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Bhatt C, Lin E, Ferreira‐Legere LE, Jackevicius CA, Ko DT, Lee DS, Schade K, Johnston S, Anderson TJ, Udell JA. Evaluating Readability, Understandability, and Actionability of Online Printable Patient Education Materials for Cholesterol Management: A Systematic Review. J Am Heart Assoc 2024; 13:e030140. [PMID: 38567668 PMCID: PMC11262522 DOI: 10.1161/jaha.123.030140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/01/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Dyslipidemia management is a cornerstone in cardiovascular disease prevention and relies heavily on patient adherence to lifestyle modifications and medications. Numerous cholesterol patient education materials are available online, but it remains unclear whether these resources are suitable for the majority of North American adults given the prevalence of low health literacy. This review aimed to (1) identify printable cholesterol patient education materials through an online search, and (2) evaluate the readability, understandability, and actionability of each resource to determine its utility in practice. METHODS AND RESULTS We searched the MEDLINE database for peer-reviewed educational materials and the websites of Canadian and American national health organizations for gray literature. Readability was measured using the Flesch-Kincaid Grade Level, and scores between fifth- and sixth-grade reading levels were considered adequate. Understandability and actionability were scored using the Patient Education Materials Assessment Tool and categorized as superior (>80%), adequate (50%-70%), or inadequate (<50%). Our search yielded 91 results that were screened for eligibility. Among the 22 educational materials included in the study, 15 were identified through MEDLINE, and 7 were from websites. The readability across all materials averaged an 11th-grade reading level (Flesch-Kincaid Grade Level=11.9±2.59). The mean±SD understandability and actionability scores were 82.8±6.58% and 40.9±28.60%, respectively. CONCLUSIONS The readability of online cholesterol patient education materials consistently exceeds the health literacy level of the average North American adult. Many resources also inadequately describe action items for individuals to self-manage their cholesterol, representing an implementation gap in cardiovascular disease prevention.
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Affiliation(s)
- Chaitanya Bhatt
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- ICESTorontoOntarioCanada
| | - Ethan Lin
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- ICESTorontoOntarioCanada
| | | | - Cynthia A. Jackevicius
- ICESTorontoOntarioCanada
- Department of Pharmacy Practice and Administration, College of PharmacyWestern University of Health SciencesPomonaCAUSA
- Veterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of TorontoTorontoOntarioCanada
- University Health NetworkTorontoOntarioCanada
| | - Dennis T. Ko
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- ICESTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of TorontoTorontoOntarioCanada
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Douglas S. Lee
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- ICESTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of TorontoTorontoOntarioCanada
- Division of Cardiology, Peter Munk Cardiac CentreUniversity Health NetworkTorontoOntarioCanada
- Ted Rogers Centre for Heart ResearchTorontoOntarioCanada
| | - Kathryn Schade
- Faculty of Arts and Social ScienceHuron University CollegeLondonOntarioCanada
| | - Sharon Johnston
- Institut du Savoir Montfort, Department of Family MedicineUniversity of OttawaOttawaOntarioCanada
| | - Todd J. Anderson
- Libin Cardiovascular Institute, Cumming School of Medicine, University of CalgaryAlbertaCanada
| | - Jacob A. Udell
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- ICESTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of TorontoTorontoOntarioCanada
- Division of Cardiology, Peter Munk Cardiac CentreUniversity Health NetworkTorontoOntarioCanada
- Women’s College HospitalTorontoOntarioCanada
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Nickel B, Ormiston‐Smith N, Hammerton L, Cvejic E, Vardon P, Mcinally Z, Legerton P, Baker K, Isautier J, Larsen E, Giles M, Brennan ME, McCaffery KJ, Houssami N. Psychosocial outcomes and health service use after notifying women participating in population breast screening when they have dense breasts: a BreastScreen Queensland randomised controlled trial. Med J Aust 2023; 219:423-428. [PMID: 37751916 PMCID: PMC10952548 DOI: 10.5694/mja2.52117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/23/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Robust evidence regarding the benefits and harms of notifying Australian women when routine breast screening identifies that they have dense breasts is needed for informing future mammography population screening practice and policy. OBJECTIVES To assess the psychosocial and health services use effects of notifying women participating in population-based breast cancer screening that they have dense breasts; to examine whether the mode of communicating this information about its implications (print, online formats) influences these effects. METHODS AND ANALYSIS The study population comprises women aged 40 years or older who attend BreastScreen Queensland Sunshine Coast services for mammographic screening and are found to have dense breasts (BI-RADS density C or D). The randomised controlled trial includes three arms (952 women each): standard BreastScreen care (no notification of breast density; control arm); notification of dense breasts in screening results letter and print health literacy-sensitive information (intervention arm 1) or a link or QR code to online video-based health literacy-sensitive information (intervention arm 2). Baseline demographic data will be obtained from BreastScreen Queensland. Outcomes data will be collected in questionnaires at baseline and eight weeks, twelve months, and 27 months after breast screening. Primary outcomes will be psychological outcomes and health service use; secondary outcomes will be supplemental screening outcomes, cancer worry, perceived breast cancer risk, knowledge about breast density, future mammographic screening intentions, and acceptability of notification about dense breasts. ETHICS APPROVAL Gold Coast Hospital and Health Service Ethics Committee (HREC/2023/QGC/89770); Sunshine Coast Hospital and Health Service Research Governance and Development (SSA/2023/QSC/89770). DISSEMINATION OF FINDINGS Findings will be reported in peer-reviewed journals and at national and international conferences. They will also be reported to BreastScreen Queensland, BreastScreen Australia, Cancer Australia, and other bodies involved in cancer care and screening, including patient and support organisations. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12623000001695p (prospective: 9 January 2023).
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Affiliation(s)
- Brooke Nickel
- School of Public Healththe University of SydneySydneyNSW
| | | | - Lisa Hammerton
- Sunshine Coast Service, BreastScreen QueenslandNambourQLD
| | - Erin Cvejic
- School of Public Healththe University of SydneySydneyNSW
| | - Paul Vardon
- Cancer Screening Unit, Queensland Department of HealthBrisbaneQLD
| | - Zoe Mcinally
- Cancer Screening Unit, Queensland Department of HealthBrisbaneQLD
| | - Paula Legerton
- Cancer Screening Unit, Queensland Department of HealthBrisbaneQLD
| | - Karen Baker
- Cancer Screening Unit, Queensland Department of HealthBrisbaneQLD
| | | | - Emma Larsen
- Sunshine Coast Service, BreastScreen QueenslandNambourQLD
| | | | - Meagan E Brennan
- School of Public Healththe University of SydneySydneyNSW
- The University of Notre Dame AustraliaSydneyNSW
| | | | - Nehmat Houssami
- School of Public Healththe University of SydneySydneyNSW
- The Daffodil Centre, the University of Sydney and Cancer Council NSWSydneyNSW
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Dolan H, McCaffery K, Houssami N, Cvejic E, Brennan M, Hersch J, Dorrington M, Verde A, Vaccaro L, Nickel B. Australian Women's Intentions and Psychological Outcomes Related to Breast Density Notification and Information: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2216784. [PMID: 35708691 PMCID: PMC9204548 DOI: 10.1001/jamanetworkopen.2022.16784] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Whether the benefits of notifying women about breast density outweigh the potential harms to inform current and future mammogram screening practice remains unknown. OBJECTIVE To assess the effect of mammographic breast density notification and information provision on women's intention to seek supplemental screening and psychological outcomes. DESIGN, SETTING, AND PARTICIPANTS A 3-arm online randomized clinical trial was conducted from August 10 to 31, 2021. Data analysis was conducted from September 1 to October 20, 2021. Participants included Australian residents identifying as female, aged between 40 and 74 years, with no history of breast cancer who were residing in jurisdictions without existing breast density notification with screening mammograms. INTERVENTIONS Women were randomized to receive 1 of the following hypothetical breast screening test result letters: screening mammogram result letter without breast density messaging (control), screening mammogram result letter with breast density messaging and an existing density information letter taken from a screening service in Australia (intervention 1), and screening mammogram result letter with breast density messaging and a health literacy-sensitive version of the letter adapted for people with lower health literacy (intervention 2). MAIN OUTCOMES AND MEASURES Primary outcomes were intention to seek supplemental screening; feeling anxious (uneasy, worried, or nervous), informed, or confused; and having breast cancer worry. RESULTS A total of 1420 Australian women were randomized and included in the final analysis. The largest group consisted of 603 women aged 60 to 74 years (42.5%). Compared with the control cohort (n = 480), women who received density notification via intervention 1 (n = 470) and intervention 2 (n = 470) reported a significantly higher intention to seek supplemental screening (0.8% vs 15.6% and 14.2%; P < .001) and feeling anxious (14.2% vs 49.4% and 48.5%; P < .001), confusion (7.8% vs 24.0% and 23.6%; P < .001), and worry about breast cancer (quite/very worried: 6.9% vs 17.2% and 15.5%; P < .001). There were no statistically significant differences in these outcomes between the 2 intervention groups. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, breast density notification and information integrated with screening mammogram results increased women's intention to seek supplemental screening and made women feel anxious, confused, or worried about breast cancer. These findings have relevance and implications for mammogram screening services and policy makers considering whether and, if so, how best to implement widespread notification of breast density as part of mammography screening. TRIAL REGISTRATION ACTRN12621000253808.
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Affiliation(s)
- Hankiz Dolan
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Erin Cvejic
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Meagan Brennan
- University of Notre Dame Australia, School of Medicine Sydney, Sydney, Australia
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Sydney, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Angela Verde
- Breast Cancer Network Australia, Melbourne, Australia
| | - Lisa Vaccaro
- Health Consumers New South Wales, Sydney, Australia
- Discipline of Behavioural and Social Sciences in Health, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Smith RE, Sprague B, Henderson LM, Kerlikowske K, Miglioretti DL, Buist DSM, Wernli KJ, Onega T, Schifferdecker K, Jackson-Nefertiti G, Johnson D, Budesky J, Tosteson ANA. Breast Density Knowledge in a Screening Mammography Population Exposed to Density Notification. J Am Coll Radiol 2022; 19:615-624. [PMID: 35341697 PMCID: PMC9119699 DOI: 10.1016/j.jacr.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Women are increasingly informed about their breast density due to state density reporting laws. However, accuracy of personal breast density knowledge remains unclear. We compared self-reported with clinically assessed breast density and assessed knowledge of density implications and feelings about future screening. METHODS From December 2017 to January 2020, we surveyed women aged 40 to 74 years without prior breast cancer, with a normal screening mammogram in the prior year, and ≥1 recorded breast density measures in four Breast Cancer Surveillance Consortium registries with density reporting laws. We measured agreement between self-reported and BI-RADS breast density categorized as "ever-dense" if heterogeneously or extremely dense within the past 5 years or "never-dense" otherwise, knowledge of dense breast implications, and feelings about future screening. RESULTS Survey participation was 28% (1,528 of 5,408), and 59% (896 of 1,528) of participants had ever-dense breasts. Concordance between self-report versus clinical density was 76% (677 of 896) among women with ever-dense breasts and 14% (89 of 632) among women with never-dense breasts, and 34% (217 of 632) with never-dense breasts reported being told they had dense breasts. Desire for supplemental screening was more frequent among those who reported having dense breasts 29% (256 of 893) or asked to imagine having dense breasts 30% (152 of 513) versus those reporting nondense breasts 15% (15 of 102) (P = .003, P = .002, respectively). Women with never-dense breasts had 6.3-fold higher odds (95% confidence interval:3.39-11.80) of accurate knowledge in states reporting density to all compared to states reporting only to women with dense breasts. DISCUSSION Standardized communications of breast density results to all women may increase density knowledge and are needed to support informed screening decisions.
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Affiliation(s)
- Rebecca E Smith
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire.
| | - Brian Sprague
- Associate Professor of Surgery, Director of the Vermont Breast Cancer Surveillance System, and Senior Epidemiologist at the Vermont Center on Behavior and Health, Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Louise M Henderson
- Professor of Radiology, Director of the Carolina Mammography Registry, and Director of the North Carolina Lung Screening Registry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karla Kerlikowske
- Professor of Medicine and Epidemiology and Biostatistics, Co-Director of the Women's Clinic, and Director of the Women's Health Fellowship at the San Francisco Veterans Affairs Medical Center, Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Diana L Miglioretti
- Dean's Professor and Division Chief of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA; Principal Investigator of the Breast Cancer Surveillance Consortium (BCSC) Administrative Core, and Affiliate Scientific Investigator, Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Diana S M Buist
- Affiliate Professor of Epidemiology, Affiliate Professor of Health Systems and Population Health, and Director of Research and Strategic Partnerships, Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Karen J Wernli
- Affiliate Associate Professor of Epidemiology and Affiliate Associate Professor of Health Systems and Population Health, Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Tracy Onega
- Jon M. and Karen Huntsman Presidential Professor in Cancer Research, Senior Director of Population Sciences, and Professor of Population Health Sciences, Department of Population Health Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Karen Schifferdecker
- Associate Professor, and Director of the Center for Program Design and Evaluation, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | | | - Dianne Johnson
- Department of Public Health Sciences, University of California, Davis, California
| | - Jill Budesky
- Department of Public Health Sciences, University of California, Davis, California
| | - Anna N A Tosteson
- James J Carroll Professor, The Dartmouth Institute for Health Policy and Clinical Practice, and Departments of Medicine and of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; and Associate Director for Population Sciences, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH USA
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5
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Gunn CM, Maschke A, Paasche-Orlow MK, Housten AJ, Kressin NR, Schonberg MA, Battaglia TA. Using Mixed Methods With Multiple Stakeholders to Inform Development of a Breast Cancer Screening Decision Aid for Women With Limited Health Literacy. MDM Policy Pract 2021; 6:23814683211033249. [PMID: 34350361 PMCID: PMC8295953 DOI: 10.1177/23814683211033249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background. When stakeholders offer divergent input, it can be unclear how to prioritize information for decision aids (DAs) on mammography screening. Objectives. This analysis triangulates perspectives (breast cancer screening experts, primary care providers [PCPs], and patients with limited health literacy [LHL]) to understand areas of divergent and convergent input across stakeholder groups in developing a breast cancer screening DA for younger women with LHL. Design. A modified online Delphi panel of 8 experts rated 57 statements for inclusion in a breast cancer screening DA over three rounds. Individual interviews with 25 patients with LHL and 20 PCPs from a large safety net hospital explored informational needs about mammography decision making. Codes from the qualitative interviews and open-ended responses from the Delphi process were mapped across stakeholders to ascertain areas where stakeholder preferences converged or diverged. Results. Four themes regarding informational needs were identified regarding 1) the benefits and harms of screening, 2) different screening modalities, 3) the experience of mammography, and 4) communication about breast cancer risk. Patients viewed pain as the primary harm, while PCPs and experts emphasized the harm of false positives. Patients, but not PCPs or experts, felt that information about the process of getting a mammogram was important. PCPs believed that mammography was the only evidence-based screening modality, while patients believed breast self-exam was also important for screening. All stakeholders described incorporating personal risk information as important. Limitations. As participants came from one hospital, perceptions may reflect local practices. The Delphi sample size was small. Conclusions. Patients, experts, and PCPs had divergent views on the most important information needed for screening decisions. More evidence is needed to guide integration of multiple stakeholder perspectives into the content of DAs.
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Affiliation(s)
- Christine M Gunn
- Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts
| | - Ariel Maschke
- Department of Medicine, Section of General Internal Medicine, Women's Health Unit, School of Medicine, Boston University, Boston, Massachusetts
| | - Michael K Paasche-Orlow
- Department of Medicine, Section of General Internal Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - Ashley J Housten
- Department of Surgery, Division of Public Health Sciences, School of Medicine, Washington University, St. Louis, Missouri
| | - Nancy R Kressin
- Department of Medicine, Section of General Internal Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - Mara A Schonberg
- Harvard Medical School, Beth Israel Deaconess Medical Center, Brookline, Massachusetts
| | - Tracy A Battaglia
- Department of Medicine, Section of General Internal Medicine, Women's Health Unit, School of Medicine, Boston University, Boston, Massachusetts
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Said A, Freudewald L, Parrau N, Ganso M, Schulz M. Pharmacists' perception of educational material to improve patient safety: A cross-sectional study on practices and awareness in Germany. Medicine (Baltimore) 2021; 100:e25144. [PMID: 33725997 PMCID: PMC7982216 DOI: 10.1097/md.0000000000025144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Educational material (EM) addresses particular safety information of medicinal products to healthcare professionals and patients. Since 2016, German national competent authorities label approved EM with a Blue Hand symbol. However, data is scarce regarding its usability as a safety communication tool in pharmacies to improve patient safety. The purpose of this study is to investigate for the first time pharmacists' awareness and perception of EM in the setting of community and hospital pharmacies in Germany.The Drug Commission of German Pharmacists surveyed its nationwide network of 677 community and 51 hospital reference pharmacies, to investigate their awareness and perception of EM. The survey was conducted between January 16 and February 10, 2020 using SurveyMonkey. Data were analyzed using Microsoft Excel.A total of 373 community and 32 hospital pharmacists participated; response rates were 55.1% and 62.8%, respectively. Overall, 320 (85.8%) community and all hospital pharmacists confirmed awareness of EM. Community and hospital pharmacists fully (n = 172, 46.9% and n = 9, 28.1%) or rather (n = 109, 29.7% and n = 10, 31.3%) agreed that EM for healthcare professionals is suitable to reduce risks of medicinal products. Moreover, 237 (64.7%) community and 17 (53.1%) hospital pharmacists confirmed to inform patients or care facilities about EM. Asking pharmacists on their personal perception of EM, the refinement of readability and accessibility was indicated.Pharmacists confirm awareness of EM and its suitability as a safety communication tool. However, from a pharmacists' perspective, the applicability and readability of EM still needs further adjustment to improve patient safety.
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Affiliation(s)
- André Said
- Drug Commission of German Pharmacists (AMK), Heidestraße 7
| | | | - Natalie Parrau
- Drug Commission of German Pharmacists (AMK), Heidestraße 7
| | - Matthias Ganso
- Drug Commission of German Pharmacists (AMK), Heidestraße 7
| | - Martin Schulz
- Drug Commission of German Pharmacists (AMK), Heidestraße 7
- Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
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