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Chloe Tolley,1 Diana Rofail,2 Adam Gater,1 Justine K Lalonde31Adelphi Values Ltd, Bollington, UK; 2Roche Products Ltd, Welwyn Garden City, UK; 3Roche S.A.S, Paris, France Abstract: Many clinical outcome assessments (COAs) were originally developed for completion via pen and paper. However, in recent years there have been movements toward electronic capture of such data in an effort to reduce missing data, provide time-stamped records, minimize administrative burden, and avoid secondary data entry errors. Although established in many patient populations, the implications of using electronic COAs in schizophrenia are unknown. In accordance with International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force recommendations, in-depth cognitive debriefing and usability interviews were conducted with people with schizophrenia (n=12), their informal (unpaid) caregivers (n=12), and research support staff (n=6) to assess the suitability of administration of various electronic COA measures using an electronic tablet device. Minimal issues were encountered by participants when completing or administering the COAs in electronic format, with many finding it easier to complete instruments in this mode than by pen and paper. The majority of issues reported were specific to the device functionality rather than the electronic mode of administration. Findings support data collection via electronic tablet in people with schizophrenia and their caregivers. The appropriateness of other forms of electronic data capture (eg, smartphones, interactive voice response systems, etc) is a topic for future investigation. Keywords: ePRO, eCOA, mode of administration, electronic data capture, usability

Introduction: There has been substantial growth in research exploring use of digital health technologies (DHT) to improve global population health. Harnessing the potential of DHT for the early detection of neurodegenerative diseases is one such area.1 According to the National Institute for Health and Care Excellence, DHTs need to be credible for UK Healthcare Professionals (HCPs); HCPs should be involved in the development and implementation process of DHTs to ensure that their needs are met and to promote the successful adoption into healthcare systems.2 Aim: To explore HCPs' perspectives on key considerations of developing and implementing DHT for the early detection of dementia causing diseases, such as Alzheimer's, within the National Health Service (NHS). Methods: Ethical approval was granted from Newcastle University Ethics Committee. HCPs with patient-facing roles within primary or secondary care NHS settings were recruited through various online networks alongside a snowball sampling approach. Participants took part in a semi-structured audio-recorded interview exploring their experience of current diagnostic practices, opinions on the early detection of dementia causing diseases and the use of DHT to aid this approach, and the challenges of implementing such interventions into healthcare. The framework approach was used to thematically analyse the verbatim transcripts to identify core concepts and themes emerging within the interviews. A list of core concepts and themes was applied systematically to the whole data set using QSR N-Vivo (Version 1.6.1). The research team then used the 'constant comparison' technique to move backwards and forwards between these data and evolve explanations until a fit was made. Results: Eighteen interviews were conducted with 11 primary and seven secondary care HCPs. Our analysis highlighted three core concepts, centring around considerations for healthcare service users, HCPs, and the DHT when developing and implementing DHT for the early detection of dementia causing diseases. HCPs recognised the potential benefits of providing an early detection of dementia causing diseases to healthcare services users, but only if a suitable intervention was available to allow individuals to potentially reduce their risk. Additionally, HCPs were concerned about the impact on health inequity, such as accessibility of this type of service to individuals who have disabilities or could be possibly digitally excluded. Many HCPs were also concerned about the impact on the healthcare system, with fears that it could overburden the NHS if sufficient resources and support were not provided for its implementation. In regard to the DHT, HCPs were positive about the possibility of a DHT to remotely capture real time data and felt it would be important to capture different modalities to help differentiate between dementia causing diseases. Discussion/Conclusion: This study highlights the need to design a DHT for the early detection of dementia causing diseases that is accessible to users, to promote health equity. This study also highlights potential barriers for researchers when implementing a DHT into the NHS, although it cannot be assumed that these are the only barriers that may be encountered; developers will need to consider this so that a future DHT meet HCPs' needs. References: 1. Frey AL, Karran M, Jimenez RC, Baxter J, Adeogun M, Bose N, Chan D, Crawford J, Dagum P, Everson R, Hinds C. Harnessing the Potential of Digital Technologies for the Early Detection of Neurodegenerative Diseases (EDoN). 2. National Institute of Health Care Excellence (NICE). (2018, December 10). Evidence standards framework for Digital Heath Technologies (ECD7). https://www.nice.org.uk/corporate/ecd7/resources/evidence-standards-framework-for-digital-health-technologies-pdf-1124017457605 [ABSTRACT FROM AUTHOR]

Introduction Adherence to haemophilia A ( HA) treatment may be influenced by patients' beliefs about their condition and treatment. Furthermore, difficulties administering treatment may lead to poor adherence. New treatment strategies aim to reduce the burden associated with administration and to improve patient perception of treatment, which, in turn, increase adherence levels. Aims This study aimed to examine patient perception of HA treatment and related factors using patient-reported outcome ( PRO) questionnaires and to confirm the psychometric properties of a recently developed questionnaire, the Haemo PREF. Methods A non-interventional, cross-sectional, questionnaire study was conducted with adult HA patients in Spain (n=31), Germany (n=10) and Italy (n=48), who were using ReFacto AF with the Fuse NGo administration device. Patients completed the Haemo PREF and other questionnaires measuring related constructs: treatment adherence, satisfaction and well-being, online at two time points. Correlational, regression and psychometric analyses were conducted. Results PRO scores indicated that patients are satisfied with and adherent to their treatment. Multivariate regression of the Haemo PREF global score identified a number of significant predictors ( P≤.05). The Haemo PREF Global Score had a moderate relationship with subscales on the related questionnaires (mean correlation=0.43; range=0.39-0.48). The Haemo PREF demonstrated good test-retest reliability (intraclass correlation coefficient=0.82), internal consistency reliability (Cronbach's alpha range=0.69-0.82) and convergent validity with measures of treatment satisfaction (Spearman correlation coefficient, r=.48) and well-being ( r=.41). Conclusion The findings suggest that patients using ReFacto AF with Fuse NGo were satisfied with and adherent to their treatment. The Haemo PREF can identify important concepts relating to patient treatment experience in HA. [ABSTRACT FROM AUTHOR]

Many studies have attempted to identify the root cause of dyslexia. Different theories of dyslexia have proposed either a phonological, attentional, or visual deficit. While research has used eye-tracking to study dyslexia, only two previous studies have used the moving-window paradigm to explore the perceptual span in dyslexic reading, and none have done so in visual search. The present study analysed the perceptual span using both reading and visual search tasks to identify language-independent attentional impairments in dyslexics. We found equivocal evidence that the perceptual span was impaired in dyslexic reading and no evidence of impairment in visual search. However, dyslexic participants did show deficits in the visual search task, with lower search accuracy and shorter saccades compared with controls. These results lend support for a visual, rather than attentional or phonological, account of dyslexia., (© 2024 John Wiley & Sons Ltd.)

Objectives: Digital literacy is increasingly crucial in pharmacy practice, and relevant education and training are required to prepare the future workforce. This study aims to explore the current and planned inclusion of digital literacy education in the undergraduate curricula of UK pharmacy schools., Methods: A mixed-methods approach was conducted with two phases. The first involved a content analysis of published curricula from all 30 UK pharmacy schools. The second phase included a survey based on the Health Education England Digital Capabilities Framework, distributed to academic staff across all pharmacy schools., Key Findings: Data from 14 pharmacy schools' curricula were included in the analysis, with 10 reporting digital literacy education. Key themes identified from the analysed documents included understanding of health informatics, applied informatics, information technology skills, and the emerging digital health technology. Nineteen respondents from 16 schools participated in the survey; digital literacy inclusion was reported by 18 participants. There was variable alignment of digital literacy competencies with the Health Education England framework. Digital literacy was mainly integrated into existing teaching sessions, predominantly through self-learning (n = 12). Electronic Health Records and remote counselling were the main focus areas within the curricula. Challenges in implementing digital literacy include a lack of expertise (n = 13), and time constraints (n = 10)., Conclusions: The trend towards embedding digital literacy in UK pharmacy curricula is clear, but disparities suggest the need for a more unified strategy. Recommendations include establishing a specific digital literacy framework aligned with professional needs, improving accessibility and transparency in curricula documents, and investing in faculty development., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society.)

Combining drugs can enhance their clinical efficacy, but the number of possible combinations and inter-tumor heterogeneity make identifying effective combinations challenging, while existing approaches often overlook clinically relevant activity. We screen one of the largest cell line panels (N = 757) with 51 clinically relevant combinations and identify responses at the level of individual cell lines and tissue populations. We establish three response classes to model cellular effects beyond monotherapy: synergy, Bliss additivity, and independent drug action (IDA). Synergy is rare (11% of responses) and frequently efficacious (>50% viability reduction), whereas Bliss and IDA are more frequent but less frequently efficacious. We introduce "efficacious combination benefit" (ECB) to describe high-efficacy responses classified as either synergy, Bliss, or IDA. We identify ECB biomarkers in vitro and show that ECB predicts response in patient-derived xenografts better than synergy alone. Our work here provides a valuable resource and framework for preclinical evaluation and the development of combination treatments., Competing Interests: Declaration of interests L.F.A.W. has received funding from Genmab BV and Bristol Myers Squibb. M.J.G. has received research grants from AstraZeneca, GlaxoSmithKline, Astex Pharmaceuticals, and Mosaic Therapeutics and is the Director and consultant for Mosaic Therapeutics., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The World Health Organisation advocates Digital Health Technologies (DHTs) for advancing population health, yet concerns about inequitable outcomes persist. Differences in access and use of DHTs across different demographic groups can contribute to inequities. Academics and policy makers have acknowledged this issue and called for inclusive digital health strategies. This systematic review synthesizes literature on these strategies and assesses facilitators and barriers to their implementation. We searched four large databases for qualitative studies using terms relevant to digital technology, health inequities, and socio-demographic factors associated with digital exclusion summarised by the CLEARS framework (Culture, Limiting conditions, Education, Age, Residence, Socioeconomic status). Following the PRISMA guidelines, 10,401 articles were screened independently by two reviewers, with ten articles meeting our inclusion criteria. Strategies were grouped into either outreach programmes or co-design approaches. Narrative synthesis of these strategies highlighted three key themes: firstly, using user-friendly designs, which included software and website interfaces that were easy to navigate and compatible with existing devices, culturally appropriate content, and engaging features. Secondly, providing supportive infrastructure to users, which included devices, free connectivity, and non-digital options to help access healthcare. Thirdly, providing educational support from family, friends, or professionals to help individuals develop their digital literacy skills to support the use of DHTs. Recommendations for advancing digital health equity include adopting a collaborative working approach to meet users' needs, and using effective advertising to raise awareness of the available support. Further research is needed to assess the feasibility and impact of these recommendations in practice., (© 2024. The Author(s).)

Background: Despite 49.1% of registered pharmacists in the UK being from a Black, Asian and Minority Ethnic (BAME) background, senior management roles within pharmacy are dominated by white males. People from BAME communities may experience minority stress which contributes to a professional attainment gap compared with non-BAME colleagues. Minority stress describes additional stressors, such as unconscious bias, micro-aggression and racial minority stress, experienced by minoritized people to adhere to the social norms of the majority. There is little evidence describing experiences of minority stress in pharmacy practice and education. The aim was to explore experiences of racial minority stress in pharmacy education and practice., Methods: A convenience sample of pharmacy students and pharmacists were recruited via email and social media posts to volunteer to take part in interviews and focus groups. A topic guide was used to explore experiences of unconscious bias, microaggressions and racial minority stress in education and practice. Interviews and focus groups were transcribed verbatim and inductively analysed using thematic analysis underpinned by a phenomenological approach. Ethical approval was granted from Newcastle University (5340/2020, 2430/2593)., Results: Forty-five participants were recruited. Six focus groups and sixteen one-to-one semi-structured interviews were conducted. The sample was varied, with 56% ( n  = 25) students and 33% ( n  = 15) registered pharmacists from community, hospital, primary care, academia and an additional 11% ( n  = 5) still in foundation training in these sectors. The sample include diversity of racial identities, including 40% ( n  = 18) South Asian, 27% ( n  = 12) White, 15% ( n  = 7) Black, 7% ( n  = 3) Chinese and Arab mixed, 2% (n = 1) and 2% (n = 1) Not disclosed. Three themes were identified - Theme 1) Experiences of racial minority stress, Theme 2) Making sense of racial minority stress, and Theme 3) Responding to racial minority stress. Participants characteristics (for example skin colour, dialect, religious dress) made them feel susceptible to judgement, racist comments and microaggressions in education and practice. Participants required time to interpret, understand and make sense of incidents of racial minority stress. Responses to stressors included 'ignoring ignorance' and using a 'professional identity' to mask feelings. However, malicious comments and actions from other pharmacy staff were responded to differently to experiences from patients. Participants reported poor self-confidence to challenge racist behaviours in the workplace., Conclusions: The aim of this study was to explore experiences of racial minority stress in pharmacy education and practice. This study shows dealing with microaggression, racial minority stress and judgement in pharmacy education and practice is a burden experienced by people from BAME backgrounds. These experiences could contribute to the professional attainment gap in pharmacy, as making sense of these experiences is an additional burden pharmacists and trainees must bear in comparison to people from non-BAME backgrounds. Further work is needed to explore interventions to reduce minority stress in pharmacy practice and education to reduce the attainment gap across the sector., Competing Interests: The authors declare they have no known competing financial interests or personal relationships that could have appeared to influence the work other than what is already reported in this paper., (© 2024 The Authors.)

Introduction: Chronic weight management and treatments for type 2 diabetes (T2D) involve a combination of lifestyle-based (diet, exercise) and pharmaceutical interventions. In people with obesity or T2D, understanding the impact of drivers/triggers on appetite and eating behaviors can be crucial to successful medical management. This study aimed to characterize perceptions and experiences regarding appetite and eating behaviors among people with obesity or T2D and identify drivers/triggers of food choices., Methods: This non-interventional, cross-sectional, qualitative study utilized semi-structured concept elicitation interviews to explore the perceptions of people with obesity and/or T2D around appetite, eating behaviors and drivers/triggers of food choices. Adult US residents (≥ 18 years) with stable body weight (± 5 kg) in the 3 months preceding participation were included in the study., Results: Forty-five participants (obesity: n = 15; overweight: n = 10; T2D: n = 20) were interviewed. Interviews were audio-recorded and transcribed verbatim for analysis. A subset of participants described eating behaviors on smartphone-based app tasks over 5 days. Most (> 96%) discussed the influence of hunger, cravings and satiety on food choices. Participants identified 22 drivers/triggers (including health, 95.6%; culture/heritage, 93.3%; location, 91.1%; stress, 88.8%). Participants also discussed associations between drivers/triggers and eating behavior concepts (appetite, hunger, cravings, satiety, motivation/determination). A conceptual model illustrating eating behavior concepts and related drivers/triggers was developed. The concept elicitation interviews identified a multitude of drivers and triggers and characterized the association of such drivers/triggers with seven core patient-reported concepts encompassing eating behaviors., Conclusion: The findings build upon existing models of factors influencing food choices. Findings confirm prior research regarding impact of drivers/triggers on food choice in people with obesity and T2D and indicate underlying disease state does not appear to influence eating behaviors in people with stable body weight., (© 2024. The Author(s).)

Oncology drug combinations can improve therapeutic responses and increase treatment options for patients. The number of possible combinations is vast and responses can be context-specific. Systematic screens can identify clinically relevant, actionable combinations in defined patient subtypes. We present data for 109 anticancer drug combinations from AstraZeneca's oncology small molecule portfolio screened in 755 pan-cancer cell lines. Combinations were screened in a 7 × 7 concentration matrix, with more than 4 million measurements of sensitivity, producing an exceptionally data-rich resource. We implement a new approach using combination Emax (viability effect) and highest single agent (HSA) to assess combination benefit. We designed a clinical translatability workflow to identify combinations with clearly defined patient populations, rationale for tolerability based on tumor type and combination-specific "emergent" biomarkers, and exposures relevant to clinical doses. We describe three actionable combinations in defined cancer types, confirmed in vitro and in vivo, with a focus on hematologic cancers and apoptotic targets., Significance: We present the largest cancer drug combination screen published to date with 7 × 7 concentration response matrices for 109 combinations in more than 750 cell lines, complemented by multi-omics predictors of response and identification of "emergent" combination biomarkers. We prioritize hits to optimize clinical translatability, and experimentally validate novel combination hypotheses. This article is featured in Selected Articles from This Issue, p. 695., (©2024 The Authors; Published by the American Association for Cancer Research.)

Objectives: Conduct a scoping review to identify the approaches used to integrate digital literacy into undergraduate pharmacy programs across different countries, focusing on methods for education, training, and assessment., Materials and Methods: Following the Joanna Briggs Institute methodology, we searched 5 electronic databases in June 2022: MEDLINE (Ovid), PubMed, Embase, Scopus, and CINAHL. Three independent reviewers screened all articles; data extraction was conducted by 2 reviewers. Any discrepancies were arbitrated by 2 additional reviewers., Results: Out of 624 articles, 57 were included in this review. Educational and training approaches for digital literacy in undergraduate pharmacy programs encompassed a theoretical understanding of health informatics, familiarization with diverse digital technologies, and applied informatics in 2 domains: patient-centric care through digital technologies, and the utilization of digital technologies in interprofessional collaboration. Blended pedagogical strategies were commonly employed. Assessment approaches included patient plan development requiring digital information retrieval, critical appraisal of digital tools, live evaluations of telehealth skills, and quizzes and exams on health informatics concepts. External engagement with system developers, suppliers, and other institutes supported successful digital literacy education., Discussion and Conclusion: This scoping review identifies various learning objectives, teaching, and assessment strategies to incorporate digital literacy in undergraduate pharmacy curricula. Recommendations include acknowledging the evolving digital health landscape, ensuring constructive alignment between learning objectives, teaching approach and assessments, co-development of digital literacy courses with stakeholders, and using standardized guidelines for reporting educational interventions. This study provides practical suggestions for enhancing digital literacy education in undergraduate pharmacy programs., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Dyslexia is theorized to be caused by phonological deficits, visuo-attentional deficits, or some combination of the two. The present study contrasted phonological and visuo-attentional theories of dyslexia using a lexical decision task administered to adult participants with and without dyslexia. Homophone and pseudo-homophone stimuli were included to explore whether the two groups differed in their reliance on phonological encoding. Transposed-letter stimuli, including both TL neighbors and TL non-words, measured potential orthographic impairment predicted by visuo-attentional deficit theories. The findings revealed no significant difference in response time or accuracy between the groups for the homophone and pseudo-homophone stimuli. However, dyslexics were significantly slower and less accurate in their responses to the TL stimuli than controls. Thus, dyslexics presented deficits consistent with visuo-attentional theories, but not with the phonological deficit theory.