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Journal articles

Abdel Shaheed, C., Maher, C.G., Williams, K.A. & Mclachlan, A.J. 2017, 'Efficacy and tolerability of muscle relaxants for low back pain: Systematic review and meta-analysis', European Journal of Pain, vol. 21, no. 2, pp. 228-237.
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© 2016 European Pain Federation - EFIC®.Muscle relaxants are commonly prescribed for low back pain (LBP); however, there is limited evidence of their clinical efficacy and tolerability. This review evaluated the efficacy and tolerability of muscle relaxants in people with LBP. We searched online databases including Medline, EMBASE, CENTRAL and PsycINFO (inception to end October 2015) and performed citation tracking for eligible randomized controlled trials (RCTs). Two authors independently extracted data and assessed risk of bias of randomized controlled trials of muscle relaxants. Pain outcomes were converted to a common 0-100 scale. Data were pooled using a random effects model with strength of evidence assessed using GRADE. Fifteen trials (3362 participants) were evaluated in this review. A total of five trials (496 participants) provide high quality evidence that muscle relaxants provide clinically significant pain relief in the short term for acute LBP; MD -21.3, [-29.0, -13.5]. There was no information on long-term outcomes. The median adverse event rate in clinical trials for muscle relaxants was similar to placebo 14.1% IQR (7.0-28.7%) and 16.0% (4.1-31.2%); p = 0.5, respectively. There is no evidence for the efficacy of benzodiazepines in LBP. For people with acute LBP, muscle relaxants provide clinically significant short-term pain relief. For chronic LBP, the efficacy of muscle relaxants is largely unknown. There was no eligible RCT evidence to support the efficacy of benzodiazepines in LBP. Prolonged use of these medicines in LBP cannot be guided by trial evidence. What does this review add?: Muscle relaxants provide clinically significant pain relief for acute low back pain. Caution must be taken with the interpretation of the findings as the evidence comes from specific muscle relaxant medicines.

Alomari, A., Wilson, V., Solman, A., Bajorek, B. & Tinsley, P. 2017, 'Pediatric Nurses' Perceptions of Medication Safety and Medication Error: A Mixed Methods Study.', Compr Child Adolesc Nurs, pp. 1-17.
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This study aims to outline the current workplace culture of medication practice in a pediatric medical ward. The objective is to explore the perceptions of nurses in a pediatric clinical setting as to why medication administration errors occur. As nurses have a central role in the medication process, it is essential to explore nurses' perceptions of the factors influencing the medication process. Without this understanding, it is difficult to develop effective prevention strategies aimed at reducing medication administration errors. Previous studies were limited to exploring a single and specific aspect of medication safety. The methods used in these studies were limited to survey designs which may lead to incomplete or inadequate information being provided. This study is phase 1 on an action research project. Data collection included a direct observation of nurses during medication preparation and administration, audit based on the medication policy, and guidelines and focus groups with nursing staff. A thematic analysis was undertaken by each author independently to analyze the observation notes and focus group transcripts. Simple descriptive statistics were used to analyze the audit data. The study was conducted in a specialized pediatric medical ward. Four key themes were identified from the combined quantitative and qualitative data: (1) understanding medication errors, (2) the busy-ness of nurses, (3) the physical environment, and (4) compliance with medication policy and practice guidelines. Workload, frequent interruptions to process, poor physical environment design, lack of preparation space, and impractical medication policies are identified as barriers to safe medication practice. Overcoming these barriers requires organizations to review medication process policies and engage nurses more in medication safety research and in designing clinical guidelines for their own practice.

Arikkatt, J., Ullah, M.A., Short, K.R., Zhang, V., Gan, W.J., Loh, Z., Werder, R.B., Simpson, J., Sly, P.D., Mazzone, S.B., Spann, K.M., Ferreira, M.A.R., Upham, J.W., Sukkar, M.B. & Phipps, S. 2017, 'RAGE deficiency predisposes mice to virus-induced paucigranulocytic asthma', eLife, vol. 6.
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© 2017, eLife Sciences Publications Ltd. All rights reserved.Asthma is a chronic inflammatory disease. Although many patients with asthma develop type-2 dominated eosinophilic inflammation, a number of individuals develop paucigranulocytic asthma, which occurs in the absence of eosinophilia or neutrophilia. The aetiology of paucigranulocytic asthma is unknown. However, both respiratory syncytial virus (RSV) infection and mutations in the receptor for advanced glycation endproducts (RAGE) are risk factors for asthma development. Here, we show that RAGE deficiency impairs anti-viral immunity during an early-life infection with pneumonia virus of mice (PVM; a murine analogue of RSV). The elevated viral load was associated with the release of high mobility group box-1 (HMGB1) which triggered airway smooth muscle remodelling in early-life. Re-infection with PVM in later-life induced many of the cardinal features of asthma in the absence of eosinophilic or neutrophilic inflammation. Anti-HMGB1 mitigated both early-life viral disease and asthma-like features, highlighting HMGB1 as a possible novel therapeutic target.

Awasthi, R., Kulkarni, G.T., Ramana, M.V., de Jesus Andreoli Pinto, T., Kikuchi, I.S., Molim Ghisleni, D.D., de Souza Braga, M., De Bank, P. & Dua, K. 2017, 'Dual crosslinked pectin–alginate network as sustained release hydrophilic matrix for repaglinide', International Journal of Biological Macromolecules, vol. 97, pp. 721-732.
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Bajorek, B., Lemay, K., Magin, P., Roberts, C., Krass, I. & Armour, C. 2017, 'Patients' Attitudes and Approaches to the Self-Management of Hypertension: Perspectives from an Australian Qualitative Study in Community Pharmacy.', High Blood Press Cardiovasc Prev, vol. 24, no. 2, pp. 149-155.
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INTRODUCTION: In the management of hypertension, blood pressure (BP) monitoring and medication use are key strategies, but they are dependent on patients' motivation to practice self-care. AIM: To gauge patients' approaches to monitoring their blood pressure, as well as explore their attitudes toward, and actions relating to, high blood pressure readings, as the key components of their self-management of hypertension. METHOD: This qualitative study, comprising individual telephone interviews, involved patients attending community pharmacies in Sydney (Australia). Patients' perspectives were elicited using a purpose-designed, semi-structured interview guide. The verbal responses were audio-recorded, transcribed verbatim, and thematically analysed. RESULTS: Three key themes arose: (1) approaches to monitoring blood pressure, (2) attitudes to variability in BP, (3) responses to high BP readings. Many patients self-regulated the frequency of monitoring based on perceived need and/or opportunity. Most were indifferent toward their readings, regarding BP fluctuations as 'normal'. When a high BP was detected, the action taken was highly variable, with no clear action plans in place. Several patients recognised a high BP to be a consequence of not taking their antihypertensive medication, triggering the resumption of short-term adherence to their preferred management strategy, i.e., self-medication with antihypertensives (i.e., restarting their medication) and/or self-management via lifestyle strategies. CONCLUSION: This study highlights patients' inappropriate self-management of hypertension. Misperceptions about hypertension, e.g., accepting BP fluctuations as normal, can produce indifferent attitudes as well as influence patients' self-management actions. This lack of insight undermines long-term adherence to antihypertensive therapy.

Crespo-Gonzalez, C., Garcia-Cardenas, V. & Benrimoj, S.I. 2017, 'The next phase in professional services research: From implementation to sustainability.', Res Social Adm Pharm.
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The provision of professional pharmacy services has been heralded as the professional and the economic future of pharmacy. There are different phases involved in a service creation including service design, impact evaluation, implementation and sustainability. The two first phases have been subject to extensive research. In the last years the principles of Implementation science have been applied in pharmacy to study the initial uptake and integration of evidence-based services into routine practice. However, little attention has been paid to the sustainability of those services, during which there is a continued use of the service previously implemented to achieve and sustain long-term outcomes. The objective of this commentary is to describe the differences and common characteristics between the implementation and the sustainability phase and to propose a definition for pharmacy. A literature search was performed. Four critical elements were identified: 1. The aim of the implementation phase is to incorporate new services into practice, the sustainability phase's aim is to make the services routine to achieve and sustain long-term benefits 2. At the implementation phase planned activities are used as a process to integrate the new service, at the sustainability phase there is a continuous improvement of the service 3. The implementation phase occurs during the period of time between the adoption of a service and its integration. Some authors suggest the sustainability phase is a concomitant phase with the implementation phase and others suggest it is independent 4. There is a lack of consensus regarding the duration of each phase. The following definition of sustainability for pharmacy services is proposed: "Sustainability is a phase in the process of a professional pharmacy service, in which the service previously integrated into practice during the implementation phase is routinized and institutionalized over time to achieve and sustain the expected service o...

Dua, K., Hansbro, N.G., Foster, P.S. & Hansbro, P.M. 2017, 'MicroRNAs as therapeutics for future drug delivery systems in treatment of lung diseases', Drug Delivery and Translational Research, vol. 7, no. 1, pp. 168-178.
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Dua, K., Shukla, S.D., de Jesus Andreoli Pinto, T. & Hansbro, P.M. 2017, 'Nanotechnology: Advancing the translational respiratory research', Interventional Medicine and Applied Science, vol. 9, no. 1, pp. 39-41.
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Dua, K., Shukla, S.D., Tekade, R.K. & Hansbro, P.M. 2017, 'Whether a novel drug delivery system can overcome the problem of biofilms in respiratory diseases?', Drug Delivery and Translational Research, vol. 7, no. 1, pp. 179-187.
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Franco-Trigo, L., Hossain, L.N., Durks, D., Fam, D., Inglis, S.C., Benrimoj, S.I. & Sabater-Hernández, D. 2017, 'Stakeholder analysis for the development of a community pharmacy service aimed at preventing cardiovascular disease', Research in Social and Administrative Pharmacy, vol. 13, no. 3, pp. 539-552.
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Participatory approaches involving stakeholders across the health care system can help enhance the development, implementation and evaluation of health services. These approaches may be particularly useful in planning community pharmacy services and so overcome challenges in their implementation into practice. Conducting a stakeholder analysis is a key first step since it allows relevant stakeholders to be identified, as well as providing planners a better understanding of the complexity of the health care system.The main aim of this study was to conduct a stakeholder analysis to identify those individuals and organizations that could be part of a leading planning group for the development of a community pharmacy service (CPS) to prevent cardiovascular disease (CVD) in Australia.An experienced facilitator conducted a workshop with 8 key informants of the Australian health care system. Two structured activities were undertaken. The first explored current needs and gaps in cardiovascular care and the role of community pharmacists. The second was a stakeholder analysis, using both ex-ante and ad-hoc approaches. Identified stakeholders were then classified into three groups according to their relative influence on the development of the pharmacy service. The information gathered was analyzed using qualitative content analysis.The key informants identified 46 stakeholders, including (1) patient/consumers and their representative organizations, (2) health care providers and their professional organizations and (3) institutions and organizations that do not directly interact with patients but organize and manage the health care system, develop and implement health policies, pay for health care, influence funding for health service research or promote new health initiatives. From the 46 stakeholders, a core group of 12 stakeholders was defined. These were considered crucial to the service's development because they held positions that could drive or inhibit progress. Sec...

Fuller, J.M., Saini, B., Bosnic-Anticevich, S., Garcia-Cardenas, V., Benrimoj, S.I. & Armour, C. 2017, 'Testing evidence routine practice: Using an implementation framework to embed a clinically proven asthma service in Australian community pharmacy'.
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Garcia-Cardenas, V., Benrimoj, S.I., Ocampo, C.C., Goyenechea, E., Martinez-Martinez, F. & Gastelurrutia, M.A. 2017, 'Evaluation of the implementation process and outcomes of a professional pharmacy service in a community pharmacy setting. A case report', Research in Social and Administrative Pharmacy, vol. 13, no. 3, pp. 614-627.
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Pharmacist-led medication review services are recognized as a key to medicines management. This case study describes the implementation process of a medication review with follow-up service in a community pharmacy setting and evaluates its initial outcomes. An implementation-effectiveness hybrid study was undertaken in a community pharmacy setting. The implementation process was divided into four different phases: Exploration and adoption, program installation, initial implementation, and full operation. A core set of implementation outcomes was measured, including penetration, implementation costs, feasibility, fidelity, acceptability, appropriateness and efficiency. The penetration rate of the service was nearly 62.5%, and the implementation costs were 57,359.67€. There was a high retention-participation rate of patients. For every month of service provision, there was a 1.27 increase in the number of patients requesting the service, compared to the number of patients being offered the service. The time spent on service provision was 171.7 min per patient. Average patient satisfaction with the service was 4.82 (SD: 0.39, scale 1–5), and the acceptance rate of care plans by patients and general medical practitioners were 96.99% and 96.46%, respectively. There were 408 negative outcomes associated with the use of medications were identified during the study (3.09 per patient), of which 96.3% were resolved. The average time per patient spent on service provision significantly decreased along the 18 months of service provision. This case report can assist individual pharmacists and professional organizations interested in implementing evidence-based services by offering an example on how to approach the implementation process in a systematic way.

Garcia-Cardenas, V., Perez-Escamilla, B., Fernandez-Llimos, F. & Benrimoj, S.I. 2017, 'The complexity of implementation factors in professional pharmacyservices'.
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Harris, J., Lang, T., Thomas, J.P.W., Sukkar, M.B., Nabar, N.R. & Kehrl, J.H. 2017, 'Autophagy and inflammasomes', Molecular Immunology.
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© 2017 Elsevier Ltd.Autophagy is a ubiquitous cellular mechanism for the targeted lysosomal degradation of various cytosolic constituents, from proteins to organelles. As an essential homeostatic mechanism, autophagy is upregulated in response to numerous environmental and pharmacological stimuli, including starvation, where it facilitates the recycling of essential amino acids. In addition, autophagy plays specific roles within the immune system; it serves as a source of peptides for antigen presentation, a mechanism for the engulfment and degradation of intracellular pathogens and as a key regulator of inflammatory cytokines. In particular, autophagy has been shown to play a number of roles in regulating inflammasome activation, from the removal of inflammasome-activating endogenous signals, to the sequestration and degradation of inflammasome components. Autophagy also plays a role in determining the fate of IL-1β, which is concentrated in autophagosomes. This review discusses a growing body of literature that suggests autophagy is a critical regulator of inflammasome activation and the subsequent release of IL-1 family cytokines.

Hsu, A.C.-.Y., Dua, K., Starkey, M.R., Haw, T.-.J., Nair, P.M., Nichol, K., Zammit, N., Grey, S.T., Baines, K.J., Foster, P.S., Hansbro, P.M. & Wark, P.A. 2017, 'MicroRNA-125a and -b inhibit A20 and MAVS to promote inflammation and impair antiviral response in COPD', JCI Insight, vol. 2, no. 7.
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Jaiswal, R., Johnson, M.S., Pokharel, D., Krishnan, S.R. & Bebawy, M. 2017, 'Microparticles shed from multidrug resistant breast cancer cells provide a parallel survival pathway through immune evasion.', BMC Cancer, vol. 17, no. 1, p. 104.
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BACKGROUND: Breast cancer is the most frequently diagnosed cancer in women. Resident macrophages at distant sites provide a highly responsive and immunologically dynamic innate immune response against foreign infiltrates. Despite extensive characterization of the role of macrophages and other immune cells in malignant tissues, there is very little known about the mechanisms which facilitate metastatic breast cancer spread to distant sites of immunological integrity. The mechanisms by which a key healthy defense mechanism fails to protect distant sites from infiltration by metastatic cells in cancer patients remain undefined. Breast tumors, typical of many tumor types, shed membrane vesicles called microparticles (MPs), ranging in size from 0.1-1 μm in diameter. MPs serve as vectors in the intercellular transfer of functional proteins and nucleic acids and in drug sequestration. In addition, MPs are also emerging to be important players in the evasion of cancer cell immune surveillance. METHODS: A comparative analysis of effects of MPs isolated from human breast cancer cells and non-malignant human brain endothelial cells were examined on THP-1 derived macrophages in vitro. MP-mediated effects on cell phenotype and functionality was assessed by cytokine analysis, cell chemotaxis and phagocytosis, immunolabelling, flow cytometry and confocal imaging. Student's t-test or a one-way analysis of variance (ANOVA) was used for comparison and statistical analysis. RESULTS: In this paper we report on the discovery of a new cellular basis for immune evasion, which is mediated by breast cancer derived MPs. MPs shed from multidrug resistant (MDR) cells were shown to selectively polarize macrophage cells to a functionally incapacitated state and facilitate their engulfment by foreign cells. CONCLUSIONS: We propose this mechanism may serve to physically disrupt the inherent immune response prior to cancer cell colonization whilst releasing mediators required for the recruitment...

Krzyzaniak, N. & Bajorek, B. 2017, 'A global perspective of the roles of the pharmacist in the NICU.', The International journal of pharmacy practice, vol. 25, no. 2, pp. 107-120.
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To describe pharmacist practice and roles performed in the neonatal intensive care unit (NICU) worldwide and to map these findings along the medicines management pathway (MMP).Quasi-systematic review.Google Scholar, Medline/PubMed and Embase were searched utilising the selected MeSH terms.Thirty sources of information were reviewed. Overall, pharmacist practice in the NICU involves a wide-range of roles, with the most commonly reported involving patient medication chart review, therapeutic drug monitoring and the provision of medication information. Studies highlight that pharmacist contribution to total parenteral nutrition (TPN) regimens and patient medication chart review is beneficial to patient outcomes. Roles beyond the regular scope of practice included involvement in immunisation programmes and research. Most of the data were collected from the USA (13 of 30), followed by the UK (6 of 30) and reports from other countries. The American, British, South African and Australian articles have reported very similar roles, with a pharmacist firmly integrated into the overall structure of the NICU team.The literature identifies that there is insufficient evidence to describe what roles are currently performed in NICUs worldwide. This is due to the lack of recently published articles leading to a large gap in knowledge in understanding what contemporary pharmaceutical services in the NICU comprise. Further research is required to address these gaps in knowledge, and identify the impact of the pharmacist's role on neonatal patient outcomes as well as to determine how to better resource NICUs to access pharmacy services.

Lloyd, G.F., Singh, S., Barclay, P., Goh, S. & Bajorek, B. 2017, 'Hospital pharmacists’ perspectives on the role of key performance indicators in australian pharmacy practice', Journal of Pharmacy Practice and Research, vol. 47, no. 2, pp. 87-95.
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© 2016 The Society of Hospital Pharmacists of Australia.Background: To date, there is no national or international consensus on which key performance indicators (KPIs) should be used to measure hospital pharmacy performance. Aim: To explore hospital pharmacists’ perspectives on the role of KPIs and to use their perspectives to suggest a set of KPIs for use in Australian hospital pharmacy practice. Methods: The study comprised of two parts. Part A involved semi-structured interviews with hospital pharmacists from major Sydney metropolitan hospitals; interviews were conducted until theme saturation was attained. Part B involved an online survey comprising Likert-scale responses and open-ended questions; the survey was distributed nationally to pharmacists via the Society of Hospital Pharmacists of Australia (SHPA) eNewsletter and Facebook page. Results: Part A: 19 hospital pharmacists were interviewed. Part B: 49 online surveys were received (after excluding incomplete submissions). Overall, the emergent themes identified that hospital pharmacists agreed that KPIs are a valuable tool for individual and departmental performance measurement; the use of KPIs was challenged by data collection difficulties, a lack of engagement from staff, and a lack of clarification regarding the intended use of KPIs and their relevance. The study identified a consolidated set of seven KPIs, proposed as standard measures for hospital pharmacy practice. Conclusion: There is a perceived need to develop national standardised KPIs to demonstrate the value of pharmacy services at the individual and departmental levels. However, there are challenges that will need to be addressed before the implementation of a set of consolidated KPIs that encompasses the full scope of pharmacy activities.

Lonie, J.M. & Tsingos-Lucas, C. 2017, 'The use of Eriksonian Hypnosis to improve patient outcomes in pharmacy practice: A novel communication skill for pharmacists.', Res Social Adm Pharm.
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Motivational Interviewing, pharmacist-based health coaching and traditional patient counseling techniques all show merit in improving communication between patients and health care providers. However, in order to effectively utilize these techniques one should have the ability to draw upon internal cognitive and psychological resources. Some patients have difficulty obtaining optimal health outcomes due to an unconscious inability to learn and connect with psychological resources. When this is the case, other methods of communication may need to be considered. With the appropriate training, Eriksonian Hypnosis or the use of techniques such as hypnotic language patterns (HLP) have the potential to be implemented into pharmacy practice settings and assist those patients who have previously failed to make positive behavior changes and act upon their health issues.

Lonie, J.M., Austin, Z., Nguyen, R., Gill, I. & Tsingos-Lucas, C. 2017, 'Pharmacist-based health coaching: A new model of pharmacist-patient care', Research in Social and Administrative Pharmacy, vol. 13, no. 3, pp. 644-652.
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This paper describes a provider-patient communication process, which although not new to health care in general, is new to the pharmacy profession. Health coaching is a technique that empowers patients to make lasting health behavior changes that improve overall well-being. It provides patients with health care implementation options that better suit their lifestyle and abilities. Health coaching programs have the potential to foster better health outcomes, especially with patients who are chronically ill or represent an at risk population for medication non-adherence (e.g. elderly, patients on psychotropic medications). Other health professions (e.g. nursing and medicine) have had success with the implementation of health coaching models. For example, nurse coaching is recognized by the American Nurse Association and recent statistics show 3.1 million nurses in the U.S.A are also trained in nurse coaching. The pharmacy profession has yet to tap the patient-related benefits of health coaching. This commentary will discuss (i) The theoretical foundations of health coaching (ii) Distinctions between health coaching, motivational interviewing and traditional medication therapy counseling (iii) Training necessary for health coaching; and (iv) How pharmacists can use health coaching in practice.

Lu, J.F., Pokharel, D. & Bebawy, M. 2017, 'A novel mechanism governing the transcriptional regulation of ABC transporters in MDR cancer cells.', Drug Deliv Transl Res, vol. 7, no. 2, pp. 276-285.
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P-glycoprotein (P-gp/ABCB1) and multidrug resistance-associated protein 1 (MRP1/ABCC1) are the main drug efflux transporters associated with treatment failure in cancer. Much attention has been focused on the molecular mechanisms regulating the expression of these transporters as a viable approach for identifying novel drug targets in circumventing cancer multidrug resistance (MDR) clinically. In this paper, we examine the role of miR-326 in the context of its intercellular transfer between cancer cells by extracellular membrane vesicles called microparticles (MPs). We observe that cellular suppression of ABCC1 by miR-326 is modulated by the presence of ABCB1 transcript. Specifically, we show that siRNA silencing of MP-transferred ABCB1 transcript reverses the knockdown effects of miRNA-326 on target MRP1/ABCC1 transcripts. We also demonstrate a dominance of ABCB1 transcripts when co-localized with ABCC1 transcripts, which is consistent with the facilitation of miR-326 function by ABCB1. This study identifies a novel pathway regulating the expression of ABC transporters and positions ABCB1 mRNA as a transcriptional regulator of other members of this superfamily in multidrug resistant cells through its actions on miRNAs.

Madan, J.R., Kamate, V.J., Awasthi, R. & Dua, K. 2017, 'Formulation, Characterization and In-Vitro Evaluation of Fast Dissolving Tablets Containing Gliclazide Hydrotropic Solid Dispersions', Recent Patents on Drug Delivery & Formulation, vol. 11, no. 999, pp. 1-1.
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Malipeddi, V.R., Awasthi, R., Ghisleni, D.D.M., de Souza Braga, M., Kikuchi, I.S., de Jesus Andreoli Pinto, T. & Dua, K. 2017, 'Preparation and characterization of metoprolol tartrate containing matrix type transdermal drug delivery system', Drug Delivery and Translational Research, vol. 7, no. 1, pp. 66-76.
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Noain, A., Garcia-Cardenas, V., Gastelurrutia, M.A., Martinez-Martinez, F., Sabater-Hernandez, D. & Benrimoj, S.I. 2017, 'Cost analysis for the implementation of a medication review with follow-up service in Spain', International Journal of Clinical Pharmacy.
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Pandya, E., Masood, N., Wang, Y., Krass, I. & Bajorek, B. 2017, 'Impact of a Computerized Antithrombotic Risk Assessment Tool on the Prescription of Thromboprophylaxis in Atrial Fibrillation.', Clinical and Applied Thrombosis/Hemostasis, pp. 1076029616670031-1076029616670031.
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The computerized antithrombotic risk assessment tool (CARAT) is an online decision-support algorithm that facilitates a systematic review of a patient's stroke risk, bleeding risk, and pertinent medication safety considerations, to generate an individualized treatment recommendation. The CARAT was prospectively applied across 2 hospitals in the greater Sydney area. Its impact on antithrombotics utilization for thromboprophylaxis in patients with nonvalvular atrial fibrillation was evaluated. Factors influencing prescribers' treatment selection were identified. The CARAT recommended a change in baseline therapy for 51.8% of patients. Among anticoagulant-eligible patients (ie, where the risk of stroke outweighed the risk of bleeding) using "nil therapy" or antiplatelet therapy at baseline, the CARAT recommended an upgrade to warfarin in 60 (30.8%) patients. For those in whom the bleeding risk outweighed the stroke risk, the CARAT recommended a downgrade from warfarin to safer alternatives (eg, aspirin) in 37 (19%) patients. Among the "most eligible" (ie, high stroke risk, low bleeding risk, no contraindications; n = 75), the CARAT recommended warfarin for all cases. Discharge therapy observed a marginal increase in anticoagulation prescription in eligible patients (n = 116; 57.8% vs 64.7%, P = .35) compared to baseline. Predictors of warfarin use (vs antiplatelets) included congestive cardiac failure, diabetes mellitus, and polypharmacy. The CARAT was able to optimize the selection of therapy, increasing anticoagulant use among eligible patients. With the increasing complexity of decision-making, such tools may be useful adjuncts in therapy selection in atrial fibrillation. Future studies should explore the utility of such tools in selecting therapies from within an expanded treatment armamentarium comprising the non-vitamin K antagonist oral anticoagulants.

Pandya, E.Y. & Bajorek, B. 2017, 'Factors Affecting Patients' Perception On, and Adherence To, Anticoagulant Therapy: Anticipating the Role of Direct Oral Anticoagulants.', The patient, vol. 10, no. 2, pp. 163-185.
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The role of the direct oral anticoagulants (DOACs) in practice has been given extensive consideration recently, albeit largely from the clinician's perspective. However, the effectiveness and safety of using anticoagulants is highly dependent on the patient's ability to manage and take these complex, high-risk medicines. This structured narrative review explores the published literature to identify the factors underpinning patients' non-adherence to anticoagulants in atrial fibrillation (AF), and subsequently contemplates to what extent the DOACs might overcome the known challenges with traditional warfarin therapy. This review comprised a two-tier search of various databases and search platforms (CINAHL, Cochrane, Current Contents Connect, EMBASE, MEDLINE Ovid, EBSCO, PubMed, Google, Google Scholar) to yield 47 articles reporting patients perspectives on, and patients adherence to, anticoagulant therapy. The findings from the literature were synthesised under five interacting dimensions of adherence: therapy-related factors, patient-related factors, condition-related factors, social-economic factors and health system factors. Factors negatively affecting patients' day-to-day lives (especially regular therapeutic drug monitoring, dose adjustments, dietary considerations) predominantly underpin a patient's reluctance to take warfarin therapy, leading to non-adherence. Other patient-related factors underpinning non-adherence include patients' perceptions and knowledge about the purpose of anticoagulation; understanding of the risks and benefits of therapy; socioeconomic status; and expectations of care from health professionals. In considering these findings, it is apparent that the DOACs may overcome some of the barriers to traditional warfarin therapy at least to an extent, particularly the need for regular monitoring, frequent dose adjustment and dietary considerations. However, their high cost, twice-daily dosing and gastrointestinal adverse effects may present...

Pozzoli, M., Traini, D., Young, P.M., Sukkar, M.B. & Sonvico, F. 2017, 'Development of a Soluplus budesonide freeze-dried powder for nasal drug delivery.', Drug Dev Ind Pharm, pp. 1-9.
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OBJECTIVE: The aim of this work was to develop an amorphous solid dispersions/solutions (ASD) of a poorly soluble drug, budesonide (BUD) with a novel polymer Soluplus(®) (BASF, Germany) using a freeze-drying technique, in order to improve dissolution and absorption through the nasal route. SIGNIFICANCE: The small volume of fluid present in the nasal cavity limits the absorption of a poorly soluble drug. Budesonide is a corticosteroid, practically insoluble and normally administered as a suspension-based nasal spray. METHODS: The formulation was prepared through freeze-drying of polymer-drug solution. The formulation was assessed for its physicochemical (specific surface area, calorimetric analysis and X-ray powder diffraction), release properties and aerodynamic properties as well as transport in vitro using RPMI 2650 nasal cells, in order to elucidate the efficacy of the Soluplus-BUD formulation. RESULTS: The freeze-dried Soluplus-BUD formulation (LYO) showed a porous structure with a specific surface area of 1.4334 ± 0.0178 m(2)/g. The calorimetric analysis confirmed an interaction between BUD and Soluplus and X-ray powder diffraction the amorphous status of the drug. The freeze-dried formulation (LYO) showed faster release compared to both water-based suspension and dry powder commercial products. Furthermore, a LYO formulation, bulked with calcium carbonate (LYO-Ca), showed suitable aerodynamic characteristics for nasal drug delivery. The permeation across RPMI 2650 nasal cell model was higher compared to a commercial water-based BUD suspension. CONCLUSIONS: Soluplus has been shown to be a promising polymer for the formulation of BUD amorphous solid suspension/solution. This opens up opportunities to develop new formulations of poorly soluble drug for nasal delivery.

Quasir Mahmood, M., Dhar Shukla, S., Dua, K. & D. Shastri, M. 2017, 'The Role of Epidermal Growth Factor Receptor in the Management of Gastrointestinal Carcinomas: Present Status and Future Perspectives', Current Pharmaceutical Design.
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Rahmawati, R. & Bajorek, B.V. 2017, 'Self-medication among people living with hypertension: a review.', Fam Pract, vol. 34, no. 2, pp. 147-153.
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Background.: Self-medication is commonly practised by patients, underpinned by health beliefs that affect their adherence to medication regimens, and impacting on treatment outcomes. Objectives.: This review explores the scope of self-medication practices among people with hypertension, in terms of the scale of use, types of medication and influencing factors. Method.: A comprehensive search of English language, peer-reviewed literature published between 2000 and 2014 was performed. Twenty-seven studies met the inclusion criteria; 22 of these focused on complementary and alternative medicines (CAMs). Results.: Anti-hypertensive medications are listed among the 11% of products that patients reportedly obtain over-the-counter (OTC) for self-medication. On average, 25% of patients use CAMs, mostly herbs, to lower blood pressure. Recommendations by family, friends and neighbours are the most influential factors for self-medication with CAMs. Faith in treatment with CAMs, dissatisfaction with conventional medicine and the desire to reduce medication costs are also cited. Most (70%) patients with hypertension take OTC medicines to treat minor illnesses. The concurrent use of anti-hypertensive medications with analgesics and herbal medicines is commonly practised. The sociodemographic profile of patients engaging in self-medication differs markedly in the articles reviewed; self-medication practices cannot be attributed to a particular profile. Low disclosure of self-medication is consistently reported. Conclusion.: This review highlights a high proportion of people with hypertension practise self-medication. Further studies are needed to assess the impact of self-medication with OTC and anti-hypertensive medications on hypertension treatment. Health professionals involved in hypertension management should be mindful of any types of self-medication practices.

Sabater-Galindo, M., Ruiz de Maya, S., Benrimoj, S.I., Gastelurrutia, M.A., Martínez-Martínez, F. & Sabater-Hernández, D. 2017, 'Patients' expectations of the role of the community pharmacist: Development and testing of a conceptual model.', Research in social & administrative pharmacy : RSAP, vol. 13, no. 2, pp. 313-320.
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The roles of community pharmacists are evolving to include provision of expanded professional pharmacy services, thus leading to an increased interest in pharmacist-patient interactions. Role theory can be used to explain the interaction between this pair of individuals, by focusing on the roles performed by each one.To develop and test a model that relates patients' image of the pharmacist to their expectations of pharmacist's role, and how this then influences patients' reactions toward the pharmacist's role.A qualitative study was undertaken, and a questionnaire was created for the development of the model, based on role theory. The content, dimensions, validity and reliability of the questionnaire were pre-tested qualitatively and in a pilot mail survey. The reliability and validity of the proposed model were tested using confirmatory factor analysis (CFA). Structural equation modelling (SEM) was used to explain relationships between dimensions of the final model.A final model was developed. CFA concluded that the model was valid and reliable (Goodness of Fit indices: χ(2)(109) = 227.662, P = 0.000, RMSEA = 0.05, SRMR = 0.05, GFI = 1.00, NNFI = 0.90, CFI = 0.92). SEM indicated that "perceived pharmacist image" was associated positively and significantly with both "professional expectations" (the standardized path coefficient of (H) = 0.719, P < 0.05), as well as "courtesy expectations" (the standardized path coefficient of (H) = 0.582, P < 0.05). At the same time, "professional expectations" were associated positively and significantly with "positive reactions" (the standardized path coefficient of (H) = 0.358, P < 0.05), but negatively with "Negative reactions" (the standardized path coefficient of (H) = -0.427, P < 0.05). "Courtesy expectations" were associated positively and significantly with "positive reactions" (the standardized path coefficient of (H) = 0.081, P < 0.05), as well as "negative reactions" (the standardized path coefficient of (H) = 0.450,...

Sabater-Galindo, M., Sabater-Hernández, D., Ruiz de Maya, S., Gastelurrutia, M.A., Martínez-Martínez, F. & Benrimoj, S.I. 2017, 'Modelling elderly patients' perception of the community pharmacist image when providing professional services.', Psychology, health & medicine, vol. 22, no. 5, pp. 578-587.
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Professional pharmaceutical services may impact on patient's health behaviour as well as influence on patients' perceptions of the pharmacist image. The Health Belief Model predicts health-related behaviours using patients' beliefs. However, health beliefs (HBs) could transcend beyond predicting health behaviour and may have an impact on the patients' perceptions of the pharmacist image. This study objective was to develop and test a model that relates patients' HBs to patient's perception of the image of the pharmacist, and to assess if the provision of pharmacy services (Intervention group-IG) influences this perception compared to usual care (Control group). A qualitative study was undertaken and a questionnaire was created for the development of the model. The content, dimensions, validity and reliability of the questionnaire were pre-tested qualitatively and in a pilot mail survey. The reliability and validity of the proposed model were tested using Confirmatory Factor Analysis (CFA). Structural Equation Modelling (SEM) was used to explain relationships between dimensions of the final model and to analyse differences between groups. As a result, a final model was developed. CFA concluded that the model was valid and reliable (Goodness of Fit indices: x²(80) = 125.726, p = .001, RMSEA = .04, SRMR = .04, GFI = .997, NFI = .93, CFI = .974). SEM indicated that 'Perceived benefits' were significantly associated with 'Perceived Pharmacist Image' in the whole sample. Differences were found in the IG with also 'Self-efficacy' significantly influencing 'Perceived pharmacist image'. A model of patients' HBs related to their image of the pharmacist was developed and tested. When pharmacists deliver professional services, these services modify some patients' HBs that in turn influence public perception of the pharmacist.

Sharma, P., Kota, A., Deshpande, D., Haghi, M. & Oliver, B. 2017, 'Autophagy and airway fibrosis: Is there a link?', F1000 Research, vol. 6, no. 409.
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In the past decade, an emerging process named “autophagy” has generated intense interest in many chronic lung diseases. Tissue remodeling and fibrosis is a common feature of many airway diseases, and current therapies do not prevent or reverse these structural changes. Autophagy has evolved as a conserved process for bulk degradation and recycling of cytoplasmic components to maintain basal cellular homeostasis and healthy organelle populations in the cell. Furthermore, autophagy serves as a cell survival mechanism and can also be induced by chemical and physical stress to the cell. Accumulating evidence demonstrates that autophagy plays an essential role in vital cellular processes, including tissue remodeling. This review will discuss some of the recent advancements made in understanding the role of this fundamental process in airway fibrosis with emphasis on airway remodeling, and how autophagy can be exploited as a target for airway remodeling in asthma and chronic obstructive pulmonary disease.

Sharma, S., Pathak, S., Gupta, G., Sharma, S.K., Singh, L., Sharma, R.K., Mishra, A. & Dua, K. 2017, 'Pharmacological evaluation of aqueous extract of syzigium cumini for its antihyperglycemic and antidyslipidemic properties in diabetic rats fed a high cholesterol diet-Role of PPARγ and PPARα.', Biomed Pharmacother, vol. 89, pp. 447-453.
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In India syzygium cumini (Myrtaceae) is commonly used traditional medicine to treat diabetes. The present study was undertaken to assess an investigation of antihyperglycemic and antidyslipidemic properties of aqueous extract of Syzigium Cumini (SC) in diabetic rats fed a high cholesterol diet. The aqueous extract of SC was screened for antihyperglycemic and antidyslipidemic activity by streptozotocin induced diabetes in rats. Animals were treated with 100, 200 and 400mg/kg body weight of aqueous extract of SC. Metformin were used as reference antihyperglycemic drugs for comparison. Administration of aqueous extract of SC or metformin for 21days resulted in a significant (P<0.05) reduction in serum glucose, insulin and Homeostasis model assessment of insulin resistance (HOMA-IR) compared with diabetic controls. Treatment with 100mg/kg/day aqueous extract of SC did not result in a significant reduction in serum insulin levels, but 200mg/kg/day and 400mg/kg/day, aqueous extract of SC and metformin showed significant reductions 17.89%, 19.60% and 24.40%, respectively. Furthermore, administration of 100, 200 and 400mg/kg/day, aqueous extract of SC and metformin resulted in significant decrease in insulin resistance of 19.20%, 41.59%, 51.55% and 68.68%, respectively. In high fat diet- streptozotocin (HFD - STZ) treated rats β-cells function (HOMA-B) were markedly reduced (5.8-fold), however observed a significant (P<0.01) improvement of β-cell function with aqueous extract of SC (400mg/kg/day) and metformin. The aqueous extract of SC seeds exhibits significant insulin-sensitizing, antidyslipidemic, antioxidant, anti-inflammatory and β-cell salvaging activity in HFD-STZ-induced type 2 diabetic rats via overexpression of PPARγ and PPARα activity, affirming its potential to be used in the prevention and treatment of type 2 diabetes mellitus (T2DM). Further isolation and characterization of active components in SC seed extract are needed to explore the other possible mech...

Soni, N., Tekade, M., Kesharwani, P., Bhattacharya, P., Maheshwari, R., Dua, K., Hansbro, P. & Tekade, R. 2017, 'Recent Advances in Oncological Submissions of Dendrimer', Current Pharmaceutical Design, vol. 23, no. 999, pp. 1-1.
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Taylor, J., Jaiswal, R. & Bebawy, M. 2017, 'Calcium-calpain Dependent Pathways Regulate Vesiculation in Malignant Breast Cells.', Curr Cancer Drug Targets.
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Multidrug resistance in cancer (MDR) occurs when tumours become cross-resistant to a range of different anticancer agents. One mechanism by which MDR can be acquired is through cell to cell communication pathways. Membrane-derived microparticles (MPs) are emerging as important signaling molecules in this process. MPs are released from most eukaryotic cells and transfer functional proteins and nucleic acids to recipient cells conferring deleterious traits within the cancer cell population including MDR, metastasis, and angiogenesis. MP formation is known to be dependent on calpain, an intracellular cysteine protease which acts to cleave the cytoskeleton underlying the plasma membrane, resulting in cellular surface blebbing. This study examines differences in vesiculation between malignant and non-malignant cells using high-resolution Atomic Force Microscopy (AFM). We demonstrate that malignant MCF-7 and MCF-7/Dx cells have an intrinsically higher degree of vesiculation at rest when compared to non-malignant human brain endothelial cells (HBEC) and human mammary epithelial cells (MBE-F).. Cellular activation with the calcium ionophore A23187 resulted in an increase in vesiculation in all cell types. We show that calpain-mediated MP biogenesis is the dominant pathway at rest in malignant cells as vesiculation was shown to be inhibited with calpain inhibitor II (ALLM). These results suggest that differences in the biogenic pathways exist in malignant and non-malignant cells and have important implications in defining novel strategies to selectively targeting malignant cells for the circumvention of deleterious traits acquired through intercellular exchange of extracellular vesicles.

Tsingos-Lucas, C., Bosnic-Anticevich, S., Schneider, C.R. & Smith, L. 2017, 'Using Reflective Writing: a Predictor of Academic Success in Different Assessment Formats', American Journal of Pharmaceutical Education, vol. 81, no. 1.
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Wang, Y. & Bajorek, B. 2017, 'Pilot of a Computerised Antithrombotic Risk Assessment Tool Version 2 (CARATV2.0) for stroke prevention in atrial fibrillation.', Cardiol J, vol. 24, no. 2, pp. 176-187.
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BACKGROUND: The decision-making process for stroke prevention in atrial fibrillation (AF) requires a comprehensive assessment of risk vs. benefit and an appropriate selection of antithrombotic agents (e.g., warfarin, non-vitamin K antagonist oral anticoagulants [NOACs]). The aim of this pilot-test was to examine the impact of a customised decision support tool - the Computerised Antithrombotic Risk Assessment Tool (CARATV2.0) using antithrombotic therapy on a cohort of patients with AF. METHODS: In this prospective interventional study, 251 patients with AF aged ≥ 65 years, admitted to a teaching hospital in Australia were recruited. CARATV2.0 generated treatment recommendations based on patient medical information. Recommendations were provided to prescribers for consideration. RESULTS: At baseline (admission), 30.3% of patients were prescribed warfarin, 26.7% an antiplatelet, 8.4% apixaban, 8.0% rivaroxaban, 3.6% dabigatran. CARATV2.0 recommended a change of therapy for 153 (61.0%) patients. Through recommendations of CARATV2.0, at discharge, 40.2% of patients were prescribed warfarin, 17.7% antiplatelet, 14.3% apixaban, 10.4% rivaroxaban, 5.6% dabigatran. Overall, the proportion of patients receiving an antithrombotic on discharge increased significantly from baseline (admission) (baseline 77.2% vs. 89.2%; p < 0.001). Prescribers moderately agreed with CARATV2.0's recommendations (kappa = 0.275, p < 0.001). Practical medication safety issues were cited as major reasons for not accepting a desire to continue therapy with CARATV2.0's recommendations. Factors predicting the prescription of antiplatelets rather than anticoagulants included higher bleeding risk and high risk of falls. An inter-speciality difference in therapy selection was detected. CONCLUSIONS: This decision support tool can help optimise the use of antithrombotic therapy in patients with AF by considering risk versus benefit profiles and rationalising treatment selection. (Cardiol J 2017; 24, 2: ...

Werth, B.L., Williams, K.A. & Pont, L.G. 2017, 'Laxative Use and Self-Reported Constipation in a Community-Dwelling Elderly Population: A Community-Based Survey From Australia', Gastroenterology Nursing, vol. 40, no. 2, pp. 134-141.
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© 2016 by the Society of Gastroenterology Nurses and Associates, Inc.The objectives of this study were to 1) determine the prevalence of laxative use and self-reported constipation and 2) identify risk factors associated with constipation in a community-dwelling elderly population. A retrospective cross-sectional survey using data from the Australian Longitudinal Study of Ageing was used to explore laxative use and constipation in a cohort of community-dwelling older persons. The prevalence of laxative use was 15% and the prevalence of self-reported constipation was 21%. Females were more likely to report constipation and use laxatives. Of those using laxatives, men were more likely to have their laxatives prescribed by a doctor whereas women were more likely to self-medicate. Poor self-rated health and a higher need for assistance with activities of daily living were identified as risk factors for constipation. Constipation is a common condition affecting the community-dwelling elderly. There is a need to optimize the management of constipation and use of laxatives in such populations.

Wong, S.L.I. & Sukkar, M.B. 2017, 'The SPARC protein: an overview of its role in lung cancer and pulmonary fibrosis and its potential role in chronic airways disease.', Br J Pharmacol, vol. 174, no. 1, pp. 3-14.
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The SPARC (secreted protein acidic and rich in cysteine) protein is matricellular molecule regulating interactions between cells and their surrounding extracellular matrix (ECM). This protein thus governs fundamental cellular functions such as cell adhesion, proliferation and differentiation. SPARC also regulates the expression and activity of numerous growth factors and matrix metalloproteinases essential for ECM degradation and turnover. Studies in SPARC-null mice have revealed a critical role for SPARC in tissue development, injury and repair and in the regulation of the immune response. In the lung, SPARC drives pathological responses in non-small cell lung cancer and idiopathic pulmonary fibrosis by promoting microvascular remodelling and excessive deposition of ECM proteins. Remarkably, although chronic airway conditions such as asthma and chronic obstructive pulmonary disease (COPD) involve significant remodelling in both the airway and vascular compartments, the role of SPARC in these conditions has thus far been overlooked. In this review, we discuss the role of SPARC in lung cancer and pulmonary fibrosis, as well as potential mechanisms by which it may contribute to the disease process in asthma and COPD.

Conferences

Ferguson, C., Saliba, B. & Bajorek, B. 2017, 'Educational interventions to increase clinicians and patient knowledge of atrial fibrillation and anticoagulation: a systematic review', Australasian Cardiovascular Nursing College, Brisbane.
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Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice. Nurses are well-placed across a range of practice settings to provide both structured and informal education to clinicians, patients and caregivers on various aspects of AF management, particularly anticoagulant therapy. Purpose: To summarise key educational interventions targeted at clinicians, patients and caregivers that have previously evidenced to increase knowledge of AF and/ or anticoagulation. Methods: Researchers undertook a systematic search of electronic databases including Medline, Scopus, CINAHL and the Cochrane Library. Original studies that were published in the date range 2006-2016 were included if they described targeted educational interventions, and/or included decision support at both the levels of the patient and the clinicians. Additionally, manual reference list searching was also conducted. Results: A total of 42 studies were reviewed. A number of core components, methods and approaches were identified within the interventions including: clinician decision support; patient decision aides; shared decision making tools; counselling and education; distance education; supply of written or textual information; multi-media resource; patient worksheet or checklist; self-monitoring; audit and feedback; academic detailing; contemporary models of AF care; individualised or group, targeted education sessions. All these demonstrated differing levels of impact on knowledge. Conclusion: A diverse range of educational interventions were identified in this review, however the quality of evidence is limited by study designs. There is scope for robust clinical trials of complex educational interventions regarding AF management, focusing on interventions that are individualised to the needs of patients and their caregivers.

Gibson, A., Shum, S.B., Aitken, A., Tsingos-Lucas, C., Sándor, Á. & Knight, S. 2017, 'Reflective writing analytics for actionable feedback', ACM International Conference Proceeding Series, pp. 153-162.
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© 2017 ACM.Reflective writing can provide a powerful way for students to integrate professional experience and academic learning. However, writing reflectively requires high quality actionable feedback, which is time-consuming to provide at scale. This paper reports progress on the design, implementation, and validation of a Reflective Writing Analytics platform to provide actionable feedback within a tertiary authentic assessment context. The contributions are: (1) a new conceptual framework for reflective writing; (2) a computational approach to modelling reflective writing, deriving analytics, and providing feedback; (3) the pedagogical and user experience rationale for platform design decisions; and (4) a pilot in a student learning context, with preliminary data on educator and student acceptance, and the extent to which we can evidence that the software provided actionable feedback for reflective writing.