BackgroundPharmacies are increasingly providing services related to contraception and STIs. Identifying pharmacy staff’ and users’ experiences and attitudes relating to sexual health services is critical to understand users’ needs and examining how pharmacy staff can most effectively contribute to patient-centred care. This systematic review aimed to examine pharmacy staff and pharmacy users’ experiences and attitudes towards the delivery of a large range of sexual health services.MethodsSeven electronic databases and the reference lists of all included studies were searched in September 2018. Studies giving insight into pharmacy users’ and pharmacy staff’s experiences and attitudes towards the delivery of services related to contraception and STIs were included. The Mixed Methods Appraisal Tool was used to assess the quality of included studies and a narrative synthesis applied to analyse evidence.ResultsNineteen studies were included. Eleven studies looked at pharmacy staff, four at users and four at both groups. Users found services accessible and convenient and staff found service provision feasible. However, several barriers to service delivery were identified including lack of privacy for delivering services, lack of trained staff available to provide services and subjective judgements being made on who should be provided or offered a service.DiscussionBarriers to service delivery need to be addressed to allow pharmacies to deliver their full potential. Future research on pharmacy-based gonorrhoea and syphilis screening, and hepatitis B vaccination is needed.PROSPERO registration numberCRD42018106807.

There is controversy about the optimum dose of neostigmine for antagonizing neuromuscular block. We have studied 57 patients undergoing gynaecological surgery to establish a dose-response relationship when neostigmine was given to antagonize atracurium-induced block. Anaesthesia was induced with thiopentone and fentanyl and maintained with nitrous oxide and enflurane in oxygen and neuromuscular block was produced with a bolus of atracurium 0.5 mg kg-1. At the time of antagonism of block, three groups received neostigmine 20, 40 or 80 micrograms kg-1 at 5-10% recovery of the compound muscle action potential of the adductor pollicis (profound block) and three groups received one of these doses at 40-50% neuromuscular recovery (light block). At profound block, antagonism was prolonged by reducing the dose of neostigmine from 40 micrograms kg-1 to 20 micrograms kg-1, but not shortened by increasing the dose from 40 micrograms kg-1 to 80 micrograms kg-1. At light block, there was no significant difference between the three groups in the time taken to reach a train-of-four ratio of 0.7. There was little benefit in increasing the dose of neostigmine from 40 micrograms kg-1 to 80 micrograms kg-1 when antagonizing profound neuromuscular block. When light block was antagonized, neostigmine 20 micrograms kg-1 was the optimum dose. We suggest that smaller doses of neostigmine than are given commonly produce adequate antagonism of atracurium-induced neuromuscular block.

Correspondence 87details. The recovery staff must at all times be aware of the identity of an anaethetist responsible for each patient whom they can call upon in case of difficulties.

Reference[I] RAILTON R, CURRIE GD, CORNER GA, EVANS AL. Malfunction of medical equipment as a result of mains borne interference.

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