%0 Journal Article %~ PubMed %A Armour, Carol L %A Reddel, Helen K %A Lemay, Kate S %A Saini, Bandana %A Smith, Lorraine D %A Bosnic-Anticevich, Sinthia Z %A Song, Yun Ju Christine %A Alles, M Chehani %A Burton, Deborah L %A Emmerton, Lynne %A Stewart, Kay %A Krass, Ines %T Feasibility and Effectiveness of an Evidence-Based Asthma Service in Australian Community Pharmacies: A Pragmatic Cluster Randomized Trial. %B The Journal of Asthma %D 2013 %C United States %I Informa Healthcare %V 50 %N 3 %P 302-309 %@ 1532-4303 %X %Z FOR Codes: 111503 %0 Journal Article %~ PubMed %A Alrashdan, Yazan A %A Alkhouri, Hatem %A Chen, Emily %A Lalor, Daniel J %A Poniris, Maree %A Henness, Sheridan %A Brightling, Christopher E %A Burgess, Janette K %A Armour, Carol L %A Ammit, Alaina J %A Hughes, J Margaret %T Asthmatic airway smooth muscle CXCL10 production: mitogen-activated protein kinase JNK involvement. %B American Journal of Physiology. Lung Cellular and Molecular Physiology %D 2012 %C United States %I American Physiological Society %V 302 %N 10 %P L1118-L1127 %@ 1522-1504 %X CXCL10 (IP10) is involved in mast cell migration to airway smooth muscle (ASM) bundles in asthma. Aims: to investigate the role of cytokine-induced MAPK activation in CXCL10 production by ASM cells from people with and without asthma. Methods: Confluent growth-arrested ASM cells were treated with inhibitors of the MAPKs ERK, p38 and JNK and transcription factor NF?B, or vehicle, and stimulated with IL-1?, TNF-? or IFN?, alone or combined (cytomix). CXCL10 mRNA and protein, JNK and NF?B p65 phosphorylation and inhibitory(I)?B? protein degradation were assessed using real-time PCR, ELISA and immunoblotting respectively. Results: Cytomix, IL-1? and TNF-? induced CXCL10 mRNA expression more rapidly in asthmatic than non-asthmatic ASM cells. IL-1? and/or TNF-?, combined with IFN?, synergistically increased asthmatic ASM cell CXCL10 release. Inhibitor effects were similar in asthmatic and non-asthmatic cells but cytomix-induced release was least affected, with only JNK and NF?B inhibitors halving it. Notably, JNK phosphorylation was markedly less in asthmatic compared with non-asthmatic cells. However in both, the JNK inhibitor SP600125 reduced JNK phosphorylation and CXCL10 mRNA levels, but did not affect CXCL10 mRNA stability, I?B? or p65 phosphorylation. Together, the JNK and NF?B inhibitors completely inhibited their CXCL10 release. Conclusion: In asthmatic compared to non-asthmatic ASM cells, JNK activation was reduced and CXCL10 gene expression was more rapid following cytomix stimulation. However in both, JNK activation did not regulate early events leading to NF?B activation. Thus JNK and NF?B provide independent therapeutic targets for limiting CXCL10 production and mast cell migration to the ASM in asthma. %Z FOR Codes: 111603 %0 Book Section %A Armour, Carol %A Chaar, Bouad %A Murray, Michael %A Ambler, Geoffrey %A Krass, Ines %T Current therapies and pharmacy programs for obesity and diabetes %B A Modern Epidemic %D 2012 %C Australia %I Sydney University Press %V %N %P 315-338 %@ 9781920899851 %E Twigg, Stephen %E Magnusson, Roger S %E Baur, Louise %X %Z FOR Codes: 111502 111716 %0 Journal Article %~ PubMed %A Emmerton, Lynne M %A Smith, Lorraine D %A Lemay, Kate S %A Krass, Ines %A Saini, Bandana %A Bosnic-Anticevich, Sinthia Z %A Reddel, Helen K %A Burton, Deborah L %A Stewart, Kay %A Armour, Carol L %T Experiences of community pharmacists involved in the delivery of a specialist asthma service in Australia. %B BMC Health Services Research %D 2012 %C United Kingdom %I BioMed Central Ltd. %V 12 %N 1 %P 164 %@ 1472-6963 %X ABSTRACT: 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. %Z FOR Codes: 111503 110203 %0 Journal Article %~ PubMed %A Naik-Panvelkar, Pradnya %A Armour, Carol %A Rose, John M %A Saini, Bandana %T Patient Preferences for Community Pharmacy Asthma Services: A Discrete Choice Experiment. %B PharmacoEconomics %D 2012 %C New Zealand %I Adis International Ltd. %V 30 %N 10 %P 961-976 %@ 1179-2027 %X Background: Specialized community pharmacy services, involving the provision of disease state management and care by pharmacists, have been developed and trialled and have demonstrated very good health outcomes. Most of these services have been developed from a healthcare professional perspective. However, for the future uptake and long-term sustainability of these services as well as for better and sustained health outcomes for patients, it is vital to gain an understanding of patients'' preferences. We can then structure healthcare services to match these preferences and needs rather than around clinical viewpoints alone. Objective: The aim of this study was to elicit patient preferences for pharmacy-based specialized asthma services using a discrete choice experiment and to explore the value/importance that patients place on the different attributes of the asthma service. The existence of preference heterogeneity in the population was also investigated. Methods: The study was conducted with asthma patients who had recently experienced a specialized asthma management service at their pharmacy in New South Wales, Australia. Pharmacists delivering the asthma service mailed out the discrete choice questionnaires to participating patients at the end of 6 months of service provision. A latent class (LC) model was used to investigate each patient''s strength of preference and preference heterogeneity for several key attributes related to asthma service provision: frequency of visits, access to pharmacist, interaction with pharmacy staff, availability of a private area for consultation, provision of lung function testing, type and depth of advice provision, number of days with asthma symptoms and cost of service. Results: Eighty useable questionnaires (of 170 questionnaires sent out) were received (response rate 47.1%). The study identified various key elements of asthma services important to patients. Further, the LC analysis revealed three classes with differing patient preferences for levels of asthma service provision. Patients in the Minimalistic Model class valued provision of lung function testing and preferred more frequent service visits. Cost of service had a negative effect on service preference for patients in this class. Patients in the Partial Model class mainly derived utility from the provision of lung function testing and comprehensive advice at the pharmacy and also wanted more frequent service visits. The Holistic Model class patients considered all attributes of the service to be important when making a choice. While the majority of the service attributes had a positive effect on preference for patients in this class, cost of service and days with symptoms of asthma had a negative effect on service preference. These patients also preferred fewer service visits. Conclusion: The study identified various key attributes that are important to patients with respect to community pharmacy-based asthma services. The results also demonstrate the existence of preference heterogeneity in the population. Asthma service providers need to take these findings into consideration in the design and development of future service models so as to increase their uptake and ensure their long-term sustainability. %Z FOR Codes: 111503 %0 Journal Article %~ PubMed %A Naik-Panvelkar, Pradnya %A Armour, Carol %A Rose, John %A Saini, Bandana %T Patients' value of asthma services in Australian pharmacies: the way ahead for asthma care. %B The Journal of Asthma %D 2012 %C United States %I Informa Healthcare %V 49 %N 3 %P 310-316 %@ 1532-4303 %X Long-term sustainability of health services requires an understanding of patients'' values and preferences. The aim of this study was to evaluate patients'' preferences as well as their willingness-to-pay (WTP) for a community pharmacy-delivered specialized asthma service using a discrete choice experiment (DCE). %Z FOR Codes: 111503 %0 Journal Article %~ PubMed %A Sukkar, Maria B %A Ullah, Md Ashik %A Gan, Wan Jun %A Wark, Peter Ab %A Chung, Kian Fan %A Hughes, J Margaret %A Armour, Carol L %A Phipps, Simon %T RAGE: a new frontier in chronic airways disease. %B British Journal of Pharmacology %D 2012 %C United Kingdom %I John Wiley & Sons Ltd. %V 167 %N 6 %P 1161-1176 %@ 0007-1188 %X Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous inflammatory disorders of the respiratory tract characterised by airflow obstruction. It is now clear that the environmental factors that drive airway pathology in asthma and COPD, including allergens, viruses, ozone and cigarette smoke, activate innate immune receptors known as pattern-recognition receptors, either directly or indirectly by causing the release of endogenous ligands. Thus, there is now intense research activity focused around understanding the mechanisms by which pattern-recognition receptors sustain the airway inflammatory response, and how these mechanisms might be targeted therapeutically. One pattern-recognition receptor that has recently come to attention in chronic airways disease is the receptor for advanced glycation end products (RAGE). RAGE is a member of the immunoglobulin superfamily of cell surface receptors that recognises pathogen- and host-derived endogenous ligands to initiate the immune response to tissue injury, infection and inflammation. Although the role of RAGE in lung physiology and pathophysiology is not well understood, recent genome-wide association studies have linked RAGE gene polymorphisms with airflow obstruction. In addition, accumulating data from animal and clinical investigations reveal increased expression of RAGE and its ligands, together with reduced expression of soluble RAGE, an endogenous inhibitor of RAGE signalling, in chronic airways disease. In this review we discuss recent studies of the ligand-RAGE axis in asthma and COPD, highlight important areas for future research, and discuss how this axis might potentially be harnessed for therapeutic benefit in these conditions. ?? 2012 The Authors. British Journal of Pharmacology ?? 2012 The British Pharmacological Society. %Z FOR Codes: 111501 %0 Journal Article %~ PubMed %A Tan, Xiahui %A Khalil, Najwa %A Tesarik, Candice %A Vanapalli, Karunasri %A Yaputra, Viki %A Alkhouri, Hatem %A Oliver, Brian G G %A Armour, Carol L %A Hughes, J Margaret %T Th1 cytokine-induced syndecan-4 shedding by airway smooth muscle cells is dependent on mitogen-activated protein kinases. %B American Journal of Physiology. Lung Cellular and Molecular Physiology %D 2012 %C United States %I American Physiological Society %V 302 %N 7 %P L700-710 %@ 1522-1504 %X In asthma, airway smooth muscle (ASM) chemokine secretion can induce mast cell recruitment into the airways. The functions of the mast cell chemoattractant CXCL10, and other chemokines, are regulated by binding to heparan sulphates such as syndecan-4. This study is the first demonstration that airway smooth muscle cells (ASMC) from people with and without asthma express and shed syndecan-4 under basal conditions. Syndecan-4 shedding was enhanced by stimulation for 24 hr with the Th1 cytokines interleukin-1? (IL-1?) or tumour necrosis factor-? (TNF?), but not interferon-? (IFN?), nor the Th2 cytokines IL-4 and IL-13. ASMC stimulation with IL-1?, TNF? and IFN? (cytomix) induced the highest level of syndecan-4 shedding. Non-asthmatic and asthmatic ASM cell-associated syndecan-4 protein expression was also increased by TNF? or cytomix at 4-8 hr, with the highest levels detected in cytomix-stimulated asthmatic cells . Cell-associated syndecan-4 levels were decreased by 24 hr, whereas shedding remained elevated at 24 hr, consistent with newly synthesised syndecan-4 being shed. Inhibition of ASMC MMP-2 did not prevent syndecan-4 shedding, whereas inhibition of ERK MAPK activation reduced shedding from cytomix-stimulated ASMC. Although ERK inhibition had no effect on syndecan-4 mRNA levels stimulated by cytomix, it did cause an increase in cell-associated syndecan-4 levels, consistent with the shedding being inhibited. In conclusion, ASMC produce and shed syndecan-4 and although this is increased by the Th1 cytokines, the MAPK ERK only regulates shedding. ASMC syndecan-4 production during Th1 inflammatory conditions may regulate chemokine activity and mast cell recruitment to the ASM in asthma. %Z FOR Codes: 111504 110203 %0 Journal Article %~ PubMed %A Seidel, Petra %A Alkhouri, Hatem %A Lalor, Daniel J %A Burgess, Janette K %A Armour, Carol L %A Hughes, J Margaret %T Thiazolidinediones inhibit airway smooth muscle release of the chemokine CXCL10: in vitro comparison with current asthma therapies. %B Respiratory Research %D 2012 %C United Kingdom %I BioMed Central Ltd. %V 13 %N %P 90 %@ 1465-993X %X %Z FOR Codes: 111502 %0 Journal Article %~ PubMed %A Saini, Bandana %A Shah, Smita %A Kearey, Phoebe %A Bosnic-Anticevich, Sinthia %A Grootjans, John %A Armour, Carol %T An interprofessional learning module on asthma health promotion. %B American Journal of Pharmaceutical Education %D 2011 %C United States %I American Association of Colleges of Pharmacy %V 75 %N 2 %P 30 %@ 1553-6467 %X To develop, implement, and evaluate a new interprofessional learning module that focused on asthma health promotion called Taking Action Together for Asthma. %Z FOR Codes: 111712 %0 Journal Article %~ PubMed %A Saini, Bandana %A Lemay, Kate %A Emmerton, Lynne %A Krass, Ines %A Smith, Lorraine %A Bosnic-Anticevich, Sinthia %A Stewart, Kay %A Burton, Deborah %A Armour, Carol %T Asthma disease management-Australian pharmacists' interventions improve patients' asthma knowledge and this is sustained. %B Patient education and counseling %D 2011 %C Ireland %I Elsevier Ireland Ltd %V 83 %N 3 %P 295-302 %@ 1873-5134 %X 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. %Z FOR Codes: 111717 %0 Journal Article %~ PubMed %A Krass, I %A Mitchell, B %A Song, Y J C %A Stewart, K %A Peterson, G %A Hughes, J %A Smith, L %A White, L %A Armour, C %T Diabetes Medication Assistance Service Stage 1: impact and sustainability of glycaemic and lipids control in patients with Type 2 diabetes. %B Diabetic Medicine %D 2011 %C United Kingdom %I Wiley-Blackwell Publishing Ltd. %V 28 %N 8 %P 987-993 %@ 1464-5491 %X To investigate (i) optimal intensity (four visits vs. six visits) and duration (6 vs. 12 months) of the Diabetes Medication Assistance Service in community pharmacy and (ii) sustainability of improvements in patients'' diabetes control associated with differing intensities of intervention. %Z FOR Codes: 111710 %0 Journal Article %~ PubMed %A Mitchell, Bernadette %A Armour, Carol %A Lee, Mary %A Song, Yun Ju %A Stewart, Kay %A Peterson, Greg %A Hughes, Jeff %A Smith, Lorraine %A Krass, Ines %T Diabetes Medication Assistance Service: The pharmacist's role in supporting patient self-management of type 2 diabetes (T2DM) in Australia. %B Patient education and counseling %D 2011 %C Ireland %I Elsevier Ireland Ltd %V 83 %N 3 %P 288-94 %@ 1873-5134 %X To evaluate the capacity and effectiveness of trained community pharmacists in delivering the Diabetes Medication Assistance Service (DMAS) via (1) number and types of self-management support interventions (SMSIs); (2) number of goals set and attained by patients and (3) patient outcomes (glycaemic control, medication adherence and satisfaction). %Z FOR Codes: 111503 %0 Journal Article %~ PubMed %A Krass, I %A Hebing, R %A Mitchell, B %A Hughes, J %A Peterson, G %A Song, Y J C %A Stewart, K %A Armour, C L %T Diabetes management in an Australian primary care population. %B Journal of clinical pharmacy and therapeutics %D 2011 %C United Kingdom %I Wiley-Blackwell Publishing Ltd. %V 36 %N %P 664-72 %@ 1365-2710 %X WHAT IS KNOWN AND OBJECTIVE: Worldwide studies have shown that significant proportions of patients with type 2 diabetes (T2DM) do not meet targets for glycaemic control, blood pressure (BP) and lipids, putting them at higher risk of developing complications. However, little is known about medicines management in Australian primary care populations with T2DM. The aim of this study was to (i) describe the management of a large group of patients in primary care, (ii) identify areas for improvement in management and (iii) determine any relationship between adherence and glycaemic, BP and lipid control. METHODS: This was a retrospective, epidemiological study of primary care patients with T2DM diabetes, with HbA(1c) of >7%, recruited in 90 Australian community pharmacies. Data collected included demographic details, diabetes history, current medication regimen, height, weight, BP, physical activity and smoking status. RESULTS AND DISCUSSION: Of the 430 patients, 98% used antidiabetics, 80% antihypertensives, 73% lipid lowering drugs and 38% aspirin. BP and all lipid targets were met by only 21% and 14% of the treated patients and 21% and 12% of the untreated patients respectively. Medication adherence was related to better glycaemic control (P = 0.04). WHAT IS NEW AND CONCLUSIONS: An evidence-base prescribing practice gap was seen in this Australian primary care population of T2DM patients. Patients were undertreated with antihypertensive and lipid lowering medication, and several subgroups with co-morbidities were not receiving the recommended pharmacotherapy. Interventions are required to redress the current evidence-base prescribing practice gap in disease management in primary care. %Z FOR Codes: 111710 %0 Journal Article %~ PubMed %A Alkhouri, H %A Hollins, F %A Moir, L M %A Brightling, C E %A Armour, C L %A Hughes, J M %T Human lung mast cells modulate the functions of airway smooth muscle cells in asthma. %B Allergy %D 2011 %C United Kingdom, Switzerland %I Wiley-Blackwell Publishing Ltd. %V 66 %N 9 %P 1231-41 %@ 1398-9995 %X Activated mast cell densities are increased on the airway smooth muscle in asthma where they may modulate muscle functions and thus contribute to airway inflammation, remodelling and airflow obstruction. %Z FOR Codes: 111504 %0 Journal Article %~ PubMed %A Grover, Charu %A Armour, Carol %A Asperen, Peter Paul Van %A Moles, Rebekah %A Saini, Bandana %T Medication Use in Children with Asthma: Not a Child Size Problem. %B Journal of Asthma %D 2011 %C United States %I Informa Healthcare %V 48 %N 10 %P 1085-1103 %@ 1532-4303 %X The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma--in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children. %Z FOR Codes: 1115 1114 %0 Journal Article %A Abdelnour, Mona %A Armour, Carol %A Reddel, Helen %A Bosnic-Anticevich, Sinthia %T Multidisciplinary asthma care teams: the role of the specialist pharmacist %B Australian Pharmacist %D 2011 %C Australia %I Pharmaceutical Society of Australia %V 30 %N 8 %P 686-691 %@ 0728-4632 %X %Z FOR Codes: 111502 %0 Book Section %A Krass, Ines %A Armour, Carol %T Preventing Disease: Screening in the Pharmacy %B Pharmacy in Public Health %D 2011 %C London %I Pharmaceutical Press %V %N %P 221-243 %@ 9780853698791 %E Krska, Janet %X %Z FOR Codes: 111503 %0 Journal Article %A Saini, Bandana %A Krass, Ines %A Smith, Lorraine %A Bosnic-Anticevich, Sinthia %A Armour, Carol %T Role of community pharmacists in asthma - Australian research highlighting pathways for future primary care models %B Australasian Medical Journal %D 2011 %C Australia %I Australasian Medical Journal Pty. Ltd. %V 4:4 %N %P 190-200 %@ 1836-1935 %X %Z FOR Codes: 111503 %0 Journal Article %~ PubMed %A Basheti, Iman A %A Qunaibi, Eyad %A Bosnic-Anticevich, Sinthia Z %A Armour, Carol L %A Khater, Samar %A Omar, Muthana %A Reddel, Helen K %T User error with Diskus and Turbuhaler by asthma patients and pharmacists in Jordan and Australia %B Respiratory care %D 2011 %C United States %I Daedalus Enterprises, Inc. %V 56 %N %P 1916-23 %@ 0020-1324 %X Use of inhalers requires accurate completion of multiple steps to ensure effective medication delivery. %Z FOR Codes: 111502 110203 %0 Journal Article %~ PubMed %A Armour, Carol L %A Lemay, Kate %A Saini, Bandana %A Reddel, Helen K %A Bosnic-Anticevich, Sinthia Z %A Smith, Lorraine D %A Burton, Deborah %A Song, Yun Ju Christine %A Alles, Marie Chehani %A Stewart, Kay %A Emmerton, Lynne %A Krass, Ines %T Using the Community Pharmacy to Identify Patients at Risk of Poor Asthma Control and Factors which Contribute to this Poor Control. %B The Journal of asthma : official journal of the Association for the Care of Asthma %D 2011 %C United States %I Informa Healthcare %V 48 %N 9 %P 914-22 %@ 1532-4303 %X 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. %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Naik Panvelkar, Pradnya %A Armour, Carol %A Saini, Bandana %T Community Pharmacy-Based Asthma Services-What Do Patients Prefer? %B The Journal of asthma : official journal of the Association for the Care of Asthma %D 2010 %C United States %I Informa Healthcare %V 47 %N 10 %P 1085-93 %@ 1532-4303 %X Patient preferences can influence the outcomes of treatment and so understanding and organizing health-care services around these preferences is vital. %Z FOR Codes: 111503 %0 Journal Article %~ PubMed %A Um, Irene S I %A Armour, Carol %A Krass, Ines %A Gill, Timothy %A Chaar, Betty B %T Managing obesity in pharmacy: the Australian experience. %B Pharmacy world & science : PWS %D 2010 %C Netherlands %I Springer Netherlands %V 32 %N 0 %P 711-20 %@ 1573-739X %X To explore pharmacists'' opinions about the provision of weight management services in community pharmacy and their attitudes towards the establishment of an accredited training course in weight management in pharmacy. %Z FOR Codes: 111503 %0 Book Section %A Basheti, Iman %A Reddel, Helen %A Armour, Carol %A Bosnic-Anticevich, S Z %T An Innovative Asthma Educational Module for Community Pharmacists %B Educational Evaluation: 21st Century Issues and Challenges %D 2009 %C United States %I Nova Science Publishers %V %N %P 31-60 %@ 9781604565775 %E Ortiz, Maria %E Rubio, Claudia %X %Z FOR Codes: 111799 %0 Journal Article %~ PubMed %A Cvetkovski, Biljana %A Armour, Carol %A Bosnic-Anticevich, Sinthia %T Asthma management in rural New South Wales: perceptions of health care professionals and people with asthma. %B Australian Journal of Rural Health %D 2009 %C Australia %I Wiley-Blackwell Publishing Asia %V 17 %N 4 %P 195-200 %@ 1038-5282 %X OBJECTIVE: To investigate the perceptions and attitudes towards asthma management of general practitioners, pharmacists and people with asthma in a rural area. DESIGN: Qualitative semistructured interviews. SETTING: Small rural centre in New South Wales. PARTICIPANTS: General practitioners, pharmacists and people with asthma in a rural area. RESULTS: General practitioners perceived that the patient provided a barrier to the implementation of optimal asthma services. They were aware that other health care professionals had a role in asthma management but were not aware of the details, particularly in relation to that of the pharmacist and would like to improve communication methods. Pharmacists also perceived the patient to be a barrier to the delivery of optimal asthma management services and would like to improve communication with the general practitioner. The impact of the rural environment for the health care professionals included workforce shortages, availability of support services and access to continuing education. People with asthma were satisfied with their asthma management and the service provided by the health care professionals and described the involvement of family members and ambulance officers in their overall asthma management. The rural environment was an issue with regards to distance to the hospital during an emergency. CONCLUSIONS: General practitioners and pharmacists confirmed their existing roles in asthma management while expressing a desire to improve communication between the two professions to help overcome barriers and optimise the asthma service delivered to the patient. The patient described minimal barriers to optimising asthma management, which might suggest that they might not have great expectations of asthma care. %Z FOR Codes: 111799 %0 Journal Article %~ PubMed %A Basheti, Iman A %A Armour, Carol L %A Reddel, Helen K %A Bosnic-Anticevich, Sinthia Z %T Long-term maintenance of pharmacists' inhaler technique demonstration skills. %B American Journal of Pharmaceutical Education %D 2009 %C United States %I American Association of Colleges of Pharmacy %V 73 %N 2 %P 32 %@ 1553-6467 %X OBJECTIVE: To assess the effectiveness of a single educational intervention, followed by patient education training, in pharmacists retaining their inhaler technique skills. METHODS: A convenience sample of 31 pharmacists attended an educational workshop and their inhaler techniques were assessed. Those randomly assigned to the active group were trained to assess and teach correct Turbuhaler and Diskus inhaler techniques to patients and provided with patient education tools to use in their pharmacies during a 6-month study. Control pharmacists delivered standard care. All pharmacists were reassessed 2 years after initial training. RESULTS: Thirty-one pharmacists participated in the study. At the initial assessment, few pharmacists demonstrated correct technique (Turbuhaler:13%, Diskus:6%). All pharmacists in the active group demonstrated correct technique following training. Two years later, pharmacists in the active group demonstrated significantly better inhaler technique than pharmacists in the control group (p < 0.05) for Turbuhaler and Diskus (83% vs.11%; 75% vs.11%, respectively). CONCLUSION: Providing community pharmacists with effective patient education tools and encouraging their involvement in educating patients may contribute to pharmacists maintaining their competence in correct inhaler technique long-term. %Z FOR Codes: 111799 %0 Journal Article %A Taylor, Susan %A Hourihan, Fleur %A Armour, Carol %A Krass, Ines %T Measuring consumer preference for models of diabetes care delivered by pharmacists %B Pharmacy Practice %D 2009 %C Spain %I Centro de Investigaciones y Publicaciones Farmaceu %V 7 %N 4 %P 195-204 %@ 1886-3655 %X %Z FOR Codes: 111503 %0 Journal Article %~ PubMed %A Armour, Carol %T The life and research of Ann Woolcock (1937-2001). %B Pulmonary Pharmacology and Therapeutics %D 2009 %C United Kingdom %I Academic Press %V 22 %N 5 %P 360-362 %@ 1522-9629 %X %Z FOR Codes: 130209 %0 Journal Article %~ PubMed %A Saini, Bandana %A Filipovska, Julija %A Bosnic-Anticevich, Sinthia %A Taylor, Susan %A Krass, Ines %A Armour, Carol %T An evaluation of a community pharmacy-based rural asthma management service. %B The Australian journal of rural health %D 2008 %C United Kingdom %I Pergamon-Elsevier Science Ltd %V 16 %N 2 %P 100-108 %@ 1038-5282 %X OBJECTIVE: To compare the effect of a pharmacist-delivered rural asthma management service (RAMS) on health outcomes for people with asthma in a rural/regional area with ''standard care'' delivered through community pharmacies. DESIGN: A parallel group controlled repeated measures study. SETTING: Community pharmacies in Central West New South Wales. INTERVENTION: Standardised protocols and resources based on national asthma management guidelines, delivered by specially trained community pharmacists. Patients visited the pharmacy at baseline and 1, 3 and 6 months after baseline in the intervention group and at baseline plus 6 months after baseline in the control group. PARTICIPANTS: The intervention pharmacists (n = 12) were trained to deliver the RAMS model, while control pharmacists (n = 8) provided standard asthma care to their recruited patients. Fifty-one and 39 patients were recruited by intervention and control pharmacists. MAIN OUTCOME MEASURE: Asthma severity score which was a composite score based on recency, frequency and severity of asthma symptoms, and asthma history. RESULTS: Data compared at the final visit between groups indicated that the RAMS patient group demonstrated a significant reduction in the asthma severity scores (7.9 +/- 2.6 versus 10.4 +/- 2.6, P < 0.001); a reduction in the risk of non-adherence to medication scores (1.6 +/- 0.7 versus 2.3 +/- 1.1, P < 0.001); and an increase in the proportion of patients owning a written action plan (50% versus 23%, P = 0.04). CONCLUSIONS: These results indicated that the community pharmacy-based RAMS model can improve asthma outcomes for patients in rural settings, and similar models for asthma and other chronic diseases should be tested rigorously and adopted in rural primary care practice. %Z FOR Codes: 111799 %0 Journal Article %A Armour, Carol %A Smtih, L D %A Krass, I %T Community Pharmacy, Disease State Management, and Adherence to Medication %B Disease Management and Health Outcomes %D 2008 %C New Zealand %I Adis International Ltd %V 16 %N %P 245-254 %@ 1173-8790 %X %Z FOR Codes: 111799 %0 Journal Article %~ PubMed %A Basheti, Iman A %A Armour, Carol L %A Bosnic-Anticevich, Sinthia Z %A Reddel, Helen K %T Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. %B Patient education and counseling %D 2008 %C Ireland %I Elsevier Ireland Ltd %V 72 %N 1 %P 26-33 %@ 0738-3991 %X To evaluate the feasibility, acceptability and effectiveness of a brief intervention about inhaler technique, delivered by community pharmacists to asthma patients. %Z FOR Codes: 110203 %0 Journal Article %~ PubMed %A Reddel, H K %A Bosnic-Anticevich, S Z %A Amour, C L %A Basheti, I %T Pharmacist interventions in asthma. %B The European respiratory journal %D 2008 %C Switzerland %I European Respiratory Society %V 32 %N 3 %P 812; author reply 812 %@ 0903-1936 %X %Z FOR Codes: 111799 %0 Book Section %A Smith, L %A Krass, I %A Armour, Carol %T Self-Management of Chronic Disease in Healthcare: The Role of Pharmacy %B Social Sciences in Health Care and Medicine %D 2008 %C United States %I Nova Science Publishers %V %N %P 199-211 %@ 9781604562866 %E Garner, Janet B %E Christiansen, Thelma C %X %Z FOR Codes: 111799 %0 Journal Article %A Gordois, A %A Armour, Carol %A Brilliant, M %A Bosnic-Anticevich, S %A Burton, D %A Emmerton, L %A Krass, I %A Saini, B %A Smith, L %A Stewart, K %T Cost-effectiveness analysis of a pharmacy asthma care program in Australia %B Disease Management and Health Outcomes %D 2007 %C New Zealand %I Adis International Ltd %V 15 %N %P 387-396 %@ 1173-8790 %X %Z FOR Codes: 111799 %0 Journal Article %~ PubMed %A Basheti, Iman A %A Reddel, Helen K %A Armour, Carol L %A Bosnic-Anticevich, Sinthia Z %T Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. %B The Journal of allergy and clinical immunology %D 2007 %C United States %I Mosby, Inc. %V 119 %N 6 %P 1537-1538 %@ 0091-6749 %X %Z FOR Codes: 110203 111708 %0 Journal Article %A Armour, Carol %A Brilliant, M %A Krass, I %T Pharmacists' views on involvement in pharmacy practice research %B Pharmacy Practice %D 2007 %C Canada %I Rogers Media Publishing Ltd %V 5 %N %P 59-66 %@ 0829-2809 %X %Z FOR Codes: 111799 %0 Journal Article %~ PubMed %A Armour, Carol %A Bosnic-Anticevich, Sinthia %A Brillant, Martha %A Burton, Debbie %A Emmerton, Lynne %A Krass, Ines %A Saini, Bandana %A Smith, Lorraine %A Stewart, Kay %T Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community. %B Thorax %D 2007 %C London %I British Medical Journal Publishing Group %V 62 %N 6 %P 496-502 %@ 1468-3296 %X BACKGROUND: Despite national disease management plans, optimal asthma management remains a challenge in Australia. Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current standards of best practice. The impact of the Pharmacy Asthma Care Program (PACP) on asthma control was assessed using a multi-site randomised intervention versus control repeated measures study design. METHODS: Fifty Australian pharmacies were randomised into two groups: intervention pharmacies implemented the PACP (an ongoing cycle of assessment, goal setting, monitoring and review) to 191 patients over 6 months, while control pharmacies gave their usual care to 205 control patients. Both groups administered questionnaires and conducted spirometric testing at baseline and 6 months later. The main outcome measure was asthma severity/control status. RESULTS: 186 of 205 control patients (91%) and 165 of 191 intervention patients (86%) completed the study. The intervention resulted in improved asthma control: patients receiving the intervention were 2.7 times more likely to improve from "severe" to "not severe" than control patients (OR 2.68, 95% CI 1.64 to 4.37; p<0.001). The intervention also resulted in improved adherence to preventer medication (OR 1.89, 95% CI 1.08 to 3.30; p = 0.03), decreased mean daily dose of reliever medication (difference -149.11 microg, 95% CI -283.87 to -14.36; p=0.03), a shift in medication profile from reliever only to a combination of preventer, reliever with or without long-acting beta agonist (OR 3.80, 95% CI 1.40 to 10.32; p=0.01) and improved scores on risk of non-adherence (difference -0.44, 95% CI -0.69 to -0.18; p=0.04), quality of life (difference -0.23, 95% CI -0.46 to 0.00; p=0.05), asthma knowledge (difference 1.18, 95% CI 0.73 to 1.63; p<0.01) and perceived control of asthma questionnaires (difference -1.39, 95% CI -2.44 to -0.35; p<0.01). No significant change in spirometric measures occurred in either group. CONCLUSIONS: A pharmacist-delivered asthma care programme based on national guidelines improves asthma control. The sustainability and implementation of the programme within the healthcare system remains to be investigated. %Z FOR Codes: 111710 %0 Journal Article %~ PubMed %A Krass, I %A Armour, C L %A Mitchell, B %A Brillant, M %A Dienaar, R %A Hughes, J %A Lau, P %A Peterson, G %A Stewart, K %A Taylor, S %A Wilkinson, J %T The Pharmacy Diabetes Care Program: assessment of a community pharmacy diabetes service model in Australia. %B Diabetic medicine : a journal of the British Diabetic Association %D 2007 %C UK %I Blackwell Publishing Ltd %V 24 %N 6 %P 677-683 %@ 0742-3071 %X AIM: To assess the impact of a community pharmacy diabetes service model on patient outcomes in Type 2 diabetes. METHODS: The study utilized a multisite, control vs. intervention, repeated-measures design within four states in Australia. Fifty-six community pharmacies, 28 intervention and 28 control, were randomly selected from a representative sample of urban and rural areas. Intervention pharmacies delivered a diabetes service to patients with Type 2 diabetes, which comprised an ongoing cycle of assessment, management and review, provided at regular intervals over 6 months in the pharmacy. These services included support for self monitoring of blood glucose, education, adherence support, and reminders of checks for diabetes complications. Control pharmacists assessed patients at 0 and 6 months and delivered no intervention. RESULTS: A total of 289 subjects (149 intervention and 140 control) completed the study. For the intervention subjects, the mean blood glucose level decreased over the 6-month study from 9.4 to 8.5 mmol/l (P < 0.01). Furthermore, significantly greater improvements in glycaemic control were seen in the intervention group compared with the control: the mean reduction in HbA(1c) in the intervention group was -0.97% (95% CI: -0.8, -1.14) compared with -0.27% (95% CI: -0.15, -0.39) in the control group. Improvements were also seen in blood pressure control and quality of life in the intervention group. CONCLUSION: A pharmacy diabetes service model resulted in significant improvements in clinical and humanistic outcomes. Thus, community pharmacists can contribute significantly to improving care and health outcomes for patients with Type 2 diabetes. Future research should focus on clarifying the most effective elements of the service model. %Z FOR Codes: 111712 111710 111702 %0 Journal Article %~ PubMed %A Smith, Lorraine %A Bosnic-Anticevich, Sinthia Z %A Mitchell, Bernadette %A Saini, Bandana %A Krass, Ines %A Armour, Carol %T Treating asthma with a self-management model of illness behaviour in an Australian community pharmacy setting. %B Social science & medicine (1982) %D 2007 %C United Kingdom %I Pergamon %V 64 %N 7 %P 1501-11 %@ 0277-9536 %X Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings. %Z FOR Codes: 111717 %0 Journal Article %~ PubMed %A Saini, Bandana %A Smith, Lorraine %A Armour, Carol %A Krass, Ines %T An educational intervention to train community pharmacists in providing specialized asthma care. %B American journal of pharmaceutical education %D 2006 %C United States %I American Association of Colleges of Pharmacy %V 70 %N 5 %P 118 %@ 1553-6467 %X OBJECTIVES: The development, implementation, and evaluation of an educational intervention to facilitate specialized asthma care provision by community pharmacists. DESIGN: Formative evaluation and a parallel group repeated measures design were used to test the effect of an educational intervention on pharmacist satisfaction and practice behavior as well as patient outcomes. The educational intervention was based on practitioner needs and principles of adult learning using flexible delivery formats. ASSESSMENT: In the intervention area, 15 pharmacists were trained with the educational intervention, and they provided specialized asthma care to 52 patients over 6 months, while in the control area, 12 pharmacists provided "usual care" to 50 patients. The intervention pharmacists were highly satisfied with the education received and rated most aspects highly. Improvements in patient clinical, humanistic, and economic outcomes in the intervention area were obtained. CONCLUSION: The positive results of the educational intervention demonstrate the effectiveness of an educational approach grounded in the theory that inducing behavioral changes in pharmacy practitioners results in improved patient outcomes. %Z FOR Codes: 111717 %0 Journal Article %~ PubMed %A Slader, Cassandra A %A Reddel, Helen K %A Jenkins, Christine R %A Armour, Carol L %A Bosnic-Anticevich, Sinthia Z %T Complementary and alternative medicine use in asthma: who is using what? %B Respirology (Carlton, Vic.) %D 2006 %C Australia %I Blackwell Publishing Asia %V 11 %N 4 %P 373-87 %@ 1323-7799 %X Consumer interest in complementary and alternative medicine (CAM) has grown dramatically in Western countries in the past decade. However, very few patients volunteer information about CAM use unless directly questioned by their health-care practitioner. Therefore, by being informed about the prevalence and modality of CAM use for asthma, as well as characteristics of users, health-care practitioners may be better able to identify patients who use CAM. In turn, this may facilitate proactive discussion and optimization of the patient''s overall asthma management. This review aims to summarize the current knowledge about use of CAM by people with asthma, and to assess the applicability of the available studies to the broader asthmatic population. Computerized literature searches were conducted on Medline, Embase, Cochrane and Allied and Complementary Medicine (AMED) databases from their inception to 13 April 2005. Search terms included: complementary medicine/therapies, alternative medicine/therapies and asthma. The bibliographies of accessible articles were searched for further papers. Seventeen studies have examined the use of CAM by people with asthma. The reported level of use for adults ranged from 4% to 79%, and for children from 33% to 89%. Among the most commonly used CAMs were: breathing techniques, herbal products, homeopathy and acupuncture. There is no strong evidence for effectiveness for any of these modalities. There is little consistency among available prevalence studies making conclusions difficult. Nevertheless, the high rates of CAM use reported in some studies indicate that CAM use should be taken into account when managing patients with asthma. %Z FOR Codes: 110403 110203 %0 Journal Article %~ PubMed %A Slader, Cassandra A %A Reddel, Helen K %A Spencer, Lissa M %A Belousova, Elena G %A Armour, Carol L %A Bosnic-Anticevich, Sinthia Z %A Thien, Francis Ck %A Jenkins, Christine R %T Double-blind randomised controlled trial of two different breathing techniques in the management of asthma. %B Thorax %D 2006 %C 4350 East West Highw %I Endocrine Soc %V 61 %N 8 %P 651-6 %@ 0040-6376 %X Previous studies have shown that breathing techniques reduce short acting beta(2) agonist use and improve quality of life (QoL) in asthma. The primary aim of this double blind study was to compare the effects of breathing exercises focusing on shallow nasal breathing with those of non-specific upper body exercises on asthma symptoms, QoL, other measures of disease control, and inhaled corticosteroid (ICS) dose. This study also assessed the effect of peak flow monitoring on outcomes in patients using breathing techniques. %Z FOR Codes: 110203 110403 %0 Journal Article %~ PubMed %A Henness, Sheridan %A van Thoor, Eveline %A Ge, Qi %A Armour, Carol L %A Hughes, J Margaret %A Ammit, Alaina J %T IL-17A acts via p38 MAPK to increase stability of TNF-alpha-induced IL-8 mRNA in human ASM. %B American journal of physiology. Lung cellular and molecular physiology %D 2006 %C United States %I American Physiological Society %V 290 %N 6 %P L1283-90 %@ 1040-0605 %X Human airway smooth muscle (ASM) plays an immunomodulatory role in asthma. Recently, IL-17A has become of increasing interest in asthma, being found at elevated levels in asthmatic airways and emerging as playing an important role in airway neutrophilia. IL-17A predominantly exerts its neutrophil orchestrating role indirectly via the induction of cytokines by resident airway structural cells. Here, we perform an in vitro study to show that although IL-17A did not induce secretion of the CXC chemokine IL-8 from ASM cells, IL-17A significantly potentiates TNF-alpha-induced IL-8 protein secretion and gene expression in a concentration- and time-dependent manner (P < 0.05). Levels of IL-8 protein produced after 24 h of incubation with TNF-alpha were enhanced 2.7-fold in the presence of IL-17A, and conditioned media significantly enhanced neutrophil chemotaxis in vitro. As IL-17A had no effect on the activity of NF-kappaB, a key transcriptional regulator of IL-8 gene expression, we then examined whether IL-17A acts at the posttranscriptional level. We found that IL-17A significantly augmented TNF-alpha-induced IL-8 mRNA stability. Interestingly, this enhanced stability occurred via a p38 MAPK-dependent pathway. The decay of IL-8 mRNA transcripts proceeded at a significantly faster rate when cells were pretreated with the p38 MAPK inhibitor SB-203580 (-0.05763 +/- 0.01964, t(1/2) = 12.0 h), compared with vehicle (-0.01030 +/- 0.007963, t(1/2) = 67.3 h) [results are expressed as decay constant (means +/- SE) and half-life (t(1/2) in h): P < 0.05]. Collectively, these results demonstrate that IL-17A amplifies the synthetic function of ASM cells, acting via a p38 MAPK-dependent posttranscriptional pathway to augment TNF-alpha-induced secretion of the potent neutrophil chemoattractant IL-8 from ASM cells. %Z FOR Codes: %0 Journal Article %~ PubMed %A Sutcliffe, A %A Kaur, D %A Page, S %A Woodman, L %A Armour, C L %A Baraket, M %A Bradding, P %A Hughes, J M %A Brightling, C E %T Mast cell migration to Th2 stimulated airway smooth muscle from asthmatics. %B Thorax %D 2006 %C 4350 East West Highw %I Endocrine Soc %V 61 %N 8 %P 657-62 %@ 0040-6376 %X BACKGROUND: Mast cell microlocalisation within the airway smooth muscle (ASM) bundle is an important determinant of the asthmatic phenotype. We hypothesised that mast cells migrate towards ASM in response to ASM derived chemokines. METHODS: Primary ASM cultures from subjects with and without asthma were stimulated with interleukin (IL)-1beta, IL-4, and IL-13 alone and in combination. Mast cell chemotaxis towards these ASM supernatants was investigated, and the chemotaxins mediating migration by using specific blocking antibodies for stem cell factor (SCF) and the chemokine receptors CCR3, CXCR1, 3 and 4 as well as the Gi inhibitor pertussis toxin and the tyrosine kinase inhibitor genistein were defined. The concentrations of CCL11, CXCL8, CXCL10, TGF-beta, and SCF in the supernatants were measured and the effect of non-asthmatic ASM supernatants on the mast cell chemotactic activity of asthmatic ASM was examined. RESULTS: Human lung mast cells and HMC-1 cells migrated towards Th2 stimulated ASM from asthmatics but not non-asthmatics. Mast cell migration was mediated through the combined activation of CCR3 and CXCR1. CCL11 and CXCL8 expression by ASM increased markedly after stimulation, but was similar in those with and without asthma. ASM supernatants from non-asthmatics inhibited mast cell migration towards the asthmatic ASM supernatant. CONCLUSION: Th2 stimulated ASM from asthmatics is chemotactic for mast cells. Non-asthmatic ASM releases a mediator or mediators that inhibit mast cell migration towards stimulated asthmatic ASM. Specifically targeting mast cell migration into the ASM bundle may provide a novel treatment for asthma. %Z FOR Codes: 110203 %0 Journal Article %A Armour, Carol %T Pharmacist Disease Management, 3rd Ed. (review) %B The Annals of Pharmacotherapy %D 2006 %C United States %I Harvey Whitney Books Company %V 40 %N %P 355-356 %@ 1060-0280 %X %Z FOR Codes: 111599 111599 %0 Journal Article %~ PubMed %A Krass, I %A Mitchell, B %A Clarke, P %A Brillant, M %A Dienaar, R %A Hughes, J %A Lau, P %A Peterson, G %A Stewart, K %A Taylor, S %A Wilkinson, J %A Armour, C %T Pharmacy diabetes care program: Analysis of two screening methods for undiagnosed type 2 diabetes in Australian community pharmacy. %B Diabetes research and clinical practice %D 2006 %C Ireland %I Elsevier Scientific Publishers %V 75 %N 3 %P 339-47 %@ 0168-8227 %X To compare the efficacy and cost-effectiveness of two methods of screening for undiagnosed type 2 diabetes in Australian community pharmacy. %Z FOR Codes: 111702 %0 Journal Article %A Krass, I %A Taylor, S %A McInman, A %A Armour, Carol %T The pharmacist's role in continuity of care in type 2 diabetes %B Journal of Pharmacy Technology %D 2006 %C United States %I Harvey Whitney Books Company %V 22 %N %P 3-8 %@ 8755-1225 %X %Z FOR Codes: 111799