Redefining the launch pad for leadership: dismantling barriers and increasing cooperation

'Learning' is the core business of higher education. Learning is required for self-development and for the development, and leadership, of others. We learn when we are challenged, although findings from neuroscience prove that unhealthy stress promotes activity in the limbic system of the brain and cognitive thinking, essential for learning, becomes impaired. Systems in Australian Higher Education were designed primarily by men who comprise 80% of senior leadership positions. Many processes are highly competitive, stimulating the release of adrenaline, testosterone and cortisol in men and women. Although short-term stress may enhance performance, long-term stress has consequences, including a negative impact on learning. The consequences affect not only the individual but all those who are influenced by that individual. Physiologically, women are more collaborative than men. This presentation will link findings from physiology, neuroscience, education, and leadership theories, to argue that we require new, collaborative approaches to lead Higher Education

Use of Prescription Medicines Among Older People

The findings of this study, conducted in 2004, laid the foundation for subsequent research about the use of medicines among older people within the Auckland region of New Zealand. This manuscript includes references relevant at the time of study while recent population statistics, government initiatives and developments are summarized in this forward, providing an updated introduction to the findings from the 2004 pilot study. Tools developed and used in this study were further refined and adapted and subsequently used in a medicines management service piloted by HealthWest Primary Health Organisation in Auckland New Zealand study. These studies informed the business case for funding of a new Medicine Management Service (Medicine Use Review and Adherence Support Service) in the Waitemata District in New Zealand

Exploring access to medicines and pharmacy services for resettled refugees

Methods: Adhering to guidelines for systematic reviews by PRISMA, this review synthesised findings of research that explored the barriers and/or facilitators of access to medication and pharmacy services for resettled refugees. Databases were searched during March 2014 and included Scopus, ProQuest Sociological Abstracts, PubMed, Embase and APAIS Health. The Australian and International grey literature was also explored. Results: Out of 651 potentially relevant articles, 9 studies met quality and inclusion criteria. The research reported in 7 of the 9 studies was conducted in the United States, 1 was conducted in Australia and the other in the United Kingdom. The majority of studies focused on Southeast Asian refugees. Themes identified across the studies included language and the use of interpreters; navigating the Western healthcare system; culture and illness beliefs; medication non-adherence; use of traditional medicine; and family, peer and community support. Discussion: The difficulties that resettled refugees experience in accessing primary healthcare services have been widely documented. In most developed countries, pharmacists are often the first healthcare professional contacted by consumers; however, the ability of refugees to access community pharmacy and medication may be limited. This review indicates a significant paucity of published research exploring barriers to medication and pharmacy services among this vulnerable population. Findings from the international literature suggest that refugees experience barriers to medication access, including language and cultural barriers, and experience difficulties navigating the pharmacy healthcare system. This review highlights the need for appropriate interpreting and translation services, as well as pharmacists demonstrating effective cross-cultural communication skills

Innovating medication reviews through a technology-enabled process

Medication reviews are effective in improving the quality of medication use among older people. However, they are conducted to various standards resulting in a wide range of outcomes which limit generalisability of findings arising from research studies. There also appear to be funding and time constraints, lack of data storage for quality improvement purposes, and non-standardised reporting of outcomes, especially clinically relevant outcomes. Furthermore, the coronavirus disease-19 (COVID-19) pandemic has restricted many face-to-face activities, including medication reviews. This article introduces a technology-enabled approach to medication reviews that may overcome some limitations with current medication review processes, and also make it possible to conduct medication reviews during the COVID-19 pandemic by providing an alternate platform. The possible advantages of this technology-enabled approach, legislative considerations and possible implementation in practice are discussed

Current and Potential Roles in Sports Pharmacy: A Systematic Review

(1) Background: The objective of this systematic review was to evaluate current and potential roles for pharmacists in sports medicine and to identify key themes in outcomes reported in studies. (2) Methods: EMBASE, MEDLINE, CINAHL, Scopus and the Cochrane Library were searched in January 2019. Peer-reviewed, original research articles were considered for inclusion. Articles published in a language other than English were excluded. Quality appraisal was performed independently by two authors. (3) Results: Findings of 11 eligible articles (10 observational and 1 experimental study design) were grouped into three themes: (i) doping prevention and control, (ii) injury management and first aid, and (iii) educational and curricular needs. Pharmacists were perceived as a good potential source of information about doping and are enthusiastic about counseling athletes, but lack knowledge and confidence in this area. While pharmacists were frequently consulted for advice on managing sprains and strains, their advice was not always guided by current evidence. Pharmacists and pharmacy students recalled limited opportunity for education in sports pharmacy. (4) Conclusion: Pharmacists showed a willingness and an aptitude to counsel athletes. However, lack of knowledge and confidence, and limited educational opportunities, were key barriers. More research is necessary to support pharmacists in this role

Human biomarker exposure from cigarettes versus novel heat-not-burn devices: a systematic review and meta-analysis

Introduction: Novel tobacco products require independent research to assess their safety. This study assessed the current literature for trials comparing levels of biomarkers of exposure (BoE) between conventional cigarettes and heat-not-burn (HNB) devices. Methods: Ten databases were searched using terms including: ‘heat not burn’, ‘iqos’, ‘teeps’, ‘mrtp’, ‘tobacco heating’, and ‘glo’, between 1st January 2010 and 13th August 2019. Randomised controlled trials assessing comparative BoE levels in humans using either conventional cigarettes or novel HNB devices were eligible. BoE were tabulated, and differences between the intervention and control groups analysed and combined using a random effects meta-analysis. Results: Ten non-blinded, randomised controlled trials were eligible, involving a total of 1,766 participants. Studies regularly reported on 12 BoE (including nicotine). HNB devices assessed included the ‘IQOS’ and ‘glo’ devices, and ‘precursor’ (being developed) HNB devices. In comparison to conventional cigarettes, all 12 BoEs assessed were significantly lower for participants assigned to a HNB device. In comparison to smoking abstinence, HNB devices were statistically equivalent for eight BoEs and significantly elevated for four BoEs. Conclusions: This review found that the potential for harm to humans is reduced when using HNB devices compared to conventional cigarettes, as indicated by significant reductions in BoE levels. Whilst these results support tobacco manufacturer claims of improved safety, the small number of studies included, limited range of BoE assessed, and involvement of the tobacco industry necessitate further independent research to confirm the HNB devices as being a safer alternative to conventional cigarettes

Residential Medication Management Reviews and continuous polypharmacy among older Australian women

Background Polypharmacy is an important consideration for the provision of Residential Medication Management Reviews (RMMRs) among older women given their enhanced risk of medication-related problems and admission to residential aged care (RAC). Objectives To determine the prevalence of the use of RMMRs among older women in RAC, and the association between RMMRs and polypharmacy, medications, and costs. Setting Older Australian women aged 79–84 years in 2005 who had at least one Medicare Benefits Schedule and Pharmaceutical Benefits Scheme record, received a service in aged care, and consented to data linkage. Methods Generalised estimating equations were used to determine the association between polypharmacy and RMMRs, while adjusting for confounding variables. Main outcome measures Prevalence of the use of RMMRs among older women in RAC, association between RMMRs and polypharmacy, medications, and costs. Results Most participants did not have continuous polypharmacy and did not receive RMMRs from 2005 [451 (67.4%)] until 2017 [666 (66.6%)]. Participants with continuous polypharmacy were 17% more likely to receive a RMMR (risk ratio 1.17; 95% confidence interval 1.11, 1.25). Participants in their final year of life and residing in outer regional/remote/very remote Australia were less likely to receive RMMRs. Out-of-pocket medication costs increased over time, and alendronate and aspirin were common contributors to polypharmacy among participants who received RMMRs. Conclusion Polypharmacy was associated with receiving RMMRs and around two-thirds of women who are entitled to a RMMR never received one. There is potential to improve the use of medicines by increasing awareness of the service among eligible individuals, their carers and health care professional

The global distribution of comorbid depression and anxiety in people with diabetes mellitus: risk-adjusted estimates

Background: Previous reports suffer from the problem that they simply pooled data using aggregate means or standard meta-analytic method. The aim of the current study was to re-estimate the point prevalence of comorbid depression and anxiety in people with diabetes. Methods: The estimates were calculated using recently introduced directly standardized effect estimate method, which gives corrected risk-adjusted estimates for the population of interests. Reported are global and regional burden of prevalence, presented as risk-adjusted prevalence estimates with 95% confidence intervals. Results: Globally, the burden of comorbid depression was higher than the burden of anxiety (23.36% vs. 17.58%) symptoms and/or disorder in people with diabetes. There was a higher burden of comorbid depression in people living in developing regions (26.32%), in women (15.41%), and when assessed by self-report scales (SRS) (22.66%). The burden of anxiety was higher in developed regions in people with Type 2 diabetes mellitus (20.15%) and when assessed by SRS (20.75%). No statistically significant differences were observed due to gross heterogeneity across countries. Conclusions: There are wide-ranging differences in studies in developed and developing regions, regarding the burden of comorbid depression and of anxiety among people with diabetes and both conditions affect approximately a fifth of the diabetic population

Treatment of diabetes in Malaysia and Australia

Background Once a disease of developed countries, type 2 diabetes mellitus (T2DM) has become widespread worldwide. For people with T2DM, achievement of therapeutic outcomes demands the rational and quality use of medicine. Aims The primary aim of this study was to examine the prevalence of diabetes and prescribing patterns of anti-diabetic medications in Australia and Malaysia. Methods The most recent, publicly available, statistical reports (2004–2008) on the use of medicines published in Australia and in Malaysia were evaluated. Defined daily doses (DDDs/1,000 population/day) were derived from the reports and used to rank and compare individual drug use. Results There was an increasing trend in the prevalence of diabetes in Australia, although there is a greater predicted increase in prevalence for Malaysia. While drugs used for the treatment of diabetes were not the most highly used drugs in Australia, their use increased during the study period, from 42.64 to 48.61 DDD/1,000/day. Anti-diabetic drugs were the most frequently dispensed class of drugs in Malaysia. Although the total consumption of anti-diabetic drugs in Malaysia decreased between 2006 and 2007 (from 40.30 to 39.72), this was followed by a marked increase to 46.69 in 2008. There was a marked reduction in the dispensing of insulin in Malaysia from 2004 to 2007 (7.77 to 3.23). Conclusion The use of drugs to treat diabetes does not reflect the usage patterns of found in Australia. Effective drug use reviews are required to ensure impartial access in middle- and low-income countries

Investigating the impact of a clinical pharmacist on the health outcomes of a paediatric pharmacists

Background: Recent fiscal scrutiny and changes in health care financing have necessitated that health care providers justify a clinical and economical basis for their involvement in patient care. Although clinical pharmacists have been shown to enhance patient health outcomes and reduce costs among adult patients, the impact of a pharmacist in paediatric patient care has not been extensively documented. Method: A team of pharmacists was established to conduct a systematic review of the literature. A title scan of papers in 5 databases was performed by 14 pharmacists using the MeSH terms Pharmacists, Medical Intervention, Paediatrics and Cost-Benefit Analysis. The underpinning research question was: "How do the professional activities of a clinical pharmacist impact the health outcomes of paediatric in-patients?" The abstracts of suitable titles were scanned and articles were read to assess relevance. Relevant articles were then evaluated independently by at least two members of the team, using critical appraisal tools suitable for quantitative, qualitative or systematic review studies. Results: The initial search identified 327 citations which after full text review and application of the scoring tool, resulted in 12 studies included in the systematic review. The average number of interventions reported varied from study to study. Dosing recommendations, pharmacokinetics and drug allergy alerts were the most commonly recorded interventions by pharmacists for a paediatric population. Evidence from this review will be used to formulate improvements to in-patient paediatric care. Conclusion: Clinical pharmacists have a positive impact on inpatient paediatric care