Developing recommendations for the safe handling of oral anti-cancer drugs in community pharmacies: A pan-Canadian consensus approach.

PURPOSE: To create a set of consensus-based and evidence-informed recommendations to provide guidance around the safe dispensing and handling of oral anti-cancer drugs in low-volume settings unique to the community pharmacy setting. METHODS: A review of published and grey literature (published in non-commercial domains such as national organizations and associations) documents and nine key informant interviews were conducted and a modified Delphi approach was taken to achieve consensus. The final list of 47 candidate recommendations was reviewed by a task force and validated by multi-disciplinary stakeholders. A draft of the statements was circulated broadly within the community pharmacy community in an effort to assess relevance and implementation feasibility. RESULTS: The final report included 44 recommendations that addressed 11 key areas germane to the safe handling of oral anti-cancer drugs in community pharmacies. Mean agreement increased from 70% to 95%. Early feedback from community pharmacy leaders during the external review suggests that many of the proposed recommendations can be feasibly implemented within a reasonable timeframe when released with appropriate education and resource materials. CONCLUSIONS: A modified-Delphi approach supplemented by key informant interviews and a comprehensive external review resulted in a set of evidence-informed, community-driven recommendations for community pharmacies. The recommendations address a gap in existing literature to improve understanding of the risks associated with handling and dispensing oral anti-cancer drugs for both community pharmacy staff and management and offer mitigating strategies to reduce those risks. Incorporating feasibility assessment actions early (through the key informant interviews) and late (through the external review) ensures recommendations are grounded in practicality and support broad and early knowledge translation strategies.

Health Concerns of Transgender and Gender Nonconforming Youth and Their Parents Upon Presentation to a Transgender Clinic.

PURPOSE: The purpose of the study was to determine the frequency of specific health concerns identified by transgender and gender nonconforming patients and their parents at initial clinic visit. METHODS: Checklists were developed in an iterative process and distributed to both patients and parents at their initial visit to a transgender clinic. Retrospective chart review and secondary data analyses were performed to determine the number of items endorsed, frequency with which each item was endorsed, and provider domain of each item endorsed: physician, social work, or both physician and social work. RESULTS: Checklists were collected from 118 patients and 103 parents. Patients endorsed a mean of 8.4 concerns (range 0-22) and parents 7.9 concerns (range 0-20). The most commonly endorsed patient concerns included use of gender-affirming hormones, steps for transition, gender-affirming surgery, restroom/dressing room use, and legal issues. Common parent concerns included general resources, child safety at school, acute mental health concerns, restroom/dressing room use, and steps for transition. Of the concerns endorsed by patients, 44% were in the social work domain, 37% in the physician domain, and 19% in both the social work and physician domain. Of the concerns endorsed by parents, 40% were in the social work domain, 31% in the physician domain, and 29% in the social work and physician domain. CONCLUSIONS: Although patients and parents had similar numbers of concerns, they primarily focused on different topics. Youth were more interested in hormones and transition, while parents were more interested with transition and acceptance. Many concerns for both patients and parents fell within the social work domain.

The Impact of Health Education Counseling on Rate of Recurrent Sexually Transmitted Infections in Adolescents.

STUDY OBJECTIVE: To evaluate the effectiveness of a sexually transmitted infection (STI) intervention by a health educator that included partner notification, condom use, and retesting within 3 months. DESIGN, SETTING, AND PARTICIPANTS: Retrospective chart review was conducted, and data were collected from 274 sexually active adolescent girls, aged 15 to 19 years, who were diagnosed with gonorrhea (GC), Chlamydia (CT), and Trichomonas (TV) infection, during a 9-month span in an urban hospital-based adolescent medicine clinic. METHODS: Data regarding recurrent STIs (GC, CT, and TV) were collected for 12 months following the incident infection. There were 161 in the intervention group (health educator counseling), and 113 controls who received usual care. Differences between groups were analyzed using χ(2) and survival analyses. RESULTS: There were no significant differences in age, gender, or race between the intervention and control groups at baseline. The majority in both groups were diagnosed initially with CT infection (57% CT, 16% GC, and 5% TV in the intervention group; 46% CT, 21% GC, and 12% TV in the control group). There was a significantly lower rate of STI in the intervention group for those retested within 12 months of the initial diagnosis (P = .002). The median (SD) time to recurrence in the intervention group was greater: 134 (14.7) days versus 116 (12.1) days (P = .034). Health education counseling, initial diagnosis with TV, and duration of time from initial diagnosis to retest (interval to retest) were significant protective factors for recurrent STI. CONCLUSIONS: Health education counseling in an urban adolescent clinic is effective in reducing recurrent infection at 12-month follow-up and can serve as an important component in reducing STI recidivism.

Impact of Post-visit Contact on Emergency Department Utilization for Adolescent Women with a Sexually Transmitted Infection.

STUDY OBJECTIVES: To understand Emergency Department (ED) utilization patterns for women who received sexually transmitted infection (STI) testing and explore the impact of post-visit telephone contact on future ED visits. DESIGN, SETTING, PARTICIPANTS: We performed a secondary analysis on a prospectively collected dataset of ED patients ages 14-21 years at a children's hospital. INTERVENTIONS AND MAIN OUTCOME MEASURES: The dataset documented initial and return visits, STI results, race, age and post-visit contact success (telephone contact ≤7 days of visit). Logistic regression was performed identifying variables that predicted a return visit to the ED, a return visit with STI testing, and subsequent positive STI results. RESULTS: Of 922 women with STI testing at their initial ED visit, 216 (23%) were STI positive. One-third (315/922) returned to the ED, 15% (141/922) returned and had STI testing, and 4% (38/922) had a subsequent STI. Of 216 STI-positive women, 59% were successfully contacted. Of those who returned to the ED, age ≥ 18 and Black race were associated with increased STI testing at a subsequent visit. Successful contact reduced the likelihood of STI testing at a subsequent ED visit (OR 0.28, 95% CI 0.01-0.8), and ED empiric antibiotic treatment had no effect on subsequent STI testing. CONCLUSION: Contacting women with STI results and counseling them regarding safe sex behaviors may reduce the number of ED patients who return with symptoms or a new exposure necessitating STI testing. The high STI prevalence and frequent return rate suggest that ED interventions are needed.

Abnormal vaginal pH and Mycoplasma genitalium infection.

STUDY OBJECTIVE: Mycoplasma genitalium (MG) is a sexually transmitted pathogen linked to female morbidity, but testing for MG is not standardized. We aimed to determine which point-of-care (POC) vaginal tests could predict MG infection. DESIGN, SETTING, PARTICIPANTS: A cross sectional study recruited sexually active adolescent women, aged 14-22 y (n = 217) from an urban medical center. INTERVENTIONS AND MAIN OUTCOME MEASURES: Vaginal swabs were POC tested for pH, amines, clue cells, sialidase, and Trichomonas vaginalis (TV). MG was detected by research-use-only transcription mediated amplification (TMA) assay. Presence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) were confirmed using TMA. Three criteria were required for diagnosis of clinical BV: pH > 4.5, presence of amines, and >20% clue cells. Associations were assessed using logistic regression (LR). RESULTS: TMA detected MG in 30 (14%), CT in 49 (23%), and NG in 21 (10%) of the samples tested. POC vaginal tests were positive for TV in 21%, amines in 52%, clue cells in 33%, sialidase in 22%, pH > 4.5 in 56%, and clinical BV in 19% of the samples tested. Using LR, pH > 4.5 was a predictor of MG (odds ratio 4.4, P < .05). Of 131 women without clinical BV or TV, 25% of those with pH > 4.5 had MG, compared to 9% of those with pH ≤ 4.5 (P = .02). CONCLUSIONS: Until standardized, approved testing for MG is available, pH may be a useful indicator to suspect MG, especially in the absence of BV and TV.

Accuracy and trust of self-testing for bacterial vaginosis.

PURPOSE: Two point-of-care tests are available to detect bacterial vaginosis (BV), a common vaginal condition. This study aimed to (1) compare the accuracy of two self-performed BV tests with clinician-performed BV tests and with clinical diagnosis of BV; and (2) compare trust of results for self-performed BV testing with clinician-performed BV testing. METHODS: Participants (14-22 years old) in a study assessing self-testing for Trichomonas vaginalis were also asked to perform a self-test for BV (using a pH or sialidase test). Results were compared with clinician-performed tests and with clinical diagnosis of BV (defined by modified Amsel criteria). A two-item subscale from a larger acceptability scale was used to assess trust at baseline, after testing, and after discussion of results. RESULTS: All 131 women performed self-BV testing correctly. Agreement between self- and clinician-performed tests was good (κ: .5-.7) Compared with clinical diagnosis of BV, self-pH was 73% sensitive and 67% specific, and self-sialidase was 40% sensitive and 90% specific. Trust in self-performed BV testing was lower than trust in clinician-performed BV testing at baseline, but increased after testing and discussion of results. CONCLUSIONS: Young women can perform self-tests for BV with reasonable accuracy, which could increase testing when pelvic examinations are not feasible. Trust in self-testing increased after experience and after discussion of test results. Although the pH test is available over the counter, young women may continue to rely on clinicians for testing.

Interaction of feedback frequency and task difficulty in children's motor skill learning.

BACKGROUND: Providing adults with knowledge of results (KR) after each practice trial (100% KR) usually is found to be detrimental to motor skill learning compared with conditions in which feedback is less frequently provided. The effect of 100% KR on children's learning is less clear, with research showing that children with cerebral palsy benefit from less frequent KR, whereas children with typical development do not. OBJECTIVE: This study was designed to examine the interaction of KR frequency and task complexity on the acquisition, retention, and transfer of a novel throwing skill in fourth- and fifth-grade children with typical development. DESIGN: This was an observational study. METHODS: Children threw beanbags for accuracy at an unseen target while walking or while standing still. These 2 levels of task complexity were crossed with 2 frequencies (33% and 100%) of KR provision. Following practice, retention tests without feedback were performed 5 minutes later and then 1 week later along with transfer tests to assess the generalizability of learning. RESULTS: Analyses revealed that learning was improved on the easy version of the task when a 33% KR frequency was provided during practice. In contrast, in the difficult version, learning was facilitated by provision of a 100% KR frequency during practice. CONCLUSIONS: Structuring practice conditions for children should take into account task complexity and feedback frequency in determining the cognitive challenge necessary for optimal skill learning. More generally, the findings suggest that practitioners teaching motor skills should design practice conditions in accordance with the cognitive processing capacity of the learner.