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Operatic Formenlehre seems to be alive and well—witness the wealth of publications on the solita forma (after Ritorni, Basevi, and Powers) and on concerto-like sonata forms in Mozart arias as early as the 1768 La finta semplice (after Mann and Rosen). But even standard operatic forms have often been thwarted—throughout opera’s long history—by dramatic exigencies. The purpose of this chapter is to explore and define subcategories of deformations in operatic storm scenes by identifying formal types along the continuum between closed operatic numbers and continuous, fragmentary musical flow. Formal (and deformational) categories are examined here in light of the topos of storm scenes from operatic selections of the Baroque, Galant, and Romantic periods, and avoiding the more traditional loci of continuous music, such as act finales.

There is considerable research regarding the adaption to functional decline associated with advanced (Stage IV) Chronic Obstructive Pulmonary Disease (COPD). This research has, however, primarily focused on physical and interventional strategies to manage disease progression and symptom burden, as opposed to the psychosocial strategies. To address this paucity, the current research explored the psychosocial strategies people with Stage IV COPD use to maintain quality of life towards the end of life. Eleven older people with Stage IV COPD living in regional Australia were interviewed to explore their experiences of ageing with COPD. The research used a theory-led analysis, informed by a Gadamerian hermeneutic phenomenological methodology, to examine participant data in relation to selection, optimisation and compensation theory (SOC). The participant stories reflected the use of selective strategies, from which a hierarchy of priority tasks emerged. Participants optimised their capacity to perform high priority tasks using a range of pragmatic and instinctive responses to ongoing change, which became more and more conscious and deliberate over time. Additionally, compensatory strategies more traditionally associated with COPD management were used to reduce the impact of symptoms. It is through the participant descriptions and perception of optimisation and compensation strategies and how they were implemented that the wider theme of 'mind over matter' emerged. The use of these strategies to adapt physically and psychosocially to COPD shows how the participants demonstrated resilience and used 'successful ageing' strategies to cope with ongoing functional decline.

This article summarizes experience and outcomes for a large, faith-based health system on a journey to ensure that its nearly 29 000-person nurse workforce has the foundational academic preparation to deliver superior, compassionate, and future-focused nursing care. The health system's bachelor of science in nursing completion strategy is summarized, including (a) programmatic structure, (b) curriculum themes, (c) participant experience, and (d) outcomes. Executive leadership's commitment and engagement are highlighted.

Background and objective Mortality and hospital separation data suggest a higher burden of chronic obstructive pulmonary disease (COPD) in indigenous than non-indigenous subpopulations of high-income countries. This study sought to accurately measure the true prevalence of post-bronchodilator airflow obstruction and forced vital capacity reduction in representative samples of Indigenous and non-Indigenous Australians. Methods This study applies cross-sectional population-based survey of Aboriginal and non-Indigenous residents of the Kimberley region of Western Australia aged 40 years or older, following the international Burden Of Lung Disease (BOLD) protocol. Quality-controlled spirometry was conducted before and after bronchodilator. COPD was defined as Global initiative for chronic Obstructive Lung Disease (GOLD) Stage 2 and above (post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio

Objectives If novel health services are to be implemented and sustained in practice, the perceptions and views of patients form a critical part of their evaluation. The aims of this study were to explore patient’s perceptions and experiences with a pharmacy asthma service and to investigate if there was a change over time. Methods Interviews and focus groups were conducted with patients participating in the asthma service at three time points. Data were transcribed verbatim and thematically analyzed using a framework approach. Key findings The service led to an enhanced awareness and understanding of asthma, changes in participants’ beliefs and attitudes towards asthma management, changes in asthma-related health behaviours and improved self-efficacy. Participants were very positive about the service and the role of the pharmacist in asthma management. There was a shift in participant perceptions and views, from being at an abstract level in those who had completed just one visit of the service to a more experiential level in those who had experienced the entire comprehensive asthma service. Conclusions A sustained experience/multiple visits in a service may lead to more concrete changes in patient perceptions of severity, beliefs, health behaviours and enhanced self-efficacy and control. The study highlights a need for such asthma services in the community.

Background and objective The bronchodilation and cardiovascular effects of bronchodilators may alter alveolar ventilation and perfusion distribution, which could subsequently affect single-breath diffusing capacity of the lungs for carbon monoxide (DL,CO) measurements. The aim of this study was to investigate the effect of salbutamol on DL,CO in subjects with and without airway obstruction and reversibility. Methods Sixty subjects were investigated with 20 in each of the three groups: normal spirometry; irreversible obstruction; and reversible obstruction. Baseline spirometry, plethysmographic lung volumes, DL,CO, pulse rate and arterial blood gases were measured. The same testing sequence was repeated after administration of a placebo inhaler and again after 400 μg salbutamol. Results Salbutamol did not affect the mean alveolar volume (VA) (P > 0.05), transfer coefficient for carbon monoxide (DL,CO/VA, KCO) (P > 0.05) or DL,CO (P > 0.05) in the normal and irreversible obstruction groups. In the reversible obstruction group, salbutamol caused an increase in the mean VA compared with placebo (P 0.05). A considerable reduction in DL,CO was found after salbutamol in four subjects in the reversible group as a result of a minor increase in VA and substantial decrease in KCO. No statistical difference in pulse rate or arterial blood gases values was detected. Conclusions Salbutamol had no effect on the mean DL,CO in any group. However, salbutamol may considerably reduce DL,CO in some individuals with reversibility secondary to its effects on VA and KCO.

Objective: To measure the prevalence of chronic obstructive pulmonary disease (COPD) among people aged 40 years or older in Australia. Design, setting and participants: A cross-sectional study of people in the community aged ≥ 40 years, selected at random using electoral rolls, in six sites chosen to reflect the sociodemographic and geographic diversity of Australia, conducted between 2006 and 2010. Standardised questionnaires were administered by interview. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and the FEV1/FVC ratio were measured by spirometry, before and after bronchodilator administration. Main outcome measure: Prevalence of COPD, classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2006 criteria. Results: Complete data were available for 1620 men (participation rate, 26%) and 1737 women (participation rate, 28%). The prevalence of GOLD Stage II or higher COPD (defined as post-bronchodilator FEV1/FVC ratio < 0.70 and FEV1 < 80% predicted) was 7.5% (95% CI, 5.7%–9.4%) among people aged ≥ 40 years, and 29.2% (95% CI, 18.1%–40.2%) among those aged ≥ 75 years. Among people aged ≥ 40 years, the prevalence of wheeze in the past 12 months was 30.0% (95% CI, 27.5%–32.5%), and prevalence of shortness of breath when hurrying on the level or climbing a slight hill was 25.2% (95% CI, 22.7%–27.6%). Conclusions: Symptoms and spirometric evidence of COPD are common among people aged 40 years or older and increase with age. Further research is needed to better understand the diagnosis and management of COPD in Australia, along with continuing efforts to prevent the disease.

Objective To assess any improvements in knowledge of asthma patients after a tailored education program delivered by pharmacists and measure the sustainability of any improvements. To ascertain patients’ perceptions about any changes in their knowledge. Methods Ninety-six specially trained pharmacists recruited patients based on their risk of poor asthma control. A tailored intervention was delivered to patients based on individual needs and goals, and was conducted at three or four time points over six months. Asthma knowledge was assessed at the beginning and end of the service, and six and 12 months after it had ended. Patients’ perceptions of the impact of the service on their knowledge were explored qualitatively in interviews. Results The 96 pharmacists recruited 570 patients, 398 (70%) finished. Asthma knowledge significantly improved as a result of the service (7.65 ± 2.36, n = 561, to 8.78 ± 2.14, n = 393). This improvement was retained for at least 12 months after the service. Patients reported how the knowledge and skills gained had led to a change in the way they managed their asthma. Conclusion Improvements in knowledge are achievable and sustainable if pharmacists used targeted educational interventions. Practice implications Pharmacist educational interventions are an efficient way to improve asthma knowledge in the community.

Eur J Clin Invest 2011; 41 (10): 1121–1128 Abstract Background Pheochromocytomas are tumours arising from chromaffin tissue located in the adrenal medulla associated with typical symptoms and signs which may occasionally develop metastases, which are defined as the presence of tumour cells at sites where these cells are not found. This retrospective analysis was focused on clinical, genetic and histopathologic characteristics of primary metastatic versus primary benign pheochromocytomas. Materials and methods We identified 41 subjects with metastatic pheochromocytoma and 108 subjects with apparently benign pheochromocytoma. We assessed dimension and biochemical profile of the primary tumour, age at presentation and time to develop metastases. Results Subjects with metastatic pheochromocytoma presented at a significantly younger age (41·4 ± 14·7 vs. 50·2 ± 13·7 years; P

berkelmans a., burton d., page k. & worrall-carter l. (2011) Registered Nurses’ smoking behaviours and their attitudes to personal cessation. Journal of Advanced Nursing67(7), 1580–1590. Abstract Aim. The aim of the study was to assess smoking behaviour of nurses including; (1) smoking prevalence and nicotine dependence; (2) demographic characteristics according to smoking status and (3) attitudes to cessation amongst current smokers. Background. Smoking amongst nurses is a barrier to the delivery of patient smoking cessation interventions. Studies on the smoking behaviour of nurses have lagged behind government surveys on smoking prevalence in the general population. Method. A descriptive, comparative study using a self-administered questionnaire was distributed to 3200 nurses over July and August of 2007 across one major metropolitan health service network in Victoria, Australia. Results. The questionnaire was completed by 1029 nurses, a response rate of 32%. Eleven per cent of nurses (n = 113) were current smokers. Nurses who smoked were more likely to be divorced/separated and report smoking amongst family and friends. Smoking was more common amongst nurses who work in psychiatry and the emergency departments. Amongst the nurses who smoked, 45% desired to stop smoking and while 89% had experienced previous quit attempts, only half had ever received help or advice about smoking cessation. The most common factors preventing smoking cessation included fear of withdrawal symptoms including stress, weight gain and anxiety. Conclusion. Smoking rates amongst nurses in this sample have declined below smoking rates amongst the general population. Considering the low uptake of smoking cessation support reported in this study, targeted strategies must be developed sensitive to the potential intrapersonal-professional struggle related to personal smoking which is at odds with nurses’ health promotion role.

To paraphrase Mark Twain, Carl Dahlhaus’s report that Italian opera buffa died with Rossini’s Barbiere, and that Verdi’s Falstaff (1893) and Donizetti’s Don Pasquale (1843) were posthumous works (N...

Background and objective: Dry powder mannitol has the potential to be used to enhance clearance of mucus in subjects with bronchiectasis. A reduction in FEV1 has been recorded in some subjects with bronchiectasis after inhaling mannitol. The aim of this study was to investigate if pre-medicating with either sodium cromoglycate (SCG) or eformoterol could inhibit this reduction in FEV1. Methods: A double-blind, placebo-controlled, randomized cross-over study was conducted. Lung function and airway response to mannitol was assessed on a control day and then re-assessed after pre-medication with placebo, SCG and eformoterol in nine subjects. Sensitivity to mannitol, expressed as the dose required to induce a 15% fall in FEV1 (PD15), and reactivity to mannitol, expressed as the % fall in FEV1 per mg of mannitol (response–dose ratio, RDR), are reported. Results: Subjects had an FEV1 of 68 ± 14% predicted, FVC of 97 ± 15% predicted and FEV1/FVC of 71 ± 8%. They were mildly hypoxemic and the SpO2 was 95 ± 2%.They had a PD15 to mannitol of 235 mg (95% CI: 150–368 mg) and a RDR of 0.057% fall in FEV1 per mg (95% CI: 0.038–0.085). After pre-medication with SCG, PD15 increased (773 mg, P

A variety of assays were utilized to determine the effects of Leptospermum petersonii essential oil on both Candida albicans and Aspergillus fumigatus. Hyphal morphology, susceptibility of spheroplasts and uptake of propidium iodide following exposure to the oil suggest that the mode of action of L. petersonii essential oil is through direct disturbance of the fungal cell membrane. Data also confirms that the volatile component of the oil is highly antifungal, independent of direct contact between the liquid oil and the fungal membrane. The degree of inhibition was greater when fungi were directly exposed to oil volatiles compared to pre-inoculation exposure of oil volatiles into the agar. It is likely that the essential oil volatiles are acting both directly and indirectly on the fungi to produce growth inhibition.

Background and objective: It is currently recommended that patients avoid large meals prior to their lung function tests. The aim of this study is to determine whether this recommendation is necessary in clinical practice. Methods: A randomized controlled cross-over trial was conducted. Subjects performed lung function tests (spirometry, measurement of lung volumes and gas transfer) prior to, directly following and 2 h after consuming a large breakfast. On the control arm, subjects performed the same lung function tests while fasting for the duration of the morning. The study subjects comprised 12 healthy subjects, 10 COPD patients and 10 patients with interstitial lung disease. Results: There were no significant differences between measurements on the meal and control days for FEV1, FVC, TLC or DLCO. There were no significant changes with time in any of these parameters over the course of either the meal or control morning. Conclusions: Common measures of lung function are not affected by the prior consumption of a large meal and it is unnecessary to advise patients to avoid a large meal prior to lung function assessment.

OPERA Mozart and His Operas. By David Cairns. Berkeley: University of California Press, 2006. [xi, 290 p. ISBN-10: 0520228987; ISBN-13: 9780520228986. $29.95.] Bibliographic references, index, illustrations. The cornucopia of literature available on Mozart's operas makes a many-coursed banquet-some might say a groaning board-for the interested reader. David Cairns, in his new book, admits as much in his first sentence: "Another book on Mozart and his operas may not be needed" (p. 1). Authors on this topic have whipped up their own concoctions out of much the same ingredients, producing an almost endless variety, from delicacies to square meals to basic field rations. But the question is: can anyone bring anything new to the table? In the late 18th century, magnificent feasts of five to six courses were the norm. So before the question above can be answered, let us sample some of the main treats already prepared. Brigid Brophy's Mozart the Dramatist: A New View of Mozart, His Operas and His Age (New York: Harcourt, Brace, & World, 1964; reprint, New York: Da Capo Press, 1988), like a savory appetizer, is a brilliant meditation on the intellectual and cultural connections of the operas, with references as far afield as Sigmund Freud, Alexander Pope, Antoine Watteau, Soren Kierkegaard, Jane Austen, Mary Wollstonecraft, and Alma Mahler. It is somewhat dated in its unquestioned Freudian and anti-Beethovian stance, but it is full of surprising details and is organized by topic ("Anarchy, Impotence and Classicism," "Women and Opera"), rather than chronology. For those who are ravenously hungry, William Mann's The Operas of Mozart (New York: Oxford University Press, 1977) is an encyclopedic reference work that provides music examples and English translations of every solo aria. It contains fascinating asides that focus on, for example, contemporary notions of key characteristics, and provides much historical and cultural background. Although this work is also a bit dated (he mentions the "age of Aquarius" on p. 1), it offers, in its author's words, "the genesis of each opera . . . exactly what words and music are contained in each musical number . . . a commentary on the whole dramatic action as it develops, as well as a critical consideration of each work." (p. 4). But by far the most satisfying dish has been brought forth by Daniel Heartz with Thomas Bauman, Mozart's Operas (Berkeley: University of California Press, 1990). Although it only treats the "operas of Mozart's mature years" (p. xii), i.e., Idomeneo to The Magic Flute, and eschews being an "operatic Baedeker" (p. xiv), Heartz provides contextual information on the operas from original sources, autograph studies, and other musicological inquiries. The book has extensive music examples, illustrations, parallel translations of texts, reliable references, and goes a long way to correcting previous misunderstandings. This work does presume a lot of background knowledge on the reader's part, and contains some musical analysis (forms, key relations), but is stuffed with enough interesting tidbits ("Mozart wrote the bass part especially large throughout his autograph so that the continuo cellist, old Innozenz Danzi, could read it," p. 47) and useful tables to sate a non-musician. Two final tastings are works that put Mozart's operas into cultural context: Mary Hunter's The Culture of Opera Buffa in Mozart's Vienna (Princeton: Princeton University Press, 1999) and Andrew Steptoe's The Mozart-DaPonte Operas (Oxford: Clarendon Press, 1988). Hunter's book is a true scholarly work, offering invaluable social, political, gender-related, and musical contexts. She treats Mozart's buffa operas as part of a "dialogue between individual operas and generic conventions of plot, character, dramatic function, musical 'type' and vocal behavior" (p. 5), and the appendices contain a list of operas she consulted (79!), the formal structures of buffa arias, and rare plot summaries. …

Objectives A pharmacy asthma care program in Australia, which included specific education on asthma and asthma medication, trigger factors, use of inhalers, and medication adherence, as well as goal setting and patient review aspects, assessed the impact of a community pharmacy asthma service on the severity of patients’ asthma over 6 months. Data from this study were used to estimate the cost effectiveness of the program.

Objective To examine the relationship between job type, weight status, and lifestyle factors that are potential contributors to obesity including, diet, physical activity (PA), and perceived stress among employees enrolled in the Working on Wellness project. Methods Randomly selected employees at 24 worksites completed a baseline survey (n = 1700); some also an in-person survey and anthropometric measures (n = 1568). Employees were classified by US labor standards as white collar (n = 1297), blue collar (n = 303), or service worker (n = 92), and 8 unknown. Associations were analyzed using chi-square and general linear model procedures and adjusted for demographics using logistic regression. Results In unadjusted models, body mass index of service workers was higher than white collar workers; fruit and vegetable intake was higher for service and blue collar than white collar; white collar workers reported highest stress levels in job and life. Nevertheless, in models adjusted for demographics, the only significant difference was for PA (ie, metabolic equivalent [MET]/min/wk), with blue collar workers reporting higher levels of PA than service workers, who reported higher levels than the white collar workers. Conclusions Future research should further examine the relationship between health and job status to corroborate the results of the current study and to consider designing future worksite health promotion interventions that are tailored by job category.

Objective: A retrospective case–control study at Monash Medical Centre (MMC), a tertiary referral hospital in Melbourne, Australia, was conducted to identify risk factors associated with very severe asthma in paediatric patients. Methodology: Asthmatics admitted to an intensive care unit (ICU; n = 52) were identified and considered to represent cases of very severe/near fatal asthma (NFA group). This group was compared to asthmatics who had been admitted on one occasion only to the emergency department at MMC (non-NFA controls, n = 53). Patient files were examined and factors that may be linked to NFA were recorded. Information not on file was obtained from patients/parents during a structured telephone interview. Data for the two groups were compared, univariate and multivariate logistic regression analyses were performed, and odds ratios (OR) were calculated. Results: Univariate analysis indicated that asthmatics with NFA were more likely to be older (P = 0.01) and have a longer duration of asthma (P = 0.02). They were also more likely to have hay fever (P = 0.002; OR, 7.6), use inhaled corticosteroids (P = 0.001), long acting β2 agonists (P = 0.02), have an asthma management plan (P = 0.006), and see a respiratory specialist (P = 0.001). Parental smoking habits were not different between the groups. Multivariate logistic regression analysis identified male gender (P = 0.05; OR, 5.7) and use of inhaled corticosteroids (P = 0.07; OR, 7.2) as factors that may be predictive of NFA. Conclusions: This study identifies a number of factors associated with NFA; many are similar to those reported in adult patients. Asthma severity explains some findings, but the data also suggest that additional independent risk factors such as gender and duration of asthma may operate in children.

Asthma is a chronic disease with both inflammatory and bronchoconstrictive elements and often requires multiple medications. Most asthma regimens include medications with different therapeutic modes of action and a number of different medication delivery devices. To effectively participate in their asthma management, patients need to recognize each of their medication types, understand their purpose, adhere to their treatment regimen, and be proficient in using the required delivery devices. This study evaluated patient knowledge of asthma pharmacotherapy and adherence. An interview study was undertaken in two rural locations, in Australia, to elicit participants' knowledge, use, and inhalation device technique. Of participants, 75.9% used preventer medication and the remaining 24.1% used reliever medication only. Of those using preventer medication, 82.5% could distinguish their preventer from a range of asthma medicines. Metered dose inhalers (MDIs) were used by 80% of participants; 23% used a Turbuhaler(R); 24% used an Accuhaler(R); and 5% used an MDI with a spacer device. The study established poor medication knowledge, suboptimal device technique, and disturbing levels of adherence with management recommendations. Asthma education strategies need to be modified to engage patients with low asthma knowledge to achieve improved patient outcomes. Further, strategies need to motivate patients to use preventer medication during times when they feel well.

Background: Asthma has been recognised as a poorly managed disease state in Australia. Rural areas have been identified as being underserviced by health professionals. Pharmacists in rural areas are in a prime position to be involved in the provision of multidisciplinary asthma care. Aim: This study investigated the impact of spirometry screening on asthma management by pharmacists in rural areas. Method: A two group (intervention: n=141, control: n=46) multicentre study design was utilised. The control group was provided with a standard medication review while the intervention group received spirometry testing and a medication review. The study protocol required pharmacists to refer participants to a doctor if required, based on spirometry or medication review results. The researchers assessed asthma severity and adequacy of asthma medication. Results: Spirometry as an intervention attracted participants to the study pharmacies and provided an opportunity for pharmacists to screen and refer a group who may otherwise be overlooked. Medication review identified suboptimal therapy, potentially contraindicated drug combinations and adverse drug reactions. Conclusion: Spirometry adds benefit to the provision of pharmaceutical care for people with asthma. This may have additional significance in rural areas where access to other health services is limited. (author abstract)

Traditional preoperative education programs have demonstrated the beneficial effects for orthopaedic patients. However, attending preoperative education classes became too difficult for patients, their families, and their friends who traveled great distances from their homes in rural Kentucky. A multidisciplinary continuous quality improvement team from University of Kentucky Chandler Medical Center created a pilot project to provide preoperative education programs for their total joint patients via an interactive telehealth network. The use of telecommunications technology in providing patient preoperative health education was successful in attracting patients from remote areas who otherwise may not have participated. The program has continued for 2 years.

Geographical Information Systems-computerised systems for the capture, storage, retrieval, analysis and display of spatial data - have recently been promoted as important tools for the study of public health. Attention must also be given to the issues involved in this relatively new application, especially in Australian conditions. These include the coarse spatial resolution of most health and social data, the propagation of error through the need to use estimates and concordance tables to handle data in mismatched official spatial boundaries, the inflexible analytical capacity of most GIS for the needs of epidemiology, and difficulties in access to data, which are compounded by the absence of a good metadata register. The conflict between the need for spatial precision in GIS and preserving the confidentiality of health data is a salient issue. Medical geographers and public heath researchers using GIS must recognise these issues in order to work together and toward extending the use of GIS technology beyond broad ecological and accessibility studies.

This report summarizes five studies of culturally diverse women who were administered the Prenatal Psychosocial Profile (PPP). These data from 3,444 rural and urban women of all childbearing ages support the validity and reliability of the PPP as a measure of stress, support from partner, and support from others. The self-esteem scale is a valid and reliable measure for Caucasian and African American women. However, the cultural appropriateness of the self-esteem scale for Native American women is questionable, and it is neither valid nor culturally appropriate for traditional Hispanic women. The mean scores for stress, partner support, and other support were similar for all groups except for scales expected to differ by sample groups. Thus, suggested cutoff scores should be useful for screening purposes. The PPP provides a brief, yet comprehensive profile that is accepted by participants and useful to researchers and clinicians.

This quasi-experimental, retrospective study used birth certificate and medical record data to evaluate the effectiveness of the Rural Oregon Minority Prenatal Program (ROMPP) in improving patterns of prenatal care utilization by rural-dwelling, low-income, Mexican-American women at risk of poor pregnancy outcomes. The ROMPP intervention provided nursing case management services and peer outreach to pregnant Mexican-American women in a rural Oregon community. The intervention group had more prenatal visits in months 2, 3, 4, 5, 6, and 7 than the comparison group (P < 0.05). The intervention group had a similar number of emergency room (ER) visits, but had more respiratory diagnoses and fewer urinary tract infections. ROMPP women had more inpatient admissions and longer lengths of stay. No differences were found in the initiation of prenatal care or the total number of prenatal care visits, nor in the timing of screening serum glucose tests. The intervention should be expanded to address the persistent attitudinal, financial, transportation and language barriers to adequate prenatal care. Nurses should increase their cultural competency and sharpen their clinical focus on advocacy, marketing, facilitation of relationships between community groups, and community organizing.

Background The role of community pharmacists in disease state management has been mooted for some years. Despite a number of trials of disease state management services, there is scant literature into the engagement of, and with, pharmacists in such trials. This paper reports pharmacists’ feedback as providers of a Pharmacy Asthma Management Service (PAMS), a trial coordinated across four academic research centres in Australia in 2009. We also propose recommendations for optimal involvement of pharmacists in academic research. Methods Feedback about the pharmacists’ experiences was sought via their participation in either a focus group or telephone interview (for those unable to attend their scheduled focus group) at one of three time points. A semi-structured interview guide focused discussion on the pharmacists’ training to provide the asthma service, their interactions with health professionals and patients as per the service protocol, and the future for this type of service. Focus groups were facilitated by two researchers, and the individual interviews were shared between three researchers, with data transcribed verbatim and analysed manually. Results Of 93 pharmacists who provided the PAMS, 25 were involved in a focus group and seven via telephone interview. All pharmacists approached agreed to provide feedback. In general, the pharmacists engaged with both the service and research components, and embraced their roles as innovators in the trial of a new service. Some experienced challenges in the recruitment of patients into the service and the amount of research-related documentation, and collaborative patient-centred relationships with GPs require further attention. Specific service components, such as the spirometry, were well received by the pharmacists and their patients. Professional rewards included satisfaction from their enhanced practice, and pharmacists largely envisaged a future for the service. Conclusions The PAMS provided pharmacists an opportunity to become involved in an innovative service delivery model, supported by the researchers, yet trained and empowered to implement the clinical service throughout the trial period and beyond. The balance between support and independence appeared crucial in the pharmacists’ engagement with the trial. Their feedback was overwhelmingly positive, while useful suggestions were identified for future academic trials.

Although asthma can be well controlled by appropriate medication delivered in an appropriate way at an appropriate time, there is evidence that management is often suboptimal. This results in poor asthma control, poor quality of life, and significant morbidity.The objective of this study was to describe a population recruited in community pharmacy identified by trained community pharmacists as being at risk for poor asthma outcomes and to identify factors associated with poor asthma control. It used a cross-sectional design in 96 pharmacies in metropolitan and regional New South Wales, Victoria, Queensland, and Australian Capital Territory in Australia. Community pharmacists with specialized asthma training enrolled 570 patients aged ≥18 years with doctor-diagnosed asthma who were considered at risk of poor asthma outcomes and then conducted a comprehensive asthma assessment. In this assessment, asthma control was classified using a symptom and activity tool based on self-reported frequency of symptoms during the previous month and categorized as poor, fair, or good. Asthma history was discussed, and lung function and inhaler technique were also assessed by the pharmacist. Medication use/adherence was recorded from both pharmacy records and the Brief Medication Questionnaire (BMQ).The symptom and activity tool identified that 437 (77%) recruited patients had poor asthma control. Of the 570 patients, 117 (21%) smoked, 108 (19%) had an action plan, 372 (69%) used combination of inhaled corticosteroid (ICS)/long-acting β(2)-agonist (LABA) medications, and only 17-28% (depending on device) used their inhaler device correctly. In terms of adherence, 90% had their ICS or ICS/LABA dispensed6 times in the previous 6 months, which is inconsistent with regular use; this low adherence was confirmed from the BMQ scores. A logistic regression model showed that patients who smoked had incorrect inhaler technique or low adherence (assessed by either dispensing history or BMQ) and were more likely to have poor control.Community pharmacists were able to identify patients with asthma at risk of suboptimal control, and factors that contributed to this were elicited. This poorly controlled group that was identified may not be visible or accessible to other health-care professionals. There is an opportunity within pharmacies to target poorly controlled asthma and provide timely and tailored interventions.