***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : The reclassification of prescription only medicines to pharmacy and general sales list medicines ( also known as non-prescription medicines ) provides the public with greater access to medicines that they can purchase for self-care . There is evidence that non-prescription medicines may be associated with inappropriate supply . This study investigated factors predicting evidence -based ( guideline compliant ) supply or non-supply of non-prescription medicines . Method : Secondary analysis of results from a r and omised controlled trial of educational interventions to promote the evidence based supply of non-prescription medicines .  Ten actors made simulated patient ( customer ) visits to 60 community pharmacies using seven scenarios reflecting different types of presentations . The dependent variable was appropriate ( guideline compliant ) supply of antifungal medication for treatment of vaginal c and idiasis . Results : No significant association was shown between guideline compliant behaviour and pharmacy type or location , or with the actor making the visit . The likelihood of guideline compliant outcome was significantly greater with symptom presentations than with condition or product presentations ( p<0.001 ) . The likelihood of a guideline compliant outcome increased ( a ) as more information was exchanged ( p<0.001 ) , ( b ) with the use of WWHAM ( a mnemonic frequently used by medicine counter assistants during consultations for non-prescription medicines ) ( p<0.001 ) ; ( c ) when specific WWHAM questions were used ( including “ description of symptoms ” ( p<0.001 ) and “ whether other medication was currently being used ” ( p<0.001 ) ; and ( d ) in consultations involving solely pharmacists compared with those involving only medicine counter assistants ( p = 0.017 ) . After adjustment for presentation type , a significant association persisted between appropriate outcome and consultations with WWHAM scores of 2 and ⩾3 , respectively . Conclusions : The nature and extent of information exchange between pharmacy staff and customers has a strong influence on the guideline compliant supply of non-prescription medicines . Future interventions to promote the safe and effective use of non-prescription medicines should address the apparent deficit in communication between pharmacy staff in general , and medicine counter assistants in particular , which may reflect both pharmacy staff skills and customer expectations Objective It is known that many people with insomnia choose to self medicate and present at community pharmacies , particularly in cases of acute insomnia . The objective of this study is to investigate how community pharmacists respond to complaints of acute insomnia from people who seek self treatment and determine the factors affecting this response . Setting Community pharmacies in New South Wales , Australia . Method A simulated patient study was conducted in 100 r and omly selected pharmacies located in Newcastle and Sydney , Australia . A st and ardized scenario of acute sleep onset insomnia and a scoring system was used in each pharmacy . Main outcome measures Main outcome measures included supply/non supply of an over the counter sleep aid  to the simulated patient , and scores for pharmacists for skills in eliciting information prior to supply of medication ( Pre Supply Score ) , counseling about medication ( Supply Score ) , or about sleep ( Sleep Score ) . Results Of the 100 pharmacies , upon simulated patient presentation , 96 % supplied a product , the remaining 4 % referred to a physician . Non-pharmacological advice was provided in 42 % . Pharmacists scored highly on advice provided with supply of a medication ( Supply scores/4 , 3.1 ± 0.9 ) , but lower on skills in eliciting information prior to supply ( Pre-supply score/8 , 3.6 ± 1.9 ) and sleep related counselling ( Sleep Score/9 , 2.1 ± 1.7 ) . Lower estimated pharmacist age , being in a chain type pharmacy , and having a visible symbol of quality accreditation were found to significantly improve ( P < 0.05 the Sleep Score outcome . Lower estimated pharmacist age as also significantly associated with higher Supply Score ( P < 0.05 ) ; whilst both lower estimated age an visible quality assurance signage were associated with higher Pre-Supply scores ( P < 0.05 ) . Conclusion The results of this study suggest that many pharmacists are responding appropriately to complaints of sleeplessness in terms of eliciting insomnia type and counseling about medicines use . However more education for pharmacists would help to further promote good sleep health , and address behaviors including reliance on medicines taking that can progressively worsen insomnia Background : The importance of theory in underpinning interventions to promote effective professional practice is gaining recognition . The Medical Research Council framework for complex interventions has assisted in promoting awareness and adoption of theory into study design . Human error theory has previously been used by high risk industries but its relevance to healthcare setting s and patient safety requires further investigation . This study used this theory as a framework to explore non-prescription medicine supply from community pharmacies . The relevance to other healthcare setting s and behaviours is discussed . Method : A 25 % r and om sample was made of 364 observed consultations for non-prescription medicines . Each of the 91 consultations was assessed by two groups : a consensus group ( stage 1 ) to identify common problems with the consultation process , and an expert group ( stages 2 and 3 ) to apply human error theory to these consultations . Paired assessors ( most of whom were pharmacists ) categorised the perceived problems occurring in each consultation ( stage 1 ) . During stage 2 paired assessors from an expert group ( comprising patient safety experts , community pharmacists and psychologists ) considered whether each consultation was compliant with professional guidelines for the supply of pharmacy medicines . Each non-compliant consultation identified during stage 2 was then categorised as a slip/lapse , mistake , or violation using human error theory ( stage 3 ) . Results : During stage 1 most consultations ( n = 75 , 83 % ) were deemed deficient in information exchange . At stage 2 , paired assessors varied in attributing non-compliance to specific error types . Where agreement was achieved , the error type most often selected was “ violation ” ( n = 27 , 51.9 % , stage 3 ) . Consultations involving product requests were less likely to be guideline compliant than symptom presentations ( OR 0.30 , 95 % CI 0.10 to 0.95 , p = 0.05 ) . Conclusions : The large proportion of consultations classified as violations suggests that either pharmacy staff are unaware of professional guidelines and thus do not follow them ( therefore these acts would not be violations ) , or that they knowingly violate the guidelines due to reasons that need further research . The methods presented here could be used in other healthcare setting s to explore healthcare professional behaviour and to develop strategies to promote patient safety and effective professional practice Objective Using a self-reported work sampling methodology this study investigated how community pharmacists utilised their time , and quantified how much time pharmacists devoted to specific activities . Setting Community pharmacies ( n = 30 ) in the Greater Belfast area . Method A classification system was developed to define all activities ( professional , semi-professional , and non-professional tasks ) which could potentially be performed by a community pharmacist in the course of a normal working day ( from 9.00 to 6.00 pm ) . A r and om bleeper device was used which was programmed to bleep r and omly approximately 13 times per day ( over 12 days ) at which time the pharmacist recorded their precise activity ( using the classification system ) at that time on a proforma . All completed data sheets for each pharmacy were entered into an Excel ® spreadsheet , where the number of observations for each activity was expressed as a proportion of the total number of observations per day . Statistical analysis was carried out in SPSS , comparing these data to similar data which had been collected in 1998 . Results Pharmacists in this study were found to spend approximately 49 % of their time engaged in professional activities , 31 % in semi-professional activities and 20 % involved in non-professional activities which was similar to that reported in 1998 . Most time was spent on assembly and labelling of products , whilst staff training occupied the least amount of pharmacists ’ time . Pharmacists with a prescription volume of less than 1,499 per month spent significantly more time counselling patients on OTC medicines and responding to symptoms than those dispensing 1,500 items/month or more ( P = 0.027 ) . Pharmacists who employed a pre- registration student apportioned less time to the assembly and labelling of products compared to those without a student ( P = 0.08 ) . Pharmacists with three or more staff spent less time on coding and endorsing of prescriptions compared to those with less staff ( P = 0.086 ) . Conclusion Pharmacists in this study are spending more time checking prescriptions ( essential component of pharmaceutical care ) and are still managing to spend only 20 % of their time on non-professional activities . However , there had been relatively little change in the way in which pharmacists in this sample spent their time compared to a previous study Objective In a prospect i ve two-phase intervention study we evaluated a newly developed computerised pharmacy decision support system ( PDSS ) for the counselling of patients with allergic rhinitis and conjunctivitis . Method Community pharmacists were invited to counsel a virtual patient in a first interview . Immediately thereafter , we trained pharmacists to operate the PDSS , which they applied in a second patient interview immediately following the training . We assessed the completeness of m and atory questions asked as defined by national guidelines . Results Participating pharmacists ( n = 50 , 78 % female , mean age 34 [ IQR : 27–40 ] years , 8 [ 2–14.5 ] years of practical experience , 32 % specialised in community pharmacy ) asked considerably more m and atory questions to confirm appropriateness of self-medication with 7 ( 5.25–9 ; 78 % ) from 9 questions compared to 2 ( 1–3 ; 22 % ) without PDSS ( median ; P < 0.001 ) . In particular , using the PDSS more than doubled m and atory questions ( 9/12 , 6.25–10 ; 75 % vs. 4/12 , 3–5 ; 33 % ; P < 0.001 ) relevant for appropriate drug selection . Conclusion Pharmacists omitted many questions m and atory to assess whether self-medication is appropriate . Using the newly developed PDSS more than doubled the number of m and atory questions asked . The results suggest that the PDSS is ready for evaluation of its impact in real patients OBJECTIVE : To evaluate community pharmacists '  interpersonal skills , ability to make appropriate assessment of a patient 's drug-related problems  , and ability to propose an appropriate therapeutic plan . DESIGN : A disguised shopper design was used . Four different case scenarios were design ed , with input from a five-member community/ primary care pharmacist advisory committee . Two different cases were assigned to each of two shoppers . One hundred and one pharmacies were shopped twice , totaling 202 shopping experiences . A three-member evaluation committee made up of clinical faculty members in ambulatory care and internal medicine assessed the appropriateness of the recommendations . SETTING : The study was conducted in 101 r and omly selected community pharmacies in the Pittsburgh area , including both chain and independent pharmacies . MAIN OUTCOME MEASURES : Main outcome measures included the quality of the pharmacists ' interpersonal skills , patient assessment skills , and recommendations . RESULTS : The majority of pharmacists demonstrated acceptable to good interpersonal skills . Overall , 31.7 % of the recommendations were appropriate , while 39.1 % were poor ( i.e. , recommendations that would likely worsen the patient 's condition or potentially harm the patient ) . In 33.2 % of the cases , recommendations were made without prior assessment of the patient 's problems . CONCLUSIONS : A lack of clinical knowledge and skills should be considered as a barrier that must be overcome if the provision of pharmaceutical care is to become a reality in community practice . OBJETIVO : Evaluar las destrezas interpersonales de farmacéuticos que ejercen en farmacias de comunidad y su habilidad para evaluar problemas relacionados con medicamentos y para proponer un plan terapéutico apropiado . DISEÑO : Un hombre y una mujer sin conocimiento de las ciencias de la salud recibieron adiestramiento que le permitiera representar situaciones clínicas preparadas por el investigador y completar una hoja de recolección de datos . Se asignó dos casos a cada persona . El investigador desarrolló cuatro casos que presentaban diferentes tipos de problemas relacionados con medicamentos . Un comité asesor compuesto por cinco farmacéuticos que ejercen en práctica ambulatoria revisó los casos . Cientouna farmacias recibieron dos visitas , para un total de 202 visitas o experiencias . Un comité evaluador compuesto por tres miembros de la facultad clínica asignada a medicina interna y atención ambulatoria evaluó las recomendaciones hechas por los farmacéuticos . ESCENARIO : Cientouna farmacias , independientes y de cadena , del área de Pittsburg se seleccionaron al azar . MEDICIÓN DE RESULT ADOS : Las medidas de result ados principales incluidas fueron : calidad de las destrezas interpersonales demostradas por los farmacéuticos , destrezas en la evaluación del paciente , y la adecuacidad de las recomendaciones hechas . RESULT ADOS : La mayoría de los farmacéuticos demostraron destrezas interpersonales de aceptables a buenas . El 31.7 % de las recomendaciones fueron apropiadas y el 39.1 % fueron pobres ( i.e. recomendaciones que podían empeorar la condición de salud o potencialmente causar daño al paciente ) . En el 33.2 % de los casos , las recomendaciones se hicieron sin analizar y evaluar los problemas de los 
    Output:
    
The review showed that in terms of the contribution of community pharmacy staff in consultations for NPMs , non‐pharmacist staff dealt with a large proportion of the consultations and pharmacists were usually involved in the consultation through referral from non‐pharmacist staff member .
Counseling was not consistently offered to everyone .
Where counseling was provided it was not always of sufficient quality .
Consultations were performed much better when symptoms were presented compared to when people made a direct product request .
Pharmacists were reported to conduct better consultations than non‐pharmacist staff .
There was evidence to suggest that where counseling was appropriately provided this afforded the person a safe environment to utilize their NPMs .