Cross-sector, sessional employment of pharmacists in rural hospitals in Australia and New Zealand: a qualitative study exploring pharmacists’ perceptions and experiences

Background: Many rural hospitals in Australia and New Zealand do not have an on-site pharmacist. Sessional employment of a local pharmacist offers a potential solution to address the clinical service needs of non-pharmacist rural hospitals. This study explored sessional service models involving pharmacists and factors (enablers and challenges) impacting on these models, with a view to informing future sessional employment. Methods: A series of semi-structured one-on-one interviews was conducted with rural pharmacists with experience, or intention to practise, in a sessional employment role in Australia and New Zealand. Participants were identified via relevant newsletters, discussion forums and referrals from contacts. Interviews were conducted during August 2012-January 2013 via telephone or Skype™, for approximately 40–55 minutes each, and recorded.Results: Seventeen pharmacists were interviewed: eight with ongoing sessional roles, five with sessional experience, and four working towards sessional employment. Most participants provided sessional hospital services on a weekly basis, mainly focusing on inpatient medication review and consultation. Recognition of the value of pharmacists’ involvement and engagement with other healthcare providers facilitated establishment and continuity of sessional services. Funds pooled from various sources supplemented some pharmacists’ remuneration in the absence of designated government funding. Enhanced employment opportunities, district support and flexibility in services facilitated the continuous operation of the sessional service. Conclusions: There is potential to address clinical pharmacy service needs in rural hospitals by cross-sector employment of pharmacists. The reported sessional model arrangements, factors impacting on sessional employment of pharmacists and learnings shared by the participants should assist development of similar models in other rural communities

A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

BACKGROUND: Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. METHODS: Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse. RESULTS: Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%). CONCLUSIONS: A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up

Carbohydrate Dependence During Prolonged, Intense Endurance Exercise

A major goal of training to improve the performance of prolonged, continuous, endurance events lasting up to 3 h is to promote a range of physiological and metabolic adaptations that permit an athlete to work at both higher absolute and relative power outputs/speeds and delay the onset of fatigue (i.e., a decline in exercise intensity). To meet these goals, competitive endurance athletes undertake a prodigious volume of training, with a large proportion performed at intensities that are close to or faster than race pace and highly dependent on carbohydrate (CHO)-based fuels to sustain rates of muscle energy production [i.e., match rates of adenosine triphosphate (ATP) hydrolysis with rates of resynthesis]. Consequently, to sustain muscle energy reserves and meet the daily demands of training sessions, competitive athletes freely select CHO-rich diets. Despite renewed interest in high-fat, low-CHO diets for endurance sport, fat-rich diets do not improve training capacity or performance, but directly impair rates of muscle glycogenolysis and energy flux, limiting high-intensity ATP production. When highly trained athletes compete in endurance events lasting up to 3 h, CHO-, not fat-based fuels are the predominant fuel for the working muscles and CHO, not fat, availability becomes rate limiting for performance

Reduced neuromuscular activity with carbohydrate ingestion during constant load cycling

The purpose of this study was to determine the effect of carbohydrate ingestion before and during intense constant load cycling to volitional fatigue on surface electromyographic (sEMG) activity from the vastus lateralis (VL) and vastus medialis (VM) muscles. After 24-h diet and training control, 8 well-trained subjects [maximal O2 uptake (VO2max) 66 ± 2 ml · kg-1 · min-1; mean ± SD] ingested 8 ml · kg-1 of either a 6.4% carbohydrate-electrolyte (CHO) or a placebo (PLA) solution immediately before, followed by 2 ml · kg-1 of the same solution every 15 min while cycling to exhaustion at 84 ± 1% of VO2max. Exercise time to fatigue was 13% longer with CHO ingestion compared to PLA (58:54 ± 8:48 vs. 51:18 ± 5:54 min:s, NS). VO2 (4.22 ± 0.11 vs. 4.20 ± 0.14 L · min-1), heart rate (172 ± 4 vs. 176 ± 4 beats · min-1), ratings of perceived effort (18 ± 0.1 vs. 19 ± 0.1), and rates of carbohydrate oxidation (314 ± 28 vs. 324 ± 26 ?mol · kg-1 · min-1) were similar for both PLA and CHO at exhaustion. There was no main treatment effect of CHO ingestion on blood glucose or lactate concentrations, nor plasma prolactin levels either during exercise or at fatigue. However, CHO ingestion attenuated the rise in EMG root mean square (RMS) activity during the latter stages (&gt;45 min) of exercise and at the point of exhaustion for both VM (0.325 ± 0.010 vs. 0.403 ± 0.020 mV; p = .006) and VL (0.298 ± 0.011 vs. 0.370 ± 0.007 mV; p =.0004). We conclude that in well-trained subjects, the ingestion of carbohydrate attenuated the increase in surface electromyographic activity during intense, constant load cycling leading to exhaustion in ?1 h. The precise mechanism(s) underlying this effect cannot be attributed to alterations in CHO availability but, instead, may be linked to changes in afferent sensory input

Regulation of metabolic genes in human skeletal muscle with short-term exercise and diet manipulation

Changes in dietary macronutrient intake alter muscle and blood substrate availability and are important for regulating gene expression. However, few studies have examined the effects of diet manipulation on gene expression in human skeletal muscle. The aim of this study was to quantify the extent to which altering substrate availability impacts on subsequent mRNA abundance of a subset of carbohydrate (CHO)- and fat-related genes. Seven subjects consumed either a low- (LOW; 0.7 g/kg body mass CHO) or high- (HIGH; 10 g/kg body mass CHO) CHO diet for 48 h after performing an exhaustive exercise bout to deplete muscle glycogen stores. After intervention, resting muscle and blood samples were taken. Muscle was analyzed for the gene abundances of GLUT4, glycogenin, pyruvate dehydrogenase kinase-4 (PDK-4), fatty acid translocase (FAT/CD36), carnitine palmitoyltransferase I (CPT I), hormone-sensitive lipase (HSL), beta-hydroxyacyl-CoA dehydrogenase (beta-HAD), and uncoupling binding protein-3 (UCP3), and blood samples for glucose, insulin, and free fatty acid (FFA) concentrations. Glycogen-depleting exercise and HIGH-CHO resulted in a 300% increase in muscle glycogen content (P&lt;0.001) relative to the LOW-CHO condition. FFA concentrations were twofold higher after LOW- vs. HIGH-CHO (P&lt;0.05). The exercise-diet manipulation exerted a significant effect on transcription of all carbohydrate-related genes, with an increase in GLUT4 and glycogenin mRNA abundance and a reduction in PDK-4 transcription after HIGH-CHO (all P&lt;0.05). FAT/CD36 (P&lt;0.05) and UCP3 (P&lt;0.01) gene transcriptions were increased following LOW- CHO. We conclude that 1) there was a rapid capacity for a short-term exercise and diet intervention to exert coordinated changes in the mRNA transcription of metabolic related genes, and 2) genes involved in glucose regulation are increased following a high- carbohydrate diet

Using microchip-reading antennas to passively monitor a mammal reintroduction in south-west Queensland

Microchip-reading devices provide an inexpensive and efficient means of passively detecting and monitoring wildlife reintroductions, particularly where intensive methods such as trapping and radio-tracking may be difficult or pose risk to animal welfare. We trialled the use of microchip- reading antennas for post-release monitoring of the survival of bilbies (Macrotis lagotis) for a reintroduction in south-west Queensland. The antennas detected 76% of the released captive- born bilbies (all microchipped) and 30% of the microchipped wild-born bilbies during the study period. Overall, the microchip-reading antennas greatly improved the rate of detection for bilbies in the enclosure compared to cage trapping alone. Of the 42 bilbies that were microchipped and had the potential to be recaptured in traps or detected on microchip readers, 33 were recorded from the combined approaches, with 20 bilbies recaptured in traps and 29 bilbies detected on the microchip readers. Antenna location/placement should be carefully considered in the context of the target species’ home range size as it may affect the probability of animals encountering the antenna. Here we demonstrate the ability to use these microchip-reading antennas to passively monitor post-release survival in a remote location, just one of many potential applications for these devices in wildlife management and conservation