Exploring the opinions of community pharmacists on the implementation of satellite methadone clinics in Malta: a small island state.

Methadone maintenance treatment (MMT) was introduced in Malta in 1987 and is provided by the Substance Misuse Outpatient Unit (SMOPU), formerly referred to as Detox. Presently Malta’s national drug policy encourages healthcare professionals and service providers to work synergistically at a centralised level, which allows healthcare professionals to refer opioid-dependent users to SMOPU and receive their prescribed methadone dose from this facility. It is to be noted that MMT is free of charge from SMOPU and is currently not available from community pharmacies in Malta. The aim of this research was to assess the opinions and attitudes of community pharmacists regarding the implementation of methadone dispensing within the community setting. This was achieved by developing a cross-sectional survey in the form of a questionnaire. This consisted of mainly Likert scale and close-ended questions, and was distributed to all 191 community pharmacies in Malta. The target population was reasonably small and readily accessible, allowing all community pharmacies in Malta to be included. The cross-sectional questionnaire was first piloted to 20 community pharmacies, followed by the complete distribution and collection from the remaining community pharmacies over a period of eight weeks, starting from January 2019. Questionnaire responses were entered into SPSS version 23 to allow analysis for statistical significance, using graphs and charts to represent collected data. The total number of questionnaires distributed among community pharmacies in Malta amounted to 215. A total of 130 completed questionnaires were returned resulting in a response rate of 60.5% (n = 130). Overall, pharmacists are more willing to dispense buprenorphine rather than methadone with 48.5% of pharmacists willing to dispense buprenorphine. Pharmacists interested in dispensing methadone within the community setting falls to 33.1%. When analysing the role of the community pharmacist in reference to MMT, 54.6% agreed that it is the pharmacist’s role to dispense methadone to drug misusers and 72.3% of the participants felt that pharmacists must be trained specifically in order to do so. However, 30% and 77% of participants responded that MMT should be available through the NHS POYC scheme available in community pharmacies and health centres respectively. If MMT were made available privately within the community setting, 96.2% of participants wish to be reimbursed for their service as extra space or staff may be required to run the service. This study demonstrates that pharmacists in Malta are more willing to supply buprenorphine rather than methadone. Hesitancy to dispensing methadone over buprenorphine arises due to lack of proper training on MMT where buprenorphine requires no such training and deals with fixed doses. Also contributing significantly to this is the lack of education and knowledge of pharmacists on the overall subject of MMT. However, with more commitment to harm reduction, proper education and training may result in an increase in professional confidence as well as an improved attitude and patient service

School-based mentoring in initial teacher education : the exploratory phase

The Faculty of Education at the University of Malta has long set its eyes on introducing some form of school-based mentoring as part of initial teacher education (ITE). Over the years, faculty staff members have become increasingly more convinced of the professional benefits that can be derived when carefully selected and trained practitioners in schools mentor ITE students during field placements. Important developments outside the Faculty have also paved the way for the eventual introduction of school-based mentoring. Suffice it to mention the declared support, at least in principle, by a number of key stakeholders outside the Faculty who operate in the field of education. This support appears to extend across the Ministry for Education and Employment, policy makers, the Directorates for Education, high ranking administrators from the state, Church and independent school sectors, school leaders and teachers, and the teachers’ union. Put differently, the indications are that the local context, in the widest sense of the word, is now ready for the development and implementation of a sustainable school-based mentoring system that is tailored to address the professional learning needs of faculty students enrolled in ITE studies.peer-reviewe

Clinical management of comorbid bipolar disorder and obsessive-compulsive disorder: A case series

Background: Apparent comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is a common condition in psychiatry and it has important nosological and therapeutic implications. Although antidepressants are the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined. Methods: Longitudinal clinical observation of three severe OCD patients who developed a manic episode during treatment with different classes of antidepressants. Results: In our cases, three features support the hypothesis of an underlying bipolarity unmasked by the antidepressant used to treat OCD: positive family history for affective disorders, manic switch induced by antidepressant and improvement of affective and obsessive-compulsive symptoms with mood stabilizers and atypical antipsychotics. Conclusions: Osler\u2019s view that medicine should be treatment of diseases, not of symptoms, is consistent with the approach of mood stabilization as a first objective in BD-OCD patients, as opposed to immediate treatment with antidepressants. Only persistent OCD patients should be prescribed antidepressants in as low a dose as feasibl

Time taken to reach undetectable viral loads in therapy-naïve HIV patients commencing ART

Peer reviewedPublisher PD

Hospital antimicrobial stewardship program implementation in the Gulf Cooperation Council States: a systematic review of evidence of implementation.

Background and Purpose: Antimicrobial resistance (AMR) has led to the development of initiatives aimed at optimizing antimicrobial use. Co-ordinated interventions for promoting and monitoring safe and effective use of antimicrobials are termed antimicrobial stewardship programs (ASP). While there are several systematic reviews on aspects of ASP, none have focused on the processes and outcomes of implementation in the Gulf Cooperation Council (GCC) States. The aim was to critically appraise, synthesize and present the available evidence on ASP implementation in the GCC States in relation to the interventions, reported outcomes and facilitators and barriers to implementation. Methodology: A systematic review protocol was developed based on PRISMA-P guidelines and registered with PROSPERO (International Prospective Register of Systematic Reviews). Electronic databases (MEDLINE, CINAHL, International Pharmaceutical Abstracts, Cochrane database and Web of Science) were searched using pre-specified terms for peer-reviewed publications in English from 2010 onward. Quality assessment, data extraction and synthesis were independently performed by two reviewers. ASP interventions were compared to the Centre of Disease Control and Prevention (CDC) checklist, a systematic assessment of key ASP interventions. Results and Discussions: ASP interventions implementation in line with CDC checklist were weak, with the majority of studies reporting only one third of the expected CDC criteria. The most commonly reported outcomes were antibiotic consumption, with very little reporting of any microbiological, clinical and economic outcomes. Key facilitators were physician and organisation support. Barriers reported included the lack of dedicated staff and lack of sufficient funding for implementation. Conclusions: There is a lack of robust studies of ASP implementation in the GCC States. Such studies should focus on CDC criteria in developing the ASP intervention and report valid and reliable outcomes including microbiological, clinical and economic outcomes. There is also a need for qualitative research to focus on facilitators, barriers and solutions to implementation

Effect of packaging and chemical treatment on storage life and physicochemical attributes of tomato (Lycopersicon esculentum Mill cv. Roma)

Fresh fruits and vegetables are inherently more liable to deterioration under tropical conditions characterized by high ambient temperatures and humidity. In determining the effects of chemical treatment on tomatoes (Lycopersicon esculentum Mill cv. Roma), fruits purchased at turning stage of ripening were packaged in low density polyethylene bags (60 μ) containing wooden dust particles moistened with 400 ppm potassium permanganate solution. Samples were treated with hot water dip, boric acid (H3BO3) dip at 1000 ppm, CaCl2 dip at 10,000 ppm, a combination of H3BO3 and calcium chloride treatment as well as control. Results of chemical treatment showed increase in weight loss, pH, and a slight increase in moisture content. Total soluble solids and titratable acidity of samples showed a steady decrease, with data on physicochemical qualities collected at 7 days interval. Fruits stored with hot water and combination of H3BO3 and CaCl2 treatments showed higher keeping quality. Shelf life elongation treatments used at tropical ambient temperature of 30 ± 2°C was able to preserve tomato fruits for 21 days from spoilage and microbial attack while retaining its colour and other physicochemical properties.Keywords: Tomato, shelf life, packaging, respiration, pretreatmen