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Cerebral palsy is a disorder of posture and movement. Multiple postural management interventions exist to prevent complications and improve outcomes. In this short review we followed a systematic approach to appraise the quality of evidence supporting each intervention and assessed the effectiveness across the International Classification of Functioning, Disability and Health (ICF) outcomes. Evidence-based recommendations are essential for assisting clinicians in selecting and implementing interventions aligned with the individual's goals. This review aims to summarize and evaluate the evidence supporting postural interventions for CP published after Gough's review in 2009. Additionally, it aims to provide clinical bottom lines according to GMFCS or MACS levels. We conducted our search for systematic reviews or population register studies evaluating postural management interventions in people with cerebral palsy using an umbrella systematic review design. We assessed the quality of evidence for each intervention and made recommendations using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) and the Evidence Alert Traffic Light approaches. From a total of 955 citations identified 33 unique studies met our inclusion criteria. The 33 studies included 41 interventions, measuring 22,835 participants, across 207 RCTs and 1 population register study. Of the 41 interventions, 14 were postural control interventions to improve movement; 11 were tone management interventions to improve movement or prevent deformity; 2 were postural management interventions to support upright posture; and 14 were postural management interventions to prevent deformity. Several postural control interventions are effective for improving movement, and several postural management interventions may prevent deformity, with hip surveillance having the best evidence. [ABSTRACT FROM AUTHOR]

Background: Carbapenemase-producing Enterobacterales (CPE) is an increasing public health concern; these bacteria are highly transmissible in hospital environments and the number of patients with these multidrug-resistant bacteria is rising. Healthcare workers caring for patients colonized with CPE offer insight into care delivery and processes in the hospital setting.Aim: To explore healthcare workers' experiences of caring for patients colonised with CPE.Methods: A scoping review method with seven electronic databases (CINAHL, Academic Search Complete, Cochrane, Embase, Medline, Web of Science and Scopus) and four grey literature databases (Open Grey, Grey Literature Report, Clinical trials.gov and WHO International Clinical Trials Registry Platform) searched using specific search terms and inclusion/exclusion criteria. PRISMA flow diagram was used to illustrate the process of article selection and thematic analysis used to form themes.Results: Three studies met the criteria to be included in this review. Two main themes were identified from analysing the articles: 'Safeguarding' and 'Power of Knowledge'. The desire to protect themselves, their families and patients was evident from the studies. Healthcare workers were aware of the importance on infection prevention and control measures such as hand hygiene, in preventing the transmission of CPE, however barriers to these were identified, such as time constraints.Conclusion: Healthcare workers have negative associations when it comes to caring for patients with CPE. Very little research has been conducted in the area and there is an opportunity to further explore the experience of healthcare workers caring for patients with CPE to identify opportunities for improvement and support of staff. [ABSTRACT FROM AUTHOR]

Introduction: The Inverse Care Law states that healthcare availability is inversely related to the needs of the population served. Increasing the provision of community pharmacy (CP) services for cardiovascular disease has been suggested to improve equity of healthcare access, particularly for screening, but few studies examine this. The aim of this study was to determine how the availability and uptake of cardiovascular disease (CVD) prevention services in CPs varies according to practice and local population characteristics.Methods: Pharmacists at all Victorian CPs were invited by phone to participate in a survey. The survey examined pharmacy characteristics, CVD-relevant service characteristics, and resources for service provision. Pharmacists who declined were asked if they would instead briefly provide key information. Area-level socioeconomic (SES) data for each pharmacy was included in the analyses. Binary logistic regression was used to determine the association of pharmacy attributes with service delivery.Results: Of 1238 CPs identified, 519 (42%) pharmacists completed the full questionnaire and 414 (33%) provided brief information. In general, services were more frequently available from pharmacies in lower SES and rural communities, with quality accreditation and with private counselling facilities. Factors predicting the likelihood of pharmacies receiving reimbursement for services that were not government-funded included having a private room or counselling area, and more than one pharmacist on duty. Factors predicting service delivery volume in the top quartile included script volume and private counselling facilities, and lower SES community profile. Only script volume predicted volume of government-funded medication reviews (MedsChecks).Discussion: Our finding that the Inverse Care Law may not apply to preventative service provision in CPs is highly notable and contrary to multiple findings in other settings. An understanding of the context and drivers of increased CP service provision in more vulnerable communities may inform the delivery of more equitable health services generally. [ABSTRACT FROM AUTHOR]

Background: In common with many developed countries, Saudi Arabia is currently experiencing an increasing cardiovascular disease (CVD) burden. However, systematic screening programs for early identification and minimization of CVD risk within community or general clinical settings are limited. Globally, research suggests that pharmacists can play an effective role in identifying, assessing, managing and referring people at risk of CVD in the community as well as in the hospital setting. This role is not yet developed in Saudi Arabia.Objectives: This study aimed to explore the perspectives of hospital and community pharmacists in Saudi Arabia about potential roles in CVD risk screening. The purpose of the study was to propose potential interventions to facilitate the development of pharmacist delivered models for CVD risk prevention and management services in Saudi Arabia.Methods: A qualitative study was conducted using semi-structured in-depth interviews and focus group discussions with a purposive convenience sample of hospital and community pharmacists in Saudi Arabia. Data collection continued until saturation was achieved. All interviews were audio recorded, transcribed verbatim and thematically analyzed.Results: A total of 50 pharmacists (26 hospital and 24 community pharmacists) participated in this study. Twenty hospital and eight community pharmacists were interviewed individually, while the remaining participants contributed to three focus groups discussions. Currently, it appears that CVD risk prevention services are rarely provided, and when offered involved provision of discrete elements only such as blood pressure measurement, rather than a consolidated evidence based approach to risk assessment. Participating pharmacists did not appear to have a clear understanding of how to assess CVD risk. Four key themes were identified: pharmacists' perception about their current roles in CVD, proposed future clinical and service roles, impeding factors and enabling factors. Subthemes were mainly related to determinants likely to influence future CVD services. These subthemes included public perception of pharmacists' roles, pharmacist-physician collaboration, legislative restrictions, systemic issues, sociocultural barriers, organizational pharmacy issues, lack of professional motivation, government and organizational support and professional pharmacy support frameworks. These influencing factors need to be addressed at micro, meso and macro systems level in order to facilitate development of new pharmacist delivered cognitive services in Saudi Arabia.Conclusions: Pharmacists in Saudi Arabia are willing to expand their role and offer pharmacy-based services, but influencing determinants have to be addressed at the individual, professional and health system levels. Further work is needed to clarify and develop practical and appropriate protocols for pharmacist CVD prevention and management services within the Saudi public and health care system. Such work should be guided by implementation science frameworks rather than embarking on conventional research trial pipelines where public benefit of generated evidence is delayed or limited. [ABSTRACT FROM AUTHOR]

Background: Screening is a critical component of efforts to reduce the population burden of cardiovascular disease (CVD), by facilitating early use of cost-effective prevention and treatment strategies. While international evidence suggests that screening in community pharmacies improves screening access and identifies at-risk individuals, concerns from medical organisations about the absence of interdisciplinary coordination and related lack of continuity of care with general practice have significantly contributed to reluctance from some stakeholders to endorse, and engage with, pharmacy-based screening initiatives. The Cardiovascular Absolute Risk Screening (CARS) study was designed to address these challenges and promote an interprofessional approach to screening for cardiovascular disease risk by pharmacists. This study describes the impact of the CARS implementation model on interdisciplinary coordination and continuity of care.Methods: In addition to clinical training, pharmacists at eleven participating pharmacies were provided with implementation training, resources and support to promote interprofessional coordination. Completion of training and pharmacy implementation plans, both of which highlighted GP engagement strategies, were pre-requisites for screening commencement. Using mixed methods approaches, data were analyzed from screening records (n = 388), researcher interviews with patients at 6-10 weeks post-screening (n = 248, 64%), and pharmacist interviews (n = 10).Results: Screening records suggested that 94% of screened individuals were advised to seek formal GP assessment, and 98% consented to sharing of results. Among interviewed participants, 81% recalled direct pharmacist action to facilitate GP engagement. Among interviewees who had seen their GP already (n = 70), 79% reported that their GP was aware of the results (another 16% were uncertain). Pharmacists reported positive GP feedback stemming from efforts at early engagement, but an absence of ongoing collaboration.Conclusions: Use of implementation planning by pharmacists, alongside clinical training, can effectively promote an interdisciplinary coordination focus by pharmacists. [ABSTRACT FROM AUTHOR]

Background: The benefits of pharmacist-led interventions in achieving desired patient outcomes have been well established. Effective patient-pharmacist relationships are required to provide high-quality pharmacy care. Limited information is available about how Arabic-speaking migrants with diabetes, in Australia, perceive patient-pharmacist relationship and how these perspectives differ from the mainstream society (represented by Caucasian English-speaking people).Objective: To examine and compare the patient-pharmacist relationship, medication underuse and adherence levels among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes.Methods: A 98-item survey incorporating several previously-validated measurements was completed by Arabic-speaking migrants (ASMs) and Caucasian English-speaking patients (ESPs) with type 2 diabetes. Participants were recruited from various healthcare settings in the Melbourne metropolitan area and rural Victoria, Australia. This survey-based, cross-sectional study was designed to explore patients' perceptions of the patient-pharmacist relationship. A descriptive analysis of responses was undertaken, and binary logistic regression was used to explore patient-pharmacist relationships.Results: A total of 701 participants were recruited; 392 ASMs and 309 ESPs. Of ASMs, 88.3% were non-adherent to their prescribed medication, compared with 45.1% of ESPs. The degree of relationship with community pharmacists differed significantly between ASMs and ESPs. Compared with ASMs, significantly more ESPs reported that they have thought about consulting a pharmacist when they had health problems (P = 0.002). Compared with ESPs, significantly fewer ASMs reported always following pharmacist recommendations (32% versus 61.9% respectively).Conclusions: Arabic-speaking migrants had less-effective relationships with community pharmacists when having their prescriptions filled. Community pharmacists' expertise appeared to be underused. These minimal relationships represent missed opportunities to improve health outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to examine perspectives of patients, health professionals, and policymakers on current practices and their future preferences for type 2 diabetes care in a tertiary hospital in Ethiopia. An exploratory qualitative study was undertaken through interviews and focus groups with patients, health professionals, and policymakers. The participants were purposively sampled. Thematic analysis was undertaken. Fifty-nine participants were involved in the study. Participants' perspectives on current practices and future preferences comprised three themes: organisation of type 2 diabetes care delivery and infrastructure; continuity of care; and structured diabetes education. The current organisation comprised physicians, such as endocrinologists and endocrinology fellows, and nurses. Some nurses received training on diabetes foot and diabetic eye, which enabled patients to receive diabetes foot and diabetic eye care, respectively. The hospital lacked essential resources, such as medications, laboratory and diagnostic services, and diabetes educators, which hindered patient-centred care. Patients complained that the physical set-up at the hospital was not conducive to their privacy during consultations. Participants reported infrequent patient follow-up and monitoring, which contributed to uncontrolled diabetes. Future preferences involved access to essential resources and comprehensive diabetes care, such as structured diabetes education for improved patient outcomes. Participants sought out the development of tailored and context-specific diabetes management approaches that could meet specific patient needs and preferences. The findings have implications for designing patient-centred diabetes care tailored to the hospital's context and key stakeholders' preferences. This tailoring requires strong leadership to ensure availability of essential resources. • Diabetes care was provided by endocrinologists, endocrinology fellows, resident doctors and general nurses. • Diabetes care lacked essential resources such as diabetes medications, laboratory and diagnostics and diabetes educators. • Patients did not receive structured diabetes education and regular monitoring such as glucose and diabetes foot and eye. • Study participants sought out a reliable supply of resources for diabetes and care that meets specific patient needs. [ABSTRACT FROM AUTHOR]

Abstract: The number of Americans affected by lactose intolerance is estimated to be between 30 and 50 million people (). Lactose intolerance is the symptoms experienced when the dose of lactose exceeds the digestive capacity of intestinal lactase (lactose maldigestion). Symptoms of intolerance typically include stomach discomfort, excessive flatulence and soft stool or diarrhea and are dependent on dose of lactose, transit time (influenced by meal composition), and colonic flora adaptation. Modest doses of lactose consumed with a meal on a regular basis are often very well tolerated. Lactose maldigestion may be caused by primary (most common), secondary, or congenital lactase non-persistence. Lactose maldigestion should not be thought of as a disease and is not a reliable indicator of lactose intolerance. The hydrogen breath test has become the most reliable method to diagnose lactose maldigestion. [Copyright &y& Elsevier]

Determining student nurses' clinical competence is underpinned by significant challenges including a lack of reliable assessments methods and multiple factors that impact on the assessment function of preceptors. The purpose of this study was to explore preceptors' views and experiences of a competency assessment tool and process used to assess BSc student nurses' clinical competence. Data were collected using a mixed method descriptive approach that included focus groups (n = 16) and a survey of preceptors (n = 837) in general, mental health and intellectual disability nursing in Ireland. This paper reports the results of the preceptor survey, which yielded a response rate of 30.4%. Findings revealed that preceptors had difficulty in understanding the language used in the competency assessment document. There was a lack of continuity of the same preceptor to students over the assessment period and over half of the preceptors gave less than 30 min to the formal interview process. Preceptors more often assessed knowledge and attitudes compared to skills. Matching preceptor roster with students, standardisation of the process and a moderator system to support the integrity of competency assessment is recommended. [ABSTRACT FROM AUTHOR]