Ko au tenei: This is me - Exploring the lived experience of underrepresented groups with pharmacy services to inform the development of pharmacy case-based learning.

INTRODUCTION: Demographic and social characteristics of underrepresented groups are often poorly described in pharmacy case-based learning, leading to poor representation of these groups in the pharmacy curriculum. This research project aimed to understand the lived experience of underrepresented groups with pharmacy services and to use this to inform the development of pharmacy case-based student learning materials. METHODS: This was a single centre, grounded theory, qualitative study. Focus groups were undertaken with six underrepresented groups: Maori, Pacific, Asian, LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual), disability, and refugee. These focus groups were conducted in Dunedin, Aotearoa New Zealand from July to August 2022. Focus group sessions were recorded and analysed to identify beliefs, ideas, and themes shared between participants and groups. FINDINGS: Participants in all focus groups had a strong desire to be seen and represented in pharmacy cases, however this was conditional on the learning being delivered in a way that upholds their beliefs, values, and voices. From these lived experiences, cultural, environmental, personal, and social factors were identified as being critical for inclusion in pharmacy case-based learning materials. CONCLUSIONS: The lived experience of underrepresented populations provides critical insights that will enhance pharmacy case-based learning. The key factors that could be included in case-based learning are: ethnicity, personal beliefs, language, disability, gender identity, sexual identity, and family. To achieve health equity and improve cultural awareness and intelligence of our future pharmacy workforce, these experiences need to become more present in curricula.

Adapting an equity-focused implementation process framework with a focus on ethnic health inequities in the Aotearoa New Zealand context.

BACKGROUND: Health intervention implementation in Aotearoa New Zealand (NZ), as in many countries globally, usually varies by ethnicity. Maori (the Indigenous peoples of Aotearoa) and Pacific peoples are less likely to receive interventions than other ethnic groups, despite experiencing persistent health inequities. This study aimed to develop an equity-focused implementation framework, appropriate for the Aotearoa NZ context, to support the planning and delivery of equitable implementation pathways for health interventions, with the intention of achieving equitable outcomes for Maori, as well as people originating from the Pacific Islands. METHODS: A scoping review of the literature to identify existing equity-focused implementation theories, models and frameworks was undertaken. One of these, the Equity-based framework for Implementation Research (EquIR), was selected for adaptation. The adaptation process was undertaken in collaboration with the project's Maori and consumer advisory groups and informed by the expertise of local health equity researchers and stakeholders, as well as the international implementation science literature. RESULTS: The adapted framework's foundation is the principles of Te Tiriti o Waitangi (the written agreement between Maori rangatira (chiefs) and the British Crown), and its focus is whanau (extended family)-centred implementation that meets the health and wellbeing aspirations, priorities and needs of whanau. The implementation pathway comprises four main steps: implementation planning, pathway design, monitoring, and outcomes and evaluation, all with an equity focus. The pathway is underpinned by the core constructs of equitable implementation in Aotearoa NZ: collaborative design, anti-racism, Maori and priority population expertise, cultural safety and values-based. Additionally, the contextual factors impacting implementation, i.e. the social, economic, commercial and political determinants of health, are included. CONCLUSIONS: The framework presented in this study is the first equity-focused process-type implementation framework to be adapted for the Aotearoa NZ context. This framework is intended to support and facilitate equity-focused implementation research and health intervention implementation by mainstream health services.

Low dose or very low dose phenylephrine and cyclopentolate microdrops for retinopathy of prematurity eye examinations (The Little Eye Drop Study): a randomised controlled non-inferiority trial.

OBJECTIVE: To determine if very low dose (VLD, 0.5% phenylephrine, 0.1% cyclopentolate) mydriatic microdrop (approximately 7 µL) administration (up to three doses) is non-inferior to low dose (LD, 1% phenylephrine, 0.2% cyclopentolate) mydriatic microdrop administration for ophthalmologist-determined successful retinopathy of prematurity eye examination (ROPEE). DESIGN: Multicentre, prospective, randomised controlled, non-inferiority clinical trial. SETTING: Four neonatal intensive care units in Aotearoa, New Zealand from October 2019 to September 2021. PATIENTS: Infants with a birth weight less than 1250 g or gestational age less than 30+6 weeks and who required a ROPEE. INTERVENTIONS: The intervention: microdrop (approximately 7 µL) of VLD (0.5% phenylephrine and 0.1% cyclopentolate) to both eyes, or the comparison: microdrop of LD (1% phenylephrine and 0.2% cyclopentolate) to both eyes. Up to three doses could be administered. MAIN OUTCOME MEASURES: The primary outcome measure was an ophthalmologist-determined successful ROPEE. RESULTS: One hundred and fifty preterm infants (LD mean GA=27.4±1.8 weeks, mean birth weight=1011±290 g, VLD mean GA=27.5±1.9 weeks, mean birth weight=1049±281 g,) were randomised. Non-inferiority for successful ROPEE was demonstrated for the VLD group compared with the LD group (VLD successful ROPEE=100%, LD successful ROPEE=100%, 95% CI no continuity correction -0.05 to 0.05) and for Maori (95% CI no continuity correction -0.02 to 0.19). CONCLUSION: VLD microdrops enable safe and effective screening for ROPEE in both Maori and non-Maori preterm infants. TRIAL REGISTRATION NUMBER: ACTRN12619000795190.

A Survey of Neonatal Nurses on Mydriatic Regimens Used in Neonatal Retinopathy of Prematurity Eye Examinations.

OBJECTIVE: This study was aimed to determine mydriatic regimen(s) used in neonatal units in Aotearoa, New Zealand (NZ), and Australia and to estimate the frequency of adverse drug events following mydriatic administration in preterm neonates. STUDY DESIGN: A cross-sectional survey was sent to neonatal nursing staff listed in the Australian and New Zealand Neonatal Network contact list. Participants were asked to state what mydriatic regimen they use, and to estimate the frequency of adverse drug events when eye drops were administered for retinopathy of prematurity eye examinations (ROPEE). RESULTS: Thirteen different mydriatic regimens were identified; phenylephrine 2.5% and cyclopentolate 0.5% (1 standard drop of each) was the most commonly used regimen. Two of the regimens exceeded adult doses and five regimens included a mydriatic that is equivalent to an adult dose. Following mydriatic instillation, the three most common adverse effects were apnea, tachycardia, and periorbital pallor. CONCLUSION: Low-concentration single-microdrop regimens are currently in use and resulting in successful ROPEE, yet doses exceeding adult doses are in use throughout Aotearoa, NZ, and Australian units. We know from this dataset that neonates are experiencing unwanted and potentially preventable, adverse effects associated with mydriatics, and every effort should be made to minimize this risk. KEY POINTS: · Thirteen different regimens are in use in Aotearoa, NZ, and Australia.. · Three regimens use doses in excess of adult doses.. · Phenylephrine 2.5% and cyclopentolate 0.5% (one standard drop of each) is the most common regimen.

Exploring How Postmillennial Pharmacy Students Balance Life Priorities and Avoid Situations Known to Deplete Resilience.

Objective. Students are facing increasing academic pressures that can contribute to poor wellbeing. Evidence to inform the development of better student support services is weak. This study aimed to explore Bachelor of Pharmacy students' self-reported life priorities and ways they strategize to avoid resilience-depleting events on a day-to-day basis.Methods. Postmillennial (those born after 1996) pharmacy students enrolled in their final year of pharmacy school were introduced to the coaching concepts of the Wheel of Life and anti-goals. Students' top eight life priorities were collected and categorized. Students were asked to submit one anti-goal targeting a strategy used to avoid resilience depletion. Anti-goals were coded according to student priority areas and overarching themes were interpreted.Results. The top priorities of 110 final-year pharmacy students were: family, finance, health, friends/relationships, study, career prospects, fitness, personal growth, travel, and mental health/wellbeing. Priorities were both similar and dissimilar to traditional coaching priorities. Sixty-eight anti-goals were coded. The themes "being prepared" and "being present" were used to summarize strategies that students employed to avoid resilience depletion.Conclusion. The life priorities of newer student generations may be changing to be more individualistic and include a greater focus on self-help, while maintaining the core priorities of family, health, and finance. These findings uphold the notion that student support mechanisms must be modernized to accommodate students' needs.

Randomised controlled pilot trial comparing low dose and very low- dose microdrop administration of phenylephrine and cyclopentolate for retinopathy of prematurity eye examinations in neonates.

AIMS: To determine ifVery low dose mydriatic eye microdrop regimen sufficiently dilates the pupil (above 4.1 mm) compared with the currently used low dose mydriatic eye microdrop regimen.Cardiovascular, gastrointestinal and respiratory adverse effects occur following eye drop instillation. METHODS: Seventeen premature infants were recruited into this prospective, randomised controlled pilot trial in January 2017 to November 2018. Data were collected from the single-centre Neonatal Intensive Care Unit, Dunedin Hospital, New Zealand. The inclusion criteria were birth weight less than 1500 g or gestational age less than 31 weeks, or any premature infant requiring red reflex testing. Infants were randomised to receive either phenylephrine 1% or 0.5% and cyclopentolate 0.2% or 0.1%, 1 microdrop in both eyes. Efficacy outcome measures were pupil size at retinopathy of prematurity eye examination (ROPEE) and ophthalmologist rating of ease of screen. RESULTS: All participants had sufficient pupillary dilation for a successful ROPEE. Ophthalmologists rated the ROPEE as easy for 90% of all examinations. Pupil dilation measurements at the time of examination, mean±SD, 4.8±0.2 (95% CI 4.5 to 5.2) mm for treatment A and 5±0.2 (95%CI 4.6 to 5.4) mm for treatment B (p=0.61). There were no statistically significant differences between the groups for safety data. CONCLUSIONS: Very low dose microdrop administration of phenylephrine and cyclopentolate appears to be effective at sufficiently dilating the neonatal pupil for ROPEEs. Low dose and very low dose microdrop mydriatic regimens may also reduce the risk of unwanted adverse effects associated with these medicines. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (reference ACTRN12616001266459p).

Development of a cancer-themed escape room learning activity for undergraduate pharmacy students.

OBJECTIVES: The aim of this study was to evaluate the feasibility of a cancer-themed escape room as a learning activity for pharmacy students. METHODS: A cancer-themed escape room was developed with four activities linked to patient assessment, communication, therapeutics and calculations. Twenty-six groups of six students challenged the escape room. Outcomes included student performance measures and resources required. A SWOC (strengths, weaknesses, opportunities, and challenges) analysis was also conducted. RESULTS: A total of 20 student groups (77%) successfully escaped. The average escape time was 22 min. The SWOC analysis identified strengths of student engagement, opportunities for expansion, weaknesses related to student preparation, and some logistical challenges. CONCLUSION: A cancer-themed escape room is a viable learning tool for pharmacy students.

Systematic review of mydriatics used for screening of retinopathy in premature infants.

INTRODUCTION: Routine retinopathy of prematurity eye examinations are an important part of neonatal care, and mydriatic medicines are essential in dilating the pupil for the eye examination. There are concerns about the level of evidence for efficacy and safety of these mydriatic medicines. OBJECTIVE: This review evaluates both efficacy and safety evidence of mydriatics used during the retinopathy of prematurity eye examination. METHOD: Systematic literature review. RESULTS: There is limited evidence guiding clinical practice for safety and efficacy of mydriatics. The majority of publications are underpowered and with an unclear to high level of bias. There are a wide variety of mydriatic regimens evaluated for efficacy and safety, and multiple regimens are associated with case reports. CONCLUSIONS: Current international guideline seems unnecessarily high, especially when the reviewed literature suggest that lower doses are effective, albiet from underpowered studies. The lowest effective combination regimen appears to be phenylephrine 1% and cyclopentolate 0.2% (1 drop). Microdrop administration of this regimen would further increase the safety profile, however, efficacy needs to be assessed.

Planum temporale asymmetry to the right hemisphere in first-episode schizophrenia.

In schizophrenia patients reduced cerebral asymmetry is an important finding and this may reflect a disturbance in cortical development. We investigated planum temporale (PT) volume and asymmetry in 23 first-episode schizophrenia patients compared to healthy controls and found for the first time an in vivo volume asymmetry of PT to the right hemisphere.