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Unintended discrepancy in medications at the time of discharge from the hospital is associated with an increased incidence of adverse drug events, including readmission to hospital. Medication literacy is an essential part of health literacy and can reduce medication discrepancies. This prospective observational cohort study aimed to measure the medication literacy of patients at the time of discharge from the hospital when managed with usual care and after the introduction of a medication literacy improvement instrument. This study involved a baseline cohort receiving usual care and a post-intervention cohort aged 50-80 years with high health literacy. The 7 Things I Should Know About My Medications at the Time of Discharge from Hospital instrument, in short, The 7 Domains MedLit Instrument, was designed by the researchers in addition to three medication literacy measurement questionnaires. Medication literacy was measured at 30 h post-discharge. The impact on readmission to hospital was assessed at 30 days post-discharge. The 7 Domains MedLit Instrument was found to significantly increase the number of patients reporting increased counselling by a clinician at the time of discharge from the hospital (clinician, 59.3 % vs. 100.0 %, X 2 (1, n = 49) = 11.10, p < 0.01, physician, 28.6 % vs. 76.2, X 2 (1, n = 49) = 10.9, p < 0.01, pharmacist 25.0 % vs. 71.4 %, X 2 (1, n = 49) = 10.4, p < 0.01)). Significantly, more patients had increased knowledge on drug interactions or adverse drug reactions after using the instrument (26.1 % vs. 61.9 %, P = 0.032 and 30.4 % vs. 66.7 %, P = 0.033, respectively). The 7 Domains MedLit Instrument and the schooling years significantly correlated with the knowledge of drug interactions and adverse drug reactions. Less post-intervention participants visited an emergency department within 30 days post-discharge. The 7 Domains MedLit Instrument significantly improved the patients' medication literacy at the time of discharge from hospital., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Deprescribing is an effective strategy to manage polypharmacy and improve patient outcomes. The notion of a potential role for pharmacists in a multidisciplinary team approach to deprescribing has been identified in quantitative and qualitative literature. However, stakeholders' perceptions of this role, and factors that may impede or facilitate the pharmacist's involvement have not been elucidated. The application in ambulatory care also requires clarification. Understanding stakeholders' views is essential to optimise involvement of the pharmacist in deprescribing and improve practice., Objectives: First, to synthesize the perspectives and experiences of stakeholders (primary care providers, pharmacists, patients, and carers) regarding the role and involvement of the pharmacist in deprescribing in ambulatory care settings. Second, to identify barriers and strategies to enhancing pharmacist involvement in deprescribing., Methods: A systematic search was conducted across CINAHL, Embase, Medline, and Scopus from database inception to April 2023 for qualitative studies in English exploring the pharmacist's role in deprescribing. Data were extracted for iterative and inductive development of themes. A meta-synthesis facilitated the identification of overarching themes. Qualitative secondary analysis enabled identification of barriers and facilitators to the pharmacist's involvement in deprescribing., Results: From 285 articles identified, 9 studies were included which explored the views of general practitioners, specialist physicians, pharmacists, nurse practitioners, patients, carers, and general practice and clinic staff as stakeholders in deprescribing in ambulatory care. The meta-synthesis identified 4 over-arching themes: (1) therapeutic impetus and the status quo mentality, (2) role and responsibility, (3) multidisciplinary care, and (4) conflicting interests in pharmacy practice. Strategies to enhance pharmacists' involvement in deprescribing emerged from the data, and the pharmacist's role was strongly encouraged by stakeholders despite logistical and perceptual barriers identified., Conclusions: Incorporation of the strategies to enhance the pharmacist's involvement in deprescribing identified in this review is encouraged to optimise patient-centred care and improve practice., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Pharmacy practice today mandates "patient-centered care", thereby assigning higher levels of professional responsibility for pharmacists leading to ethical challenges. These challenges often involve ethical principles, institutional, personal, or other constraints that can pull practitioners in incompatible opposite directions, creating "ethical dilemmas" in many circumstances. Pharmacists are expected to handle challenges competently and in the best interest of patients. Literature underlines the positive impact of educational interventions focusing on ethical awareness and competence, and that "gaps" existed in pharmacy training/curricula for Jordanian pharmacists. The objective of this study was to develop, implement, and evaluate the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian university., Educational Activity and Setting: Fifth-year pharmacy students attending summer school at a university in Jordan from July to September 2020 were invited to participate in an educational intervention (suite of didactic online lectures and skills-based workshops). This study was delivered in four parts, with a pretest administered immediately before and a posttest survey immediately after the educational intervention, the educational intervention (three phases), and focus-group discussions to elicit students' feedback., Findings: Findings indicated enhanced levels of confidence in students' decision-making. The development of students' moral reasoning and decision-making skills were also observed to be improved., Summary: This study highlighted the importance of the implementation of an ethics course in pharmacy undergraduate curricula. It emphasized the positive impact this course made on the students' learning experiences and provided a strong environment for discussion and group learning., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Evaluations of computerized provider order entry (CPOE) systems have revealed that reductions in certain types of medication errors occur simultaneously with the emergence of system-related errors - errors that are unlikely or not possible to occur with the use of paper-based medication charts. System-related errors appear to persist many years post-implementation of CPOE, although little is known about whether the types and rates of system-related errors that occur immediately following CPOE implementation are similar to those that endure or emerge after years of system use., Objective: To analyze and synthesize the literature on system-related errors, specifically in relation to the length of time that CPOE systems have been in use, to determine what is currently known about how system-related errors change over time., Methods: A literature search was undertaken using the PubMed database to identify English language articles published between January 2005 and March 2020 that provided original data on system-related errors resulting from CPOE system use. Studies were included if they provided results on system-related errors and information relating to the length of time that CPOE had been in use., Results: Thirty-one studies met the inclusion criteria for this narrative review. System-related errors were identified and described during short, medium and long-term use of CPOE systems, but no single study examined how errors changed over time. In comparing findings across studies, results suggest that system-related errors persist with long-term use of CPOE systems, although likely to occur at a reduced rate., Conclusions: This review has highlighted a significant gap in knowledge on how system-related errors change over time. Determining what and when system-related errors occur and the system factors that contribute to their occurrence at different time points after CPOE implementation is necessary for the future prevention and mitigation of these errors., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To explore the literature describing the delivery and assessment of Mental Health First Aid (MHFA) training among university students., Data Sources: The databases MEDLINE, PreMEDLINE, CINAHL, EMBASE, ERIC, and PsycINFO were searched to identify publications describing MHFA training and assessment among university students since 2000., Study Selection: All studies, regardless of design, that described the delivery and assessment of MHFA training among university students, at any level, were included in this systematic review., Data Extraction: The discipline and level of students; the version, length, and integration of MHFA training; and the constructs used to assess students post-MHFA training were extracted from each study., Results: Of the initial 1662 records, 12 were included. Eight studies were conducted in Australia, 3 in the United States, and 1 in the United Kingdom. Most students were enrolled in health care or social work degree programs across all years of their program with 4 studies involving pharmacy students. Three studies described integrating compulsory MHFA training for university students. Most studies reported on the delivery of the Standard or Adult version of MHFA training; no study reported on MHFA for Tertiary Students. Post-MHFA training, students were assessed on mental health knowledge, literacy, intentions, confidence, stigma, and skills application. Only 2 studies described assessment methods involving direct observation of behaviors, whereas the rest relied on self-reported measurements., Conclusion: Despite the spread of MHFA to over 25 countries and the availability of tertiary student-specific training, the studies included in this systematic review were conducted in only 3 countries and mainly involved Standard and Adult MHFA training. Most assessments relied on self-reported measures. Future studies involving different versions of MHFA training, and the exploration of novel competency-based assessment methods among a diverse range of students from different countries are warranted., (Copyright © 2020 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Medication discrepancies directly impact patient safety and can adversely impact quality of care and resource utilization at transitions of care., Objectives: To develop a common nomenclature and taxonomy for classifying and reporting medication discrepancies and to assess the content validity and reliability of the taxonomy., Methods: The taxonomy was developed following a multi-stage process. The content of the taxonomy was then assessed using expert opinion through a two-round modified Delphi process. The expert panel comprised 10 experts who were selected based on pre-defined selection criteria. Six experienced pharmacists were then invited to classify medication discrepancies from a number of fictitious cases (adapted from authentic cases) using the taxonomy., Results: The medication discrepancy taxonomy (MedTax) comprises 12 main types and 28 sub-types of discrepancies. A set of operational instructions and definitions to aid the use of the taxonomy was formulated. The overall Average content validity index (Ave-CVI) was 0.93 and interrater reliability was 0.67 (multirater κfree), indicating substantial agreement. An excellent internal consistency of the taxonomy was established (Kuder-Richardson Formula 20 (KR-20) = 0.92)., Conclusions: A content valid and reliable taxonomy for classifying medication discrepancies was developed. The MedTax may be used to classify medication discrepancies identified following medication reconciliation services. The clear and consistent reporting of medication discrepancies arising from medication reconciliation services may be of value to policy makers, healthcare professionals and researchers, when evaluating such services. The MedTax was designed to fill an essential void in global endeavors to reinforce standardization of medication reconciliation practices and to improve medication safety across transitions of care., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Obtaining accurate patient medication histories and performing medication reconciliation are core pharmacy practice skills that optimize patient safety at transitions of care. Competency-based learning and assessment of medication reconciliation skills are essential methods in undergraduate pharmacy education. The aim of this study was to investigate the impact of an in-classroom simulation- and feedback-driven training activity on pharmacy students' medication reconciliation skills, self-perceived confidence, and overall student satisfaction., Methods: Over a three-day learning activity in 2016, pharmacy students from a private university in Jordan were assessed by roleplay on their ability to conduct a simulated patient medication interview, obtain the Best Possible Medication History, reconcile the history against a hospital medication chart, identify discrepancies, and document findings. Students received immediate feedback and observed peers undergo the assessment process. Pre- and post-simulation questionnaires and supplementary focus groups enabled collection of quantitative and qualitative data pertaining to student self-perceived confidence, perceptions, experiences, and usefulness of the course., Results: Assessment-based competency scores demonstrated significant improvement in student performance during the activity. Self-perceived confidence scores significantly improved after the medication reconciliation training intervention. Focus group content analysis yielded positive responses such as students valuing receiving feedback on performance and recommendations for future training., Conclusions: Simulation with feedback was a useful tool to teach pharmacy students medication reconciliation in Jordan. Subsequent to the study, medication reconciliation and interactive teaching methods were added to curriculum to supplement traditional teaching modalities., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Physical abuse is a significant cause of infant morbidity and mortality. Early detection in the emergency department (ED) is crucial., Objective: We describe the impact of a clinical pathway focused on early involvement of the child protection team (CPT) and social work (SW) team for infants presenting to a pediatric emergency department with an injury concerning for abuse., Methods: The pathway lists 10 injuries associated with abuse in infants and directs consultation of the CPT and SW. It was implemented at a single site on April 1, 2014. Seasonally matched data were collected 12 months before and after implementation on all children < 12 months of age with a qualifying injury. Demographics, CPT and SW consults, referral to Child Protective Services, diagnostic studies, and ultimate determination of abuse by the CPT were collected., Results: Implementation of the pathway was associated with an increase in consultation of the CPT from 17% to 47% (p < 0.001) and SW from 33% to 52% (p < 0.001). CPT and SW consultations were obtained more frequently for those on public compared to private insurance prior to implementation but not after (CPT: odds ratio [OR] 4.32; p = 0.046; 95% confidence interval [CI] 1.03-18.15; SW: OR 3.23, p = 0.034; 95% CI 1.09-9.74). Diagnostic testing increased in the post-pathway period. There was no difference in the detection of abusive injury or number of missed cases., Conclusions: These findings suggest that this clinical pathway was successful in increasing involvement of the CPT and SW teams and reducing socioeconomic disparity in the evaluation of infants with injuries concerning for abuse., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The assessment of content validity is a critical and complex step in the development process of instruments which are frequently used to measure complex constructs in social and administrative pharmacy research. The aims of this study were to investigate the elements of content validity; to describe a practical approach for assessing content validity; and to discuss existing content validity indices. This is a narrative review of the assessment and quantification of content validity. It describes the key stages of conducting the content validation study and discusses the quantification and evaluation of the content validity estimates. Content validity provides evidence about the degree to which elements of an assessment instrument are relevant to and representative of the targeted construct for a particular assessment purpose. The assessment of content validity relies on using a panel of experts to evaluate instrument elements and rate them based on their relevance and representativeness to the content domain. It is a three-stage process that includes; the development stage, judgment and quantifying stage, and revising and reconstruction stage. To quantify the expert judgments, several indices have been discussed in this paper such as the content validity ratio (CVR), content validity index (CVI), modified-Kappa, and some agreement indices. A practical guide describes the process of content validity evaluation is provided. In summary, content validation processes and content validity indices are essential factors in the instrument development process, should be treated and reported as important as other types of construct validation. Determining item CVI and reporting an overall CVI are important components necessary to instruments especially when the instrument is used to measure health outcomes or to guide a clinical decision making. Content validity deserves a rigorous assessment process as the obtained information from this process are invaluable for the quality of the newly developed instrument., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: In an ever-changing environment, pharmacy education is in the race to catch up and excel to produce competent pharmacists. Examining academic institutions, including schools of pharmacy, their internal systems and framework, it seems appropriate to view these institutions using multiple lenses. Bolman and Deal conceptualized a method to examine organizations using four constructs (structural, human resource, political, and symbolic). The Eastern Mediterranean Region (EMR), with deep-rooted pharmacy education and practice was the setting for this research., Objectives: To explore factors affecting academic reform in undergraduate pharmacy education in the EMR from stakeholders' and students' perspectives; and to apply Bolman and Deal's four-frame organizational change model to explore how these issues might be viewed., Methods: A multiple-method approach was employed and involved collecting, analyzing and integrating qualitative semi-structured interview data with open-ended questions in a survey. Cross-sector stakeholder sample from various EMR countries was recruited and interviewed. Final year pharmacy students from one school of pharmacy in Jordan were surveyed., Results: Emergent themes were indicative that academic reform was addressed by all frames of the Bolman and Deal model. Structural and political frames received substantial weighing pointing to the importance of curricular reform, collaboration and leadership. A need for skillful and role-model teaching academic staff was highlighted, and in harmony with the human resource frame. Issues within the symbolic frame were readily apparent in the data and spanned the other three frames in relation to heritage, customs and cultural barriers., Conclusions: Issues pertinent to academic reform in pharmacy were presented. Viewing change in pharmacy schools from multiple perspectives highlighted the need for structural changes to pharmacy programs, human resource management, political will, leadership, and collaboration. The importance of understanding cultural aspects of organizations is critical as it is these that provide identity to any organization and help reformers better manage change., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Skin injury is the most common form of child physical abuse. Although the pattern and visual appearance of skin injury and the treatment needed for the injury is similar in children and adults, characteristics of infant and childhood skin may complicate the diagnosis of injury. A good understanding of normal developmental presentation of accidental injury from infancy to adulthood, locations for injury that should trigger consideration of abuse, and cutaneous mimics of abuse across the lifespan are critical to the identification of suspected abuse. Adults and older children can provide a history directly to providers, though it should be noted that abused adults and children may not always disclose the true cause of their injuries. In infants and very young children, a history from the patient is lacking due to the verbal abilities of the child, and a parent or other caregiver may provide a false or misleading history that can complicate the diagnosis and treatment. The approach to taking the history, when abuse is suspected, is a critical part of the evaluation, and best practice will vary depending on whether your patient is a child or an adult., (Copyright © 2017. Published by Elsevier Inc.)

Background: The International Pharmaceutical Federation (FIP) Global Competency Framework (GbCF) was developed as a mapping tool to provide guidance for foundation level pharmacy practice and professional development. The Eastern Mediterranean Region (EMR) with a deep rooted pharmacy history is yet to adopt an explicit competency framework., Objective: To review the literature for evidence of competency-based pharmacy education in the EMR, including pharmacists' and pharmacy students' perceptions of knowledge and skills acquired during training at undergraduate, post-graduate, and life-long learning levels., Methods: Six electronic databases were searched for articles published between 1990 and 2014. Titles and abstracts were screened according to the inclusion criteria. Full articles identified for inclusion were assessed and mapped to a relevant domain of the GbCF., Results: Totally, 57 studies met the inclusion criteria. The majority of studies portrayed pharmacists' and pharmacy students' opinions regarding educational aspects of their experiences. Participants generally cited the need for more practice-based training, modernization of curriculum, continuing pharmacist education and greater involvement in public health promotion, and research to strengthen professional competency. Interventional studies-enhanced knowledge and skills after training was provided to pharmacists and pharmacy students. No studies pertaining to the organization and management domain of the GbCF were found., Conclusion: Despite paucity of studies that specifically investigated aspects of competency-based pharmacy education in the EMR, results provided impressions of what participants perceived as beneficial, or lacking in their education to attain certain competencies. Results point toward the need to implement a competency framework specific to the EMR., (Copyright © 2016 Elsevier Inc. All rights reserved.)

We have previously reported on the deregulation of cellular microRNAs involved in hematopoiesis and inflammation in human T-cell lymphotropic virus type 1 (HTLV-I)-transformed cells. In this study, we demonstrate that miR-150 and miR-223 specifically target the signal transducer and activator of transcription 1 (STAT1) 3' untranslated region, reducing STAT1 expression and dampening STAT1-dependent signaling in human T cells. The effects of miR-150 and miR-223 on endogenous STAT1 were confirmed using inducible cell lines. Our studies also showed that miR-150 expression is upregulated by interleukin-2 signaling in adult T cell leukemia/lymphoma (ATL) cells. HTLV-I-transformed and ATL-derived cells have reduced levels of miR150 and miR223 expression, which coincide with increased STAT1 expression and STAT1-dependent signaling. Knockdown of STAT1 by short hairpin RNA demonstrated that the constitutive activation of STAT1 is required for the continuous proliferation of HTLV-I-transformed cells. Our studies further demonstrate that increased expression of STAT1 in ATL cells is associated with higher levels of major histocompatibility complex class I expression. Previous studies have demonstrated that the pressure exerted by natural killer (NK) cells in vivo can edit leukemic tumor cells by forcing an increased expression of major histocompatibility complex class I to escape immune clearance. STAT1-expressing tumor cells produce more aggressive tumors because they cannot be eliminated by NK cells. Our results suggest that therapeutic approaches using combined targeting of STAT1 and MHC class I may be an effective approach to activate NK cell-mediated clearance of ATL tumor cells., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Research has shown that consumers prefer a pharmacist who is skilled in communication and pays particular attention to friendliness, empathy and attentiveness. Medication management interviews tend to be more time consuming than other patient-pharmacist interactions. The extra time for these interviews provides patients with an opportunity to evaluate the quality of interpersonal care provided by the pharmacist. Patient evaluations of pharmacists may influence their intentions to use medication management services. In previous studies, a conceptual model based on information-seeking theory was developed and used to explain a significant amount of the variation in consumers' and caregivers' willingness to use Australia's Home Medicines Review (HMR) service., Objective: The aim of this paper was to extend the conceptual model to include the influence of patients' evaluation of interpersonal care provided. We aimed to test the hypothesis that patients' perceptions of how well the pharmacist listened to them during their most recent HMR interview (Listening) would increase their willingness to re-use HMR (Willingness)., Methods: Patients (N = 595) who had experienced Australia's Home Medicines Review (HMR) within the previous 6 months completed questionnaires. Exploratory and confirmatory factor analyzes were used to validate the measurement scales. Structural equation modeling was used to test the model., Results: The structural model provided a reasonable fit to the data and explained 53% of the variation in Willingness. The structural model revealed that Listening increased patients' perceptions that the HMR provided positive outcomes (Outcomes) (β = 0.37, P < 0.05) and directly and indirectly increased Willingness (β = 0.61, P < 0.05)., Conclusion: These results suggest that patients' willingness to use a medication management service in the future is strongly influenced by their perceptions of how well the pharmacist listened to them during their last medication review interview. Improving pharmacist listening skills may be explored as a strategy for improving patient engagement with pharmacy services., (Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.)

Background: Hospital pharmacists around the world are becoming increasingly involved in promoting the responsible use of medicines through clinical pharmacy services. This is reflected in the Basel Statements developed by the International Pharmaceutical Federation Hospital Pharmacy Section, particularly the theme 'Influences on Prescribing.' Some countries, particularly in Asia, are currently establishing clinical pharmacy services and would benefit from identification of facilitators., Objectives: To validate a survey exploring clinical pharmacy services focusing on pharmacists' influences on prescribing, based on Basel Statements 28-31, and the factors that affect their implementation in the Western Pacific Region (WPR)., Methods: Content and face validity of the survey (BS28-31) was established. This resulted in the BS28-31 consisting of 20 questions, which included a Clinical Pharmacy Services Facilitators (CPSF) scale (25 items) to measure respondents' perceptions of facilitators of clinical pharmacy services. The BS28-31 was emailed to hospital pharmacy directors in the WPR. The survey was made available in English, Japanese, Chinese, Vietnamese, Lao, Khmer, French and Mongolian. Principal components and internal consistency analyses were conducted to assess the reliability and construct validity of the CPSF scale., Results: The final survey was sent to a total of 2525 hospital pharmacy directors in the WPR of which 726 were returned from 31 nations yielding a response rate of 29%. Two items in the scale were removed due to low communalities (0.22 and 0.16). The resulting 23 item scale produced a parsimonious two-factor solution, divided into internal (e.g. individual pharmacist traits and pharmacy departmental structure/resources) and environmental facilitators (e.g. government support, patient and physician expectations). This two factor solution explained 51.5% of the variance. In addition, the Cronbach's α for the internal and environmental subscales were 0.94 and 0.78 respectively., Conclusion: The BS28-31 survey was found to be a reliable and valid instrument for assessing hospital pharmacy directors' perceptions of clinical pharmacy services regarding pharmacists' influences on prescribing and their facilitators in the WPR., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: The recent legalization of mifepristone has given women in Australia a new option for termination of pregnancy. Pharmacists are well positioned to provide information and supply mifepristone for patients. However, there are ethical and legal concerns in Australia regarding the supply of mifepristone, as pharmacists may choose to conscientiously object to supplying mifepristone and are subject to differing abortion laws between states and territories in Australia. The objective of this study was to explore attitudes and knowledge of Australian pharmacists about mifepristone., Study Design: Semistructured interviews were conducted with 41 registered pharmacists working in a pharmacy or hospital in Sydney, Australia. When data saturation was achieved, audiotaped transcripts were deidentified and transcribed verbatim. Data were thematically analyzed using a framework approach for applied policy research and categorized into the following themes: contextual, diagnostic, evaluative and strategic., Results: Analysis of the transcripts yielded four themes: (a) pharmacists' contextual view on pregnancy termination, the role of the pharmacist and impact on the pharmacy workplace; (b) diagnostic reasons for differing views; (c) evaluation of actual and perceived pharmacy practice in relation to the supply of mifepristone and (d) strategies to improve pharmacists' services, awareness and education., Conclusion: Australian pharmacists in this study perceived themselves to have a potentially important role as medicine experts in patient health care and safety in medical termination of pregnancy. However, there was a general lack of clinical, ethical and legal knowledge about medical termination of pregnancy and its legislation., Implications: To ensure patient safety, well-being and autonomy, there is an imperative need for pharmacist-specific training and guidelines to be made available and open discussion to be initiated within the profession to raise awareness, in particular regarding professional accountability for full patient care., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: This article explores medication information seeking behavior (MISB). We aimed to develop a scale for measuring MISB and use it to explore the relationships between MISB, adherence and factors, which drive information seeking., Methods: Patients (N=910) using multiple medicines completed questionnaires. Exploratory and confirmatory factor analyses were performed. Correlations and multivariate analyses were used to investigate the relationships between variables., Results: Respondents sought medication information mainly from health professionals and written medicines information. The medication information seeking behavior scale (MISB) had acceptable reliability and validity. Information seeking was most intense among respondents who had recent changes in their medicine regimen and worries about their medicines. Those who sought medication information from autonomous sources were more likely to be non-adherent than those who never did (OR=2.00 [1.48, 2.70]). Seeking information from health professionals had no influence on adherence., Conclusion: Health practitioners should carefully attend to patients' questions about medicines information. When patients mention that they are worried about their medicines and have sought medication information from television, magazines, brochures or family and friends, this could be a sign that they tend towards non-adherent behavior., Practice Implications: The MISB scale could be used to learn more about patients' use of medication information., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Previous research has demonstrated that some patients who are at risk of experiencing medication-related problems express a lack of willingness to use pharmacist-provided medication management services. Little is known about the factors that influence willingness to use these services among patients who have not yet experienced the service., Objectives: The aim of this study was to test a model of willingness to use the Australian Home Medicines Review (HMR) service. Specifically, this study aimed to determine the influence of positive and negative outcome expectancies and communication efficacy over willingness among patients who were eligible to receive the service but have not yet experienced it., Methods: A cross-sectional survey was conducted with patients who were recruited by 264 community pharmacists throughout Australia. Patients were included in the study if they had not yet experienced HMR but were taking more than 5 medicines daily or more than 12 doses daily. Measurement scales were developed using exploratory and confirmatory factor analyses. Structural equation modeling was used to test the model., Results: Questionnaires received from 286 patients (15.6%) were analyzed. Multi-item measurement scales were observed to have acceptable construct reliabilities (range, 0.69-0.94). Importantly, respondents held overall neutral expectations about the personal benefits of HMR (positive outcome expectancies) but high communication efficacy. Structural equation modeling revealed that positive outcome expectancies (β=0.56, P<.001) and communication efficacy (β=0.25, P<.05) influenced willingness to use, whereas negative outcome expectancies had no significant effect., Conclusions: The extent to which patients believe that HMR would provide them with increased medicines knowledge, improve their medicines management capability, and reduce their medicine concerns had a significant influence over willingness to use the service. Because these expectancies are relatively low, there appears to be significant scope for increasing patient demand for these services. Patient-directed material about medication management services should highlight the provision of medication information., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: In 2008, the Basel Statements were developed to reflect the future of hospital pharmacy worldwide. Included were a key set of statements regarding the expanding role of hospital pharmacists' influence on prescribing from the management of medicines formularies to being an active member of the therapeutic decision-making process., Objectives: This study aimed to validate a survey to measure Basel Statement 26 regarding the role of medicines formularies and the factors that affect its use in the Western Pacific Region (WPR)., Methods: The survey was developed in consultation with a WPR advisory group and current literature. The survey was translated using the forward-backward method into Chinese (simplified) and Vietnamese. The instrument was pilot tested in a stratified random sample of 260 hospital pharmacy directors in the WPR. Principal components analysis (PCA) was applied to the data to assess construct validity of the Medicines Formulary Scale that assessed responders' perceptions of their formulary and impact on utilization., Results: The Medicines Formulary Survey was completed by 107 hospital pharmacy directors or equivalent. The survey contained the Medicines Formulary Scale in addition to questions regarding the content and review process of the hospital's formulary as well as demographic questions. Application of the PCA procedures resulted in a parsimonious 2-factor solution in which 33.8% of the variance was explained. The Cronbach alpha for the 17-item scale was found to be 0.70. The Cronbach alpha values for the first and second factor/subscales were 0.76 and 0.68, respectively., Conclusion: The Medicines Formulary Survey appears reliable and valid for assessing hospital pharmacy directors' perceptions of hospital medicine formularies in the WPR. Further development of validated instruments to assess other areas of hospital pharmacy practice will help track the progression of hospital pharmacy and aid in globalization of the profession., (Copyright © 2012 Elsevier Inc. All rights reserved.)

In this overland flow simulation experiment, the relationships between flow path length, flow rate and the concentration of different P fractions were investigated. Overland flow was simulated using a 3 mx0.12 m laboratory flume. To remove the impact of rainfall on P lost in overland flow, simulated rainfall was not used during these experiments. Instead overland flow was generated by pumping water into the flume at the surface of the grass sod. The experimental setup allowed for the variation in flow path length and flow rate between and during experimental runs. The results demonstrated that an increase in flow path length caused an increase in Total Dissolved P (TDP), Dissolved Reactive P (DRP) and Total Reactive P (TRP) concentration in overland flow (p<0.01) while an increase in flow rate resulted in a decrease in the concentration of these P fractions in overland flow due to dilution (p<0.01). Total P (TP), Particulate P (PP) and Dissolved Organic P were not affected by the variables tested during this study. When flow path length was increased in conjunction with flow rate, there was an increase in TDP, DRP, and TRP concentrations despite the impact of greater dilution. The results indicate that variations in flow path length during a rainfall event may play a role in determining the concentration of dissolved P fractions in overland flow at field scale.

Mandibular symmetry was compared between a group of 28 subjects exhibiting Class II subdivision malocclusions and 30 subjects with Class I malocclusions who served as the control group. With submentovertex radiographs, symmetry was assessed by measuring the relative difference in spatial position of mandibular landmarks in both anteroposterior and transverse dimensions as determined by coordinate systems representing the cranial floor, mandible, and mandibular dentition. Only those variables representing the anteroposterior difference between right and left mandibular molar positions showed a statistically significant difference between the groups. Whether the position of the mandibular molars was measured relative to the cranial floor or within the mandible itself, the mandibular first molar was located more posteriorly on the Class II side of the subdivision malocclusion within a mandible that exhibited no other unusual asymmetry.