Evaluation of pharmacist clinical recommendations in a geriatric hospital

Objectives: This study was undertaken to record the number and type of recommendations made by pharmacists reviewing the drug treatment of older patients, to note acceptance of these recommendations by physicians and to assess clinical significance of pharmacist recommendations. Method: Three pharmacists providing inpatient services at Zammit Clapp Hospital were asked to record specific details of all recommendations given using a designed documentation form. The clinical impact of the pharmacists’ recommendations was assessed by the pharmacists making the recommendations together with a panel of two independent pharmacists and a medical doctor who had to rate the contribution of each recommendation as major, moderate, minor or of no clinical significance. Key findings: A total of 263 valid pharmacist recommendations were documented. The most frequent recommendations, accounting for 20.5% (n=54) of the total number of recommendations were adjustment to dosage, frequency and time of administration followed by discontinuation of a medication. The majority of recommendations were accepted by physicians (80%) and were rated by the panel to be of moderate (60.5%) clinical significance. Conclusion: Clinical pharmacists make a number of recommendations of significant clinical benefit to the care of hospitalised elderly patients, the majority of which are accepted by physicians.peer-reviewe

Ancient anchors from Malta and Gozo

In 2011, the national archaeological collection managed by Heritage Malta included 24 lead anchor stocks. They are the remains of ancient wooden anchors used on boats that sheltered in the harbours and bays of the Maltese Islands. This paper includes a gazetteer documenting these stocks with the aim of highlighting their value to maritime archaeology and to create a tool that will facilitate further study.peer-reviewe

Development of protocols for the provision of headache and back-pain treatments in Maltese community pharmacies

Objective: The purpose of this study was to draw up two protocols designed to help Maltese pharmacists care for consumers seeking treatment for headache and back pain and to subsequently use the protocols to assess pharmacists’ management of the named conditions. Method: The setting was a sample of 10 of the 207 community pharmacies in Malta. Two flow-chart protocols for headache and back-pain management were developed from various reference sources. The protocols were first tested in a community pharmacy for practicality and applicability in a pilot study. In nine other pharmacies chosen at random the pharmacists’ manner of addressing 10 headache and 10 back-pain cases in each pharmacy was compared with that recommended in the protocols. Consumers who visited the pharmacy to fill a prescription, to purchase a named product or for advice on how to deal with symptoms wereincluded in the study. Key findings: Of the 212 pharmacist interventions assessed, cases where pharmacists responded to symptoms were managed with the highest average compliance (57%) whereas cases in which the consumer asked for a product by name were managed with an average compliance with the protocols of 46%. Cases in which consumers presented at the pharmacy with a prescription were managed with an average compliance of 55%. Conclusions: Protocols may be used as a means of measuring the impact of the intervention of community pharmacists in patient care. The findings suggest a lack of advice given to consumers presenting at the pharmacy to request a named product.peer-reviewe

Life expectancy, mortality and elections : their association during elections in Malta

Introduction: While life expectancy has increased over the past thirty years, such increases have not been constant around election times in Malta. This study seeks to explore the relationship between the time of elections in Malta and specific mortality rates. Aim: To determine if there is an association between mortality and elections in Malta. Method: Yearly age specific death rates for all-cause mortality, mortality from ischaemic heart disease, cerebrovascular disease, other heart diseases and all circulatory diseases as well as suicides were calculated from the Malta National Mortality Register for the period between 1985 and 2013. Years when elections and referenda were held between 1985 and 2013 were obtained from the Electoral Commission.1 The years 1985 – 2013 were coded using dummy variables to categorise them into pre-election, post-election, election year or any other year. Data was analysed using Poisson’s regression technique in STATA with Mortality Rate Ratio (MRR) presented as the outcome measure. Results: A significant increase in overall mortality during election years resulted for circulatory disease MRR 1.058 (p<0.001; 95% CI 1.029-1.087), cerebrovascular disease MRR 1.09 (p=0.002; 95% CI 1.032-1.155) and other heart diseases MRR 1.36 (p<0.001; 95% CI 1.276-1.449). A significant increase was also noted during pre- election years in circulatory disease MRR 1.046 (p=0.002; 95% CI 1.017-1.075) and other heart diseases MRR 1.33 (p<0.001; 95% CI 1.248-1.422) and post-election years for cerebrovascular disease MRR 1.08 (p=0.009; 95% CI 1.020-1.150) and other heart diseases MRR 1.19 (p<0.001; 95% CI 1.108-1.273)) relative to the other years. Conclusion: This ecological study provides an indication that mortality patterns may be associated with the electoral cycle in Malta. Further research on individual physical and psychological responses to political events, particularly around election time is warranted.peer-reviewe

Persons with autism and persons with ADHD : the need to understand and improve services for families in Malta

Persons diagnosed with autism, or Autism Spectrum Disorder (ASD) and/or Attention Deficit Hyperactivity Disorder (ADHD) are often reported to perform significantly low in overall wellbeing when compared to their neurotypical counterparts (van Heijst & Geurts, 2015; Meier et al., 2011). With active participation in society considered to be a key factor surrounding wellbeing (Askari et al., 2015), it comes as no surprise therefore that the reduced levels of involvement reported in areas such as social engagement, education, and leisure may be major contributors to this (Deserno et al, 2016). Over the years, Malta has made considerable shifts towards the recognition of certain rights when it comes to disability, although negative attitudes still exist, both from the general public, as well as professionals (Cardona, 2013). This study therefore sought to understand the experiences of those living with autism and/or ADHD in the local scenario, looking into how current support structures impact their livelihood. Using a mixed-method approach involving quantitative and qualitative data collection strategies, this study sought to highlight insider voices, attempting to ‘take stock’ of the status of the evidence base, listening to the voices of those concerned and their experiences with local services and within the wider local community as a whole, identifying any gaps in services or data along the way. The findings of this study indicate that locally, persons living with autism and/or ADHD, encounter challenges throughout their development from children into adulthood which considerably impact their performance and consequently their wellbeing. A number of areas for development were identified. The services surrounding the attainment of a diagnosis for instance, were found to be typically carried out professionally in the case of those flagged at early years, however, were severely lacking when it came to adults. Moreover, a vast majority (80%) of adult service user participants in the study had received their diagnosis during adulthood, exposing a local picture where diagnoses are not being made early enough, leading to individuals facing foundation schooling and critical years without the necessary support. Although services users who are being diagnosed as adults may have faced a different situation when they were of school age, since these conditions were less known and there was less awareness, nevertheless, caregivers are still reporting that there are instances where they know that there is a condition but find it hard to access a diagnosis as they are told to wait until the child is older. Support services and referrals for treatment offered following diagnosis were also found to be severely lacking, with 91% of service user respondents and 6 82% of caregiver participants not having received any services or information after receiving their diagnosis. Encouraging achievements within the educational and employment realm were observed, however areas for improvement still remain, with finding indicating this may be more so the case for those living with autism. Levels of dissatisfaction with services were reported across large numbers of participants with the highest ranked dissatisfaction expressed towards how well services were connected amongst each other, followed by access to services following diagnosis. Several lamented long waiting lists, lack of trained professionals and infrequency and inconsistency across public services provided. In addition to this, over 70% of participants reported being dissatisfied with the prospects for lifelong fulfilment, accompanied by concerns about services not catering for different age groups, particularly adolescence and even more so adulthood. These findings were also echoed in data gathered from service providers, who in the larger part, shared that there were waiting lists associated with the provision of their services – in some cases, of even more than 13 months. A review of the services provided amongst participating service providers also reflected the critical reduction in services available for adults when compared to younger ages. Amongst service providers, the largest challenge in offering services both for ASD and ADHD was lack of trained professionals. These include a range of services, such as occupational therapy, speech therapy, behaviour specialists, health and educational services as well as social services, amongst others. Over the years, valuable developments have been achieved when it comes to Malta catering for the needs of all of its citizens, including those living with ADHD or ASD. The views and experiences discussed in this study have brought several commendations for milestones reached and have also highlighted several others that still need to be worked as a society towards. Ultimately, awareness and understanding across the different strata and branches of society is at the base of making these developments possible. The study concludes with a list of recommendations proposed for the enhanced wellbeing of those living with these conditions and society at large. These include, amongst others, recommendations for policy, such as the creation of a one-stop shop for provision of services, the introduction of quiet rooms in places such as hospitals and schools, the incentivising of youngsters to undertake studies related to disability in order to enrich the local pool of professionals, and the involvement of diagnosed individuals in decision-making processes. Recommendations for further research are also laid out, such as investigating gender differences related to ASD and ADHD, where females are typically underdiagnosed, or further examining the findings of this study by looking into ASD and ADHD separately to bring more insight into, for instance, findings related to the educational and employment attainments for these groupsnon peer-reviewe

Participant perceptions of different forms of deliberative monetary valuation : Comparing democratic monetary valuation and deliberative democratic monetary valuation in the context of regional marine planning

As conceptual and theoretical discussions on environmental valuation approaches have advanced there is growing interest in the impact that valuation has on decision making. The perceived legitimacy of the outputs of valuation studies is seen as one factor influencing their impact on policy decisions. One element of this is ensuring that participants of valuation processes see the results as legitimate and would be willing to accept decisions based on these findings. Here, we test the perceived legitimacy to participants of two approaches to deliberative monetary valuation, deliberated preferences and Deliberative Democratic Monetary Valuation, in the context of marine planning in the Clyde estuary in Scotland. We compare and contrast deliberated preference and deliberative democratic monetary valuation and track their emergence as responses to critiques of conventional stated preference approaches. We then present the results of our case study where we found that deliberative democratic monetary valuation produced valuations that were perceived as more legitimate that deliberated preference as the basis for decision making by those involved in the valuation process. </jats:p

The Minute Alga Schizocladia ischiensis (Schizocladiophyceae, Ochrophyta) Isolated by Germling Emergence from 24 m Depth off Rhodes (Greece)

This research was funded by the UK Natural Environment Research Council in support to FCK(program Oceans 2025–WP 4.5 and grants NE/D521522/1 and NE/J023094/1) and the NERC National Facility for Scientific Diving (NFSD/14/02). We would also like to thank the TOTAL Foundation (Project “Brown algal biodiversity and ecology in the Eastern Mediterranean Sea”). This work also received support from AFP from the project IDEALG (France: ANR-10-BTBR-04) and from FCK from the Marine Alliance for Science and Technology for Scotland pooling initiative. MASTS is funded by the Scottish Funding Council (grant reference HR09011) and contributing institutions.Peer reviewedPublisher PD

Arctic marine phytobenthos of northern Baffin Island

This project was supported by SAMS and NFSD core funding (Oceans 2025 WP 4.5 from the UK Natural Environment Research Council), the European Commission (ASSEMBLE, grant agreement no. 227799), and the TOTAL Foundation (Paris; Project “Macroalgal and oomycete benthic diversity in the Canadian Marine Arctic”). This work also received funding from the MASTS pooling initiative (The Marine Alliance for Science and Technology for Scotland) and their support is gratefully acknowledged. MASTS is funded by the Scottish Funding Council (grant reference HR09011) and contributing institutions. We also would like to thank Laura Grenville-Briggs (KTH, Stockholm) for help with bioinformatics analyses as well as Cindy Grant and Philippe Archambault (University of Quebec, Rimouski) for help with preparing the map of the study area (Fig. 1).Peer reviewedPublisher PD