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Professionals working in the emergency department (ED) are regularly exposed to traumatic events. Rates of posttraumatic mental health conditions vary widely in the literature and there is no agreement that rates in ED staff are elevated relative to other populations.We conducted a systematic review of international literature reporting prevalence of posttraumatic stress disorder (PTSD), depression, and anxiety in ED personnel to determine whether prevalence is elevated compared to the general community, and to evaluate convergent evidence across the literature for predictive factors. To our knowledge, there is no comprehensive review on this topic in the literature at this time.Seven databases were searched for studies reporting rates of PTSD, depression, and anxiety in ED personnel. Two independent researchers screened studies and assessed quality using Munn's Prevalence Critical Appraisal Instrument. Best-evidence synthesis determined whether conditions demonstrated elevated prevalence compared to the general population of Canada, a conservative benchmark.Twenty-four studies from 12 countries and a combined sample size of 4768 were included. PTSD rates ranged from 0% to 23.6% (mean 10.47%), depression ranged from 0.7% to 77.1% (mean 24.8%), and anxiety rates ranged from 2.4% to 14.6% (mean 9.29%). Each condition was elevated compared to the general population. Sociodemographic variables were not consistent predictors. Elevated PTSD seemed most strongly related to workplace exposure and maladaptive coping.ED professionals have an elevated risk of experiencing PTSD, depression, and anxiety. Identification of organizational and workplace predictors are needed to inform interventions that will reduce risk and provide optimal treatment and management of PTSD, depression, and anxiety in ED settings.

BACKGROUND: In the face of significant costs for injured worker rehabilitation and its impact on society, ongoing examination of how rehabilitation is carried out is warranted. OBJECTIVE: To review recent studies that explored the impact of the worker’s choice in terms of provider and treatment on the outcome for the worker in injury rehabilitation. METHOD: A systematic literature review was conducted using searches through electronic databases, with studies retrieved then subjected to a quality appraisal. RESULTS: Nineteen studies were eligible for inclusion. Studies reviewed found that choice of provider or treatment generated more positive outcomes for workers, and workers preferred a treatment provider familiar with their care. The worker’s ability to exercise choice was affected by conflict with other stakeholders and misalignment of expectations. The relationship between choice and costs was unclear, sometimes conflicting. CONCLUSIONS: The impact of treatment and provider choice on outcomes for workers remains unclear. The worker’s ability to choose may be hampered by systemic constraints, access to preferred providers, misalignment of stakeholder expectations, and the worker’s ability to engage in decision making. Greater worker engagement in their rehabilitation could potentially reduce costs as well as improve psychosocial outcomes.

The UK Dental Medicines Advisory Service (UKDMAS) provides advice to dentists and other dental healthcare professionals concerning the use of medicines and medical devices in dentistry. The commonly asked questions posed to the UKDMAS concerning medicines used for the management of oromucosal disease and dry mouth are discussed with answers supplemented by relevant information from clinicians. This article includes questions related to topical corticosteroids and analgesics used for oral ulceration, antifungal therapy and saliva replacement products.

The UK Dental Medicines Advisory Service (UKDMAS) provides advice to dentists and other dental healthcare professionals concerning the use of medicines and medical devices in dentistry. The commonly asked questions posed to the UKDMAS concerning the prescribing, administering or dispensing of medicines in dental practice are discussed with answers supplemented by relevant information from clinicians. These include: different classes of medicines, unlicensed medicines, prescriptions, Patient Group Directions, Patient Specific Directions and dispensing of medicines - if appropriate.

Due to high rates of potentially traumatic exposure (PTE) within the firefighting profession, a large body of literature concerning firefighters’ mental health has developed over recent decades. However, given variable prevalence outcomes and the largely descriptive nature of most studies, it is unclear whether the prevalence of trauma-related mental disorders in firefighters is elevated in comparison with the general population. The present systematic review examined literature on prevalence of posttraumatic stress disorder, depression, and anxiety in firefighters exposed to routine, duty-related PTEs to synthesize prevalence outcomes across the literature. Systematic search of 6 databases was conducted to review eligible articles published between 1980 and 2017 in any language. In all, 40 articles concerned firefighters exposed to routine work-related PTE. We report that strong evidence exists to suggest that the prevalence of posttraumatic stress disorder and depression is elevated in firefighters compared with the general population of Canada, whereas moderate evidence exists for the elevated prevalence of anxiety disorders. However, measurement tool is a substantial source of variability in prevalence estimates across the literature, and few predictive factors bear consistent relationships to posttraumatic stress disorder across samples. Future work should focus on measurement variance and examine possible interactions between commonly assessed predictive factors for disorder risk in firefighters.

Although numerous studies have reported on PTSD prevalence in high-risk occupational samples, previous meta-analytic work has been severely limited by the extreme variability in prevalence outcomes.The present systematic review and meta-regression examined methodological sources of variability in PTSD outcomes across the literature on high-risk personnel with a specific focus on measurement tool selection.The pooled global prevalence of PTSD in high-risk personnel was 12.1% [6.5%, 23.5%], and was similar to estimates obtained in other meta-analytic work. However, meta-regression revealed that PTSD prevalence differed significantly as a function of measurement tool selection, study inclusion criteria related to previous traumatic exposure, sample size, and study quality. PTSD prevalence estimates also differed significantly by occupational group and over time, as has also been reported in previous work, though exploratory examination of trends in measurement selection across these factors suggests that measurement strategy may partially explain some of these previously reported differences.Our results highlight a pressing need to better understand the role of measurement strategies and other methodological choices in characterizing variable prevalence outcomes. Understanding the role of methodological variance will be critical for work attempting to reliably characterize prevalence as well as risk and protective factors for PTSD.

PurposeThe past few decades have witnessed significant growth in the disability sector and the rehabilitation counseling profession has responded by broadening its scope of practice to serve a range of people who experience illness, injury, and social disadvantage. Despite the sector's growth and the profession's flexible response to it, the rehabilitation counseling profession in Australia continues to face challenges in relation to its professional identity. The purpose of this article is to identify these challenges and present solutions by reviewing literature and professionalization responses in Australia and the United States.MethodIn this article, we examine ways of transcending the professional identity challenges faced by the Australian rehabilitation counseling community. This is achieved firstly by defining the characteristics of professions and their application to rehabilitation counseling and second, by suggesting possible actions to advance the profession.ResultsThe necessary responses identified include the need for stronger professional governance, further development of the evidence base, and strict professional membership regulations. These goals will require the input of professional bodies and members, universities, rehabilitation regulators, employers, people with disabilities, and their families.ConclusionsRehabilitation counseling is a valued allied health and human service profession in the Australian work injury and disability sectors. By drawing on the experience of the profession in the United States, the authors have identified issues and solutions to facilitate the sustainability and advancement of rehabilitation counseling in Australia.

Public transportation workers are exposed to higher levels of stress related to accidents, injuries, and person-under-train events when compared to other workers. This systematic review integrates the existing literature on mental health among high-risk public transportation workers to estimate the prevalence of post-traumatic stress disorder (PTSD), major depressive and anxiety symptoms following critical incidents while on duty. This systematic review is part of a larger systematic review which examines mental health and work outcomes of individuals working in professions at high risk of critical incident exposure, i.e., high-risk professions. Articles were included if they measured the prevalence of PTSD, Major Depressive Disorder (MDD) and Anxiety Disorder (AD) in a transportation population following exposure to a major incident, for example, a person-under-a-train. Among the ten articles, all reported prevalence of PTSD which ranged from 0.73 to 29.9%. Four articles reported prevalence of depression among transportation workers exposed to a critical incident and prevalence outcomes ranged from 0.05 to 16.3%. Only two reported prevalence of anxiety from 1.3 to 13.9%. This literature reports that transportation workers are prone to involvement in traumatic accidents leading to higher rates of PTSD compared to the general population. Strategies to reduce transportation accidents and to provide transportation workers follow-up mental health support is needed for this vulnerable population.

Ambulance personnel, including paramedics, emergency medical technicians, and others, are exposed to potentially distressing situations frequently as a function of their duties. The present systematic review evaluated the prevalence of trauma-related mental disorders, including posttraumatic stress disorder (PTSD), depression, and anxiety in ambulance personnel with best-evidence narrative synthesis across an international dataset of 24 eligible studies to determine whether prevalence is elevated in this occupational group relative to the general population. In addition, we integrate and synthesize findings related to predictive factors for the prevalence of these disorders across the literature, broadly grouping predictive factors into three categories: individual-difference factors (e.g., sociodemographics), exposure-related factors (e.g., frequency), and organizational factors (e.g., support from supervisors). The relationship between exposure-related factors and depression/anxiety symptoms is of special interest because both disorders may occur outside the context of traumatic stress but are also highly comorbid with PTSD. We report strong evidence that prevalence rates of probable PTSD, depression, and anxiety disorder are elevated in ambulance personnel. The strongest predictive associations for PTSD symptoms concerned exposure-related and organizational factors, whereas individual-difference factors bore weak or inconsistent associations with symptoms. Importantly, there is a concerning lack of data regarding the impact of workplace traumatic exposure on depression and anxiety in ambulance personnel, and as such it is not possible at present to differentiate between manifestation of symptoms following exposure compared with ongoing symptoms unrelated to the workplace. Addressing this gap in the literature is of critical importance for guiding organizational response to these disorders in ambulance service. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Firefighting service is known to involve high rates of exposure to potentially traumatic situations, and research on mental health in firefighting populations is of critical importance in understanding the impact of occupational exposure. To date, the literature concerning prevalence of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) has not distinguished between symptomology associated routine duty-related exposure and exposure to large-scale disaster. The present systematic review synthesizes a heterogeneous cross-national literature on large-scale disaster exposure in firefighters and provides support for the hypothesis that the prevalence of PTSD, major depressive disorder, and anxiety disorders are elevated in firefighters compared with rates observed in the general population. In addition, we conducted narrative synthesis concerning several commonly assessed predictive factors for disorder and found that sociodemographic factors appear to bear a weak relationship to mental disorder, while incident-related factors, such as severity and duration of disaster exposure, bear a stronger and more consistent relationship to the development of PTSD and depression in cross-national samples. Future work should expand on these preliminary findings to better understand the impact of disaster exposure in firefighting personnel.

Background The prevalence of PTSD in police officers has been the subject of a large and highly variable empirical literature. The present systematic review evaluates the extant literature on PTSD in police officers using an international dataset. Methods We employed best-evidence narrative synthesis to evaluate whether PTSD prevalence in police is elevated in comparison to the general population of Canada (8%), which itself has a higher lifetime PTSD prevalence than many other regions and thus serves as a conservative standard of comparison. Results PTSD prevalence in police varied considerably across studies from 0% - 44% (M = 14.87%, Median = 9.2%). Despite this variability, strong evidence exists to suggest PTSD prevalence is elevated in police officers. Examination of possible sources of variability in prevalence outcomes highlighted substantial variability in outcomes due to the selection of measurement tool for assessing PTSD (e.g., DSM vs. IES). Examination of commonly-assessed predictive factors for PTSD risk across the literature showed that individual-difference factors (e.g., age, years of service) bear weak-to-nonexistent relationships with PTSD risk, while incident-specific factors (e.g., severity of exposure) are more strongly and consistently associated with PTSD prevalence. Organizational factors (e.g., low support from supervisor) are at present understudied but important possible contributors to PTSD risk. Conclusions PTSD prevalence is elevated in police officers and appears most strongly related to workplace exposure. Measurement variability remains a critical source of inconsistencies across the literature with drastic implications for accurate detection of officers in need of mental health intervention.

We conducted a systematic review of the empirical literature examining the effectiveness of psychological interventions for post-traumatic symptomatology in police, firefighters, and paramedic pers...

Digital Interprofessional Learning Client Documentation (D-IPL Client Docs) is an initiative designed to develop student interprofessional communication skills through electronic record writing and a virtual simulation (VS) or live virtual simulation (LVS) case conference. The aims of the study were to (a) identify whether D-IPL Client Docs supports student learning in the affective domain and (b) compare the learning outcomes for students participating in the VS versus the LVS case conference. Data were drawn from 83 Bachelor of Social Work students who had participated with other health professional students in the D-IPL Client Docs activities. The reflective journals submitted by this cohort of social work students were analyzed qualitatively and quantitatively using the Griffith University Affective Learning Scale. Qualitative analyses revealed that the activities enabled students in both groups to learn about themselves, their roles, and the roles of others, and the benefits of interprofessional collaboration in optimizing client outcomes. Quantitatively, the VS mode appeared to be more effective in supporting students to develop higher order affective learning; however, the effect size was small. Future studies should involve a larger sample size and include students from various professions to ascertain the transferability of findings.

The UK Dental Medicines Advisory Service (UKDMAS) provides advice to dentists and other dental healthcare professionals concerning the use of medicines and medical devices in dental prescribing, administering, or dispensing. The commonly asked questions posed to the UKDMAS concerning the prescribing of high-strength fluoride toothpastes and use of fluoride varnishes in dental practice are discussed with answers, supplemented by relevant information from clinicians. These include: the prescribing of high-strength fluoride toothpastes and application of fluoride varnish in particular patient groups; issues concerning the amounts of fluoride toothpaste that can be prescribed; regulations related to the supply of fluoride toothpastes by dental hygienists and therapists; and the constituents and selection of fluoride varnishes.

In addition to high-risk and high-stress events that police officers routinely encounter, many are also exposed to extreme traumatic exposures or disasters caused by nature (eg. Hurricanes) and hum...

Purpose The purpose of this systematic review is to evaluate the extant literature on depression and anxiety disorders in police using a multinational data set to determine whether the prevalence of these trauma-related disorders (TRMDs) is elevated in comparison to the general population. Design/methodology/approach Systematic review was employed in combination with best-evidence narrative synthesis to evaluate these hypotheses. Findings Despite wide variability in prevalence outcomes across the literature, strong evidence supports the hypothesis that the prevalence of depression is elevated in police, whereas moderate evidence supports the same hypothesis regarding anxiety. Preliminary evaluation of commonly examined predictive factors for each disorder demonstrated weak and inconsistent associations between these TRMDs and sociodemographic factors. No studies evaluated the relationship between incident-related factors (e.g. severity or frequency of exposure) and TRMDs, thus, at present, the literature on police is almost entirely unable to address the question of whether the prevalence of these disorders in police is influenced by exposure to work-related trauma. Research limitations/implications The findings highlight a critical need for future work to address incident-related factors in predicting symptoms of depression and anxiety in police samples to determine whether these disorders bear a unique relationship to work-related traumatic exposure. Such work will significantly benefit the design and implementation of successful prevention and intervention strategies in the workplace. Originality/value The present review provides a comprehensive synthesis of a highly variable literature, highlighting critical gaps in our current knowledge of TRMDs in police and suggesting numerous avenues for future study.

In addition to the daily stressors of the job, correctional officers are exposed to violence, direct threat to themselves, and ultimately workplace injury at rates considerably higher than that of ...

The UK Dental Medicines Advisory Service (UKDMAS) provides advice to dentists and other dental healthcare professionals concerning the use of medicines and medical devices in dentistry. The commonly asked questions posed to the UKDMAS concerning the prescribing, administering or dispensing of oral anxiolytic medicines in dental practice are discussed with answers supplemented by relevant information from clinicians. These include: types of oral anxiolytics available, prescribing guidelines, appropriate dosing regimens, indications and contraindications to prescribing and drug interactions.

The UK Dental Medicines Advisory Service (UKDMAS) provides advice to dentists and other dental healthcare professionals concerning the use of medicines and medical devices in dentistry. The commonly asked questions posed to the UKDMAS concerning the prescribing and administering of dental emergency drugs in dental practice are discussed, with answers supplemented by relevant information from clinicians. These include the drugs that need to be stocked in the emergency drugs kit in dental practice, their formats and storage, and the restrictions on which members of the dental team can administer the drugs.

Introduction Significant changes have taken place in the profile of prescription medicines being taken by the adult UK population over the last decade. The aims of this article are to review the literature to understand the overall trends and underlying factors, and then to compare this with the medication profile of a cohort of adult special care dental (SCD) patients. Materials and method Five hundred patient records were examined and retrospective data on systemic medicines being taken were obtained and classified according to the index used in the British National Formulary (BNF).Results The results revealed a high level of polypharmacy with 57% of SCD patients taking three or more medicines compared to 24% of the population in England. Antiepileptic drugs were the most frequently taken group of medicines (42%), followed by antidepressants (39.7%) and antipsychotics (37.6%). Conclusions Our results demonstrate the medical complexity of patients in this cohort and enable clinicians to increase their familiarity with the most commonly taken medicines and the tools available to manage the implications for dental care.

A number of medications may cause oral ulceration by either systemic or local mechanisms. Alendronic acid tablets, when in prolonged contact with the oral mucosa, are one such medication. When prescribing alendronic acid tablets, it is important to ensure that the patient is able to take them correctly and, if this is not the case, that alternative methods of bone protection are considered. When patients present with oral ulceration, it is important to consider whether a medicine could be causing a localized tissue reaction. This case series highlights three cases of alendronic acid-induced oral ulceration. CPD/Clinical Relevance: Practitioners should be aware of the potential oral unwanted effects of medications, including oral ulceration induced by prolonged mucosal contact with alendronic acid.

To provide an international analysis of employees' views of the influence of disability management (DM) on the workplace.An international research team with representation from Australia, Canada, China, and Switzerland collected survey data from employees in public and private companies in their respective regions. Due to lack of availability of current measures, a research team-created survey was used and a total of 1201 respondents were collected across the four countries.Multiple linear (enter) regression was also employed to predict DM's influence on job satisfaction, physical health, mental health, workplace morale and reduced sickness absence, from respondents' perceptions of whether their company provided disability prevention, stay-at-work, and return-to-work initiatives within their organization. One-way ANOVA comparisons were used to examine differences on demographic variables including company status (public versus private), union status (union versus nonunion), and gender.The perceived influence of DM programs was related to perceptions of job satisfaction; whereas, relationships with mental health, physical health, morale, and sickness absence were variable according to type of DM program and whether the response was related to self or others. Difference analyses (ANOVA) revealed significantly more positive perceptions for private and nonunion organizations; no gender effects were found.There is perceived value of DM from the perspective of employees, especially with respect to its value for coworkers. Implications for Rehabilitation Rehabilitation efforts should continue to focus attention on the value of disability management (DM). In particular, DM that is fully committed to the biopsychosocial model would be supported by this research. Employees reported the most value in the psychosocial variables addressed by DM, such that rehabilitation professionals could focus on these valued aspects to improve buy-in from employees. The interest in coworker value may provide another avenue for rehabilitation efforts to increase uptake, by highlighting the value of intervention efforts for employee coworkers. Rehabilitation professionals in union environments may need to be particularly cognizant of the need for encouraging psychosocial and coworker value potentially seen by employees in order to increase acceptance and participation for organizational DM efforts.

In Western countries, an increasing number of companies has difficulties with recruiting and retaining employees, along with growing employer responsibilities in the workplace. Therefore, companies’ interest in disability management programs has increased. This article examines employee perspectives of disability management and how it is related to job satisfaction, physical and mental health, workplace morale and sickness absence. Employees from seven Swiss companies (N=482), from the private and public sector, participated in either an online and paper-and-pencil survey for this present study. The survey asked employees to report their views of how disability management is related to job satisfaction, mental health, physical health, workplace morale and absenteeism. The Swiss employees participating in the study knew about disability management and related programs, which are implemented in their company. They valued them as moderately helpful for a variety of factors related to workplace wellbeing, and regarded the programs generally as high quality and wanted them to continue, because they contribute to job satisfaction, mental health, physical health, workplace morale and reduced sickness absence. However, employees also saw more value in disability prevention (DP) and stay at work (SAW) programs than in return to work (RTW) programs. Male employees and those working for public organisations saw more benefit in disability management programs than female employees and those working in the private sector.

Summary What is known and objective Adverse drug reaction reporting in the UK is lower than expected based on epidemiological data. This study aims to explore (a) nonmedical prescribers’ (NMP) confidence in identifying and reporting ADRs, (b) NMP prescribing habits and engagement with the Yellow Card Scheme (YCS) and (c) NMP desire for future training in the identification and reporting of ADRs. Methods A survey was distributed across NMP networks in the north‐west of England using Survey Monkey. Univariate analyses were performed to compare the features of reporters and nonreporters, Kruskal‐Wallis H tests for comparisons within multiple subgroups and Spearman's rank correlation coefficient for response associations between answers to ordered‐category questions. Results and discussion A total of 570 responses were available for analysis, an estimated response rate of 20%. Less than half (n = 219; 38.4%) reported submitting a Yellow Card to the YCS, and the majority of those individuals have submitted five or less Yellow Cards; 28 responders reported more than five submissions. Being professionally qualified for more years (linear regression: B = 0.30, P

Private sector rehabilitation counsellors operate in a dynamic and complex environment in which their decisions are influenced by several stakeholder interests including workers’ compensation authority regulators, scheme appointed agents, employers, and injured workers. The potentially competing interests of all parties often challenge the values and professional responsibilities of rehabilitation counsellors. The current study aimed to address the gap identified in the literature concerning ethical dilemmas unique to private sector rehabilitation counselling in Australia. A qualitative methodology was adopted to examine: a) the types of ethical dilemmas most encountered by rehabilitation counsellors working in the context of private sector settings; and b) rehabilitation counsellors' preferred methods for resolving ethical dilemmas in this context. Findings revealed that rehabilitation counsellors interviewed had experienced an array of ethical dilemmas in their practice, reflecting some of the inherent challenges in Australia’s private rehabilitation sector. The findings have implications for the ethics education and professional development of rehabilitation counsellors, and provide a foundation for future ethics research in rehabilitation counselling.

BACKGROUND: Organizational culture has received increasing attention in terms of its influence on workplace health and productivity, yet there has been little research on its relationship with employer-based disability programs. OBJECTIVE: This study explored the relationship between disability management and organizational culture in Australian and Canadian organizations. METHODS: Thematic analysis was conducted on data from semi-structured interviews with 16 employees, including injured workers, human resource managers and disability managers in two Australian and two Canadian large organizations. RESULTS: Seven themes were identified: 1. Consistency between espoused beliefs and artifacts in organization; 2. Genuineness of interest in well-being of injured worker; 3. Level of ongoing support of worker following injury; 4. Communication with injured workers; 5. Level of support from supervisors and co-workers; 6. Promptness in claims processing and covering medical costs and; 7. Focus on wellness and injury prevention. It was found that organizational culture may impact the delivery and perceived value of employer-based disability management programs. CONCLUSIONS: Given the potential relationship between organizational culture and disability management, employers should facilitate a positive workplace culture by ensuring consistency among underlying values, espoused values and actual treatment of employees, including injured workers.

Vocational rehabilitation services have been implemented in a number of countries to facilitate the return to work of sick and injured workers, yet little research has been undertaken to document competencies required to provide services globally. This study compared the job tasks, functions, and knowledge domains deemed important by Australian and German rehabilitation professionals working in vocational rehabilitation settings to identify common practice domains. An online survey comprising items from the Rehabilitation Skills Inventory–Amended and the International Survey of Disability Management was completed by 149 Australian and 217 German rehabilitation professionals. Items from each measure were submitted to factor analysis, using principal axis factoring as the extraction technique. Three common domains were identified: (a) vocational counseling, (b) workplace disability case management, and (c) workplace intervention and program management. Differences in skill and knowledge domains centered on the levels of specialization in vocational rehabilitation practices in each country. Ongoing transnational research is required to ensure that a “global curriculum” covers core competencies, while at the same time allowing for specialization at a local level.

A Canadian sample was collected as an aspect of a large international project, with representation from Australia, Canada, China, and Switzerland. In each country, interview and survey data were collected using team-created research tools. Canadian survey data on disability management (DM) perceptions were collected from 218 employees in both public and private organisations. Our Canadian employee sample reported perceived influence of disability prevention on job satisfaction, physical health, mental health, and morale for both themselves and their coworkers. Return to work programs were seen as valuable for job satisfaction of both the employee and coworkers, as well as the physical health of coworkers. Similarly, stay at work programs were seen as valuable for mental health and morale of coworkers. There was no relationship between perceived influence of DM interventions and reduction of sickness absence. The influence of DM was perceived as more positive for private and/or nonunionised workplaces. No gender differences were evident.

Gaps in information about patient medication adherence may contribute to preventable adverse drug events and patient harm. Hence, health-quality advocacy groups, including the Joint Commission, have called for the implementation of standardized processes to collect and compare patient medication lists. This manuscript describes the implementation of a self-service patient kiosk intended to check in patients for a clinic appointment and collect a medication adherence history, which is then available through the electronic health record. We used business process engineering and simulation modeling to analyze existing workflow, evaluate technology impact on clinic throughput, and predict future infrastructure needs. Our empiric data indicated that a multi-function healthcare kiosk offers a feasible platform to collect medical history data. Furthermore, our simulation model showed a non-linear association between patient arrival rate, kiosk number, and estimated patient wait times. This study provides important data to help administrators and healthcare executives predict infrastructure needs when considering the use of self-service kiosks.

The purpose of this study was to explore how employees perceive their organisation's efforts to address the management of stress in their workplaces and to examine differences based on demographic variables of organisational location and size. A convenience sample of 85 people at an international disability management conference completed a Management of Stress in the Workplace Questionnaire. Results of this survey indicated that employees were not positive about their organisations efforts to manage stress in either prevention or rehabilitation activities. Employees from smaller organisations rated their workplace environments more positively than larger organisations. A perceived high incidence of stress in an organisation was negatively related to perceptions about the work environment. Lower perceived levels of stress-related compensation claims were associated with higher ratings of prevention and higher workplace environment ratings. Effective disability management programs need to address a range of individual, organisational and system factors that cause and exacerbate stress injuries. In addition to the provision of a range of prevention and rehabilitation services, it is important that organisations look at ways to improve workplace culture and, by association, job satisfaction and workplace morale.

The Medicines Act 1968 governs who can supply medicines in the U.K. The Act allows dentists to issue any medicine directly to a patient. However, this only applies if patients are receiving private treatment. The current NHS terms of service do not allow dentists to supply any medicines, other than those for immediate use before the issue of a prescription, directly to a patient receiving NHS treatment. A prescription must be supplied for ongoing treatment. If a dentist issues medicines directly to a patient, they must be labelled as a dispensed medicine as directed by the Medicines Act 1968 and the Medicines and for Human Use Regulations (1994).Medicines are highly regulated and compliance with the law requires an understanding of the different laws governing medicines in relation to dentists.

Queries regarding medicines management, pharmaceutical care and possible drug interactions will occur at some time during your patient care but who can you contact to seek advice? Here, Christine Randall explains the role of the North West Medicines Information in providing that all-important information to the health professional.

Disability management is now recognised as an effective means of managing the increasing global costs of injury and disability. However, research on disability management particularly employee perceptions of its value, are sparse. This paper reports on the Australian findings of a large international project that included Canada, China, Switzerland and Australia, which examined employee perspectives of disability management related to job satisfaction, physical and mental health, workplace morale and reduced sickness absence. Data was collected from 365 employees in 10 large private and public companies using an online survey tool that focused on three components of a disability management program — disability prevention (DP), stay at work (SAW) and return to work (RTW) programs — in relation to the dependent variables of job satisfaction, physical and mental health, workplace morale, sickness absence. Multivariate regression was used to predict disability management's influence on the dependent variables. Results demonstrated positive perceptions regarding the perceived benefits of disability management to both individual employees and their perceptions of coworkers. It was apparent that each component of a disability management program (DP, SAW, and RTW) is positively related to job satisfaction, physical and mental health, workplace morale and reduced sickness absence Disability management programs were perceived as more beneficial in private, as opposed to public, workplaces; however, no differences were evident according to union status or gender of the respondent. It is possible disability management may impact on organisational productivity via variables associated with workplace culture, as well as through the direct benefits flowing from preventing and managing injury. Given the significant costs associated with absenteeism, an outcome of interest to many employers was the finding that employees perceived SAW programs as the most beneficial in terms of reducing absenteeism for both themselves and their coworkers.

The costs of occupational stress are rising and employers increasingly need to address occupational stress, prevention and rehabilitation issues. However, there is a relative lack of understanding about implementing strategies within specific organisational contexts. Extant literature indicates a need for integrated prevention and rehabilitation strategies that address specific organisational climates that contribute to stress. The Queensland Police Service (QPS) is one policing organisation facing significant occupational stress issues requiring organisational solutions. This article describes a Participatory Action Research case study, the aim of which is to develop an occupational rehabilitation system within the QPS to address identified stress issues. A combination of background information, interview and focus group data is being used to determine stress issues and provide potential solutions to specifically address the needs of the QPS. The findings of this study emphasise the importance of participant involvement in identifying issues and generating solutions, as well as demonstrating the value of taking a systemic approach. The findings suggest that the use of the Participatory Action Research approach is invaluable in promoting the long-term success of the QPS change process.

Our new series on serious ADRs focusses on rare but potentially fatal drug reactions and how to recognise and avoid them. This first article considers the features and management of neuroleptic malignant syndrome. Copyright © 2006 Wiley Interface Ltd

The management of anti-coagulated dental patients in primary care has changed over the last decade. There is now considerable evidence that many patients can safely be managed without stopping or altering their warfarin. This paper summarizes the evidence and provides guidance for the dentist on identifying which patients can be managed in primary care. Generally, such patients are those with a stable INR within the therapeutic range, between 2.0 and 4.0, undergoing simple extractions, scaling and minor surgical procedures, for whom local haemostatic measures are used, including packing with a haemostatic dressing, suturing and application of local pressure. Management advice is presented in the form of an algorithm providing additional information on postoperative care.Dental practitioners in primary care treat an increasing number of patients taking warfarin, so identification of patients who may be treated is of importance.

Objective To evaluate the drug profile of patients attending general dental practice and to assess the significance of this for the provision of dental care. Design and setting Prospective study of adult patients attending five general dental practices in Merseyside. Materials and methods Patients were questioned about prescribed medication. The data were analysed to assess any potential oral side-effects, pertinent drug interactions, or potential complications of dental treatment. Results A total of 1103 patients were recruited; of these, 287 (26%) were taking systemic medication. Conclusion Approximately a quarter of dental patients attending for routine dental care were taking prescribed medication. The majority of these drugs have significant implications for the general dental practitioner.

There is a strong connection between disability and decreased participation rates in the Australian labour market. Australian government policy recognises vocational rehabilitation as a key strategy to increase employment rates of people with disabilities.This paper examines current Australian disability employment policies and practices. It also reviews vocational rehabilitation competency research to identify knowledge and skill domains central to quality service provision, and explores the delivery of tertiary level vocational rehabilitation education.Policy changes in Australia over the last decade have been aimed at addressing the unsustainable increase in disability benefits. In this context vocational rehabilitation services continue to be viewed as crucial in assisting people with disabilities to maintain employment and reduce disengagement. Competencies research has consistently identified vocational counselling, personal counselling, professional practice and case management as central to quality vocational rehabilitation service provision. Two competencies identified in recent research, workplace disability case management and workplace interventions and program management, reflect the centrality of vocational rehabilitation to disability management.Changes in the policy environment to reduce the number of disability pension recipients will inevitably lead to an increased demand for trained vocational rehabilitation personnel. Given the development of strong accreditation standards for vocational rehabilitation education and practice that underpin the provision of tertiary level rehabilitation counselling training programs, professionally qualified rehabilitation counsellors are ideally placed to address the complex employment needs of people with a disability.It is important to understand changes that may occur in policy environments in terms of their impact on vocational rehabilitation service delivery for people with disabilities. Variable levels of training in the vocational rehabilitation sector result in people with complex needs not consistently receiving the services they need to access and maintain employment. Practitioners need to focus increasingly on individualized service delivery where the client has significant control over decisions about their rehabilitation program.

The pharmacy profession has undergone substantial change over the last two to three decades. Whilst medicine supply still remains a central function, pharmacist’s roles and responsibilities have become more clinic and patient focused. In the community (primary care), pharmacists have become important providers of healthcare as Western healthcare policy advocates patient self-care. This has resulted in pharmacists taking on greater responsibility in managing minor illness and the delivery of public health interventions. These roles require pharmacists to more fully use their clinical skills, and often involve diagnosis and therapeutic management. Community pharmacists are now, more than ever before, in a position to identify, record and report medication safety incidents. However, current research suggests that diagnostic ability of community pharmacists is questionable and they infrequently report to local or national schemes. The aim of this paper is to highlight current practice and suggest ways in which community pharmacy can more fully contribute to patient safety.

Objective A “demonstration” scheme for adverse drug reaction (ADR) reporting by United Kingdom community pharmacists began in April, 1997. The objective of this study was to investigate community pharmacists' attitudes to and knowledge of ADR reporting and the “yellow card” scheme. Method Structured face-to-face interview with community pharmacists, using a prepiloted questionnaire. Setting Randomly selected community pharmacies within one demonstration scheme area. Key findings Almost all of the pharmacists (28, 93 per cent) were aware that they were able to report ADRs but only one had done so. Just under half recalled receiving the official information pack and half of these had read it. Reasons given for not submitting reports were lack of information or time, and that most reactions seen were already well-recognised. Although most pharmacists knew that serious reactions to established drugs should be reported, fewer recognised the need to report unusual reactions to established drugs and reactions to herbal medicines. Few participants knew the reporting criteria for “black triangle” drugs. Reporting on over-the-counter (OTC) products was an area specifically identified where it was expected that community pharmacists could “add value” to the previous, yellow card, scheme. It was thus of some concern that 21 pharmacists (70 per cent) agreed that they would be unlikely to report an ADR to a product they had counter-prescribed for a patient. Few respondents had negative attitudes to the scheme. Most agreed that ADR reporting is important, and a professional role in which pharmacists should be involved. Conclusion Community pharmacists are supportive of their involvement in ADR reporting. Their concerns about reporting need to be addressed and further publicity given to the scheme if reporting is to increase. Our findings suggest that more research is needed to identify the factors which encourage and inhibit reporting, and that further efforts may be needed to promote ADR reporting.

Background: There is ample evidence that returning to suitable work is good for an injured worker's health and wellbeing. Evidence from the 2013 National Return to Work Survey shows a positive relationship between employers’ treatment of injured workers and return to work outcomes.Objectives: The case studies project aims to provide: •employers with examples of practical solutions, practices or systems to improve return to work outcomes, and•policy makers with a summary of key themes and best practice approaches to inform the development of policy and programs.Methods: Organisations for the case studies will be shortlisted from recent Australian national return to work award winners and finalists. Key players within the organisations, including managers, supervisors, rehabilitation co-ordinators and recovered injured workers, will be interviewed to obtain information and attitudes on the early intervention and return to work approaches. An analysis of the case studies and a literature review on current best practice for early intervention and return to work will be conducted from which key themes and practices will be identified.Findings: The project will produce two reports: case studies of six organisations’ practices, and an analytical report on key findings and best practice for early intervention and return to work. The case studies will provide employers and workers published examples of practical approaches to improving return to work outcomes. The case studies also explore the roles and views of management, supervisors and injured workers. The analytical report will examine the case studies and report on key themes and best practice, providing policy makers and employers with an analysis of findings. The 2013 National Return to Work survey provides supporting evidence of the positive relationship between return to work outcomes and a range of variables related to the role of the employer and the workplace.Conclusion: It is anticipated the case studies project will provide examples of practical approaches to improving early intervention and return to work outcomes, which other organisations may consider implementing.

A significant proportion of injured workers are not able to return to their original job. Employers have a responsibility as part of their disability management programs to assist this population to find a new vocation. The purpose of this qualitative study is to explore the résumé-development process in terms of its potential impact on job-search behaviour for injured workers who are unable to return to their previous job. Data were collected from 22 Australian rehabilitation counsellors via questionnaires, sample documents, and telephone interviews. Thematic analysis of the data reveals that the résumé-development process may be useful in promoting effective job-search behaviour in clients. However, for this to occur it is suggested that the résumé-development process must provide relevant knowledge and skills, overcome or reduce clients’ doubts, address disability but focus on ability, provide ongoing emotional and practical support, value individualisation, and increase clients’ motivation. It is speculated that the findings may be explained by the increased sense of self-efficacy that occurs through participation in the résumé-development process.

People with disabilities are generally not considered as able participants in the workforce (paid or volunteer work) and therefore, they often experience exclusion from participating in mainstream employment opportunities. People with disabilities experience various barriers to employment, such as discrimination in the workplace, stigma, prejudice and stereotypes. However, some people with disabilities participate in the workforce and make valuable contributions towards economic development, social capital and wider society. This literature review summarises published research findings about the challenges that people with disabilities experience in pursuing employment opportunities, including volunteering and paid positions; and in undertaking these roles. Furthermore, it explores possible interventions to improve employment outcomes that are effective from the perspectives of people with disabilities. Findings indicate that effective practice takes an inclusive approach and allows clients to take ownership of solutions in relation to addressing the challenges they experience in the employment sector. For this reason, two different community development projects, which particularly focused on employment challenges for people with disabilities, as well as outlining strategies and solutions that promote client ownership were reviewed. Additionally, employment support techniques and strategies, as well as human rights’ principles on work and employment for people with disabilities will be debated. Finally, implications for research and practice for the rehabilitation counselling profession and the disability employment services sector are discussed. Keywords: disability, employment barriers, challenges, vocational rehabilitation, community development, labour market, social inclusion, human rights, strategies & interventions

Dentists prescribe a limited range of medicines but it is important that they consider the effects of all medicines their patients are taking when providing dental care. In the UK, a national medicines information (UKMi) service funded by the National Health Service is available to advise health professionals on prescribing and to support evidence-based practice. This paper presents the results of a survey of 151 dental health professionals who contacted the UKMi service for advice. Enquiries most commonly involved antibiotics (32%), but dental health professionals also asked for advice on legal issues relating to medicines (10%), and on managing patients receiving bisphosphonates (9%), local anaesthetics (6%) and antiplatelet drugs (5%). One hundred and forty-six (97%) enquirers used the advice provided: for managing current patients, planning the care of future patients, for continuing professional development and teaching others. Two thirds of enquirers used the information provided to check if current or proposed management was appropriate, one half to change therapy and over one quarter to identify, manage or avoid adverse effects or drug interactions.

The Shipman Inquiry has lead to a number of changes in the regulations that govern controlled drugs. Some of these changes, in particular the change in schedule of midazolam from Schedule 4 to Schedule 3 and the introduction of private controlled drug prescriptions, which are now mandatory for all private prescribers, have implications for dentists. This paper aims to outline the current regulations governing controlled drugs that are relevant to dentists and covers how to obtain, prescribe, store and dispose of them.Controlled drugs are the most highly regulated medicines and recent changes in the regulations governing them have implications for dentists in both private and NHS practice.

Over the past decade, there has been growth in the delivery of vocational rehabilitation services globally, as countries seek to control disability-related expenditure, yet there has been minimal research outside the United States on competencies required to work in this area. This study reports on research conducted in Australia to determine current job function and knowledge areas in terms of their importance and frequency of use in the provision of vocational rehabilitation. A survey comprising items from the Rehabilitation Skills Inventory-Amended and International Survey of Disability Management was completed by 149 rehabilitation counselors and items submitted to factor analysis. T-tests and analyses of variance were used to determine differences between scores of importance and frequency and differences in scores based on work setting and professional training. Six factors were identified as important and frequently used: (i) vocational counseling, (ii) professional practice, (iii) personal counseling, (iv) rehabilitation case management, (v) workplace disability case management, and (vi) workplace intervention and program management. Vocational counseling, professional practice and personal counseling were significantly more important and performed more frequently by respondents in vocational rehabilitation settings than those in compensation settings. These same three factors were rated significantly higher in importance and frequency by those with rehabilitation counselor training when compared with those with other training. In conclusion, although 'traditional' knowledge and skill areas such as vocational counseling, professional practice, and personal counseling were identified as central to vocational rehabilitation practice in Australian rehabilitation agencies, mean ratings suggest a growing emphasis on knowledge and skills associated with disability management practice.