USING THE SIMULATED PATIENT METHODOLOGY TO ASSESS THE QUALITY OF COUNSELLING IN GERMAN COMMUNITY PHARMACIES: A SYSTEMATIC REVIEW FROM 2005 TO 2018

The simulated patient methodology (SPM) is a form of participatory observation and can be used to assess the quality of counselling. The aim is to review those papers reporting the use of the SPM in German community pharmacies (CPs) from the beginning of 2005 to the end of 2018. The reporting items in the study were derived from the PRISMA Statement. We conducted a systematic search in the GVK-Plus, Embase, Web of Science, PubMed and Google Scholar databases. Additional sources included the personal literature collection of 1 of the reviewers and the reference lists from international systematic reviews and potentially relevant papers. The quality of the papers included was evaluated using the AXIS tool. A total of 5 papers were included. The SPM that was used varied greatly in the papers. The quality of counselling was assessed in the papers as being rather poor. The quality of the papers differed for specific assessment criteria. Only an extremely small number of papers could be included, in contrast to other countries. The papers for Germany demonstrate that there is a considerable need for improvement in the quality of counselling in CPs. Also, the deficits identified here for the application of the SPM should be avoided in future papers. It must also be recommended that the SPM be reported in future papers using uniform reporting standards, which are yet to be developed, to ensure better comparability

How Relevant Is the Parallax Effect on Low Centered Pelvic Radiographs in Total Hip Arthroplasty

The correct cup position in total hip arthroplasty (THA) is usually assessed on anteroposterior low centered pelvic radiographs, harboring the risk of misinterpretation due to projection of a three-dimensional geometry on a two-dimensional plane. In the current study, we evaluate the effect of this parallax effect on the cup inclination and anteversion in THA. In the course of a prospective clinical trial, 116 standardized low centered pelvic radiographs, as routinely obtained after THA, were evaluated regarding the impact of central beam deviation on the cup inclination and anteversion angles. Measurements of the horizontal and vertical beam offset with two different methods of parallax correction were compared with each other. Furthermore, the effect of parallax correction on the accuracy ofmeasuring the cup position was investigated. The mean difference between the two parallax correction methods was 0.2° ± 0.1° (from 0° to 0.4°) for the cup inclination and 0.1° ± 0.1° (from −0.1° to 0.2°) for the anteversion. For a typically intended cup position of a 45° inclination and 15° anteversion, the parallax effect led to a mean error of −1.5° ± 0.3° for the inclination and 0.6° ± 1.0° for the anteversion. Central beam deviation resulted in a projected higher cup inclination up to 3.7°, and this effect was more prominent in cups with higher anteversion. In contrast, the projected inclination decreased due to the parallax effect up to 3.2°, especially in cups with high inclination. The parallax effect on routinely obtained low centered pelvic radiographs is low and not clinically relevant due to the compensating effect of simultaneous medial and caudal central beam deviation

Galactic Abundances: Report of Working Group 3

We summarize the various methods and their limitations and strengths to derive galactic abundances from in-situ and remote-sensing measurements, both from ground-based observations and from instruments in space. Because galactic abundances evolve in time and space it is important to obtain information with a variety of different methods covering different regions from the Very Local Insterstellar Medium (VLISM) to the distant galaxy, and different times throughout the evolution of the galaxy. We discuss the study of the present-day VLISM with neutral gas, pickup ions, and Anomalous Cosmic Rays, the study of the local interstellar medium (ISM) at distances <1.5 kpc utilizing absorption line measurements in H I clouds, and the study of galactic cosmic rays, sampling contemporary (~15 Myr) sources in the local ISM within a few kiloparsec of the solar system. Solar system abundances, derived from solar abundances and meteorite studies are discussed in several other chapters of this volume. They provide samples of matter from the ISM from the time of solar system format ion, about 4.5 Gyr ago. The evolution of galactic abundances on longer time scales is discussed in the context of nuclear synthesis in the various contributing stellar objects

Medication dispensing, additional therapeutic recommendations, and pricing practices for acute diarrhoea by community pharmacies in Germany: a simulated patient study

Background: In Germany over-the-counter medications (OTC) – which since 2004 are no longer subject to binding prices – can only be purchased in pharmacies. Pharmacy owners and their staff therefore have a special responsibility when dispensing, advising on and setting the prices of medications. Objective: The aim of this study was to assess medication dispensing, additional therapeutic recommendations and pricing practices for acute diarrhoea in adults and to evaluate the role of the patient’s approach (symptom-based versus medication-based request) in determining the outcome of these aspects. Methods: A cross-sectional study was conducted from 1 May to 31 July 2017 in all 21 community pharmacies in a medium-sized German city. Symptom-based and medication-based scenarios related to self-medication of acute diarrhoea were developed and used by five simulated patients (SPs) in all of the pharmacies (a total of 84 visits). Differentiating between the different test scenarios in terms of the commercial and active ingredient names and also the prices of the medications dispensed, the SPs recorded on collection forms whether the scenario involved generic products or original preparations as well as whether recommendations were made during the test purchases regarding an additional intake of fluids. Results: In each of the 84 test purchases one preparation was dispensed. However, a preparation for oral rehydration was not sold in a single test purchase. On the other hand, in 74/84 (88%) of test purchases, medications with the active ingredient loperamide were dispensed. In only 35/84 (42%) of test purchases, the patient was also recommended to ensure an ‘adequate intake of fluids’ in addition to being dispensed a medication. In symptom-based scenarios significantly more expensive medications were dispensed compared to the medication-based scenarios (Wilcoxon signed rank test: z = -4.784, p < 0.001, r = 0.738). Also within the different scenarios there were enormous price differences identified – for example, in the medication-based scenarios, even for comparable loperamide generics the cheapest preparation cost EUR 1.99 and the most expensive preparation cost EUR 4.53. Conclusions: Oral rehydration was not dispensed and only occasionally was an adequate intake of fluids recommended. There were also enormous price differences both between and within the scenarios investigated

Replication Data for: Do north-eastern German pharmacies recommend a necessary medical consultation for acute diarrhoea? Magnitude and determinants using a simulated patient approach.

A cross-sectional covert simulated patient study was conducted in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern. The aim of this study was to determine whether a necessary recommendation to consult a doctor was made and what the quality of questioning and – if a medication was dispensed – the quality of information provided were in this context. Moreover, to determine which factors predicted a necessary referral to a doctor

How Relevant Is the Parallax Effect on Low Centered Pelvic Radiographs in Total Hip Arthroplasty

The correct cup position in total hip arthroplasty (THA) is usually assessed on anteroposterior low centered pelvic radiographs, harboring the risk of misinterpretation due to projection of a three-dimensional geometry on a two-dimensional plane. In the current study, we evaluate the effect of this parallax effect on the cup inclination and anteversion in THA. In the course of a prospective clinical trial, 116 standardized low centered pelvic radiographs, as routinely obtained after THA, were evaluated regarding the impact of central beam deviation on the cup inclination and anteversion angles. Measurements of the horizontal and vertical beam offset with two different methods of parallax correction were compared with each other. Furthermore, the effect of parallax correction on the accuracy ofmeasuring the cup position was investigated. The mean difference between the two parallax correction methods was 0.2° ± 0.1° (from 0° to 0.4°) for the cup inclination and 0.1° ± 0.1° (from −0.1° to 0.2°) for the anteversion. For a typically intended cup position of a 45° inclination and 15° anteversion, the parallax effect led to a mean error of −1.5° ± 0.3° for the inclination and 0.6° ± 1.0° for the anteversion. Central beam deviation resulted in a projected higher cup inclination up to 3.7°, and this effect was more prominent in cups with higher anteversion. In contrast, the projected inclination decreased due to the parallax effect up to 3.2°, especially in cups with high inclination. The parallax effect on routinely obtained low centered pelvic radiographs is low and not clinically relevant due to the compensating effect of simultaneous medial and caudal central beam deviation

A Nationwide Mystery Caller Evaluation of Oral Emergency Contraception Practices from German Community Pharmacies: An Observational Study Protocol

To prevent unwanted pregnancies, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is recommended by the guidelines of the German Federal Chamber of Pharmacists (BAK). In this respect, community pharmacies (CPs) in Germany have a major responsibility for information gathering, selecting the appropriate medicine, availability and pricing, among other things. Therefore, it would be appropriate to conduct a study with the aim of investigating information gathering, a possible recommendation as well as availability and pricing for oral EC in German CPs. A representative nationwide observational study based on the simulated patient methodology (SPM) in the form of covert mystery calls will be conducted in a random sample of German CPs stratified according to the 16 federal states. Each selected CP will be randomly called once successfully by one of six both female and male trained mystery callers (MCs). The MCs will simulate a product-based scenario using the request for oral EC. For quality assurance of the data collection, a second observer accompanying the MC is planned. After all mystery calls have been made, each CP will receive written, pharmacy-specific performance feedback. The only national SPM study on oral EC to date has identified deficits in the provision of self-medication consultations with the help of visits in the CPs studied. International studies suggest that UPA in particular is not always available. Significant price differences could be found analogous to another German study for a different indication