Engagement in Hepatitis C and HIV Prevention: Community Pharmacists’ Knowledge and Attitudes Regarding Non-Prescription Syringe Dispensing Legislation

Since 2010, the incidence of acute Hepatitis C Virus (HCV) infections in the U.S. has nearly quadrupled. Re-use and sharing of syringes among people who inject drugs (PWID) is a significant contributor to increased rates of HCV transmission and a risk factor for HIV infection. Community pharmacists are uniquely positioned to offer harm reduction services that lower the transmission of HCV/HIV by providing sterile syringes to PWID. However, legislation on non-prescription syringe dispensing varies by state and differences in individual pharmacists’ interpretation and attitudes regarding these laws may impact their willingness to participate in harm reduction services. Little is known about the impact of these factors on pharmacist engagement with harm reduction services in central Appalachia, a region particularly hard-hit by the opioid epidemic. The objective of this project is to qualitatively evaluate open-ended responses collected as part of a survey administered to community pharmacists in three central Appalachian states in order to determine: 1) pharmacists’ knowledge and attitudes regarding their state’s non-prescription syringe dispensing laws; and 2) the correlation of attitudes about state legislation to pharmacists’ intent to sell syringes to PWID. A telephonic community pharmacist survey on non-prescription syringe attitudes and behaviors was conducted between April and June 2018 in Northeast Tennessee, Western North Carolina, and Southwest Virginia. Survey responses were obtained from pharmacists practicing in 391 community pharmacies (51% response rate) in the study region. Transcribed responses to open-ended survey questions were extracted from the dataset and a qualitative analysis was completed using a generalized inductive approach. A single investigator coded all qualitative data and a second investigator coded data from a random selection of 10% of the respondents in order to develop themes through consensus. Descriptive analysis was conducted using SPSS version 25 to compare syringe law attitude thematic categories to respondents’ intent to sell syringes to PWID. Preliminary analysis identified discrepancies in pharmacists’ non-prescription syringe law knowledge, state-specific differences in pharmacists’ non-prescription syringe law attitudes, and underlying differences in willingness to sell syringes to PWID based on attitudes. The findings may encourage pharmacists to reflect on personal attitudes and interpretation of state-specific legislation as factors that may influence participation in an evidence-based harm reduction strategy for prevention of HCV/HIV transmission. This study offers preliminary results that will serve as a basis for larger studies and interventions aimed at reducing ambiguity in pharmacists’ interpretation of non-prescription syringe dispensing laws and encouraging pharmacists to counter the spread of HCV/HIV in an evidence-based manner

Spatial multimode structure of atom-generated squeezed light

We investigated the spatial distribution of quantum fluctuations in a squeezed vacuum field, generated via polarization self-rotation (PSR) interaction of an ensemble of Rb atoms and a strong near-resonant linearly polarized laser field. We found that the noise suppression is greatly effected by the transverse profile of a spatial mask, placed in both the squeezed field and the local oscillator, as well as its position along the focused beam near the focal point. These observations indicate the spatial multimode structure of the squeezed vacuum field. We have developed a theoretical model that describes the generation of higher-order Laguerre-Gauss modes as a result of PSR light-atom interaction. The prediction of this model is in a good qualitative agreement with the experimental measurements

Factors that impact on recruitment to randomised trials in health care: a qualitative evidence synthesis

BACKGROUND: Randomised trials (also referred to as 'randomised controlled trials' or 'trials') are the optimal way to minimise bias in evaluating the effects of competing treatments, therapies and innovations in health care. It is important to achieve the required sample size for a trial, otherwise trialists may not be able to draw conclusive results leading to research waste and raising ethical questions about trial participation. The reasons why potential participants may accept or decline participation are multifaceted. Yet, the evidence of effectiveness of interventions to improve recruitment to trials is not substantial and fails to recognise these individual decision-making processes. It is important to synthesise the experiences and perceptions of those invited to participate in randomised trials to better inform recruitment strategies. OBJECTIVES: To explore potential trial participants' views and experiences of the recruitment process for participation. The specific objectives are to describe potential participants' perceptions and experiences of accepting or declining to participate in trials, to explore barriers and facilitators to trial participation, and to explore to what extent barriers and facilitators identified are addressed by strategies to improve recruitment evaluated in previous reviews of the effects of interventions including a Cochrane Methodology Review. SEARCH METHODS: We searched the Cochrane Library, Medline, Embase, CINAHL, Epistemonikos, LILACS, PsycINFO, ORRCA, and grey literature sources. We ran the most recent set of searches for which the results were incorporated into the review in July 2017. SELECTION CRITERIA: We included qualitative and mixed-methods studies (with an identifiable qualitative component) that explored potential trial participants' experiences and perceptions of being invited to participate in a trial. We excluded studies that focused only on recruiters' perspectives, and trials solely involving children under 18 years, or adults who were assessed as having impaired mental capacity. DATA COLLECTION AND ANALYSIS: Five review authors independently assessed the titles, abstracts and full texts identified by the search. We used the CART (completeness, accuracy, relevance, timeliness) criteria to exclude studies that had limited focus on the phenomenon of interest. We used QSR NVivo to extract and manage the data. We assessed methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We used thematic synthesis to analyse and synthesise the evidence. This provided analytical themes and a conceptual model. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. Our findings were integrated with two previous intervention effectiveness reviews by juxtaposing the quantitative and qualitative findings in a matrix. MAIN RESULTS: We included 29 studies (published in 30 papers) in our synthesis. Twenty-two key findings were produced under three broad themes (with six subthemes) to capture the experience of being invited to participate in a trial and making the decision whether to participate. Most of these findings had moderate to high confidence. We identified factors from the trial itself that influenced participation. These included how trial information was communicated, and elements of the trial such as the time commitment that might be considered burdensome. The second theme related to personal factors such as how other people can influence the individual's decision; and how a personal understanding of potential harms and benefits could impact on the decision. Finally, the potential benefits of participation were found to be key to the decision to participate, namely personal benefits such as access to new treatments, but also the chance to make a difference and help others. The conceptual model we developed presents the decision-making process as a gauge and the factors that influence whether the person will, or will not, take part. AUTHORS' CONCLUSIONS: This qualitative evidence synthesis has provided comprehensive insight into the complexity of factors that influence a person's decision whether to participate in a trial. We developed key questions that trialists can ask when developing their recruitment strategy. In addition, our conceptual model emphasises the need for participant-centred approaches to recruitment. We demonstrated moderate to high level confidence in our findings, which in some way can be attributed to the large volume of highly relevant studies in this field. We recommend that these insights be used to direct or influence or underpin future recruitment strategies that are developed in a participant-driven way that ultimately improves trial conduct and reduces research waste

Factors that impact on recruitment to randomised trials in health care : a qualitative evidence synthesis (Review)

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