ORCID Profile
0000-0002-8682-1218
Current Organisations
University of Leeds
,
University of Manchester
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Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.CPTL.2019.02.020
Abstract: Outcomes-based education requires active student learning with assessment strategies that foster deep approaches to learning, which are often influenced by students' perceptions of assessment. We aimed to investigate the perceptions of pharmacy students at an Australian university about their experiences of assessment and its impact on their learning. A mixed-methods study was conducted involving a self-administered questionnaire and semi-structured focus groups. Descriptive statistics were used to rate the perceived value of different assessment tools and confirmed by themes arising from the focus groups. Examination results over a five-year period were also collated to assess congruence between perceptions and academic performance. From the 123 questionnaire and nine focus group participants, short-answer questions were the most positively-received form of assessment due to students being able to demonstrate and receive marks for partial knowledge. Multiple-choice questions received mixed response as they were cited as being useful in assessing student knowledge but potentially difficult to interpret/answer correctly. Reflective pieces received the lowest ratings and were considered the least beneficial. Key identified themes were ensuring quality assurance of assessment processes, use of authentic assessment, timely feedback, and appropriate match between workload and assessment weightings. Overall, there was congruence between students' exam scores and their perceptions of the different assessment types. Strategic planning and delivery of correctly-weighted authentic assessments with the provision of constructive feedback are key elements for active engagement of students and achievement of life-long learning outcomes.
Publisher: Wiley
Date: 08-2021
DOI: 10.1111/AJR.12776
Abstract: To assess whether outcomes of peripheral artery disease (PAD) were related to remoteness from the treating tertiary vascular centre. Participants with a variety of types of occlusive and aneurysmal diseases were recruited from a tertiary hospital in North Queensland, Australia. Remoteness was assessed by residence outside Townsville and estimated distance to the vascular centre. Cox proportional hazard analyses were used to examine the association of remoteness with outcome. Cohort study. The primary outcome was requirement for surgery to treat PAD. Secondary outcomes were major adverse cardiovascular events (MACE) and all‐cause mortality. Of 2487 patients recruited, 1274 (51.2%) had at least one PAD surgery, 720 (29.0%) at least one MACE, and 909 (36.6%) died during a median of 4.2 (inter‐quartile range 1.3‐7.7) years. Compared to Townsville residents (n = 1287), those resident outside Townsville (n = 1200) had higher rates of PAD surgery (hazard ratio, HR 1.55, 95% confidence intervals, CI, 1.39, 1.73) but no increased risk of MACE (HR 1.00, 95% CI 0.86, 1.16) or death (HR 1.03, 95% CI 0.90, 1.17). This association was attenuated when adjusting for distance from the vascular centre (HR 1.31, 95% CI 1.14, 1.51). Patients in the highest quartile of distance presented with lower ankle‐brachial pressure index, more severe carotid artery disease and larger aortic diameter. People with PAD in North Queensland residing furthest from the tertiary hospital presented with more severe artery disease and had greater rates of PAD surgery.
Publisher: No publisher found
Date: 2017
Publisher: Wiley
Date: 17-01-2019
DOI: 10.1002/JPPR.1477
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 02-2021
Do health warnings on cigarette sticks dissuade smokers and non-smokers? A focus group and interview study of Australian university students
Publisher: Informa UK Limited
Date: 05-2019
DOI: 10.2147/PRBM.S193754
Publisher: MDPI AG
Date: 09-04-2020
Abstract: The aim of this study was to evaluate the preliminary efficacy and user acceptance of My Care Hub (MCH) mobile app—developed to provide evidenced-based support and education on diabetes self-management (DSM). Using a mixed-methods design, the efficacy and acceptability of MCH were measured among people with type 1 or type 2 diabetes after three weeks of intervention. The primary outcome measure was level of involvement with DSM, while the mediating factors were skills and self-efficacy for DSM. Telephone interviews were conducted to elucidate information on perceptions of the app’s impact on participants’ DSM and interest in future use. Statistically significant improvements were observed between pre- and post-intervention measures: DSM activities (4.55 ± 1.14 vs. 5.35 ± 0.84 p = 0.001) skills (7.10 ± 1.99 vs. 7.90 ± 1.67 p = 0.04) and self-efficacy (7.33 ±1.83 vs. 8.07 ± 1.54 p = 0.03). Multivariate analysis showed that self-efficacy had the strongest, though not significant influence on DSM. Interview findings revealed that the app reinforced knowledge and provided motivation to participate in DSM activities. The study suggested a positive impact of MCH on DSM and acceptability by patients. To confirm these promising results, further large scale and long-term studies are required.
Publisher: Public Library of Science (PLoS)
Date: 13-11-0028
DOI: 10.1371/JOURNAL.PONE.0241802
Abstract: To assess whether survival and clinical events following elective abdominal aortic aneurysm (AAA) repair were associated with remoteness of residence in North Queensland, Australia. This retrospective cohort study included participants undergoing elective AAA repair between February 2002 and April 2020 at two hospitals in Townsville, North Queensland, Australia. Outcomes were all-cause survival and AAA-related events, defined as requirement for repeat AAA repair or AAA-related mortality. Remoteness of participant’s place of residence was assessed by the Modified Monash Model classifications and estimated distance from the participants’ home to the tertiary vascular centre. Cox proportional hazard analysis examined the association of remoteness with outcome. The study included 526 participants undergoing elective repair by open (n = 204) or endovascular (n = 322) surgery. Fifty-four (10.2%) participants had a place of residence at a remote or very remote location. Participants' were followed for a median of 5.2 (inter-quartile range 2.5–8.3) years, during which time there were 252 (47.9%) deaths. Survival was not associated with either measure of remoteness. Fifty (9.5%) participants had at least one AAA-related event, including 30 (5.7%) that underwent at least one repeat AAA surgery and 23 (4.4%) that had AAA-related mortality. AAA-related events were more common in participants resident in the most remote areas (adjusted hazard ratio 2.83, 95% confidence intervals 1.40, 5.70) but not associated with distance from the participants’ residence to the tertiary vascular centre The current study found that participants living in more remote locations were more likely to have AAA-related events but had no increased mortality following AAA surgery. The findings emphasize the need for careful follow-up after AAA surgery. Further studies are needed to examine the generalisability of the findings.
Publisher: International Pharmaceutical Federation (FIP)
Date: 29-10-2020
DOI: 10.46542/PE.2020.201.336345
Abstract: Introduction: The transition to clinical studies can be a source of stress, though little is known about how pharmacy students manage this transition. This mixed-methods study investigated factors influencing student transition from pre-clinical to clinical years of an Australian pharmacy degree. Methods: Students rated and discussed their confidence in performing pharmacy-related skills, factors influencing their ability to carry out these skills and key enabling factors and barriers that influenced their transition. Results: Differences in teaching and assessment style and placement workload affected the transition experience. Self-confidence in the clinical learning environment was enhanced by patient contact, previous pharmacy work experience, case-based learning and supportive placement supervisors. A perceived lack of relevance of pre-clinical learning and heavy workload during placement were major barriers to a smooth transition. Conclusions: Support systems are essential to foster transition into the clinical learning environment with confidence and effective application of theoretical knowledge to real-world practice.
Publisher: Informa UK Limited
Date: 06-2017
DOI: 10.2147/IPRP.S132091
Publisher: E.U. European Publishing
Date: 31-01-2018
DOI: 10.18332/TID/82191
Publisher: Oxford University Press (OUP)
Date: 18-07-2018
DOI: 10.1111/IJPP.12470
Abstract: We aimed to identify the experiences of Australian community pharmacists with smokers and their associated perceptions of effective health warnings on in idual cigarette sticks. A mixed-methods online survey was distributed to Australian pharmacists through pharmacy-specific social media pages, and the Pharmaceutical Society of Australia, followed by semi-structured face-to-face interviews with pharmacists in Townsville, Australia, who were purposively s led. The interviews continued until data saturation was achieved. Participants described their experiences with smokers, perceptions and effectiveness ratings of current cigarette packaging warnings, and 12 text warnings ( ided into four themes) on in idual cigarette sticks, and their general opinions on effective anti-tobacco health warnings. Seventy pharmacists participated in the survey and 17 pharmacists in the interviews. Both groups of pharmacists cited smoking-related personal or close-contact illness, pressure by family members or physicians and the financial costs of smoking as being the main drivers for quit attempts. Most interviewed pharmacists interact with smokers several times per week. Cigarette stick warnings describing mortality consequences (especially the ‘minutes of life lost’ warning) and the financial consequences of tobacco use were rated as significantly more effective than current packaging warnings (odds ratio [OR] = 2.23 95% confidence interval [CI]: 1.12–4.12, P = 0.02, and 1.97 95%CI: 1.01–3.84, P = 0.04, respectively). Pharmacists have considerable experience assisting smokers with quitting and based on these experiences believe that novel and tangible health warnings on cigarette sticks may be an effective future measure to combat tobacco use. Further research on the opinions of a more erse range of health professionals and the general community will generate more robust findings regarding this method of intervention.
Publisher: Springer International Publishing
Date: 2022
Publisher: Springer Science and Business Media LLC
Date: 24-08-2020
DOI: 10.1186/S12909-020-02186-2
Abstract: The transition from pre-clinical to clinical medical training is often characterised by several challenges which may have different impacts on students’ well-being and learning experiences. To ensure smooth transition, it’s important to understand how these students navigate through the challenging processes. This study employed a mixed-methods design using a survey, focus groups and interviews among medical students who had entered their first clinical year of study (Year 4). Using a 5-point Likert scale, survey participants rated items which related to their transition experience in the areas of professional socialisation workload patient contact knowledge and skills and learning and education. The qualitative questions explored challenges in transition, coping strategies and recommendations to foster smooth transitioning. The survey data was analysed using descriptive and inferential statistics while thematic analysis was used to establish emerging themes from the qualitative data. The Westerman Transition Framework was utilised in the triangulation of study findings. A total of 141 students participated in the survey while 12 students participated in the focus group discussions and interviews. The quantitative part of the study showed that the students were anxious about the process and considered the workload to be heavy while also identifying gaps in their knowledge. Similarly, the qualitative findings revealed that workload and professional socialisation were identified as disruptive novel elements and the students also reported feelings of inadequacy and incompetence due to perceived knowledge gaps. These shortcomings and challenges were tackled by seeking support from peers and senior medical students as a way of coping with the anxiety and stress. As the students progressed, they admitted and accepted that the transition was a gradual process and an essential learning curve. The process of transitioning from preclinical to clinical years is considered stressful and abrupt with the introduction of disruptive novel elements that create feelings of incompetence and unpreparedness in students. Educators need to consider developing social and developmental strategies that emphasise nurturing and empowering clinical learning environments and facilitate reflective and transformative life-long learning opportunities for students.
Publisher: Wiley
Date: 15-04-2009
Abstract: By deprotonation of the corresponding tris(pyrazolyl)methane ((Me)Tpm) precursor complexes [M((Me)Tpm)(2)][(OTf)(2)] (1 and 2), the zwitterionic tris(pyrazolyl)methanide iron(II) (3) and cobalt(II) (4) "sandwich" complexes of the general formula [M((Me)Tpmd)(2)] are easily accessible. The structurally characterised complexes 3 and 4 are the first such homoleptic 3d transition metal species to feature two "naked", outward pointing pyramidal carbanions. Density functional theory calculations show metal-centred HOMOs and LUMOs with the destabilised carbanion orbitals in the energy region of the filled transition-metal-centred frontier orbitals. The electronic structures of these complexes have been investigated in detail by various spectroscopic techniques such as NMR, EPR, SQUID, Mössbauer, etc. Both complexes adopt a high-spin (HS) configuration at room temperature in solution and in the solid state. A thermally induced high-spin to low-spin (HS-LS) transition is observed for the iron(II) complex 3. The HS-LS transition temperature of 3 in solution differs from that in the solid state, which in turn strongly depends on the amount of solvent molecules in the crystal lattice. Electrochemical studies on the corresponding cobalt(II) complex 4 provide evidence for a HS-Co(II) LS-Co(III) transition upon oxidation, which was confirmed by preliminary synthetic oxidation reactions. Overall, it can be concluded that the related kappa(3)N-donor ligands tris(pyrazolyl)hydroborates (Tp(R)) and (R)Tpmd ligands have similar bonding properties and that the metal cations experience more or less the same ligand environment.
Publisher: BMJ
Date: 07-2020
DOI: 10.1136/BMJDRC-2020-001590
Abstract: Hyperbaric oxygen therapy (HBOT) has been suggested to improve healing of lower limb ulcers, though the quality of available evidence is weak to moderate. This study assessed the opinions and use of HBOT by specialists treating lower limb ulcers. Accredited vascular surgeons and podiatrists in Australia and New Zealand were sent an online survey via their professional organizations. The survey asked about their use and opinions of HBOT in treating lower limb ischemic, neuropathic and venous ulcers. Data were summarized with descriptive statistics. Non-parametric tests were used to compare survey results obtained from vascular surgeons and podiatrists. 61 vascular surgeons and 40 podiatrists completed the survey. Thirty-seven specialists used HBOT for treating lower limb ulcers, with the remainder indicating they did not feel there was a role for HBOT (n=25) or did not have access to HBOT (n=39). Less than 8% of specialists indicated that HBOT frequently or always had a role in treating ischemic, neuropathic or venous ulcers. Compared with podiatrists, vascular surgeons were significantly less likely to indicate HBOT had a treatment role for any ulcer type (p .001, p=0.004, and p .001, respectively), though significantly more likely to indicate they currently used HBOT for treating lower limb ulcers (p .001). Most specialists (n=76) believed that a large clinical trial is needed to determine the efficacy of HBOT in treating lower limb ulcers. Vascular surgeons and podiatrists do not feel HBOT has a frequent role in treating lower limb ulcers, but do feel there needs to be a large clinical trial to test its value.
Publisher: Wiley
Date: 20-04-2022
DOI: 10.1111/EJE.12687
Abstract: Clinical experience is a crucial component of dental education as it prepares students for real‐world practice. Our study aimed to investigate the transition from preclinical to clinical training experiences of dental students at a regional Australian dental school. A mixed‐methods study was conducted using a survey and focus groups. Participants were dental students who recently transitioned into clinical training. Survey data were analysed quantitatively using descriptive statistics, whilst the qualitative data were thematically analysed using the conceptual framework of organisational socialisation theory (OST). Forty‐eight of the 69 students in the cohort completed the survey and 10 participated in the focus groups. The quantitative findings revealed that the transition was perceived to be abrupt and associated with a heavy workload. However, orientation sessions and engaging in chairside teaching made transitioning into clinical studies easier. The qualitative findings revealed that the transition process occurred in three phases. In phase 1, participants navigated the educational and social challenges using developmental characteristics such as resilience and positivity. Lessons learnt in phase 1 were used to make necessary learning adjustments in phase 2 and this subsequently enhanced developmental growth in the final phase, which helped ease the transition. This study confirms that transitioning into clinical training can be complex. However, the educational and socialisation challenges associated with the transition can provide stimulating developmental learning opportunities that advance students’ adjustments to the clinical environment with positive, empowering and motivational outcomes that facilitate a smooth transition.
Publisher: SAGE Publications
Date: 16-05-2022
DOI: 10.1177/15347346221099798
Abstract: This study explored health professionals’ perceptions of current issues and opportunities for the secondary prevention of diabetes-related foot disease (DFD), and potential strategies for improving DFD care. From May to October 2020, relevant Australian health professionals completed an online survey which used ordinal scales, ranking questions, and open text fields to assess perceptions about the importance of aspects of secondary prevention for DFD and elements for a prevention program. Quantitative data were summarised and compared between professions using non-parametric tests, and qualitative data was analysed using conceptual content analysis to identify emerging themes. Perceptions from 116 health professionals with experience in managing patients with DFD were obtained, including 69 podiatrists, 21 vascular surgeons, 16 general practitioners, and ten nurses. Access and adherence to appropriate offloading footwear was perceived as a key element for effective DFD care, and believed to be affected by social and economic factors, such as the cost of footwear, as well as patient-related factors, such as motivation to wear footwear and adhere to other medical therapies. In addition to a lack of patient motivation and financial limitations, health professionals also believed patients lacked an understanding of the likelihood and severity of DFD recurrence. Several elements of care were perceived as missing from practice, including psychological support and ways to improve footwear adherence, with health professionals identifying several strategies for the design and implementation of an effective secondary prevention program. Prospective trials evaluating secondary prevention programs are required to determine the most effective means for preventing DFD recurrence.
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.SAPHARM.2022.05.002
Abstract: The primary health care management of chronic disease affecting Aboriginal and Torres Strait Islander peoples requires healthcare quality and equity demands to be met, and systems that foster better team-based care. Non-dispensing pharmacists (NDPs) integrated within primary healthcare settings can enhance the quality of patient care, although factors that enable or challenge integration within these settings need to be better understood. To investigate enabling factors and barriers influencing integration of NDPs within Aboriginal community-controlled health services delivering primary health care. This was achieved through qualitative evaluation of the Integrating Pharmacists within Aboriginal Community Controlled Health Services (IPAC) Trial exploring the perceptions of NDPs, community pharmacists, healthcare staff, managers, and Aboriginal and Torres Strait Islander patients of these services. NDPs were employed across twenty urban, rural, and remote services in three Australian states and provided pre-defined medication-related roles to adult Aboriginal and Torres Strait Islander patients. Perceptions were elicited from online surveys, interviews, and focus groups. Transcripts were thematically analyzed using the constant comparison method to identify, compare, and refine emerging themes. One hundred and four participants informed the findings, including 24 NDPs, 13 general practitioners, 12 service managers, 10 community pharmacists, 17 health service staff, and 17 patients. Enablers of integration included: personal (previous experience with Aboriginal and Torres Strait Islander peoples, cultural awareness, skills, in idual attributes) health service-related (induction programs, Aboriginal Health Worker support, team-building initiatives) and community-related factors (engaged community elders, leaders, cultural mentors, community pharmacy ch ions). Barriers to NDP integration included a lack of systems supports for patients and staff to adapt to NDP roles, health service factors, travel requirements, a lack of community linkages, and time and budget constraints. NDP integration within primary health care services has potential to enhance medication-related services to Aboriginal and Torres Strait Islander peoples if enabling factors are supported and health systems and adequate resources facilitate the integration of pharmacists within these settings.
Publisher: Public Library of Science (PLoS)
Date: 25-05-2021
DOI: 10.1371/JOURNAL.PONE.0251634
Abstract: The transition experience into university can be challenging for health profession students as they are required to rapidly learn erse and adaptable problem solving skills and advanced reflective thinking processes which are necessary to address complex patient-care problems, particularly in the face of uncertainty within a dynamic and rapidly evolving learning environment. A mixed-methods study was conducted to identify factors influencing this transition for first-year medical, dental, and pharmacy students at a regional Australian university. The Student Adaption to College Questionnaire (SACQ) examined participants’ levels of adjustment to university, while Schlossberg’s 4 S transition model was utilised in a framework analysis of the focus group and interview responses. Complete survey responses were obtained from 198 students, 17 of whom also participated in focus group discussions or interviews. Mean adjustment ratings obtained from the SACQ responses were academic (6.09 ± 1.3) personal-emotional (5.53 ± 1.55), social (6.30 ± 1.38), and institutional attachment (6.96 ± 1.6). These results indicate that the personal and emotional aspects of this transition were more challenging for the students. Analysis of the qualitative data revealed that generally, for these highly motivated health-professions students, dropping out of university was not an option and this had a positive influence on their ability to adjust to their new learning environment. Nonetheless, the transition involved role change school-leavers were excited about their newly found independence, while for mature-aged students, returning to university allowed them to pursue their lifelong dreams. Adjustment was more challenging for international, mature-aged and female students, with personal and social factors influencing the transition for each of these demographic groups. To facilitate smooth transition into university, tertiary education institutions must consider tailored on-going support strategies that promote social interaction among students with varied backgrounds and personal characteristics.
Publisher: MDPI AG
Date: 29-06-2023
DOI: 10.3390/BIOMEDICINES11071859
Abstract: This systematic review pooled evidence from randomised controlled trials (RCTs) on the effectiveness of dietary upregulators of nitric oxide (NO) in improving the walking and quality of life of patients with peripheral artery disease (PAD). RCTs examining the effect of dietary upregulators of NO in patients with PAD were included. The primary outcome was the maximum walking distance. Secondary outcomes were the initial claudication distance, the six-minute walking distance, quality of life, the ankle-brachial pressure index (ABI), adverse events and risk of mortality, revascularisation or utation. Meta-analyses were performed using random effects models. The risk of bias was assessed using Cochrane’s ROB-2 tool. Leave-one-out and subgroup analyses were conducted to assess the effect of in idual studies, the risk of bias and intervention type on pooled estimates. Thirty-four RCTs involving 3472 participants were included. Seven trials tested NO donors, nineteen tested antioxidants, three tested NO synthase inducers and five tested enhancers of NO availability. Overall, the dietary supplements significantly improved the initial claudication (SMD 0.34 95%CI 0.04, 0.64 p = 0.03) but not maximum walking (SMD 0.13 95%CI −0.17, 0.43 p = 0.39) distances. Antioxidant supplements significantly increased both the maximum walking (SMD 0.36 95%CI 0.14, 0.59 p = 0.001) and initial claudication (SMD 0.58 95%CI 0.26, 0.90 p 0.001) distances. The dietary interventions did not improve the physical function domain of the Short Form-36 (SMD −0.16 95%CI −0.32, 0.00 p = 0.38), ABI or risk of adverse events, mortality, revascularisation or utation. Dietary NO upregulators, especially antioxidants, appear to improve the initial claudication distance in patients with PAD. Larger high-quality RCTs are needed to fully examine the benefits and risks of these treatments. PROSPERO Registration: CRD42022256653.
Publisher: Wiley
Date: 30-07-2022
DOI: 10.1002/JPPR.1819
Abstract: The gabapentinoids pregabalin and gabapentin are not recommended for managing acute pain in the absence of neuropathic symptoms, but such use is prominent in this setting. To assess gabapentinoid prescribing practices for gabapentinoid‐naïve patients after surgery and trauma. A retrospective review of surgical and trauma admissions at a large, Australian, tertiary teaching hospital for patients prescribed a gabapentinoid for the first time, from February 2019 to May 2019, inclusive. One hundred and eighty‐nine of 5494 (3.4%) gabapentinoid‐naïve surgical and trauma inpatients were prescribed a gabapentinoid, with 110 of the 189 (58.2%) also discharged on a gabapentinoid. Of the 110 patients, 60 (54.5%) were prescribed a gabapentinoid for either non‐neuropathic pain or undocumented pain indication, and the remainder for neuropathic symptoms. Only 66 (60.0%) patients discharged with a gabapentinoid had a plan for further management such as de‐escalation or general practitioner follow‐up. Of the 67 prescriptions written for patients on discharge, 32 (47.8%) were written as non‐government subsidised prescriptions. Four patients considered at high risk of developing addictive behaviours were discharged on a gabapentinoid. In this study, initiation and maintenance of gabapentinoid therapy in previously naïve surgical and trauma patients was infrequent, although it was often prescribed for an unclear or non‐neuropathic indication with little provision of, or no information for, intended duration of use. This review provides an opportunity for further intervention at the transition of care to minimise inappropriate long‐term gabapentinoid use and could be used to facilitate further research evaluating the impact of hospital‐prescribed gabapentinoids in the community.
Publisher: Springer Science and Business Media LLC
Date: 19-06-2018
DOI: 10.1007/S00431-018-3187-X
Abstract: Clinical pharmacists provide beneficial services to adult patients, though their benefits for paediatric hospital patients are less defined. Five databases were searched using the MeSH terms 'clinical pharmacist', 'paediatric aediatric', 'hospital', and 'intervention' for studies with paediatric patients conducted in hospital settings, and described pharmacist-initiated interventions, published between January 2000 and October 2017. The search strategy after full-text review identified 12 articles matching the eligibility criteria. Quality appraisal checklists from the Joanna Briggs Institute were used to appraise the eligible articles. Clinical pharmacist services had a positive impact on paediatric patient care. Medication errors intercepted by pharmacists included over- and under-dosing, missed doses, medication history gaps, allergies, and near-misses. Interventions to address these errors were positively received, and implemented by physicians, with an average acceptance rate of over 95%. Clinical pharmacist-initiated education resulted in improved medication understanding and adherence, improved patient satisfaction, and control of chronic medical conditions.Conclusion: This review found that clinical pharmacists in paediatric wards may reduce drug-related problems and improve patient outcomes. The benefits of pharmacist involvement appear greatest when directly involved in ward rounds, due to being able to more rapidly identify medication errors during the prescribing phase, and provide real-time advice and recommendations to prescribers. What is Known: • Complex paediatric conditions can require multiple pharmaceutical treatments, utilised in a safe manner to ensure good patient outcomes • The benefits of pharmacist interventions when using these treatments are well-documented in adult patients, though less so in paediatric patients What is New: • Pharmacists are adept at identifying and managing medication errors for paediatric patients, including incorrect doses, missed doses, and gaps in medication history • Interventions recommended by pharmacists are generally well-accepted by prescribing physicians, especially when recommendations can be made during the prescribing phase of treatment.
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.JVS.2021.07.248
Abstract: This review aimed to systematically pool evidence from randomized clinical trials on the efficacy of interventions in assisting smoking cessation in participants with peripheral artery disease (PAD). Publicly available databases were searched for randomized clinical trials testing the effect of interventional programs in achieving smoking cessation in participants with PAD who were current smokers. The primary outcome was smoking cessation at the end of follow-up. Meta-analyses were performed using random effect models and reported as risk ratios and 95% confidence intervals. Risk of bias and publication bias were assessed using a modified version of the Cochrane Collaboration's tool and funnel plots, respectively. Six randomized clinical trials testing smoking cessation programs comprising physician advice, behavioral counselling from an expert delivered in-person or over the telephone, and the provision of nicotine replacement therapy and/or varenicline in 558 smokers with PAD were included. A meta-analysis suggested that, overall, these interventions did not significantly increase the chance of quitting smoking (risk ratio, 1.48 95% confidence interval, 0.84-2.61), with low heterogeneity between studies (I Overall, previously tested smoking cessation interventions have not been effective in achieving smoking cessation in people with PAD. Further research is needed to develop and test interventions that can effectively help current smokers with PAD to quit.
Publisher: JMIR Publications Inc.
Date: 14-01-2020
Abstract: obile health apps are commonly used to support diabetes self-management (DSM). However, there is limited research assessing whether such apps are able to meet the basic requirements of retaining and engaging users. his study aimed to evaluate participants’ retention and engagement with My Care Hub, a mobile app for DSM. he study employed an explanatory mixed methods design. Participants were people with type 1 or type 2 diabetes who used the health app intervention for 3 weeks. Retention was measured by completion of the postintervention survey. Engagement was measured using system log indices and interviews. Retention and system log indices were presented using descriptive statistics. Transcripts were analyzed using content analysis to develop themes interpreted according to the behavioral intervention technology theory. f the 50 in iduals enrolled, 42 (84%) adhered to the study protocol. System usage data showed multiple and frequent interactions with the app by most of the enrolled participants (42/50, 84%). Two-thirds of participants who inputted data during the first week returned to use the app after week 1 (36/42, 85%) and week 2 (30/42, 71%) of installation. Most daily used features were tracking of blood glucose (BG 28/42, 68%) and accessing educational information (6/42, 13%). The interview results revealed the app’s potential as a behavior change intervention tool, particularly because it eased participants’ self-care efforts and improved their engagement with DSM activities such as BG monitoring, physical exercise, and healthy eating. Participants suggested additional functionalities such as extended access to historical analytic data, automated data transmission from the BG meter, and periodic update of meals and corresponding nutrients to further enhance engagement with the app. he findings of this short-term intervention study suggested acceptable levels of participant retention and engagement with My Care Hub, indicating that it may be a promising tool for extending DSM support and education beyond the confines of a physical clinic.
Publisher: Wiley
Date: 24-04-2023
DOI: 10.1111/AJR.12989
Abstract: Secondary prevention is essential in reducing recurrence of diabetes‐related foot disease (DFD) but is frequently poorly implemented in clinical practice. To explore the perceptions of people with diabetes‐related foot disease (DFD) on their self‐perceived knowledge in managing DFD, facilitators and barriers influencing their DFD care, and ideas and preferences for a secondary prevention program. Sixteen people with a history of DFD from Queensland and Victoria, Australia, underwent semi‐structured interviews. Interviews were audio‐recorded over telephone and transcribed and analysed following a thematic framework. Participants were asked about their experiences and perceptions relating to DFD and factors influencing the care they receive for DFD relevant to the development of a secondary prevention program for DFD. Participants had high self‐perceived knowledge in managing DFD, especially in implementing healthy lifestyle changes and conducting daily foot checks and foot care, though most received support from family members acting as carers. However, issues with access and adherence to offloading footwear, and a lack of clear education received on footwear and other aspects of DFD care were perceived as major barriers. Improved patient education, provided in a consistent manner by proactive clinicians was perceived as an essential part of secondary prevention. Telehealth was perceived positively through facilitating faster care and considered a good adjunct to standard care. Health and technological literacy were considered potentially major barriers to the effectiveness of remote care. People with DFD require improved access to offloading footwear and education about secondary prevention, which could be provided by telehealth with adequate support.
Publisher: SAGE Publications
Date: 19-05-2021
DOI: 10.1177/19322968211012456
Abstract: Diabetes-related foot disease (DFD) management requires input from multiple healthcare professionals, and has worse outcomes for people living in remote localities by comparison to urban areas. Remotely delivered healthcare may reduce this disparity. This overview summarizes current evidence on the effectiveness, stakeholder perceptions, and cost-effectiveness of remotely delivered healthcare for DFD. A search of 5 databases was conducted to identify systematic reviews published between January 2000 and June 2020. Eligible reviews were those evaluating remotely delivered monitoring or management of patients at risk of or with active DFD, or clinicians managing these patients. Risk of bias was assessed using the AMSTAR-2 tool. Eight reviews were eligible for inclusion, including 88 primary studies and 8509 participants, of which 36 studies involving 4357 participants evaluated remotely delivered monitoring or management of DFD. Only one review had a low risk of bias, with most reviews demonstrating limited search strategies and poor reporting of participants. Evidence on effectiveness was mixed, with meta-analyses demonstrating long-term ulcer healing and mortality were not significantly different between telehealth and standard care groups, although the lower-limb utation rate was significantly decreased in one meta-analysis. Perceptions of telehealth by patients and clinicians were generally positive, whilst acknowledging limitations relating to access and use. Cost-effectiveness data were limited, with poor reporting preventing clear conclusions. Remotely delivered healthcare of DFD is well received by patients and clinicians, but its effectiveness is unclear. High quality trials are needed to evaluate the risks and benefits of remotely delivered DFD management.
Publisher: SAGE Publications
Date: 28-04-2023
DOI: 10.1177/26350106231170531
Abstract: The purpose of the study was to understand patient perspectives about the impact and prevention of diabetes-related foot disease (DFD). An online survey was distributed to patients with a history of DFD during 2020. The survey was designed alongside clinical specialists and DFD patients and utilized the health belief model. It asked about the impact of DFD on health, perceptions on preventive strategies, perceived need for additional support, and patient preferences for telehealth in DFD management. Quantitative data were summarized descriptively and compared between groups. Open-text responses were analyzed using conceptual content analysis. Of 80 participants with a history of DFD, foot ulcers were the complication most often experienced, with over two-thirds having been admitted to hospital for a DFD-related issue and over one-third having a DFD-related utation. Participants had ranging perceptions on the effect of DFD on health, from minimal to crippling. Those with previous severe DFD complications leading to hospital admission found a lack of mobility and independence the consequences of most concern. Using offloading footwear was perceived as very important for preventing DFD complications, although the use of offloading footwear was low, with participants citing issues relating to cost, comfort, appearance, and access to footwear as barriers to better adherence. Perceptions on telehealth were mixed, with many participants not having access to or being comfortable with the use of digital technologies. Patients with DFD require additional supports for effective prevention, including offloading footwear.
Publisher: Japan Atherosclerosis Society
Date: 06-2021
DOI: 10.5551/JAT.62778
Publisher: Springer Science and Business Media LLC
Date: 09-02-2022
DOI: 10.1186/S12909-022-03120-4
Abstract: Perceived readiness for practice can help mitigate the stress and uncertainty associated with transitioning from university into the workforce. This study aimed to identify factors influencing the readiness for clinical practice among final-year medical, dental, and pharmacy students at an Australian regional university. The study utilised a sequential explanatory mixed-methods approach with surveys administered for the quantitative phase and interviews/focus groups for the qualitative phase. Descriptive statistics and inductive thematic analysis were utilised for the quantitative and qualitative data, respectively. Triangulation of findings from both phases facilitated in-depth understanding of the factors that influenced participants’ self-perceived readiness for clinical practice. From the three disciplines, 132 students completed the survey and 14 participated in the focus groups and interviews. Students felt most prepared in their patient-centred capabilities, core skills, and advanced consultation skills, and least prepared in their system-related capabilities and clinical care skills. Themes identified as essential enablers and confidence builders in relation to workforce readiness in all three disciplines were: gained knowledge and skills, value of clinical placement experiences, support from peers, family and staff. However, students felt their work-readiness was impaired by heavy academic workloads and poor knowledge of health care systems, which affected skills development. Participants suggested additional support in health care system and clinical governance, mental healthcare, and induction to placement sites to further improve their work readiness. The findings of this study suggest that improving work-readiness of healthcare students requires alignment of learning needs to real-world practice opportunities, ensuring support systems are appropriate, and early familiarisation with the healthcare system.
Publisher: Hindawi Limited
Date: 07-03-2017
DOI: 10.1017/JSC.2017.3
Abstract: Introduction: The efficacy of varenicline as a smoking cessation aid is affected by commonly-occurring issues, such as intolerable adverse events, cravings and withdrawal symptoms, and poor medication adherence. Improvement in quit rates may be achieved through tailoring doses relative to in idual smokers’ behaviours, and previous experiences with smoking cessation medications. Aims: The aim of this review is to evaluate smoking cessation outcomes from published randomised controlled trials that have attempted to improve the efficacy and tolerability of varenicline through modifying its dosage regimen compared to placebo. Methods: A systematic search of the literature up to June 2016 was conducted to identify randomised controlled trials, where varenicline was administered in a regimen not consistent with the current clinical guidelines. Outcome measures evaluated included continuous abstinence rates, changes in cravings, withdrawal symptoms, smoking behaviours, adverse event rates, and premature therapy discontinuations. Results: Ten randomised controlled trials, encompassing four different modifications to standard varenicline therapy, matched the eligibility criteria. Modifications such as the extended duration of therapy and the use of a flexible quit date were effective compared to placebo and have been implemented into some clinical guidelines, whereas other modifications do not appear to produce any benefit for smokers, or require further research to ascertain their suitability for clinical practice. Conclusions: Some varenicline therapy modifications may lead to improvements in efficacy and tolerability. Further research on the effect of modifications such as daily doses higher than 2mg, tapering doses, and the use of extended pre-quit varenicline may advance varenicline therapy outcomes.
Publisher: Frontiers Media SA
Date: 15-03-2022
DOI: 10.3389/FENDO.2022.848695
Abstract: Remotely delivered interventions may be more efficient in controlling multiple risk factors in people with diabetes. To pool evidence from randomized controlled trials testing remote management interventions to simultaneously control blood pressure, blood glucose and lipids. PubMed/Medline, EMBASE, CINAHL and the Cochrane library were systematically searched for randomized controlled trials (RCTs) until 20 th June 2021. Included RCTs were those that reported participant data on blood pressure, blood glucose, and lipid outcomes in response to a remotely delivered intervention. Three authors extracted data using a predefined template. Primary outcomes were glycated hemoglobin (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), systolic and diastolic blood pressure (SBP & DBP). Risk of bias was assessed using the Cochrane collaboration RoB-2 tool. Meta-analyses are reported as standardized mean difference (SMD) with 95% confidence intervals (95%CI). Twenty-seven RCTs reporting on 9100 participants (4581 intervention and 4519 usual care) were included. Components of the remote management interventions tested were identified as patient education, risk factor monitoring, coaching on monitoring, consultations, and pharmacological management. Comparator groups were typically face-to-face usual patient care. Remote management significantly reduced HbA1c (SMD -0.25, 95%CI -0.33 to -0.17, p& .001), TC (SMD -0.17, 95%CI -0.29 to -0.04, p& .0001), LDL-c (SMD -0.11, 95%CI -0.19 to -0.03, p=0.006), SBP (SMD -0.11, 95%CI -0.18 to -0.04, p=0.001) and DBP (SMD -0.09, 95%CI -0.16 to -0.02, p=0.02), with low to moderate heterogeneity (I²= 0 to 75). Twelve trials had high risk of bias, 12 had some risk and three were at low risk of bias. Heterogeneity and potential publication bias may limit applicability of findings. Remote management significantly improves control of modifiable risk factors. [ www.crd.york.ac.uk rospero/display_record.php?RecordID=258433 ], identifier PROSPERO (CRD42021258433).
Publisher: Springer Science and Business Media LLC
Date: 17-01-2019
Publisher: Bentham Science Publishers Ltd.
Date: 12-02-2016
DOI: 10.2174/1574886311207040282
Abstract: Varenicline, the newest agent marketed for smoking cessation is regarded as effective in providing prolonged smoking abstinence. However, its adverse effect profile may cause discontinuation, potentially reducing smoking abstinence rates, thus requiring an examination of the frequency and impact of adverse effects on discontinuation. We sought only Randomised Controlled Trials (RCTs) evaluating the effectiveness and safety of varenicline on humans, with a follow-up period of at least three months and an average Fagerstrom Test for Nicotine Dependence (FTND) score at least 5 (moderate dependence) for both the active and placebo groups. PubMed, Medscape, JCU One Search, ClinicalTrials.gov (U.S.), and the Cochrane Collaboration from January 2006 to January 2015 were searched. Fixed and random effects models were run to determine relationships between adverse effects and premature discontinuation from varenicline. 12 RCTs were included, involving 5 459 patients, with those receiving varenicline found to be nearly twice as likely (Odds ratio (OR) = 1.82 [1.47 2.26]) to experience adverse effects compared to those patients on a placebo. The active group experienced nearly a 1.5 times higher (OR = 1.47 [1.19 1.81]) rate of discontinuation. Nausea, insomnia, and headache are the most commonly reported adverse effects, with ORs of 4.40 [3.80 5.11], 1.75 [1.48 2.08], and 1.20 [1.02 1.41] respectively. Adverse effects experienced during varenicline treatment appear to be associated with higher discontinuation, which are linked to lowered smoking cessation rates, suggesting a need for strategies to minimise the impacts of adverse effects, to better ensure adherence.
Publisher: Springer Science and Business Media LLC
Date: 02-03-2022
DOI: 10.1186/S13047-022-00523-W
Abstract: There is a lack of high quality evidence to guide the optimal management of diabetes-related foot infection, particularly in cases of severe diabetes-related foot infection and diabetes-related foot osteomyelitis. This study examined the opinions of surgeons about the preferred management of severe diabetes-related foot infection. Vascular and orthopaedic surgeons in Australia and New Zealand were invited to complete an online survey via email. The survey included multi-choice and open-ended questions on clinical management of diabetes-related foot infection. Responses of vascular surgeons and orthopaedic surgeons were compared using non-parametric statistical tests. Open-text responses were examined using inductive content analysis. 29 vascular and 20 orthopaedic surgeons completed the survey. One-third (28.6%) used best-practice guidelines to assist in decisions about foot infection management. Areas for guideline improvement identified included more specific advice regarding the indications for available treatments, more recommendations about non-surgical patient management and advice on how management can be varied in regions with limited health service resource. The probe-to-bone test and magnetic resonance imaging were the preferred methods of diagnosing osteomyelitis. Approximately half (51.2%) of respondents indicated piperacillin combined with tazobactam as the preferred antibiotic choice for empirical treatment of severe diabetes-related foot infection. Negative pressure wound therapy was the most common way of managing a wound following debridement. All vascular surgeons (100%) made revascularisation decisions based on the severity of ischemia while most orthopaedic surgeons (66.7%) were likely to refer to vascular surgeons to make revascularisation decisions. Vascular surgeons preferred using wound swabs while orthopaedic surgeons favoured tissue or bone biopsies to determine the choice of antibiotic. Respondents perceived a moderate variation in management decisions between specialists and supported the need for randomised controlled trials to test different management pathways. Most vascular and orthopaedic surgeons do not use best-practice guidelines to assist in decisions about management of diabetes-related foot infection. Vascular and orthopaedic surgeons appear to have different preferences for wound s ling to determine choice of antibiotic. There is a need for higher quality evidence to clarify best practice for managing diabetes-related foot infection.
Publisher: JMIR Publications Inc.
Date: 11-06-2020
DOI: 10.2196/17802
Abstract: Mobile health apps are commonly used to support diabetes self-management (DSM). However, there is limited research assessing whether such apps are able to meet the basic requirements of retaining and engaging users. This study aimed to evaluate participants’ retention and engagement with My Care Hub, a mobile app for DSM. The study employed an explanatory mixed methods design. Participants were people with type 1 or type 2 diabetes who used the health app intervention for 3 weeks. Retention was measured by completion of the postintervention survey. Engagement was measured using system log indices and interviews. Retention and system log indices were presented using descriptive statistics. Transcripts were analyzed using content analysis to develop themes interpreted according to the behavioral intervention technology theory. Of the 50 in iduals enrolled, 42 (84%) adhered to the study protocol. System usage data showed multiple and frequent interactions with the app by most of the enrolled participants (42/50, 84%). Two-thirds of participants who inputted data during the first week returned to use the app after week 1 (36/42, 85%) and week 2 (30/42, 71%) of installation. Most daily used features were tracking of blood glucose (BG 28/42, 68%) and accessing educational information (6/42, 13%). The interview results revealed the app’s potential as a behavior change intervention tool, particularly because it eased participants’ self-care efforts and improved their engagement with DSM activities such as BG monitoring, physical exercise, and healthy eating. Participants suggested additional functionalities such as extended access to historical analytic data, automated data transmission from the BG meter, and periodic update of meals and corresponding nutrients to further enhance engagement with the app. The findings of this short-term intervention study suggested acceptable levels of participant retention and engagement with My Care Hub, indicating that it may be a promising tool for extending DSM support and education beyond the confines of a physical clinic.
Publisher: Frontiers Media SA
Date: 17-10-2018
Publisher: Informa UK Limited
Date: 24-01-2020
DOI: 10.1080/10410236.2019.1567442
Abstract: University students are exposed to casual smoking, increasing their risk of developing nicotine addiction, which can extend into adulthood. A novel anti-tobacco intervention being investigated is the use of health warnings on in idual cigarette sticks. We explored the perceptions of university students on the effectiveness of health warnings on cigarette packaging and in idual cigarette sticks. An online survey was distributed to first-year university students enrolled at a regional university in North-Eastern Australia. Participants rated on 5-point Likert scales and commented using open-text comment boxes, the effectiveness of current cigarette packaging warnings, and 12 text warnings ( ided into four themes immediate and short-term consequences [ISC], long-term and mortality consequences [LMC], social and financial consequences [SFC], and supportive messages to quit [SMQ]) on in idual cigarette sticks, in preventing non-smokers from smoking, and in encouraging current smokers to quit. Participants (
Publisher: Springer Science and Business Media LLC
Date: 07-09-2021
DOI: 10.1186/S13643-021-01802-6
Abstract: Conflicting findings and the analysis of unpublished and retracted data have led to controversy on the safety of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in people with COVID-19 infection. This meta-analysis examined the association of prescription of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) with the outcome from COVID-19. A systematic search was conducted to find published studies that reported the outcome of COVID-19 in relation to prescription of ACEI or ARB. Two authors (MF and AD) independently screened and extracted data and assessed study quality and strength of association using standardised tools. The endpoints for the meta-analyses were severe or critical disease outcome and mortality based on standardised criteria. Twenty-six studies including 8389 people prescribed ACEI or ARB and 20,989 people not prescribed these medications were included. The quality of studies varied, and the overall strength of association was poor with a high risk of confounding bias. Patients prescribed ACEI or ARB had a greater prevalence of risk factors. Meta-analysis found an association between prescription of ACEI or ARB with severe or critical disease outcome (risk ratio, RR, 1.23, 95% confidence interval, CI, 1.06 to 1.42, p = 0.006, I 2 = 88%) but this association was lost in sensitivity analyses. There was no association between ACEI or ARB prescription and mortality (RR 1.18, 95% CI 0.92 to 1.50, p = 0.19, I 2 = 82%). This meta-analysis suggests that people prescribed ACEI or ARB more commonly had severe or critical disease outcome, but not mortality, in published cohorts of patients diagnosed with COVID-19. This finding is most likely due to a greater prevalence of risk factors in these patients rather than due to exposure to angiotensin pathway inhibitors.
Publisher: Oxford University Press (OUP)
Date: 23-10-2019
DOI: 10.1093/NTR/NTZ200
Abstract: Novel tobacco products require independent research to assess their safety. This study assessed the current literature for trials comparing levels of biomarkers of exposure (BoE) between conventional cigarettes (CC) and heat-not-burn (HNB) devices. Ten databases were searched using terms including: “heat not burn,” “iqos,” “teeps,” “mrtp,” “tobacco heating,” and “glo” between January 1, 2010 and August 13, 2019. Randomized controlled trials (RCTs) assessing comparative BoE levels in humans using either CC or novel HNB devices were eligible. BoE were tabulated, and differences between the intervention and control groups were analyzed and combined using a random-effects meta-analysis. Ten nonblinded, RCTs were eligible, involving a total of 1766 participants. Studies regularly reported on 12 BoE (including nicotine). HNB devices assessed included the “IQOS” and “glo” devices and “precursor” (being developed) HNB devices. In comparison to CC, all 12 BoEs assessed were significantly lower for participants assigned to an HNB device. In comparison to smoking abstinence, HNB devices were statistically equivalent for eight BoEs and significantly elevated for four BoEs. This review found that the potential for harm to humans is reduced when using HNB devices compared to CC as indicated by significant reductions in BoE levels. Whilst these results support tobacco manufacturer claims of improved safety, the small number of studies included, limited range of BoE assessed, and involvement of the tobacco industry necessitate further independent research to confirm the HNB devices as being a safer alternative to CC. This study supports claims made by tobacco manufacturers on the improved safety of HNB tobacco devices in comparison to CC. These novel devices lead to reduced exposure to key biomarkers, which are linked to the health consequences attributed to tobacco use. This has strong implications for international public health as well as further research and policy development relating to the safety aspects and legalities of novel tobacco products.
Publisher: Baishideng Publishing Group Inc.
Date: 15-06-2021
Publisher: Springer Science and Business Media LLC
Date: 23-05-2023
Publisher: Frontiers Media SA
Date: 09-05-2022
Publisher: Hindawi Limited
Date: 20-09-2017
DOI: 10.1017/JSC.2017.17
Abstract: Background: Varenicline remains the most effective medication for smoking cessation however, discontinuation as a result of adverse events negatively impacts medication adherence, and the likelihood of a quit attempt being successful. Post-treatment cravings and withdrawal symptoms may also occur, increasing the likelihood of treatment failure, due to lapse and relapse after achieving initial abstinence. This protocol details a trial investigating changes in the effectiveness and tolerability of varenicline, when an extended step-up and step-down regimen are used. Methods: A phase four, randomised, double-blinded, placebo-controlled single-centre study with a treatment period of 16 weeks, and follow-up period of 12 weeks will be conducted. Up to 201 participants will be enrolled and allocated in a 1:1:1 ratio to a placebo-matching control group, step-up, or step-down intervention group, all receiving behavioural counselling and quitting advice. Participants will be contacted weekly during treatment and fortnightly during follow-up. Eligible participants are smokers over 18 years old, willing to quit smoking, are able to attend clinic visits, and have no uncontrolled or serious medical issues. Primary outcome measures are comparisons of biochemically confirmed continuous abstinence rates, 7-day point prevalence abstinence rates, and the frequency, severity and duration of adverse events, cravings and withdrawal symptoms. Secondary outcome measures are participant adherence to the study medication throughout treatment, and comparisons of changes in smoking satisfaction and reward. Effects of each regimen on smoking cessation will be assessed by logistic regression, with survival analyses used for a more precise estimate of when cessation occurs. Primary endpoints will then be compared using a general linear model. Australian New Zealand Clinical Trials Registry: ACTRN12616000802404p
Publisher: Wiley
Date: 27-09-2020
DOI: 10.1111/AJR.12662
Publisher: E.U. European Publishing
Date: 28-03-2019
DOI: 10.18332/TID/104753
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2021
End Date: 2021
Funder: James Cook University
View Funded ActivityStart Date: 2020
End Date: 2021
Funder: National Health and Medical Research Council
View Funded Activity