s Pharmedia: No Benefit in Pharmacist Intervention | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Pharmedia: No Benefit in Pharmacist Intervention

Neil Johnston

articles by this author...

Introducing current ideas, perspectives and issues, to the profession of pharmacy

Editor's Note:
The media item below was recently published in MJA Insights.
It, along with many other articles, is a sample of the ongoing anti-pharmacy sentiment that is being spread by official medicine.
To me it is a nonsense to talk of collaboration between pharmacy and medicine on one hand, and to be professionally insulting on the other.
My view is that the medical profession has a lot of repair work to undertake to purify the drug evidence base that has been damaged beyond belief by its collaboration with Big Pharma, and the ongoing bid to denigrate the profession of pharmacy at every opportunity.
What seems to terrify official medicine about pharmacy and other registered health professionals such as nurses?
I2P asked Mark Coleman to comment on this situation, and his comments appear below the Insights item.

No benefit in pharmacist intervention

MJA Insights Monday 25th November 2013

THE ongoing bid by pharmacists to expand their primary health care role has been struck a blow by US research showing no health benefits from a pharmacy-led medication adherence intervention.

“Unfortunately this adds to the ongoing evidence that these types of pharmacy interventions have no positive health impacts”, Dr Evan Ackermann, chair of the Royal Australian College of General Practitioners’ National Standing Committee for Quality Care, told MJA InSight.

The research, published in JAMA Internal Medicine, randomly assigned 241 acute coronary syndrome (ACS) patients from four medical centres in the US to either the intervention group (n = 122) or usual care (n = 119). (1)

The intervention, which lasted 1 year after hospital discharge, included pharmacist-led medication reconciliation and tailoring; patient education; collaborative care between the pharmacist and the patient’s primary care clinician and/or cardiologist; and voice messaging (educational and medication refill reminder calls).

Although the results showed that 89.3% of those in the intervention group were adherent compared with 73.9% in the usual care group, there was no significant improvement in the proportion of patients who achieved blood pressure and low-density lipoprotein cholesterol level goals.

Dr Ackermann said there was no evidence to support medication interventions in primary care, or for medication reconciliation by a pharmacist at hospital admission or discharge.

“Systematic reviews undertaken by the National Prescribing Service (NPS) and other high-quality reviews consistently fail to find benefit from this type of intervention”, he said. (2), (3)

Dr Ackermann said further research should focus specifically on issues raised by the NPS review.

He called for research priority to be given to medication safety interventions in diseases where medication was an important part of care and where patients were prone to high hospital admission rates (e.g., heart failure), the use of drugs associated with a high risk of adverse events, and high-risk settings such as aged care facilities and transfer of care.

He said evidence about the factors contributing to adverse drug events should be used to develop strategies that improved early detection and prevention of adverse drug events.

“I believe this can only occur within the confines of a general practice, using pharmacy funding schemes that do not rely on the sale of medications”, Dr Ackermann said.

An editorial in JAMA Internal Medicine predicted that if the studied intervention were applied to every patient with ACS in the US it “would add $1 billion annually to health care costs”. (4)

“The relatively modest increases in already high rates of medication regimen adherence in the patients studied may not translate into improved outcomes even if maintained for 3 to 5 years or longer”, the author wrote.

Before recommending investment in this strategy, “it would be prudent to know that patient outcomes will actually improve”.

Andrew Matthews, national director for quality assurance and standards at the Pharmacy Guild, said that as medicines experts, pharmacists considered improving medicine adherence as a key role of their profession.

Mr Matthews said the JAMA Internal Medicine research was consistent with other research showing improvement in patient outcomes associated with higher levels of adherence.

“The Guild sees this as further evidence supporting the expansion of pharmacists’ primary health care role”, he said.

1. JAMA Intern Med 2013; Online 18 November
2. National Prescribing Service 2009; Medication safety in the community
3. Br J Clin Pharmacol 2008; 65: 303-316
4. JAMA Intern Med 2013; Online 18 November

Mark Coleman

I have been asked to comment on the above article.
Let me get this straight.
A doctor prescribes treatment in the form of a drug that no matter how “safe” it is deemed by its manufacturer will have side effects and will have interactions with other drugs, complementary medicines and perhaps food or nutritional supplements.
If polypharmacy is present, that represents more complexity and safety issues.

The prescribing doctor relies on the drug's sponsor to provide accurate and relevant information that has been produced through a medical research process generally paid for by the sponsor.

The pharmacists in the study achieved an increased rate of adherence to a very high level of 89.3% but
“there was no significant improvement in the proportion of patients who achieved blood pressure and low-density lipoprotein cholesterol level goals.”

That means the doctor's prescribing was deficient or that is the maximum efficacy achievable through the drugs used had been reached.
The pharmacist brief was to generate adherence, not to improve outcomes under the direct control of the prescriber.

So why is the pharmacist blamed for the lack of patient improvement and where was there an opening for a pharmacist to change the treatment?

This study clearly demonstrates that through poor treatment design and lack of drug efficacy, no additional improvement was available to any degree.
The Pharmacy Guild is right – this is further evidence supporting the expansion of a pharmacists' primary health care role.
A role that has always existed, but never fully utilised due to poor health policy and planning (by government pressured by the medical fraternity).

This is a very clear reason for having a multi-approach to primary health care and a variety of health practitioners available to provide different perspectives and treatments.
Competition between health providers will induce better service, reduce the retail price for a service and provide patient satisfaction-or they walk to another provider format.

Did the prescribing doctors in the study drill down in the sponsor data to prove that the initial sponsor data could be replicated?
Was there a process in place to allow pharmacists to collaboratively change the treatment to improve potential outcomes?

This Insight article contains some very weird logic, and tunnel vision at best.

The best that can happen in the trial intervention activity is to provide a safety level protecting patients from unintended harm through unplanned circumstances.
This may save a patient's life but not necessarily reduce blood pressure or cholesterol readings.
This is the responsibility of the prescriber.

Having been a clinical pharmacist in a hospital, I have seen many of these interventions that may have saved a patient's life, but did not necessarily improve markers for particular patients.
The saving of a single life more than justifies pharmacist monitoring and intervention.

It also provides a quality control on prescribers, which leads me to another observation.
Medical media have also been prolific about “non medical” prescribers, which of course, includes pharmacists and other allied health prescribers.
They are all a "danger to the patient" and should not be allowed, according to various medical spokespersons, usually having some affiliation with the AMA.

Let me also get this straight.
Pharmacists, the drug experts who receive more training than any other health professional in drug use, are likely to be “unsafe prescribers” ?

I think not, given the corrections and information I have delivered to medical doctors, from interns to specialists, over the years.
Medical prescribing is a cause of bureaucratic bottlenecks and a range of inefficiencies that results in higher treatment costs and frustrations to other “collaborators” with the medical profession.
In turn that generates higher costs to the patient and to the taxpayer.
Pharmacist and other allied health prescribing will definitely ease congestion within the PBS system, but of course, it may reduce medical visits and the fees that would have been attached to those visits.

Pharmacists have undergone a long period of having dispensing fees frozen under an agreement with the government.
Doctors had their fees frozen for a much shorter period (six months) but already they are elevating their charges to well above the Medicare charge for bulk-billing.
Pharmacists are not legally able to do that.
Doctors are now becoming too expensive, so instead of improving the quality of service to justify the increase in service fees, they look to appropriate funds from other professions and also their patients.
This is why the only form of collaboration that doctors will recognise is one where a medical practice receives the funding for a pharmacy service and employs a pharmacist (taking a commission along the way, of course).
You also see campaigns to interrupt fee reimbursements from medical funds or Medicare to leave a bigger pool for doctors and less competitors in the field recruiting patients away from orthodox medical practices.
Shouldn't all you doctors be looking at streamlining your practices and openly competing on service and price?
Is this what terrifies you, particularly when pharmacy is mentioned?

And I can't leave off this commentary without mentioning a statement made by one of those AMA affiliated doctors who said recently that pharmacists should not be involved with vaccination services.
Not because of training deficiencies, but because we did not have suitable refrigerators and could not financially afford to hold stocks.
This displays the level of ignorance these doctors have regarding pharmacy practices.
They know nothing and do not even attempt to find out before firing bullets.
Pharmacies, by virtue of their activities, were the first to be accredited for cold chain systems as well as the wholesalers supplying them.
There are very strict rules in place governing the management of cold chain items.

In fact, the number of breaches found in doctor surgeries over time, well exceeds anything found in community pharmacies.

And in relation to stock holding of vaccines, this has only diminished because doctors saw an opportunity to earn extra dollars by holding stock themselves.
This created a big dent in sales through pharmacies, so pharmacies only purchased vaccines on patient presentation of a prescription.
It was only when mismanagement of stocks by doctors caused a prescription to be written.
Supply difficulties in these instances were self-engineered when doctors saw themselves as dispensers as well being prescribers. They stuffed up the supply chain.

Well, that is enough commentary on this subject.

Needless to say, pharmacy will have to see a lot of improvement in the attitudes of medical doctors, a reduction of arrogance and a communion of equals, coupled with respect for the roles of all health practitioners.
And it would be more practical for doctors to accept the spirit of competition and improvement rather than repression and political skulduggery as the means of creating a collaborative future.
We all want you to remain in your role, but we will not accept the unprofessional behaviour that we have come to expect.
You are no longer seen as gods by other health professionals or your patients.
This does not mean that there is not genuine respect and collaboration at the coalface between some individual pharmacists and doctors.
It does moderately exist.
Only the politicians need to put back in their manners.

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