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

Comorbid bipolar disorder and obsessive-compulsive disorder: An old debate renewed

Abstract assent

Use of normalization process theory to explore key stakeholders’ perceptions of the facilitators and barriers to implementing electronic systems for medicines management in hospital settings.

Background: Limited data exist on the facilitators and barriers to implementing electronic systems for medicines management in hospitals. Whilst numerous studies advocate system use in improved patient safety and efficiency within the health service, their rate of adoption in practice has been slow. Objective: To explore the perceptions of key stakeholders towards the facilitators and barriers to implementing electronic prescribing systems, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospital settings using Normalization Process Theory as a theoretical framework. Methods: Individual face-to-face semi-structured interviews were conducted in three public hospitals in Ireland with 23 consenting participants: nine nurses; four pharmacists; two pharmacy technicians; six doctors; and two Information Technology managers. Results: Enhanced patient safety and efficiency in healthcare delivery emerged as key facilitators to system implementation, as well as the need to have clinical champions and a multi-disciplinary implementation team to promote engagement and cognitive participation. Key barriers included inadequate training and organisational support, and the need for ease and confidence in system use to achieve collective action. Conclusions: Many themes that are potentially transferable to other national settings have been identified and extend the evidence base. This will assist organisations around the world to better plan for implementation of medication-related eHealth systems

The prevalence and predictors of comorbid bipolar disorder and obsessive-compulsive disorder: A systematic review and meta-analysis

Abstract Background: Although some authors have recently investigated the co-occurrence of anxiety and bipolar disorders, the topic remains insufficiently studied. Defining the prevalence and predictors of BD-OCD comorbidity has important nosological, clinical and therapeutic implications. Methods: A systematic review and meta-analysis was conducted on the prevalence and predictors of comorbid BD-OCD. Relevant papers published through March 30th, 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. Results: 46 articles met inclusion criteria. The pooled prevalence of OCD in BD was 17.0% (95% CI 12.7-22.4%), which was comparable to the results reported by the pooled prevalence of BD in OCD (18.35%, 95% CI 13.2-24.8%). With regard to OCD-BD predictors, a higher mean age predicted a lower prevalence of OCD in BD patients. Sub group meta-analyses reported higher OCD prevalence rates in BD children and adolescents (24.2%, compared to 13.5% in adults), in BD-I patients (24.6%, compared to 13.6% in mixed BD patients), and among population-based studies (22.2%, compared to 13.2% in hospital-based studies). Limitations: Most studies use retrospective assessment scales with low sensitivity in discriminating true ego-dystonic obsessions from depressive ruminations that may bias results towards an overestimation of obsessive symptom prevalence. Conclusions: This first systematic review and meta-analysis of the prevalence and predictors of comorbid BD-OCD confirms that BD-OCD comorbidity is a common condition in psychiatry with children and adolescents and BD-I patients as the most affected subgroups

The NDT Investigations Carry out at the Arudj Cathedral, Armenia

Arudj Cathedral, Armenia, is an example of early-Christian domed-hall that dates 671-672. A deep structural analysis of the building was developed by Politecnico di Milano, during the II° Level Master for Architects and Archaeologists named “Restoration Training and Support to Local Institutions for the Preservation and Conservation of Armenian Heritage”. The preservation project mainly focuses on deepen the knowledge level of the building in relation to the architectonical and structural aspects in order to offer a working method with the aim to propose and teach alternative solutions for static and seismic consolidation. This paper reports the NDT investigations of the surveys carried out at the Cathedral of Arudj and the results obtained at the laboratory of the Politecnico di Milano. The NDT investigations were carried out by the Authors and here following are briefly described. Sonic investigations on masonry structures were applied for a qualitative comparison of the walls, based on the variation of the sonic velocity values in the presence of areas with lower density, voids or cavities. The passive thermographic technique was applied to identify the distribution of capillary ascent in masonry structures. In order to offer a longterm verification of the evolution of the crack pattern, after having identify the cracks present on the masonry structures some displacement transducers have been fixed to state their evolution hourly. Finally, a series of laboratory tests were carried out to determine the main mechanical characteristics of the constituent stone

Outpatient parenteral antibiotic therapy (OPAT): a qualitative study of patient perspectives in those choosing not to self-administer.

OPAT is a well established treatment for administration of intravenous (IV) antibiotics, and models of administration include home self-administration. Despite this offering advantages, statistics indicate that less patients in the research centre home self-administer compared with other national centres

Is the pharmacy profession innovative enough?: meeting the needs of Australian residents with chronic conditions and their carers using the nominal group technique

Background Community pharmacies are ideally located as a source of support for people with chronic conditions. Yet, we have limited insight into what innovative pharmacy services would support this consumer group to manage their condition/s. The aim of this study was to identify what innovations people with chronic conditions and their carers want from their ideal community pharmacy, and compare with what pharmacists and pharmacy support staff think consumers want. Methods We elicited ideas using the nominal group technique. Participants included people with chronic conditions, unpaid carers, pharmacists and pharmacy support staff, in four regions of Australia. Themes were identified via thematic analysis using the constant comparison method. Results Fifteen consumer/carer, four pharmacist and two pharmacy support staff groups were conducted. Two overarching themes were identified: extended scope of practice for the pharmacist and new or improved pharmacy services. The most innovative role for Australian pharmacists was medication continuance, within a limited time-frame. Consumers and carers wanted improved access to pharmacists, but this did not necessarily align with a faster or automated dispensing service. Other ideas included streamlined access to prescriptions via medication reminders, electronic prescriptions and a chronic illness card. Conclusions This study provides further support for extending the pharmacist’s role in medication continuance, particularly as it represents the consumer’s voice. How this is done, or the methods used, needs to optimise patient safety. A range of innovative strategies were proposed and Australian community pharmacies should advocate for and implement innovative approaches to improve access and ensure continuity of care

Is there a role for the pharmacist in screening for metabolic syndrome?

Evidence for a pharmacist role in the screening of MetS has been shown to be effective in at risk populations. Despite migrants being an at risk group for the development of MetS, no literature has described screening of migrants by pharmacists. The aim of this research was therefore to identify the impact of the pharmacist role in screening migrants on arrival in a Middle Eastern country and following 24 months of residency in the Middle East. This was a prospective longitudinal observational study. Migrants aged 18–65 years were informed about the research by pharmacists and consented to participate. Baseline screening for MetS risk factors was conducted. Parameters included glycated haemoglobin (HbA1c), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), blood pressure (BP) and waist circumference (WC). All migrants with identified metabolic abnormalities at this screening stage were referred to physicians by the pharmacist for further management. Migrants with normal metabolic parameters at baseline were invited to be re-screened by pharmacists. This will allow identification of an increase in any incidence of MetS, and will allow for earlier intervention and management. Of the 1379 identified migrants, 460 consented to participate; 70% were men and 82.2% (378) were Asians. Pharmacist-led screening revealed 13.9% (64) with abnormal BP, 6.7% (31) with pre-diabetes, 21.4% (91) with elevated TG, 25% (115) with low HDL–C and 47% (219) with high WC. 16% (75) were found to have MetS and were referred to the physician for follow-up. These participants were consequently identified as at risk for development of MetS at a much earlier stage. A total of 199 migrants with normal metabolic parameters will be followed-up following 24 months of residency in the Middle East. Throughout the study, migrants with metabolic abnormalities were referred by pharmacists to physicians for further management. The study indicates that pharmacist screening is effective for early identification and potential early management of MetS in this migrant population

Future enhanced clinical role of pharmacists in emergency departments in England:multi-site observational evaluation

Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at their Emergency Department, recorded anonymized details of 400 cases and categorized each into one of four possible options: cases which could be managed by a community pharmacist; could be managed by a hospital pharmacist independent prescriber; could be managed by a hospital pharmacist independent prescriber with additional clinical training; or medical team only (unsuitable for pharmacists to manage). Impact indices sensitive to both workload and proportion of pharmacist manageable cases were calculated for each clinical group. Main outcome measure Proportion of cases which could be managed by a pharmacist. Results 18,613 cases were observed from 49 sites. 726 (3.9%) of cases were judged suitable for clinical management by community pharmacists, 719 (3.9%) by pharmacist prescribers, 5202 (27.9%) by pharmacist prescribers with further training, and 11,966 (64.3%) for medical team only. Impact Indices of the most frequent clinical groupings were general medicine (13.18) and orthopaedics (9.69). Conclusion The proportion of Emergency Department cases that could potentially be managed by a pharmacist was 36%. Greatest potential for pharmacist management was in general medicine and orthopaedics (usually minor trauma). Findings support the case for extending the clinical role of pharmacists

Blockade of IGF2R improves muscle regeneration and ameliorates Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is a debilitating fatal X-linked muscle disorder. Recent findings indicate that IGFs play a central role in skeletal muscle regeneration and development. Among IGFs, insulinlike growth factor 2 (IGF2) is a key regulator of cell growth, survival, migration and differentiation. The type 2 IGF receptor (IGF2R) modulates circulating and tissue levels of IGF2 by targeting it to lysosomes for degradation. We found that IGF2R and the store-operated Ca2+ channel CD20 share a common hydrophobic binding motif that stabilizes their association. Silencing CD20 decreased myoblast differentiation, whereas blockade of IGF2R increased proliferation and differentiation in myoblasts via the calmodulin/calcineurin/NFAT pathway. Remarkably, anti-IGF2R induced CD20 phosphorylation, leading to the activation of sarcoplasmic/endoplasmic reticulum Ca2+-ATPase (SERCA) and removal of intracellular Ca2+. Interestingly, we found that IGF2R expression was increased in dystrophic skeletal muscle of human DMD patients and mdx mice. Blockade of IGF2R by neutralizing antibodies stimulated muscle regeneration, induced force recovery and normalized capillary architecture in dystrophic mdx mice representing an encouraging starting point for the development of new biological therapies for DMD