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Saini B, Collins M. The quest for safer benzodiazepines for use in insomnia, where are we at? Sleep 2024; 47:zsad303. [PMID: 38044567 DOI: 10.1093/sleep/zsad303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| | - Mary Collins
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Basheti MM, Bussing J, Grunstein R, Gordon C, Saini B. Developing, Implementing, and Evaluating the Effectiveness of a Sleep Health Educational Module for Pharmacy Students. Am J Pharm Educ 2024; 88:100632. [PMID: 38092088 DOI: 10.1016/j.ajpe.2023.100632] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/19/2023] [Accepted: 12/05/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE Pharmacists need sleep health knowledge and management skills to deliver evidence-based treatments to patients with sleep disorders/disturbances. This study aimed to develop, implement, and evaluate a pedagogically informed, interactive sleep health educational module for pharmacy students. METHODS An educational module utilizing a flipped classroom approach, with an interactive lecture, student self-reflection of sleep patterns, case discussions, and pharmacist-patient role-play scenarios, was designed and implemented. A questionnaire assessing pre/post-module changes in knowledge about and attitudes toward sleep health as well as post-module learning satisfaction, was administered to all participating second-year pharmacy students at an Australian university. RESULTS Mean total knowledge scores for participating students (n = 125, 70.4% female) improved significantly, from a baseline of 11.1 ± 3.8 to 17.1 ± 3.5 post-module (range: 0-25). Attitudes toward sleep health were moderately high at baseline (28.8 ± 3.2) and improved marginally post-module (29.4 ± 3.8) (range: 10-50); however, this increase was insignificant. Participants expressed high satisfaction with the module through subjective feedback, and post-module reflective statements indicated plans for changing sleep behaviors. CONCLUSION The results of this study have shown that a targeted educational module for pharmacy students improved sleep health knowledge. It appeared that positive attitudes toward sleep health were not significantly increased which may reflect a ceiling effect. Future modules should focus on attitudinal aspects of positive sleep health to enhance pharmacists' skills in providing clinically related sleep health care to patients with sleep disturbance.
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Affiliation(s)
- Mariam M Basheti
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia; Woolcock Institute of Medical Research, CIRUS Sleep and Chronobiology Research Group, Sydney, NSW, Australia.
| | - Jocelyn Bussing
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia
| | - Ronald Grunstein
- Woolcock Institute of Medical Research, CIRUS Sleep and Chronobiology Research Group, Sydney, NSW, Australia; University of Sydney, Faculty of Medicine and Health, School of Medicine, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Christopher Gordon
- Woolcock Institute of Medical Research, CIRUS Sleep and Chronobiology Research Group, Sydney, NSW, Australia; University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, NSW, Australia
| | - Bandana Saini
- University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia; Woolcock Institute of Medical Research, CIRUS Sleep and Chronobiology Research Group, Sydney, NSW, Australia
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Burke AW, Saini B, Maundu J, Clark B, Wilkinson G, Moles RJ. Exploring First Nations' and Cultural Safety Content of Pharmacy Curricula With Academics in Australia. Am J Pharm Educ 2024; 88:100605. [PMID: 37852578 DOI: 10.1016/j.ajpe.2023.100605] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/27/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE This study aimed to explore academics' views on Aboriginal and/or Torres Strait Islander Health and Cultural Safety content in pharmacy school curricula to inform recommendations for future curricula. METHODS All 18 Australian pharmacy schools were contacted, and interviews were conducted with consenting heads of school and/or their delegate(s). The interviews covered what the school was doing with respect to the First Nations theme in the revised accreditation standards and further ideas for improvement. Audio recordings of interviews were transcribed verbatim via an online transcription service. Transcripts were thematically analyzed and coded according to the framework approach and mapped to the Aboriginal and Torres Strait Islander Health Curriculum Framework. Coding was facilitated using NVivo software. RESULTS All 18 schools consented to participate and a total of 22 interviews were conducted. The pharmacy accreditation standards were well known to most educators, however, the dissemination of the Aboriginal and Torres Strait Islander Health Curriculum Framework, introduced in 2014, appeared to be poor. Many interviewees (n = 14) expressed that the current content regarding Aboriginal health and cultural safety/competence was lacking and cited barriers that have led to a lack of development such as a lack of First Nations staff and expertize. CONCLUSION While cultural safety/competency was taught in all Australian pharmacy schools, it is apparent that pharmacy schools are at various stages in their development of Aboriginal and Torres Strait Islander Health curriculum design and implementation. Future resources should be developed and made available.
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Affiliation(s)
| | - Bandana Saini
- University of Sydney School of Pharmacy, Sydney, NSW, Australia
| | | | - Bronwyn Clark
- Australian Pharmacy Council, Canberra, ACT, Australia
| | | | - Rebekah J Moles
- University of Sydney School of Pharmacy, Sydney, NSW, Australia
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Loh ZC, Hussain R, Ong SC, Saini B, Muneswarao J, Ur-Rehman A, Babar ZUD. Over-the-counter use of short-acting beta-2 agonists: a systematic review. J Pharm Policy Pract 2023; 16:119. [PMID: 37814312 PMCID: PMC10561505 DOI: 10.1186/s40545-023-00627-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The widespread use of short-acting beta-2 agonists (SABA) as an as-needed treatment for asthma is well-established. However, excessive use of SABA has been linked to undesirable outcomes such as increased risk of asthma attacks, exacerbations, and even death. The availability of SABA as an over-the-counter (OTC) medication has contributed to their overuse, leading to undertreated asthma and reduced access to asthma education. OBJECTIVE This systematic review aimed to summarize the prevalence, characteristic features of, and factors contributing to over-the-counter SABA purchase or overuse. METHODS The databases searched included PubMed, Scopus, Springer Link, Google Scholar, CINAHL, and APA PsycArticles. Original research articles reporting the prevalence, characteristics features, and factors regarding over-the-counter SABA use, available as full text, published in English language between the year 2000 and April 2023 were included in this review. Commentaries, letters to editor, review articles, qualitative studies, clinical trials, and conference proceedings were excluded. Data extraction was followed by a review of the quality of studies included and data were then synthesized for meaningful findings. This systematic review had been registered in the PROSPERO with registration number CRD42023421007. RESULTS A total of 18 articles were included. The prevalence range of OTC SABA users in populations were 1.4% to 39.6% and SABA over-users among OTC users were 14% to 66.4%. Factors mostly associated with this behavior were moderate-severe asthma, and less use of preventers. On top of that, not understanding the risk of SABA overuse was clear in many studies that explored this factor. CONCLUSION Over-the-counter purchase and overuse of SABA medication is a common problem, leading to adverse consequences such as uncontrolled asthma and increased healthcare utilization. Addressing these issues requires improved patient education about their conditions and adequate information regarding the potential long-term effects of SABA use by the healthcare providers. Management and education of asthma patients, including regular monitoring and follow-up, can help reduce overuse of SABA medication and prevent negative consequences.
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Affiliation(s)
- Zhe Chi Loh
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia
| | - Rabia Hussain
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia.
| | - Siew Chin Ong
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia
| | - Bandana Saini
- Faculty of Medicine and Health, University of Sydney School of Pharmacy, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Jaya Muneswarao
- Pharmacy Department, Hospital Pulau Pinang, 10990, George Town, Pulau Pinang, Malaysia
| | | | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
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Williams CT, Zaidi STR, Saini B, Castelino R. The Role of Adult Vaccines as Part of Antimicrobial Stewardship: A Scoping Review. Antibiotics (Basel) 2023; 12:1429. [PMID: 37760725 PMCID: PMC10525636 DOI: 10.3390/antibiotics12091429] [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: 08/06/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a significant global health concern, causing an estimated 700,000 deaths annually. Although immunisation has been shown to significantly reduce AMR, the role of vaccines as part of antimicrobial stewardship (AMS) practices is often overlooked. OBJECTIVE To identify and examine the available literature on the role of vaccines as part of AMS practices. METHOD A scoping review was conducted in the following databases: MEDLINE, Embase, Scopus, CINAHL, CCRCT, IPA, and WoS, along with grey literature sources. The review was conducted using the JBI Methodology for Scoping Reviews and reported in line with the PRISMA-SCr checklist. RESULTS Among the 1711 records identified, 34 met the inclusion criteria; 8 discussed only the concept, while 26 discussed both the concept and the vaccine implementation method in AMS practices. There were eight recommended and/or utilised types of AMS activities identified involving vaccines, under four key themes of vaccine-related AMS strategies: Education, Screening, Vaccination, and Monitoring. Influenza and pneumococcal vaccines had the most evidence for inclusion. CONCLUSION Overall, the evidence supports the role of vaccines as part of AMS practices and the value of their inclusion in creating improved and comprehensive AMS strategies to further combat the development of AMR.
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Affiliation(s)
| | | | - Bandana Saini
- Faculty of Medicine and Health, University of Sydney, Camperdown 2050, Australia (R.C.)
| | - Ronald Castelino
- Faculty of Medicine and Health, University of Sydney, Camperdown 2050, Australia (R.C.)
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Lavender I, McCartney D, Marshall N, Suraev A, Irwin C, D'Rozario AL, Gordon CJ, Saini B, Grunstein RR, Yee B, McGregor I, Hoyos CM. Cannabinol (CBN; 30 and 300 mg) effects on sleep and next-day function in insomnia disorder ('CUPID' study): protocol for a randomised, double-blind, placebo-controlled, cross-over, three-arm, proof-of-concept trial. BMJ Open 2023; 13:e071148. [PMID: 37612115 PMCID: PMC10450062 DOI: 10.1136/bmjopen-2022-071148] [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: 12/21/2022] [Accepted: 08/07/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Insomnia is the most prevalent sleep disorder, with few effective pharmacotherapies. Anecdotal reports and recent preclinical research suggest that cannabinol (CBN), a constituent of Cannabis sativa derived from delta-9-tetrahydrocannabinol, could be an effective treatment. Despite this, the isolated effects of CBN on sleep have yet to be systematically studied in humans. METHODS The present protocol paper describes a randomised, double-blind, placebo-controlled, single-dose, three-arm, cross-over, proof-of-concept study which investigates the effects of CBN on sleep and next-day function in 20 participants with clinician-diagnosed insomnia disorder and an Insomnia Severity Index Score ≥15. Participants receive a single fixed oral liquid dose of 30 mg CBN, 300 mg CBN and matched placebo, in random order on three treatment nights; each separated by a 2-week wash-out period. Participants undergo overnight sleep assessment using in-laboratory polysomnography and next-day neurobehavioural function tests. The primary outcome is wake after sleep onset minutes. Secondary outcomes include changes to traditional sleep staging, sleep-onset latency and absolute spectral power during non-rapid eye movement (NREM) sleep. Tertiary outcomes include changes to sleep spindles during NREM sleep, arousal indices, absolute spectral power during REM sleep and subjective sleep quality. Safety-related and exploratory outcomes include changes to next-day simulated driving performance, subjective mood and drug effects, postural sway, alertness and reaction time, overnight memory consolidation, pre and post-sleep subjective and objective sleepiness; and plasma, urinary, and salivary cannabinoid concentrations. The study will provide novel preliminary data on CBN efficacy and safety in insomnia disorder, which will inform larger clinical trials. ETHICS AND DISSEMINATION Human Research Ethics Committee approval has been granted by Bellberry (2021-08-907). Study findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER NCT05344170.
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Affiliation(s)
- Isobel Lavender
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Danielle McCartney
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Nathaniel Marshall
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Anastasia Suraev
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Irwin
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Angela L D'Rozario
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Christopher J Gordon
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| | - Bandana Saini
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- CPC-RPA clinic, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Brendon Yee
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
- CPC-RPA clinic, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Iain McGregor
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Basheti MM, Bawa Z, Grunstein R, Grivell N, Saini B, Gordon CJ. Improving sleep health management in primary care: A potential role for community nurses? J Adv Nurs 2023; 79:2236-2249. [PMID: 36756941 PMCID: PMC10952398 DOI: 10.1111/jan.15577] [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: 07/28/2022] [Revised: 12/13/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
AIMS To explore community nurses sleep health practices and their perspectives on improving sleep health care provision. DESIGN An exploratory study utilizing the qualitative description methodology. METHODS Semi-structured interviews were conducted with community nurses from May 2019 - October 2021. Interviews were audio-recorded, transcribed, and subjected to an inductive thematic analysis using a constructivist-interpretive paradigm. RESULTS Twenty-three Australian community nurses were interviewed. Participants frequently encountered sleep disturbances/disorders in their patients. Data analysis yielded three main themes: (1) Sleep health in the community serviced, (2) sleep health awareness and management, and (3) community nurses' A to Z of improving sleep health. The most common sleep disorder presentations were insomnia and sleep apnea. Although most community sleep apnea cases were appropriately managed, insomnia was often mismanaged. Participants described their sleep health knowledge as deficient, with the majority advocating for increased sleep-related education tailored to their profession. Other important factors needed for improving sleep health provision were standardized patient treatment/referral pathways, increased interprofessional collaboration, and sufficient time for patient consults. CONCLUSION Community nurses service a patient population that requires increased sleep health care. However, they are currently underequipped to do so, leading to suboptimal treatment provision. Providing community nurses with the appropriate resources, such as increased sleep-related education and standardized treatment frameworks, could enable them to better manage sleep disturbance/disorder presentations, such as insomnia. IMPACT Little is known about how community nurses care for patients with sleep disturbance/sleep disorders. This study found that contemporary sleep health care was lacking due to knowledge deficits, competing challenges, and a need for standardized care pathways. These findings can inform the development of targeted education/training and standardized guidelines for community nurses providing sleep health care to patients as well as the design of future practice models of care provision. PATIENT OR PUBLIC CONTRIBUTION Previous research by authors has involved extensive engagement with patients and health professionals, such as community pharmacists, general practitioners, and naturopaths who play a role in sleep health in the primary health care sector. These previous research projects built a significant understanding of the patient and health practitioner experience and have provided the background to the concept and design of this study.
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Affiliation(s)
- Mariam M. Basheti
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
- Sleep and Circadian Research GroupWoolcock Institute of Medical ResearchSydneyNew South WalesAustralia
| | - Zeeta Bawa
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
- Brain and Mind Centre, School of Psychology, Faculty of ScienceThe University of SydneyCamperdownNew South WalesAustralia
- Lambert Initiative for Cannabinoid TherapeuticsThe University of SydneyCamperdownNew South WalesAustralia
| | - Ronald Grunstein
- Sleep and Circadian Research GroupWoolcock Institute of Medical ResearchSydneyNew South WalesAustralia
- School of Medicine, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
- Royal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Nicole Grivell
- Adelaide Institute for Sleep Health/FHMRI Sleep, College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
- Sleep and Circadian Research GroupWoolcock Institute of Medical ResearchSydneyNew South WalesAustralia
| | - Christopher J. Gordon
- Sleep and Circadian Research GroupWoolcock Institute of Medical ResearchSydneyNew South WalesAustralia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
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Bawa Z, Saini B, McCartney D, Bedoya-Pérez M, McLachlan AJ, McGregor IS. A cross-sectional survey exploring the knowledge, experiences and attitudes of Australian pharmacists toward medicinal cannabis. Int J Clin Pharm 2023; 45:375-386. [PMID: 36446995 PMCID: PMC9708126 DOI: 10.1007/s11096-022-01519-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Australian pharmacists currently dispense a wide range of prescription-only cannabis-based medicines. Recent regulatory changes will expand the role of pharmacists, allowing certain low-dose cannabidiol products to be supplied without a prescription in pharmacies. This harmonises Australia with many other countries where cannabidiol products are readily available to consumers. AIM To examine Australian pharmacists' experience, knowledge and attitudes towards medicinal cannabis and their preparedness to supply over-the-counter low-dose cannabidiol products. METHOD We conducted a cross-sectional study using a 51-item on-line questionnaire that was informed by previous surveys of health professionals and assessed for face validity. Australian pharmacists were recruited to complete the survey between May and December 2021, primarily through professional pharmacy organisations. Pharmacists were included in the final dataset if they completed the demographic characteristics section and at least one additional section of the questionnaire. Data were analysed using descriptive and relational statistical tests. RESULTS There were 272 attempts to complete this survey and 217 responses included in the final dataset. Over half of the respondents (60.0%, 130/217) had dispensed at least one medicinal cannabis prescription during their career and 58.5% (127/217) had received at least one medicinal cannabis enquiry in the last fortnight. Only around half (53.9%, 117/217) felt comfortable supplying medicinal cannabis products and fewer (39.3%, 79/201) were confident discussing cannabis-related enquiries. More than half of the respondents (58.7%, 118/201) supported the provision of low-dose cannabidiol products through pharmacies. Two-thirds (67.8%, 80/118) of respondents achieved relatively low scores (< 60%) in the knowledge component of the survey. Most respondents (94.2%, 178/189) endorsed a need for further training in this area. CONCLUSION Australian pharmacists tended to support medicinal cannabis availability and improved access to low-dose cannabidiol products via pharmacies. However, results highlight a need for improved training and education of pharmacists around cannabis-based medicines.
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Affiliation(s)
- Zeeta Bawa
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - Bandana Saini
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Danielle McCartney
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Miguel Bedoya-Pérez
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, NSW, Australia.
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia.
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Sweetman A, Lovato N, Chai-Coetzer CL, Saini B. De-prescribing long-term use of benzodiazepines in primary care practice: where to next? Sleep 2023; 46:7026163. [PMID: 36738299 DOI: 10.1093/sleep/zsad015] [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] [Received: 12/19/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Alexander Sweetman
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Nicole Lovato
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Ching Li Chai-Coetzer
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.,Respiratory and Sleep Service, Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Bandana Saini
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.,School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
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Judge DJ, Miller CB, Bartlett DJ, Jomaa I, Wong KKW, Saini B, Semsarian CR, Espie CA, Kyle SD, Grunstein RR, Yee BJ, Marshall NS. Armodafinil to reduce the sleepiness related side-effects of sleep restriction therapy being used to treat insomnia disorder: An open label clinical trial pilot study compared with historical controls. J Sleep Res 2023; 32:e13699. [PMID: 36003019 PMCID: PMC10909410 DOI: 10.1111/jsr.13699] [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: 03/14/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 02/03/2023]
Abstract
Sleep restriction therapy (SRT) is an effective stand-alone behavioural intervention for insomnia disorder. However, its daytime side effects, particularly sleepiness, may be troubling for patients and/or may be a necessary part of the patient's treatment journey. This pilot trial aims to explore the potential benefit of armodafinil, a wakefulness promoter. Patients were treated with SRT with open label adjunctive armodafinil (150 mg/day). Thirty-three patients from previous studies that have undergone exactly the same SRT intervention acted as controls. The primary outcome measure was the insomnia severity index (ISI), and secondary outcomes were the Epworth sleepiness scale, sleep restriction adherence scale (SRAS), and safety from baseline through to 12 weeks. We recruited 25 patients into the trial. Data for the primary end point (ISI at 12 weeks) was available for 20 of the participants. The baseline insomnia severity index was 20.2 (SD 3.3) and decreased to 9.1 (SE 1.1), with no change, to 10.2 and 11.2 at weeks 6 and 12 respectively (all p > 0.05 compared with baseline). The insomnia severity index values for armodafinil patients were statistically inferior to historical controls at the primary time point of 12 weeks (11.2 vs. 6.7, p < 0.01). Sleep restriction therapy plus armodafinil treatment was associated with frequent minor side effects but was generally safe and acceptable to patients. Sleep restriction therapy was associated with a robust clinical response in the insomnia severity index values for insomnia patients. Based upon historical control data, armodafinil does not appear to have beneficial adjunctive effects in addition to sleep restriction therapy alone.
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Affiliation(s)
- Daniel J. Judge
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Department of Respiratory and Sleep Medicine, RPAHSydney Local Health DistrictSydneyNew South WalesAustralia
- Department of Respiratory and Sleep MedicineCairns HospitalQueenslandAustralia
| | - Christopher B. Miller
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Big Health LtdLondonUK
| | - Delwyn J. Bartlett
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Ibrahim Jomaa
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Keith K. W. Wong
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Department of Respiratory and Sleep Medicine, RPAHSydney Local Health DistrictSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Bandana Saini
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Caitlin R. Semsarian
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Colin A. Espie
- Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience InstituteUniversity of OxfordOxfordUK
| | - Simon D. Kyle
- Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience InstituteUniversity of OxfordOxfordUK
| | - Ron R. Grunstein
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Department of Respiratory and Sleep Medicine, RPAHSydney Local Health DistrictSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Brendon J. Yee
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Department of Respiratory and Sleep Medicine, RPAHSydney Local Health DistrictSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Nathaniel S. Marshall
- NeuroSleep and Woolcock Institute of Medical ResearchUniversity of Sydney, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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11
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Lartey ST, Lung T, Serhal S, Bereznicki L, Bereznicki B, Emmerton L, Bosnic-Anticevich S, Saini B, Billot L, Krass I, Armour C, Jan S. Healthcare expenditure and its socio-demographic and clinical predictors in Australians with poorly controlled asthma. PLoS One 2023; 18:e0279748. [PMID: 36603182 PMCID: PMC9815839 DOI: 10.1371/journal.pone.0279748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 12/01/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Asthma has substantial and increasing health and economic burden worldwide. This study aimed to estimate healthcare expenditure and determine the factors that increase expenditure in Australians with poorly controlled asthma. METHODS Individuals ≥18 years of age with poorly controlled asthma, as determined by a score ≥1.5 on the Asthma Control Questionnaire, were included in the study. Healthcare utilization costs from medical services and medications were estimated over an average follow-up of 12 months from administratively linked data: the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. A generalized linear model with gamma distribution and log link was used to predict participants' key baseline characteristics associated with variations in healthcare costs. RESULTS A total of 341 participants recruited through community pharmacies were included. The mean (standard deviation, SD) age of participants was 56.6 (SD 17.6) years, and approximately 71% were females. The adjusted average monthly healthcare expenditure per participant was $AU386 (95% CI: 336, 436). On top of the average monthly costs, an incremental expenditure was found for each year increase in age ($AU4; 95% CI: 0.78, 7), being unemployed ($AU201; 95% CI: 91, 311), one unit change in worsening quality of life ($AU35; 95% CI: 9, 61) and being diagnosed with depression and anxiety ($AU171; 95% CI: 36, 306). CONCLUSIONS In a cohort of Australian patients, characterized by poor asthma control and co-morbidities individuals impose substantial economic burden in terms of Medicare funded medical services and medications. Programs addressing strategies to improve the quality of life and manage co-morbid anxiety and depression and encourage asthma patients' engagement in clinically tolerable jobs, may result in significant cost savings to the health system.
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Affiliation(s)
- Stella T. Lartey
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
- NIHR Applied Research Collaboration, East of England, United Kingdom
- * E-mail:
| | - Thomas Lung
- The George Institute for Global Health, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Serhal
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Luke Bereznicki
- College of Health and Medicine, University of Tasmania, Hobart, Australia
| | | | - Lynne Emmerton
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Laurent Billot
- The George Institute for Global Health, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ines Krass
- School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Carol Armour
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Central Sydney Area Health Service, Sydney, New South Wales, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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12
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Loh ZC, Hussain R, Balan S, Saini B, Muneswarao J, Ong SC, Babar ZUD. Perceptions, attitudes, and behaviors of asthma patients towards the use of short-acting β2-agonists: A systematic review. PLoS One 2023; 18:e0283876. [PMID: 37079594 PMCID: PMC10118161 DOI: 10.1371/journal.pone.0283876] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/17/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Short-acting β2-agonists (SABA), the most potent and rapid-acting relievers are commonly used to provide quick relief of asthma symptoms. However, there is an increasing concern regarding the misuse of SABA medicines. OBJECTIVE This qualitative systematic review aims to determine, evaluate, and summarize the perceptions, attitudes, and behaviors towards the use of SABA from the patients' perspectives. METHODS The databases searched included PubMed, Scopus, PsycINFO, CINAHL, and Cochrane database. Original research articles reporting the perceptions, attitudes, or behaviors of asthma patients towards the use of SABA, which was available as full text, published in the English language between the year 2000 and February 2023 were included in the review. Commentaries, letters to editor, review articles, and conference proceedings were excluded. RESULTS A total of five articles were included. Six overarching themes were obtained: (1) perceptions on health status; (2) perceptions and attitudes towards the impact of asthma; (3) perceptions towards asthma control; (4) perceptions towards asthma knowledge; (5) risk perceptions; (6) perceptions, attitudes, and behaviors towards the use of SABA. CONCLUSION Despite the fact that SABA could rapidly alleviate asthma symptoms, SABA over-users were less likely to describe their health status and asthma control as 'excellent'. Most SABA over-users did not know that frequent SABA usage would worsen their asthma control, and they exhibited psychological linkage towards the use of SABA. Collaborative efforts between policymakers, healthcare professionals and patients are warranted to reconstruct SABA prescribing practice and usage.
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Affiliation(s)
- Zhe Chi Loh
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
| | - Rabia Hussain
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
| | - Shamala Balan
- Pharmacy Department, Hospital Tengku Ampuan Rahimah, Klang, Selangor, Malaysia
| | - Bandana Saini
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jaya Muneswarao
- Pharmacy Department, Hospital Pulau Pinang, George Town, Pulau Pinang, Malaysia
| | - Siew Chin Ong
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
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13
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Ong JA, Rego J, Ung T, Kumar S, Ash K, Saini B, Yates P. Palliative care education in an Australian undergraduate pharmacy curriculum: an exploratory descriptive study. International Journal of Pharmacy Practice 2022; 31:218-224. [PMID: 36541698 DOI: 10.1093/ijpp/riac093] [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] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
Abstract
Objectives
To examine the self-perceived knowledge, confidence and preparedness of undergraduate pharmacy students to provide palliative care.
Methods
A descriptive exploratory analysis was conducted in 2021 at an Australian university involving final-year pharmacy students (n = 200) who were provided with the opportunity to complete a survey on self-perceived knowledge, confidence and preparedness overall and with respect to a range of graduate capabilities which are essential to provide care in palliative care settings. Key capability areas include: communication, showing empathy, making clinical judgements and self-reflection. This was measured using the Palliative Care Curriculum for Undergraduates Questionnaire which was distributed electronically. Descriptive statistics were undertaken and Mann–Whitney U tests were used to explore any differences in outcomes with respect to factors related to demographics, personal experience and education. Thematic analysis was utilised for qualitative data.
Key findings
Forty-five percent of the student cohort (n = 89) responded, 70% of whom were female, and the median age for students was 22 years. Median scores (interquartile range) were modest for overall self-perceived knowledge: 5.0 (3.0–5.0), confidence: 4.0 (3.0–5.0) and preparedness: 4.0 (2.5–5.0). Students who had participated in learning about palliative care through clinical placements (n = 25, 28%), self-directed learning activities (n = 18, 20%) or case-/problem-based learning (n = 14, 16%) demonstrated a statistically significant increase in overall preparedness (P = 0.017), confidence with specific capabilities including evidence-based practice (P = 0.013), responding to medication queries (P < 0.05) and managing symptoms other than pain (P = 0.018).
Conclusions
Findings suggest students were confident to manage symptoms and medication-related issues but less confident to address distress or discuss sensitive matters with patients and their families. There may be a need for greater exposure and practical experience in palliative care settings.
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Affiliation(s)
- Jennifer A Ong
- University of Sydney School of Pharmacy , New South Wales , Australia
| | - Joanna Rego
- Queensland University of Technology School of Nursing , Brisbane , Australia
| | - Tina Ung
- University of Sydney School of Pharmacy , New South Wales , Australia
| | - Shweta Kumar
- University of Sydney School of Pharmacy , New South Wales , Australia
| | - Kylie Ash
- Queensland University of Technology School of Nursing , Brisbane , Australia
| | - Bandana Saini
- University of Sydney School of Pharmacy , New South Wales , Australia
| | - Patsy Yates
- Queensland University of Technology School of Nursing , Brisbane , Australia
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14
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Serhal S, Krass I, Emmerton L, Bereznicki B, Bereznicki L, Bosnic-Anticevich S, Saini B, Billot L, Armour C. Patient uptake and outcomes following pharmacist-initiated referrals to general practitioners for asthma review. NPJ Prim Care Respir Med 2022; 32:53. [DOI: 10.1038/s41533-022-00315-6] [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] [Received: 04/20/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
AbstractUptake and outcomes of pharmacist-initiated general practitioner (GP) referrals for patients with poorly controlled asthma were investigated. Pharmacists referred at-risk patients for GP assessment. Patients were categorized as action takers (consulted their GP on pharmacist’s advice) or action avoiders (did not action the referral). Patient clinical data were compared to explore predictors of uptake and association with health outcomes. In total, 58% of patients (n = 148) received a GP referral, of whom 78% (n = 115) were action takers, and 44% (n = 50) reported changes to their asthma therapy. Patient rurality and more frequent pre-trial GP visits were associated with action takers. Action takers were more likely to have an asthma action plan (P = 0.001) at month 12, and had significantly more GP visits during the trial period (P = 0.034). Patient uptake of pharmacist-initiated GP referrals was high and led to GP review and therapy changes in patients with poorly controlled asthma.
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15
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Nassar RI, Saini B, Obeidat NM, Atatreh N, Basheti I. Assessing adherence to medications: Is there a difference between a subjective method and an objective method, or between using them concurrently? Pharm Pract (Granada) 2022; 20:2723. [PMID: 36793904 PMCID: PMC9891798 DOI: 10.18549/pharmpract.2022.4.2723] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/05/2022] [Indexed: 12/13/2022] Open
Abstract
Background Patients' adherence to medication can be assessed by several subjective or objective methods. The Global Initiative for Asthma (GINA) has recommended the use of both measures simultaneously. Objective To assess patients' adherence to medication using a subjective or an objective method separately, and via using a combination of both methods. As well as identifying the degree of agreement between the two methods. Methods Participants who met the study inclusion criteria completed the Adherence to Asthma Medication Questionnaire (AAMQ). A retrospective audit was conducted in order to extract pharmacy refill records for the previous twelve months. The patients' pharmacy refill records were expressed using the Medication Possession Ratio (MPR). Data were analyzed using the Statistical Package for Social Science. The degree of agreement was determined by Cohen's kappa coefficient (κ). Results In terms of the difference in the ability of each method to identify non-adherent patients, a higher percentage of non-adherent patients were identified using the self-reported AAMQ (61.4%) compared to the pharmacy refill records (34.3%). When both methods, in combination, were used to assess adherence, the percentage of non-adherent patients was 80.0%, which is higher than each method when used separately. Twenty percent of the patients were considered adherent on both assessment methods, while 15.7% were considered non-adherent via both methods. Consequently, the AAMQ and pharmacy refill records agreed on 35.7% of the patients. The degree of agreement analysis showed a low correlation between the two methods. Conclusion The combination strategy resulted in a higher percentage of non-adherent patients, compared to using a subjective (the AAMQ) or an objective (the pharmacy refill records) method. The GINA guideline proposition may be supported by the present study's findings.
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Affiliation(s)
- Razan I Nassar
- MSc. Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
| | - Bandana Saini
- PhD. Professor in Clinical Pharmacy, College of Pharmacy, University of Sydney, Sydney, Australia.
| | - Nathir M Obeidat
- PhD. Professor in Medicine, Faculty of Medicine, The University of Jordan, Amman, Jordan, Department of Internal Medicine, Respiratory and Sleep Medicine, Jordan University Hospital.
| | - Noor Atatreh
- PhD. College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates, AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates.
| | - Iman Basheti
- PhD. Faculty of Pharmacy, Applied Science Private University, 11931, Amman, Jordan; Faculty of Pharmacy, The University of Sydney, 2006, Sydney, Australia.
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16
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Bhowmik MD D, Das C, Verma P, Maity I, Mourya B, Saini B, Subbiah A, Bagchi S, Yadav R, Mahajan S, Agarwal S. POS-039 RENAL ABSCESSES (COMPLICATED BY ACUTE KIDNEY INJURY) IN YOUNG OTHERWISE HEALTHY NON-DIABETIC ADULTS WITHOUT URINARY TRACT ABNORMALITIES – A CASE SERIES. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.07.056] [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: 10/14/2022] Open
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17
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Basheti MM, Tran M, Wong K, Gordon C, Grunstein R, Saini B. Australian Consultant Pharmacists' Potential Roles in Sleep Health Care: Exploring a New Avenue for Improving the Management of Insomnia. Behav Sleep Med 2022; 20:622-637. [PMID: 34520308 DOI: 10.1080/15402002.2021.1975718] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The first-line treatment for insomnia is cognitive-behavioral therapy. However, there is persistent use of pharmacotherapy, particularly, sedative-hypnotics. Consultant pharmacists can provide medication review services for people using multiple medications. Therefore, they are well placed to provide sleep health/insomnia care with regard to sedative-hypnotic use and behavioral treatment recommendations/sleep health education. However, this avenue is, as yet, unexplored. OBJECTIVES To explore consultant pharmacists' current sleep health-related provisions and what their perspectives are around developing/implementing a consultant pharmacist-led behavioral service for insomnia. METHODS Qualitative semi-structured interviews were conducted with a convenience-based sample of consultant pharmacists. Interviews were audio-recorded, transcribed, and inductively analyzed. RESULTS Twenty-four consultant pharmacists were interviewed. Three themes were gauged: 1) Trivializing insomnia and sleep health, 2) Providing patient-centered care, 3) Service implementation - What do we need to consider? Participants commonly dealt with older patients and frequently encountered patients with sleep complaints/taking sleep medications. Generally, it was believed that sleep health was given minimal priority, with other comorbidities taking precedence in health provisions. Patients' attitudes toward management approaches were regarded critical to future treatment developments. While interested in expanding their sleep health/insomnia practice, participants expressed the need for appropriate education/training, funding, and collaborative treatment frameworks. CONCLUSION Insomnia/sleep health concerns are growing. Primary health professionals need to scale up their sleep health-care provisions to accommodate for this health demand. Consultant pharmacists are interested/willing to expand their sleep-related practice and provide evidence-based insomnia therapies; however, factors such as education/training, service configuration support, and patient attitudes should be addressed.
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Affiliation(s)
- Mariam M Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Cirus, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Minh Tran
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Australian Association of Consultant Pharmacy, Australia
| | - Keith Wong
- Cirus, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,School of Medicine, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Christopher Gordon
- Cirus, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Ronald Grunstein
- Cirus, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,School of Medicine, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Cirus, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia
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18
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Gudka S, Haynes E, Scotney J, Mukherjee S, Frenkel S, Sivam S, Swieca J, Chamula K, Cunnington D, Saini B. Narcolepsy: Comorbidities, complexities and future directions. Sleep Med Rev 2022; 65:101669. [PMID: 36037569 DOI: 10.1016/j.smrv.2022.101669] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/09/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/15/2022]
Abstract
Patients with narcolepsy live with a lifelong sleep-wake disorder, impairing their quality of life, productivity, educational and employment outcomes. Clinicians are becoming aware that a significant aspect of the burden of this disease relates to frequent comorbid conditions, including aspects of the patient's emotional, metabolic, sleep and immune health. This review explores the literature describing the comorbidities seen in patients with narcolepsy, to enhance understanding of these often complex presentations. It hopes to encourage a multidisciplinary approach, to collaborate with patients and a broad clinical team, and to maximise clinical and quality of life outcomes, for those living with narcolepsy.
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Affiliation(s)
- Sajni Gudka
- Urban Impact Project and Adjunct Senior Research Fellow, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Emma Haynes
- Urban Impact Project and Research Fellow, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | | | - Sutapa Mukherjee
- Respiratory and Sleep Medicine, Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University and Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | | | - Sheila Sivam
- Woolcock Institute of Medical Research, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - John Swieca
- Sleep Doctors Australia, Melbourne Sleep Disorders Centre, VIC, Australia
| | | | | | - Bandana Saini
- Woolcock Institute of Medical Research, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
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19
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Malhotra V, Harnett J, McIntyre E, Steel A, Wong K, Saini B. To "tell or not to tell"-Exploring disclosure about medicine use by people living with sleep disorders. J Integr Med 2022; 20:338-347. [PMID: 35440415 DOI: 10.1016/j.joim.2022.03.004] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the difference in rates and reasons for disclosure of either conventional or complementary medicine (CM) to healthcare practitioners between people living with sleep disorders (SDs) and those without SDs. METHODS A cross-sectional survey (N = 2019 adults) that measured sociodemographic characteristics, health status, health service utilisation, health literacy and health communication (medicine disclosure) of a representative sample of Australians was conducted. Data from participants reporting an SD (n = 265) were compared to those not reporting an SD to assess measures of health communication and disclosure about medicine use. RESULTS Overall, rates of medicine disclosure to both conventional and CM practitioners were high, in respondents with (70%) and without an SD (57%). Those reporting an SD had higher expectations of their conventional health practitioner's knowledge of CM, associated clinical decision-making skills, and approval of CM use, and held a higher degree of concern about drug interactions (P < 0.05). The main reasons cited for disclosing CM use to conventional health practitioners and conventional medicine use to CM practitioners were "I want them to fully understand my health status" and "I was concerned about drug interactions with the CMs used." CONCLUSION The high rate of medicine use disclosure by people with SDs is driven by an intention to inform their healthcare practitioner about their health status and concerns about potential medicine interactions. Therefore, research about the expectations that people with an SD have of their conventional healthcare practitioners' knowledge of CM and CM-drug interactions requires further examination. Likewise, further examination of CM practitioner's conventional medicine knowledge is encouraged.
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Affiliation(s)
- Vibha Malhotra
- School of Pharmacy, Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales 2006, Australia
| | - Joanna Harnett
- School of Pharmacy, Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales 2006, Australia; The Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, the University of Technology, Sydney, New South Wales 2007, Australia.
| | - Erica McIntyre
- The Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, the University of Technology, Sydney, New South Wales 2007, Australia; Institute for Sustainable Futures, the University of Technology, Sydney, New South Wales 2007, Australia
| | - Amie Steel
- The Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, the University of Technology, Sydney, New South Wales 2007, Australia
| | - Keith Wong
- The Woolcock Institute of Medical Research, the University of Sydney, Sydney, New South Wales 2037, Australia; Sydney Medical School, Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales 2006, Australia; Department of Respiratory & Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales 2006, Australia; The Woolcock Institute of Medical Research, the University of Sydney, Sydney, New South Wales 2037, Australia
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20
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Alzayer R, Almansour HA, Basheti I, Chaar B, Al Aloola N, Saini B. Asthma patients in Saudi Arabia - preferences, health beliefs and experiences that shape asthma management. Ethn Health 2022; 27:877-893. [PMID: 32931314 DOI: 10.1080/13557858.2020.1817868] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
UNLABELLED Objectives: The aim of this study was to explore the experience of Saudi participants in managing their asthma and their perspectives about using future pharmacy-based services for asthma management. METHODS Semi-structured interviews were conducted with adult Saudis with asthma or those who were a carer of a child with asthma. Participants were recruited from medical practices and community centres in Riyadh, Saudi Arabia. Verbatim transcribed interviews were inductively analysed using thematic analysis. RESULTS Twenty-three Saudi participants with asthma or caring for those with asthma took part in interviews which lasted on average for 25 min. Most participants did not have well-controlled asthma. Thematic analyses of the interview transcripts highlighted four key emergent themes: participants experience of asthma, participants' beliefs and perceptions about health and medicines, perception of health professionals and advocacy and social support. Many participants expressed an emotional burden in their lived experience of asthma. Lack of self-management skills were evident in participants' reluctance to make decisions in emergency situations. Some participants had strong beliefs about using herbal medicines rather than western medicines. Using social media or consulting with their family members with asthma was a common preference, rather than consulting healthcare professionals. Participants' were rather unclear about pharmacy asthma care services and reported not having experienced such services in their pharmacies. CONCLUSION Inadequate self-management behaviours may affect the level of asthma control in people with asthma in Saudi Arabia. Improved primary care models with extensive focus on asthma education are needed to relieve the over-reliance on tertiary care help-seeking models that are currently the norm. Current evidence-based information also needs to be prepared in patient friendly formats and disseminated widely. Community pharmacists would need to be trained and skilled inpatient engagement and would have to win the public trust for viable asthma services provision.
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Affiliation(s)
- Reem Alzayer
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Hadi A Almansour
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Iman Basheti
- Vice President and Dean of the Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Betty Chaar
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Noha Al Aloola
- College of Pharmacy, Clinical Pharmacy Department, King Saud University, Riyadh, Saudi Arabia
| | - Bandana Saini
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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21
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Nassar RI, Saini B, Obeidat NM, Basheti IA. Development and validation of the Adherence to Asthma Medication Questionnaire (AAMQ). Pharm Pract (Granada) 2022; 20:2673. [PMID: 35919791 PMCID: PMC9296092 DOI: 10.18549/pharmpract.2022.2.2673] [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] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 11/14/2022] Open
Abstract
Background: Adherence to medication is the cornerstone to achieve the best treatment outcome. Pharmacists are healthcare professionals found in a pivotal position to assess asthmatic patients’ adherence to medication. A brief, reliable, and valid measure of patients adherence to mediations is useful to enable the pharmacists to deliver that vital service. Objective: To develop a reliable and valid adherence assessment tool for asthmatic patients. Methods: The Adherence to Asthma Medication Questionnaire (AAMQ-13) was developed based on an extensive literature review, followed by applying the Delphi technique, and then it was pilot-tested by 55 patients. The final AAMQ-13 was completed by 213 patients. Psychometric evaluation was assessed including reliability, criterion validity, and construct validity. Results: The AAMQ-13 is a feasible 13-item questionnaire, as it can be completed within an average of two minutes. It has high reliability (Cronbach’s alpha= 0.87). Criterion-concurrent validity was established by comparing the AAMQ-13 to the Test of the Adherence to Inhaler (TAI) and the pharmacy refill records. Criterion-convergent validity was established by comparing the AAMQ-13 to the Asthma Control Test (ACT) questionnaire and the Positive Health Behaviors Scale (PHBS). Construct validity was established through AAMQ-13 factor analysis which revealed two factors explaining 51.76% of the total variance. Conclusion: The AAMQ-13 is a reliable and valid questionnaire with several desirable characteristics as it has high reliability, good criterion validity, and strong construct validity. The AAMQ-13 is a suitable questionnaire that can identify non-adherent patients and reveal the reasons behind their non-adherence : Asthma; Adherence to medication; Compliance; Questionnaire; Self-report; Scale; Survey
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Affiliation(s)
- Razan I Nassar
- MSc. Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
| | - Bandana Saini
- PhD. Professor in Clinical Pharmacy, College of Pharmacy, The University of Sydney, Sydney, Australia.
| | - Nathir M Obeidat
- PhD. Professor in Medicine, Faculty of Medicine, The University of Jordan, Amman, Jordan.
| | - Iman A Basheti
- PhD. Professor in Clinical Pharmacy, Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Sciences Private University, Amman, Jordan.
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22
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Serhal S, Saini B, Bosnic-Anticevich S, Krass I, Emmerton L, Bereznicki B, Bereznicki L, Weier N, Mitchell B, Wilson F, Bawa Z, Wright B, Wilson K, Segrott R, Gomez M, Armour C. A Multi-Mode Education Program to Enhance Asthma Care by Pharmacists. Am J Pharm Educ 2022; 86:8633. [PMID: 34400397 PMCID: PMC10159417 DOI: 10.5688/ajpe8633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/09/2021] [Accepted: 08/09/2021] [Indexed: 05/06/2023]
Abstract
Objective. To provide optimal asthma care, community pharmacists must have advanced, contemporary knowledge, and the skills to translate that knowledge into practice. The development and evaluation of an innovative multi-mode education program to enhance pharmacists' clinical knowledge and practical skills is described.Methods. The online education modules were collaboratively developed alongside asthma and pharmacy organizations. The education program was comprised of five evidence-based education modules delivered online and a skills review conducted either in-person with real-time feedback (urban pharmacists) or via video upload and scheduled video-conference feedback (regional and remote pharmacists). A mixed methods approach was used to evaluate the feedback obtained from pharmacists to assess the content, efficacy, and applicability of the education.Results. Ninety-seven pharmacists opted into the program and successfully completed all education requirements. A larger proportion of pharmacists did not pass trial protocol-based education modules on their first attempts compared to the number that passed the asthma and medication knowledge-based modules. Prior to skills review, the proportion of pharmacists demonstrating device technique competency was suboptimal. Pharmacists rated the education modules highly in both quantitative and qualitative evaluations and reported that the program adequately prepared them to better deliver care to asthma patients.Conclusion. We developed, implemented, and evaluated a novel multi-mode asthma education program for community pharmacists that supports knowledge and practical skill development in this crucial area of patient care. The education program was well received by pharmacists. This form of education could be used more broadly in international collaborative trials.
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Affiliation(s)
- Sarah Serhal
- Woolcock Institute of Medical Research-Glebe, NSW, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research-Glebe, NSW, Australia
- The University of Sydney School of Pharmacy, Camperdown, NSW, Australia
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research-Glebe, NSW, Australia
- The University of Sydney School of Pharmacy, Camperdown, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | - Ines Krass
- The University of Sydney School of Pharmacy, Camperdown, NSW, Australia
| | - Lynne Emmerton
- Curtin University, Curtin Medical School, Perth, WA, Australia
| | - Bonnie Bereznicki
- University of Tasmania, Tasmanian School of Medicine, Hobart, Tasmania, Australia
| | - Luke Bereznicki
- University of Tasmania, School of Pharmacy and Pharmacology, Hobart, Tasmania, Australia
| | - Naomi Weier
- Pharmaceutical Society of Australia, Deakin, ACT, Australia
| | | | - Frances Wilson
- Woolcock Institute of Medical Research-Glebe, NSW, Australia
| | - Zeeta Bawa
- Woolcock Institute of Medical Research-Glebe, NSW, Australia
| | - Bronwen Wright
- Curtin University, Curtin Medical School, Perth, WA, Australia
| | - Kiara Wilson
- University of Tasmania, School of Pharmacy and Pharmacology, Hobart, Tasmania, Australia
| | | | | | - Carol Armour
- Woolcock Institute of Medical Research-Glebe, NSW, Australia
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23
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Serhal S, Armour C, Billot L, Krass I, Emmerton L, Saini B, Bosnic-Anticevich S, Bereznicki B, Bereznicki L, Shan S, Campain A. Integrating Pharmacy and Registry Data Strengthens Clinical Assessments of Patient Adherence. Front Pharmacol 2022; 13:869162. [PMID: 35401235 PMCID: PMC8990834 DOI: 10.3389/fphar.2022.869162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Accurate clinical assessment of patient adherence using reliable and valid measures is essential in establishing the presence of adherence issues and support practices for pharmacists.Objective: This investigation aims to conduct a novel assessment of patient adherence to asthma controller therapy by combining 1) patient-specific dosage data found in pharmacy dispensing data with 2) centrally collected administrative claims records, to determine the added value of using both sources of data.Methods: A total of 381 clinically uncontrolled asthma patients, from 95 community pharmacies across three Australian States were recruited and provided consent for the retrieval of their claims records and pharmacy dispensing data. Patients were stratified as multiple or single pharmacy users and adherence scores were calculated via the proportion of days covered (PDC) method using 1) patient claims records, 2) patient pharmacy dispensing data, and 3) combined claims records and pharmacy dispensing data. Cohort and subgroup adherence estimates were then compared.Results: Low levels of adherence were evident amongst the cohort irrespective of the data source used. PDC estimates based on claims records alone or combined claims records and pharmacy dispensing data were significantly higher than estimates based on pharmacy dispensing data for the total cohort (56%, 52%, 42% respectively, p < 0.001) and more noticeably for multiple pharmacy users (67%, 64%, 35% respectively, p < 0.001). PDC estimates based on combined claims records and pharmacy dispensing data were significantly lower than estimates based on claims records alone, indicating that perhaps standard daily dose is not a robust proxy for prescribed dosage to inhaled respiratory devices in adherence approximations. Poorer adherence was found amongst single pharmacy users than multiple pharmacy users when combined claims records and pharmacy dispensing data (46% compared to 64% respectively, p < 0.001) or claims records alone (51% compared to 67% respectively, p < 0.001) were compared.Conclusion: Access to routine collected data increases clinical acuity over patient adherence to asthma controller medications and is a valuable resource for health care professionals. A policy of secure accessibility of such data at the patient-pharmacist or patient-GP interface may allow real-time intervention and assist in decision making across numerous therapeutic areas.
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Affiliation(s)
- Sarah Serhal
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Sarah Serhal,
| | - Carol Armour
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute, Newtown, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ines Krass
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Lynne Emmerton
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | | | - Luke Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Sana Shan
- The George Institute, Newtown, NSW, Australia
| | - Anna Campain
- The George Institute, Newtown, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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24
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Menczel Schrire Z, Phillips CL, Chapman JL, Duffy SL, Wong G, D'Rozario AL, Comas M, Raisin I, Saini B, Gordon CJ, McKinnon AC, Naismith SL, Marshall NS, Grunstein RR, Hoyos CM. Safety of higher doses of melatonin in adults: A systematic review and meta-analysis. J Pineal Res 2022; 72:e12782. [PMID: 34923676 DOI: 10.1111/jpi.12782] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022]
Abstract
Melatonin is commonly used for sleep and jetlag at low doses. However, there is less documentation on the safety of higher doses, which are being increasingly used for a wide variety of conditions, including more recently COVID-19 prevention and treatment. The aim of this review was to investigate the safety of higher doses of melatonin in adults. Medline, Scopus, Embase and PsycINFO databases from inception until December 2019 with convenience searches until October 2020. Randomised controlled trials investigating high-dose melatonin (≥10 mg) in human adults over 30 years of age were included. Two investigators independently abstracted articles using PRISMA guidelines. Risk of bias was assessed by a committee of three investigators. 79 studies were identified with a total of 3861 participants. Studies included a large range of medical conditions. The meta-analysis was pooled data using a random effects model. The outcomes examined were the number of adverse events (AEs), serious adverse events (SAEs) and withdrawals due to AEs. A total of 29 studies (37%) made no mention of the presence or absence of AEs. Overall, only four studies met the pre-specified low risk of bias criteria for meta-analysis. In that small subset, melatonin did not cause a detectable increase in SAEs (Rate Ratio = 0.88 [0.52, 1.50], p = .64) or withdrawals due to AEs (0.93 [0.24, 3.56], p = .92), but did appear to increase the risk of AEs such as drowsiness, headache and dizziness (1.40 [1.15, 1.69], p < .001). Overall, there has been limited AE reporting from high-dose melatonin studies. Based on this limited evidence, melatonin appears to have a good safety profile. Better safety reporting in future long-term trials is needed to confirm this as our confidence limits were very wide due to the paucity of suitable data.
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Affiliation(s)
- Zoe Menczel Schrire
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
| | - Craig L Phillips
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Julia L Chapman
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
| | - Shantel L Duffy
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Grace Wong
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
| | - Angela L D'Rozario
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
| | - Maria Comas
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
| | - Isabelle Raisin
- University Library, The University of Sydney, Sydney, New South Wales, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Gordon
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew C McKinnon
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nathaniel S Marshall
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Healthy Brain Ageing Program, Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Centre for Sleep and Chronobiology, University of Sydney, Sydney, New South Wales, Australia
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25
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Serhal S, Mitchell B, Krass I, Emmerton L, Bereznicki B, Bereznicki L, Shan S, Billot L, Bosnic-Anticevich S, Saini B, Armour C. Rethinking the gold standard – The feasibility of randomized controlled trials within health services effectiveness research. Res Social Adm Pharm 2022; 18:3656-3668. [DOI: 10.1016/j.sapharm.2022.03.017] [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: 12/30/2021] [Revised: 02/24/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
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26
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Serhal S, Saini B, Bosnic-Anticevich S, Emmerton L, Bereznicki B, Bereznicki L, Mitchell B, Wright B, Wilson K, Krass I, Bec, Mecon SJ, Billot L, Armour C. Pharmacist-delivered asthma management services - what do patients think? J Am Pharm Assoc (2003) 2022; 62:1260-1269.e2. [DOI: 10.1016/j.japh.2022.02.009] [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: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
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27
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Leong CWY, Leow JWS, Grunstein RR, Naismith SL, Teh JZ, D’Rozario AL, Saini B. A systematic scoping review of the effects of central nervous system active drugs on sleep spindles and sleep-dependent memory consolidation. Sleep Med Rev 2022; 62:101605. [DOI: 10.1016/j.smrv.2022.101605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/15/2022] [Accepted: 01/26/2022] [Indexed: 11/26/2022]
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28
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Serhal S, Saini B, Bosnic-Anticevich S, Krass I, Emmerton L, Bereznicki B, Bereznicki L, Mitchell B, Wilson F, Wright B, Wilson K, Weier N, Segrott R, Cleveland R, Jan S, Shan S, Billot L, Armour C. A Targeted Approach to Improve Asthma Control Using Community Pharmacists. Front Pharmacol 2022; 12:798263. [PMID: 35024035 PMCID: PMC8743269 DOI: 10.3389/fphar.2021.798263] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 10/20/2021] [Accepted: 11/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Building on lessons learnt from evidence-based community pharmacy asthma management models, a streamlined and technology supported Pharmacy Asthma Service (PAS) was developed to promote the integration of the service into routine practice. Objective: This study investigates the efficacy of the PAS in improving asthma symptom control and other health outcomes. Methods: A two-arm pragmatic cluster randomized controlled trial was implemented in 95 pharmacies across three Australian States. Participants were adults with poorly controlled asthma as per the Asthma Control Questionnaire (ACQ), with or without allergic rhinitis. Patients within the PAS arm engaged in four consultations with the pharmacist over a 12-month period. An evidence-based algorithm guided pharmacies, via a trial specific software, to deliver a series of interventions targeting three issues underpinning uncontrolled asthma (medication use and adherence, inhaler technique, and allergic rhinitis management) to patient clinical asthma status and patient need. Comparator arm patients received a minimal intervention likened to usual practice involving referral of eligible patients to the GP and two follow-up consultations with their pharmacist to collect comparative data. Results: In total, 143 of 221 PAS patients (65%) and 111 of 160 comparator patients (69%) completed the trial. Improvements in asthma control were achieved in both the PAS (mean difference (MD) in ACQ from baseline = −1.10, p <.0001) and comparator (MD in ACQ from baseline = −0.94, p <.0001) arms at the trial end; however, there were no significant differences between the two arms (MD = −0.16, 95% CI −0.41 to 0.08, p = 0.19). Patients’ quality of life in the PAS arm improved significantly when compared with the comparator arm (MD in Impact of Asthma on Quality-of-Life Questionnaire (IAQLQ) = −0.52, 95% CI −0.89 to −0.14, p = 0.0079). Conclusion: Despite the PAS achieving a greater improvement in patients’ quality of life, the pharmacist-led service and usual practice arm produced comparable improvements in asthma control. These results ask us to reflect on current standards of usual care, as it appears the standard of asthma care in usual practice has evolved beyond what is reported in the literature.
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Affiliation(s)
- Sarah Serhal
- Woolcock Institute of Medical Research, Sydney, NSW, Australia.,School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, Sydney, NSW, Australia.,School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Central Sydney Area Health Service, Sydney, NSW, Australia
| | - Ines Krass
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Lynne Emmerton
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | | | - Luke Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | | | - Frances Wilson
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Bronwen Wright
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Kiara Wilson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Naomi Weier
- The Pharmaceutical Society of Australia, Deakin, ACT, Australia
| | | | - Rhonda Cleveland
- National Asthma Council Australia, South Melbourne, VIC, Australia
| | - Stephen Jan
- The George Institute, Newtown, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Sana Shan
- The George Institute, Newtown, NSW, Australia
| | - Laurent Billot
- The George Institute, Newtown, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Carol Armour
- Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Central Sydney Area Health Service, Sydney, NSW, Australia
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29
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Nassar RI, Basheti IA, Saini B. Exploring Validated Self-Reported Instruments to Assess Adherence to Medications Used: A Review Comparing Existing Instruments. Patient Prefer Adherence 2022; 16:503-513. [PMID: 35237029 PMCID: PMC8885149 DOI: 10.2147/ppa.s352161] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To provide an overview of instruments that measure adherence to medications to facilitate selection of an instrument and to provide a summary of some published adherence assessment tools tailored to be used by the healthcare team, especially the pharmacists. DATA SOURCES Studies were identified via PubMed, Medline, Embase, and Google Scholar using the search terms medication adherence, compliance, persistence, combined with the terms questionnaire, scale, survey, self-report, and instrument. STUDY SELECTION Articles written in English, describing questionnaire instruments that were psychometrically evaluated (reporting a good coefficient of internal consistency, reliability assessed through Cronbach's alpha, and had been validated against a subjective or objective measure), and containing 30 or fewer items were included. DATA SYNTHESIS Twelve instruments were identified and included in this review. Instruments were reviewed by evaluating specific characteristics (number of items, sample size, reliability, sensitivity, specificity, questionnaire completion time, criterion validity, and component analysis). CONCLUSION Various instruments are used to assess patient adherence to medications; however, no single one performs well on all criteria. Every instrument has different advantages and unique properties. A particular instrument can be chosen after considering certain factors, such as the specific requirements, population, the needed time to complete the questionnaire, the sensitivity, and the specificity of the questionnaire. Moreover, there is a recognized need to provide primary care medication adherence services customized to patient's needs. A link for teamwork between healthcare providers such as pharmacists and patients is needed. This link can be a validated instrument to assess patient's adherence to medication.
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Affiliation(s)
- Razan Izzat Nassar
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Iman Amin Basheti
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
- Correspondence: Iman Amin Basheti, Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan, P. O. Box 166, Email
| | - Bandana Saini
- College of Pharmacy, The University of Sydney, Sydney, NSW, Australia
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30
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Fino LB, Alsayed AR, Basheti IA, Saini B, Moles R, Chaar BB. Implementing and evaluating a course in professional ethics for an undergraduate pharmacy curriculum: A feasibility study. Curr Pharm Teach Learn 2022; 14:88-105. [PMID: 35125200 DOI: 10.1016/j.cptl.2021.11.031] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/23/2021] [Accepted: 11/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pharmacy practice today mandates "patient-centered care", thereby assigning higher levels of professional responsibility for pharmacists leading to ethical challenges. These challenges often involve ethical principles, institutional, personal, or other constraints that can pull practitioners in incompatible opposite directions, creating "ethical dilemmas" in many circumstances. Pharmacists are expected to handle challenges competently and in the best interest of patients. Literature underlines the positive impact of educational interventions focusing on ethical awareness and competence, and that "gaps" existed in pharmacy training/curricula for Jordanian pharmacists. The objective of this study was to develop, implement, and evaluate the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian university. EDUCATIONAL ACTIVITY AND SETTING Fifth-year pharmacy students attending summer school at a university in Jordan from July to September 2020 were invited to participate in an educational intervention (suite of didactic online lectures and skills-based workshops). This study was delivered in four parts, with a pretest administered immediately before and a posttest survey immediately after the educational intervention, the educational intervention (three phases), and focus-group discussions to elicit students' feedback. FINDINGS Findings indicated enhanced levels of confidence in students' decision-making. The development of students' moral reasoning and decision-making skills were also observed to be improved. SUMMARY This study highlighted the importance of the implementation of an ethics course in pharmacy undergraduate curricula. It emphasized the positive impact this course made on the students' learning experiences and provided a strong environment for discussion and group learning.
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Affiliation(s)
- Leen B Fino
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia; President of Applied Science Private University, Amman, Jordan.
| | - Ahmad R Alsayed
- President of Applied Science Private University, Amman, Jordan.
| | - Iman A Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia; President of Applied Science Private University, Amman, Jordan.
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia.
| | - Rebekah Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia.
| | - Betty B Chaar
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney NSW, 2006, Australia.
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31
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Stubbs MA, Clark VL, Cheung MMY, Smith L, Saini B, Yorke J, Majellano EC, Gibson PG, McDonald VM. The Experience of Living with Severe Asthma, Depression and Anxiety: A Qualitative Art-Based Study. J Asthma Allergy 2021; 14:1527-1537. [PMID: 34949926 PMCID: PMC8691197 DOI: 10.2147/jaa.s328104] [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] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Severe asthma, depression and anxiety often co-exist and increase disease burden. Currently there are no published studies investigating severe asthma and psychological comorbidity using arts-based methodology. We aimed to (i) illustrate the individual experience of adults living with severe asthma, with and without symptoms of depression and/or anxiety and (ii) to explore common characteristics depicted in artworks between those groups. Patients and Methods A qualitative arts-based study was conducted. Adults with severe asthma were categorised into two groups according to Hospital Anxiety and Depression Scale scores (<8 on either subscale [SA-D/A] (N=15) or (≥8 on one or both subscales [SA+D/A] (N=15). Art thematic analysis was undertaken using a hybrid approach. The Common-Sense Model of Self-Regulation was used to examine frequencies in artworks. Results Participants with severe asthma alone and severe asthma with depression/anxiety were of older age (median 67 and 63 years respectively). There was greater asthma QoL impairment in participants with psychological comorbidity than without (4.7 ± 8.3 versus 5.8 ± 0.85, p=<0.01). Analysis of art works identified three themes: (1) “darkness” depicting misery, isolation and sadness; (2) “impacts” describing physical and social consequences; and (3) “resilience” illustrating acceptance and perseverance of living with all three conditions. Conclusion Art-based research in severe asthma facilitates detailed exploration of intimate and individual experiences. Darkness, impacts and resilience are common themes emerging from artworks. Understanding these experiences may help guide assessment and treatment of psychological comorbidity in the clinic.
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Affiliation(s)
- Michelle A Stubbs
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, The University of Newcastle, Newcastle, New South Wales, Australia.,The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Vanessa L Clark
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, The University of Newcastle, Newcastle, New South Wales, Australia.,The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Melissa Mei Yin Cheung
- The University of Sydney Children's Hospital Westmead, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Lorraine Smith
- School of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
| | - Bandana Saini
- School of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia.,Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - Janelle Yorke
- School of Health Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Eleanor C Majellano
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, The University of Newcastle, Newcastle, New South Wales, Australia.,The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter G Gibson
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, The University of Newcastle, Newcastle, New South Wales, Australia.,The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council Centre for Research Excellence in Severe Asthma, The University of Newcastle, Newcastle, New South Wales, Australia.,The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
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Almansour HA, Aloudah NM, Alhawassi TM, Chaar B, Krass I, Saini B. Physicians' views on cardiovascular disease risk prevention services by pharmacists and potential for collaboration. Exploratory Research in Clinical and Social Pharmacy 2021; 4:100077. [PMID: 35479842 PMCID: PMC9029915 DOI: 10.1016/j.rcsop.2021.100077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/10/2021] [Accepted: 09/26/2021] [Indexed: 10/26/2022] Open
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Tang D, Dinh H, Almansour H, Burlutsky G, Bussing J, Eisenhauer B, Gopinath B, Flood VM, Saini B. Evaluation of educational interventions on eye health for dietetic and pharmacy professions: a pre-post study. BMC Med Educ 2021; 21:478. [PMID: 34493275 PMCID: PMC8424804 DOI: 10.1186/s12909-021-02905-3] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND We piloted an educational intervention that aimed to enhance awareness about nutrition-age-related macular degeneration (AMD) links among practising and student dietitians then expanded the scope of this intervention to include general eye health, which was delivered to pharmacy students. METHODS A pilot intervention was conducted in 2019 at the Dietitians Australia Conference (Gold Coast, Australia) where practising and student dietitians underwent a 2-hour small group educational workshop on nutrition and AMD links. Pre-post questionnaires were administered to participants, with voluntary completion of both questionnaires an indicator of consent to participate in the intervention. The primary intervention outcome was a change in AMD-related nutrition knowledge pre-post intervention. A larger intervention was then conducted at the University of Sydney (Sydney, Australia) where pharmacy students underwent a 4-hour educational module to improve general eye health knowledge, as well as student perceptions and attitudes towards a pharmacists' role in low vision care. Similarly, pre-post questionnaires were administered, with voluntary completion of both questionnaires an indicator of consent to participate in the intervention. The primary intervention outcomes were changes in total knowledge, total perception and total attitude scores pre-post intervention. RESULTS (1) Among 10 accredited and 5 student dietitians, there was significant overall knowledge improvement (mean pre-post score: 7.07 ± 1.94 vs. 10.8 ± 1.01, p = 0.001) specifically around appropriate dietary advice, food sources of key AMD-related nutrients, and awareness of supplements. (2) Among 179 second-year pharmacy students enrolled in the 'Pharmacy Practice' Unit of Study (Bachelor of Pharmacy, University of Sydney), total eye health knowledge (6.25 ± 1.93 vs. 6.64 ± 2.0; p = 0.011) significantly improved, along with total perception scores (41.54 ± 5.26 vs. 42.45 ± 4.95; p = 0.004). Total attitude scores were not significantly different. CONCLUSIONS The pilot intervention improved relevant nutrition-AMD knowledge among practising/student dietitians. The modified intervention for pharmacy students also significantly improved general eye health knowledge as well as students' perception of a pharmacists' role in low vision care.
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Affiliation(s)
- Diana Tang
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, 176 Hawkesbury Road, New South Wales, 2145, Sydney, Australia.
- Macquarie University Hearing, Macquarie University, North Ryde, New South Wales, Australia.
| | - Helen Dinh
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Hadi Almansour
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - George Burlutsky
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, 176 Hawkesbury Road, New South Wales, 2145, Sydney, Australia
| | - Jocelyn Bussing
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Bamini Gopinath
- Macquarie University Hearing, Macquarie University, North Ryde, New South Wales, Australia
| | - Victoria M Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Western Sydney Local Health District, Westmead Hospital, Westmead, New South Wales, Australia
| | - Bandana Saini
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Krishnapriya R, Nizamudeen C, Saini B, Mozumder MS, Sharma RK, Mourad AHI. MOF-derived Co 2+-doped TiO 2 nanoparticles as photoanodes for dye-sensitized solar cells. Sci Rep 2021; 11:16265. [PMID: 34381114 PMCID: PMC8358052 DOI: 10.1038/s41598-021-95844-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/28/2021] [Indexed: 11/11/2022] Open
Abstract
Facile synthesis and application of nano-sized semiconductor metal oxides for optoelectronic devices have always affected fabrication challenges since it involves multi-step synthesis processes. In this regard, semiconductor oxides derived directly from metal-organic frameworks (MOFs) routes have gained a great deal of scientific interest owing to their high specific surface area, regular and tunable pore structures. Exploring the application potential of these MOF-derived semiconductor oxides systems for clean energy conversion and storage devices is currently a hot topic of research. In this study, titanium-based MIL-125(Ti) MOFs were used as a precursor to synthesize cobalt-doped TiO2-based dye-sensitized solar cells (DSSCs) for the first time. The thermal decomposition of the MOF precursor under an air atmosphere at 400 °C resulted in mesoporous anatase-type TiO2 nanoparticles (NPs) of uniform morphology, large surface area with narrow pore distribution. The Co2+ doping in TiO2 leads to enhanced light absorption in the visible region. When used as photoanode in DSSCs, a good power conversion efficiency (PCE) of 6.86% with good photocurrent density (Jsc) of 13.96 mA cm-2 was obtained with the lowest recombination resistance and the longest electron lifetime, which is better than the performance of the pristine TiO2-based photoanode.
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Affiliation(s)
- R Krishnapriya
- Mechanical Engineering Department, College of Engineering, United Arab Emirate University, Al Ain 15551, UAE
- Department of Chemistry, Indian Institute of Technology Jodhpur, Jodhpur, 342037, Rajasthan, India
| | - C Nizamudeen
- Mechanical Engineering Department, College of Engineering, United Arab Emirate University, Al Ain 15551, UAE
| | - B Saini
- Department of Chemistry, Indian Institute of Technology Jodhpur, Jodhpur, 342037, Rajasthan, India
| | - M Sayem Mozumder
- Department of Chemical and Petroleum Engineering, College of Engineering, United Arab Emirate University, Al Ain, 15551, UAE
| | - Rakesh K Sharma
- Department of Chemistry, Indian Institute of Technology Jodhpur, Jodhpur, 342037, Rajasthan, India
| | - A-H I Mourad
- Mechanical Engineering Department, College of Engineering, United Arab Emirate University, Al Ain 15551, UAE.
- National Water and Energy Centre, United Arab Emirate University, Al Ain, 15551, UAE.
- On Leave From Mechanical Design Department, Faculty of Engineering, Helwan University, Cairo, Egypt.
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Haycock J, Grivell N, Redman A, Saini B, Vakulin A, Lack L, Lovato N, Sweetman A, Zwar N, Stocks N, Frank O, Mukherjee S, Adams R, McEvoy RD, Hoon E. Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners. BMC Fam Pract 2021; 22:158. [PMID: 34294049 PMCID: PMC8299615 DOI: 10.1186/s12875-021-01510-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/20/2021] [Indexed: 02/07/2023]
Abstract
Background Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line treatment for insomnia, however research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice. Methods A descriptive, pragmatic qualitative study. Purposive sampling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using thematic analysis. Results Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care; 2) Complexities in managing insomnia; and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited. Conclusions General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners. Greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services, such as benzodiazepine withdrawal support and psychologists, would benefit insomnia management within general practice.
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Affiliation(s)
- Jenny Haycock
- National Centre for Sleep Health Services Research, Adelaide, Australia. .,FHMRI Sleep Health/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Nicole Grivell
- National Centre for Sleep Health Services Research, Adelaide, Australia.,FHMRI Sleep Health/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Anne Redman
- National Centre for Sleep Health Services Research, Adelaide, Australia.,Sax Institute, Sydney, Australia
| | - Bandana Saini
- National Centre for Sleep Health Services Research, Adelaide, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andrew Vakulin
- National Centre for Sleep Health Services Research, Adelaide, Australia.,FHMRI Sleep Health/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Leon Lack
- National Centre for Sleep Health Services Research, Adelaide, Australia.,College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Nicole Lovato
- National Centre for Sleep Health Services Research, Adelaide, Australia.,FHMRI Sleep Health/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Alexander Sweetman
- National Centre for Sleep Health Services Research, Adelaide, Australia.,FHMRI Sleep Health/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Nicholas Zwar
- National Centre for Sleep Health Services Research, Adelaide, Australia.,Faculty of Health Sciences & Medicine, Bond University, Queensland, Robina, Australia
| | - Nigel Stocks
- National Centre for Sleep Health Services Research, Adelaide, Australia.,Discipline of General Practice, University of Adelaide, Adelaide, Australia
| | - Oliver Frank
- National Centre for Sleep Health Services Research, Adelaide, Australia.,Discipline of General Practice, University of Adelaide, Adelaide, Australia
| | - Sutapa Mukherjee
- National Centre for Sleep Health Services Research, Adelaide, Australia.,FHMRI Sleep Health/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Southern Adelaide Local Health Network, SA Health, Adelaide, Australia
| | - Robert Adams
- National Centre for Sleep Health Services Research, Adelaide, Australia.,FHMRI Sleep Health/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Southern Adelaide Local Health Network, SA Health, Adelaide, Australia
| | - R Doug McEvoy
- National Centre for Sleep Health Services Research, Adelaide, Australia.,FHMRI Sleep Health/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Elizabeth Hoon
- National Centre for Sleep Health Services Research, Adelaide, Australia.,Discipline of General Practice, University of Adelaide, Adelaide, Australia
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Affiliation(s)
- Sheila Sivam
- Royal Prince Alfred Hospital, Sydney, NSW.,Woolcock Institute of Medical Research, Sydney, NSW.,University of Sydney, Sydney, NSW
| | | | - John Swieca
- SleepDoctors Australia, Melbourne, VIC.,Melbourne Sleep Disorders Centre, Melbourne, VIC
| | | | - Bandana Saini
- Woolcock Institute of Medical Research, Sydney, NSW.,University of Sydney, Sydney, NSW
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Mohammad A, Saini B, Chaar BB. Pharmacists' experiences serving culturally and linguistically diverse patients in the Australian community pharmacy setting. Int J Clin Pharm 2021; 43:1563-1573. [PMID: 34076804 DOI: 10.1007/s11096-021-01284-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022]
Abstract
Background There has been no in depth published study to date reporting on community pharmacists' current experiences and their future practice needs relating to providing culturally competent pharmaceutical care to Australian culturally and linguistically diverse patients with low English proficiency. Objective To explore community pharmacists' experiences serving culturally and linguistically diverse patients who have low English proficiency. Setting Community pharmacists in Australia. Method Focus group discussions with practising community pharmacists were conducted. Participants were recruited from metropolitan Sydney. Discussion centred around their current experiences and practice changes needed to enhance the provision of culturally competent pharmaceutical care. Thematic analysis using the constant comparison method within a grounded theory approach was performed on the data collected. Main outcome measure Participants' experiences in providing culturally competent care to culturally and linguistically diverse patients with low English proficiency. Results Thirty community pharmacists participated in six focus group discussions. Inadequate provision of culturally competent care was found to be primarily due to the issue of language incongruence between pharmacist and patient. Participants proposed various means with which such care may be provided to ensure patient safety. Conclusion Pharmacist participants expressed being inadequately equipped to provide culturally competent care in the community setting and identified potential means by which such care may be delivered. Addressing identified barriers that hinder community pharmacists' capacity to engage in culturally competent practice can potentially improve provision of pharmaceutical care to culturally and linguistically diverse patients with low English proficiency.
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Affiliation(s)
- Annim Mohammad
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Bandana Saini
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Betty Bouad Chaar
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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Basheti IA, El‐hajji F, Nassar R, Thiab S, Barakat M, Basheti M, Berardi A, Saini B. Pharmacists' awareness of COVID-19 and perceptions of their roles, barriers, and roles of policymakers: Exploring the Middle East and North Africa (MENA). Int J Clin Pract 2021; 75:e14074. [PMID: 33550698 PMCID: PMC7995131 DOI: 10.1111/ijcp.14074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/03/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) was declared in January 2020 as a public health emergency of international concern. The Middle East and North Africa (MENA) suffered from several pandemics previously. Pharmacists have vital roles to play to prevent the spread of this virus. OBJECTIVES To assess the COVID-19 awareness amongst pharmacists from Arabic-speaking countries located in the MENA region, and to assess their perspectives of their role, barriers, and roles of the educational institutions/pharmaceutical associations. METHODS An online survey was conducted to run a descriptive cross-sectional study in Jordan from 12th to 22nd April 2020. The questionnaire was validated (face validity) and put on Facebook and directed for pharmacists only (clarified in the introduction of the questionnaire). Assessment of pharmacists' awareness (20 questions) about pandemics and COVID-19, their perceived roles and barriers, and roles of the educational institutions (eg, universities) and pharmaceutical associations (eg, Pharmacists Syndicate) was performed. Data were analysed using Statistical Package for the Social Science (SPSS). RESULTS Study participants (n = 2589) had a mean age of 29.3 (8.2) years and 1329 (51.5%) were females. Most of the participants were from Egypt (n = 819, 40.8%), followed by Jordan, Algeria, and Syria. Regarding the sources of information about coronavirus management, 60.8% of participants got their information from social media. Fear of contracting the coronavirus while performing their duties was reported by the majority of pharmacists as the main barrier to delivering their roles (82.3%). The majority of pharmacists identified positive roles for the pharmaceutical institutions (74.8%) and pharmaceutical associations (63.6%). CONCLUSION Pharmacists from the MENA countries believe they got enough education previously about pandemics, and the majority follow the latest coronavirus updates from social media. Fear was reported as the major barrier that requires resolution by the policymakers. Certain gaps in the awareness about COVID-19 were identified.
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Affiliation(s)
- Iman A. Basheti
- Department of Clinical Pharmacy and TherapeuticsFaculty of PharmacyApplied Science Private UniversityAmmanJordan
| | - Feras El‐hajji
- Department of Clinical Pharmacy and TherapeuticsFaculty of PharmacyApplied Science Private UniversityAmmanJordan
| | - Razan Nassar
- Department of Clinical Pharmacy and TherapeuticsFaculty of PharmacyApplied Science Private UniversityAmmanJordan
| | - Samar Thiab
- Department of Pharmaceutical Chemistry and PharmacognosyFaculty of PharmacyApplied Science Private UniversityAmmanJordan
| | - Muna Barakat
- Department of Clinical Pharmacy and TherapeuticsFaculty of PharmacyApplied Science Private UniversityAmmanJordan
| | | | - Alberto Berardi
- Department of Pharmaceutical Sciences and PharmaceuticsFaculty of PharmacyApplied Science Private UniversityAmmanJordan
| | - Bandana Saini
- College of PharmacyUniversity of SydneySydneyAustralia
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Tasai S, Kumpat N, Dilokthornsakul P, Chaiyakunapruk N, Saini B, Dhippayom T. Impact of Medication Reviews Delivered by Community Pharmacist to Elderly Patients on Polypharmacy: A Meta-analysis of Randomized Controlled Trials. J Patient Saf 2021; 17:290-298. [PMID: 30920431 DOI: 10.1097/pts.0000000000000599] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the impact of medication reviews delivered by community pharmacists to elderly patients on polypharmacy. METHODS A systematic literature search was performed in four bibliographic databases/search engine (PubMed, Embase, CENTRAL, and IPA) and three gray literature sources (OpenGrey, ClinicalTrials.gov, and Digital Access to Research Theses - Europe) from inception to January 2018. Randomized controlled trials were selected if they met the following criteria: (a) studied in patients 65 years or older who were taking four or more prescribed medications; (b) the "test" interventions were delivered by community pharmacists; and (c) measured one of these following outcomes: hospitalization, emergency department (ED) visit, quality of life, or adherence. Quality of the included studies was assessed using the Cochrane Effective Practice and Organization of Care Group risk of bias tool. Random-effects model meta-analyses were performed. RESULTS Of the 3634 articles screened, four studies with a total of 4633 participants were included. The intervention provided in all included studies was clinical medication review. Three studies were at low risk of bias, and the remaining study had unclear risk of bias. When compared with usual care, medication reviews provided by community pharmacist significantly reduced risk of ED visits (risk ratio = 0.68; 95% confidence interval = 0.48-0.96). There was also a tendency that pharmacist interventions decreased risk of hospitalizations (risk ratio = 0.88; 95% CI = 0.78-1.00), although no statistical significant. CONCLUSIONS The current evidence demonstrates that clinical medication reviews for older people with polypharmacy reduces the risk of ED visits. Medication reviews can be considered as another area where community pharmacists can contribute to improve patient safety.
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Affiliation(s)
| | | | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | | | - Bandana Saini
- Sydney Pharmacy School, Faculties of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
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Murphy AL, Peltekian SM, Helwig M, Macdonald M, Martin-Misener R, Saini B, Neyedli H, Giacomantonio C, Gardner DM. Driving performance assessments for benzodiazepine receptor agonist-related impairment: a scoping review protocol. JBI Evid Synth 2021; 19:242-250. [PMID: 33165178 DOI: 10.11124/jbisrir-d-19-00420] [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] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to identify, map, and characterize the evidence for assessments that measure driving performance in people taking benzodiazepine receptor agonists. INTRODUCTION Benzodiazepines and Z-drugs are widely prescribed for the treatment of anxiety disorders and insomnia even though they are not recommended as an initial treatment for these indications. Benzodiazepine and Z-drug use is associated with an elevated risk of traffic accidents, and guidance documents instruct patients to consult with their health care providers for instructions on how to safely operate a motor vehicle while consuming these medications. However, little is known about the assessments that measure driving performance regarding the extent and length of impairment from the consumption of the individual benzodiazepines and Z-drugs. INCLUSION CRITERIA Eligible studies will include participants who are new, intermittent, or chronic users of benzodiazepines and Z-drugs. No exclusions will be applied regarding the health status of participants or whether their benzodiazepine and Z-drug use is for an approved indication as indicated by government agencies (eg, Health Canada) or practice guidelines. Studies that examine the consumption of a benzodiazepine and Z-drug in association with the operation of a motor vehicle (real or simulated) with direct or indirect objective or standard subjective measures or indicators of impairment while operating a motor vehicle will be considered. METHODS Embase (Elsevier), MEDLINE (Ovid), and PsycINFO (EBSCO) will be searched as sources of published studies. Only studies published in English will be included, and there will be no limit on dates of publication. After screening the titles and abstracts of identified citations, two independent reviewers will retrieve potentially relevant full-text studies and extract data. Data will be presented in diagrammatic or tabular form accompanied by a narrative summary.
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Affiliation(s)
- Andrea L Murphy
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | | | - Melissa Helwig
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,WK Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada
| | - Marilyn Macdonald
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Ruth Martin-Misener
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Bandana Saini
- School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Heather Neyedli
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Chris Giacomantonio
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Halifax Regional Police, Halifax, NS, Canada
| | - David M Gardner
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,College of Pharmacy, Dalhousie University, Halifax, NS, Canada
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Almansour HA, Aloudah NM, Alhawassi TM, Chaar B, Krass I, Saini B. Cardiovascular disease risk prevention services by pharmacists in Saudi Arabia: what do policymakers and opinion leaders think? J Pharm Policy Pract 2021; 14:42. [PMID: 33958004 PMCID: PMC8100751 DOI: 10.1186/s40545-021-00319-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cardiovascular disease (CVD) is an emerging contributor to national morbidity and mortality in Saudi Arabia. CVD risk prevention services are limited, particularly with an over-utilised public health sector and an under-utilised and under-resourced primary care sector. Globally, there is evidence that community pharmacists can play a key role in CVD prevention within primary care. However, the perspectives of policymakers and opinion leaders are critical to successful translation of evidence into practice. Thus, the aim was to engage policymakers and professional leaders in discussions about implementing high-quality CVD risk prevention services in community pharmacy. Methods Qualitative semi-structured interviews were conducted, audio-recorded and transcribed verbatim. All transcripts were thematically analysed. Results A total of 23 participants (87% male) from government and non-government sectors were interviewed. Of these, almost 65% had pharmacy qualifications. Limited provision of CVD risks preventative services in primary care was acknowledged by most participants and building community pharmacists’ capacity to assist in preventive health services was viewed favourably as one way of improving the status quo. The data yielded four key themes: (1) future pharmacy CVD health service models; (2) demonstrable outcomes; (3) professional engagement and advocacy; and (4) implementability. CVD health services roles (health screening, primary and secondary prevention services), pragmatic factors and tiered models of care (minimal, medium, and comprehensive pharmacist involvement) were discussed. The need for humanistic, clinical, and cost effectiveness outcomes to be demonstrated and active involvement of professional bodies were deemed important for such services to be sustainable. Professional pharmacy governance to develop pharmacy careers and workforce, pharmacy curricular reform and ongoing education were posed as key success factors for novel pharmacy roles. Practice policies, standards, and guidelines were seen as required to adhere to stringent quality control for future pharmacy services provision. Participant’s implementation vision for such services included scalability, affordability, access, adoption and health system reform. Most discussions focused on the need for structural improvement with limited input regarding processes or outcomes required to establish such models. Conclusions Most participants favoured pharmacy-based CVD risk prevention services, despite the variability in proposed service models. However, prior to developing such services, support structures at the health system and health professional level are needed as well as building public support and acceptability for pharmacy services. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-021-00319-6.
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Affiliation(s)
- Hadi A Almansour
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Building Number A15, Sydney, NSW, 2006, Australia.
| | - Nouf M Aloudah
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Betty Chaar
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Building Number A15, Sydney, NSW, 2006, Australia
| | - Ines Krass
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Building Number A15, Sydney, NSW, 2006, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Building Number A15, Sydney, NSW, 2006, Australia.,Woolcock Institute of Medical Research, Sydney, NSW, Australia
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Abstract
Objective: The purpose of the study was to determine and describe the clinical approach Australian naturopaths take in providing care for people with sleep disorders, as it well known that Australians commonly seek care from naturopathic practitioners and no data on naturopathic practices for people with sleep disorders is currently documented.Participants: Naturopaths registered with the Australian PRACI (Practitioner Research and Collaboration Initiative) involved in the clinical management of people with sleep disorders.Methods: Consenting participants were invited to participate in semi-structured phone interviews conducted with the aid of a project-specific interview guide until data saturation was evident. Interview recordings were transcribed verbatim and analyzed thematically.Results: A total of 20 naturopaths across 5 different Australian states were interviewed, 4 themes were identifiable. Thematic interpretation suggests that (1) sleep health consults were common and involved detailed history taking by providers, (2) herbal remedies supported by lifestyle and sleep hygiene behaviors were the most common treatments recommended, and (3) interprofessional communication to medical doctors was seldom reciprocated. Government-funded research and establishing statutory registration of naturopaths were identified as key steps in profiling the professions role and to develop/evaluate integrated patient-centered sleep health care models.Conclusion: Naturopaths engage in the treatment of sleep disorders yet face barriers in executing an integration of such approaches within the current health care system. Research is required to explore how to overcome these barriers and develop integrated patient-centered models of care within tertiary sleep clinics and/or primary care physicians.
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Affiliation(s)
- Vibha Malhotra
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Joanna Harnett
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The Australian Research Centre in Complementary and Integrative Medicine, The University of Technology, Sydney, Australia
| | - Keith Wong
- The Woolcock Institute of Medical Research, University of Sydney, NSW, Australia.,Faculty of Medicine and Health, Sydney Medical School, Sydney, Australia.,Royal Prince Alfred Hospital, Camperdown, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The Woolcock Institute of Medical Research, University of Sydney, NSW, Australia
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Webster R, Usherwood T, Joshi R, Saini B, Armour C, Critchley S, Di Tanna GL, Galgey S, Hespe CM, Jan S, Karia A, Kaur B, Krass I, Laba TL, Li Q, Lo S, Peiris DP, Reid C, Rodgers A, Shiel L, Strathdee J, Zamora N, Patel A. An electronic decision support-based complex intervention to improve management of cardiovascular risk in primary health care: a cluster randomised trial (INTEGRATE). Med J Aust 2021; 214:420-427. [PMID: 33899216 DOI: 10.5694/mja2.51030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine whether a multifaceted primary health care intervention better controlled cardiovascular disease (CVD) risk factors in patients with high risk of CVD than usual care. DESIGN, SETTING Parallel arm, cluster randomised trial in 71 Australian general practices, 5 December 2016 - 13 September 2019. PARTICIPANTS General practices that predominantly used an electronic medical record system compatible with the HealthTracker electronic decision support tool, and willing to implement all components of the INTEGRATE intervention. INTERVENTION Electronic point-of-care decision support for general practices; combination cardiovascular medications (polypills); and a pharmacy-based medication adherence program. MAIN OUTCOME MEASURES Proportion of patients with high CVD risk not on an optimal preventive medication regimen at baseline who had achieved both blood pressure and low-density lipoprotein (LDL) cholesterol goals at study end. RESULTS After a median 15 months' follow-up, primary outcome data were available for 4477 of 7165 patients in the primary outcome cohort (62%). The proportion of patients who achieved both treatment targets was similar in the intervention (423 of 2156; 19.6%) and control groups (466 of 2321; 20.1%; relative risk, 1.06; 95% CI, 0.85-1.32). Further, no statistically significant differences were found for a number of secondary outcomes, including risk factor screening, preventive medication prescribing, and risk factor levels. Use of intervention components was low; it was highest for HealthTracker, used at least once for 347 of 3236 undertreated patients with high CVD risk (10.7%). CONCLUSIONS Despite evidence for the efficacy of its individual components, the INTEGRATE intervention was not broadly implemented and did not improve CVD risk management in participating Australian general practices. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616000233426 (prospective).
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Affiliation(s)
- Ruth Webster
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW.,The George Institute for Global Health, Sydney, NSW
| | - Tim Usherwood
- Sydney Medical School, University of Sydney, Sydney, NSW
| | - Rohina Joshi
- The George Institute for Global Health, Sydney, NSW.,The George Institute for Global Health India, New Delhi, India
| | | | - Carol Armour
- The Woolcock Institute, University of Sydney, Sydney, NSW
| | | | | | - Shane Galgey
- The George Institute for Global Health, Sydney, NSW
| | | | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW
| | | | - Baldeep Kaur
- The George Institute for Global Health, Sydney, NSW
| | | | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW
| | - Qiang Li
- The George Institute for Global Health, Sydney, NSW
| | - Serigne Lo
- Melanoma Institute, University of Sydney, Sydney, NSW
| | | | | | | | | | | | - Nuria Zamora
- The George Institute for Global Health, Sydney, NSW
| | - Anushka Patel
- The George Institute for Global Health, Sydney, NSW.,The University of Sydney, Sydney, NSW
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Fathima M, Bawa Z, Mitchell B, Foster J, Armour C, Saini B. COPD Management in Community Pharmacy Results in Improved Inhaler Use, Immunization Rate, COPD Action Plan Ownership, COPD Knowledge, and Reductions in Exacerbation Rates. Int J Chron Obstruct Pulmon Dis 2021; 16:519-533. [PMID: 33688177 PMCID: PMC7936701 DOI: 10.2147/copd.s288792] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate the effectiveness of a pilot community pharmacy care model for patients with chronic obstructive pulmonary disease (COPD) to improve: 1) inhaler technique; 2) medication adherence; and 3) uptake of non-pharmacological treatment and prevention activities. Patients and Methods Forty "host" pharmacies in Sydney were invited to recruit eligible patients and to provide a counselling room/area in their pharmacy for service provision. Eligible patients were referred to two "consultant" pharmacists, specifically trained to deliver a specialized pharmacy COPD service which involved 3 in-pharmacy visits and 2 follow-up phone calls over a 6-month period. The service consisted of 1) inhaler technique assessment; 2) medication adherence assessment; and 3) referrals to the patient's general practitioner (GP) to facilitate the uptake of non-pharmacological resources as well as to review COPD medications/devices, as required. Pre-post analyses were conducted using paired Student's t-test and Wilcoxon Signed Rank Test for independent variables and chi-squared tests for proportional data. Results Nine "host" pharmacies recruited 40 patients, of whom 37 completed the baseline Visit and 27 completed all Visits. A total of 270 interventions were provided by the "consultant" pharmacists with most provided at Visit 1 (176). The most common interventions were addressing patient gaps in COPD knowledge and inhaler technique. A total of 119 referrals were made to GPs for various reasons, the most common being for a COPD action plan, pulmonary rehabilitation, or pneumonia vaccination. There were significant improvements pre-post intervention in inhaler use competence, COPD knowledge, immunization rate for pneumonia, exacerbation rate and COPD plan ownership. Conclusion In this pilot study, the specialized pharmacy-based COPD care model delivered by "consultant" pharmacists in community pharmacies provided significant health benefits for patients. Further research is needed to assess the model's effectiveness in a larger population as well as when measured against standard care.
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Affiliation(s)
- Mariam Fathima
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Zeeta Bawa
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Bernadette Mitchell
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Juliet Foster
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Carol Armour
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia.,School of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
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45
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Basheti MM, Gordon C, Bawa Z, Grunstein R, Saini B. Sleep health management in community pharmacy: Where are we and where should we be heading? Res Social Adm Pharm 2021; 17:1945-1956. [PMID: 33602626 DOI: 10.1016/j.sapharm.2021.02.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Poor sleep health is now recognised as a significant risk factor for chronic diseases and is associated with considerable comorbidity and mortality. Community pharmacists are primary care clinicians with an integral role in sleep health promotion and chronic sleep disorder management; however, it is unclear to what extent this is currently being undertaken or what the perspectives of Australian community pharmacists regarding their role in sleep health are. OBJECTIVES To explore community pharmacists' current sleep health practice and perspectives on the potential future of sleep health care in community pharmacy. METHODS Qualitative semi-structured interviews were carried out with a maximally varied, convenience-based purposive sample of community pharmacists. Interviews were audio-recorded, transcribed verbatim and subjected to, in sequence; an inductive analysis followed by a deductive approach where the inductively derived thematic structure was used as a framework. RESULTS Twenty-five community pharmacists from two Australian states were interviewed. Insomnia and obstructive sleep apnea (OSA) were the most frequently encountered sleep disorders in community pharmacy presentations. Four key themes were derived from the data: 1) Preparedness, 2) Approach, 3) Capabilities and 4) What needs to change? All participants reported that their sleep health knowledge was insufficient and emphasized the need for more education and training. Although some were engaged in providing OSA services, none of the participants offered services for insomnia or other sleep disorders. Time/task pressures, low health system/health care professional sleep health recognition/awareness and the lack of standardised pharmacy-specific sleep health management guidelines were commonly cited barriers for sleep health service provision. CONCLUSION Community pharmacists commonly manage day-to-day sleep health; however, most expressed a need for increased sleep health recognition/awareness by the health system, targeted education/training for pharmacists and support for the future provision of community pharmacy-delivered sleep health services. With the appropriate implementation strategies, community pharmacists could utilise their availability and accessibility to improve the future of primary care sleep health management.
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Affiliation(s)
- Mariam M Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
| | - Christopher Gordon
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Zeeta Bawa
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Brain and Mind Centre, School of Psychology, Faculty of Science, The University of Sydney, NSW, Australia
| | - Ron Grunstein
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia; School of Medicine, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia
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46
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Menczel Schrire Z, Phillips CL, Duffy SL, Marshall NS, Mowszowski L, La Monica HM, Gordon CJ, Chapman JL, Saini B, Lewis SJG, Naismith SL, Grunstein RR, Hoyos CM. Feasibility of 3-month melatonin supplementation for brain oxidative stress and sleep in mild cognitive impairment: protocol for a randomised, placebo-controlled study. BMJ Open 2021; 11:e041500. [PMID: 33568368 PMCID: PMC7878132 DOI: 10.1136/bmjopen-2020-041500] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/30/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Melatonin has multiple proposed therapeutic benefits including antioxidant properties, synchronisation of the circadian system and lowering of blood pressure. In this protocol, we outline a randomised controlled trial to assess the feasibility, acceptability and tolerability of higher dose (25 mg) melatonin to target brain oxidative stress and sleep disturbance in older adults with mild cognitive impairment (MCI). METHODS AND ANALYSIS The study design is a randomised double-blind, placebo-controlled, parallel group trial. Forty individuals with MCI will be recruited from the Healthy Brain Ageing Clinic, University of Sydney and from the community, and randomised to receive either 25 mg oral melatonin or placebo nightly for 12 weeks. The primary outcomes are feasibility of recruitment, acceptability of intervention and adherence to trial medication at 12 weeks. Secondary outcomes will include the effect of melatonin on brain oxidative stress as measured by magnetic resonance spectroscopy, blood pressure, blood biomarkers, mood, cognition and sleep. Outcomes will be collected at 6 and 12 weeks. The results of this feasibility trial will inform a future conclusive randomised controlled trial to specifically test the efficacy of melatonin on modifiable risk factors of dementia, as well as cognition and brain function. This will be the first trial to investigate the effect of melatonin in the population with MCI in this way, with the future aim of using this approach to reduce progression to dementia. ETHICS AND DISSEMINATION This protocol has been approved by the Sydney Local Health District Ethics Committee (X18-0077). This randomised controlled trial will be conducted in compliance with the protocol published in the registry, the International Conference for Harmonisation on Good Clinical Practice and all other applicable regulatory requirements. The findings of the trial will be disseminated via conferences, publications and media, as applicable. Participants will be informed of results of the study at the conclusion of the trial. Eligible authors will include investigators who are involved in the conception and design of the study, the conduct of the trial, the analysis of the results, and reporting and presentation of study findings. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry (ANZCTRN 12619000876190). PROTOCOL VERSION V.8 15 October 2020.
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Affiliation(s)
- Zoe Menczel Schrire
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
| | - Craig L Phillips
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Shantel L Duffy
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nathaniel S Marshall
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Haley M La Monica
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher J Gordon
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Julia L Chapman
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
| | - Bandana Saini
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Simon J G Lewis
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hosptial, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Camilla M Hoyos
- Healthy Brain Ageing Program, The University of Sydney School of Psychology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia
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Stevens D, Leong CWY, Cheung H, Arciuli J, Vakulin A, Kim JW, Openshaw HD, Rae CD, Wong KKH, Dijk DJ, Siong Leow JW, Saini B, Grunstein RR, D'Rozario AL. Sleep spindle activity correlates with implicit statistical learning consolidation in untreated obstructive sleep apnea patients. Sleep Med 2021; 86:126-134. [PMID: 33707093 DOI: 10.1016/j.sleep.2021.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE/BACKGROUND The aim of this study was to examine the relationship between overnight consolidation of implicit statistical learning with spindle frequency EEG activity and slow frequency delta power during non-rapid eye movement (NREM) sleep in obstructive sleep apnea (OSA). PATIENTS/METHODS Forty-seven OSA participants completed the experiment. Prior to sleep, participants performed a reaction time cover task containing hidden patterns of pictures, about which participants were not informed. After the familiarisation phase, participants underwent overnight polysomnography. 24 h after the familiarisation phase, participants performed a test phase to assess their learning of the hidden patterns, expressed as a percentage of the number of correctly identified patterns. Spindle frequency activity (SFA) and delta power (0.5-4.5 Hz), were quantified from NREM electroencephalography. Associations between statistical learning and sleep EEG, and OSA severity measures were examined. RESULTS SFA in NREM sleep in frontal and central brain regions was positively correlated with statistical learning scores (r = 0.41 to 0.31, p = 0.006 to 0.044). In multiple regression, greater SFA and longer sleep onset latency were significant predictors of better statistical learning performance. Delta power and OSA severity were not significantly correlated with statistical learning. CONCLUSIONS These findings suggest spindle activity may serve as a marker of statistical learning capability in OSA. This work provides novel insight into how altered sleep physiology relates to consolidation of implicitly learnt information in patients with moderate to severe OSA.
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Affiliation(s)
- David Stevens
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | | - Helena Cheung
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Joanne Arciuli
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Andrew Vakulin
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Jong-Won Kim
- Department of Healthcare IT, Inje University, Inje-ro 197, Kimhae, Kyunsangnam-do, 50834, South Korea
| | - Hannah D Openshaw
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - Caroline D Rae
- Neuroscience Research Australia (NeuRA), Sydney, Australia; School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Keith K H Wong
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney Health Partners, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, UK; UK Dementia Research Institute at the University of Surrey, UK
| | - Josiah Wei Siong Leow
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - Bandana Saini
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney Health Partners, NSW, Australia; Sydney Medical School, The University of Sydney, NSW, Australia
| | - Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; The University of Sydney, School of Psychology, Brain and Mind Centre and Charles Perkins Centre, Australia.
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Cheung MMY, Saini B, Smith L. Integrating drawings into health curricula: university educators' perspectives. Med Humanit 2020; 46:394-402. [PMID: 31826925 DOI: 10.1136/medhum-2019-011775] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
The literature has identified promising findings regarding the application of arts-based initiatives to enhance healthcare professional (HCP) training. Research shows that drawings offer a window into the authentic, insider view of health and illness, with potential to be a platform for healthcare student and HCP learning. In addition, drawings may also have a place in health communication. Our previous work provides support for the educational application of patients' drawings in bringing HCPs closer to the patient's lived experience. Subsequently, this study aimed to explore university educators' opinions regarding the implementation of drawings as an educational tool for higher education healthcare students. The objective of this study was to explore pathways for using drawings as an art form in an educational context, and provide recommendations for developing curricula and resources for further evaluation. Findings from focus group interviews with nine university educators revealed support for the use of drawings as a novel medium as they offer rich insights into the patient's perspective while encouraging creative and critical thinking. Key perceived benefits were that drawings foster student appreciation of (1) the holistic impact of illness, (2) the importance of patients' priorities and (3) the value of learning from the patient. Patients' drawings of their experiences would offer needed opportunities for students to explicitly reflect about the 'person' holistically rather than view the patient as a 'biomedical problem'. Shifting students' perspectives and possible assumptions to be better aligned with and appreciative of the patient's experiences was noted as central to adopting a person-centred approach to healthcare practice. Our findings suggest that incorporating drawings, or indeed other art forms, as educational tools would be a valuable addition to the health curricula.
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Affiliation(s)
- Melissa Mei Yin Cheung
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Bandana Saini
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Serhal S, Saini B, Bosnic-Anticevich S, Krass I, Wilson F, Armour C. Medication Adherence in a Community Population with Uncontrolled Asthma. Pharmacy (Basel) 2020; 8:pharmacy8040183. [PMID: 33036454 PMCID: PMC7711630 DOI: 10.3390/pharmacy8040183] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022] Open
Abstract
It is well documented that the use of medications in asthma and allergic rhinitis is often suboptimal, and consequently, patients remain symptomatic. This study aimed to determine the extent and type of medication-related issues contributing to poor asthma control by profiling medication management in those most at risk—a population with clinically uncontrolled asthma. Participants (n = 363) were recruited from Australian community pharmacies, and a dispensed medication history report for the previous 12 months was collected to examine medication adherence and factors affecting adherence. Information was also collected regarding participant asthma control and asthma/allergic rhinitis (if applicable) management. The participants’ mean asthma control score was 2.49 (± 0.89 SD, IQR = 1.20) (score ≥ 1.5 indicative of poorly controlled asthma), and 72% were either non-adherent or yet to initiate preventer therapy. Almost half had been prescribed high doses of inhaled corticosteroid and 24% reported use of oral corticosteroids. Only 22% of participants with concomitant allergic rhinitis were using first line treatment. A logistic regression model highlighted that participant health care concession status and hospital admissions were associated with better adherence. Suboptimal medication management is evident in this at-risk population.
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Affiliation(s)
- Sarah Serhal
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2031, Australia; (B.S.); (S.B.-A.); (F.W.); (C.A.)
- Correspondence: ; Tel.: +61-4-1495-9883
| | - Bandana Saini
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2031, Australia; (B.S.); (S.B.-A.); (F.W.); (C.A.)
- School of Pharmacy, The University of Sydney, A15, Science Rd, Camperdown, NSW 2006, Australia;
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2031, Australia; (B.S.); (S.B.-A.); (F.W.); (C.A.)
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Ines Krass
- School of Pharmacy, The University of Sydney, A15, Science Rd, Camperdown, NSW 2006, Australia;
| | - Frances Wilson
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2031, Australia; (B.S.); (S.B.-A.); (F.W.); (C.A.)
| | - Carol Armour
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2031, Australia; (B.S.); (S.B.-A.); (F.W.); (C.A.)
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Meaklim H, Jackson ML, Bartlett D, Saini B, Falloon K, Junge M, Slater J, Rehm IC, Meltzer LJ. Sleep education for healthcare providers: Addressing deficient sleep in Australia and New Zealand. Sleep Health 2020; 6:636-650. [DOI: 10.1016/j.sleh.2020.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 12/24/2022]
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