration, and optimizing the documentation of drug allergies, adverse drug reactions and medication incidents. METHODS: A pilot-controlled trial was performed in a purposive sample of two residential aged care homes. Both homes belonged to the same organization; the study site had 104 beds and the control site had 100 beds. All permanent residents were eligible for inclusion in the study if written consent was provided. A residential care pharmacist position was implemented at the study site for six months, with a focus on performing medication reviews and quality improvement activities. Observational audits of medication rounds were performed, and documentation relating to allergies, adverse drug reactions, and medication incidents was obtained from both sites before and after the pharmacist trial period. RESULTS: At the study site, there was a significant reduction over the trial in the proportion of inappropriate dosage form modification (from 24% to 0% of all dosage form modifications; P < 0.01). Mean time spent on medication rounds per resident reduced from 4.8 minutes per resident (SD 1.1) to 3.2 minutes per resident (SD 1.7) per round (P < 0.05). The incidence of previous allergy and adverse drug reaction documentation significantly improved from 77% of residents pre-study to 100% of residents post-study (P < 0.01). Mean monthly medication incident reports significantly improved from 13.3 (SD 7.4) pre-study to 25.7 (SD 10.8) post-study (P < 0.05). There was no change in these outcomes at the control site. WHAT IS NEW AND CONCLUSION: Including a pharmacist in a residential aged care home can improve medication administration practices by reducing inappropriate dosage form modification and staff time spent on medication administration rounds, and increasing the documentation of resident allergies, adverse drug reactions and medication incidents. These findings warrant further exploration in a large randomized controlled trial.

Pharmacist-led influenza vaccination services in residential aged care homes: A pilot study.

OBJECTIVES: The feasibility of pharmacist-led influenza vaccination services in residential aged care homes has not previously been studied. The primary objective of this pilot study was to evaluate the feasibility of this service. The secondary objective was to assess the effect of the service on employee vaccination rates. METHODS: An in-house pharmacist-led vaccination service was implemented at a single site in 2017. De-identified employee influenza vaccination records at this site for 2016 and 2017 were compared to assess the change in vaccination rate. RESULTS: The residential care pharmacist administered 37% of all influenza vaccinations to employees (n = 78) in 2017. Between 2016 and 2017, there was a significant improvement in the employee vaccination rate at the site (46.5% vs 69.2%, P < 0.01). CONCLUSIONS: It is feasible for pharmacists to administer influenza vaccinations to employees in residential aged care. The flexibility of an in-house pharmacist improves accessibility and can therefore promote uptake of influenza vaccination by employees.

Analytical quality and effectiveness of point-of-care testing in community pharmacies: A systematic literature review.

BACKGROUND: Point-of-care tests are characterised through the ability of conducting them near the patient's side without the necessity of a laboratory. They can be applied in different healthcare settings to improve patients' access to testing. OBJECTIVE: To evaluate the effectiveness and analytical quality of point-of-care tests performed in the community pharmacy. METHODS: Six electronic databases were systematically searched using a predefined search strategy. Interventional studies that reported on the effectiveness of the point-of-care tests and accuracy studies that investigated their analytical quality were included. The literature search, study selection, and data extraction were performed independently by two researchers. RESULTS: In total, eleven studies were identified focusing on blood glucose, cholesterol, creatinine, uric acid, liver enzymes, international normalized ratio for anticoagulation therapy, bone mineral density for osteoporosis, forced expiratory volume for chronic obstructive pulmonary disease, and infection with human immunodeficiency virus. The included studies showed that point-of-care tests that were conducted and analysed in community pharmacies had satisfactory analytical quality and that the interventions applying these tests were effective overall. CONCLUSIONS: Community pharmacies are well suited to deliver a wide range of point-of-care tests. In the future this will allow easier access to various screening and diagnostic tests for patients.

Quality Use of the Pathology Data in Home Medicines Reviews: A Retrospective Evaluation.

BACKGROUND: Laboratory tests can be important tools for the assessment of pharmacotherapy. Nonetheless, there are no previous studies that have explicitly focused on the role of pathology data in Home Medicines Reviews (HMR), an Australian medication review program. OBJECTIVE: Evaluate pharmacists' recommendations regarding laboratory testing in the medication review process. METHODS: This retrospective review of HMRs assessed the prevalence of the pathology data provided by general practitioners. Additionally, the pharmacists' recommendations based on these laboratory data were compared with national and international guidelines. RESULTS: In total, 580 reports were evaluated. Of these, 179 reports did not contain any pathology data. Pharmacists commented on provided laboratory values in 324 reports and recommended further testing in 473 reports. Not all suggestions were related to previous values or were in line with guidelines. Most recommendations were regarding vitamin D and lipids (69% and 62% of medication review reports, respectively). Particularly, regarding renal impairment, pharmacists used their knowledge on dose adjustments and contraindications. In relation to full blood count, vitamin B12, and thyroid function, unjustified screenings were often recommended. In 26% of all reports, the pharmacists requested an array of tests without explaining the necessity for these tests. Conclusion and Relevance: Pharmacists provided useful advice based on the pathology data, which was concordant with national and international guidelines; however, in some cases, there was no rationale for the test recommendations provided. The outcome of the HMR program might be further enhanced if pharmacists had direct access to the patients' pathology data.

Why does the need for medication become a barrier to breastfeeding? A narrative review.

PROBLEM: The need for medication during lactation can contribute to the early cessation of breastfeeding. BACKGROUND: Breastfeeding women may require medication for acute or chronic health conditions. For some women this need for medication can become a barrier to breastfeeding; this is despite the fact that the majority of medications are considered to be compatible with lactation. AIM: This narrative review aims to investigate factors relating to medicines safety that could contribute to medication unnecessarily becoming a barrier to breastfeeding. METHODS: A selective literature search using PubMed, Scopus and Google Scholar was conducted over a 6-month period using the search terms "breastfeeding", "lactation", "medication" and "information". Articles were assessed to identify whether they addressed the impact of medication use on the decision to breastfeed. FINDINGS: Fifty six articles were identified as having appropriate discussion about decision making for the safe use of medication during lactation. Themes identified included variable and conflicting safety advice for medicines; difficulty interpreting risks associated with medicine use; societal pressures faced by the breastfeeding woman; and the varied knowledge and training of health professionals involved in the care of breastfeeding women. CONCLUSION: Poor quality of information about medicine safety during lactation can contribute to confusion in giving recommendations. This confusion can result in early cessation of breastfeeding or insufficient health care for the breastfeeding woman.

Feasibility of Integrating Residential Care Pharmacists into Aged Care Homes to Improve Quality Use of Medicines: Study Protocol for a Non-Randomised Controlled Pilot Trial.

Older adults are particularly susceptible to iatrogenic disease and communicable diseases, such as influenza. Prescribing in the residential aged care population is complex, and requires ongoing review to prevent medication misadventure. Pharmacist-led medication review is effective in reducing medication-related problems; however, current funding arrangements specifically exclude pharmacists from routinely participating in resident care. Integrating an on-site clinical pharmacist into residential care teams is an unexplored opportunity to improve quality use of medicines in this setting. The primary objective of this pilot study is to investigate the feasibility of integrating a residential care pharmacist into the existing care team. Secondary outcomes include incidence of pharmacist-led medication review, and incidence of potential medication problems based on validated prescribing measures. This is a cross-sectional, non-randomised controlled trial with a residential care pharmacist trialled at a single facility, and a parallel control site receiving usual care and services only. The results of this hypothesis-generating pilot study will be used to identify clinical outcomes and direct future larger scale investigations into the implementation of the novel residential care pharmacist model to optimise quality use of medicines in a population at high risk of medication misadventure.