The Psychological Impacts of Pill Dysphagia: A Mixed Methods Study.

Pill dysphagia is a common problem amongst older adults, with significant health consequences. Previous research has found that dysphagia can negatively affect an individuals mental health and wellbeing. However, this research has not been extended to pill-specific dysphagia, which presents distinct differences from the challenges posed by swallowing food and liquids. These differences extend to causes, demographics, and physical health ramifications. This study aimed to address this gap in the literature by investigating the effects of pill dysphagia on the wellbeing of older adults. A community sample of 132 Australians aged 65-97 years completed a survey about their wellbeing and difficulty swallowing pills. Thirty-one participants who met the criteria for pill dysphagia completed further open-ended questions detailing the effects of pill dysphagia and how they manage it. Analyses of the quantitative data indicated that difficulty swallowing pills was unrelated to negative affect but negatively related to positive affect, life satisfaction, and eudemonic wellbeing. Supplementary analyses controlling for health-related variables found no significant relationships between difficulty swallowing pills and wellbeing. Responses to the open-ended questions revealed a range of physical, psychological, and practical impacts of pill dysphagia, and successful and unsuccessful methods used to assist in swallowing pills. The findings partially support the hypothesised effects of pill dysphagia on wellbeing. However, further research is required to establish if more severe pill dysphagia predicts wellbeing over and above self-rated health. Future interventions should incorporate wellbeing promotion strategies for older adults with pill dysphagia.

"Can differences in hospitalised mild traumatic brain injury (mTBI) outcomes at 12 months be predicted?"

OBJECTIVES: To identify risk factors for poor outcome one year post-mild traumatic brain injury (mTBI). DESIGN: This study was a prospective observational study using consecutive adult hospital admissions with mTBI. SUBJECTS: A total of 869 consecutive mTBI patients were enrolled in this study. METHODS: All patients were reviewed by the specialist TBI rehabilitation team at six weeks and one year following mTBI. Demographic and injury data collected included: age, gender, TBI severity and Glasgow Coma Scale (GCS). At twelve months, global outcome was assessed by the Extended Glasgow Outcome Score (GOSE) and participation restriction by the Rivermead Head Injury Follow-up Questionnaire (RHFUQ) via semi-structured interview. An ordinal regression (OR) was used to identify associated factors for poor GOSE outcome and a linear regression for a poor RHFUQ outcome. RESULTS: In the GOSE analysis, lower GCS (p < 0.001), medical comorbidity (p = 0.027), depression (p < 0.001) and male gender (p = 0.008) were identified as risk factors for poor outcome. The RHFUQ analysis identified: lower GCS (p = 0.002), female gender (p = 0.001) and injuries from assault (p = 0.003) were variables associated with worse social functioning at one year. CONCLUSION: mTBI is associated with a significant impact upon the physical health and psychosocial function of affected individuals. The results of this study demonstrate that differences in mTBI outcome can be identified at twelve months post-mTBI and that certain features, particularly GCS, are associated with poorer outcomes.

W' reconstitution rate at different intensities above critical torque: the role of muscle size and maximal strength.

NEW FINDINGS: What is the central question of this study? Do muscle size, maximal force and exercise intensity influence the recovery time constant for the finite impulse above critical torque (τIET' )? What is the main finding and its importance? Muscle size and maximal strength have different influences on the parameters of the hyperbolic torque-time to task failure relationship. Greater muscle size and maximal strength, as well as exercise at an intensity of 60% MVC, prolong τIET' during intermittent isometric exercise. ABSTRACT: Muscle perfusion and O2 delivery limitations through muscle force generation appear to play a major role in defining the hyperbolic torque-time to task failure (Tlim ) relationship. Therefore, we aimed to determine the influence of muscle size and maximal strength on the recovery time constant for the finite impulse above critical torque (τIET' ). Ten men participated in the study and performed intermittent isometric tests until task-failure (Tlim ) for the knee-extensors (KE) (35% and 60% maximal voluntary contraction (MVC)) and plantar flexors (PF) (60% MVC). The τIET' was determined for each of these Tlim tests using the IET'BAL model. The IET' (9738 ± 3080 vs. 2959 ± 1289 N m s) and end-test torque (ET)(84.5 ± 7.1 vs. 74.3 ± 12.7 N m) were significantly lower for PF compared to KE (P < 0.05). Exercise tolerance (Tlim ) was significantly longer for PF (239 ± 81 s) than KE (150 ± 55 s) at 60% MVC, and significantly longer for KE at 35% MVC (641 ± 158 s) than 60% MVC. The τIET' was significantly faster at 35% MVC (641 ± 177 s) than 60% MVC (1840 ± 354 s) for KE, both of which were significantly slower than PF at 60% MVC (317 ± 102 s). This study showed that τIET' during intermittent isometric exercise is slower with greater muscle size and maximal strength.

Pharmacological management of post-traumatic stress disorder and its associated nightmares: A survey of psychiatrists.

WHAT IS KNOWN AND OBJECTIVE: To describe the pharmacological management of post-traumatic stress disorder (PTSD) by psychiatrists, with a focus on their use of clinical guidelines and the role of prazosin for nightmares. METHODS: An online survey of Australian and New Zealand psychiatrists was conducted. Aspects included respondent demographics, familiarity and usage of guidelines for PTSD, and opinions on the safety and efficacy of prazosin for PTSD-associated nightmares. RESULTS AND DISCUSSION: A total of 157 responses were recorded, 106 of which were complete. The most frequently used guideline for PTSD management was over 10 years old and used by only 48% of respondents. Peer-reviewed scientific journals were the most common additional source used by psychiatrists to inform their practice. For the targeted treatment of nightmares, 35 different medications had been trialled by respondents. Prazosin had been prescribed by 86% of psychiatrists for PTSD-associated nightmares, with only 2% reporting it to be ineffective in reducing nightmare frequency and/or intensity. Psychiatrists who were familiar with prazosin-mentioning guidelines (P < .05) and those who more frequently treat patients with PTSD (P < .01) were most likely to have prescribed prazosin. WHAT IS NEW AND CONCLUSION: Psychiatrists generally do not rely on guidelines to inform the treatment of PTSD. Off-label prescription of prazosin for PTSD-associated nightmares occurs frequently, with positive perceived outcomes, despite conflicting published evidence and a lack of local guideline recommendations for its use.

The effect of socioeconomic deprivation on 12 month Traumatic Brain Injury (TBI) outcome.

Objectives: To assess the impact of social deprivation on Traumatic Brain Injury (TBI) global outcome.Design: The study was a prospective observational study conducted using consecutive admissions with TBI.Subjects: 1322 consecutive adult patients with TBI were recruited into the study between 2010 and 2015.Methods: All patients were assessed by the TBI rehabilitation team at both six weeks and 12 months following TBI. Details of the injury and demographic data was collated at six weeks. This included age, gender and ZIP Code. Social deprivation was measured by the Indices of Multiple Deprivation (IMD) Score. The outcome measure used was the Extended Glasgow Outcome Score (GOSE) at 12 months. Univariate analysis was followed by a Multi-Ordinal Regression to evaluate predictor variables.Results: With regard to the representation of IMD deciles, the study population approximated to the general Sheffield population (p = .139). Within the univariate analysis, statistically significant relationships were noted between IMD and GOSE (p = <.001). The Ordinal Regression revealed a significant relationship between worse GOSE and IMD (p = .002), age (p = .001), GCS (p < .001), alcohol intoxication (p < .001) and Medical Comorbidity (p = .041).Conclusion: Increasing social deprivation is associated with poorer global TBI outcomes at 12 months.

Antifungal Drug Use for Onychomycosis.

BACKGROUND: Onychomycoses are fungal nail infections affecting predominantly toenails, and mainly caused by dermatophyte fungi, molds and some Candida species. Nail infections can be mild with purely cosmetic implications, but they can also negatively influence quality of life. The deep-seated nature of fungi within the nail plate, prolonged treatment, poor patient adherence, frequent recurrences, and development of resistance to various antimicrobial agents make onychomycosis difficult to successfully treat. AREAS OF UNCERTAINTY: When and how should clinicians prescribe systemic and topical antifungal drugs for onychomycosis? DATA SOURCES: A narrative review was undertaken of the current literature identified in Medline, Scopus, CINAHL, the Cochrane library, and Google Scholar. RESULTS: Treatment is often lengthy and requires persistence and patient education. Definitive mycological diagnosis, and an individualized evaluation of risks and benefits of different treatments are imperative before initiating therapy. The choice of treatment can be influenced by the age and general health of the patient, the causative organism, the number of affected nails, and the extent of nail involvement. Oral antifungals offer greater likelihood of a cure than topicals, but oral therapy carries greater risks and requires closer monitoring. Oral terbinafine is the treatment of choice, followed by itraconazole pulse regimen. The newly approved topical agents, efinaconazole and tavaborole, were superior to placebo in clinical trials and appear to produce slightly improved mycological cure rates compared to previous topicals, but further direct comparisons are needed. CONCLUSIONS: The treatment of onychomycosis can be challenging, as most therapeutic options are lengthy, expensive and potentially unsuccessful.

Evaluation of dietary and lifestyle changes as modifiers of S100ß levels in Alzheimer's disease.

There is a significant body of research undertaken in order to elucidate the mechanisms underlying the pathology of Alzheimer's disease (AD), as well as to discover early detection biomarkers and potential therapeutic strategies. One such proposed biomarker is the calcium binding protein S100ß, which, depending on its local concentration, is known to exhibit both neurotrophic and neuroinflammatory properties in the central nervous system. At present, relatively little is known regarding the effect of chronic S100ß disruption in AD. Dietary intake has been identified as a modifiable risk factor for AD. Preliminary in vitro and animal studies have demonstrated an association between S100ß expression and dietary intake which links to AD pathophysiology. This review describes the association of S100ß to fatty acids, ketone bodies, insulin, and botanicals as well as the potential impact of physical activity as a lifestyle factor. We also discuss the prospective implications of these findings, including support of the use of a Mediterranean dietary pattern and/or the ketogenic diet as an approach to modify AD risk.

Complementary medicine use among Australian patients in an acute hospital setting: an exploratory, cross sectional study.

BACKGROUND: The use of Complementary Medicines (CMs) has significantly increased in Australia over the last decade. This study attempts to determine the extent to which complementary and alternative medicines are recorded, ceased or initiated in the acute hospital setting and investigate which health professionals have a role in this process. METHODS: A cross-sectional study of inpatients was conducted at a major tertiary teaching hospital. Patient's medical records were examined to determine the rates of complementary medicine (CM) use and recording on medication charts and discharge prescriptions. Patient progress notes were audited to determine which health professionals were involved with the initiation or cessation of CMs during the inpatient stay. RESULTS: Three hundred and forty-one patients were included for analysis of which 44.3% (n = 151) participants were recorded as utilizing a CM. Patients were admitted on a mean of 2 (±1.4[Sd]; 0-9[range]) CMs and discharged on a mean of 1.7 CMs (±1.3[Sd]; 0-5[range]). 274 individual CMs were recorded on inpatient medication reconciliation forms with multivitamins, magnesium, fish oil and cholecalciferol recorded the most frequently. One hundred and fifty-eight changes to patient CM usage were recorded during the patient hospitalisation. One hundred and seven of these changes (68%) were not accounted for in the patient progress notes. CONCLUSION: Patients use of CM in this hospital setting do not reflect the national estimated usage. On the occasions that CM products are included in patient records, they are subsequently deprescribed following patient examination in hospital. It is currently unclear which health professionals have a role in this deprescribing process.

Effect of long-term nutraceutical and dietary supplement use on cognition in the elderly: a 10-year systematic review of randomised controlled trials.

Nutraceuticals have generated interest as a way to mitigate the cognitive decline in older adults. The aim of this systematic review was to determine the evidence for these claims from the scientific literature in randomised, double-blinded, controlled trials (duration: ≥1 year; participants: n≥100; age(mean): ≥65 years). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched four electronic databases (PubMed, Scopus, CINAHL and Web of Science) and identified twenty-five studies published between the 15·June·2006 and 14·June·2016. Interventions included B-vitamins, n-3 fatty acids, antioxidant vitamins and herbs. Of the B-vitamin studies, four found benefits to cognition with supplementation. The first of these B-vitamin studies, in individuals with mild cognitive impairment (n 266; duration=2 years), included benefit to executive function (P=0·015) and improvements in the Mini-Mental State Examination (MMSE) among participants with baseline homocysteine above 11·3 µmol/l (P<0·001). In the same sample, the second study found cognitive benefits of B-vitamins dependent on the higher baseline plasma n-3 fatty acid status. The third B-vitamin study (n 900; duration=2 years) reported improved performance in immediate (P=0·046) and delayed recall (P=0·013), whereas the fourth study (n 856; duration=2 years) reported slower rate of cognitive decline in the MMSE (P=0·05). One study investigating DHA treatment (n 402; duration=1·5 years) revealed the slower rate of cognitive change in apoE e4 non-carriers (P=0·03). As only five included studies revealed notable benefits, presently based on the specific compounds explored here, there is not compelling evidence to support the use nutraceuticals to improve cognition in the elderly. Future long-term trials of nutraceuticals should investigate interactions with lifestyle, blood biomarkers and genetic risk factors.

Lapatinib plus capecitabine in patients with HER2-positive metastatic breast cancer: A systematic review
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OBJECTIVE: Human epidermal growth factor receptor 2 (HER2)-positive breast cancer, which accounts for 20 - 25% of cases of breast cancers, is highly aggressive. Due to cardiotoxicity and increasing resistance associated with trastuzumab, the first-line treatment, there is a need for effective second-line therapies in treating HER2-positive breast cancer. In this context, there has been increasing interest in the combination of lapatinib plus capecitabine. The aim of this systematic review was to assess the efficacy of lapatinib plus capecitabine for HER2-positive breast cancer after progression with trastuzumab therapy, in comparison with capecitabine monotherapy and other agents such as vinorelbine and trastuzumab emtansine. MATERIALS AND METHODS: We performed a keyword search in five electronic databases (OVID MEDLINE, the Cochrane Library, Web of Science, SCOPUS, and CINAHL; January 2010 to April 2017) for trials in patients with HER2-positive breast cancer that has progressed on trastuzumab. After screening, the relevant studies were assessed for their methodological quality (including selection bias, randomization, control for confounders, and blinding) by two reviewers independently. RESULTS AND DISCUSSION: A total of 50 studies were identified; only 6 of those met the inclusion criteria and were analyzed. Five received a weak rating on the quality assessment tool, and none could be considered as being of high scientific quality after taking the risk of bias and other confounding variables into account. The studies demonstrated that lapatinib plus capecitabine is effective in extending median overall (OS) and progression-free survival (PFS) outcomes, achieving OS of 37.6 - 108.7 weeks and PFS of 21.1 - 30 weeks across studies. However, median OS and PFS for trastuzumab emtansine therapy were found to be considerably better (133.9 weeks and 41.6 weeks, respectively) than for lapatinib plus capecitabine. CONCLUSION: The results suggest that the combination of lapatinib plus capecitabine can improve PFS and OS in patients with HER2-positive breast cancer that has progressed on trastuzumab. However, it appears that trastuzumab emtansine provides better treatment outcomes in this context.
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Are we doing enough to prevent poor-quality antimalarial medicines in the developing world?

BACKGROUND: Malaria is a deadly parasitic disease that affects more than 3 billion people worldwide, in predominantly resource-poor countries. Despite malaria being preventable and treatable, a large number of adults and children, mostly in Africa, die from this disease each year. One contributor to needless morbidity and mortality is the production and distribution of poor-quality antimalarial medicines; indeed, it is estimated that over 122,000 deaths of children under 5 years of age in sub-Saharan countries were caused by poor-quality antimalarial medicines, in 2013 alone. DISCUSSION: Poor-quality medicines include those that are deliberately falsified for monetary gain and may contain incorrect amounts or even no active ingredients at all, as well as products that are inadequate due to poor compliance to conventional quality standards and medicines that have degraded over time. Across a number of studies it has been reported that 4-92% of antimalarials tested are poor quality. This represents a massive risk to the population subjected to the use of these medicines, in the form of more severe and prolonged illness, additional costs to individuals who already have very little money, and lack of confidence in treatments. The continuing circulation of poor-quality medicines results from a number of factors, including insufficient regulatory capacity in susceptible countries, inadequate funding to perform regulatory functions, poor coordination between regulatory authorities, and inefficient import/export control systems. To combat the distribution of poor-quality medicines a number of organisations have developed guidelines for the procurement of antimalarials, and programs to educate consumers about the risks of poor-quality medicines and incentivise retailers to identify and report falsified medicines. The development of new technologies to quickly identify poor-quality medicines in the field is also essential, and some significant advances have been made. CONCLUSION: There has been considerable improvement in the delivery of high-quality antimalarials to those who need them; however, there is still an urgent need for a collective response by the international community, political leaders, regulatory bodies, and pharmaceutical companies. This should include political commitment for enhanced research and development funding, such as for new innovative track-and-trace field devices, and international efforts to strengthen and harmonise drug regulation practices.

Monoclonal antibody therapy in cancer: When two is better (and considerably more expensive) than one.

WHAT IS KNOWN AND OBJECTIVE: It is 20 years since the US Food and Drug Administration approved the first successful monoclonal anticancer antibody, trastuzumab. The therapeutic utility of monoclonal antibodies in cancer is often limited by partial clinical responses and the development of tumour resistance. An expanding strategy, to be reviewed here, to overcome the limited response and resistance to monotherapy utilizes concurrent treatment with two synergistic monoclonal antibodies. COMMENT: Key examples include two monoclonal antibodies, each engaging a distinct site of human epidermal growth factor receptor 2 (HER2), in the treatment of breast cancer and a combination of antibodies to two distinct T-cell antigens for the treatment of melanoma. Here, we provide an overview of the rationale and evidence for using selected monoclonal antibodies in combination for treating some cancers, along with potential hazards, especially autoimmune-related toxicities. WHAT IS NEW AND CONCLUSION: Thorough research, the development of panels of biomarkers and individualization of therapy will be necessary to optimize the use of these combinations and minimize the substantial risk of overstimulating the immune system.

Chemotherapy in Pancreatic Cancer: A Systematic Review.

BACKGROUND AND AIM: Pancreatic cancer is one of the most fatal cancers. Cytotoxic chemotherapy remains the mainstream treatment for unresectable pancreatic cancer. This systematic review evaluated and compared the overall survival (OS) and progression-free survival (PFS) outcomes obtained from recent phase 2 and 3 clinical trials of pancreatic cancer chemotherapy. MATERIALS AND METHODS: Thirty-two studies were included and compared based on chemotherapy agents or combinations used. Additionally, outcomes of first-line versus second-line chemotherapy in pancreatic cancer were compared. RESULTS: In studies that investigated the treatments in adjuvant settings, the highest OS reported was for S-1 in patients, who received prior surgical resection (46.5 months). In neoadjuvant settings, the combination of gemcitabine, docetaxel, and capecitabine prior to the surgical resection had promising outcomes (OS of 32.5 months). In non-adjuvant settings, the highest OS reported was for the combination of temsirolimus plus bevacizumab (34.0 months). Amongst studies that investigated second-line treatment, the highest OS reported was for the combination of gemcitabine plus cisplatin (35.5 months), then temsirolimus plus bevacizumab (34.0 months). CONCLUSIONS: There is a need to develop further strategies besides chemotherapy to improve the outcomes in pancreatic cancer treatment. Future studies should consider surgical interventions, combination chemotherapy, and individualized second-line treatment based on the prior chemotherapy.

Australian pharmacists' knowledge of the efficacy and safety of complementary medicines.

Global usage and expenditure on complementary medicines is increasing. Over 50% of consumers purchase these products from pharmacies and expect pharmacists to provide them with appropriate information regarding efficacy and safety of these products. Internationally, pharmacists have identified their lack of detailed knowledge of the efficacy and safety of these products as a barrier to recommending these products. Currently, little is known about the actual knowledge Australian pharmacists have of these products. This research seeks to determine Australian pharmacists' knowledge of the efficacy and safety of complementary medicines. An online survey was validated and distributed by three professional pharmacy bodies in Australia and online social media to survey Australian pharmacists' knowledge of a selection of complementary medicines that are defined as having therapeutic benefits as per the Australian Therapeutic Guidelines. In total, 535 complete surveys were returned and included in the final analysis. Surveys were predominantly completed by community pharmacists. The mean knowledge score obtained was 62%. There were no statistically significantly different results from pharmacists with a nutritional qualification. Australian pharmacists appear to have a basic knowledge of complementary medicines with a defined clinical effect. Specialised and targeted education focussing on relevant and efficacious complementary medicines with strong clinical evidence base is required.

Scabies: an ancient global disease with a need for new therapies.

BACKGROUND: Scabies is an ancient disease (documented as far back as 2500 years ago). It affects about 300 million people annually worldwide, and the prevalence is as high as about 60% in Indigenous and Torres Strait Islander children in Australia. This is more than six times the rate seen in the rest of the developed world. Scabies is frequently complicated by bacterial infection leading to the development of skin sores and other more serious consequences such as septicaemia and chronic heart and kidney diseases. This causes a substantial social and economic burden especially in resource poor communities around the world. DISCUSSION: Very few treatment options are currently available for the management of scabies infection. In this manuscript we briefly discuss the clinical consequences of scabies and the problems found (studies conducted in Australia) with the currently used topical and oral treatments. Current scabies treatment options are fairly ineffective in preventing treatment relapse, inflammatory skin reactions and associated bacterial skin infections. None have ovicidal, antibacterial, anti-inflammatory and/or anti-pruritic properties. Treatments which are currently available for scabies can be problematic with adverse effects and perhaps of greater concern the risk of treatment failure. The development of new chemical entities is doubtful in the near future. Though there may be potential for immunological control, the development of a vaccine or other immunotherapy modalities may be decades away. The emergence of resistance among scabies mites to classical scabicides and ineffectiveness of current treatments (in reducing inflammatory skin reactions and secondary bacterial infections associated with scabies), raise serious concerns regarding current therapy. Treatment adherence difficulties, and safety and efficacy uncertainties in the young and elderly, all signal the need to identify new treatments for scabies.

Examination of the nutritional intake of patients undergoing opioid replacement therapy: A systematic review.

AIM: This systematic review aimed to determine the level of existing research that investigates the intake, specifically macro and micronutrient intake, of patients undergoing opioid replacement therapy. METHODS: A systematic review was conducted across PubMed, Embase, Cochrane and CINAHL databases using a pre-determined protocol. Studies published between 2001 and 2022 assessing macronutrient or micronutrient intake in opioid replacement therapy patients were included. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was utilised for quality appraisal.  Data from each of the included papers was synthesised in a narrative manner. Data extracted included all measurements of nutrition including macronutrient, and micronutrient intake and any bioanalysis results and methods utilised. RESULTS: Seven papers (one cohort study and six cross-sectional studies, n = 443) were included that investigated an aspect of nutritional intake in patients receiving opioid replacement therapy. The majority of included papers reported an assessment of both macro and micronutrient and resulting energy intake as determined by food consumption. The included papers described a picture of irregular nutritional intake in patients undergoing opioid replacement therapy. CONCLUSION: Minimal research into the nutritional intake of opioid replacement therapy patients exists. The existing research is suggestive of irregular nutritional intake from both macro and micronutrient consumption and indicates a need for further studies and increased attention on this vulnerable patient group.

Does creatine supplementation affect recovery speed of impulse above critical torque?

We previously reported that creatine supplementation improved intermittent isometric exercise performance by augmenting the total impulse performed above end-test torque (total IET'). However, our previous analyses did not enable mechanistic assessments. The objective of this study was to determine if creatine supplementation affected the IET' speed of recovery. To achieve this objective, we retrospectively analyzed our data using the IET' balance model to determine the time constant for the recovery of IET' (τIET'). Sixteen men were randomly allocated into creatine (N = 8) or placebo (N = 8) groups. Prior to supplementation, participants performed quadriceps all-out exercise to determine end-test torque (ET) and IET'. Participants then performed quadriceps exercise at ET + 10% until task-failure before supplementation (Baseline), until task-failure after supplementation (Creatine or Placebo), and until the Baseline time after supplementation (Creatine- or Placebo-Isotime). τIET' was faster than Baseline for Creatine (669 ± 98 vs 470 ± 66 s), but not Placebo (792 ± 166 vs 786 ± 161 s). The creatine-induced change in τIET' was inversely correlated with the creatine-induced changes in both the rate of peripheral fatigue development and time to task-failure. τIET' was inversely correlated with total IET' and ET in all conditions, but creatine supplementation shifted this relationship such that τIET' was faster for a given ET. Creatine supplementation, therefore, sped the recovery of IET' during intermittent isometric exercise, which was inversely related to the improvement in exercise performance. These findings support that the improvement in exercise performance after creatine supplementation was, at least in part, specific to effects on the physiological mechanisms that determine the IET' speed of recovery.HIGHLIGHTSSixteen healthy participants were randomly allocated to creatine supplementation or placebo groups.Creatine supplementation accelerated the time constant for the recovery of IET' (τIET').The time constant for the recovery of IET' (τIET') was inversely related to both the rate of peripheral fatigue development and the time to task failure.

Novel pictograms to improve pharmacist understanding of the number needed to treat (NNT).

INTRODUCTION: Number needed to treat (NNT) is a clinically useful "yardstick" used to gauge the efficacy of therapeutic interventions. The objective of this project was to develop and pilot a series of pictograms and assess their impact on pharmacist understanding of the NNT. METHODS: Three decision aids containing NNT pictograms were developed following a preliminary literature review and three focus groups with current Australian-registered pharmacists and pharmacist interns. Pharmacists then tested the pictograms in a research pilot in clinical encounters until (1) ≥ 3 sessions had occurred or (2) a two-week period had elapsed from commencement. Knowledge assessment was administered both pre- and post-pilot. Transcription and inductive thematic analysis were applied to focus group data. Descriptive statistics, Wilcoxon signed rank, and McNemar's tests were used to analyse the pilot data. RESULTS: Six core themes regarding NNT decision aid development were identified with >80% consensus across three focus groups (N = 11). Comparison of the pre-post measures (n = 10) showed an increase in median scores after use of NNT decision aids, correlating to a moderate Cohen classified effect size (d = 0.54). Wilcoxon matched pairs test demonstrated a statistically insignificant influence of NNT pictograms on the knowledge assessment survey (P > .05). CONCLUSIONS: While the NNT is not a new concept, its incorporation as part of pictograms for health practitioner enrichment is novel. This pilot study suggests that utilizing decision aids with NNT pictograms as counselling adjuncts appears promising in the realm of enhancing pharmacists' understanding of the NNT.