Consumer and Healthcare Professional Led Priority Setting for Quality Use of Medicines in People with Dementia: Gathering Unanswered Research Questions

Background: Historically, research questions have been posed by the pharmaceutical industry or researchers, with little involvement of consumers and healthcare professionals. Objective: To determine what questions about medicine use are important to people living with dementia and their care team and whether they have been previously answered by research. Methods: The James Lind Alliance Priority Setting Partnership process was followed. A national Australian qualitative survey on medicine use in people living with dementia was conducted with consumers (people living with dementia and their carers including family, and friends) and healthcare professionals. Survey findings were supplemented with key informant interviews and relevant published documents (identified by the research team). Conventional content analysis was used to generate summary questions. Finally, evidence checking was conducted to determine if the summary questions were 'unanswered'. Results: A total of 545 questions were submitted by 228 survey participants (151 consumers and 77 healthcare professionals). Eight interviews were conducted with key informants and four relevant published documents were identified and reviewed. Overall, analysis resulted in 68 research questions, grouped into 13 themes. Themes with the greatest number of questions were related to co-morbidities, adverse drug reactions, treatment of dementia, and polypharmacy. Evidence checking resulted in 67 unanswered questions. Conclusion: A wide variety of unanswered research questions were identified. Addressing unanswered research questions identified by consumers and healthcare professionals through this process will ensure that areas of priority are targeted in future research to achieve optimal health outcomes through quality use of medicines

The effect of common reductions in letter size and contrast on accommodation responses in young adult myopes and emmetropes

PURPOSE: Accommodation errors during reading and the subsequent near work-induced transient myopia (NITM) that occurs have been implicated in the development and progression of myopia. This study investigated the effects of two letter variables, size and contrast, on accommodation accuracy during the near task and on NITM and its subsequent decay. These were varied so as to mimic what might occur when students photocopy and reduce reading materials. METHODS: Based on their refractive errors, young adult subjects (18-25 years) were classified into three groups: emmetropes (n = 19), stable myopes (n = 17), and progressing myopes (n = 17). Three print sizes (N4, N6, and N8) and two print contrasts (90% and 60%) were used to give six different reading targets. Targets were presented in random order at 25 cm (4 D demand) and the text read for comprehension for 3 minutes. For each target, accommodation accuracy and NITM and its decay were measured using the free space Shin-Nippon SRW-5000 autorefractor. RESULTS: When data for all subjects were pooled, there was a significant effect of letter size (p = 0.030) but not contrast (p = 0.898) on accommodation accuracy; however, differences were small and unlikely to be clinically relevant. NITM (p = 0.033) and its decay (p = 0.012) also varied with letter size. NITM was greater and decay longer for larger letters. We found no effect of refractive error group on accommodation accuracy. In contrast, there was a significant difference in the magnitude of NITM and its decay for emmetropic and myopic subjects (although no effect of progression status); myopes had larger NITM values and longer decay times to baseline than emmetropes (NITM myopes: 0.37 +/- 0.14D vs. emmetropes: 0.19 +/- 0.17 D, p = 0.005; decay time myopes: 15.12 +/- 6.58 seconds vs. emmetropes 7.10 +/- 4.82 seconds, p = 0.0045). The differences in NITM and its decay between the two refractive groups were of similar magnitude for all six combinations of letter size and contrast. CONCLUSIONS: Our data do not support the suggestion that common reductions in letter size or contrast of reading material (as might occur for photocopied reading materials) cause greater accommodation inaccuracy and greater near work-induced adaptation effects that would exacerbate myopia development in young adults