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Background: Investigating beliefs about medicines has been of interest over the past years, with studies aiming to better understand theoretical reasons behind development of such beliefs. Objective: This study aimed to produce a culturally and contextually appropriate version of the Beliefs about Medicines Questionnaire (BMQ) in the Maltese language and to assess its psychometric properties. Methods: Medication beliefs were evaluated using the BMQ which is divided into two sections: BMQ-General (sub-scales: Overuse and Harm, 4 items per sub-scale) and BMQ-Specific (sub-scales: Necessity and Concerns, 5 items per sub-scale). Following translation/back translation, the Maltese version of the BMQ was applied to patients having asthma, diabetes, cardiovascular disease or depression who attended out-patients’ clinics at the main state general hospital in Malta between June and September 2013. Cronbach’s alpha coefficient, alpha, was used to determine internal consistency of the BMQ and Principal Component Analysis using Varimax rotation with Kaiser normalisation was carried out to analyse component loading of the items on the respective sub-scales. Results: The Maltese version of the BMQ showed acceptable internal consistency for the harm scale (alpha=0.56), the necessity scale (alpha=0.73) and the concerns scale (alpha=0.66), however the overuse scale gave poor internal consistency (alpha=0.48) due to the item on natural remedies which posed some difficulty in the Maltese sample. The final solution for Principal Component Analysis yielded a four-factor structure representing the 4 sub-scales of the BMQ, with results being comparable to previous studies out in different languages. Conclusion: The Maltese version of the BMQ was found to have acceptable psychometric properties for the beliefs about medicines in the Maltese population.

Appropriate prescribing remains an important priority in all medical areas of practice. Objective: The objective of this study was to apply a Medication Appropriateness Index (MAI) to identify issues of inappropriate prescribing amongst patients admitted from the Emergency Department (ED).Method: This study was carried out at Malta’s general hospital on 125 patients following a two-week pilot period on 10 patients. Patients aged 18 years and over and on medication therapy were included. Medication treatment for inappropriateness was assessed by using the MAI. Under-prescribing was also screened for. Results: Treatment charts of 125 patients, including 697 medications, were assessed using a MAI. Overall, 115 (92%) patients had one or more medications with one or more MAI criteria rated as inappropriate, giving a total of 384 (55.1%) medications prescribed inappropriately. The mean SD MAI score per drug was 1.78 (SD=2.19). The most common medication classes with appropriateness problems were supplements (20.1%), antibiotics (20.0%) and steroids (19.8%). The most common problems involved incorrect directions (26%) and incorrect dosages (18.5%). There were 36 omitted medications with untreated indications. Conclusion: There is considerable inappropriate prescribing which could have significant negative effects regarding patient care.

Objective: To investigate knowledge of medicines and sources of information about medicines among adolescents in Malta.Methods: A self-administered questionnaire was used to survey knowledge of medicines and information sources among adolescents attending secondary schools in Malta. A random stratified sample design generated a sample size of 514 students. Knowledge of medicines was investigated by questions that included topics about the efficacy of medicines, proper communication during a medical consultation, the safety of medicines, antibiotic use and pictograms. Results: The analytical sample, of which 53.8% were girls, was made up of 474 students, aged 14-16 years. The students obtained a mean score of 22.92 points (SD = 4.31) out of a maximum of 32 points for medicine knowledge. More than 30.0% of the respondents did not mark the correct answer for 40.6% of the questions that investigated knowledge of medicines. The family physician, community pharmacist and parents were the sources of information that were mostly cited. A proportion of 4.4% had obtained information from the teacher. A quarter of the respondents (24.7%) had obtained information from friends/schoolmates, young relatives or the media, generally television (17.3%). Conclusion: Although the level of knowledge about medicines among this study sample of Maltese students was good, there appeared to be particular misconceptions with regard to important aspects associated with the proper use of medicines. These findings highlight the need to educate adolescents about the proper use of medicines. The most important information providers about medicines appeared to be the physician, pharmacist and parents. It is being suggested that education campaigns should be organized in order to help parents guide adolescents on how to use medicines appropriately. In addition, adolescents would benefit if more information about the proper use of medicines would be disseminated by means of television programs and school-based health education curricula.

Pharmacy in Moldova is undergoing a period of transition. The professional practice is adjusting to a market-oriented economy from the previous Soviet system. The pharmaceutical sector has been liberalised giving rise to a significant increase in the number of community pharmacies. This has led to some adverse effects on the profession of pharmacy with pharmacists having considerable difficulties fulfilling their professional aspirations and possibly losing confidence in further developing their professional role. Objective: To assess community pharmacists’ attitudes towards their professional practice and to determine their perceived competence in various pharmaceutical activities.Methods: A questionnaire which addressed managerial activities, dispensing activities, pharmaceutical care activities, inter-professional relationships, public health and competence was mailed to 600 community pharmacists who were asked to score the importance and perceived competence for each activity on a scale ranging from 0-5. In the case of pharmaceutical care activities, pharmacists were asked to score their degree of agreement or disagreement as to whether it is the responsibility of the pharmacist to engage in specific pharmaceutical care activities.Results: A total of 370 valid questionnaires were returned giving a response rate of 61.7%. Managerial and dispensing activities were scored the highest both in terms of perceived importance and competence. The more innovative pharmaceutical care activities scored relatively low. Overall scores relating to the importance of pharmacists engaging in public health activities appear to be the lowest of the entire questionnaire. Younger pharmacists between the ages of 22-30 obtained significantly higher scores with regards to the perceived pharmacist’s responsibility in engaging in various pharmaceutical care activities. Respondents who practiced in an accredited pharmacy scored higher in the majority of questions.Conclusion: Pharmacists in Moldova appear to be deeply rooted in the traditional approach to the practice of pharmacy pertaining mainly to distributive practice model and are somewhat distant from the other models of practice such as pharmaceutical care, drug information and self-care.

Copyright of Pharmacy Practice (1886-3655) is the property of Centro de Investigaciones y Publicaciones Farmaceuticas S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pharmacy Practice (1886-3655) is the property of Centro de Investigaciones y Publicaciones Farmaceuticas S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ERRATUM TO: West LM, Cordina M, Cunningham S. Clinical pharmacist evaluation of medication inappropriateness in the emergency department of a teaching hospital in Malta. Pharmacy Practice 2012; 10(4):181-187. doi: 10.4321/s1886-36552012000400001

Background: Pharmacists and medical doctors are two professional groups that very often receive their education and practice in the same environment. However, their approach to patient care and collaboration tends to be different and this may lead to both frustration and conflict which may adversely affect patient care. Personality has been identified as a psychological issue that could contribute to conflict in a work situation. Objective: To study the personality traits of a cohort of students studying pharmacy and medicine at the University of Malta in their first and final year. Methods: The Gordon Personal Profile – Inventory was administered to a cohort of pharmacy and medical students in their first year and once again administered to the same cohort who completed their course of study in their final year. Basic demographic data was also collected. Results: In first year the most pronounced traits for both student groups were those of Emotional Stability and Personal Relations. Over a period of five years, there were shifts in personality traits. In their final year pharmacy students were characterized by high scores for Cautiousness and Personal Relations while medical students exhibited medium scores in Cautiousness and Emotional Stability. Conclusion: The changes in personality traits over the duration of the course were not radical changes but rather that of traits becoming more pronounced.

Marginalised people experience diminished access to pharmaceutical care and worse medication-related outcomes than the general population. Health equity is a global priority. This article explores the key evidence of health inequity and medication use, structures the causes and contributory factors and suggests opportunities that can be taken to advance the pharmaceutical care agenda so as to achieve health equity. The causes of, and contributors to, this inequity are multi-fold, with patient- and person-related factors being the most commonly reported. Limited evidence is available to identify risk factors related to other aspects of a personal medication use system, such as technology, tasks, tools and the internal and the external environments. Multiple opportunities exist to enhance equity in medication-related outcomes through pharmaceutical care research and practice. To optimise the effects and the sustainable implementation of these opportunities, it is important to (1) ensure the meaningful inclusion and engagement of members of marginalised groups, (2) use a person-centred approach and (3) apply a systems-based approach to address all of the necessary components of a system that interact and form a network as work processes that produce system outcomes.

Objective: To analyse the accuracy of antenatal ultrasound screening in Malta, comparing detection rates within the private and public sectors, and with the rest of Europe. To assess local trends in accuracy for each organ system., Material and Methods: Ethics approval was obtained to gather routinely collected data from the national congenital anomalies registry between 2016 and 2018. This was analysed to determine local antenatal ultrasound accuracy rates and trends. Electronic medical appointment record data was also used to indirectly determine whether a significant difference existed in the detection of antenatal anomalies in mothers scanned privately and those scanned within the public sector. χ2-for-trend was used to analyse changes in the accuracy rates. European Surveillance of Congenital Anomalies (EUROCAT) data was used to compare scanning accuracy in Malta and other EUROCAT centres., Results: The local rate of undetected congenital anomalies was 62.0% for public scans and 83.9% for private scans. Local trends over the three-year period showed an improvement in accuracy rates in detecting isolated syndromes (p=0.05), anomalies of the renal system (p=0.02) and craniofacial anomalies (p=0.05). Malta’s overall performance was similar to other EUROCAT centres., Conclusion: Scans carried out within the public sector are more accurate than private scans, and Malta’s overall performance was similar to other EUROCAT centres.

Background: The pandemic is at a paradoxical stage, with vaccine roll out initiated but a significantly elevated level of infection and death. Hope for recovery lies in high equitable vaccine uptake., Objective: The study aimed to: i) explore attitudes and factors influencing attitudes, towards the COVID-19 vaccine amongst people living in Malta, ii) identify the reasons as to why individuals are unsure or unwilling to take the vaccine., Methods: Two consecutive, short, anonymous online surveys using social media platforms were used to gather data from adult individuals. The first study was open to residents in Malta, while the second study invited international participation. Study 1 consisted of 17 questions inspired by the Theories of Planned Behaviour and Reasoned Action. Study 2 asked participates whether they were willing, unwilling or unsure of taking the vaccine and their reasons for being unsure or unwilling., Results: A total of 2,529 individuals participated in Study 1 and 834 in Study 2. In both studies respondents were predominantly female having a tertiary education. Over 50% declared that they were willing to take the vaccine, with males being more willing (t=5.83, df=1164.2, p<0.00005). Opinions of significant others- family and friends (r=0.22, p<0.005) and health professionals (r=0.74, p<0.005) were associated with willingness to take the vaccine. Vaccine hesitancy was present in the study population with 32.6% being unsure and 15.6% declaring that they were not willing to take the vaccine. Females were more likely to be unsure (Chi-squared=14.63, df=4, p=0.006). Lack of vaccine safety was the main reason cited for unwillingness to take the vaccine. Predictors for willingness to take the vaccine were: i) The belief that the COVID-19 vaccine will protect the health of the people who take it; ii) Valuing the advice of health professionals regarding the effectiveness of COVID-19 vaccine; iii) Having taken the influenza vaccine last year and; iv) Encouraging their elderly parents to take the vaccine., Conclusions: COVID-19 vaccination information campaigns should promote group strategies, focusing on emphasising the safety of the vaccine and offer reassurance, especially to women., Competing Interests: CONFLICT OF INTEREST None., (Copyright: © Pharmacy Practice and the authors.)

Background . Education should support the gradual development of students' necessary abilities to empower them in participating in decision-making together with health care professionals. Aim . The aim of this study was (1) to evaluate baseline knowledge regarding medication and medication wastage among primary school children and (2) to determine the short- and long-term effects of an educational intervention. Methods . Ten primary state schools around Malta were invited to participate; 5 accepted participation (3 control and 2 intervention). Children aged 9 to 12 years attending the sixth grade completed a self-reported questionnaire containing 20 questions, with total scores ranging from 0 to 20. Students from the intervention classes filled in a questionnaire pre and post an educational seminar. All students answered the questionnaire again after 8 months. ANOVA (analysis of variance) with repeated measures was used to compare difference between preintervention and postintervention mean scores. Results . Overall, 40.8% (160/392) of children participated. Mean ± SD age was 10 ± 0.4years; 52.5% (n = 84) were boys. Average preintervention knowledge score for all 5 schools was 11.5 ± 3.6, with 43.1% (n = 69) obtaining responses ≥13 (median). A repeated-measures ANOVA with a Greenhouse-Geisser correction determined that mean knowledge scores differed significantly between preintervention and postintervention ( F [1, 81.000] = 75.190, P < .0005). Intervention students retained a significant increase in knowledge scores at 8 months ( P = .026). Discussion and Conclusion . The significantly improved knowledge score following the educational intervention both in the short- and long-term demonstrated the success of the intervention. These findings provide a basis for the introduction of education about medication and medication wastage in schools., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The accessibility of services within community pharmacies provides an ideal opportunity to manage minor ailments, yet over £1.1 billion is spent by the National Health Service (NHS) in the United Kingdom (UK) in managing minor ailments in high cost settings. There is a need to review the evidence base around clinical effectiveness of pharmacy-based management of minor ailments since the absence of such may lead to under-utilisation of pharmacy services and non-implementation of available pharmacy service models. This study aimed to systematically review the methodological approaches used to assess clinical outcomes of pharmacy-based management of minor ailments in the research literature., Methods: A systematic review was conducted to identify relevant literature using the following databases: Medline, EMBASE, CINAHL, IPA, CRD, CDSR, and Google Scholar from publication year 2000 onwards. Studies were included if they evaluated clinical outcomes of pharmacy-based management of any minor ailments, with or without a comparator setting such as Emergency Departments (EDs) or general practices. Screening and selection of titles, abstracts and full texts followed by data extraction and quality assessment (QA) was conducted. Paired researchers, from the team, reviewed papers using a protocol based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). QA was undertaken using the Critical Appraisal Skills Programme (CASP). Reporting was conducted in accordance with PRISMA checklist and statements., Results: A total of 19 studies were included. The majority of studies were observational, conducted in community pharmacies, and did not use a comparator participant group nor a comparator setting. Interventions included counselling, medicines supply and provision of advice on the management of minor ailments. One study used the randomised controlled trial (RCT) design with majority of the study utilising observational design. A range of clinical outcomes including symptom severity, pattern, resolution, and quality of life were reported. Methods used for the assessment of clinical outcomes were, overall, poorly reported. This included a lack of information on the development and validation of the data collection tools and the timing of baseline and follow-up data collection. Adverse clinical outcomes data were collected by only seven studies., Conclusions: Currently, there are methodological limitations in the studies that have sought to assess clinical outcomes of pharmacy-based management of minor ailments. Such lack of high quality evidence may contribute to failings to shift care from high cost settings, such as EDs and general practices. Generation of high quality evidence is likely to influence public choices when seeking care for minor ailments. There is scope for development of a core outcomes set specific to minor ailments management and development of a validated methodology for measuring such outcomes in a research study., Competing Interests: The authors have declared that no competing interests exist.

Objective: To determine the impact of lean thinking on the original time required to prepare the necessary documentation in relation to the preparation of parenteral chemotherapy/monoclonal antibodies., Method: Four pharmacists and one pharmacy technician from the oncology hospital (Malta) all participated in eight focus groups linked to the different constructs of Normalisation Process Theory (NPT): coherence, cognitive participation, collective action and reflexive monitoring. The value stream documentation process was mapped by analysing all steps in the process where each activity must add value for the patient; tools of lean thinking were applied. Points causing delay in processing were considered critical; possible changes to minimise time waste were discussed and implemented. Time spent on critical points was measured by timing in minutes each step of the process 1 month before and after the changes had been implemented and calculating the mean±SD. An audit was performed comparing the process with standard operating procedures to determine whether any steps required quality improvement., Results: Three critical points were identified: time required to search for pharmacy patient medication records for chemotherapy/monoclonal antibodies required on the day; time to generate preparation labels; and time to generate worksheets. Overall, a total of 122±8.6 min (p=0.06) were saved per day, a 37% decrease from the original documentation time. Five deficiencies were identified in the documentation process audit; corrective action was proposed., Conclusions: By applying lean thinking, non-value-added steps leading to time waste in the documentation process were eliminated. This concept could be implemented by using NPT as part of a strategic system to reduce waste., Competing Interests: Competing interests: None declared.

Objective: To determine, using the Gordon Personal Profile-Inventory (GPP-I), if the personality traits of first-year pharmacy students match the traits required for patient-centered practice., Methods: The GPP-I, which measures the personality traits of ascendency, responsibility, emotional stability, sociability, cautiousness, original thinking, personal relations, and vigor, was administered to incoming pharmacy students at the beginning of their first semester., Results: The pharmacy school had attracted students with strong traits of original thinking, followed by personal relations, and vigor. The students, however, were limited in emotional stability and ascendency., Conclusion: The pharmacy profession needs to be more proactive in projecting the desired image and communicate its increasingly challenging and patient-oriented practice to attract individuals whose personalities are conducive to current practice models.