the otc treatment clinic

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1 educatio Supportig Traiig Iitiatives the otc treatmet cliic Commo coditios ad their treatmet optios This module has bee edorsed with the NPA s Traiig Seal as suitable for use by medicies couter assistats as part of their ogoig learig. Complete the questios at the ed to iclude i your self-developmet portfolio Welcome to TM s OTC Treatmet Cliic series. This hady, four-page sectio is specially desiged so that you ca detach it from the magazie ad keep it for future referece. Each moth, TM covers a differet OTC treatmet area to help you keep up-to-date with the latest product developmets. I this issue, we focus o asal health ad hygiee. At the ed of the module there are multiple choice questios for you to complete, so your progress ca be moitored by your pharmacist. You ca fid out more i the Couter Itelligece Plus traiig guide. The last six topics we have covered are: l Coughs l Oral care l Pregacy-related ski coditios l Sore throats l Headlice l Irritable bowel sydrome You ca dowload previous modules from module 189 Nasal health ad hygiee author: Jae Feely, PhD for this module OBJECTIVES: After studyig this module, assistats will: Be familiar with the basic structure ad fuctio of the ose ad siuses Be familiar with commo coditios that ca affect the ose Kow which OTC products ca be recommeded for commo asal coditios Kow which customers should be referred to the pharmacist Be able to advise o lifestyle tips to help maitai good asal hygiee. Whether you re i the habit of keepig it to the gridstoe, turig it up at thigs or eve cuttig it off to spite your face, there s o deyig that the subject of this moth s OTC Treatmet Cliic is as plai as the ose o your face! But jokig aside, how ofte do we actually stop ad thik about our ose ad all the thigs it goes through especially durig the cold ad flu seaso? We may ot give our oses a secod thought most of the time, but if we re feelig stuffy ad cogested, or if our ose just wo t stop ruig, it certaily makes us feel uder the weather. Ad have you oticed that if you ca t smell properly, your sese of taste is off too? This moth we ll cover coditios like rhiitis, asal cogestio, siusitis ad post-asal drip all of which are likely to be affectig a fair umber of your customers this witer. What does the ose do? Well, the most obvious thig is our sese of smell. Whe we smell somethig good or bad molecules i the air we breathe stimulate special erve cells i the ose. These olfactory cells are foud i a small area high up i the ose ad they coect directly to the brai. May thigs ca affect our sese of smell, icludig a cold, smokig, some medicies, asal polyps or prologed exposure to certai chemicals. The ose also acts as a vital processig system, treatig the air before it eters the lugs. The ose is able to achieve all of these actios because of its specific structure. The asal structure The ose is made up of a combiatio of boe ad cartilage. At the top, aroud the bridge, the structure is boe. Towards the frot, the ose is mostly cartilage ad this cotiues iside, where a cartilage called the asal septum divides the ose ito two halves. Air eters ito each of these halves through the ostrils. However, the ose TM JANUARY 2013 PULL OUT AND KEEP

2 the otc treatmet cliic reflective exercise Barry, 45, frequetly travels by plae for work, but suffers from cogestio durig the flights. His parter read about somethig for dry ose ad Barry asks if you kow what this is. He does ot take ay medicatio ad does ot suffer from ay other coditios. What would you recommed? A asal solutio or spray based o salie or seawater would be suitable. Such a product ca provide atural relief from asal cogestio ad would be useful for Barry as he speds a sigificat amout of time i a plae, which is a dry eviromet that could be the cause of his stuffy ose. Barry asks for a product for his six-moth-old so who, he says, has a slightly stuffy ose. He has o other symptoms. A salie or seawater preparatio would be suitable. Such products are geerally suitable for the whole family (but always check labels first). Stérimar Baby has a specific ozzle with a protective flage that prevets the spray beig iserted too far ito the ose. This helps to avoid the risk of ijury i a baby or child up to the age of three. Barry asks for a decogestat tablet for a blocked ose. He is takig lisiopril for high blood pressure. Decogestat tablets cotai igrediets such as pheylephrie ad pseudoephedrie, which are ot recommeded for people who does t stay divided. Towards the back of the ose, the two asal cavities joi together aroud the area called the asopharyx. I this area you ll also fid the adeoid tissue ad the Eustachia tubes, which lik to the middle ear. (We detailed this area i September s issue of TM, whe we covered sore throats.) This is also where the tear ducts drai, explaiig why your ose rus whe you cry! The side walls iside the ose iclude three structures called turbiates. These are figerlike projectios of boe that divide the asal cavity ito three, groove-like passages. These icrease the surface area iside the ose ad regulate the flow of air through the cavity. The etire asal cavity is lied with a membrae that produces a thi film of clear mucus. This helps humidify the air we breathe have high blood pressure. Such a product would ot be suitable for Barry. Refer him to the pharmacist who might recommed either steam ihalatio (although care should be take to avoid scaldig with hot water) or a OTC product. Puttig a ihalat o the pillow at ight ca also provide relief. Barry describes symptoms of pai travellig from his ose to uder his eyes. He says that the discharge from his ose is gree. This souds like a case of siusitis, with possible ifectio. Siusitis occurs whe the siuses become blocked ad is ofte associated with a cold. Mucus produced i the siuses ormally drais ito the ose. Whe mucus caot drai from the siuses, bacteria i the mucus may grow, leadig to a sius ifectio. Barry has gree asal discharge, which suggests a ifectio. He may require atibiotics ad should be referred to a GP. The customer is a 25-year-old woma who is sufferig from a ruy ose ad a headache. A product cotaiig a atihistamie ad a aalgesic would help to dry up the ruy ose ad treat the headache. If the product you recommed cotais paracetamol, war this customer ot to take ay other product cotaiig paracetamol or at least to avoid doublig up o the paracetamol dose. i ad traps particles like allerges, bacteria ad viruses. If the iside of the ose is too dry, its various fuctios will be impaired. The asal cavity is also lied with millios of tiy hairs called cilia. These hairs move i a rhythmic fashio ad work together to propel particles ad excess mucus out of the ose. The siuses The siuses are four pairs of air-filled cavities foud i the boes of the face, aroud the ose ad eyes. The same mucus membrae that lies the asal cavity also coats the iside of the siuses. Mucus produced here drais ito the ose. Aythig that blocks this draiage ca lead to a build up of pressure i the siuses ad this ca be felt as sius pai or a headache. If the sius cavities become blocked, bacteria i the mucus may grow, leadig to a sius ifectio. Rhiitis (ruy ose) Rhiitis is the medical term for iflammatio ad swellig of the mucus membrae iside the ose. This iflammatio icreases the amout of mucus produced ad, as a result, customers may complai of a ruy ose. Rhiitis ca be defied by the duratio of symptoms: l Acute rhiitis This is a short-lived coditio, ofte triggered by a viral ifectio or a allergy. Viral rhiitis is usually liked to the commo cold. Other possible viral culprits iclude the flu virus, ad illesses like brochiolitis, chickepox, rubella ad measles. I additio to a ruy ose, sufferers may complai of seezig, asal cogestio, post-asal drip, cough ad fever. Allergic rhiitis is triggered by a allergic reactio. The symptoms may be seasoal, such as with hayfever, or year-roud if the allerge is pet dader or house dust mites. Symptoms also iclude seezig, itchy ose, itchy or watery eyes ad asal cogestio. Some people suffer from what is termed vasomotor rhiitis, where the blood vessels i the ose are overly sesitive to thigs like bright lights, cold temperatures, pait fumes, spicy foods, stress, alcohol or tobacco smoke. l Chroic rhiitis This is a loger-lastig coditio that may be caused by ay of the followig: Atrophic rhiitis the mucus membrae iside the ose this ad hardes, causig the asal passages to dry out. This is more likely to occur i the elderly ad may be accompaied by the formatio of crusts iside the ose ad a offesive odour. Sufferers may also report recurrig osebleeds ad loss of smell Hormoal imbalace e.g. durig pregacy, puberty or whe takig oral cotraceptives or hormoe replacemet therapy. A uderactive thyroid glad is aother possible cause Rhiitis medicametosa this is caused by the overuse of asal decogestats. You may have heard it referred to as reboud cogestio. Nasal decogestats work by reducig the swellig of the asal mucosa, but if they are used for too log they may cause the liig or the ose to swell agai, triggerig a re-emergece of symptoms. Overlappig coditios May of the coditios discussed i this module ted to have some degree of overlap. I other words, it s possible for someoe with rhiitis to also report asal cogestio or someoe with a stuffy ose to also suffer from sius pai. PULL OUT AND KEEP TM JANUARY 2013

3 the otc treatmet cliic Nasal cogestio Nasal cogestio is aother commo symptom of ifectios such as colds ad flu. It ca also occur with allergies, hormoe chages durig pregacy ad exposure to irritats like tobacco smoke, etc. However, asal cogestio ca also be liked to structural abormalities, e.g. if the asal septum is deviated or bet or if there has bee a ijury to the ose. I childre, elarged adeoids are a commo cause of asal cogestio. The paret may report that the child breathes through their mouth ad sores while asleep. With youg childre, there s also the possibility that they may have iserted a foreig object ito their ostril. Cosider this if the paret reports a foul-smellig discharge draiig from oe ostril. Siusitis The term siusitis simply meas that the siuses are iflamed ad this is usually caused by a ifectio or a allergy. As metioed, the siuses are air-filled spaces i the boes aroud the eyes ad ose. Normally, mucus drais through small chaels ito the ose. However, if these chaels get blocked, the siuses ca become cogested ad iflamed. The siuses behid the cheekboes are most commoly affected. Siusitis ca be acute (symptoms last less tha 12 weeks), or chroic (coditio persists for loger). Symptoms may iclude: l Pai or tederess i the forehead, cheeks or aroud the eyes l Headache l Fever l A blocked or ruy ose l Cough l Loss of smell or taste l Bad breath. I additio, asal secretios may be thick ad rage i colour from white to yellow/gree or eve be tiged with blood. Yellow or gree mucus may be a idicatio of a bacterial ifectio that requires atibiotics. Post-asal drip Normally, all mucus secretios from the ose drai to the back of the throat ad are swallowed i a process we re ot usually aware of. However, sometimes a perso may feel as if mucus is accumulatig at the back of the throat. This is termed post-asal drip. Post-asal drip may occur whe a perso is sufferig from a cold or a allergy. Excess mucus productio may mea they become more aware of it draiig at the back of the throat. This draiage may also irritate delicate tissues i the area ad trigger coughig. If the secretios from the ose are thicker tha ormal, this may make it feel like it is slow to drai or difficult to swallow. Thicker mucus may be liked to a sius ifectio, dry air or a allergy to substaces such as dairy products. Post-asal drip may also be experieced i situatios where the perso has problems with their throat muscles or are ot swallowig efficietly. Stress ca be a factor here, as ca gastro-oesophageal reflux disease (GORD). Whe to refer l Symptoms which are severe or last loger tha 10 days l A fever lastig for more tha three days l Nasal discharge that is yellow/gree ad accompaied by sius pai or pressure l Blood i the asal discharge or a persistet clear discharge after a head ijury l Chage i visio or swellig aroud the eyes l Nasal cogestio i a baby that causes difficulty feedig l A child who may have a foreig object iside the ose l Symptoms that iitially improve but the worse l Ayoe takig prescribed medicatio for a chroic medical coditio l Symptoms that persist despite the use of appropriate OTC medicatio. OTC treatmet optios The OTC product of choice will deped o the perso s symptoms ad the cause of those symptoms, although this may ot always be obvious. Ask the WWHAM questios ad refer to your pharmacist whe ecessary. Also, check all product labels ad draw your customers attetio to the correct dosage istructios. l Seawater ad salie asal sprays Nasal sprays based o seawater or salie ca be used to give atural relief from a umber of asal coditios. For those who suffer from dry ose, or who sped time i dry eviromets, these sprays are also a optio. The Stérimar rage offers asal sprays based o 100 per cet atural seawater that are suitable for the whole family, icludig babies ad pregat wome. The products ca be used aloe or with medicatio. Stérimar Nasal Hygiee is a isotoic solutio (i.e. the solutio has the same salt cocetratio as cells i the huma body), which ca be used two to six times a day, or more if eeded, for as log as required. The stroger Stérimar Cogestio Relief is a hypertoic solutio (i.e. the solutio has a higher salt cocetratio tha cells i the huma body), which relieves cogestio. It ca be used betwee two ad six times a day for a short period. Stérimar Baby has a specific ozzle with a Some topical decogestats ca be effective for up to 12 hours protective flage that prevets the spray beig iserted too far ito the ose. This helps to avoid the risk of ijury i childre from birth to three years of age. Tixylix Salie Nasal Drops ca be used to relieve a dry, irritated or blocked ose. Vicks First Defece Micro-Gel is a asal spray based o plat extracts that traps germs ad helps the body to remove them aturally. l Decogestats A blocked, stuffy ose ca be relieved with OTC decogestats: Oral decogestats These work by costrictig the blood vessels i the liig of the ose. This reduces swellig ad opes up the asal passages. As a result, the perso feels less cogested ad breathes more easily. Examples of oral decogestats iclude pheylephrie (e.g. No-Drowsy Sudafed Cogestio Relief Capsules, No-Drowsy Sudafed Decogestat Elixir) ad pseudoephedrie (e.g. Cotac No Drowsy 12 Hour Relief, No-Drowsy Sudafed 12 Hour Relief, No-Drowsy Sudafed Childre s Syrup). Both active igrediets are also available i combiatio cold remedies or formulated with a aalgesic to relieve pai. Decogestats are ot usually recommeded for childre uder 12, for wome who are breastfeedig or for people who have certai health coditios such as high blood pressure. They should also be avoided by ayoe takig atidepressats called mooamie oxidase ihibitors. Cocers have bee voiced over the potetial for misuse of products cotaiig ephedrie ad pseudoephedrie. The Royal Pharmaceutical Society advises that products TM JANUARY 2013 PULL OUT AND KEEP

4 the otc treatmet cliic cotaiig these active igrediets should oly be sold by pharmacists or by suitably traied pharmacy staff uder the supervisio of a pharmacist. There are also limits o the quatities that ca be sold ad it is illegal to sell ay pseudoephedrie product at the same time as a ephedrie product. Topical decogestats These are applied as sprays or asal drops ad have a local actio. Loger-actig topical decogestats such as xylometazolie (e.g. No-Drowsy Sudafed Decogestat Nasal Spray, Otrivie Nasal Spray rage) ad oxymetazolie (e.g. Vicks Siex Decogestat Nasal Spray, Vicks Siex Soother) are effective for eight to 12 hours. Also available are shorter-actig igrediets such as ephedrie ad pheylephrie (e.g. Feox Nasal Drops). Topical decogestats work quickly but may cause reboud cogestio if they are used for log periods of time. To prevet this, topical decogestats should ot be used for more tha five to seve days. Check idividual product labels for details. l Ihalats A wide rage of volatile substaces or oils are available i products that ca be ihaled, either directly or after beig dissolved i hot water, although with the latter method, care should be take to avoid scaldig with hot water. Breathig feels cooler, easier ad cogestio is relieved after use. Commo examples iclude methol, eucalyptus, peppermit, pie oil ad camphor. OTC brads iclude Care Methol & Eucalyptus Ihalatio, Covoia Vapor Drops, Happiose, Karvol, Metholatum Vapor Rub, Olbas, Sufflebabe ad Vicks. l Combiatio cold remedies These products combie differet active igrediets to target may cold ad flu symptoms. Products may iclude a aalgesic for aches, pais ad fever, a decogestat for a stuffy ose ad possibly a atihistamie to dry up asal secretios or somethig to tackle a tickly cough. OTC rages iclude Beechams, Beyli, Day Nurse, Lemsip ad Vicks. Combiatio products are certaily more coveiet tha takig several differet medicies ad those that come i hot drik formulatios may also add comfort value. However, whe recommedig combiatio products, be aware of the followig: Make sure that the perso ca safely take all of the igrediets i the product Avoid ay uecessary medicatio e.g. if the perso does t have a cough, do t opt for a product cotaiig a expectorat or a cough suppressat Avoid doublig up o igrediets e.g. if the combiatio product cotais paracetamol, customers should ot take additioal paracetamol tablets for a headache Night time products may cause drowsiess, so alert customers ot to drive or operate machiery while takig these products. l Hayfever remedies If the perso s asal symptoms appear to be allergy related, a atihistamie may be recommeded. We covered hayfever i detail i the April 2012 issue of TM. self-care tips l Keep asal passages moist by usig seawater or salie sprays, washes or drops l Drik plety of fluids (e.g. water, fruit juices, fruit or herb teas or clear soups) to help clear asal cogestio l Steam ihalatios, a hot steamy shower or a vaporiser may help a stuffy ose l Do ot smoke ad avoid smoky atmospheres l Be scrupulous about persoal hygiee. Cover the mouth whe seezig; wash hads regularly; discard used tissues immediately; do t share kitche utesils or cups, especially whe sufferig from a cold l For childre, raise the head of the bed a few iches or use extra pillows to ease ay breathig difficulties l Use a OTC cold remedy appropriate to the symptoms. assessmet questios: asal health ad hygiee For each questio, select oe correct aswer. Discuss your aswers with your pharmacist. 1. Which of the followig statemets is TRUE? a) The oly fuctio of the huma ose is the sese of smell b) The ose filters, humidifies ad warms the air we breathe c) The huma ose is totally made up of cartilage there is o boe d) The iside of the ose eeds to be kept dry i order to carry out all of its fuctios efficietly 2. Which of the followig statemets is FALSE? a) The siuses are four pairs of air-filled cavities foud i the boes of the face b) If aythig blocks the draiage of mucus from the siuses, pressure ca build up ad ifectio may result c) Rhiitis is the medical term for iflammatio of the sius cavities d) Acute rhiitis is most likely liked to a viral ifectio such as a cold, or to a allergy like hayfever 3. Which of the followig statemets does NOT apply to rhiitis? a) Vasomotor rhiitis ca be triggered i sesitive idividuals by thigs like bright lights, cold temperatures ad spicy foods b) Atrophic rhiitis occurs whe the membrae iside the ose this ad hardes. It is a commo cocer i youger childre c) Hormoal chages ca affect the ose, causig symptoms of rhiitis or asal cogestio d) The overuse of asal decogestats ca cause reboud symptoms of rhiitis ad asal cogestio 4. Which of the followig are possible symptoms of acute siusitis? a) Pai or tederess i the forehead, cheeks or aroud the eyes b) Fever c) A blocked or ruy ose d) All of the above 5. Which of the followig customers ca safely self-medicate with a appropriate OTC product? a) A ma i his early 40s reportig fever, sius pressure ad a asal discharge that is yellow/gree i colour b) A teeager whose symptoms started to improve but are ow gettig worse ad have lasted loger tha 10 days c) A youg mother i her early 30s whose mild seasoal allergies come with occasioal asal cogestio d) A child whose mother suspects may have poked a pea up his ose 6. Which of the followig statemets is TRUE? a) Nasal sprays based o atural seawater ca provide relief from cogestio, rhiitis, allergies ad siusitis b) There are o limitatios o the duratio of treatmet with OTC decogestats sprays c) There is o dager of doublig up o doses with combiatio cold remedies d) Allowig the asal mucosa to dry out is a recommeded step i maitaiig good asal hygiee Warig: The cotet cotaied i this module is the copyright of Traiig Matters ad caot be reproduced without permissio i the form of a valid writte licece grated after July 1, Ubraded pictures copyright Photodisc/Digital Stock/iStockphoto. Published uder licece by Commuicatios Iteratioal Group Ltd, Reget Street, Lodo W1B 5TB. Tel: [email protected]

5 OTC treatmet i practice Commo coditios ad their treatmet optios StérimarTM For a cleaer, healthier ose this witer... aturally Nasal cogestio ca really get a perso dow i fact, it is reported to be oe of the most bothersome symptoms of a commo cold. 1 But whatever the cause (a cold, siusitis, allergic rhiitis, etc), there is oe brad UK doctors recommed to clear ad clease the asal passages of excess mucus ad uwated cotamiats Stérimar. Objectives After readig this article, you should be able to: Uderstad the causes of asal cogestio Offer customers appropriate treatmet advice Uderstad the beefits of usig a atural seawater based asal spray Kow where to go to for free CPD o asal health. What causes asal cogestio? A blocked or stuffy ose ca be caused by excess mucus ad our atural immue respose to cold ad flu germs ad allerges. While ayoe ca suffer, childre ad babies ca be particularly susceptible sice their asal cavities are still developig ad there is less space for air flow i the first place. What is Stérimar ad how does it work? Stérimar is a 100 per cet atural solutio of seawater that comes i a easy to use microdiffusio spray. Packed with beeficial sea mierals, it has bee cliically prove to clease the asal passages as well as clearig them of excess mucus ad uwated cotamiats before they ca cause problems. Who ca use Stérimar? Stérimar is so getle it ca be used by ay member of the family eve ewbor babies ad pregat wome. 2 There are o kow iteractios with medicies, ad ca be used by those who caot take medicatio. Tailorig the treatmet There are three products i the Stérimar rage, which ca help to ease certai asal coditios ad allergies ad keep the ose clea ad healthy: Stérimar Nasal Hygiee a isotoic spray which ca be used by adults ad childre, from the age of three to provide relief from allergies, siusitis, rhiitis ad chroic coditios Stérimar Cogestio Relief a hypertoic spray which is also suitable for childre as youg as three ad has the added beefit of helpig to relieve cogestio, siusitis, rhiitis ad rhiopharygitis Stérimar Baby a getle, easy to use spray that ca be used from birth. Key product features Naturally washes away germs, allerges ad excess mucus Provides relief from asal coditios such as siusitis ad rhiitis Keeps the asal passages i optimum coditio to help reduce the risk of further ifectios or allergic reactios There is a product withi the rage for every member of the family, from pregat wome to small childre ad ewbor babies All products are 100 per cet atural, are getle o the asal mucosa, ad have o cotraidicatios with medicies All products i the rage are available o prescriptio ad are recommeded by doctors i the UK. 1. A blocked ad stuffy ose is oe of the most bothersome symptoms of commo cold says the Commo Cold Cetre i Cardiff Check product specificities ADAPTED FROM TRAINING MATTERS JANUARY 2013

6 promotio Actio poits Esure adequate stocks of each variety of Stérimar, particularly at this time of year whe colds ad flu are rife ad cogestio is ofte a troublesome symptom Esure ew parets are aware that Stérimar is oe of very few cliically prove medicatios that ca be give to childre ad babies right from birth, to ease cogestio. Sca the QR code to fid out how to use Stérimar. The Stérimar Academy The Stérimar Academy is a free educatioal resource for healthcare professioals. It offers a wide rage of busiess tools ad CPD cotet for the whole pharmacy team, icludig CPD o colds ad iflueza. To fid out more, visit: Claire Scott is a busy workig mum I practice... ad has three youg childre. She says they seem to catch oe cold after aother at this time of year ad that they particularly struggle with sleepig at ight. She asks if there is aythig you ca recommed, eve though her yougest has oly recetly tured oe. Firstly, you should reassure Claire that childre are more susceptible to colds as their immue resistace to the cold ad flu viruses is still at a early stage of developmet. They are also more likely to complai of cogestio because their asal cavities have yet to fully develop. Suggest that usig Stérimar two to six times a day, icludig before bedtime, could really help clear their asal passages easig cogestio so that they ca all get a better ight s sleep. Ad because it is 100 per cet atural ad based o seawater, there should be o problems with usig Stérimar alog with medicatio such as ifat pai relief suspesios if they have other cold-related symptoms that also eed addressig. What product should you recommed? Claire s eldest two, beig at school ad ursery, could beefit from usig Stérimar Cogestio Relief (hypertoic) as it washes away cold ad flu germs before they develop. If they are already complaiig of beig buged up, it will help relieve cogestio. Meawhile, Claire s baby could be give Stérimar Key poits Stérimar is the brad recommeded by UK doctors. Stérimar is available o prescriptio. Baby (isotoic) which comes i a easy to use spray ad is getle eough to be used from birth. Whichever product you recommed, emphasise that keepig oses clea ad clear with Stérimar should have the added beefit of helpig to reduce the risk of further ifectio. What other advice should you offer? To help promote restful sleepig whe the childre have colds, suggest they have a warm bath before bed ad are propped up slightly higher tha usual with a extra pillow. You should also let Claire kow that Stérimar is available o prescriptio, which could save her some moey especially as she has three childre. puttig the OTC treatmet cliic ito practice Warig: The cotet of this module is the copyright of Traiig Matters ad caot be reproduced without permissio i the form of a valid writte licece grated after July 1, Ubraded pictures copyright Photodisc/Digital Stock/iStockphoto. Published uder licece by Commuicatios Iteratioal Group Ltd, Reget Street, Lodo W1B 5TB. Tel: [email protected] THE MAGAZINE FOR PROFESSIONAL ASSISTANTS ADAPTED FROM TRAINING MATTERS JANUARY 2013