Theory-based communication skills training for medicine counter assistants to improve consultations for non-prescription medicines

Context: Medicine counter assistants (MCAs) supply the majority of non-prescription medicines (NPMs) to consumers. Suboptimal communication during consultations between consumers and MCAs has been identified as a major cause of inappropriate supply. Evidence from medical consultations suggests that training in specified communication skills can change professional behaviour. Methods: A feasibility study was conducted to evaluate the effect of theory-based communication skills training for MCAs. Thirty MCAs were recruited from 21 community pharmacies in Grampian, Scotland. The intervention comprised 2 4-hour training sessions, held 1 month apart. The sessions were informed by results from previous studies and the Calgary−Cambridge evidence-based model of communication skills training. Strategies for guiding individuals through change were adopted from cognitive behavioural therapy techniques. The theory of planned behaviour was used to assess potential pathways to behaviour change. Recorded data were collected during covert visits to the pharmacies by simulated patients at baseline and 1 month after each training session. Communication performance was measured as the number and type of questions asked. Results: Compared with baseline measures, the total number of questions asked increased in the intervention group at both timepoints. No change was shown in the control group between baseline and follow-up 1, and a decrease was shown in the total number of questions from follow-up 1 to 2. The intervention appeared to have greater effect on consultations involving advice, compared with those concerning product requests. Discussion: Communication performance improved following training. Increased information exchange is associated with guideline-compliant supply of NPMs. A substantive randomised, controlled trial is now planned to assess the intervention.This study was funded by the Chief Scientist Office, Scottish Executive Health Department

An indirect Raman spectroscopy method for the quantitative measurement of respirable crystalline silica collected on filters inside respiratory equipment

This article describes the development of an analytical method to measure respirable crystalline silica (RCS) collected on filters by a miniature sampler placed behind respirators worn by workers to evaluate their ‘true’ exposure. Test samples were prepared by aerosolising a calibration powder (Quin B) and by pipetting aliquots from suspensions of bulk material (NIST 1878a and Quin B) onto filters. Samples of aerosolised RCS collected onto polyvinyl chloride PVC filters were ashed and their residue was suspended in isopropanol and filtered into a 10 mm diameter area onto silver filters. Samples were also collected by the Health and Safety Executive's (HSE) miniature sampler from within the facepiece of a respirator on a breathing manikin during a simulated work activity. Results obtained using Raman spectroscopy were compared with X-ray diffraction (XRD) measurements, which was used as a reference method and a linear relationship was obtained. Raman has similar estimates of uncertainty when compared with the XRD methods over the measurement range from 5 to 50 mg and obtained the lowest limit of detection (LOD) of 0.26 mg when compared with XRD and Fourier Transform Infrared FTIR methods. A significant intercept and slope coefficient greatly influenced the higher LOD for indirect XRD method. The level of precision and low LOD for Raman spectroscopy will potentially enable workplace measurements at lower concentrations below the Workplace Exposure Limit (WEL) than are achieved using current analytical instrumentation. Different inward leakage ratio (ILR) measurement approaches were compared using six aerosolised sandstone dust tests. For the three highest inward leakage ratios the Portacount® obtained higher values than the RCS mass or the miniWRAS ratios, the latter of which reporting both particle number and quartz mass concentration. However, these limited ILR data were insufficient to establish statistical correlations between the measurement methods

Crystal Structures of Phosphodiesterases 4 and 5 in Complex with Inhibitor 3-Isobutyl-1-methylxanthine Suggest a Conformation Determinant of Inhibitor Selectivity

Cyclic nucleotide phosphodiesterases (PDEs) are a superfamily of enzymes controlling cellular concentrations of the second messengers cAMP and cGMP. Crystal structures of the catalytic domains of cGMP-specific PDE5A1 and cAMP-specific PDE4D2 in complex with the nonselective inhibitor 3-isobutyl-1-methylxanthine have been determined at medium resolution. The catalytic domain of PDE5A1 has the same topological folding as that of PDE4D2, but three regions show different tertiary structures, including residues 79-113, 208-224 (H-loop), and 341-364 (M-loop) in PDE4D2 or 535-566, 661-676, and 787-812 in PDE5A1, respectively. Because H- and M-loops are involved in binding of the selective inhibitors, the different conformations of the loops, thus the distinct shapes of the active sites, will be a determinant of inhibitor selectivity in PDEs. IBMX binds to a subpocket that comprises key residues Ile-336, Phe-340, Gln-369, and Phe-372 of PDE4D2 or Val-782, Phe-786, Gln-817, and Phe-820 of PDE5A1. This subpocket may be a common site for binding nonselective inhibitors of PDEs

Effect of Monetary Incentives on Mail Survey Response Rates for Midwestern Farmers

Response rates to mail-based surveys have declined in recent decades, and survey response rates for farmers tend to be low overall. Maintaining high response rates is necessary to prevent non-response bias. Historically, incentives have been an effective tool to increase response rates with general populations. However, the effect of incentives on farmers has not been well tested. In this study, we experimentally manipulated the use of a $2 incentive in two surveys targeted at farmers. We tested both the use of the incentive and the timing of incentive distribution in the survey process. We found the incentive significantly increased response rates with farmers but there was no significant effect of when the incentive was distributed. Additionally, we evaluated the cost-effectiveness of using the incentive. While the incentive increased response rate, the cost per survey response also increased and the cost of the incentive was not offset by the increased response rate

cGMP-dependent protein kinase Iα associates with the antidepressant-sensitive serotonin transporter and dictates rapid modulation of serotonin uptake

<p>Abstract</p> <p>Background</p> <p>The Na⁺/Cl^--dependent serotonin (5-hydroxytryptamine, 5-HT) transporter (SERT) is a critical element in neuronal 5-HT signaling, being responsible for the efficient elimination of 5-HT after release. SERTs are not only targets for exogenous addictive and therapeutic agents but also can be modulated by endogenous, receptor-linked signaling pathways. We have shown that neuronal A3 adenosine receptor activation leads to enhanced presynaptic 5-HT transport <it>in vitro </it>and an increased rate of SERT-mediated 5-HT clearance <it>in vivo</it>. SERT stimulation by A3 adenosine receptors derives from an elevation of cGMP and subsequent activation of both cGMP-dependent protein kinase (PKG) and p38 mitogen-activated protein kinase. PKG activators such as 8-Br-cGMP are known to lead to transporter phosphorylation, though how this modification supports SERT regulation is unclear.</p> <p>Results</p> <p>In this report, we explore the kinase isoform specificity underlying the rapid stimulation of SERT activity by PKG activators. Using immortalized, rat serotonergic raphe neurons (RN46A) previously shown to support 8-Br-cGMP stimulation of SERT surface trafficking, we document expression of PKGI, and to a lower extent, PKGII. Quantitative analysis of staining profiles using permeabilized or nonpermeabilized conditions reveals that SERT colocalizes with PKGI in both intracellular and cell surface domains of RN46A cell bodies, and exhibits a more restricted, intracellular pattern of colocalization in neuritic processes. In the same cells, SERT demonstrates a lack of colocalization with PKGII in either intracellular or surface membranes. In keeping with the ability of the membrane permeant kinase inhibitor DT-2 to block 8-Br-cGMP stimulation of SERT, we found that DT-2 treatment eliminated cGMP-dependent kinase activity in PKGI-immunoreactive extracts resolved by liquid chromatography. Similarly, treatment of SERT-transfected HeLa cells with small interfering RNAs targeting endogenous PKGI eliminated 8-Br-cGMP-induced regulation of SERT activity. Co-immunoprecipitation studies show that, in transporter/kinase co-transfected cells, PKGIα specifically associates with hSERT.</p> <p>Conclusion</p> <p>Our findings provide evidence of a physical and compartmentalized association between SERT and PKGIα that supports rapid, 8-Br-cGMP-induced regulation of SERT. We discuss a model wherein SERT-associated PKGIα supports sequentially the mobilization of intracellular transporter-containing vesicles, leading to enhanced surface expression, and the production of catalytic-modulatory SERT phosphorylation, leading to a maximal enhancement of 5-HT clearance capacity.</p

Multiple Conformations of Phosphodiesterase-5: IMPLICATIONS FOR ENZYME FUNCTION AND DRUG DEVELOPMENT

Phosphodiesterase-5 (PDE5) is the target for sildenafil, vardenafil, and tadalafil, which are drugs for treatment of erectile dysfunction and pulmonary hypertension. We report here the crystal structures of a fully active catalytic domain of unliganded PDE5A1 and its complexes with sildenafil or icarisid II. These structures together with the PDE5A1-isobutyl-1-methylxanthine complex show that the H-loop ( residues 660-683) at the active site of PDE5A1 has four different conformations and migrates 7-35 angstrom upon inhibitor binding. In addition, the conformation of sildenafil reported herein differs significantly from those in the previous structures of chimerically hybridized or almost inactive PDE5. Mutagenesis and kinetic analyses confirm that the H-loop is particularly important for substrate recognition and that invariant Gly(659), which immediately precedes the H-loop, is critical for optimal substrate affinity and catalytic activity