Development of an evaluation framework for health information communication technology in contemporary pharmacy practice.

Background: Health information communication technology (ICT) has rapidly evolved in contemporary pharmacy practice worldwide. The Australian healthcare system is experiencing a paradigm shift to real-time interconnectivity for practitioners and consumers and interoperable digital health. With these developments come a need to evaluate use of technologies specifically in pharmacy practice to optimize their clinical functionality. There are no published frameworks for evaluating ICT needs or implementation in pharmacy practice. Objective: This paper proposes a theoretical framework for evaluating health ICT in pharmacy. Methods: Development of the evaluation framework was informed by a systematic scoping review and health informatics literature. Specifically, the framework drew upon critical appraisal and concept mapping of the TAM, ISS and HOT-fit validated models, with respect to health ICT in contemporary pharmacy practice. Results: The proposed model was named the Technology Evaluation Key (TEK). The TEK comprises of 10 domains; healthcare system, organization, practitioner, user interface, ICT, use, operational outcomes, system outcomes, clinical outcomes and timely access to care. Conclusions: This is the first published proposed evaluation framework developed for health ICT specifically in contemporary pharmacy practice. TEK represents a pragmatic way to ensure the development, refinement and implementation of new and existing technologies in contemporary pharmacy practice to keep pace with the clinical and professional requirements of community pharmacists. Operational, clinical and system outcomes should be evaluated as coexisting factors that may impact implementation. Validation research utilizing Design Science Research Methodology will enhance utility for end users and ensure the relevance and application of the TEK to contemporary pharmacy practice.

Healthcare expenditure and its socio-demographic and clinical predictors in Australians with poorly controlled asthma.

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.

Health information communication technology evaluation frameworks for pharmacist prescribing: A systematic scoping review.

BACKGROUND: Information communication technology (ICT) is instrumental in pharmacists' current practice and emerging roles. One such role is prescribing, which requires the use of clinical guidelines and documentation of decision-making, commonly via ICT. Development and refinement of ICT should be guided by evaluation frameworks that describe or measure features of ICT and its implementation. In the context of pharmacist prescribing, these evaluation frameworks should be specific to health stakeholders and the pharmacy setting. OBJECTIVES: To identify ICT evaluation frameworks from health-related literature and review frameworks relevant to the development, implementation, and evaluation of pharmacist prescribing. METHODS: A database search of CINAHL, Cochrane Library, EMBASE, Medline (Ovid), ProQuest, Scopus, Web of Science and grey literature was conducted, using combinations of keywords relating to 'ICT', 'utilization', 'usability', and 'evaluation framework'. Abstracts and titles were screened according to inclusion criteria. Identified evaluation frameworks were critiqued for relevance to pharmacy practice. RESULTS: Twenty-two articles were identified, describing the development or application of 20 evaluation frameworks. None of the frameworks was developed specifically for pharmacy practice. The Technology Acceptance Model (TAM), describing use behavior, behavior intention, perceived usefulness, and perceived ease of use, was the most widely utilized framework. The Information System Success (ISS) and Human-Organization and Technology Fit (HOT-fit) are notable evaluation frameworks that address user and organizational influences in health ICT utility, and factors of both can address the limitation of TAM. CONCLUSIONS: The findings call for development of an agile evaluation framework for the system under review; however, this can prove difficult due to the heterogenicity and complexity of the healthcare system, particularly contemporary pharmacy practice. While the TAM appears useful to evaluate user attitudes and intentions towards ICT, its relevance to ICT in contemporary community pharmacy practice requires exploration.

Patient uptake and outcomes following pharmacist-initiated referrals to general practitioners for asthma review.

Uptake 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.

Integrating Pharmacy and Registry Data Strengthens Clinical Assessments of Patient Adherence.

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.

Rethinking the gold standard - The feasibility of randomized controlled trials within health services effectiveness research.

BACKGROUND: An evidence-based randomized controlled trial for a novel Pharmacy Asthma Service was tested in 3 Australian states. Positive asthma outcomes were achieved after the 12-month intervention, albeit in both the intervention and comparator arms. The current investigation uses a mixed methods approach to 1) qualitatively explore how comparator arm pharmacists implemented the trial protocol and 2) quantitatively examine how this may have impacted patient outcomes in this trial. METHODS: Post-intervention semi-structured qualitative interviews were conducted with 20 pharmacists, representing 21 of 37 (57%) comparator arm pharmacies that completed the trial. Based on these interviews, pharmacies were classified as 'adherent' to the trial protocol (reporting no interventions other than general practitioner referral) or 'non-adherent' (reporting at least one extra intervention to the trial protocol), or 'inconclusive'. These subgroups were compared descriptively in relation to patient outcomes. RESULTS: Overall, 33% (n = 8/24) of the comparator pharmacies who were interviewed (n = 21) or determined to have monitoring by a project officer to ensure adherence to the protocol (n = 3) were classified as adherent), 58% (n = 14/24) as non-adherent, 8% inconclusive (n = 2/24). While all patients commenced with uncontrolled asthma (Asthma Control Questionnaire score (ACQ) > 1.5), after 12 months the mean ACQ score for patients from adherent comparator pharmacies ('true control') was 1.8 (still uncontrolled asthma) compared to a score of 1.4 (controlled asthma) in the non-adherent comparator group. Quality of life significantly improved in the non-adherent comparator group over the 12 months of the trial. CONCLUSION: The majority of pharmacists in the comparator arm who were interviewed, introduced their own interventions, which may have influenced the outcomes of the trial. The naturalistic setting of the study was not protective against these confounders. These findings question the feasibility of comparator arms within primary care settings and that alternative study designs should be considered when designing future intervention studies in pharmacy practice.

Pharmacist-delivered asthma management services-what do patients think?

BACKGROUND: Evaluating pharmacy services from the perspective of the end user-patients-is imperative for ensuring the sustainability of services. OBJECTIVES: This study evaluated patient feedback regarding an evidence-based community pharmacist-delivered Pharmacy Asthma Service (PAS), in terms of overall satisfaction, satisfaction with PAS delivery, and perceived impact, and explored determinates of satisfaction. METHODS: All patients who received the 12-month PAS (n = 143) were invited to provide feedback via a project-specific patient evaluation survey upon completion of the final consultation. The survey included a mix of 5-point Likert-type scale items, multiple-choice questions, and free-text response questions. Overall satisfaction was determined by a single 5-point Likert-type scale question. Satisfaction with service delivery and overall impact were assessed using a 4-item and 8-item Likert-type scale, respectively, and a summative score computed for each section. Patient PAS data including demographics and management outcomes were then cross tabulated against overall satisfaction, satisfaction with PAS delivery, and impact. RESULTS: Feedback was received from 71% (n = 101) of patients who completed the PAS. The results indicated high overall patient satisfaction, with 86% of respondents very satisfied with the service. Patients identified positive impacts of the PAS including improved understanding and management of asthma and allergic rhinitis. Similarly, almost all patients were satisfied with service delivery including the pharmacist's knowledge and their ability to assist (98%) and the privacy of the pharmacy setting (91%). Patients who had controlled asthma at the end of the trial had higher levels of overall satisfaction (χ2 = 9.584, df = 5, P = 0.048) and reported greater overall impact on asthma and allergic rhinitis management (U = 1593.5, P = 0.004). CONCLUSION: The diffusion of health services within community pharmacy practice is dependent upon patient receptivity and how the services align with patient needs. The positive satisfaction received indicates that the PAS would be welcomed by patients with asthma in future.

A Multi-Mode Education Program to Enhance Asthma Care by Pharmacists.

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.

Immunization training for pharmacy students: a student-centered evaluation.

BACKGROUND: Persistent and emerging public health challenges mean Pharmacy students require training in immunization services. Curtin University, Australia, integrated blended-delivery immunization training into the final-year Bachelor of Pharmacy (Hons) and graduate-entry Master of Pharmacy curricula in 2019 and 2020, utilizing materials licenced from the Pharmaceutical Society of Australia. OBJECTIVE: This study evaluated changes in students' attitude, confidence, self-perceived knowledge and self-perceived skills pre- and post-training delivered in 2020. METHODS: Pre- and post-training questionnaires featured 42 opinion statements grouped under headings 'Attitudes', 'Confidence', 'Self-Perceived Knowledge' and 'Self-Perceived Skills', and answered using five-point Likert scales (1 = strongly disagree to 5 = strongly agree). Completed pre- and post-training questionnaires were matched using respondent-generated codes. Data were subjected to descriptive and multivariate regression analysis to test pre-post changes and associations and changes in mean scores. RESULTS: 128 (95.5%) and 132 (98.5%) students completed the pre- and post-training questionnaires, respectively. Immunization training resulted in significant (p<0.05) improvement in students' mean Confidence score (3.33 vs 3.96), Self-Perceived Knowledge score (3.08 vs 4.47) and Self-Perceived Skills score (2.81 vs 4.55). Improvement in students' mean Attitude score was also statistically significant (4.45 vs 4.61), yet more positively skewed pre-training. No significant pre-post differences were found between the Bachelor and Master students. Post-training, all respondents agreed that the training program increased their attitude, confidence, perceived knowledge and perceived skills, rating the training experience as either Excellent (91.6%) or Good (8.4%). CONCLUSIONS: Immunization training integrated into final-year BPharm (Hons) and MPharm curricula improved Attitudes, Confidence, Self-Perceived Knowledge and Self-Perceived Skills, all key to further role development in public health. This method is recommended to other Pharmacy schools to determine the impact and acceptability of immunization training programs amongst students.

Immunization training for pharmacy students: a student-centered evaluation

Background: Persistent and emerging public health challenges mean Pharmacy students require training in immunization services. Curtin University, Australia, integrated blended-delivery immunization training into the final-year Bachelor of Pharmacy (Hons) and graduate-entry Master of Pharmacy curricula in 2019 and 2020, utilizing materials licenced from the Pharmaceutical Society of Australia. Objective: This study evaluated changes in students’ attitude, confidence, self-perceived knowledge and self-perceived skills pre- and post-training delivered in 2020. Methods: Pre- and post-training questionnaires featured 42 opinion statements grouped under headings ‘Attitudes’, ‘Confidence’, ‘Self-Perceived Knowledge’ and ‘Self-Perceived Skills’, and answered using five-point Likert scales (1 = strongly disagree to 5 = strongly agree). Completed pre- and post-training questionnaires were matched using respondent-generated codes. Data were subjected to descriptive and multivariate regression analysis to test pre-post changes and associations and changes in mean scores. Results: 128 (95.5%) and 132 (98.5%) students completed the pre- and post-training questionnaires, respectively. Immunization training resulted in significant (p<0.05) improvement in students’ mean Confidence score (3.33 vs 3.96), Self-Perceived Knowledge score (3.08 vs 4.47) and Self-Perceived Skills score (2.81 vs 4.55). Improvement in students’ mean Attitude score was also statistically significant (4.45 vs 4.61), yet more positively skewed pre-training. No significant pre-post differences were found between the Bachelor and Master students. Post-training, all respondents agreed that the training program increased their attitude, confidence, perceived knowledge and perceived skills, rating the training experience as either Excellent (91.6%) or Good (8.4%) (AU)

A Targeted Approach to Improve Asthma Control Using Community Pharmacists.

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.

Pharmacists experience of and perspectives about recruiting patients into a community pharmacy asthma service trial.

BACKGROUND: Research trials testing the impact of community pharmacy services require adequate and appropriate recruitment of patients by participating pharmacists, however, this step presents an ongoing challenge. OBJECTIVE: To identify factors affecting recruitment of patients in community pharmacies participating in a multi-center trial of a pharmacy asthma service in Australia (Pharmacy Trial Program - Asthma and Rhinitis Control (PTP-ARC). METHODS: The PTP-ARC protocol required identification and recruitment of seven eligible asthma patients per pharmacy. Pharmacists responsible for sites that failed to recruit or retain any patients into the PTP-ARC trial participated in a semi-structured telephone interview about their experiences with these elements of the trial. The interviews were recorded, transcribed and coded using QSR International's NVivo 11 software. The analysis was conducted with reference to the COM-B framework (Capability, Opportunity, Motivation). RESULTS: Pharmacists from 47 of 50 eligible pharmacies were interviewed. Seventeen factors were isolated and mapped to the COM-B framework. Psychological capability (recruitment hesitancy, research literacy and health literacy), physical capability (technological barriers, staffing issues and pharmacy busyness), physical opportunity (patient busyness, trial timing, study protocol, support and location), social opportunity (health literacy and supportive milieu), reflective motivation (incentive for participation, simplification) and automatic motivation (patient attitudes and pharmacist-felt experience) were factors affecting pharmacists' participation. Challenges identified included: issues with the software, unfamiliarity with research procedures generally (and specifically with the PTP-ARC protocols), the patients' lack of interest and pharmacists' lack of time. CONCLUSIONS: To the best of our knowledge, this is the first study to focus on issues affecting patient recruitment into a pharmacy health services (asthma) trial in real time. To propel evidence-based trials towards practice implementation, user-friendly software, pharmacists' training on research and patient-engagement and adequate remuneration to address pharmacist time issues need to be key foci for health services design and implementation research.

Comparison of training responses and performance adaptations in endurance-trained men and women performing high-intensity interval training.

The efficacy of high-intensity interval training (HIIT) to elicit physiological and performance adaptations in endurance athletes has been established in men and to a lesser extent in women. This study compared lactate threshold (LT2) and performance adaptations to HIIT between men and women. Nine male and eight female cyclists and triathletes completed trials to determine their LT2 and 40 km cycling performance before, and after 10 HIIT sessions. Each HIIT session consisted of 10 × 90 s at peak power output, separated by 60 s active recovery. Main effects showed that HIIT improved peak power output (p = 0.05; ES: 0.2); relative peak power output (W.kg-1; p = 0.04; ES: 0.3 and W.kg-0.32; p = 0.04; ES: 0.3); incremental time to fatigue (p = 0.01; ES: 0.4), time trial time (p < 0.001; ES: 0.7) and time trial power output (p < 0.001; ES: 0.7) equally in both sexes. Although LT2 power output explained 77% of the performance improvement in women, no variable explained the performance improvement in men, suggesting another mechanism(s) was involved. Although HIIT improved cycling performance in men and women, it might not be appropriate to evaluate the effectiveness of HIIT using the same variables for both sexes.

The Efficacy of the Lactate Threshold: A Sex-Based Comparison.

Hoffmann, SM, Skinner, TL, van Rosendal, SP, Osborne, MA, Emmerton, LM, and Jenkins, DG. The efficacy of the lactate threshold: A sex-based comparison. J Strength Cond Res 34(11): 3190-3198, 2020-The second lactate threshold (LT2) has previously been associated with endurance performance; however, comparisons between sexes are lacking regarding its efficacy. The aim of this study was to compare LT2 between men and women, specifically regarding its (a) relationship with endurance performance and (b) capacity to establish training and competition intensities. Competitive male (mean ± SD: age, 27.7 ± 4.7 years; V[Combining Dot Above]O2max, 59.7 ± 5.2 ml·kg·min; n = 10) and female (mean ± SD: age, 27.3 ± 6.2 years; V[Combining Dot Above]O2max, 54.5 ± 5.3 ml·kg·min; n = 12) cyclists and triathletes completed an incremental cycle trial to volitional fatigue (for determination of V[Combining Dot Above]O2max and LT2 via the modified D-max method), a constant load (±5%) exercise trial of 30 minutes at LT2 power output, and a 40-km cycle time trial. The LT2 significantly correlated with 40-km cycling performance in both men (r = -0.69 to -0.77; p < 0.01-0.05) and women (r = -0.63 to -0.75; p < 0.01-0.05). All men sustained LT2 power output for 30 minutes, compared with 82% of women. Despite LT2 reflecting a similar heart rate, V[Combining Dot Above]O2, and [La] to those elicited during a 40-km time trial in both men and women, power output at LT2 was 6% higher (p < 0.05) than mean time trial power output in women, with no significant difference in men. Based on these findings, sex-specific recommendations have been suggested in regard to the use of LT2 for establishing performance potential, prescribing endurance training intensities and setting 40-km performance intensity.

Oral Contraceptive Use Influences On-Kinetic Adaptations to Sprint Interval Training in Recreationally-Active Women.

INTRODUCTION: Oral contraceptive (OC) use influences peak exercise responses to training, however, the influence of OC on central and peripheral adaptations to exercise training are unknown. This study investigated the influence of OC use on changes in time-to-fatigue, pulmonary oxygen uptake, cardiac output, and heart rate on-kinetics, as well as tissue saturation index to 4 weeks of sprint interval training in recreationally active women. METHODS: Women taking an oral contraceptive (OC; n = 25) or experiencing natural menstrual cycles (MC; n = 22) completed an incremental exercise test to volitional exhaustion followed by a square-wave step-transition protocol to moderate (90% of power output at ventilatory threshold) and high intensity (Δ50% of power output at ventilatory threshold) exercise on two separate occasions. Time-to-fatigue, pulmonary oxygen uptake on-kinetics, cardiac output, and heart rate on-kinetics, and tissue saturation index responses were assessed prior to, and following 12 sessions of sprint interval training (10 min × 1 min efforts at 100-120% PPO in a 1:2 work:rest ratio) completed over 4 weeks. RESULTS: Time-to-fatigue increased in both groups following training (p < 0.001), with no difference between groups. All cardiovascular on-kinetic parameters improved to the same extent following training in both groups. Greater improvements in pulmonary oxygen up-take kinetics were seen at both intensities in the MC group (p < 0.05 from pre-training) but were blunted in the OC group (p > 0.05 from pre-training). In contrast, changes in tissue saturation index were greater in the OC group at both intensities (p < 0.05); with the MC group showing no changes at either intensity. DISCUSSION: Oral contraceptive use may reduce central adaptations to sprint interval training in women without influencing improvements in exercise performance - potentially due to greater peripheral adaptation. This may be due to the influence of exogenous oestradiol and progestogen on cardiovascular function and skeletal muscle blood flow. Further investigation into female-specific influences on training adaptation and exercise performance is warranted.

Development and exploratory analysis of software to detect look-alike, sound-alike medicine names.

BACKGROUND: 'Look-alike, sound-alike' (LASA) medicines may be confused by prescribers, pharmacists, nurses and patients, with serious consequences for patient safety. The current research aimed to develop and trial software to proactively identify LASA medicines by computing medicine name similarity scores. METHODS: Literature review identified open-source software from the United States Food and Drug Administration for screening of proposed medicine names. We adapted and refined this software to compute similarity scores (0.0000-1.0000) for all possible pairs of medicines registered in Australia. Two-fold exploratory analysis compared: RESULTS: Screening of the Australian medicines register identified 7,750 medicine pairs with at least moderate (arbitrarily ≥0.6600) name similarity, including many oncology, immunomodulating and neuromuscular-blocking medicines. Computed similarity scores and resulting risk categories demonstrated a modest correlation with the manually-calculated similarity scores (r = 0.324, p < 0.002, 95 % CI 0.119-0.529). However, agreement between the resulting risk categories was not significant (Cohen's kappa = -0.162, standard error = 0.063). CONCLUSIONS: The software (LASA v2) has potential to identify pairs of confusable medicines. It is recommended to supplement incident reports in risk-management programs, and to facilitate pre-screening of medicine names prior to brand/trade name approval and inclusion of medicines in formularies.

Medicines reclassification from a pharmaceutical industry perspective: An international qualitative study.

BACKGROUND: Widening access to medicines through reclassification ('switching') of medicines from prescription to non-prescription is an international trend generally welcomed by community pharmacists. Research has focused on scheduling and committee deliberations affecting reclassification, rather than industry aspects, despite industry's role in driving reclassifications. The research aimed to identify how pharmaceutical industry and product-related factors influence reclassification, and to explore stakeholder acceptability of government or third-party driven reclassifications. METHODS: Sixty-five in-depth, semi-structured interviews were conducted with 80 key informants (including representatives from regulatory bodies, industry, pharmacy and medicine) in developed countries including the United States, the United Kingdom, Japan, Australia, and New Zealand. The questions explored barriers and enablers to reclassification at the local (micro-), regional (meso-) and global (macro-) levels. Analysis of transcribed interviews entailed descriptive and thematic approaches. RESULTS: Pharmaceutical industry decisions to drive medicine reclassification reflect characteristics of the company, product, and external environment at all levels. For the company, financial factors, company focus (e.g. on prescription business versus non-prescription business), and capability in non-prescription medicines and reclassification were common influences. Products with significant non-prescription market potential and a well-known prescription medicine brand name most suited reclassification, usually near patent expiry. Barriers included immediate generic entry post-reclassification, and a short-term profitability and/or prescription business focus. Some countries allow government or a third-party (including pharmacy) to drive reclassifications, with examples of successful reclassifications ensuing. Some industry and other participants held concerns about this practice, particularly in the United States. Concerns included insufficient resourcing, and the pharmaceutical company's business, potentially encouraging product withdrawal or legal challenge. CONCLUSIONS: This study is the first to explore both pharmaceutical industry factors affecting reclassification and acceptability of alternate drivers of reclassification. Factors beyond clinical safety and efficacy and the local reclassification environment can influence reclassification. Pharmacy-driven reclassification might be one alternative.

Prescribing and Administration of Opioid Analgesics in Residents of Aged Care Facilities.

OBJECTIVE: Optimal pain management in residents requires an understanding of prescribing and administration of opioid analgesics. This study aimed to describe opioid administration for elderly residents in a selection of aged care facilities. METHODS: A cross-sectional audit of analgesics administration was conducted for all 458 residents of three-aged care facilities on May 1, 2017. The facilities (each ~160 beds) represented a geographically diverse area in Perth, Australia, and varying service levels by nurse practitioners. Data were accessed using the iCare® platform and transcribed into a customized database. Data were reported descriptively, with relationships between categorical variables examined using the Chi-square analysis. Main outcome measures in the study were the prevalence of administration of opioids compared to that of nonopioid analgesics and no analgesics on the audit date, and characteristics of the opioid prescriptions (the type of prescriber and nursing/care staff involved in the dose administration). FINDINGS: Of 458 residents, 95 (20.7%) received an opioid analgesic on the audit date; 231 had also received a nonopioid analgesic. The most common opioid (34 residents) was a brand of oxycodone hydrochloride and naloxone hydrochloride as 10/5 mg tablets. There was no significant tendency for opioid prescribing by classification of the prescriber, nor for any category of nursing/care staff to administer the particular types of analgesics. CONCLUSION: The tendency for prescribing of opioids showed no significant among the prescribers. Finally, the administration of opioids was predominantly by caregivers. This represents the first step in a program of activity to ensure the quality use of potent analgesics in an aged care provider network.

Medical cannabis: A needs analysis for people with epilepsy.

BACKGROUND AND PURPOSE: Medical cannabis may be effective treatment for refractory epilepsy. It is timely to seek users' and potential users' opinions in regard to its place in the management of epilepsy. MATERIALS AND METHODS: An online survey was administered to members of an epilepsy support organisation in Western Australia. Experience with cannabis for management of epilepsy was explored, along with desire to trial a particular pharmaceutical formulation(s). RESULTS: People with epilepsy (33/71) and carers (38/71) participated. Fifty-four participants indicated no experience with medical cannabis, although 35, mainly with inadequate response to prescription medicines, were willing to ask for a prescription. Concerns included difficulty accessing cannabis and high cost of this treatment. Tablets/capsules was the most acceptable dosage form for development. CONCLUSION: These findings suggest wide interest in trialling medical cannabis in individual cases of refractory epilepsy, despite the developing body of literature and some concerns about cost and procurement.