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Purpose: Therapeutic drug monitoring (TDM) is widely recognised as a key attribute of clinical pharmacologists; yet, the extent to which physicians undertaking postgraduate training in clinical pharmacology (hereafter trainees) are involved in TDM is poorly characterised. Our own experience suggests wide variation in trainee exposure to TDM. Method: We performed a Europe-wide cross-sectional internet-based survey of trainees to determine the nature and extent of trainee involvement in TDM. Results: There were 43 responses from eight countries analysed. Of the 21 respondents from the UK, all were also training in general internal medicine (GIM), while all of the respondents who were solely training in clinical pharmacology were from outside the UK. Overall, 86.0% of respondents reported access to drug monitoring for clinical care at their affiliated institution, of which 81.0% were personally involved in TDM in some capacity. On average, trainees reported that drug monitoring was available for 16 of the 33 (48%) of the drug/drug classes surveyed. UK-based respondents were involved in requesting drug-level investigations and interpreting the results for patients under their care in 76.2% and 85.7% of cases, respectively, while non-UK respondents supported other healthcare professionals to interpret results in 45.4% of cases. Trainees felt TDM training was generally either insufficient or very inadequate. Conclusion: While access to TDM is relatively available at institutions where trainees are based, the role of trainees is variable and affected by a variety of factors including country and training programme. Universally, trainees feel they need more education in TDM. [ABSTRACT FROM AUTHOR]

Objective: To understand the experiences of vulnerable clients who used telehealth during the Coronavirus pandemic. Design: The study employed a qualitative enquiry, utilising semi‐structured interviews lasting 30‐60 minutes with a thematic analysis approach to explore factors influencing client experience with telehealth. Setting: A wide range of locations across Tasmania, Australia. Participants: Twelve participants who were considered to be vulnerable on a number of domains, including: health and human wellbeing factors, social risk factors, functional limitations, and individual behavioural factors. Interventions: The provision of telehealth consultations to vulnerable clients. Main outcome measures: Four global themes were discovered: i) Telehealth saves time, money and energy; ii) User friendly technology facilitates care; iii) Rapport and confidentiality helps clients to feel safe; and iv) Fit for purpose telehealth provides a quality service. Results: The discovered themes entailed the major finding that most participants were satisfied with the overall quality of the telehealth service they received and the convenience of this service. Concerns were raised regarding the limitations around social interaction, physical examination, and access to fit‐for‐purpose telehealth devices. Conclusion: This research with vulnerable clients, from Tasmania, supports the evidence that the utilisation of telehealth allows more convenient access to care. To optimise the service, however, concerns regarding the desire for social interaction, appropriate physical examination, and access to fit‐for‐purpose telehealth devices will need to be addressed. [ABSTRACT FROM AUTHOR]

Objective. Capture-recapture analysis was used to more accurately quantify the admission rate for acute pancreatitis in a regional hospital setting, in comparison to the usual method of case ascertainment. Reasons for differences in capture for the various methods were also sought. Methods. Admissions for acute pancreatitis were enumerated over a 40-month period using three data sources: hospital classification of admission diagnoses, prospective case identification, and receipt of diagnosis-specific pathology specimens. Capture-recapture analysis was applied with log-linear modelling to account for likely dependency between data sources. Covariates were noted to explain capture probability by the various data sources and for eventual stratification in the analysis process. Results. For the census period, there were 304 admissions after merging of data sources, giving a crude admission rate of 7.6 per month. Crude ascertainment rates for discharge records and prospective identification were 44% and 52% respectively. Following log-linear modelling, total admissions more than doubled to 644 (adjusted admission rate 16.1 per month). Of the covariates considered, admissions of less than three days' duration and those occurring in December and January were significantly associated with increased capture by the hospital discharge records data source. Conclusions. In this clinical setting, admissions for acute pancreatitis are grossly underestimated by the standard case ascertainment method. The reasons for this are not clear. Hospital discharge records are nevertheless more effective than prospective case ascertainment for certain cases, such as brief admissions and those in holiday periods. What is known about the topic? Capture-recapture analysis was originally developed in animal ecology, but has since been used to estimate both prevalent and incident cases of human disease. What does this paper add? This study exposes possible deficiencies in the single-source case ascertainment methods used by most hospitals to enumerate incident cases. It is the first time that capture-recapture techniques have been used to estimate acute pancreatitis admissions. What are the implications for practitioners? To obtain accurate admissions estimates for diseases such as acute pancreatitis, capture-recapture analysis with multiple data sources is advisable. One possible solution may be to conduct intermittent prospective censuses to complement existing retrospective ascertainment methods. On a more general level, clinical staff should be better trained to provide more accurate and detailed information in case records. [ABSTRACT FROM AUTHOR]

Purpose: Statins have potential anti-inflammatory effects, but the association between statin use and lower incidence of pneumonia is unclear. We have therefore performed a systematic review on the risk of pneumonia in statin users versus non-users. Methods: MEDLINE and EMBASE were searched in December 2010 for controlled observational studies that reported on the risk of pneumonia in statin users. We performed a random effects meta-analysis and assessed heterogeneity using the I statistic. Results: A total of 451 citations were screened, and ultimately nine studies (4 case-control, 4 retrospective cohort, 1 prospective cohort) with more than 3 million participants were included in the meta-analysis. Pooled analysis of seven studies that reported unadjusted data failed to show a significantly reduced risk of pneumonia [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.84-1.06, p = 0.33, I = 79%] in statin users as compared to non-users. However, a significant reduction in the likelihood of pneumonia associated with statin use ( n = 8 studies, OR 0.85, 95% CI 0.75-0.97, p = 0.02, I = 81%) was found in the meta-analysis of adjusted data. Both analyses were limited by substantial statistical heterogeneity. Sensitivity analysis failed to fully clarify the source of heterogeneity, but cohort studies seemed to be less heterogenous ( n = 5 studies, OR 0.92, 95% CI 0.84-1.01, I = 43%). Conclusion: Our findings indicate that the purported benefit of statins in preventing pneumonia is inconsistent, and of low magnitude, with upper bounds of the confidence interval being close to null. In view of the substantial statistical and clinical heterogeneity in the dataset, there is no convincing evidence to support the therapeutic application of statins for reducing the risk of pneumonia. [ABSTRACT FROM AUTHOR]

The health disparities and care needs of lesbian, gay, bisexual, transgender and intersex (LGBTI+) patients are becoming well known. However, healthcare practitioners (HCPs) and medical students across the Global North report limited understanding of this population and express concern about their capacity to meet the needs of LGBTI + patients. To address these gaps in literature and practice, this study draws on qualitative interviews with 12 clinicians and five health professional students exploring their understandings and approaches to LGBTI + inclusive practice in Tasmania, Australia. Through a reflexive thematic analysis, we identified that both practicing clinicians and students did not believe that their training adequately prepared them to treat LGBTI + patients. Other key barriers included reduced awareness of LGBTI + community needs due to the lack of exposure to LGBTI + patients and unfamiliarity with appropriate referral pathways in the regional Tasmanian context. Conversely, factors enabling provision of LGBTI + inclusive care included prior experience working with LGBTI + patients and establishing a network of supportive colleagues and local services. Participants who identified as LGBTI + themselves saw their personal experiences as a strength in supporting LGBTI + patients. While awareness of LGBTI + inclusive health practice is increasing, Tasmanian practitioners report insufficient training and practical difficulties with referral as key challenges. [ABSTRACT FROM AUTHOR]

This study describes the illness narratives that inform treatment-seeking behaviours for acute abdominal conditions in Cambodia, and thereby explores factors impeding the timely delivery of surgical intervention. Semi-structured qualitative interviews were undertaken with patients who had undergone abdominal surgery at Siem Reap Provincial Hospital between 2011 and 2014. Interviews collected basic demographic information and also patient narratives based on Groleau's McGill Illness Narrative Interview (MINI). Interviews were contemporaneously translated from Khmer to English and recorded for transcription. A content analysis of interview transcripts based on narrative enquiry was undertaken. Ninety-seven patients participated in the study and five themes emerged from the data. These were: Explanatory models about the causes of abdominal pain and effects of surgery; Pre-surgery stoicism and illness management; Fear of poor outcomes and death; Burden of treatment costs and anticipated recovery time; and, Enhancing community trust in surgery. Our findings add the patient voice to the limited evidence about access to surgery, and socio-cultural and financial barriers affecting treatment-seeking behaviours in Cambodia. By understanding the collective narratives surrounding experiences of abdominal surgery, efforts to improve surgical services in Cambodia may be better informed of the reasons patients delay treatment. [ABSTRACT FROM AUTHOR]