Australasian Medical Journal
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Provision of Opioid Substitution Therapy Services in Australian Pharmacies
Get PDFOpioid dependence, despite being the subject of significant public funding, remains a costly burden to Australian society in human and economic terms. The most cost effective public health strategy for managing opioid dependence is opioid substitution therapy (OST), primarily through the use of methadone or buprenorphine. Supervised dispensing of OST from specialist clinics and community pharmacies plays a crucial role in enhancing compliance, monitoring treatment and reducing diversion. Australia compared with other countries in the world, ranks very high in illicit opioid use; hence there is a great demand for OST. The utilisation of community pharmacies for stable patients has many advantages. For public clinics, patient transfer to community pharmacies relieves workload and costs, and increases capacity for new OST patients. From a patient’s perspective, dosing at a pharmacy is more flexible and generally more preferable. Pharmacists stand to gain clientele, profit and receive small incentives from state governments in Australia, for their services. Yet, many “unmet needs” exist and there is a high demand for more involvement in OST service provision in community pharmacy in Australia. In the UK there has been a steady increase in community pharmacy provision of OST, and pharmacists appear ready to provide further healthcare services to these patients. The role of pharmacy in some countries in Europe, such as Germany, is less prominent due to their approach to harm minimisation and the complex, variable nature of OST provision across the European Union. The provision of OST by pharmacists in the USA on the other hand is of lesser frequency as the healthcare system in the USA encourages detoxification clinics to handle cases of illicit drug addiction. At a time when harm minimisation strategies constitute a topic of considerable political and public interest, it is important to understand the scope and variability of pharmacy involvement in drug policy in Australia. Hence, this review highlights the role of pharmacists in OST and explores the scope for expanding this role in the future
An Expanded Prescribing Role for Pharmacists
Get PDFExpanded pharmacist prescribing is a new professional practice area for pharmacists. Currently, Australian pharmacists’ prescribing role is limited to over-the-counter medications. This review aims to identify Australian studies involving the area of expanded pharmacist prescribing. Australian studies exploring the issues of pharmacist prescribing were identified and considered in the context of its implementation internationally. Australian studies have mainly focused on the attitudes of community and hospital pharmacists towards such an expansion. Studies evaluating the views of Australian consumers and pharmacy clients were also considered. The available Australian literature indicated support from pharmacists and pharmacy clients for an expanded pharmacist prescribing role, with preference for doctors retaining a primary role in diagnosis. Australian pharmacists and pharmacy client’s views were also in agreement in terms of other key issues surrounding expanded pharmacist prescribing. These included the nature of an expanded prescribing model, the need for additional training for pharmacists and the potential for pharmacy clients gaining improved medication access, which could be achieved within an expanded role that pharmacists could provide. Current evidence from studies conducted in Australia provides valuable insight to relevant policymakers on the issue of pharmacist prescribing in order to move the agenda of pharmacist prescribing forwards
Unusual Vascular Anatomy in a Human Cadaver
No full textDuring the routine dissection in the Department of Anatomy of Rural Medical College, Loni, we found a rare variation in branching pattern of common carotid artery (CCA) and external carotid artery (ECA) bilaterally. The knowledge of possible anatomical variations of CCA and ECA are especially important in surgery of head, neck and face; and also for radiologist to understand and interpret cerebral angiography. The case is reported here and the clinical significance of this variation is emphasized
Polymyositis associated with Non-Secretory Myeloma – A Case Report
Get PDFIdiopathic inflammatory myopathies (IIM) are a heterogeneous group of disorders characterized by proximal muscle weakness and inflammation of skeletal muscle, often associated with malignancies. The association of Idiopathic inflammatory myositis and malignancies has been reported rarely in Asian countries. We are reporting a rare case of polymyositis associated with non-secretory myeloma with hypercalcemia and renal failure. Patient presented with features of myositis and renal failure, the search for malignancy revealed non-secretory myeloma. Since the patient refused chemotherapy, he is managed symptomatically for hypercalcemia and renal failure
Informed Consent in Suicide Prevention Research
No full textEthical issues are inherent in research with vulnerable populations; researchers are encouraged to view these issues as challenges rather than obstacles. This paper details the request of a suicide prevention research collaboration to collect data in specific circumstances involving the waiver of consent. The conflicting multi-ethics committees’ responses to this request are examined, with the purpose of highlighting the resultant impact of delayed multi-site ethical approvals. Implications of the committees’ responses for this research in terms of being able to address the original stated project aims of improving future acute health service provision to suicidal individuals are discussed
Occupational Stress and Police
No full textBackgroundPolice work tends to impose a high degree of stress and a multiplicity of stressful situations which can affect the physical, mental and interpersonal relationships of police personnel. The objective of the present study was to assess the level of stress among police personnel and to find the association of various factors with the level of stress among police personnel.Method A cross-sectional study was conducted among 102 police personnel in Wardha city. A structured questionnaire based on The Professional Life Stress Test by Fontana was given to all participants. A grading scale was used to link participant’s verbal descriptions of perceived stress to a numerical scoring system being given scores between zero and five. The total score obtained for each respondent was considered as a measure of stress level. ResultsDifferent stressors that were identified among the police personnel included criticism by superiors, excess work, no rewards, inadequate value given to abilities and commitments and no satisfaction from work. Seventy participants scored >15 which indicated that stress in the workplace was a problem, while 32 participants scored ≤15, indicating stress in the workplace was not a problem. A significant association was found with between age group, marital status, education and working hours and the level of stress among police personnel.ConclusionThe majority of police personnel studied were under stress at their workplace due to a variety of stressors. This indicates the necessity to modify the organizational environment within the police force
Hypertension Among Older Malays living in Rural Malaysia
No full textBackgroundWe are living in an ageing world. The prevalence of hypertension which is an established risk factor for cardiovascular disease and stroke increases with age. The aim of the study was to determine the prevalence of hypertension among the elderly Malays living in rural parts of north Malaysia. Method This cross-sectional study was conducted among the elderly (aged ≥60) Malay residents living in 22 villages in a north-western state called Kedah in Malaysia from 2007 to 2009. Kedah has one of the highest rates of elderly population in the country. Data was collected by trained research assistants. Besides the baseline demographic information, blood pressure was measured using standardised methods using a manual sphygmomanometer. ResultsThe response rate was 97.7%. The prevalence of hypertension among the elderly in these villages was 54.5% (228), 118 (28.2%) were known to be hypertensive and were on medication and an additional 110 (26.3%) respondents were newly diagnosed. Elevated mean systolic (146.17 ± 25.23) and diastolic (89.68 ± 15.60) blood pressure was noted among the known hypertensive. There was an almost fourfold risk (OR 3.64) of having uncontrolled blood pressure among the known hypertensive on treatment. Those with malnutrition were at an almost twofold at risk of being hypertensive (OR 1.73). Binary logistics regression showed occupation (OR 1.65), marital status (OR 2.32) and body mass index (BMI) (OR 1.62) as significant predictor variables.ConclusionScreening the elderly for hypertension will benefit this group of people by reducing the morbidity and mortality associated with this conditio
Surgical Removal of Impacted Teeth
Get PDFBackgroundThe aim of the study was to undertake a six-year analysis from 1999/00 to 2004/05, of the demographic characteristics of hospitalisations for the surgical removal of impacted teeth in Western Australia under general anaesthesia.Method Data for the current analysis was obtained from the Western Australian Hospital Morbidity Data System (HMDS). Gender, age, indigenous status, place of residence, type of hospital admitted, insurance status, and Diagnostic Related Group (DRG) cost estimates for the procedure were analysed.ResultsA total of 37.6% of all oral health-related hospitalisations in Western Australia over the six years were for the removal of impacted teeth. Admitted patients were predominantly females (58.8%) and very few Indigenous people were hospitalised (0.2%). The average age of patients was 21.4 years (sd=9.9). Metropolitan patients were hospitalised 1.5 times more than rural patients for this condition. The majority of patients were hospitalised at a private metropolitan hospital and were insured. The total cost of hospitalisation for this condition contributes to 27% of all the oral health condition-related hospitalisation costs. ConclusionThis study suggests that the hospital-based removal of impacted teeth in Western Australia is associated with factors such as indigenous status, age, gender and private hospital access along with insurance status raising interesting questions over the equity of provision of this servic