Use of research evidence varied in efforts to expand specific pharmacist autonomous prescriptive authority: an evaluation and recommendations to increase research utilization.

BACKGROUND: An expanding body of literature shows that pharmacists' interventions improve health outcomes and are cost-saving. However, diverse state regulations of pharmacists' scope of practice create a discrepancy between what pharmacists are trained to do and what they legally can do. This study investigated how stakeholders utilized research evidence when developing expanded scope of practice policies in their respective states. METHODS: Using autonomous pharmacist prescriptive authority as a surrogate for general pharmacist scope of practice, a general policy document analysis was performed to understand the scope of practice landscape for pharmacists across the United States. Next, semi-structured interviews with policy-makers and pharmacy advocates were conducted to explore how the identified states in the policy document analysis utilized evidence during the policy-making process. Investigators analysed findings from the transcribed interviews through application of the SPIRIT Action Framework. Resulting codes were summarized across themes, and recommendations to researchers about increasing utilization of research evidence were crafted. RESULTS: Sixteen states with 27 autonomous pharmacist prescriptive authority policies were identified. Public health need and safety considerations motivated evidence engagement, while key considerations dictating utilization of research included perceptions of research, access to resources and experts, and the successful implementation of similar policy. Research evidence helped to advocate for and set terms for pharmacist prescribing. Barriers to research utilization include stakeholder opposition to pharmacist prescribing, inability to interpret research, and a lack of relevant evidence. Recommendations for researchers include investigating specific metrics to evaluate scope of practice policy, developing relationships between policy-makers and researchers, and leveraging pharmacy practice stakeholders. CONCLUSIONS: Overall, alignment of researcher goals and legislative priorities, coupled with timely communication, may help to increase research evidence engagement in pharmacist scope of practice policy. By addressing these factors regarding research engagement identified in this study, researchers can increase evidence-based scope of practice, which can help to improve patient outcomes, contain costs, and provide pharmacists with the legal infrastructure to practise at the top of their license.

Hypothalamic-Pituitary-Adrenal Axis Pediatric Safety Studies Submitted to the FDA.

BACKGROUND: Corticosteroid use has been associated with hypothalamic-pituitary-adrenal (HPA) axis suppression which can predispose the pediatric patient to multiple immune- and growth-related adverse effects. The objectives of this review were to identify the pediatric drug development programs involving corticosteroids and the associated pediatric HPA axis suppression studies submitted to the US Food and Drug Administration (FDA), capture FDA guidance topic related recommendations, and determine the consistency of HPA axis data in prescription corticosteroid labeling. METHODS: A review of FDA submissions from January 2002 to July 2018 involving corticosteroid products and HPA axis testing in pediatric patients was conducted. The adrenal function testing methods, number of pediatric HPA axis dedicated studies, duration of these studies, and the labeling outcomes were assessed. RESULTS: Of the 437 total drug products that were submitted to FDA, only 36 products were corticosteroids or a corticosteroid combination product yielding a total of 83 pediatric clinical studies. Twenty-four of the 36 products included 37 HPA axis suppression dedicated studies which employed different measurement methods. The pediatric HPA axis suppression trial data collected did not necessitate any new actionable recommendations in the FDA labeling. CONCLUSION: Future pediatric drug development program goals would be to determine whether HPA axis suppression studies should be conducted, establish optimal testing methods if HPA axis testing is performed, continue to update guidances for industry, and actionable labeling recommendations. However, regulatory policy related to conducting pediatric HPA axis studies requires additional scientific research and discussion by the pediatric drug development community.

The Lived Experience of Sisters With an Incarcerated Brother: A Phenomenological Study.

The major increase of incarcerated individuals in the United States has led to a variety of issues. The experience of incarceration has an impact on not only the individual but the entire family system. However, the impact on the sibling relationship has yet to be explored in the literature. The current study examined the lived experience of sisters with an incarcerated brother. In this qualitative study, semi-structured interviews with five sisters with an incarcerated brother were conducted. The results displayed five themes that emerged from the interviews: emotional impact, adjustment, prison experience, family impact, and stigma. The results informed clinical implications for marriage and family therapists working within the incarcerated population. In addition, specific suggestions are provided in how to best advocate for this population through research and clinical work. Moreover, the current study punctuates the specific and dire need for therapeutic intervention and broader policy change among many other efforts.

Do Children Classified With Specific Language Impairment Have a Learning Disability in Writing? A Meta-Analysis.

In this meta-analysis, we examined whether children classified with specific language impairment (SLI) experience difficulties with writing. We included studies comparing children with SLI to (a) typically developing peers matched on age (k = 39 studies) and (b) typically developing younger peers with similar language capabilities (k = six studies). Children classified with SLI scored lower on writing measures than their typically developing peers matched on age (g = -0.97) when all writing scores in a study were included in the analysis. This same pattern occurred for specific measures of writing: quality (g = -0.92), output (g = -1.00), grammar (g = -0.68), vocabulary (g = -0.68), and spelling (g = -1.17). A moderator analysis revealed that differences in the writing scores of children classified with SLI and typically developing peers matched on age were not as large, but were still statistically significant, when assessment involved a contrived response format (vs. measured based on students' writing), researcher-created measures (vs. norm-referenced tests), or SLI included just children with a speech disorder (vs. children with a language disorder). Children classified with SLI further scored lower on writing than typically developing peers with similar language capabilities (g = -0.47). We concluded that children with SLI experience difficulties with writing.

A Brief Report on the Ethical and Legal Guides For Technology Use in Marriage and Family Therapy.

Marriage and family therapists (MFTs) use ethical codes and state licensure laws/rules as guidelines for best clinical practice. It is important that professional codes reflect the potential exponential use of technology in therapy. However, current standards regarding technology use lack clarity. To explore this gap, a summative content analysis was conducted on state licensure laws/rules and professional ethical codes to find themes and subthemes among the many aspects of therapy in which technology can be utilized. Findings from the content analysis indicated that while there have been efforts by both state and professional organizations to incorporate guidance for technology use in therapy, a clear and comprehensive "roadmap" is still missing. Future scholarship is needed that develops clearer guidelines for therapists.