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Abstract Background The increasing use of complementary and alternative medicines in Australia has generated concern regarding the information on these products available to both healthcare providers and the public. The aim of this study was to examine the practice behaviours of naturopaths in relation to both the provision of and access to information on complementary and alternative medicines (CAM). Methods A representative sample of 300 practicing naturopaths located nationally were sent a comprehensive survey which gathered data on self reported practice behaviour in relation to the provision of information on oral CAM to clients and the information needs of the practitioners themselves Results A response rate of 35% was achieved. Most practitioners (98%) have a dispensary within their clinic and the majority of practitioners perform the dispensing themselves. Practitioners reported they provided information to clients, usually in the form of verbal information (96%), handwritten notes (83%) and printed information (75%). The majority of practitioners (over 75%) reported always giving information on the full name of the product, reason for prescribing, expected response, possible interactions and contraindications and actions of the product. Information resources most often used by practitioners included professional newsletters, seminars run by manufacturers, patient feedback and personal observation of patients. Most practitioners were positive about the information they could access but felt that more information was required in areas such as adverse reactions and safe use of CAM in children, pregnancy and breastfeeding. Most naturopaths (over 96%) were informed about adverse events through manufacturer or distributor newsletters. The barriers in the provision of information to clients were misleading or incorrect information in the media, time constraints, information overload and complex language used in printed information. The main barrier to the practitioner in information access was seen as the perceived division between orthodox and complementary medicine practitioners. Conclusion Our data suggest most naturopaths were concerned about possible interaction between pharmaceuticals and CAM, and explore this area with their patients. There is scope to improve practitioners' access to information of adverse events including an increased awareness of sources of information such as the Australian Therapeutic Goods Administration (TGA) website.

BACKGROUND: The increasing use of complementary and alternative medicines in Australia has generated concern regarding the information on these products available to both healthcare providers and the public. The aim of this study was to examine the practice behaviours of naturopaths in relation to both the provision of and access to information on complementary and alternative medicines (CAM). METHODS: A representative sample of 300 practicing naturopaths located nationally were sent a comprehensive survey which gathered data on self reported practice behaviour in relation to the provision of information on oral CAM to clients and the information needs of the practitioners themselves. RESULTS: A response rate of 35% was achieved. Most practitioners (98%) have a dispensary within their clinic and the majority of practitioners perform the dispensing themselves. Practitioners reported they provided information to clients, usually in the form of verbal information (96%), handwritten notes (83%) and printed information (75%). The majority of practitioners (over 75%) reported always giving information on the full name of the product, reason for prescribing, expected response, possible interactions and contraindications and actions of the product. Information resources most often used by practitioners included professional newsletters, seminars run by manufacturers, patient feedback and personal observation of patients. Most practitioners were positive about the information they could access but felt that more information was required in areas such as adverse reactions and safe use of CAM in children, pregnancy and breastfeeding. Most naturopaths (over 96%) were informed about adverse events through manufacturer or distributor newsletters. The barriers in the provision of information to clients were misleading or incorrect information in the media, time constraints, information overload and complex language used in printed information. The main barrier to the practitioner in information access was seen as the perceived division between orthodox and complementary medicine practitioners. CONCLUSION: Our data suggest most naturopaths were concerned about possible interaction between pharmaceuticals and CAM, and explore this area with their patients. There is scope to improve practitioners' access to information of adverse events including an increased awareness of sources of information such as the Australian Therapeutic Goods Administration (TGA) website. [ABSTRACT FROM AUTHOR]

Premature mortality in people living with a severe mental illness (SMI) is often attributed to multiple factors including the use of medicines such as antipsychotics. Second-generation antipsychotics (SGAs) are known to cause metabolic syndrome which can increase the risk of cardiovascular disease. Practice guidelines have recommended regular physical health monitoring, particularly of metabolic parameters, however, metabolic monitoring for people living with SMI using antipsychotics remains suboptimal. Therefore, highlighting the need for ongoing research. This scoping review aimed to provide an overview of current metabolic monitoring practices. We anticipate that this information will assist clinicians and policymakers and inform future research. The following databases were searched: MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), the Cochrane Database of Systemic Reviews (Wiley), APA PsycInfo (Ovid) and Scopus (Elsevier Science Publishers). The target group was adults (aged ≥ 18) diagnosed with SMI (including bipolar disorder, major depressive disorder and psychotic disorders) and taking SGAs. In total, 44 studies from 14 countries were retrieved. Our findings highlighted that most studies conducted in hospitals did not report on metabolic monitoring practices. Additionally, the roles and responsibilities of healthcare professionals in metabolic monitoring for SMI were infrequently described and parameters such as waist circumference and BMI were often poorly monitored. The scoping review highlights that no streamlined approach towards metabolic monitoring currently exists. There is a need to stipulate and define the roles and responsibilities of all health professionals involved in metabolic monitoring in SMI to optimise care for these individuals. Moreover, there is a need for ongoing research, particularly in the community setting, to promote increased accessibility to metabolic monitoring for SMI., (© 2024. The Author(s).)

Discussion regarding burnout in health professionals, including community pharmacists, has grown substantially since the arrival of the COVID-19 pandemic. Rapid legislative and societal behavioural changes led to significant global disruption of physical and emotional wellbeing during the pandemic as pharmacists continued to provide care while under unprecedented levels of stress. Community pharmacists have had an essential role in maintaining face-to-face care as the number of COVID-19 diagnoses and deaths rose. Communications emerged from the World Health Organization which implored long-term changes to healthcare workplaces, including increased access to psychosocial support for employees. Peer support is a unique initiative, and it is low-cost and accessible across many platforms. Its main purpose is to bring people together with shared experiences and can often include people in the same career field or workplace. The feasibility and efficacy of peer support programs have been studied in other professional groups such as nurses and physicians, and also in undergraduate medical students. The conclusions drawn from these studies suggest that involvement in peer support reduced the risk of burnout and increased workplace engagement. In contrast to many other healthcare professionals, community pharmacists often work in relative isolation. Research has shown that younger pharmacists, and those in the earlier stages of their careers, reported feeling stressed, undervalued, and supported. They also mentioned a desire for access to a mentoring or coaching program. Following the success of peer support in other cohorts, research is needed to verify if this intervention will similarly benefit early career community pharmacists., Competing Interests: Disclosures The authors declare no relevant conflicts of interest or financial relationships., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Objective: To explore community pharmacy consumers' knowledge and attitudes of mental illness, support services, and community pharmacists' role in supporting people living with mental illness (PLMI)., Methods: This survey was conducted in 15 community pharmacies between June and September 2019. Participants were aged 18 years or older without prior or ongoing history of mental illness and/or with close family members with mental illness. Open-ended responses to the anonymous questionnaire were analysed using content analysis., Key Findings: Majority of the 380 participants were female (57.4%) with a mean age 52.9 years and 33.7% having completed university. Most (70.3%) believed that people with mental illness had a negative image due to poor health literacy providing possible solutions of 'awareness campaigns', 'education and training', and 'increased government funding for mental health (MH) support services'. Only 33.7% and 63.7% of participants were aware of Mental Health Week and the R U OK? Campaign, respectively. Whilst 12.4% of participants had participated in MH campaigns, only 3.4% were aware of community pharmacists-led MH educational activities. There were significant differences between adults (<65 years) and older adults (≥65 years old) with the latter reporting a more negative image for mental illness (P < 0.05) and having less exposure and engagement with MH resources (P < 0.001) and campaigns (P < 0.01)., Conclusion: Despite awareness, participants reported low engagement with MH campaigns. Additionally, older adults had lower MH literacy and exposure to resources and campaigns. This study highlighted that the community lacked awareness of what pharmacists can offer to support PLMIs., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society.)

Introduction: Heart failure (HF) is an increasing global concern. Despite evidence-based pharmacotherapy, associated morbidity and mortality remain high. This study aimed to assess the acceptability, feasibility, and value of the NPS MedicineWise dose reminder app in a tiered, pharmacist-led intervention to address medication non-adherence in patients with HF., Methods: This prospective, single-blinded, randomised controlled trial recruited 55 patients with HF between September 2019 and October 2020. Participants were randomly assigned to either the intervention or control arms. Intervention participants used the app which prompted medication administration at each dosing interval. Control participants received standard care and remained blinded to the app throughout the study. Treatment non-adherence prompted a tiered, pharmacist-led intervention. Comparison of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) at baseline and 6-months measured the app's value in supporting medication adherence. Secondary outcome measures included self-reported medication knowledge, health-related quality of life, psychological wellbeing, and signs and symptoms of HF. Data were analysed using standard statistical tests with significance set at α 0.05., Results: Approximately half of respondents reported managing HF and medications better by using the MedicineWise app (Tier 1). Most respondents expressed satisfaction with the in-app messages (Tier 2) and pharmacists' phone calls (Tier 3). The intervention participants demonstrated a significant improvement in the SEAMS between baseline and 6-months follow-up., Discussion: It is feasible and potentially of value to use the MedicineWise app with a tiered, pharmacist-led intervention to support medication adherence in patients with HF. Our findings provide clinicians with "real-world" information on the practicality and potential value of using mobile health to support treatment adherence in patients with HF., Trial Registration Number: Australian New Zealand Clinical Trials Registry Clinical trial registration number: ACTRN12619000289112p (http://www.ANZCTR.org.au/ACTRN12619000289112p.aspx)., Competing Interests: NP and KY were employees of NPS MedicineWise at the time of the study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2023 Chapman-Goetz, Packham, Yu, Gabb, Potts, Prosser, Arstall, Burdeniuk, Chan, Wilson, Hotham and Suppiah.)

Objective: This review aimed to identify current pharmacological and non-pharmacological treatment employed in emergency departments (EDs) for the management of patients presenting with illicit drug-related presentations (IDP) and compare current treatments with recommendations provided in guidelines., Method: The review consists of English peer-reviewed journal articles and grey literature published in electronic databases: Ovid MEDLINE, PubMed, Embase Classic+Embase, Ovid Emcare and APA PsycInfo between 2015 and 2022., Results: Twelve studies were identified from the search, with agitation and aggression being the most common presentations, and cannabis being the most prevalent illicit drug. Ventilatory support and restraints were the most reported non-pharmacological interventions while benzodiazepines and antipsychotics were the most commonly prescribed pharmacological agents. Non-coercive de-escalation strategies were recommended in all guidelines, with verbal de-escalation being the initial approach before other interventions, such as medications and restraints. However, de-escalation strategies were not reported in any studies., Conclusions: Pharmacological interventions for patients with IDP and related symptoms were in accordance with guidelines. Use of restraints was identified in included studies with notable lack of reporting of de-escalation strategies which may have been deemed insignificant and not reported. Future research could investigate the appropriateness of restrictive interventions as well as the employment of non-restrictive de-escalation strategies., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In Australia, mental illness has been recognised as a National Health Priority area, with the coronavirus pandemic adding a layer of urgency to the need to address the multiple health problems faced by clients with mental illnesses. Whilst much has been done in efforts to support these clients, little is known about their medication knowledge and experience with health professionals. The aim of the study was to explore the knowledge and beliefs of clients on the use of psychotropic medications and study their experiences with healthcare providers. Adult participants at a not-for-profit community-managed specialist mental health service provider in Adelaide, South Australia were recruited. Four focus group sessions were conducted between February 2020 and March 2021. All sessions were co-facilitated by a peer practitioner with lived experience. Sessions were audio recorded and transcribed verbatim. Participants (n = 27) reported that provision of medication education was inadequate and, in some cases, non-existent. There was an apparent lack of support for monitoring and managing common side effects, such as weight gain. Participants described not being involved in any decision-making processes and that establishing and maintaining a therapeutic relationship with their healthcare providers was challenging. Perceived stigma remains a barrier in accessing healthcare. Despite participants regularly interacting with a range of healthcare providers, findings highlight key gaps in care, particularly medication education and establishing a therapeutic relationship with their healthcare providers. Future mental health reforms should consider the provision of additional medication education in community settings, such as at not-for-profit organisations. Moreover, healthcare providers should take a proactive approach in establishing therapeutic relationships., (© 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)

Introduction: Physical health conditions are the leading causes of death in people living with severe mental illness. In particular, the risk of metabolic syndrome; the constellation of abnormalities in weight, blood pressure, blood glucose and lipid levels, is high in this cohort. It has been recognised that commonly prescribed pharmacological agents for mental illness can further amplify the risk of developing metabolic syndrome; therefore, monitoring guidelines are in place for consumers prescribed antipsychotics. However, there is a disconnect between recommended guidelines and current practice. Our study aims to investigate: (1) the feasibility of a community pharmacist-led physical health monitoring for metabolic parameters in consumers with mental illness currently taking second generation antipsychotics and (2) the potential outcomes of the intervention (eg, rates and outcome of referrals to general practitioners, relationship between the pharmacist's lifestyle counselling advice and change in metabolic parameters)., Methods and Analysis: We propose a longitudinal metabolic monitoring study led by community pharmacists with one-to-one consultations between trained pharmacists and participants at set intervals over a 12-month period. Our primary outcome is to determine the feasibility of the pharmacist-led intervention. The secondary outcome is to explore the overall health outcomes of consumers enrolled in the intervention. This is a mixed-methods study including both quantitative and qualitative outcomes. Qualitative data will be analysed via the process of data immersion, coding and identification of themes. Quantitative outcomes will be analysed using IBM Statistics SPSS software. Univariate descriptive, regression analysis and dependent t-tests will be performed. Statistical significance will be at α 0.05., Ethics and Dissemination: Our study has been approved by the institutional Human Research Ethics Committee (Protocol no: 203433). Findings will be made publicly available in peer-reviewed articles, conference presentations to health professionals, as well as other stakeholders. Protocol V.2.1, August 2021., Trial Registration Number: ACTRN12621001435875., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Heart failure (HF) is an increasing global concern. Despite evidence-based pharmacotherapy, morbidity and mortality remain high in HF. Medication non-adherence is a crucial factor in optimising clinical outcomes. A growing number of smartphone applications (apps) assist management. While evidence support their use to promote treatment adherence, apps alone may not be the solution. The objective of this pilot study is to assess the acceptability and feasibility of a tiered intervention added to the NPS MedicineWise dose reminder app (MedicineWise app) in supporting medication adherence in HF., Methods and Analysis: This prospective, single-blinded, randomised controlled trial will recruit 55 Australian patients with HF to be randomly assigned to either intervention (MedicineWise app + usual care) or control (usual care alone) arm. Control participants will remain unaware of the intervention throughout the study. At baseline, intervention participants will be instructed in the MedicineWise app. A reminder will then prompt medication administration at each dosing interval. If non-adherence is suggested from 24 hourly reports (critical medications) or 72 hours (non-critical medications), the individual/s will be escalated through a tiered, pharmacist-led intervention. The primary outcome will be the acceptability and feasibility of this approach in supporting adherence. Between-group comparison of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) at baseline, 3 and 6 months will be used to measure the app's value in supporting adherence. Secondary outcome measures include self-reported medication adherence and knowledge, health-related quality of life, psychological wellbeing, signs and symptoms of HF, and medication and HF knowledge., Ethics and Dissemination: The protocol received ethics approval from Central Adelaide Clinical Human Research Ethics Committee (Protocol number R20190302) and University of South Australia Human Research Ethics Committee (Protocol number 202450). Findings will be disseminated through peer-reviewed journals., Trial Registration Number: Australian New Zealand Clinical Trials Registry Clinical trial number: ACTRN12619000289112p (http://www.ANZCTR.org.au/ACTRN12619000289112p.aspx)., Competing Interests: The authors have declared that no competing interests exist.

Objectives: The nation was recovering from the aftermath of the catastrophic 2019-2020 bushfires when the first cases of the COVID-19 pandemic emerged in Australia. During the peak of the pandemic, Australia closed both its state and international borders to all travelers and interstate travel was very tightly regulated. Community pharmacists and pharmacy staff were one of the very few primary healthcare workers still serving their communities during these periods of strict lockdown. In this personal view article, the challenges and their toll on the mental health and wellbeing of these "essential workers" are described., Key Findings: Community pharmacists and pharmacy staff were under immense pressure to remain open and serve their communities amidst rapidly changing legislation and, at times, conflicting advice from the range of Australian health agencies. Rapid changes to workload and workflow were combined with the dilemma of balancing professional obligations with the personal duty of keeping themselves and their sometimes geographically distant families safe. Fluctuating demands and traumatic situations found community pharmacy staff often feeling distressed and underprepared., Summary: Despite a global pandemic following a season of extraordinary bushfires, it has barely been acknowledged that community pharmacy staff are one of the highest risk groups for long-term psychological impacts. To our knowledge, very little research has addressed the toll of these cataclysmic events on this group of essential healthcare workers., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: This systematic review aims to identify and synthesize available qualitative evidence related to patient, parent/carer, and health care professional experiences of medication adherence in children and adolescents with asthma., Introduction: Poor medication adherence is a common cause of treatment failure in children with asthma. Research into promoting treatment adherence has found that the most effective interventions are complex. In a child with asthma, the child, the parents/carers, and the health care professional all have important roles in adhering to medication regimens. This review aims to explore the experiences of the patient, parent/carer, and health care professional in managing a child's asthma., Inclusion Criteria: This review will consider children and adolescents between the ages of three and 19 years with asthma, as well as the parent/carer and health care professionals who care for a child with asthma. Qualitative studies exploring the experiences of adherence or nonadherence to asthma medication will be included., Methods: A three-stage search will be conducted and will include published and gray literature. Databases to be searched include CINAHL, Embase, PubMed, PyscINFO, Scopus, and Web of Science. Only studies published in English will be considered, with no date limitation. Identified studies will be screened for inclusion by two independent reviewers. Data will be extracted using a standardized tool, and reviewers will discuss any disagreement. Data synthesis will adhere to the meta-aggregative approach to categorize findings. The categories will be synthesized into a set of findings that can be applied as evidence-based practice., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 JBI.)

Objective: To improve an adherence documentation tool utilised by Australian Clinical Pharmacists in hospitals., Method: Surveys and a focus group session were methods employed to study the perceptions of clinical pharmacists and medical officers on the 'Medication Management Plan (MedMAP)' as an adherence documentation tool and the perceived limitations, if any, of the form., Key Findings: The MedMAP had limitations which could potentially affect patient care in hospitals. The modified form was successfully trialled over a period of two weeks with favourable results., Conclusion: The study identified the shortcomings of the MedMAP form and further underlined the importance of continual auditing of pivotal adherence documentation tools in hospital., (© 2018 Royal Pharmaceutical Society.)

Objective: To identify patterns of medication load, client's care team, coordination of healthcare and clients' understanding of their medications., Methods: Face-to-face interviews were conducted with community-dwelling older Australians between June and August 2017 in three community pharmacies in Adelaide, South Australia., Key Findings: Forty interviews were conducted. On average, participants were taking 7.53 medicines with 77.5% using five or more regularly. Lack of collaboration between healthcare professionals, need for increased communication between prescribers and increased patient education on medicines, were highlighted. This study demonstrates that polypharmacy and inappropriate prescribing are occurring within the community pharmacy setting, but shows insight into how these concerns can be overcome, by implementing pharmacist-led services such as non-dispensing pharmacists in community pharmacies., Conclusion: Careful consideration when prescribing and effective communication are required to minimise risks associated with polypharmacy in this population., (© 2018 Royal Pharmaceutical Society.)

Upper limb function was investigated in children with ADHD using objective methods. We hypothesised that children with ADHD exhibit abnormal dexterity, force application during manipulation of a novel object, and movement rhythmicity. Two groups of age- and gender-matched children were investigated: 35 typically developing children (controls, 10.5 ± 0.4 years, 32M-3F) and 29 children (11.5 ± 0.5 years, 27M-2F) with formally diagnosed ADHD according to DSM-IV-TR criteria. Participants underwent a series of screening tests and tests of upper limb function while "off" medication. Objective quantification of upper limb function involved measurement of force during a grip and lift task, maximal finger tapping task, and maximal pinch grip. Acceleration at the index finger was also measured during rest, flexion and extension, and a postural task to quantify tremor. The Movement Assessment Battery for Children-2 (MABC-2) was also administered. Significant between-group differences were observed in movement rhythmicity, manipulation of a novel object, and performance of the MABC-2 dexterity and aiming and catching components. Children with ADHD lifted a novel object using a lower grip force (P = 0.036), and held the object with a more variable grip force (P = 0.003), than controls. Rhythmicity of finger tapping (P = 0.008) and performance on the dexterity (P = 0.007) and aiming and catching (P = 0.042) components of the MABC-2 were also significantly poorer in the ADHD group than controls. Movement speed, maximum pinch grip strength, and tremor were unaffected. The results of the study show for the first time that ADHD is associated with deficits in multiple, but not all domains of upper limb function.

Patients obtaining a prescription from a pharmacy expect that the drug will be effective and have minimal side-effects. Unfortunately, drugs exhibit the desired effect in ~25-60% of people prescribed any medication. Adverse effects occur at a rate of 10% in patients taking a medication, and this rate increases during and after hospitalisation, with the transition of care back to the ambulatory setting posing a particular risk. Pharmacogenomics testing has been shown to optimise pharmacotherapy by increasing medication effectiveness and reducing drug-related toxicity, thus curtailing overall healthcare costs. Evidence from international studies have shown that community pharmacists would be able to offer this highly relevant professional service to their clients, given suitable training. This specific training complements pharmacists' existing skills and expertise by educating them in an emerging scientific area of pharmacogenomics. However, in an increasingly tight financial climate, the provision of pharmacogenomics testing by Australian community pharmacists will only be viable with an appropriate reimbursement through the Medicare Benefits Schedule, currently accessible by other allied health practitioners but not by pharmacists.

Objective: Opioids are one of the most commonly prescribed medicines for chronic pain. However, their use for chronic pain has been controversial. The objective of this literature review was to identify the role of genetic polymorphisms on patient treatment parameters (opioid dose requirements, response, and adverse effects) for opioids used in malignant and nonmalignant chronic pain. The opioids that this review focuses on are codeine, morphine, oxycodone, tramadol, and fentanyl., Method: A literature search of databases Medline and Embase was carried out, and studies up to April 2016 were included in this review. Studies were included based on a combination of key words: chronic pain and related terms, pharmacogenetics and related terms, and opioids and related terms., Results: Among the 1,408 individual papers retrieved from the search in Medline and Embase, 32 original articles were included in this review, with none related to codeine. The 32 papers reported various study designs, opioids, and polymorphisms being studied for associations with treatment outcomes. This literature review reveals that variants in ABCB1, OPRM1, and COMT have been replicated for opioid dosing and variants in ABCB1 have been replicated for both treatment response and adverse effects., Conclusions: Currently, there are few validated studies to form a strong evidence base to support pharmacogenomics testing when initiating opioid therapy. However, the field of pharmacogenomics in chronic pain is likely to expand over the coming years, with the increasing number of treatment options available and larger cohorts being assembled in order to identify true associations., (© 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Background: Product information is a popular medicines information resource; however, there is some evidence that its pregnancy and lactation information is overconservative, which can lead to inadequate treatment of pregnant and lactating women., Methods: A thorough analysis of pregnancy and lactation information within Australian Product Information and Consumer Medicines Information was performed. The statements within these resources were compared with established clinical resources: Australian Medicines Handbook, Therapeutic Guidelines, South Australian Perinatal Practice Guidelines, Organization of Teratology Information Specialists, LactMed, Motherisk and the Pregnancy and Breastfeeding Medicines Guide published by the Royal Women's Hospital Melbourne., Results: Product Information was found to be the most cautious resource, with 44.5% of pregnancy recommendations and 69% of lactation recommendations reviewed being more conservative than other resources., Conclusion: Product Information is an imperfect and often overconservative reference for pregnant and lactating women. Health professionals are urged to review established clinical resources to inform decision making.

Most commonly used drugs are relatively safe for breastfed babies. The dose received via milk is generally small and much less than the known safe doses of the same drug given directly to neonates and infants. Drugs contraindicated during breastfeeding include anticancer drugs, lithium, oral retinoids, iodine, amiodarone and gold salts. An understanding of the principles underlying the transfer into breast milk is important, as is an awareness of the potential adverse effects on the infant. Discussion with the mother about the possibility of either negative product information or ill-informed advice from others will reduce the confusion and anxiety that may be generated. Good resources about medicines and breastfeeding are available and include state-based medicines information services.

This study investigated views and experiences of over 40 health professionals regarding pregnancy and lactation advice in Australian Product Information (PI). Quality up-to-date information is required when prescribing medication to this demographic. It was found that reliance on PI can result in negative ramifications. These interviews amplify earlier, somewhat limited evidence that PI recommendations are likely overconservative, outdated and unreflective of clinical practice in this field., (© 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Aim: To gain insight into the treatment experiences of children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD)., Methods: Convenience sampling was used to recruit eligible parents and carers at paediatric clinics of the Children's, Youth and Women's Health Service to participate in an interview to discuss experiences, using a semi-structured questionnaire., Results: Thirty-five interviews were conducted. Twenty-five subjects had trialled an average of 1.5 interventions prior to receiving an ADHD diagnosis, namely, dietary modifications (46%), behavioural therapy (24%), learning assistance (8%) and natural remedies (8%). Following an ADHD diagnosis, 25 subjects tried an average of 2.8 interventions, most commonly behavioural therapies (48%), expressive therapies (48%) and fish oil (36%). All subjects started psychostimulant medication after receiving an ADHD diagnosis. Despite 52% of parents expressing initial reluctance towards psychostimulants, 97% reported positive experiences with use in terms of schooling, social interaction and family life. Of those being treated with psychostimulants, 22 (73%) were concurrently using other treatments at the time of interview., Conclusions: Few patients use psychostimulant medication in isolation, with the majority of parents using multiple approaches to manage their child's behaviour. Parents tried a variety of therapies before commencing psychostimulant medication, often because of fears regarding psychostimulant safety. Parents were generally happy with the results gained; however adolescents interviewed were less convinced of the benefits of psychostimulants., (© 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

Objective: To determine, by surveying Australian community pharmacists, the perceived barriers to the provision of information about complementary and alternative medicines (CAMs) and suggestions for overcoming them., Method: Anonymous, self-administered survey sent to a random sample of 701 pharmacists registered in three states of Australia in 2004., Main Outcome Measure: Pharmacists' perceived barriers to the provision of information about CAMs., Results: A total of 344 questionnaires were returned by pharmacists (49% response) of which 211 (30%) were currently practising in community pharmacy. Ninety-five percent of surveyed community pharmacists indicated that they personally received enquires about CAMs, with fewer than 15% reporting they were "very confident" in answering queries about safety, interactions or benefits of CAMs. Frequently used CAM information sources were those from manufacturers and distributors, professional newsletters and journals and textbooks. Pharmacists' perceived barriers to the provision of CAM information included a lack of suitable training (most training was informal), deficiencies in available information sources, a lack of managerial support, the need for regulatory changes, consumer beliefs about CAM safety and time constraints due to competing demands in daily practice. Pharmacists proposed improvements to overcome these barriers including improvements to training., Conclusion: There is scope for pharmacy professional organisations and educational institutions to further support pharmacists in their practice through providing information on the best information sources available and training that meets the needs of undergraduate students, pharmacists and other pharmacy staff. There is a need to examine regulatory requirements concerning the provision of product information with CAMs in Australia and to implement mechanisms for increasing consumer awareness of regulatory procedures for these medicines.

As prescribers of opioid pharmacotherapies, general practitioners (GPs) are pivotal to the sustainability of opioid pharmacotherapy treatment services. The goal of this study was to examine the nature and sustainability of the Australian GP prescriber workforce in order to inform future programmes and policy development in this area. Data were collected from four Australian states: South Australia, Queensland, Victoria and New South Wales. Key features of the available data were: a heavy client load carried by a small number of prescribers, a high proportion of trained but inactive prescribers, and a high proportion (one-third to two-thirds) of medical practitioners who undertake training but do not take up prescribing, i.e. a high attrition rate. Available data indicate significant shortfalls in the number of prescribers available in each state to service this patient population. Across all states a relatively small number of prescribers were providing services for the majority of methadone clients. In order to achieve sustainable, high quality prescriber service provision, workforce development strategies are needed which focus on recruitment of new prescribers, and the support and retention of existing and inactive prescribers. Establishment of systematic and detailed data collection systems should also be considered a priority.