Optimising the impact of education for community pharmacy in Australia

Aims & rationale/Objectives : This paper examines the extent to which different models of community pharmacist continuing education (CE) are evidence-based. It also describes the impact of varying education models on attendance and attitudes within the profession.

Methods : A literature review was conducted to establish principles that should be applied to health professional education, and pharmacy in particular. Interviews were conducted with representatives from four organisations involved in the education of pharmacists to understand their current models. Four focus groups were held with community pharmacists to understand their educational experiences and attitudes.

Principal findings : The purpose of CE is to improve the clinical performance of health practitioners. Literature examining outcomes from CE underlines the importance of adult learning principles. Focus groups supported the view that consideration of these principles is beneficial. These principles, including problem-based learning, clinical applicability, relevance, and active involvement in the learning process, are currently incorporated into educational models to varying extents. Access problems such as cost, distance, insufficient flexibility in delivery, and poor promotion of educational opportunities prevent many pharmacists from taking responsibility for their own learning. A lack of appropriate assessment by some registering authorities is counterproductive to achieving CE outcomes in clinical practice. Participants already engaged in continuing professional development (CPD) agreed with the principles of its introduction.

Discussion : Optimising outcomes from CE requires considerable input from numerous stakeholders. The recent introduction of mandatory pharmacist CPD across Australia should encourage an individual focus on learning outcomes. Focus group participants are likely to be education enthusiasts and may not represent the views of the entire profession.

Implications : This study identifies the need for a system-wide approach for achieving outcomes from CE. It is therefore advisable that a coordinated strategy be developed by all stakeholders for education delivery so as to optimise the impact of CE.

A population-based approach to optimising the use of anti-hypertensives

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Optimising discrete event simulation models using a reinforcement learning agent

A reinforcement learning agent has been developed to determine optimal operating policies in a multi-part serial line. The agent interacts with a discrete event simulation model of a stochastic production facility. This study identifies issues important to the simulation developer who wishes to optimise a complex simulation or develop a robust operating policy. Critical parameters pertinent to 'tuning' an agent quickly and enabling it to rapidly learn the system were investigated.

Optimising care for people with chronic disease : foreword

Chronic disease self-management emerged as an organised, formal entity in Australia in the 1980s, when a specific group-based program was introduced from the United States. This program, the Stanford Arthritis Self-Management Course, was promulgated in Australia and other countries by its creator, Professor Kate Lorig of Stanford University. The program showed much early promise, particularly with its dissemination and uptake by an enthusiastic non-government sector. Over subsequent years it has matured, and many other programs endeavouring to support patients to engage in self-management have been developed. In some ways, chronic disease self-management has become mainstream.1-3

Modelling and optimising operations of a plant using JIT philosophy

An Australian automotive component company plans to assemble and deliver seats to a car manufacturer on a "just-in-time" basis at its new plant. The research objective was to model seat assembly operations and apply Toyota goal chasing algorithm and user defined algorithm to balance workload among all the assembly workstations and areas.

The mobile skilled workforce : optimising benefits for rural communities

Many small rural communities with ageing populations and limited opportunities for young people are not attracting skilled workers, but have a flow of skilled people through the community as locums, seasonal workers or contractors. This project investigated the question: how can rural communities capture maximum benefit from professional and other highly skilled workers in the context of an increasingly mobile and transitory workforce? It found that rural communities derive a wide range of benefits from mobile skilled workers. Effectiveness of the integration process determines the nature and extent of mobile skilled worker contribution to the community. Community settings that encourage and support mobile skilled worker integration are identified in terms of culture, leadership and interactional infrastructure. These same settings also influence mobile skilled worker retention in rural communities. Rural communities need to be proactive in matching worker and community characteristics, and this begins with the recruitment process. Mobile skilled workers need assistance and support to develop a primary social contract, and the process needs to be monitored. This is a community-wide responsibility and requires a coordinated, whole-of-community approach. This is the first Australian study to explore how rural communities can capture the advantages from highly skilled mobile workers. Rural communities that make the most of the available pool of skills can increase resilience, identification and uptake of opportunities such as new enterprises, good practice in natural resource management, enhanced social and leisure opportunities, and the quality and range of local services. The importance of this report is that it provides a broad range of strategies for rural communities wanting to know how to optimise the benefits they derive from mobile skilled workers, regardless of their location or rural industry base.

Targeted exercise against osteoporosis : a systematic review and meta-analysis for optimising bone strength throughout life

Background
Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures, but its effect on whole bone strength has remained inconclusive. The primary purpose of this systematic review and meta-analysis was to evaluate the effects of long-term supervised exercise (≥6 months) on estimates of lower-extremity bone strength from childhood to older age.

Methods
We searched four databases (PubMed, Sport Discus, Physical Education Index, and Embase) up to October 2009 and included 10 randomised controlled trials (RCTs) that assessed the effects of exercise training on whole bone strength. We analysed the results by age groups (childhood, adolescence, and young and older adulthood) and compared the changes to habitually active or sedentary controls. To calculate standardized mean differences (SMD; effect size), we used the follow-up values of bone strength measures adjusted for baseline bone values. An inverse variance-weighted random-effects model was used to pool the results across studies.

Results
Our quality analysis revealed that exercise regimens were heterogeneous; some trials were short in duration and small in sample size, and the weekly training doses varied considerably between trials. We found a small and significant exercise effect among pre- and early pubertal boys [SMD, effect size, 0.17 (95% CI, 0.02-0.32)], but not among pubertal girls [-0.01 (-0.18 to 0.17)], adolescent boys [0.10 (-0.75 to 0.95)], adolescent girls [0.21 (-0.53 to 0.97)], premenopausal women [0.00 (-0.43 to 0.44)] or postmenopausal women [0.00 (-0.15 to 0.15)]. Evidence based on per-protocol analyses of individual trials in children and adolescents indicated that programmes incorporating regular weight-bearing exercise can result in 1% to8% improvements in bone strength at the loaded skeletal sites. In premenopausal women with high exercise compliance, improvements ranging from 0.5% to 2.5% have been reported.

Conclusions
The findings from our meta-analysis of RCTs indicate that exercise can significantly enhance bone strength at loaded sites in children but not in adults. Since few RCTs were conducted to investigate exercise effects on bone strength, there is still a need for further well-designed, long-term RCTs with adequate sample sizes to quantify the effects of exercise on whole bone strength and its structural determinants throughout life.

Optimising e-mail communication : the impact of seminar-and computer-based training

Employees continue to report multifarious e-mail concerns ('e-mail defects') including ambiguous unclear messages, e-mail overload, security and privacy issues, and e-mail interruptions. These defects have an effect on employee efficiency and effectiveness. This paper explores the importance of identifying e-mail defects and the effectiveness of training employees in efficient use of e-mail at four UK organisations, using Seminar-Based Training (SBT) and Computer-Based Training (CBT) delivery modes. The findings suggest that SBT has a diminishing impact over a very short period of time, but a combined approach of SBT and CBT is more effective and provides better results.

Optimising the life cycle energy performance of residential buildings

A holistic approach to low-energy building design is essential to ensure that any efficiency improvement strategies provide a net energy benefit over the life of the building. Previous work by the authors has established a model for informing low-energy building design based on a comparison of the life cycle energy demand associated with a broad range of building assemblies. This model ranks assemblies based on their combined initial and recurrent embodied energy and operational energy demand. The current study applies this model to an actual residential building in order to demonstrate the application of the model for optimising a building’s life cycle energy performance. The aim of this study was to demonstrate how the availability of comparable energy performance information at the building design stage can be used to better optimise a building’s energy performance. The life cycle energy demand of the case study building, located in the temperate climate of Melbourne, Australia, was quantified using a comprehensive embodied energy assessment technique and TRNSYS thermal energy simulation software. The building was then modelled with variations to its external assemblies in an attempt to optimise its life cycle energy performance. The alternative assemblies chosen were those shown through the author’s previous modelling to result in the lowest life cycle energy demand for each building element. The best performing assemblies for each of the main external building elements were then combined into a best-case scenario to quantify the potential life cycle energy savings possible compared to the original building. The study showed that significant life cycle energy savings are possible through the modelling of individual building elements for the case study building. While these findings relate to a very specific case, this study demonstrates the application of a model for optimising building life cycle energy performance that may be applied more broadly during early-stage building design to optimise life cycle energy performance.