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1.  Evaluating the Quality of Randomized Controlled Trials that Examine the Efficacy of Natural Health Products: A Systematic Review of Critical Appraisal Instruments 
The purpose of this project was to conduct a systematic review to identify instruments designed to evaluate the quality of randomized controlled trials (RCTs) of natural health products (NHPs). Instruments were examined for inclusion of items assessing methods, identity and content of the NHP, generalizability of results and instructions for use. Online databases, websites, textbooks and reference lists were searched to identify instruments. Relevance assessment and data extraction of articles were completed by two investigators and disagreements were settled by the third investigator. Data were analyzed using descriptive statistics. Of the 4442 citations identified, 29 were potentially relevant with 16 meeting the criteria for inclusion. None of the instruments stated they were validated; content in the four areas of interest varied considerably. The most common items included randomization sequence generation (100%), blinding (100%), allocation concealment (75%) and participant flow (75%). Only nine of the NHP instruments included at least one item to appraise the specific content of the NHP. The CONSORT Statement for Herbal Interventions most closely addressed the four areas of interest; however, this instrument was specific for herbs. There is a need for the development of a validated instrument for assessment of the quality of RCTs that would be useful for herbs as well as other NHPs.
doi:10.1093/ecam/nem186
PMCID: PMC2781780  PMID: 18955310
Checklists; herbs; quality assessment
2.  Pharmacist educators in family medicine residency programs: A qualitative analysis 
BMC Medical Education  2012;12:74.
Background
25-29% of North American family medicine residency programs utilize a pharmacist to teach residents. Little is known about the impact that these pharmacist educators have on residency training. The purpose of this study was to examine the experiences of residents, residency directors and pharmacists within Canadian family medicine residency programs that employ a pharmacist educator to better understand the impact of the role.
Methods
Recruitment from three cohorts (residents, residency directors, pharmacists) within family medicine residency programs across Canada for one-on-one semi-structured interviews followed by thematic analysis of anonymized transcript data.
Results
11 residents, 6 residency directors and 17 pharmacist educators participated in interviews. Data themes were: (1) strong value of the teaching with respect to improved resident knowledge, confidence and patient care delivery; (2) lack of a formal pharmacotherapy curriculum; (3) desire for expansion of pharmacist teaching; (4) impact of teaching on collaboration; (5) impact of teaching on residency program faculty; and (6) lack of criticism of the role.
Conclusions
The pharmacist educator role is valued within residency programs across Canada and the role has a positive impact on several important aspects of family medicine resident training. Suggestions for improvement focused on expanding the teaching role and on implementing a formal curriculum for pharmacist educators to follow.
doi:10.1186/1472-6920-12-74
PMCID: PMC3494584  PMID: 22883928
3.  Can green tea preparations help with weight loss? 
Canadian Pharmacists Journal : CPJ  2014;147(3):159-160.
doi:10.1177/1715163514528668
PMCID: PMC4025876  PMID: 24847368
4.  Development and evaluation of an instrument for the critical appraisal of randomized controlled trials of natural products 
Background
The efficacy of natural products (NPs) is being evaluated using randomized controlled trials (RCTs) with increasing frequency, yet a search of the literature did not identify a widely accepted critical appraisal instrument developed specifically for use with NPs. The purpose of this project was to develop and evaluate a critical appraisal instrument that is sufficiently rigorous to be used in evaluating RCTs of conventional medicines, and also has a section specific for use with single entity NPs, including herbs and natural sourced chemicals.
Methods
Three phases of the project included: 1) using experts and a Delphi process to reach consensus on a list of items essential in describing the identity of an NP; 2) compiling a list of non-NP items important for evaluating the quality of an RCT using systematic review methodology to identify published instruments and then compiling item categories that were part of a validated instrument and/or had empirical evidence to support their inclusion and 3) conducting a field test to compare the new instrument to a published instrument for usefulness in evaluating the quality of 3 RCTs of a NP and in applying results to practice.
Results
Two Delphi rounds resulted in a list of 15 items essential in describing NPs. Seventeen item categories fitting inclusion criteria were identified from published instruments for conventional medicines. The new assessment instrument was assembled based on content of the two lists and the addition of a Reviewer's Conclusion section. The field test of the new instrument showed good criterion validity. Participants found it useful in translating evidence from RCTs to practice.
Conclusion
A new instrument for the critical appraisal of RCTs of NPs was developed and tested. The instrument is distinct from other available assessment instruments for RCTs of NPs in its systematic development and validation. The instrument is ready to be used by pharmacy students, health care practitioners and academics and will continue to be refined as required.
doi:10.1186/1472-6882-9-11
PMCID: PMC2687413  PMID: 19389240
5.  Bioidentical hormone therapy: Nova Scotia pharmacists' knowledge and beliefs 
Pharmacy Practice  2012;10(3):159-167.
Objective
To investigate Nova Scotia (NS) pharmacists' knowledge and beliefs regarding the use of bioidentical hormones (BHs) for the management of menopause related symptoms.
Methods
Using Dillman’s tailored design methodology, an invitation to complete the web-based questionnaire was emailed to pharmacists in NS as part of the Dalhousie College of Pharmacy Continuing Pharmacy Education Department's (CPE) weekly email update. Data was analyzed using descriptive statistics.
Results
Of approximately 1300 e-mails sent, 113 pharmacists completed the questionnaire (response rate 8.7%). The majority of respondents (94%) knew that BHs were not free from adverse drug reactions. More than 50% were aware that conjugated equine estrogens and medroxyprogesterone acetate were not examples of BHs. For seven of eleven knowledge questions, 33-45% indicated that they did not know the answer. When asked about their beliefs regarding BHs, many believed that BHs were similar in efficacy (49%) or more effective (21%) than conventional hormone therapy (CHT) for vasomotor symptoms. Most respondents also believed that both BHs and CHT had similar safety profiles. Additionally, responding pharmacists indicated that more education would be helpful, especially in the area of safety and efficacy of BHTs compared to CHT.
Conclusions
NS pharmacists knew BHs were not free of adverse effects, however knowledge was lacking in other areas. This may reflect the level of coverage of this topic in pharmacy school curriculums and in the pharmacy literature. Results indicate a need for additional education of NS pharmacists with respect to BHs, which could be accomplished through modification of undergraduate pharmacy programs and supplementary CPE.
PMCID: PMC3780489  PMID: 24155832
Pharmacists; Health Knowledge, Attitudes, Practice; Estradiol Congeners; Menopause; Canada
6.  Emergency contraception 
Canadian Family Physician  2012;58(5):548-554.
Abstract
Objective
To determine the extent to which Nova Scotian FPs prescribe and provide emergency contraceptive pills (ECPs) and to explore their knowledge of and attitudes toward ECPs.
Design
Survey of Nova Scotian FPs using a modified Dillman method.
Setting
All regions of Nova Scotia.
Participants
Family physicians registered with Dalhousie University’s Division of Continuing Medical Education.
Main outcome measures
Sex differences in the provision of ECPs and knowledge and attitudes about the ECP Plan B.
Results
Of 913 eligible FPs, 155 (17.0%) participated in the survey. Respondents resembled the sampling frame closely. Most physicians (64.0%) had prescribed ECPs in the previous year (mean number of prescriptions, 4.92); only 12.9% provided ECPs in advance of need. Knowledge about Plan B was quite good, except for knowledge of the time frame for potential effectiveness; only 29.2% of respondents answered that question correctly. Respondents generally supported nonprescription availability of ECPs, but 25.0% of FPs were concerned that this could lead to less use of more effective methods of contraception, and 39.2% believed that it would encourage repeat use. Younger FPs provided ECPs more often than their older colleagues, while female respondents had better knowledge about Plan B. In multivariate analysis being younger than 40 years was marginally associated with prescribing Plan B and with prescribing any form of ECP.
Conclusion
Most Nova Scotian FPs provided ECPs and had generally good knowledge about and attitudes toward providing such contraception without prescription. However, FPs were poorly informed about the length of time that Plan B can be effective, which could potentially affect use when patients consult several days after unprotected sex. There were some concerns about nonprescription availability of ECPs, which could have implications for recommending it to patients. Rarely were ECPs prescribed for advance use, which might represent a lost prevention opportunity, especially for adolescents who often do not use effective contraception.
PMCID: PMC3352797  PMID: 22586200
7.  Pharmacists teaching in family medicine residency programs 
Canadian Family Physician  2011;57(9):e341-e346.
Abstract
Objective
To determine the percentage of family medicine residency programs that have pharmacists directly involved in teaching residents, the types and extent of teaching provided by pharmacists in family medicine residency programs, and the primary source of funding for the pharmacists.
Design
Web-based survey.
Setting
One hundred fifty-eight resident training sites within the 17 family medicine residency programs in Canada.
Participants
One hundred residency program directors who were responsible for overseeing the training sites within the residency programs were contacted to determine the percentage of training sites in which pharmacists were directly involved in teaching. Pharmacists who were identified by the residency directors were invited to participate in the Web-based survey.
Main outcome measures
The percentage of training sites for family medicine residency that have pharmacists directly involved in teaching residents. The types and the extent of teaching performed by the pharmacists who teach in the residency programs. The primary source of funding that supports the pharmacists’ salaries.
Results
More than a quarter (25.3%) of family medicine residency training sites include direct involvement of pharmacist teachers. Pharmacist teachers reported that they spend a substantial amount of their time teaching residents using a range of teaching modalities and topics, but have no formal pharmacotherapy curriculums. Nearly a quarter (22.6%) of the pharmacists reported that their salaries were primarily funded by the residency programs.
Conclusion
Pharmacists have a role in training family medicine residents. This is a good opportunity for family medicine residents to learn about issues related to pharmacotherapy; however, the role of pharmacists as educators might be optimized if standardized teaching methods, curriculums, and evaluation plans were in place.
PMCID: PMC3173442  PMID: 21918131
8.  Knowledge of, beliefs about, and perceived barriers to the use of the emergency contraception pill among women aged 18-51 in Nova Scotia 
Pharmacy Practice  2011;9(3):148-155.
Objective
To investigate women in Nova Scotia (NS), Canada with respect to their knowledge of, beliefs about, and perceptions of barriers to accessing emergency contraception pills (ECP).
Methods
A random digit dialing approach was used to survey a representative sample of NS women aged 18-51. Analyses described the knowledge, beliefs, and perceived barriers associated with ECP access among participants. Particular focus was given to differences between younger (age 18-31) and older (age 32-51) women.
Results
The survey response rate of 49% achieved the desired sample size of 770. Overall, women in NS appeared to be poorly informed about ECP with regards to effectiveness, proper timing of administration, how it works, as well as how to access Plan B®. Younger women (age 18-31) were significantly more likely than older women (age 32-51) to know that ECP does not always prevent pregnancy (p<0.01), that it can be taken more than 12 hours after unprotected intercourse (p<0.01), and that it is available without a prescription in pharmacies (p<0.01). Thirty percent of women agreed that ECP will cause an abortion, with older women (p<0.01) being more likely than younger women to agree. Cost and lack of privacy in pharmacies were identified as potential barriers to access.
Conclusions
Lack of knowledge and the perception that ECP causes an abortion may influence a woman’s ability to consider ECP as an option should she find herself at risk of an unplanned pregnancy. To address this, efforts should be made to educate women (including older women) about ECP and its availability in pharmacies.
PMCID: PMC3870174  PMID: 24367469
Contraception, Postcoital; Women’s Health; Health Knowledge, Attitudes, Practice; Age Factors; Canada
9.  Defining bioidentical hormones for menopause-related symptoms 
Pharmacy Practice  2011;9(1):16-22.
In the last decade, the use of bioidentical hormones (BHs) to treat menopause-related symptoms has become increasingly popular. However, the many different definitions of BHs have led to a great deal of confusion often making it difficult for health care providers to discuss this area with patients.
Objective
The purpose of this paper was to produce a concise definition of bioidentical hormones, based on a review of the literature.
Methods
Searches, using systematic review methodology, were conducted from inception to June 2010 in PubMed, EMBASE, IPA, The Journal of International Compounding and the Internet to identify definitions of bioidentical hormones. There were no restrictions on type, date or language of publication. Included papers/website included those that contained a definition of BHs. Definitions were extracted, similarities and differences summarized, and these were then examined to produce a concise definition.
Results
Sixty-three definitions were found. Based on the analysis of similarities and differences, the following definition, comprised of three components (term being defined; category to which term belongs; distinctive characteristics of term) was produced: “Bioidentical hormones are chemical substances that are identical in molecular structure to human hormones.”
Conclusions
This definition clearly and concisely explains the meaning of BHs which should lead to a common understanding of the term and limit confusion among health care providers, the general public and the scientific community.
PMCID: PMC4132968  PMID: 25132885
Hormone Replacement Therapy; Menopause; Dissent and Disputes

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