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Brookfield S, Steadman KJ, Nissen L, Gartner CE. Pharmacist-only supply of nicotine vaping products: proposing an alternative regulatory model for Australia. Tob Control 2024:tc-2023-058414. [PMID: 38599788 DOI: 10.1136/tc-2023-058414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
Regulation of nicotine vaping products (NVPs) is an ongoing challenge across the world. Australia currently has a globally unique NVP regulatory model that requires a medical prescription to purchase and use NVPs, with further restrictions in progress in response to evidence of widespread illicit NVP sales. Against this background, we examine the new measures and consider a modification of the model to pharmacist-only supply as an option for increasing access to NVPs for smoking cessation, while retaining health practitioner oversight of supply. We describe the strengths and challenges of implementing a pharmacist-only NVP supply option in Australia. Compared with the current prescription-only model, pharmacist-only supply could increase access to a lower exposure nicotine product in a highly regulated therapeutic context while addressing youth access and purchasing for non-therapeutic use, reduce demand for illicit products for smoking cessation purposes and avoid overburdening medical services with consultations to obtain NVP prescriptions. This approach can also accommodate current government goals such as eliminating NVP advertising, youth-focused branding and supply from grocery and convenience stores.
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Affiliation(s)
- Samuel Brookfield
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, The University of Queensland, Herston, Queensland, Australia
| | - Kathryn J Steadman
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, The University of Queensland, Herston, Queensland, Australia
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Lisa Nissen
- Centre for the Business and Economics of Health, Faculty of Business Economics and Law, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Coral E Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, The University of Queensland, Herston, Queensland, Australia
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Therkildsen J, Rohde PD, Nissen L, Thygesen J, Hauge EM, Langdahl BL, Boettcher M, Nyegaard M, Winther S. A genome-wide genomic score added to standard recommended stratification tools does not improve the identification of patients with very low bone mineral density. Osteoporos Int 2023; 34:1893-1906. [PMID: 37495683 PMCID: PMC10579117 DOI: 10.1007/s00198-023-06857-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/10/2023] [Indexed: 07/28/2023]
Abstract
The role of integrating genomic scores (GSs) needs to be assessed. Adding a GS to recommended stratification tools does not improve the prediction of very low bone mineral density. However, we noticed that the GS performed equally or above individual risk factors in discrimination. PURPOSE We aimed to investigate whether adding a genomic score (GS) to recommended stratification tools improves the discrimination of participants with very low bone mineral density (BMD). METHODS BMD was measured in three thoracic vertebrae using CT. All participants provided information on standard osteoporosis risk factors. GSs and FRAX scores were calculated. Participants were grouped according to mean BMD into very low (<80 mg/cm3), low (80-120 mg/cm3), and normal (>120 mg/cm3) and according to the Bone Health and Osteoporosis Foundation recommendations for BMD testing into an "indication for BMD testing" and "no indication for BMD testing" group. Different models were assessed using the area under the receiver operating characteristics curves (AUC) and reclassification analyses. RESULTS In the total cohort (n=1421), the AUC for the GS was 0.57 (95% CI 0.52-0.61) corresponding to AUCs for osteoporosis risk factors. In participants without indication for BMD testing, the AUC was 0.60 (95% CI 0.52-0.69) above or equal to AUCs for osteoporosis risk factors. Adding the GS to a clinical risk factor (CRF) model resulted in AUCs not statistically significant from the CRF model. Using probability cutoff values of 6, 12, and 24%, we found no improved reclassification or risk discrimination using the CRF-GS model compared to the CRF model. CONCLUSION Our results suggest adding a GS to a CRF model does not improve prediction. However, we noticed that the GS performed equally or above individual risk factors in discrimination. Clinical risk factors combined showed superior discrimination to individual risk factors and the GS, underlining the value of combined CRFs in routine clinics as a stratification tool.
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Affiliation(s)
- J Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark.
| | - P D Rohde
- Department of Health Science & Technology, Aalborg University, Selma Lagerløfs Vej 24, 9269, Gistrup, Denmark
| | - L Nissen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - J Thygesen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
- Department of Clinical Engineering, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - E-M Hauge
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
| | - B L Langdahl
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - M Boettcher
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
| | - M Nyegaard
- Department of Health Science & Technology, Aalborg University, Selma Lagerløfs Vej 24, 9269, Gistrup, Denmark
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark
| | - S Winther
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark
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Spinks J, Violette R, Boyle DI, Petrie D, Fanning L, Hall KK, Kelly F, Wheeler AJ, Ware RS, Byrnes J, Chen E, Donald A, Ellis N, DelDot M, Nissen L. Activating pharmacists to reduce the frequency of medication-related problems (ACTMed): a stepped wedge cluster randomised trial. Med J Aust 2023; 219:325-331. [PMID: 37586750 DOI: 10.5694/mja2.52073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Medicines are the most frequent health care intervention type; their safe use provides significant benefits, but inappropriate use can cause harm. Systemic primary care approaches can manage serious medication-related problems in a timely manner. OBJECTIVES ACTMed (ACTivating primary care for MEDicine safety) uses information technology and financial incentives to encourage pharmacists to work more closely with general practitioners to reduce the risk of harm, improve patients' experience of care, streamline workflows, and increase the efficiency of medical care. METHODS AND ANALYSIS The stepped wedge cluster randomised trial in 42 Queensland primary care practices will assess the effectiveness of the ACTMed intervention. The primary outcome will be the proportion of people at risk of serious medication-related problems - patients with atrial fibrillation, heart failure, cardiovascular disease, type 2 diabetes, or asthma or chronic obstructive pulmonary disease - who experience such problems. We will also estimate the cost per averted serious medication-related problem and the cost per averted potentially preventable medication-related hospitalisation. ETHICS APPROVAL The University of Queensland Human Research Ethics Committee approved the pilot (2021/HE002189) and trial phases of the ACTMed study (2022/HE002136). Access to Patron data was granted by the Patron Data Governance Committee (PAT052ACTMed). Access to linked hospitalisations and deaths data are subject to Public Health Act approval (pending). DISSEMINATION OF FINDINGS A comprehensive dissemination plan will be co-developed by the researchers, the ACTMed steering committee and consumer advisory group, project partners, and trial site representatives. Aboriginal and Torres Strait Islander communities will be supported in leading community-level dissemination. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (pilot: ACTRN12622000595718; 21 April 2022; full trial: ACTRN12622000574741; 14 April 2022).
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Affiliation(s)
- Jean Spinks
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
| | - Richard Violette
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
- Griffith University, Gold Coast, QLD
| | - Douglas Ir Boyle
- HaBIC Research Information Technology Unit, the University of Melbourne, Melbourne, VIC
| | - Dennis Petrie
- Centre for Health Economics, Monash University, Melbourne, VIC
| | - Laura Fanning
- Centre for Health Economics, Monash University, Melbourne, VIC
- Box Hill Hospital, Melbourne, VIC
| | | | | | - Amanda J Wheeler
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD
- The University of Auckland, Auckland, New Zealand
| | - Robert S Ware
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD
| | - Esa Chen
- Centre for Health Economics, Monash University, Melbourne, VIC
| | | | | | - Megan DelDot
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
| | - Lisa Nissen
- Centre for the Business and Economics of Health, the University of Queensland, Brisbane, QLD
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Mazza D, Assifi AR, Hussainy SY, Bateson D, Johnston S, Tomnay J, Kasza J, Church J, Grzeskowiak LE, Nissen L, Cameron ST. Expanding community pharmacists' scope of practice in relation to contraceptive counselling and referral: a protocol for a pragmatic, stepped-wedge, cluster randomised trial (ALLIANCE). BMJ Open 2023; 13:e073154. [PMID: 37652588 PMCID: PMC10476139 DOI: 10.1136/bmjopen-2023-073154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Improving access to effective contraception has the potential to reduce unintended pregnancy and abortion rates. Community pharmacists could play an expanded role in contraceptive counselling and referral to contraceptive prescribers particularly when women are already attending community pharmacy to obtain emergency contraceptive pills (ECPs) or to have medical abortion (MA) medicines dispensed. The ALLIANCE trial aims to compare the subsequent uptake of effective contraception (hormonal or intrauterine) in women seeking ECP or MA medicines, who receive the ALLIANCE community pharmacy-based intervention with those who do not receive the intervention. METHODS AND ANALYSIS ALLIANCE is a stepped-wedge pragmatic cluster randomised trial in Australian community pharmacies. The ALLIANCE intervention involves community pharmacists delivering structured, patient-centred, effectiveness-based contraceptive counselling (and a referral to a contraceptive prescriber where appropriate) to women seeking either ECPs or to have MA medicines dispensed. Women participants will be recruited by participating pharmacists. A total of 37 pharmacies and 1554 participants will be recruited. Pharmacies commence in the control phase and are randomised to transition to the intervention phase at different time points (steps). The primary outcome is the self-reported use of effective contraception at 4 months; secondary outcomes include use of effective contraception and the rate of pregnancies or induced abortions at 12 months. A process and economic evaluation of the trial will also be undertaken. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Monash University Human Research Ethics Committee (#34563). An explanatory statement will be provided and written consent will be obtained from all participants (pharmacy owner, pharmacist and women) before their commencement in the trial. Dissemination will occur through a knowledge exchange workshop, peer-reviewed journal publications, presentations, social media and conferences. TRIAL REGISTRATION NUMBER ACTRN12622001024730.
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Affiliation(s)
- Danielle Mazza
- SPHERE NHMRC Centre of Research Excellence, Department General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anisa Rojanapenkul Assifi
- SPHERE NHMRC Centre of Research Excellence, Department General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Safeera Yasmeen Hussainy
- SPHERE NHMRC Centre of Research Excellence, Department General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Deborah Bateson
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, University of Melbourne, Shepparton, Victoria, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jody Church
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Luke E Grzeskowiak
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Lisa Nissen
- Centre for the Business & Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Sharon Tracey Cameron
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
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Lim K, Lum E, Nissen L, Broom A, Seale H. Consumer perceptions of community pharmacists' involvement in antimicrobial stewardship: A quantitative study. Explor Res Clin Soc Pharm 2023; 10:100281. [PMID: 37274416 PMCID: PMC10236209 DOI: 10.1016/j.rcsop.2023.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023] Open
Abstract
Background Community pharmacist involvement in antimicrobial stewardship (AMS) within primary care is underutilised. Despite this view being consistently held across the pharmacy sector's policy, academic and professional spheres, there is limited understanding of how this positioning aligns with consumers' perceptions and expectations. Objective To explore participants' experience using antibiotics and their engagement with pharmacists to support their use. Methods Online survey of Australian adults recruited via Dynata's research panel in November 2022. Questions were organised into three sections: 1) understanding the participant's use of antibiotics, including their information needs; 2) exploring engagement with pharmacists on a cold and flu enquiry using a vignette question; and 3) demographic information. Results Doctors (42.0%), pharmacists (29.8%) and the internet including general searches (14.3%) were the top three sources for antibiotic information. Information about side effects and anticipated time to effect were more broadly sought from pharmacists than what was provided. Over 50% of respondents indicated alignment between the best practice example of a pharmacist providing cold and flu management advice with their own experience. 17% of respondents indicated that they would seek doctor's advice when considering cold and flu management options compared to 10% seeking pharmacist's advice. No statistically significant results between age groups or gender were observed. Conclusion Better visibility of community pharmacists' involvement in managing minor ailments in primary care, including more explicit linkage of pharmacist-administered vaccination services as an AMS strategy can support optimal antimicrobial use.
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Affiliation(s)
- Kathryn Lim
- School of Population Health, University of New South Wales, Australia
| | - Elaine Lum
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Lisa Nissen
- Centre for the Business and Economics of Health, The University of Queensland, Australia
| | - Alex Broom
- School of Social and Political Sciences, The University of Sydney, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Australia
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Salter SM, Li D, Trentino K, Nissen L, Lee K, Orlemann K, Peters I, Murray K, Leeb A, Deng L. Safety of Four COVID-19 Vaccines across Primary Doses 1, 2, 3 and Booster: A Prospective Cohort Study of Australian Community Pharmacy Vaccinations. Vaccines (Basel) 2022; 10:vaccines10122017. [PMID: 36560426 PMCID: PMC9786585 DOI: 10.3390/vaccines10122017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Four COVID-19 vaccines are approved for use in Australia: Pfizer-BioNTech BNT162b2 (Comirnaty), AstraZeneca ChAdOx1 (Vaxzevria), Moderna mRNA-1273 (Spikevax) and Novavax NVX-CoV2373 (Nuvaxovid). We sought to examine adverse events following immunisation (AEFI) at days 3 and 42 after primary doses 1, 2, 3 and booster. We conducted active vaccine safety surveillance from 130 community pharmacies in Australia integrated with AusVaxSafety, between August 2021-April 2022. Main outcomes: AEFI at 0-3 days post-vaccination; medical review/advice at 3 days and 42 days post-vaccination; SARS-CoV-2 breakthrough infection by day 42. Of 110,024 completed day 3 surveys (43.6% response rate), 50,367 (45.8%) reported any AEFI (highest proportions: Pfizer 42%, primary dose 3; AstraZeneca 58.3%, primary dose 1; Moderna 65.4% and Novavax 58.8%, both primary dose 2). The most common AEFI reported across all doses/vaccines were local reactions, systemic aches and fatigue/tiredness. Overall, 2172/110,024 (2.0%) and 1182/55,329 (2.1%) respondents sought medical review at days 3 and 42, respectively, and 931/42,318 (2.2%) reported breakthrough SARS-CoV-2 infection at day 42. We identified similar AEFI profiles but at lower proportions than previously reported for Pfizer, AstraZeneca, Moderna and Novavax COVID-19 vaccines. Moderna vaccine was the most reactogenic and associated with higher AEFI proportions across primary doses 2, 3, and booster.
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Affiliation(s)
- Sandra M. Salter
- School of Allied Health, The University of Western Australia, Perth, WA 6000, Australia
| | - Dani Li
- MedAdvisor International Pty Ltd., Melbourne, VIC 3000, Australia
| | - Kevin Trentino
- Medical School, The University of Western Australia, Perth, WA 6000, Australia
| | - Lisa Nissen
- Centre for Business and Economics of Health, Faculty of Business, The University of Queensland, Brisbane, QLD 4000, Australia
| | - Kenneth Lee
- School of Allied Health, The University of Western Australia, Perth, WA 6000, Australia
| | | | | | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, WA 6000, Australia
- Correspondence:
| | - Alan Leeb
- SmartVax, Perth, WA 6000, Australia
- Illawarra Medical Centre, Perth, WA 6000, Australia
| | - Lucy Deng
- National Centre for Immunisation Research and Surveillance, Westmead, NSW 2145, Australia
- The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia
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Cheneymann A, Therkildsen J, Winther S, Nissen L, Thygesen J, Langdahl B, Hauge EM, Böttcher M. POS1151 OPPORTUNISTIC BONE MINERAL DENSITY SCREENING IN PATIENTS UNDERGOING CARDIAC CT SCANS: EFFECT OF USING IMAGES CONTAINING INTRAVENOUS CONTRAST. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundOsteoporosis is under-diagnosed worldwide causing increased risk of fractures and death (1). Computed tomography (CT) scans performed on other indications such as coronary artery disease harbor the potential for automatic detection of low volumetric bone mineral density (vBMD) of the vertebrae using quantitative CT (QCT); hence allowing estimation of future fracture risk (2). CT is often performed with intravenous (iv) contrast administration. In 2015, the International Society of Clinical Densitometry stated: “There is insufficient evidence to judge the effect of contrast agents on a classification of low BMD” (3); this position remains. Thus, it is important to assess the effect of contrast enhancement in order to broaden the potential of vBMD screening using routine CT scans.ObjectivesWe aimed to compare thoracic vBMD measurements from CT scans with and without iv contrast enhancement.MethodsThis cross-sectional multicenter sub-study is based on a larger clinical trial, Dan-NICAD-1, from which we randomly selected a cohort of 136 participants. First, a non-contrast scan was performed followed by a contrast-enhanced scan during which 60-90mL of iv contrast was administered (Iomeron, 350 mgI/mL). Mindways QCT Pro software was used to measure BMD values (mg/cm3) and the mean estimate was calculated for each participant (4). American College of Radiology quantitative CT cut-off values for lumbar spine were used to categorize patients into very low (<80mg/cm3), low (80-120mg/cm3), or normal BMD (>120mg/cm3).ResultsIn 136 participants undergoing cardiac CT (Table 1), we found a different mean vBMD before vs. after contrast; 117.5 mg/cm3 [95%CI: 111.6–123.4] vs. 132.1 mg/cm3 [95%CI: 125.1–139.1], p<.0001. The absolute difference was 14.7mg/cm3 [95%CI: 12.3–17.0]; the relative difference, was 12.5% [95% CI: 10.5–14.5]. In total, 8/15 (53%) participants changed from very low BMD to low BMD after contrast administration, and 21 participants (21/63, 33%) changed from low to normal BMD (Figure 1). No participants changed from very low BMD to normal BMD.Table 1.Demographics by vBMD*CharacteristicsAll (n=136)Very low BMD (n=15)Low BMD (n=63)Normal BMD (n=58)Gender M:F89:478:749:1432:26Age, yrs (range)57±9 (40-73)64±6 (48-72)59±8 (44-73)54±8 (40-72)Mean vBMD before contrast, mg/cm92.2±16.168.0±10.598.0±10.1151.5±21.9Mean vBMD after contrast, mg/cm95.2±16.068.6±10.5100.8±10.3159.6±31.6Risk factorsDiabetes mellitus**16079Smoking status**Never6541744Former181710Active5252423Bone dataDXA performed previously**7232Osteoporosis diagnosed previously**1010Family history of osteoporosis**22589Anti-osteoporotic medication**152310* Classifications defined by American College of Radiology and grouped using the non-enhanced CT. Data: number of participants, (range) and mean with standard deviations.** Self-reportedFigure 1.Participants with change in BMD category after contrast administration Figure 1. vBMD measurements before and after contrast administration. 33/136 participants changed BMD category illustrated by the dotted lines (80 mg/cm3; 120 mg/cm3). Black lines: increase in vBMD after contrast (n=29); blue lines: decrease in vBMD after contrast (n=4).ConclusionOur data suggest a significant effect of contrast on clinical vBMD measurements; thus, this should be adjusted for before using contrast-enhanced cardiac CT for opportunistic vBMD screening. This urges further studies on the effect of scan protocols on the contrast-enhanced increase in BMD.References[1]M. S. Nanes et al., Seminars in nuclear medicine44, 439-450 (2014).[2]J. Therkildsen et al., Radiology296, 499-508 (2020).[3]K. Engelke et al., Journal of clinical densitometry18, 393-407 (2015).[4]J. Therkildsen et al., Journal of Clinical Densitometry23, (2018).AcknowledgementsThe Danish Osteoporosis Foundation, The Danish Council for Independent Research (DFF–7025–00103), the Danish Heart foundation (15-R99-A5837–22920), the Hede Nielsen Foundation, Acarix A/S (unrestricted grant) and Mrs. Lily Benthine Lunds Foundation of 1.6. 1978 supported this project. The authors would like to thank all study participants and the clinical staff involved in this project.Disclosure of InterestsAndia Cheneymann: None declared, Josephine Therkildsen: None declared, Simon Winther Grant/research support from: Disclosed an unrestricted grant from Acarix A/S., Louise Nissen: None declared, Jesper Thygesen: None declared, Bente Langdahl Consultant of: Worked as a consultant for Amgen, UCB, Gedeon-Richter, Eli Lilly and Gedeon., Grant/research support from: Received honorariums from Amgen, UCB, Eli Lilly, Gedeon-Richter and Astellas. Received financial grants from Amgen and the Novo Nordic Foundation., Ellen-Margrethe Hauge Consultant of: Received honorariums and/or consulting fees from AbbVie, Sanofi, Sobi, and SynACT Pharma., Grant/research support from: Research grants to Aarhus University Hospital from Danish Regions Medicine Grants, Danish Rheumatism Association, Roche, Novartis, and Novo Nordic Foundation., Morten Böttcher Consultant of: Advisory board participation for NOVO Nordisk, Astra-Zeneca, Pfizer, Boeringer Ingelheim, Bayer, Sanofi, Novartis and Acarix.
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Ogilvie M, Nissen L, Kyle G, Hale A. An evaluation of a collaborative pharmacist prescribing model compared to the usual medical prescribing model in the emergency department. Res Social Adm Pharm 2022; 18:3744-3750. [DOI: 10.1016/j.sapharm.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/26/2022] [Accepted: 05/07/2022] [Indexed: 11/28/2022]
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Graham K, Matricciani L, Banwell H, Kumar S, Causby R, Martin S, Nissen L. Australian podiatrists scheduled medicine prescribing practices and barriers and facilitators to endorsement: a cross-sectional survey. J Foot Ankle Res 2022; 15:11. [PMID: 35135610 PMCID: PMC8822637 DOI: 10.1186/s13047-022-00515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Non-medical prescribing is one healthcare reform strategy that has the potential to create health system savings and offer equitable and timely access to scheduled medicines. Podiatrists are well positioned to create health system efficiencies through prescribing, however, only a small proportion of Australian podiatrists are endorsed to prescribe scheduled medicines. Since scheduled medicines prescribed by Australian podiatrists are not subsidised by the Government, there is a lack of data available on the prescribing practices of Australian podiatrists. The aim of this research was to investigate the prescribing practices among Australian podiatrists and to explore barriers and facilitators that influence participation in endorsement. Methods Participants in this quantitative, cross-sectional study were registered and practicing Australian podiatrists who were recruited through a combination of professional networks, social media, and personal contacts. Respondents were invited to complete a customised self-reported online survey, developed using previously published research, research team’s expertise, and was piloted with podiatrists. The survey contained three sections: demographic data including clinical experience, questions pertaining to prescribing practices, and barriers and facilitators of the endorsement pathway. Results Respondents (n = 225) were predominantly female, aged 25–45, working in the private sector. Approximately one quarter were endorsed (15%) or in training to become endorsed (11%). Of the 168 non-endorsed respondents, 66% reported that they would like to undertake training to become an endorsed prescriber. The most common indications reported for prescribing or recommending medications include nail surgery (71%), foot infections 474 (88%), post-operative pain (67%), and mycosis (95%). The most recommended Schedule 2 medications were ibuprofen, paracetamol, and topical terbinafine. The most prescribed Schedule 4 medicines among endorsed podiatrists included lignocaine (84%), cephalexin (68%), flucloxacillin (68%), and amoxicillin with clavulanic acid (61%). Conclusion Podiatrists predominantly prescribe scheduled medicines to assist pain, inflammatory, or infectious conditions. Only a small proportion of scheduled medicines available for prescription by podiatrists with endorsed status were reportedly prescribed. Many barriers exist in the current endorsement for podiatrists, particularly related to training processes, including mentor access and supervised practice opportunities. Suggestions to address these barriers require targeted enabling strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00515-w.
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Affiliation(s)
- Kristin Graham
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
| | - Lisa Matricciani
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.,Clinical & Health Sciences, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Helen Banwell
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Saravana Kumar
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Ryan Causby
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Saraid Martin
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Lisa Nissen
- Faculty of Health School of Clinical Sciences, Queensland University of Technology, Brisbane, QL, 4000, Australia
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10
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Sabuj MZR, Dargaville TR, Nissen L, Islam N. Inhaled ciprofloxacin-loaded poly(2-ethyl-2-oxazoline) nanoparticles from dry powder inhaler formulation for the potential treatment of lower respiratory tract infections. PLoS One 2021; 16:e0261720. [PMID: 34941946 PMCID: PMC8699692 DOI: 10.1371/journal.pone.0261720] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/07/2021] [Indexed: 12/04/2022] Open
Abstract
Lower respiratory tract infections (LRTIs) are one of the fatal diseases of the lungs that have severe impacts on public health and the global economy. The currently available antibiotics administered orally for the treatment of LRTIs need high doses with frequent administration and cause dose-related adverse effects. To overcome this problem, we investigated the development of ciprofloxacin (CIP) loaded poly(2-ethyl-2-oxazoline) (PEtOx) nanoparticles (NPs) for potential pulmonary delivery from dry powder inhaler (DPI) formulations against LRTIs. NPs were prepared using a straightforward co-assembly reaction carried out by the intermolecular hydrogen bonding among PEtOx, tannic acid (TA), and CIP. The prepared NPs were characterized by scanning electron microscopy (SEM), dynamic light scattering (DLS), Fourier transform infrared spectroscopy (FTIR), powder X-ray diffraction analysis (PXRD), differential scanning calorimetry (DSC), and thermogravimetric analysis (TGA). The CIP was determined by validated HPLC and UV spectrophotometry methods. The CIP loading into the PEtOx was between 21-67% and increased loading was observed with the increasing concentration of CIP. The NP sizes of PEtOx with or without drug loading were between 196-350 nm and increased with increasing drug loading. The in vitro CIP release showed the maximum cumulative release of about 78% in 168 h with a burst release of 50% in the first 12 h. The kinetics of CIP release from NPs followed non-Fickian or anomalous transport thus suggesting the drug release was regulated by both diffusion and polymer degradation. The in vitro aerosolization study carried out using a Twin Stage Impinger (TSI) at 60 L/min air flow showed the fine particle fraction (FPF) between 34.4% and 40.8%. The FPF was increased with increased drug loading. The outcome of this study revealed the potential of the polymer PEtOx as a carrier for developing CIP-loaded PEtOx NPs as DPI formulation for pulmonary delivery against LRTIs.
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Affiliation(s)
- Mohammad Zaidur Rahman Sabuj
- Faculty of Health, Pharmacy Discipline, School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tim R. Dargaville
- Faculty of Science, School of Chemistry and Physics, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lisa Nissen
- Faculty of Health, Pharmacy Discipline, School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nazrul Islam
- Faculty of Health, Pharmacy Discipline, School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Immunology and Infection Control (CIIC), Queensland University of Technology, Brisbane, Queensland, Australia
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11
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Nissen L, Winding TN, Prescott E, Nyegaard M, Schmidt SE, Shafi BH, Winther S, Bottcher M. Impact of socioeconomic position on coronary artery disease burden in men and women with de-novo symptoms suggestive of chronic coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Low socioeconomic position (SEP) is associated with shorter life expectancy and one of the main drivers is an increase in cardiovascular deaths. A higher prevalence of risk factors only partly explains the complex multifactorial pathogenesis. The aim of this study was to investigate the association between SEP and the development of coronary artery disease (CAD) assessed as calcium score (CACS) at coronary computed tomography angiography (CCTA) as well as stenosis at downstream invasive coronary angiography (ICA) in a population presenting with symptoms suggestive of chronic coronary syndrome (CCS). A secondary aim was to establish whether SEP affects men and women differently.
Methods
We included 50,561 patients (Mean age 57.35±11.50, 53.7% women) from the Western Denmark Heart Registry (WDHR) with no previous CAD undergoing CCTA from 2008–2019 for suspected CCS. ICA was conducted in patients where obstructive CAD was not excluded at CCTA. Outcome measures was level of CACS and haemodynamically significant stenosis at ICA defined as either fractional flow reserve <0.80 or visually assed diameter stenosis of ≥50% stenosis. Odds Ratio of haemodynamically significant stenosis at ICA was calculated using multiple logistic regression and models adjusted for risk factors (smoking, medical treatment for hypertension, medical treatment for high cholesterol, diabetes and family history of CAD). Information on SEP was obtained from national registries. We included mean individual income at age 30–60 or until CCTA (quintiles); and length of education (<10 years, 10–13 years or >13 years). Information on risk factors was obtained from the WDHR registry.
Results
Mean number of risk factors are presented in each educational group in Figure 1. Median CACS for women with <10 years of education is 2 [0–82] vs. 0 [0–15] for women with >13 years of education (p<0.001). For men <10 years of education median CACS is 10 [0–143] vs. 8 [0–118] for men with >13 years of education (p=0.05) (Figure 1). Mean number of risk factors are presented at each level of income in Figure 2. For women with low income median CACS was 6 [0–103] vs. 0 [0–3] for women with high income (p<0.001). For men with low income median CACS is 8 [0–144] vs. 5 [0–105] for men with high income (p=0.002) (Figure 2). The odds ratio (OR) of a stenosis at downstream ICA was 1.47 (p=0.004) for women with <10 years of education vs. >13 years of education and 1.17 for men (p=0.122). OR of stenosis at ICA was 2.40 (p<0.001) for women with low income (1 quintile) using high income (5 quintile) as reference and 1.12 for men (p=0.321).
Conclusion
In de-Novo patients referred for CAD rule-out both coronary calcium score and the prevalence of stenosis at ICA is strongly correlated to low income and short education. The correlation seems to be stronger in women compared to men and calls for further research into the mechanism behind low SEP and atherosclerosis.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Unit West Jutland Research foundation Figure 2
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Affiliation(s)
- L Nissen
- Regional Hospital West Jutland, Department of Cardiology, Herning, Denmark
| | - T N Winding
- Regional Hospital West Jutland, Department of Occupational Medicine, Danish Ramazzini Centre, Herning, Denmark
| | - E Prescott
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Nyegaard
- Aarhus University, Department of Biomedicine, Aarhus, Denmark
| | - S E Schmidt
- Aalborg University, Department of Health Science and Technology, Aalborg, Denmark
| | - B H Shafi
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S Winther
- Regional Hospital West Jutland, Department of Cardiology, Herning, Denmark
| | - M Bottcher
- Regional Hospital West Jutland, Department of Cardiology, Herning, Denmark
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12
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Singh G, Nesaraj R, Bchara N, Kop B, Leeb A, Nissen L, Peters I, Perry D, Salter S, Lee K. Immunisation provider experiences with an automated short message service-based active surveillance system for monitoring adverse events following immunisation: A qualitative descriptive study. Digit Health 2021; 7:20552076211038165. [PMID: 34616563 PMCID: PMC8488908 DOI: 10.1177/20552076211038165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Currently, active surveillance systems to monitor adverse events following
immunisation are limited to hospitals, and medical and immunisation clinics.
Globally, community pharmacies represent a significant destination for
immunisation services. However, until recently, pharmacies lacked active
surveillance systems. We therefore wished to explore pharmacists’
experiences with SmartVax: an active surveillance system that has recently
been integrated for use in Australian community pharmacies. Specifically, we
wished to explore pharmacists’ perceived (1) benefits of using SmartVax, (2)
areas for improvement in the system, and (3) issues with future/ongoing
access to the system. Methods The present study forms the qualitative arm of a convergent mixed-methods
pilot study. In the present study, we performed semi-structured interviews
with pharmacist immunisers after a 21- to 22-week trial period with
SmartVax. Thematic analysis of interview transcripts was performed
independently by two researchers in QSR NVivo 12, using the framework
method. Results Fifteen participants completed the semi-structured interviews. A broad range
of perceived benefits were cited by participants, including the usability of
SmartVax, the ease of patient follow-up facilitated by the system, and
enhancement to the patient–pharmacist relationship. Participants voiced a
desire for the system to have more granularity and a faster response time in
the report generated for pharmacies. When asked about issues with
future/ongoing access to SmartVax, cost concerns of the system were the
prevailing theme. Conclusions The present study suggests that, among pharmacist immuniser end-users of
SmartVax, the system is perceived to be easy-to-use, facilitates patient
follow-up, and enhances the patient–pharmacist relationship.
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Affiliation(s)
- Gurkamal Singh
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Australia
| | - Rachel Nesaraj
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Australia
| | - Nicolas Bchara
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Australia
| | - Benjamin Kop
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Australia
| | - Alan Leeb
- Illawarra Medical Centre, Australia.,SmartVax, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Australia
| | | | - Danae Perry
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Australia
| | - Sandra Salter
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Australia
| | - Kenneth Lee
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Australia
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13
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Fox A, Joseph R, Cardiff L, Thoms D, Yates P, Nissen L, Chan RJ. Evidence-informed implementation of nurse prescribing under supervision: An integrative review. J Adv Nurs 2021; 78:301-313. [PMID: 34477229 DOI: 10.1111/jan.14992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/10/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
AIM To explore evidence reporting facilitators and barriers to implementation of nurse prescribing and provide practical recommendations for evidence-informed implementation and adoption of nurse prescribing under a supervision model. BACKGROUND As demand for access to quality health care services increases, health professional roles are expanding to meet population needs. Nurse prescribing has been effective in some countries and is being considered globally to address growing health care demand. Successful implementation of health service models requires careful planning and consideration. No existing reviews have examined implementation factors in the literature. DESIGN Integrative review. DATA SOURCES CINAHL, MEDLINE, PubMed and EMBASE databases were searched from inception to 15 April 2020. REVIEW METHODS This integrative review is guided by Whittemore and Knafl and adheres to PRISMA reporting guidelines. The sustainability of innovation framework was used to synthesize data concerning implementation and sustainability factors (i.e. innovation, organizational, political, workforce and financial) for nurse prescribing. RESULTS A total of 39 articles were reviewed with literature predominantly reporting findings related to non-medical and nurse prescribing under various models. Variable evidence was found to inform nurse prescribing across five implementation and sustainability factors identifying several areas that require in-depth consideration. Very little evidence is available on nurse prescribing under supervision. CONCLUSION Introduction of service reform is often costly. This review highlights gaps in the literature and raises areas for consideration prior to implementation of this new service delivery model. The introduction of nurse prescribing must be planned and informed by available evidence to support effective adoption, practice and patient outcomes. IMPACT There are significant gaps in evidence related to nurse prescribing under a supervision model. Based on the evidence synthesized in this review, this paper provides practical recommendations for health service providers, managers, clinicians, educators and researchers to support implementation and adoption of nurse prescribing.
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Affiliation(s)
- Amanda Fox
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ria Joseph
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lynda Cardiff
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Debra Thoms
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Patsy Yates
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lisa Nissen
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Raymond Javan Chan
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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14
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Gondora N, Versteeg SG, Carter C, Bishop LD, Sproule B, Turcotte D, Halpape K, Beazely MA, Dattani S, Kwong M, Nissen L, Chang F. The role of pharmacists in opioid stewardship: A scoping review. Res Social Adm Pharm 2021; 18:2714-2747. [PMID: 34261590 DOI: 10.1016/j.sapharm.2021.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The opioid epidemic is an international public health concern. Pharmacists are in a strategic position to promote and implement effective opioid stewardship due to both their central role on health care teams and frequent interaction with patients. Despite this integral role, pharmacists do not have harmonized scopes of practice in opioid stewardship. OBJECTIVES This scoping review was conducted to identify and critically review the role of pharmacists in opioid stewardship and identify future areas of study. METHODS The scoping review was conducted according to the methodological framework proposed by Arksey and O'Malley, which was further modified by the Joanna Briggs Institute. Six databases were searched for original, peer-reviewed research; PubMed (MEDLINE), Ovid Embase, Ovid International Pharmaceutical Abstracts, Scopus, Cochrane Library, and APA PsycInfo. RESULTS In 92% of the included studies (n = 77), opioid stewardship interventions led by either a pharmacist or in an interdisciplinary team resulted in improvements in at least one outcome measure, with education and medication therapy adjustments being the most predominant activities. Other areas supported by evidence include community stakeholder education, policy and guideline setting, and risk assessment. CONCLUSION This scoping review provides valuable insight into the various roles pharmacists can have in opioid stewardship. The findings from this review identified opioid stewardship activities that can make significant contributions towards reducing the impact of the opioid crisis. This review informs future research and has the potential to influence pharmacy practice on a national and international scale.
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Affiliation(s)
- Nyasha Gondora
- School of Pharmacy, University of Waterloo, Ontario, Canada
| | | | - Caitlin Carter
- School of Pharmacy, University of Waterloo, Ontario, Canada
| | - Lisa D Bishop
- School of Pharmacy, Memorial University, Newfoundland and Labrador, Canada
| | - Beth Sproule
- Centre for Addiction and Mental Health & Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
| | - Dana Turcotte
- College of Pharmacy, University of Manitoba, Manitoba, Canada
| | - Katelyn Halpape
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatchewan, Canada
| | | | - Shelita Dattani
- Neighborhood Pharmacy Association of Canada, Ottawa, Ontario, Canada
| | - Mona Kwong
- British Columbia Centre on Substance Use, British Columbia, Canada
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Feng Chang
- School of Pharmacy, University of Waterloo, Ontario, Canada.
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15
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Salter S, Singh G, Nissen L, Trentino K, Murray K, Lee K, Kop B, Peters I, Leeb A. Active vaccine safety surveillance of seasonal influenza vaccination via a scalable, integrated system in Western Australian pharmacies: a prospective cohort study. BMJ Open 2021; 11:e048109. [PMID: 34103321 PMCID: PMC8190048 DOI: 10.1136/bmjopen-2020-048109] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES We integrated an established participant-centred active vaccine safety surveillance system with a cloud-based pharmacy immunisation-recording program in order to measure adverse events following immunisation (AEFI) reported via the new surveillance system in pharmacies, compared with AEFI reported via an existing surveillance system in non-pharmacy sites (general practice and other clinics). DESIGN A prospective cohort study. PARTICIPANTS AND SETTING Individuals >10 years receiving influenza immunisations from 22 pharmacies and 90 non-pharmacy (general practice and other clinic) sites between March and October 2020 in Western Australia. Active vaccine safety surveillance was conducted using short message service and smartphone technology, via an opt-out system. OUTCOME MEASURES Multivariable logistic regression was used to assess the primary outcome: differences in proportions of AEFI between participants immunised in pharmacies compared with non-pharmacy sites, adjusting for confounders of age, sex and influenza vaccine brand. A subgroup analysis of participants over 65 years was also performed. RESULTS Of 101 440 participants (6992 from pharmacies; 94 448 from non-pharmacy sites), 77 498 (76.4%) responded; 96.1% (n=74 448) within 24 hours. Overall, 4.8% (n=247) pharmacy participants reported any AEFI, compared with 6% (n=4356) non-pharmacy participants (adjusted OR: 0.87; 95% CI: 0.76 to 0.99; p=0.039). Similar proportions of AEFIs were reported in pharmacy (5.8%; n=31) and non-pharmacy participants (6; n=1617) aged over 65 years (adjusted OR: 0.94; 95% CI: 0.65 to 1.35; p=0.725). The most common AEFIs in pharmacy were: pain (2%; n=104), tiredness (1.9%; n=95) and headache (1.7%; n=88); and in non-pharmacy sites: pain (2.3%; n=1660), tiredness (1.9%; n=1362) and swelling (1.5%; n=1121). CONCLUSIONS High and rapid response rates demonstrate good participant engagement with active surveillance in both pharmacy and non-pharmacy participants. Significantly fewer AEFIs reported after pharmacist immunisations compared with non-pharmacy immunisations, with no difference in older adults, may suggest different cohorts attend pharmacy versus non-pharmacy immunisers. The integrated pharmacy system is rapidly scalable across Australia with global potential.
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Affiliation(s)
- Sandra Salter
- Division of Pharmacy, The University of Western Australia School of Allied Health, Perth, Western Australia, Australia
| | - Gurkamal Singh
- Division of Pharmacy, The University of Western Australia School of Allied Health, Perth, Western Australia, Australia
| | - Lisa Nissen
- Clinical Sciences, Pharmacology and Pharmaceutical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kevin Trentino
- The University of Western Australia School of Population and Global Health, Perth, Western Australia, Australia
| | - Kevin Murray
- The University of Western Australia School of Population and Global Health, Perth, Western Australia, Australia
| | - Kenneth Lee
- Division of Pharmacy, The University of Western Australia School of Allied Health, Perth, Western Australia, Australia
| | - Benjamin Kop
- Division of Pharmacy, The University of Western Australia School of Allied Health, Perth, Western Australia, Australia
| | - Ian Peters
- Illawarra Medical Centre, Perth, Western Australia, Australia
| | - Alan Leeb
- Illawarra Medical Centre, Perth, Western Australia, Australia
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16
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Graham K, Banwell HA, Causby RS, Kumar S, Tian EJ, Nissen L. Barriers to and facilitators of endorsement for scheduled medicines in podiatry: a qualitative descriptive study. J Foot Ankle Res 2021; 14:16. [PMID: 33691758 PMCID: PMC7944244 DOI: 10.1186/s13047-021-00457-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Australian podiatrists and podiatric surgeons who have successfully completed the requirements for endorsement for scheduled medicines, as directed by the Podiatry Board of Australia, are eligible to prescribe a limited amount of schedule 2, 3, 4 or 8 medications. Registration to become endorsed for scheduled medicines has been available to podiatrists for over 10 years, yet the uptake of training has remained low (approximately 2% of registered podiatrists/podiatry surgeons). This study aimed to explore barriers to and facilitators of engagement with endorsement for scheduled medicines by podiatrists. METHODS Qualitative descriptive methodology informed this research. A purposive maximum variation sampling strategy was used to recruit 13 registered podiatrists and a podiatric surgeon who were either endorsed for scheduled medicines, in training or not endorsed. Semi-structured interviews were employed to collate the data which were analysed using thematic analysis. RESULTS Three overarching super-ordinate themes were identified which encompassed both barriers and facilitators: (1) competence and autonomy, (2) social and workplace influences, and (3) extrinsic motivators. Within these, several prominent sub-themes emerged of importance to the participants including workplace and social networks role in modelling behaviours, identifying mentors, and access to supervised training opportunities. Stage of life and career often influenced engagement. Additionally, a lack of financial incentive, cost and time involved in training, and lack of knowledge of training requirements were influential barriers. Rural podiatrists encountered a considerable number of barriers in most of the identified areas. CONCLUSION A multitude of barriers and facilitators exist for podiatrists as part of the endorsement for scheduled medicines. The findings suggest that a lack of engagement with endorsement for scheduled medicines training may be assisted by a more structured training process and increasing the number of podiatrists who are endorsed to increase the numbers of role models, mentors, and supervision opportunities. Recommendations are provided for approaches as means of achieving, and sustaining, these outcomes.
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Affiliation(s)
- Kristin Graham
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
| | - Helen A Banwell
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Ryan S Causby
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Saravana Kumar
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Esther Jie Tian
- Allied Health & Human Performance, The University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Lisa Nissen
- Faculty of Health, School, Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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17
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Gunn T, Rowntree P, Starkey D, Nissen L. The use of virtual reality computed tomography simulation within a medical imaging and a radiation therapy undergraduate programme. J Med Radiat Sci 2021; 68:28-36. [PMID: 33000561 PMCID: PMC7890924 DOI: 10.1002/jmrs.436] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 08/18/2020] [Accepted: 09/07/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The use of virtual reality (VR) simulation in the education of healthcare professionals has expanded into the field of medical radiation sciences. The purpose of this research was to report on the student experience of the integration of VR education for both medical imaging (MI) and radiation therapy (RT) students in learning computed tomography (CT) scanning. METHODS A survey was performed to evaluate students' perceived confidence in performing diagnostic and planning CT scans in the clinical environment following VR CT simulation tutorials. Students from both MI and RT participated in providing quantitative and qualitative data. RESULTS The MI students (n = 28) and RT students (n = 38) provided quantitative results linking their engagement (perceived usefulness, ease of use, enjoyment) with their perceived confidence. The 15 (54%) MI students who recorded a maximum engagement score had a mean confidence score 1.02 higher than the students not fully engaged (Fisher's exact test 14.549, P = 0.00). The results from the RT cohort revealed 68% of students agreed or strongly agreed to the addition of VR CT simulation helping in the learning of CT. CONCLUSION It can be concluded that the integration of innovative learning opportunities such as VR CT simulation has the potential to increase student confidence and improve student preparation for the clinical environment.
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Affiliation(s)
- Therese Gunn
- School of Clinical SciencesFaculty of HealthQueensland University of Technology (QUT)BrisbaneQLDAustralia
- Institute of Health and Biomedical Innovation (QUT)BrisbaneQLDAustralia
| | - Pamela Rowntree
- School of Clinical SciencesFaculty of HealthQueensland University of Technology (QUT)BrisbaneQLDAustralia
- Institute of Health and Biomedical Innovation (QUT)BrisbaneQLDAustralia
| | - Deborah Starkey
- School of Clinical SciencesFaculty of HealthQueensland University of Technology (QUT)BrisbaneQLDAustralia
- Institute of Health and Biomedical Innovation (QUT)BrisbaneQLDAustralia
| | - Lisa Nissen
- School of Clinical SciencesFaculty of HealthQueensland University of Technology (QUT)BrisbaneQLDAustralia
- Institute of Health and Biomedical Innovation (QUT)BrisbaneQLDAustralia
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18
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Spinks J, Birch S, Wheeler AJ, Nissen L, Freeman C, Thai T, Byrnes J. Provision of home medicines reviews in Australia: linking population need with service provision and available pharmacist workforce. AUST HEALTH REV 2020; 44:973-982. [PMID: 33213693 DOI: 10.1071/ah19207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/07/2020] [Indexed: 11/23/2022]
Abstract
Objective Identifying and quantifying the health needs of a population are the basis of evidence-based health policy and workforce planning. The motivation for undertaking the present study was to evaluate whether the current level of medication review services corresponds to population need, as proxied by the rate of polypharmacy, and to undertake a preliminary analysis of the sufficiency of the current workforce. This paper: (1) estimates the age- and sex-standardised rates of polypharmacy as a proxy for population need for home medicines review; (2) compares the rate of polypharmacy with current service provision of home medicines reviews; and (3) links the estimated need for services with the current number and location of pharmacist providers. Methods Age- and sex-adjusted polypharmacy rates, by state, were estimated from the National Health Survey of Australia (2017-18), service levels were estimated from national-level administrative claims data (2017-18) and the current workforce was estimated from the Australian Association of Consultant Pharmacists (2018). The current level of service provision was compared to the estimated population need for services, alongside the size of the pharmacy workforce required if need was met. Results The adjusted rate of polypharmacy in Australia, using the strictest definition of ≥10 medications and ≥3 current chronic illnesses, was 1389 per 100000 population. The illustrative needs-based analysis suggests that there may be a disconnect between the current level of service provision and population health needs. Conclusion Given that polypharmacy is a risk factor for medication-related problems, and that medication review is one of the few targeted strategies currently available to address medication-related problems in the population, service provision may be inadequate. Policy options to improve service provision could include interventions to increase workforce productivity and relaxing the current eligibility criteria for review, especially in rural and remote areas. What is known about the topic? Polypharmacy is a risk factor for medication-related problems, which can cause increased morbidity and mortality in the population. What does this paper add? This paper provides representative, population-based rates of polypharmacy in Australia and uses these rates in a needs-based analysis of service provision and workforce adequacy to provide home medicines review services. What are the implications for practitioners? Several policy options are available for consideration, including interventions to increase workforce productivity and relaxation of the current eligibility criteria for medicines review, especially in rural and remote areas.
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Affiliation(s)
- Jean Spinks
- Centre for Applied Health Economics, Griffith University, N78, 1.11, Nathan Campus, 170 Kessels Road, Nathan, Qld 4111, Australia. ; and Menzies Health Institute Queensland, Griffith University, Brisbane, Qld 4111, Australia. ; and Corresponding author.
| | - Stephen Birch
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Qld 4072, Australia.
| | - Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, Qld 4111, Australia.
| | - Lisa Nissen
- Faculty of Health, Queensland University of Technology, Brisbane, Qld 4000, Australia.
| | - Christopher Freeman
- School of Pharmacy, University of Queensland, Brisbane, Qld 4072, Australia. ; and Pharmaceutical Society of Australia (PSA), Deakin, ACT 2600, Australia
| | - Thao Thai
- Centre for Health Economics, Monash University, Caulfield, Melbourne, Vic. 3162, Australia.
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, N78, 1.11, Nathan Campus, 170 Kessels Road, Nathan, Qld 4111, Australia. ; and Menzies Health Institute Queensland, Griffith University, Brisbane, Qld 4111, Australia.
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19
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Rasmussen L, Nissen L, Westra J, Knudsen L, Madsen L, Johansen J, Urbonaviciene G, Holm N, Christiansen E, Boetker H, Boettcher M, Winther S. Combining minimal risk stratification and prediction of obstructive CAD – clinical utility of a dual pre-test probability model. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The recently updated pre-test probability (PTP) model for diagnosing chronic coronary syndrome suggested by the European Society of Cardiology (ESC) was designed to predict the presence of obstructive coronary artery disease (CAD). In addition to this model, identification of non-obstructive CAD and utilization of preventive interventions may also lower rates of death and non-fatal myocardial infarction. Opposite to the ESC PTP, the minimal risk tool (MRT) is a new model developed to identify individuals without CAD but symptoms suggestive of CAD. We explored a combined use of the 2 models to predict the absence or presence of obstructive CAD.
Methods
This was a sub-study of the Danish study of Non-Invasive testing in Coronary Artery Disease (Dan-NICAD) which included patients with low-intermediate PTP of CAD. Minimal risk was defined as having a coronary calcium score of 0, no evidence of coronary atherosclerosis at coronary computed tomography angiography, and no cardiovascular (CV) events defined as myocardial infarction, death or revascularization in the mean observation period of 3.1 [2.7–3.4] years. Obstructive CAD was defined as a fractional flow reserve <0.80 in a major vessel during invasive coronary angiography (ICA) or a high-grade stenosis by visual assessment (>90% lumen reduction).
The risk factors included in the MRT were age, sex, smoking history, diabetes mellitus, dyslipidaemia, family history of premature CAD, hypertension, symptoms related to stress, and high-density lipoprotein concentration. Based on a point-system ranging from 0–5, the MRT and the ESC PTP were combined (dual-PTP) (figure 1). A dual-PTP ≤1 indicated very low risk. Using both minimal risk and obstructive CAD as references, the dual PTP was compared to the MRT and the ESC PTP through tests of model discrimination.
Results
Of the 1544 eligible patients, 710 (46%) had normal coronary arteries and no CV events. Obstructive CAD was diagnosed in 152 (10%).
Equivalent to a dual-PTP <1 point, 209 patients with ESC PTP<5% and MRT>50% or ESC PTP 5–15% and MRT >75% were classified as very low risk. Of these patients, 84% were at true minimal risk (red area figure 1). Furthermore, only 6 patients would have been diagnosed with obstructive CAD at ICA, and 0 events would be missed. The dual-PTP was non-inferior to the MRT and the ESC PTP in identifying patients having minimal risk and obstructive CAD, respectively (minimal risk: c-statistics 0.74 (0.72–0.77) vs. 0.76 (0.73–0.78); obstructive CAD: c-statistics 0.66 (0.62–0.70) vs. (0.67 (0.63–0.72)). The dual-PTP was superior to the ESC PTP in discriminating patients at minimal risk (c-statistics 0.74 (0.72–0.77) vs. 0.69 (0.67–0.71).
Conclusions
Combining the ESC PTP and the MRT, the dual-PTP seems to enable accurate prediction of both patients with minimal risk and patients with obstructive CAD. Based on the dual-PTP, patients can safely be deferred from or referred for diagnostic testing
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Aarhus University, Health Research Fund of Central Denmark Region
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Affiliation(s)
- L Rasmussen
- Regional Hospital Herning, Department of Cardiology, Herning, Denmark
| | - L Nissen
- Regional Hospital Herning, Department of Cardiology, Herning, Denmark
| | - J Westra
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L.L Knudsen
- Regional Hospital Herning, Department of Cardiology, Herning, Denmark
| | - L.H Madsen
- Regional Hospital Herning, Department of Cardiology, Herning, Denmark
| | - J.K Johansen
- Regional Hospital Silkeborg, Department of Cardiology, Silkeborg, Denmark
| | - G Urbonaviciene
- Regional Hospital Silkeborg, Department of Cardiology, Silkeborg, Denmark
| | - N.R Holm
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - E.H Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H.E Boetker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Boettcher
- Regional Hospital Herning, Department of Cardiology, Herning, Denmark
| | - S Winther
- Regional Hospital Herning, Department of Cardiology, Herning, Denmark
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20
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McCourt E, Singleton J, Tippett V, Nissen L. Disaster preparedness amongst pharmacists and pharmacy students: a systematic literature review. International Journal of Pharmacy Practice 2020; 29:12-20. [DOI: 10.1111/ijpp.12669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 11/29/2022]
Abstract
Abstract
Objectives
In the aftermath of a disaster, the services provided by pharmacists are essential to ensure the continued health and well-being of the local population. To continue pharmacy services, it is critical that pharmacists are prepared for disasters. A systematic literature review was conducted to explore pharmacists’ and pharmacy students’ preparedness for disasters and the factors that affect preparedness.
Methods
This review was conducted in April 2020 through electronic databases CINAHL, MEDLINE, Embase, PubMed, Scopus and PsycINFO, and two disaster journals. Search terms such as ‘pharmacist*’, ‘disaster*’ and ‘prepared*’ were used. The search yielded an initial 1781 titles. Articles were included if they measured pharmacists or pharmacy students’ disaster preparedness. After screening and quality appraisal by two researchers, four articles were included in final analysis and review. Data were extracted using a data collection tool formulated by the researchers. Meta-analysis was not possible; instead, results were compared across key areas including preparedness ratings and factors that influenced preparedness.
Key findings
Three articles focused on pharmacy students’ preparedness for disasters, and one on registered pharmacists’ preparedness. Preparedness across both groups was poor to moderate with <18% of registered pharmacists found to be prepared to respond to a disaster. Factors that potentially influenced preparedness included disaster competency, disaster interventions and demographic factors.
Conclusion
For pharmacists, the lack of research around their preparedness speaks volumes about their current involvement and expectations within disaster management. Without a prepared pharmacy workforce and pharmacy involvement in disaster management, critical skill and service gaps in disasters may negatively impact patients.
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Affiliation(s)
- Elizabeth McCourt
- Redland Hospital, Queensland Health, Cleveland, Qld, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
| | | | | | - Lisa Nissen
- Redland Hospital, Queensland Health, Cleveland, Qld, Australia
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21
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Spinks J, Bettington E, Downes M, Nissen L, Wheeler A. Does policy change to allow pharmacist provision of influenza vaccination increase population uptake? A systematic review. AUST HEALTH REV 2020; 44:582-589. [PMID: 32674753 DOI: 10.1071/ah19196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/02/2019] [Indexed: 11/23/2022]
Abstract
Objective The aims of this study were to estimate the effect of pharmacists' vaccinating for influenza on overall vaccination rates and to assess whether any effect differs for at-risk subgroups compared with the general population. Methods A systematic review was undertaken, adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched during July 2019 and included Medline (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and the Cochrane Library. Results The largest difference reported in overall population vaccination rates associated with pharmacists undertaking influenza vaccinations was an increase of 10%; the smallest showed no discernible effect. The effect was graduated: pharmacists with the most autonomy demonstrated the largest rate increases. There was evidence of substitution by pharmacists, but the effect size was small. Conclusions The effect of allowing pharmacists to administer influenza vaccinations appears positive, but small. Given that pharmacists are likely to provide vaccinations at a lower cost than doctors, there may be cost-savings to the health system and consumers. Future research may include evaluating pharmacist-provided vaccinations compared with (or in combination with) other strategies, such as advertising, to increase access and uptake across the range of providers, as well as ongoing research to address vaccine hesitancy. What is known about the topic? In Australia, and many other countries, community pharmacies provide an alternative and accessible option for influenza vaccination; however the effect on overall vaccination rates remains unclear. What does this paper add? This systematic review of the international literature suggests that pharmacist-provided vaccinations increase uptake; substitution of doctors by pharmacists may result in cost savings. What are the implications for practitioners? The findings of this study are important for health policy makers and health workforce researchers aiming to maximise population vaccination rates and workforce efficiency. In the absence of available Australian data, data from the international experience of legislating pharmacists to vaccinate against influenza are summarised and critiqued. Results can be used when determining the best health workforce and policy mix with regard to the vaccination workforce.
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Affiliation(s)
- Jean Spinks
- Centre for Applied Health Economics, 1.11 N78, 170 Kessels Road, Griffith University, Nathan, Qld 4111, Australia. ; and Menzies Health Institute Queensland, Griffith University, Brisbane, Qld 4111, Australia. ; and Corresponding author.
| | - Emilie Bettington
- Australian Government, Department of Health, Level 15, 160 Ann Street, Brisbane, Qld 4000, Australia.
| | - Martin Downes
- Centre for Applied Health Economics, 1.11 N78, 170 Kessels Road, Griffith University, Nathan, Qld 4111, Australia. ; and Menzies Health Institute Queensland, Griffith University, Brisbane, Qld 4111, Australia.
| | - Lisa Nissen
- Faculty of Health, Level 9, Q Block, Room 911, Queensland University of Technology, Brisbane, Qld 4000, Australia.
| | - Amanda Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, Qld 4111, Australia. ; and School of Human Services and Social Work, N17 1.02, 170 Kessels Road, Griffith University, Nathan, Qld 4111, Australia
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22
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Gondora N, Sanyal C, Carter C, Nethercott A, Sproule B, Turcotte D, Halpape K, Bishop LD, Nissen L, Beazely MA, Kwong M, Versteeg S, Chang F. The role of pharmacists in opioid stewardship: Protocol. Res Social Adm Pharm 2020; 17:993-996. [PMID: 33773640 DOI: 10.1016/j.sapharm.2020.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The opioid crisis is a worldwide public health concern. In North America, evidence suggests that the increase in opioid prescriptions correlates with the observed increase in opioid-related mortality and morbidity. Pharmacists are in a strategic position to promote effective opioid stewardship as they have a central role on healthcare teams. However, in many contexts, pharmacists do not have a harmonized scope of practice and no standardized opioid stewardship approach has been implemented. OBJECTIVES A scoping review will be conducted to identify and summarize evidence on the role of pharmacists in opioid stewardship and identify areas for future study. METHODS The scoping review will be conducted according to the methodological framework proposed by Arksey and O'Malley, which was further modified by the Joanna Briggs Institute. Six databases will be searched which include PubMed, Embase, International Pharmaceutical Abstracts, Scopus, Cochrane Library, and APA PsycInfo. PROJECT IMPACT The findings of this review will identify opioid stewardship activities that can contribute towards reducing the impact of the opioid crisis. Additionally, it will provide foundational strategies to promote policy level change and foster a harmonized scope of practice. This review has the potential to inform future research, impact pharmacy practice, and drive policy change.
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Affiliation(s)
- Nyasha Gondora
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, Ontario, N2G 1C5, Canada
| | - Chiranjeev Sanyal
- Canadian Pharmacists Association, 1785 Alta Vista Dr, Ottawa, Ontario, K1G 3Y6, Canada
| | - Caitlin Carter
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, Ontario, N2G 1C5, Canada
| | - Ashley Nethercott
- Shoppers Drug Mart, 78 Front St E, Strathroy, Ontario, N7G 1Y7, Canada
| | - Beth Sproule
- Centre for Addiction and Mental Health & Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario, M5S 3M2, Canada
| | - Dana Turcotte
- College of Pharmacy, University of Manitoba, Apotex Centre, Winnipeg, MB R3E 0T5, Canada
| | - Katelyn Halpape
- College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Lisa D Bishop
- School of Pharmacy, Memorial University, 300 Prince Philip Dr, St. John's Newfoundland and Labrador, NL A1B 3V6, Canada
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George St, Brisbane City QLD, 4000, Brisbane, Australia
| | - Michael A Beazely
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, Ontario, N2G 1C5, Canada
| | - Mona Kwong
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia, V6Z 2A9, Canada
| | - Sarah Versteeg
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, Ontario, N2G 1C5, Canada
| | - Feng Chang
- School of Pharmacy, University of Waterloo, 10 Victoria St S A, Kitchener, Ontario, N2G 1C5, Canada.
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23
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Khanal S, Veerman L, Ewen M, Nissen L, Hollingworth S. Availability, Price, and Affordability of Essential Medicines to Manage Noncommunicable Diseases: A National Survey From Nepal. Inquiry 2020; 56:46958019887572. [PMID: 31823665 PMCID: PMC6906349 DOI: 10.1177/0046958019887572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the availability, price, and affordability
of essential noncommunicable disease (NCD) medicines in Nepal. A cross-sectional
survey was conducted in Nepal in 2015 using World Health Organization/Health
Action International (WHO/HAI) methodology. We collected data on the
availability and price of 60 essential NCD medicines from medicine distribution
outlets in both the public and private health care sectors in 6 regions.
Essential NCD medicines were more available in the private sector (78%) than the
public sector (60%). Furosemide tablets were the cheapest (NPR 0.6/10 tablets)
and streptokinase injections were the most expensive (NPR 2200/vial) drugs.
There was no significant difference (P > .05) in
availability and affordability of essential NCD medicines across the 6 survey
areas. Treating selected NCD conditions with medicines was generally affordable,
with 1 month of treatment costing no more than a day’s wage of the lowest paid
unskilled government worker. The lower availability of NCD medicines in the
public sector limits the effectiveness of the government’s policy of providing
free health services at public facilities. Although NCD medicines were generally
affordable, future health policy should aim to ensure improved equitable access
to NCD medicines, particularly in public facilities.
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Affiliation(s)
- Saval Khanal
- Nepal Health Research and Innovation Foundation, Lalitpur, Nepal.,School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Lennert Veerman
- School fo Medicine, Griffith University, Southport, Australia
| | - Margaret Ewen
- Health Action International, Amsterdam, The Netherlands
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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24
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Affiliation(s)
- Arjun Poudel
- School of Clinical Sciences, Queensland University of Technology, Queensland, Australia.,Sankalpa Foundation Pvt. Ltd., Pokhara, Nepal
| | - Bhuvan Kc
- Sankalpa Foundation Pvt. Ltd., Pokhara, Nepal.,School of Pharmacy, Monash University, Malaysia
| | - Shakti Shrestha
- Sankalpa Foundation Pvt. Ltd., Pokhara, Nepal.,School of Pharmacy, University of Queensland, Queensland, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Queensland, Australia.,School of Pharmacy, University of Queensland, Queensland, Australia
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25
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Sani AR, Zin CS, Mohamed AH, Izat M, Tan HL, Ng KS, Nissen L. Exploration of change in persistence patterns of opioid use among patients with non‐cancer and cancer pain over a 3‐year follow‐up period. J Pharm Pract Res 2020. [DOI: 10.1002/jppr.1573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Asween R. Sani
- Department of Pharmacy Practice Kulliyyah of Pharmacy International Islamic University Malaysia Kuantan Malaysia
| | - Che S. Zin
- Department of Pharmacy Practice Kulliyyah of Pharmacy International Islamic University Malaysia Kuantan Malaysia
| | - Abdul H. Mohamed
- Department of Anaesthesiology and Critical Care Kulliyyah of Medicine International Islamic University Malaysia Kuantan Malaysia
| | - Munira Izat
- Department of Pharmacy Hospital Kuala Lumpur Kuala Lumpur Malaysia
| | - Hung L. Tan
- Department of Anaesthesiology, Intensive Care and Pain Management Hospital Kuala Lumpur Kuala Lumpur Malaysia
| | - Kim S. Ng
- Department of Anaesthesiology Intensive Care and Pain Management, Hospital Selayang Selangor Malaysia
| | - Lisa Nissen
- Faculty of Health School of Clinical Sciences Queensland University of Technology Brisbane Australia
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26
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Ahmadvand A, Kavanagh D, Clark M, Drennan J, Nissen L. Trends and Visibility of "Digital Health" as a Keyword in Articles by JMIR Publications in the New Millennium: Bibliographic-Bibliometric Analysis. J Med Internet Res 2019; 21:e10477. [PMID: 31855190 PMCID: PMC6940860 DOI: 10.2196/10477] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/21/2019] [Accepted: 10/17/2019] [Indexed: 01/04/2023] Open
Abstract
Background Digital health has become an advancing phenomenon in the health care systems of modern societies. Over the past two decades, various digital health options, technologies, and innovations have been introduced; many of them are still being investigated and evaluated by researchers all around the globe. However, the actual trends and visibility of peer-reviewed publications using “digital health” as a keyword to reflect the topic, published by major relevant journals, still remain to be quantified. Objective This study aimed to conduct a bibliographic-bibliometric analysis on articles published in JMIR Publications journals that used “digital health” as a keyword. We evaluated the trends, topics, and citations of these research publications to identify the important share and contribution of JMIR Publications journals in publishing articles on digital health. Methods All JMIR Publications journals were searched to find articles in English, published between January 2000 and August 2019, in which the authors focused on, utilized, or discussed digital health in their study and used “digital health” as a keyword. In addition, a bibliographic-bibliometric analysis was conducted using the freely available Profiles Research Networking Software by the Harvard Clinical and Translational Science Center. Results Out of 1797 articles having “digital health” as a keyword, published mostly between 2016 and 2019, 277 articles (32.3%) were published by JMIR Publications journals, mainly in the Journal of Medical Internet Research. The most frequently used keyword for the topic was “mHealth.” The average number of times an article had been cited, including self-citations, was above 2.8. Conclusions The reflection of “digital health” as a keyword in JMIR Publications journals has increased noticeably over the past few years. To maintain this momentum, more regular bibliographic and bibliometric analyses will be needed. This would encourage authors to consider publishing their articles in relevant, high-visibility journals and help these journals expand their supportive publication policies and become more inclusive of digital health.
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Affiliation(s)
- Alireza Ahmadvand
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - David Kavanagh
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Michele Clark
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Judy Drennan
- School of Advertising, Marketing, and Public Relations, QUT Business School, Queensland University of Technology, Brisbane, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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27
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Shrestha S, Poudel A, Steadman K, Nissen L. Outcomes of deprescribing interventions in older patients with life-limiting illness and limited life expectancy: A systematic review. Br J Clin Pharmacol 2019; 86:1931-1945. [PMID: 31483057 DOI: 10.1111/bcp.14113] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/07/2019] [Accepted: 08/24/2019] [Indexed: 01/01/2023] Open
Abstract
AIMS Older patients with life-limiting illness (LLI) and limited life expectancy (LLE) continue to receive potentially inappropriate medicines, consequently deprescribing is often necessary. However, deprescribing in this population can be complex and challenging. Therefore, we aimed to investigate the evidence for outcomes of deprescribing interventions in older patients with LLI and LLE. METHODS Studies on deprescribing intervention and their outcomes in age ≥65 years with LLI and LLE were searched using PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Google Scholar. Medication appropriateness was primary outcome, while clinical and cost-related outcomes were secondary. Eligibility, data extraction and quality assessment were followed by a narrative synthesis of data. RESULTS Of 9 studies (1375 participants), 3 reported on primary outcome. One study showed a significant reduction in medication inappropriateness by 34.9% (P < .001) from admission to close-out, the second achieved 29.4% (P < .001) and 15.1% (P = .003) reduction at 12 and 24 months, respectively. The third reported that their intervention stopped (17.2%) and altered the dose (2.6%) of high-risk medications. Commonly reported clinical outcomes were mortality (n = 3), quality of life (n = 2) and falls (n = 2). Outcomes in terms of cost were reported as overall cost (n = 2), medication cost (n = 1) and health care expenditure (n = 1). CONCLUSION Our findings suggest that deprescribing in older patients with LLI and LLE can improve medication appropriateness, and has potential for enhancement of several clinical outcomes and cost savings, but the evidence needs to be better established.
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Affiliation(s)
- Shakti Shrestha
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Arjun Poudel
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kathryn Steadman
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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28
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Abstract
In Australia, it is estimated that around 17% to 87% of cancer patients have used
one form of complementary therapy during their cancer treatment. There are
numerous reasons and contributing factors for cancer patients to consider using
complementary and alternative medicine (CAM). CAM information and products are
readily available. However, the level of evidence to support the benefits of use
in the cancer setting is limited, and the associated adverse effects and
interactions with conventional medicine may not be fully studied. Besides, not
all health professionals favor the concept of integrative health approaches, or
have the confidence in dealing with CAM due to a lack of knowledge and
standardization of practices. A thematic review of the literature was performed
on the main contributing factors to cancer patients’ use of CAM, as well as the
current issues that may be encountered by the patients and health
professionals.
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Affiliation(s)
- Ellen Jones
- 1 Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Lisa Nissen
- 2 Queensland University of Technology, Brisbane, Queensland, Australia
| | | | | | - Carol Windsor
- 2 Queensland University of Technology, Brisbane, Queensland, Australia
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29
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Abstract
In Australia, it is estimated that around 17% to 87% of cancer patients have used one form of complementary therapy during their cancer treatment. There are numerous reasons and contributing factors for cancer patients to consider using complementary and alternative medicine (CAM). CAM information and products are readily available. However, the level of evidence to support the benefits of use in the cancer setting is limited, and the associated adverse effects and interactions with conventional medicine may not be fully studied. Besides, not all health professionals favor the concept of integrative health approaches, or have the confidence in dealing with CAM due to a lack of knowledge and standardization of practices. A thematic review of the literature was performed on the main contributing factors to cancer patients’ use of CAM, as well as the current issues that may be encountered by the patients and health professionals.
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Affiliation(s)
- Ellen Jones
- 1 Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Lisa Nissen
- 2 Queensland University of Technology, Brisbane, Queensland, Australia
| | | | | | - Carol Windsor
- 2 Queensland University of Technology, Brisbane, Queensland, Australia
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30
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Snoswell CL, Flor M, Tessier C, Ratanjee S, Hale A, Matthews A, Nissen L, Coombes I. Accuracy checking of dispensed medications by a pharmacy technician: a hospital case study. AUST HEALTH REV 2019; 44:410-414. [PMID: 31771746 DOI: 10.1071/ah18267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/21/2019] [Indexed: 11/23/2022]
Abstract
Medication order accuracy checking is an integral and time-consuming component of the current Australian pharmacist's role. However, the pharmacy profession internationally has moved towards separating the checking task into two parts: a clinical check performed by the registered pharmacist and a technical accuracy check delegated to an appropriately trained pharmacy technician. This case study demonstrates that in an Australian hospital pharmacy context, appropriately trained pharmacy technicians have the potential to be more proficient and time efficient than pharmacists when undertaking accuracy checking of dispensed medications.
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Affiliation(s)
- Centaine L Snoswell
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia. ; and School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Qld 4102, Australia; and Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital, Brisbane, Qld 4102, Australia; and Corresponding author.
| | - Melynda Flor
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia.
| | - Cameron Tessier
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia.
| | - Sunita Ratanjee
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia.
| | - Andrew Hale
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia. ; and School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Qld 4102, Australia; and School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Qld 4059, Australia.
| | - Andrew Matthews
- Society of Hospital Pharmacists of Australia, PO Box 1774, Collingwood, Vic. 3066, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Qld 4059, Australia.
| | - Ian Coombes
- Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia. ; and School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Qld 4102, Australia; and School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Qld 4059, Australia.
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Poudel A, Berry R, McCarthy A, Walpole E, Yates P, Nissen L. Medication use in older, terminally ill cancer patients: Are all medications appropriate? A longitudinal audit. Palliat Med 2019; 33:1232-1235. [PMID: 31272282 DOI: 10.1177/0269216319860701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Arjun Poudel
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Robyn Berry
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Alexandra McCarthy
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Nursing, University of Auckland, Auckland, New Zealand
| | - Euan Walpole
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Patsy Yates
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Christiansen MK, Nissen L, Winther S, Frost L, Johansen JK, Jensen HK, Botker HE, Bottcher M, Nyegaard M. P870A genetic risk score is associated with increased coronary plaque burden but not specific plaque features: a coronary computed tomography study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Genetic risk scores (GRSs) based on risk variants identified from genome-wide association studies (GWASs) predict coronary artery disease (CAD) risk. However, it is unknown whether the GRS is associated with coronary plaque burden or specific high-risk plaque features responsible for the clinical disease onset.
Purpose
To investigate if a GRS is associated with coronary plaque burden and specific plaque characteristics, in patients with suspected stable CAD referred for coronary computed tomography angiography (CTA).
Methods
We consecutively included and genotyped 1645 patients undergoing coronary CTA. Using LDPred, a previously validated GRS was calculated as the weighted sum of the number of CAD risk variants identified from the CARDIoGRAMplusC4D GWAS meta-analysis. Plaques were evaluated using an 18-segment model and characterized by stenosis severity (0%, 1–49%, 50–69%, 70–100%) and composition (calcified (>80% calcified), mixed-calcified (50–80% calcified), mixed-soft (20–50% calcified), or soft (<20% calcified)). The segment stenosis score and the coronary artery calcium score (CACS) were used as measures of plaque burden. Multivariate regression models were used to assess the effect per standard deviation (SD) of the GRS with adjustment for age, sex, hypertension, hypercholesterolemia, BMI, chest pain symptoms, and active smoking.
Results
For each SD increase in the GRS, the segment stenosis score increased with 49% (p=8.6e-27) and CACS increased with 110% (p=2.3e-24). The GRS was associated with a higher risk of plaque stenosis >50% (OR: 1.74, p=3.2e-15), calcified (OR: 1.65, p=3.0e-16), mixed-calcified (OR: 1.64, p=1.5e-8), mixed-soft (OR: 1.44, p=1.6e-6), and soft plaques (OR: 1.40, p=3.0e-6), and all coronary vessels were more often affected with plaques (all p-values <1.0e-4).
When analyzing the plaque characteristics (3007 plaques in 849 patients), the GRS was associated with stenosis severity (OR per severity category: 1.15 (p=0.005), but not with extent of calcification, proximal location, or presence in any of the major coronary vessels (all p-values >0.05).
GRS and Plaque burden
Conclusion
The GRS was strongly associated with the extent and severity of CAD at coronary CTA, but not any specific plaque characteristics per se. The results may suggest that polygenic risk based on large CAD-GWAS increases CAD risk through increased coronary plaque burden rather than specific plaque features.
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Affiliation(s)
- M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Nissen
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - S Winther
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - J K Johansen
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - H K Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H E Botker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Bottcher
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - M Nyegaard
- Aarhus University, Department of Biomedicine, Aarhus, Denmark
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Christiansen MK, Winther S, Nissen L, Johansen JK, Westra JS, Holm NR, Frost L, Botker HE, Christiansen EH, Bottcher M, Nyegaard M. P2713A genetic risk score improves discrimination of hemodynamically obstructive coronary artery disease (CAD) beyond the CAD Consortium scores in patients at low-to-intermediate risk of CAD. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Genetic risk scores (GRSs), based on variants identified in genome-wide association studies (GWAS), have been shown to predict risk of coronary artery disease (CAD). However, the clinical potential remains unknown.
Purpose
To investigate whether a GRS improves discrimination of hemodynamically obstructive CAD beyond the CAD Consortium scores and coronary artery calcium score (CACS) in patients referred for coronary computed tomography angiography (CTA).
Methods
We consecutively included and genotyped 1645 patients undergoing CACS scoring and coronary CTA on a suspicion of CAD. Using LDPred, a recently validated GRS was calculated as the weighted sum of the number of CAD risk variants identified from the CARDIoGRAMplusC4D GWAS meta-analysis. Patients with a ≥50% stenosis on CTA further underwent invasive coronary angiography (ICA) with fractional flow reserve (FFR). Hemodynamically obstructive CAD was defined as a visual ICA stenosis >90%, FFR <0.80, or a quantitative coronary analysis stenosis >50% if FFR was not feasible. Discrimination was evaluated by receiver-operating characteristics.
Results
Median age was 57 (interquartile range 50–64) years and 799 (49%) were males. Hemodynamically obstructive CAD was present in 14 (4%) with a low GRS (<20th percentile), 91 (9%) with an intermediate GRS (20th–80th percentile) and 53 (16%) with a high GRS (>80th percentile) (p<0.0001). Adding the GRS improved the area under the receiver-operating curve (AUC) on top of the CAD Consortium basic score (from 0.67 to 0.72, p=0.0052), and the CAD Consortium clinical score (0.70 to 0.74, p=0.0084), but not on top of the CAD Consortium clinical score + CACS (0.85 to 0.86, p=0.30). Improvement in discrimination on top of the CAD Consortium scores was predominantly driven by females ≤57 years (CAD Consortium basic score ± GRS: 0.60 to 0.78, p=0.0004; CAD Consortium clinical score ± GRS: 0.63 to 0.78, p=0.0007). The GRS did not improve discrimination in any subgroups including CACS (CAD Consortium clinical score + CACS ± GRS: all p-values >0.05).
Conclusion
A GRS improves discrimination of hemodynamically obstructive CAD beyond CAD consortium scores, particularly in young women. However, the additive discriminative value is attenuated in models including CACS.
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Affiliation(s)
- M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S Winther
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Nissen
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - J K Johansen
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - J S Westra
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - N R Holm
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - H E Botker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - E H Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Bottcher
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - M Nyegaard
- Aarhus University, Department of Biomedicine, Aarhus, Denmark
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Ramis MA, Chang A, Conway A, Lim D, Munday J, Nissen L. Theory-based strategies for teaching evidence-based practice to undergraduate health students: a systematic review. BMC Med Educ 2019; 19:267. [PMID: 31319892 PMCID: PMC6637485 DOI: 10.1186/s12909-019-1698-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/08/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Undergraduate students across health professions are required to be capable users of evidence in their clinical practice after graduation. Gaining the essential knowledge and clinical behaviors for evidence-based practice can be enhanced by theory-based strategies. Limited evidence exists on the effect of underpinning undergraduate EBP curricula with a theoretical framework to support EBP competence. A systematic review was conducted to determine the effectiveness of EBP teaching strategies for undergraduate students, with specific focus on efficacy of theory-based strategies. METHODS This review critically appraised and synthesized evidence on the effectiveness of EBP theory-based teaching strategies specifically for undergraduate health students on long or short-term change in multiple outcomes, including but not limited to, EBP knowledge and attitudes. PubMed, CINAHL, Scopus, ProQuest Health, ERIC, The Campbell Collaboration, PsycINFO were searched for published studies and The New York Academy of Medicine, ProQuest Dissertations and Mednar were searched for unpublished studies. Two independent reviewers assessed studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. RESULTS Twenty-eight studies reporting EBP teaching strategies were initially selected for review with methodological quality ranging from low to high. Studies varied in course duration, timing of delivery, population and course content. Only five included papers reported alignment with, and detail of, one or more theoretical frameworks. Theories reported included Social Cognitive Theory (one study), Roger's Diffusion of Innovation Theory (two studies) and Cognitive Apprenticeship Theory (one study). Cognitive Flexibility Theory and Cognitive Load Theory were discussed in two separate papers by the same authors. All but one study measured EBP knowledge. Mixed results were reported on EBP knowledge, attitudes and skills across the five studies. CONCLUSIONS EBP programs for undergraduate health students require consideration of multiple domains, including clinical behaviors, attitudes and cognitive learning processes; Interventions grounded in theory were found to have a small but positive effect on EBP attitudes. The most effective theory for developing and supporting EBP capability is not able to be determined by this review therefore additional rigorous research is required.
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Affiliation(s)
- Mary-Anne Ramis
- Mater Health, Evidence in Practice Unit & Queensland Centre for Evidence Based Nursing and Midwifery, A Joanna Briggs Institute Centre of Excellence, South Brisbane, QLD 4101 Australia
- Queensland University of Technology, School of Nursing, Victoria Park Road, Kelvin Grove, Brisbane, Queensland 4059 Australia
| | - Anne Chang
- Queensland University of Technology, School of Nursing, Kelvin Grove Campus, Victoria Park Road, Brisbane, 4059 Australia
| | - Aaron Conway
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5G 2N2 Canada
| | - David Lim
- School of Science and Health, Western Sydney University, Sydney, 2751 Australia
| | - Judy Munday
- Queensland University of Technology, School of Nursing, Kelvin Grove Campus, Victoria Park Road, Brisbane, 4059 Australia
- Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | - Lisa Nissen
- Queensland University of Technology, School of Clinical Sciences, Gardens Point Campus, QLD, Brisbane, 4000 Australia
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Ramis MA, Chang A, Nissen L. Factors Influencing Undergraduate Students' Intention to Use Evidence-Based Practice After Graduation: Development and Validation of a Theory-Based Prediction Model. Worldviews Evid Based Nurs 2019; 16:397-407. [PMID: 31274232 DOI: 10.1111/wvn.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite curriculum requirements for evidence-based practice (EBP) to be a key component of undergraduate health students' training, few studies have investigated factors influential to students' intention to use EBP after graduation. Self-efficacy is known to mediate and motivate behavior; therefore, it may be a crucial factor linking undergraduate students' EBP education and adoption of positive EBP behaviors. AIMS To develop, test, and validate a multivariate, theory-based prediction model with the outcome of students' intention to use EBP after graduation. METHODS A correlational study with structural equation modeling was conducted. Model factors were determined from Bandura's self-efficacy theory and previous literature. An online survey comprised of seven validated scales and a demographic tool was distributed to a sample of undergraduate nursing and paramedic students. Two episodes of data collection were conducted to test and validate the model. RESULTS Evidence-based practice beliefs directly and significantly influenced student intention to use EBP in both models. Sources of EBP self-efficacy also had significant but indirect influence on the outcome variable. Overall variance for intention to use EBP was 25% for the initial model and 18% for the validated model. LINKING EVIDENCE TO ACTION Evidence-based practice curriculum that supports positive EBP beliefs and integrates Bandura's sources of self-efficacy has potential to positively influence students' intention to use EBP after graduation.
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Affiliation(s)
- Mary-Anne Ramis
- Mater Health, Evidence in Practice Unit, Queensland Centre for Evidence Based Nursing and Midwifery: A Joanna Briggs Institute Centre of Excellence, South Brisbane, Qld, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
| | - Anne Chang
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
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Schmidt SE, Winther S, Larsen BS, Groenhoej MH, Nissen L, Westra J, Frost L, Holm NR, Mickley H, Steffensen FH, Lambrechtsen J, Nørskov MS, Struijk JJ, Diederichsen ACP, Boettcher M. Coronary artery disease risk reclassification by a new acoustic-based score. Int J Cardiovasc Imaging 2019; 35:2019-2028. [PMID: 31273633 PMCID: PMC6805823 DOI: 10.1007/s10554-019-01662-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/27/2019] [Indexed: 01/08/2023]
Abstract
To determine the potential of a non-invasive acoustic device (CADScor®System) to reclassify patients with intermediate pre-test probability (PTP) and clinically suspected stable coronary artery disease (CAD) into a low probability group thereby ruling out significant CAD. Audio recordings and clinical data from three studies were collected in a single database. In all studies, patients with a coronary CT angiography indicating CAD were referred to coronary angiography. Audio recordings of heart sounds were processed to construct a CAD-score. PTP was calculated using the updated Diamond-Forrester score and patients were classified according to the current ESC guidelines for stable CAD: low < 15%, intermediate 15–85% and high > 85% PTP. Intermediate PTP patients were re-classified to low probability if the CAD-score was ≤ 20. Of 2245 patients, 212 (9.4%) had significant CAD confirmed by coronary angiography ( ≥ 50% diameter stenosis). The average CAD-score was higher in patients with significant CAD (38.4 ± 13.9) compared to the remaining patients (25.1 ± 13.8; p < 0.001). The reclassification increased the proportion of low PTP patients from 13.6% to 41.8%, reducing the proportion of intermediate PTP patients from 83.4% to 55.2%. Before reclassification 7 (3.1%) low PTP patients had CAD, whereas post-reclassification this number increased to 28 (4.0%) (p = 0.52). The net reclassification index was 0.209. Utilization of a low-cost acoustic device in patients with intermediate PTP could potentially reduce the number of patients referred for further testing, without a significant increase in the false negative rate, and thus improve the cost-effectiveness for patients with suspected stable CAD.
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Affiliation(s)
- S E Schmidt
- Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark.
| | - S Winther
- Department of Cardiology, Region Hospital Herning, Herning, Denmark
| | - B S Larsen
- Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark
- Acarix, Lyngby, Denmark
| | - M H Groenhoej
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - L Nissen
- Department of Cardiology, Region Hospital Herning, Herning, Denmark
| | - J Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - L Frost
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark
| | - N R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - H Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - F H Steffensen
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - J Lambrechtsen
- Department of Cardiology, Svendborg Hospital, Svendborg, Denmark
| | | | - J J Struijk
- Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark
| | | | - M Boettcher
- Department of Cardiology, Region Hospital Herning, Herning, Denmark
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Winther S, Nissen L, Westra J, Frost L, Holm NR, Christiansen EH, Botker HE, Bottcher M. 305Performance of CAD consortium pre-test probability models in patients with symptoms suggestive of coronary artery disease and a low-intermedium risk profile, a study with myocardial perfusion imaging. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez119.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Winther
- Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - L Nissen
- Regional Hospital West Jutland, Department of Cardiology, Herning, Denmark
| | - J Westra
- Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - N R Holm
- Aarhus University Hospital, Skejby, Aarhus, Denmark
| | | | - H E Botker
- Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - M Bottcher
- Regional Hospital West Jutland, Department of Cardiology, Herning, Denmark
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Nissen L, Winther S, Westra J, Ejlersen JA, Isaksen C, Rossi A, Holm NR, Urbonaviciene G, Gormsen LC, Madsen LH, Christiansen EH, Maeng M, Knudsen LL, Frost L, Brix L, Bøtker HE, Petersen SE, Bøttcher M. Influence of Cardiac CT based disease severity and clinical symptoms on the diagnostic performance of myocardial perfusion. Int J Cardiovasc Imaging 2019; 35:1709-1720. [PMID: 31016502 DOI: 10.1007/s10554-019-01604-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/15/2019] [Indexed: 12/14/2022]
Abstract
We aimed to identify factors influencing the sensitivity of perfusion imaging after an initial positive coronary computed tomography angiography (CCTA) using invasive coronary angiography (ICA) with conditional fractional flow reserve (FFR) as reference. Secondly we aimed to identify factors associated with revascularisation and to evaluate treatment outcome after ICA. We analysed 292 consecutive patients with suspected significant coronary artery disease (CAD) at CCTA, who underwent perfusion imaging with either cardiac magnetic resonance (CMR) or myocardial perfusion scintigraphy (MPS) followed by ICA with conditional FFR. Stratified analysis and uni- and multiple logistic regression analyses were performed to identify predictors of diagnostic agreement between perfusion scans and ICA and predictors of revascularisation. Myocardial ischemia evaluated with perfusion scans was present in 65/292 (22%) while 117/292 (40%) had obstructive CAD evaluated by ICA. Revascularisation rate was 90/292 (31%). The overall sensitivity for perfusion scans was 39% (30-48), specificity 89% (83-93), PPV 69% (57-80) and NPV 68% (62-74). Stratified analysis showed higher sensitivities in patients with multi-vessel disease at CCTA 49% (37-60) and typical chest pain 50% (37-60). Predictors of revascularisation were multi-vessel disease by CCTA (OR 3.51 [1.91-6.48]) and a positive perfusion scan (OR 4.69 [2.49-8.83]). The sensitivity for perfusion scans after CCTA was highest in patients with typical angina and multiple lesions at CCTA and predicted diagnostic agreement between perfusion scans and ICA. Abnormal perfusion and multi vessel disease at CCTA predicted revascularisation.
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Affiliation(s)
- L Nissen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark.
| | - S Winther
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - J Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - J A Ejlersen
- Department of Nuclear Medicine, Hospital Unit West Jutland, Herning, Denmark
| | - C Isaksen
- Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - A Rossi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Diagnostic Imaging, Humanitas Research Hospital, Milan, Italy
| | - N R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - L C Gormsen
- Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - L H Madsen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark
| | - E H Christiansen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - M Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - L L Knudsen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark
| | - L Frost
- Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - L Brix
- Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - H E Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - S E Petersen
- William Harvey Research Institute, Queen Mary University of London, London, UK
- St. Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - M Bøttcher
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark
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Khanal S, Veerman L, Nissen L, Hollingworth S. Forecasting the amount and cost of medicine to treat type 2 diabetes mellitus in Nepal using knowledge on medicine usage from a developed country. Journal of Pharmaceutical Health Services Research 2019. [DOI: 10.1111/jphs.12265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
This research was aimed to forecast the amount and cost of medicines required to treat people with type 2 diabetes mellitus (T2DM) in Nepal over 30 years.
Methods
We modelled the financial burden of T2DM medicines by estimating the cost of medicines to treat all cases of T2DM in Nepal over three decades based on the prevalence of T2DM in Nepal, the Nepalese costs of medicine and the T2DM medicine use profile of Australia.
Key findings
With the current T2DM prevalence trend, it would cost US$63–95 million in 2013 to purchase T2DM medicines for Nepal, if Nepalese receive the same mix of T2DM medicines as used in Australia. This cost is almost one-quarter of the total health budget of Nepal (US$308 million). The cost of medicines to treat T2DM is projected to triple between 2013 and 2043.
Conclusions
With the medicines for only T2DM projected to cost about 25% of the entire health budget, the planned health insurance seems unaffordable if patients are treated with the same medicines as those in one of the best healthcare systems in the world. The government needs to stimulate rational prescribing and secure additional funding through taxation, health insurance or health levy to provide such medicines and services.
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Affiliation(s)
- Saval Khanal
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
- Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Lennert Veerman
- School of Medicine, Griffith University, Southport, QLD, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Hale A, Merlo G, Nissen L, Coombes I, Graves N. Cost-effectiveness analysis of doctor-pharmacist collaborative prescribing for venous thromboembolism in high risk surgical patients. BMC Health Serv Res 2018; 18:749. [PMID: 30285744 PMCID: PMC6167876 DOI: 10.1186/s12913-018-3557-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background Current evidence to support cost effectiveness of doctor- pharmacist collaborative prescribing is limited. Our aim was to evaluate inpatient prescribing of venous thromboembolism (VTE) prophylaxis by a pharmacist in an elective surgery pre-admission clinic against usual care, to measure any benefits in cost to the healthcare system and quality adjusted life years (QALYs) of patients. Method A decision tree model was developed to assess cost effectiveness of pharmacist prescribing compared with usual care for VTE prophylaxis in high risk surgical patients. Data from the literature was used to inform decision-tree probabilities, utility, and cost outcomes. In the intervention arm, a pharmacist prescribed patient’s regular medications, documented a VTE risk assessment and prescribed VTE prophylaxis. In the usual care arm, resident medical officers were responsible for prescribing regular medications, and for risk assessment and prescribing of VTE prophylaxis. The base scenario assessed the cost effectiveness of a pre-existing pre-admission clinic pharmacy service that takes on a collaborative prescribing role. The alternative scenario assessed the benefits of introducing a pre-admission clinic pharmacy service where previously there had not been one. Probabilistic sensitivity analysis was conducted to explore uncertainty in the model. Results In both the base-case scenario and the alternative scenario pharmacist prescribing resulted in an increase in the proportion of patients adequately treated and a decrease in the incidence of VTE resulting in cost savings and improvement in quality of life. The cost savings were $31 (95% CI: -$97, $160) per patient in the base scenario and $12 (95% CI: -$131, $155) per patient in the alternative scenario. In both scenarios the pharmacist-doctor prescribing resulted in an increase in QALYs of 0.02 (95% CI: -0.01, 0.005) per patient. The probability of being cost effective at a willingness to pay off $40,000 was 95% in the base scenario and 94% in the alternative scenario. Conclusion Delegation of the prescribing of VTE prophylaxis for high risk surgical patients to a pharmacist prescriber in PAC, as part of a designated scope of practice, would result in fewer cases of VTE and associated lower costs to the healthcare system and increased QALYs gained by patients. Trial registration Pre admission clinic study registered with ANZCTR-ACTR Number ACTRN12609000426280.
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Affiliation(s)
- Andrew Hale
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Royal Brisbane and Women's Hospital, Cnr Butterfield St and Bowen Bridge Road, Herston, Brisbane, 4029, Australia.
| | - Greg Merlo
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, 4059, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Level 9, Q Block Room, 911, Brisbane, 4000, Australia
| | - Ian Coombes
- Royal Brisbane and Women's Hospital, Cnr Butterfield St and Bowen Bridge Road, Herston, Brisbane, 4029, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, 4059, Australia
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Ahmadvand A, Murtagh J, Nissen L. Bringing futurism into medical education: Harnessing augmented reality to foster more engagement. Aust J Gen Pract 2018; 47:490-491. [PMID: 30114875 DOI: 10.31128/afp-10-17-4369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Alireza Ahmadvand
- MD, General Practitioner and Research Scholar, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Qld
| | - John Murtagh
- MD, Emeritus Professor, Department of General Practice, School of Primary Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Vic
| | - Lisa Nissen
- PhD, Head, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Qld.
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Therkildsen J, Winther S, Jorgensen HS, Nissen L, Thygesen J, Iversen P, Frost L, Hauge EM, Bottcher M. P1564Coronary artery disease detected on cardiac computed tomography scans is associated with low bone mineral density in female patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - S Winther
- Department of Cardiology, Aarhus, Denmark
| | | | - L Nissen
- Region Hospital Herning, Herning, Denmark
| | - J Thygesen
- Aarhus University Hospital, Medical Technology, Aarhus, Denmark
| | - P Iversen
- Aarhus University Hospital, Medical Technology, Aarhus, Denmark
| | - L Frost
- Aarhus University Hospital, Medical Technology, Aarhus, Denmark
| | - E M Hauge
- Aarhus University Hospital, Rheumatology, Aarhus, Denmark
| | - M Bottcher
- Department of Cardiology, Aarhus, Denmark
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Winther S, Nissen L, Westra JS, Frost L, Urbonaviciene G, Holm NR, Christiansen EH, Botker HE, Bottcher M. P2697Performance of CAD consortium risk stratification score in patients with symptoms suggestive of coronary artery disease and a low-intermedia risk profile, a study with FFR as reference stan. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Winther
- Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - L Nissen
- Regional Hospital West Jutland, Department of Cardiology, Herning, Denmark
| | - J S Westra
- Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - G Urbonaviciene
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - N R Holm
- Aarhus University Hospital, Skejby, Aarhus, Denmark
| | | | - H E Botker
- Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - M Bottcher
- Regional Hospital West Jutland, Department of Cardiology, Herning, Denmark
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Ahmadvand A, Murtagh J, Nissen L. Bringing futurism into medical education: Harnessing augmented reality to foster more engagement. Aust J Gen Pract 2018. [DOI: 10.31128/ajgp-10-17-4369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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45
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Ahmadvand A, Gatchel R, Brownstein J, Nissen L. The Biopsychosocial-Digital Approach to Health and Disease: Call for a Paradigm Expansion. J Med Internet Res 2018; 20:e189. [PMID: 29776900 PMCID: PMC5984274 DOI: 10.2196/jmir.9732] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/10/2018] [Accepted: 02/10/2018] [Indexed: 01/22/2023] Open
Abstract
Digital health is an advancing phenomenon in modern health care systems. Currently, numerous stakeholders in various countries are evaluating the potential benefits of digital health solutions at the individual, population, and/or organizational levels. Additionally, driving factors are being created from the customer-side of the health care systems to push health care providers, policymakers, or researchers to embrace digital health solutions. However, health care providers may differ in their approach to adopt these solutions. Health care providers are not assumed to be appropriately trained to address the requirements of integrating digital health solutions into daily everyday practices and procedures. To adapt to the changing demands of health care systems, it is necessary to expand relevant paradigms and to train human resources as required. In this article, a more comprehensive paradigm will be proposed, based on the ‘biopsychosocial model’ of assessing health and disease, originally introduced by George L Engel. The “biopsychosocial model” must be leveraged to include a “digital” component, thus suggesting a ‘biopsychosocial-digital’ approach to health and disease. Modifications to the “biopsychosocial” model and transition to the “biopsychosocial-digital” model are explained. Furthermore, the emerging implications of understanding health and disease are clarified pertaining to their relevance in training human resources for health care provision and research.
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Affiliation(s)
- Alireza Ahmadvand
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Robert Gatchel
- Department of Psychology, College of Science, University of Texas at Arlington, Arlington, TX, United States
| | - John Brownstein
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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46
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Ahmadvand A, Drennan J, Burgess J, Clark M, Kavanagh D, Burns K, Howard S, Kelly F, Campbell C, Nissen L. Novel augmented reality solution for improving health literacy around antihypertensives in people living with type 2 diabetes mellitus: protocol of a technology evaluation study. BMJ Open 2018; 8:e019422. [PMID: 29705754 PMCID: PMC5931308 DOI: 10.1136/bmjopen-2017-019422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Low health literacy is common in people with type 2 diabetes mellitus (T2DM) (up to 40%), associated with decreased self-efficacy in managing T2DM and its important complications, mainly hypertension. This study introduces, for the first time, an easy-to-use solution based on augmented reality (AR) on smartphones, to enhance health literacy around antihypertensive medicines. It assesses the feasibility of the solution for improving health literacy, oriented specifically to angiotensin II receptor blockers; embedding the health literacy improvement into the use cycle of angiotensin II receptor blockers and providing continuous access to information as a form of patient engagement. METHODS AND ANALYSIS This is a technology evaluation study with one technology group (AR plus usual care) and one non-technology group (usual care). Both groups receive face-to-face communications with community pharmacists regarding angiotensin II receptor blockers; the technology group receive additional AR-enhanced digital consumer medicine information throughout the use of their medications. The primary outcome is the change in health literacy and the hypothesis is that the proportions of people who show high health literacy will be larger in the technology group. Mixed effects models will be used to analyse solution effectiveness on outcomes. Multiple regression models will be used to find additional variables that might affect the relationship between health literacy and the AR solution. ETHICS AND DISSEMINATION Queensland University of Technology (QUT) Human Research Ethics Committee has approved the study as a low-risk technology evaluation study (approval number: 1700000275). Findings will be disseminated via attending scientific conferences and publishing in peer-reviewed journals. Facilitated by QUT, two press releases have been published in public media and two presentations have been made in university classrooms.
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Affiliation(s)
- Alireza Ahmadvand
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Judy Drennan
- School of Advertising, Marketing and Public Relations, QUT Business School, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jean Burgess
- Digital Media Research Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michele Clark
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Kavanagh
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kara Burns
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Advertising, Marketing and Public Relations, QUT Business School, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sarah Howard
- QUT Library, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fleur Kelly
- Diabetes Queensland, Brisbane, Queensland, Australia
| | - Chris Campbell
- Business Management, Terry White Chemmart Group, Brisbane, Queensland, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Nissen L, Winther S, Westra J, Ejlersen JA, Isaksen C, Rossi A, Holm NR, Urbonaviciene G, Gormsen LC, Madsen LH, Christiansen EH, Maeng M, Knudsen LL, Frost L, Brix L, Bøtker HE, Petersen SE, Bøttcher M. Diagnosing coronary artery disease after a positive coronary computed tomography angiography: the Dan-NICAD open label, parallel, head to head, randomized controlled diagnostic accuracy trial of cardiovascular magnetic resonance and myocardial perfusion scintigraphy. Eur Heart J Cardiovasc Imaging 2018; 19:369-377. [PMID: 29447342 DOI: 10.1093/ehjci/jex342] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/17/2017] [Indexed: 01/01/2023] Open
Affiliation(s)
- L Nissen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark
| | - S Winther
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - J Westra
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - J A Ejlersen
- Department of Nuclear Medicine, Regional Hospital West Jutland, Gl.landevej 61, 7400 Herning, Denmark
| | - C Isaksen
- Department of Radiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - A Rossi
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - N R Holm
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - L C Gormsen
- Department of Nuclear Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - L H Madsen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark
| | - E H Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - M Maeng
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - L L Knudsen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark
| | - L Frost
- Department of Cardiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - L Brix
- Department of Radiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - H E Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - S E Petersen
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - M Bøttcher
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark
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Ramis M, Chang A, Nissen L. Undergraduate Health Students’ Intention to Use Evidence‐Based Practice After Graduation: A Systematic Review of Predictive Modeling Studies. Worldviews Evid Based Nurs 2017; 15:140-148. [DOI: 10.1111/wvn.12268] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Mary‐Anne Ramis
- Doctoral Candidate, School of Nursing, Queensland University of TechnologyKelvin Grove Campus, Brisbane, Qld, Australia; Mater Health, Evidence in Practice Unit South Brisbane QLD Australia
| | - Anne Chang
- Adjunct ProfessorSchool of Nursing, Queensland University of Technology Kelvin Grove Campus Brisbane QLD Australia
| | - Lisa Nissen
- Professor (Head), School of Clinical SciencesQueensland University of Technology Gardens Point Campus Brisbane QLD Australia
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Lum EPM, Page K, Nissen L, Doust J, Graves N. Australian consumer perspectives, attitudes and behaviours on antibiotic use and antibiotic resistance: a qualitative study with implications for public health policy and practice. BMC Public Health 2017; 17:799. [PMID: 29017473 PMCID: PMC5635573 DOI: 10.1186/s12889-017-4813-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 10/02/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Consumers receive over 27 million antibiotic prescriptions annually in Australian primary healthcare. Hence, consumers are a key group to engage in the fight against antibiotic resistance. There is a paucity of research pertaining to consumers in the Australian healthcare environment. This study aimed to investigate the perspectives, attitudes and behaviours of Australian consumers on antibiotic use and antibiotic resistance, to inform national programs for reducing inappropriate antibiotic consumption. METHOD Semi-structured interviews with 32 consumers recruited via convenience and snowball sampling from a university population in South East Queensland. Interview transcripts were deductively and inductively coded. Main themes were identified using iterative thematic analysis. RESULTS Three themes emerged from the analysis, to elucidate factors affecting antibiotic use: (a) prescription type; (b) consumer attitudes, behaviours, skills and knowledge; and (c) consumer engagement with antibiotic resistance. Consumers held mixed views regarding the use of delayed antibiotic prescriptions, and were often not made aware of the use of repeat antibiotic prescriptions. Consumers with regular general practitioners were more likely to have shared expectations regarding minimising the use of antibiotics. Even so, advice or information mediated by general practitioners was influential with all consumers; and helped to prevent inappropriate antibiotic use behaviours. Consumers were not aware of the free Return of Unwanted Medicines service offered by pharmacies and disposed of leftover antibiotics through household waste. To engage with mitigating antibiotic resistance, consumers required specific information. Previous public health campaigns raising awareness of antibiotics were largely not seen by this sample of consumers. CONCLUSIONS Australian consumers have specific information needs regarding prescribed antibiotics to enable appropriate antibiotic use behaviours. Consumers also have expectations for high quality general practice consults conducted in a manner that increases consumer confidence in the treatment decision, regardless of whether an antibiotic is prescribed. To reduce inappropriate consumption of antibiotics and to more fully engage Australian consumers in mitigating antibiotic resistance, changes in health policy and practice are required.
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Affiliation(s)
- Elaine P. M. Lum
- School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Katie Page
- School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove Campus, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, QLD 4000 Australia
| | - Jenny Doust
- Centre for Research in Evidence Based Practice, Bond University, 14 University Drive, Robina, QLD 4226 Australia
| | - Nicholas Graves
- The Australian Centre for Health Services Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD 4059 Australia
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Saw PS, Nissen L, Freeman C, Wong PS, Mak V. A qualitative study on pharmacists’ perception on integrating pharmacists into private general practitioner’s clinics in Malaysia (online appendix). Pharm Pract (Granada) 2017. [DOI: 10.18549/pharmpract.2017.03.971supp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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