bluuebunny/crossref_metadata_2025 huggingface dataset:
Guidelines for Safe Handling of Contact Sensitisers
Authors: Davies Domenica
Published: March 2016

Contact sensitisers diphencyprone and dinitrochlorobenzene are used in hospitals and specialised settings for the treatment of warts and alopecia areata, which have not responded to more conventional or readily available therapies. These chemicals are hazardous and after an accidental spill in our hospital, it was evident that guidelines for the safe handling of these preparations were needed. This report explains how the safety issues associated with the handling and use of diphencyprone and dinitrochlorobenzene were addressed.
Antiplatelet Therapy for Acute Coronary Syndromes
Authors: Wang Lexin
Published: March 2016

A common feature of acute coronary syndromes (ACS) is a partial occlusion of major coronary arteries due to atherosclerotic plaque disruption and subsequent thrombus formation. The antiplatelet drug aspirin has been one part of the standard therapy for ACS but has a number of adverse effects such as upper gastrointestinal bleeding and peptic ulceration. New antiplatelet agents, such as the thienopyridine derivatives and glycoprotein IIb/IIIa receptor antagonists, are potent inhibitors of platelet aggregation and thrombus formation. They reduce cardiac mortality and morbidity in patients with ACS. When used in addition to aspirin and/or heparin, they produce further reductions in cardiac death and myocardial infarction.
Education Outreach to the Community: Does Hospital Pharmacy Have a Role?
Authors: Alvarez Stephanie J , Larmour Ian , Tapley Nicole , Buick Megan , Greene Louise , Hines Lisa , Davies Jan
Published: March 2016

This paper describes the activities carried out by a hospital pharmacy department as part of a national co‐ordinated care trial. The objective was to examine ways in which a hospital pharmacy could provide support to general practitioners (GPs) involved in the trial through the promotion of rational, safe, effective and economic use of medication. A Pharmacy Strategy Group was established and identified five service products: education outreach, drug information services, special medication review and counselling, medication check‐up and computer database analysis. The scope of these services and the experience gained in the trial is outlined. The most successful service was the education outreach program. This was highly valued by the GPs and following the program there was a reduction in prescribing of non‐steroidal anti‐inflammatory drugs. The experience gained offers an insight into the potentially valuable contribution that hospital pharmacists can make to promote appropriate, safe and effective use of medication.
Pharmacological Management of Benign Prostatic Hypertrophy and Prostate Cancer in Older Men
Authors: Moran Juli A , Street Philip R , Rogerson John W
Published: March 2016

Benign prostatic hypertrophy (BPH) and prostate cancer are common conditions affecting older men. Treatment options for these conditions depend on the severity of symptoms, comorbidities and patient choice and include observation, medications and surgery.

BPH is an important cause of lower urinary tract symptoms. Alpha‐adrenergic antagonists are useful for mild to moderate symptoms of BPH. Trans‐urethral resection of the prostate is the most effective treatment for the relief of symptoms and is the only treatment recommended for serious complications of the disease.

After skin cancers, prostate cancer is the commonest malignancy in older males. Hormonal manipulation with luteinising hormone releasing hormone analogues and antiandrogens form the mainstay of treatment of metastatic prostate cancer.

This article will review the use of drugs and their place in the overall management of these disorders.
Communication of Adverse Drug Reactions between the Hospital Health Care Team and General Practitioners: How Effective Is It?
Authors: Clark Leia M , Bellett Pamela K , Robinson Maxine
Published: March 2016

Aim: To assess the communication format for adverse drug reaction (ADR) reports between the hospital and the general practitioner (GP).

Method: The research group conducted a survey to evaluate the ADR reports sent from the hospital pharmacy department to the patient's GP. The survey, by questionnaire, sought to determine satisfaction with the format of the report and an indication of the usefulness of this report to the GP. Every GP who had received an ADR report in the previous 11 months was sent the questionnaire, a blank ADR report and a return envelope. A computer database was used to collate the results.

Results: The survey was sent to 106 GPs; 47 replies were received, a response rate of 44%. Sixty‐eight per cent (32/47) remembered receiving the ADR report and all these GPs used the report in patient care plans. Fifty‐nine per cent (19/32) of GPs were not aware of the reported ADR from any other source. Four GPs (13%) had previously been aware of the reported ADR prior to the patient's admission to hospital although the hospital was not. Forty‐seven GPs commented on the format of the ADR report and the majority considered the format suitable and sufficiently detailed; however, 19% (6/32) felt the drug in question should be more clearly highlighted and 53% requested the report be typed.

Conclusion: ADR reports from this Area Health Service are useful to GPs and well received by them. Improvement of communication of ADRs across the hospital‐community interface is required. The results of the survey will also form a platform for discussions with the Central Coast Division of GPs.
Management of Oesophageal Disease in the Elderly
Authors: Hebbard Geoffrey S , Heddle Richard , McClure Anna F
Published: March 2016

Oesophageal disease becomes increasingly common with age and is therefore prevalent in the elderly (<70 yr). Oesophageal disease may present with symptoms related to the oesophagus‐dysphagia, odynophagia or chest pain‐and presents a number of management challenges related to the presence of comorbidities in this group. With the exception of infections and the occasional malignancy, diseases affecting the oesophagus are generally chronic, progressive and not amenable to curative therapy.

Oesophageal diseases affecting the elderly may be grouped into gastrooesophageal reflux disease, motility disorders, malignancy, infection and drug‐induced oesophageal disease.

This article reviews the use of drugs and their place in the overall management of these disorders.
Syndrome of Inappropriate Antidiuretic Hormone Secretion Secondary to Venlafaxine
Authors: Alderman Christopher P
Published: March 2016

Objective: To present a case of syndrome of inappropriate antidiuretic hormone secretion secondary to treatment with venlafaxine.

Clinical features: An 83‐year‐old woman developed significant hyponatraemia during treatment with venlafaxine 75 mg daily. Her serum sodium concentration declined to 125 mmol/L at the nadir. Fluid restriction failed to correct her hyponatraemia; however, a trial of demeclocycline 300 mg four times daily increased serum sodium to 138 mmol/L. Venlafaxine and demeclocycline were both subsequently discontinued and her serum sodium remained within the reference range without further intervention.

Discussion: The relationship between syndrome of inappropriate antidiuretic hormone secretion and psychotropic therapy is extensively documented but most reports focus on the association between hyponatraemia and treatment with tricyclic antidepressants or selective serotonin reuptake inhibitors. This case provides additional evidence that venlafaxine may cause SIADH.
Constipation in Older People Pharmacological Management Issues
Authors: Woodward Michael C
Published: March 2016

Constipation is a common complaint amongst older people although they are often concerned about features of constipation other than bowel action frequency. A careful assessment should be made, including a history, examination and appropriate investigations. Non‐pharmacological management often avoids the use of laxatives and includes adequate fibre, fluid and exercise.

The laxatives most appropriate for older people include stimulants such as senna, bulking agents and osmotic agents such as polyethylene glycol plus electrolytes or sorbitol. Short‐term use is nearly always sufficient. Faecal impaction should be sought and managed before giving oral agents. Enemas and suppositories are usually appropriate for impaction and for excessive straining. Management of constipation with these measures will avoid long‐term use and abuse of laxatives.
Celecoxib Use and Overuse—Too Much ‘Celebration’?
Authors: Graudins Linda V , Gazarian Madlen
Published: March 2016

Aim: To characterise indications for celecoxib use in a hospital population and to evaluate whether hospital prescribing of celecoxib was consistent with agreed hospital guidelines.

Method: Data were collected for patients dispensed celecoxib over a 7‐week period (August to October 2000) at a large metropolitan teaching hospital. Clinical pharmacists used a standardised data collection form to collect prescribing information.

Results: Of the 70 patients available for review, 50% had been prescribed celecoxib by their general practitioner prior to admission. All of these patients were prescribed celecoxib for rheumatoid arthritis, osteoarthritis or chronic pain conditions. Of the 35 patients prescribed celecoxib by hospital prescribers, only eight (23%) were considered to have an appropriate indication, as defined by existing hospital Pharmacy and Therapeutics Committee (PTC) guidelines. The largest category of inappropriate use in hospital was for acute pain (40%). A substantial proportion of patients (43%) were prescribed celecoxib as ‘first line’ rather than ‘second line’ therapy. Documentation of reasons for celecoxib use was poor in the majority of cases.

Conclusion: This drug usage evaluation has identified substantial inappropriate use of celecoxib in hospital patients, suggesting limited awareness or acceptance of PTC guidelines by hospital prescribers. The inappropriate prescribing of cyclooxygenase‐2 specific inhibitors has both economic and safety implications and requires further intervention and evaluation.
Hospital Pharmacists Fail to Record Their Research in the Quality Use of Medicines Mapping Project
Authors: Dooley Michael J , Lu Phuong L
Published: March 2016

Aim: To quantify the number of projects with a quality use of medicines (QUM) focus that were presented at the Society of Hospital Pharmacists of Australia 1999 Federal and 2000 Biennial Clinical conferences that have been entered in the Quality Use of Medicines Mapping Project (QUMmap).

Methods: Published abstracts of contributed papers and posters were examined. Abstracts that had a major focus on improving or supporting QUM in Australia were considered suitable to have been entered in the database. The QUMmap was searched to determine if the projects had been contributed to the database.

Results: 258 presentations were reviewed from both meetings; 226 (88%) were classified as suitable for inclusion and, of these, 9 (4.0%) were identified in the database.

Conclusion: Only 4% of projects with a QUM focus presented at two major hospital pharmacy conferences had been entered in the QUMmap. Strategies need to be implemented to improve the rate of contributions. Individuals utilising the QUMmap could conclude that hospital pharmacists have a limited role in these activities and this could result in the omission of pharmacy as an important player in research and QUM activities.
Issues in the Interpretation and Design of Studies Investigating Drug‐Related Morbidity and Mortality
Authors: Easton‐Carter Kylie L , Chapman Colin B , Brien Jo‐anne E
Published: March 2016

While drug‐related morbidity and mortality are currently of significant concern, considerable controversy exists regarding the frequency of these adverse events. Much of this controversy can be explained by differences in methods used to investigate drug‐related morbidity and mortality. The definitions used, patient populations studied, monitoring methods employed, and the use of causality and clinical significance classifications are the primary factors contributing to the differences encountered. This paper aims to provide an appreciation of the impact of these factors on the interpretation and design of studies investigating drug‐related morbidity and mortality.
Extemporaneous Prescribing: Whatever Happened to It? A Survey of Australian General Practitioners
Authors: Pappas Arthur , MacPherson Ross , Stewart Kay
Published: March 2016

Objectives: Recent Australian and New Zealand studies have shown that dispensing of extemporaneous products by pharmacists has declined over recent years to only 1 to 2% of total prescriptions. The purpose of this study was to survey general practitioners (GPs) to identify the scope of extemporaneous prescribing, reasons for any limitations to such prescribing and their interest in further education.

Method: A mail survey comprising eighteen questions was distributed by eleven Divisions of General Practice from five Australian States to 1138 GPs.

Results: 318 replies were received which equated to aresponse rate of 28%. 52% of respondents were male with 87% from inner city/suburban practices. The primary source of instruction in extemporaneous prescribing was either experience (48%) or medical school (25%), and the majority (68%) either never or rarely prescribed extemporaneous preparations. The main reasons given were lack of product knowledge (78%) and items not being listed on the Pharmaceutical Benefits Scheme (29% ). When extemporaneous products were prescribed, the most common were topical (31% often or very often) and eye/ear/nose (16% often or very often). Despite the overall low level of extemporaneous prescribing, there was considerable interest (94% overall) in accessing information on these products with at least two‐thirds of respondents considering that the Internet would be a useful or very useful medium for accessing appropriate information.

Conclusion: Although extemporaneous products are no longer commonly prescribed, the majority of GPs surveyed do not see these products as ‘a thing of the past’, and expressed a desire to learn more. There may be an opportunity for the medical and pharmaceutical professions to collaborate in maintaining this traditional area of practice.
Pharmacokinetics of Nasal Fentanyl
Authors: Lim Stephen (CB) , Paech Michael J , Sunderland V Bruce , Roberts Malcolm J , Banks Samantha L , Rucklidge Matthew WM
Published: March 2016

Objective: To investigate the pharmacokinetics of intranasal fentanyl in adult post‐operative female patients.

Method: Patients received both intravenous and intranasal fentanyl (approximately 50 µg) in a randomised cross‐over study.

Results: Pharmacokinetic data sets from 19 patients showed intranasal fentanyl produced plasma levels within the therapeutic range within two minutes, with median bioavailability values of 55 % (pH 6 formulation) and 71% (pH 8 formulation) . Mean peak serum concentrations were 0.33 ng/mL (pH 6) and 0.37 ng/mL (pH 8) respectively, compared with 2.33 ng/mL after intravenous fentanyl.

Conclusion: We conclude that the absorption of intranasal fentanyl is rapid, the bioavailability more than half that of intravenous administration and that the formulations studied are suitable for more extensive clinical evaluation.
The Application of Emerging Technologies in Genomics and Proteomics to Drug Development
Authors: Mahler Stephen M , Chin David Y , Van Dyk Derek D
Published: March 2016

The completion of the first draft of the Human Genome Project and the emerging discipline of proteomics will have a major impact on the future and practice of pharmacy and medicine in the longer‐term. The identification of single nucleotide polymorphisms within the human genome and especially those within genes will contribute to the elucidation of disease and disease processes, and to profiling individual drug response and susceptibility to drug side effects. New drug targets will be discovered principally through proteomic techniques such as two‐dimensional gel electrophoresis, liquid chromatography and mass spectrometry. The creation of large libraries of synthetic compounds and natural products from rain forests, coral reefs and other biologically significant ecosystems, the development of high‐throughput screening tools by pharmaceutical companies and the discovery of new targets through proteomics will ensure a surge in new drug development. Through pharmacogenomics, the hope is that treatment of patients may be fine‐tuned according to their genetic make‐up and profile, to maximise therapeutic efficacy while minimising side effects. The future development and refinement of proteomic techniques will be central for these outcomes in drug development to come to fruition.
Developing Key Competencies for a Clinical Pharmacy Education and Peer Review Program
Authors: Clifford Rhonda M , Plumridge Richard J
Published: March 2016

Objectives: To describe a model for the development of a competency‐based clinical pharmacy training program using educational principles and practice change strategies.

Method: The program development was guided by educational literature and advice from an educationalist and a staff development consultant. Clinical pharmacy competencies were identified in a series of consultant‐led staff forums. Performance indicators and evidence guides were established to measure attainment of each competency. Staff values were also identified and a practice change strategy devised. Instructional methods were devised which optimised progression to competent practice: reading, lectures, interactive tutorials, guided discussion, case presentations, case‐based training, simulation/role play and practice‐based learning. These were supported by interactive training through mentoring, individualised practice‐based learning using direct instruction, modelling (problem clarification), coaching (practice in problem solving), and facilitating (self evaluation).

Conclusion: This model provides a sound approach to clinical pharmacy education as it is based on an accepted definition of competency and uses values established by staff combined with recognised educational principles and practice change strategies.
Pharmacogenomics—Clinical and Social Implications
Authors: Brien Jo‐anne E
Published: March 2016

‘Personal pills’ was a headline in a 1998 issue of Scientific American. It highlighted the expectations now realistically held by clinicians and consumers that future choices about drug therapy may be based on an individual's DNA. There is broad relevance of genomics research to all aspects of our understanding of the pathogenesis and treatment of diseases. The variability in response of individuals to specific drug therapies and the rates of adverse drug reactions are likely to be informed by elucidation of a genetic basis for this variation. An outcome of the Human Genome Project is the development of a functional genomics approach to identification of genes associated with risk of disease, identification of therapeutic targets and prediction of drug response. The genes associated with disease susceptibility are potential targets for novel therapies. The application of pharmacogenomics to create ‘smart’ therapeutics has been outlined, such that genetic information may be used to select optimum drug and dose. New scientific and clinical applications have also heralded concerns about the social, legal, and ethical issues associated with the use of genetic information.
Assessment of Drug‐Related Problems and Clinical Pharmacists' Interventions in an Indian Teaching Hospital
Authors: Parthasarathi Gurumurthy , Ramesh Madhan , Kumar Jakka Krishna , Madaki Shivakumar
Published: March 2016

Aim: To identify drug‐related problems (DRPs) at a major Indian teaching hospital, to assess the acceptance of recommendations made by clinical pharmacists and evaluate the level of involvement of pharmacists in drug therapy decisions.

Method: A prospective study was conducted over a six‐month period in the medical wards of the Jagadguru Shri Shivarathreeshwara (JSS) Medical College Hospital, Mysore, India. A decision‐making model proposed by Campagna (and modified by Wood) was applied to evaluate pharmacists' involvement in drug therapy decisions.

Results: Of the 245 DRPs identified, 237 involved active clinical pharmacist interventions. The most common DRPs were inappropriate dosage (31%), inappropriate drug selection (17%) and adverse drug reactions (13%). Ninety per cent of the pharmacists' recommendations were accepted and led to change in therapy in 79% of cases. Most of the interventions were classified (according to the decision‐making model) as corrective (78%) or proactive (19%).

Conclusion: The incidence of DRPs identified in this study is higher than reported in some studies in developed countries. But the acceptance rate of clinical pharmacists' interventions was comparable to studies conducted in countries where clinical pharmacy is well‐developed and indicate the acceptance and recognition of clinical pharmacists as active members of the healthcare team at JSS Medical College Hospital.
Introducing a Multidisciplinary Medication Safety Program in a Major Hospital
Authors: Van de Vreede Melita A , Kenneally Anne L , Lubliner Mark
Published: March 2016

Aim: To describe the introduction of a medication safety program in a major hospital.

Method: Medication safety was identified as an organisational priority and a multidisciplinary Drug Management Committee convened to promote medication safety and reduce the potential for error. Methods included analysis of medication‐related incident reports and implementation of educational strategies and new processes.

Outcomes: The following safety initiatives have been successfully implemented and sustained: warfarin prescribing and administration time was altered to avoid prescribing by after hours hospital medical officers; the use of potassium chloride ampoules has been reduced by introducing premixed potassium chloride infusion packs and will be further reduced by the introduction of 10mmol in 100mL premixed packs for fluid‐restricted patients. Other changes include medication imprest review and rationalisation, the introduction of a safe prescribing program for interns, and standardising protocols for drug infusions.

Conclusion: The program has been successful because of strong executive support, an enthusiastic multidisciplinary team, application of quality improvement methods and extensive staff consultation and education.
Cell‐Based Therapies—A Role for Pharmacy Technicians
Authors: Burnett Donna , Dooley Michael J , Wall Dominic
Published: March 2016

Aim: To develop pharmacy technician involvement in the manufacture of cell‐based therapies for the treatment of cancer.

Method: A tripartite collaboration between the Centre for Blood Cell Therapies (CBCT), pharmacy department (Peter MacCallum Cancer Centre) and clinical trial sponsor was formalised. The skills required by pharmacy technicians as well as areas for specific background training were identified and didactic education sessions prepared. Plans were prepared for certified training at the clinical trial sponsor's manufacturing facility in Paris, France.

Results: Two pharmacy technicians with extensive aseptic chemotherapy experience commenced the education program in January 2001 with initial didactic education in a range of areas. In February 2001, the selected pharmacy technicians and the senior scientist of the cell manipulation laboratory travelled to Paris, France for formal certified training and validation with the trial sponsor. The technicians successfully completed the training and validation process and are now qualified cell processing technologists. A final validation of the facilities and personnel was completed in July 2001 by the trial sponsor. Additional technicians have now been trained and the current involvement of pharmacy technicians in the CBCT is approximately 40 hours per week. In addition, a review of the remuneration for pharmacy technicians was undertaken and a six‐tier pay structure implemented.

Conclusion: Pharmacy technicians can be readily trained to manufacture cell‐based therapies. This project has highlighted that pharmacy technicians have the experience, expertise and capacity to expand their roles within healthcare delivery.
Deprescribing: Achieving Better Health Outcomes for Older People through Reducing Medications
Authors: Woodward Michael C
Published: March 2016

Older people are prescribed a disproportionate number of medications. Polypharmacy leads to reduced compliance, increases the risk of adverse drug effects and may lead to poor medication outcomes. There is considerable evidence of inappropriate as well as excessive prescribing for older people. Although there are risks, medication outcomes can be improved through deprescribing.

The principles of deprescribing include reviewing all current medications, identifying medications to be ceased, substituted or reduced, planning a deprescribing regimen in partnership with the patient and frequently reviewing and supporting the patient. Medications to be used with caution will be discussed and practical deprescribing advice offered in this review.

A clear understanding of the purpose and risk of medication by the prescribing team and the patient, and a considered deprescribing plan, can improve health outcomes in older people.
In‐Home Medication Reviews for War Veterans: Early Experience in Australia
Authors: Sorensen Lene , King Michelle A , Peck Robert , Roberts Michael S
Published: March 2016

Objective: To evaluate the initial impact of in‐home medication reviews for war veterans by accredited pharmacists.

Method: Medication use, health service use, and corresponding costs for 92 veterans and war widow(er)s were compared between a ‘before intervention’ period and ‘after intervention’ period via prescription database analysis. Inappropriate medication use according to Beers' criteria was also identified.

Results: The intervention led to a higher number of medications initiated and ceased than medications continued. There was a statistically insignificant increase in the number of medications (12.6 to 13.9), and the mean health service cost ($1818.66 to $2123.26). There was an insignificant increase in the use of inappropriate medication according to Beers' criteria.

Conclusion: This medication review service introduced the concept of medication reviews to the Australian domiciliary setting. In‐home medication reviews are now widely available to any Australian at risk of medication misadventure.
Management of the Older Patient with Multiple Myeloma
Authors: Smith Carole L
Published: March 2016

More than 50% of patients with multiple myeloma are over the age of 60 years at the time of presentation. The presenting features in the elderly are the same as for younger patients, with bone lesions and pathological fractures, hypercalcaemia, anaemia and renal impairment. Some patients are asymptomatic with a paraprotein found incidentally. Fit patients up to the age of 70 years without cardiovascular or significant renal disease may be managed in the same way as younger patients by firstly having their tumour load reduced with combination IV chemotherapy, followed by high‐dose chemotherapy with peripheral blood stem cell rescue. In younger patients this aggressive approach has been shown to afford a survival advantage of approximately 18 months. Patients of more advanced age or with significant co‐morbidities may achieve a good response with judicious administration of oral chemotherapy, commonly melphalan and prednisolone. With dose adjustments to reduce toxicities patients can have durable disease responses and relief of symptoms even in the very elderly. The median survival without high‐dose chemotherapy is 3 to 5 years. This prognosis is not age‐specific, but agerelated co‐morbidities may limit treatment options and hence affect the prognosis adversely. Some patients have indolent disease with a superior prognosis, requiring treatment only with progression and development of symptoms. Prophylaxis with bisphosphonates has been shown to reduce the incidence of fractures and radiotherapy can afford excellent palliation. The introduction of thalidomide to routine care has given a further palliative treatment, with a third of patients refractory to chemotherapy responding. Clinical studies addressing the use of thalidomide earlier in treatment are being undertaken. Dose reduction is often required in older patients because of increased somnolence and constipation. Withdrawal may be required because of neurotoxicity. Newer agents with similar properties to thalidomide but with fewer toxicities are eagerly awaited.
Impact of High‐Cost Drugs for Individual Patient Use
Authors: Gallego Gisselle , Melocco Terry , Taylor Susan J , Brien Jo-anne E
Published: March 2016

Aim: To document and describe the individual patient use (IPU) scheme at St Vincent's Hospital, Sydney in terms of submissions and approvals and assess the financial impact of the scheme on the hospital drug expenditure.

Method: All submissions for IPU approvals received between January 1997 and December 2001 were reviewed. Submissions were collected on a calendar year basis. Data collection and analysis included identification of approved medication and indication, off‐label or approved indication, prescriber, ward, outcome of therapy, person deciding the approval, approval date duration and expiry, amount of medication dispensed and the cost of therapy. The annual cost and proportion of overall drug expenditure for each approval was calculated.

Results: The number of approvals had a trend to increase each year. 67.1% of the IPU approvals were for off‐label indications. Requested feedback on clinical outcomes was provided only in 18% of cases. The drug acquisition cost of the IPU scheme more than doubled in the period between 1999 and 2001. Similarly the proportion of the drug expenditure on IPU drugs increased significantly (p < 0.001) from 1.6% in 1999 to 3.6% in 2001.

Conclusion: The results indicated that the number of approvals and submissions for IPU had a tendency to increase. The financial impact of the IPU scheme increased over the years reviewed.
Pharmacy Clinical and Distribution Service Delivery Models in Australian Public Hospitals
Authors: O'Leary Karen M , Allinson Yvonne M
Published: March 2016

An electronic questionnaire was sent to 239 public hospital pharmacy services in Australia to update and expand on a survey undertaken in 2001. The key findings from the 109 respondents (46%) showed that:

1. the average proportion of time pharmacists spent on clinical activities was 47%;

2. the average proportion of time spent on distribution activities was 37% and management activities was 16%;

3. in Victoria, the State with considerable uptake of the Pharmaceutical Benefits Scheme, the proportion of time spent on distribution services by pharmacists had increased slightly in the last 2 years. There had also been a change in the use of pharmacy technicians: 24% of their time was devoted to supporting clinical services and management activities;

4. the role of pharmacy technicians is changing; more than 30 full‐time equivalent positions were involved in supporting clinical pharmacy activities;

5. the vast majority of hospital pharmacy services (94%) offered some form of clinical service to some or all of their overnight patients; however, only 75% offered clinical services to some or all of their same‐day patients;

6. the clinical service delivery model used ranged considerably across and within States and Hospital Peer Groups; 55% of hospital pharmacy services had a mixed clinical service model in their hospital;

7. 7 hospitals offered a 7‐day‐a‐week clinical pharmacy service;

8. 19 hospitals had clinical pharmacy services available in emergency departments and 10 in pre‐admission clinics;

9. 32 hospital pharmacy services offered non‐admitted or discharge patients access to medicines through the Pharmaceutical Benefits Scheme;

10. 32% of hospital pharmacy services offered a comprehensive distribution service to non‐admitted patients and 28% offered a comprehensive service to discharge patients;

11. access to the Pharmaceutical Benefits Scheme was not the only factor driving the level of service delivered; 66% of hospitals with access to the Pharmaceutical Benefits Scheme offered a comprehensive service to non‐admitted patients and 75% a comprehensive service to discharge patients; and

12. the distribution service delivery model used for inpatients ranged considerably across and within States and Hospital Peer Groups. Australian public hospitals generally use a hybrid distribution model for inpatients where a ward‐based system is supported by an individual patient‐based system.
Aspirin‐Induced Sneezing
Authors: Ramesh Madhan , Parthasarathi Gurumurthy , Singhal Rohit
Published: March 2016

Aim: To present a case of aspirin‐induced sneezing.

Clinical features: A 19‐year‐old male developed sneezing during the intermittent use of aspirin 325 mg for the treatment of headache, over a 2‐year period. When rechallenged, he developed sneezing 2 hours after taking the aspirin dose and the reaction persisted for 2 to 3 days. The frequency of sneezing was greatest during the first day. The patient was not treated and recovered spontaneously 2 to 3 days after ingesting the dose.

Discussion: The causality assessment of the reaction as assessed by the World Health Organization assessment scale was ‘certain’. The limitation of this assessment may be the fact that rechallenge with individual excipients of the product was not undertaken. Although sneezing has been reported with other drugs, no reference to aspirin‐induced sneezing could be found.
Community Pharmacists and Men's Health in Rural Victoria
Authors: Wood Penelope J , Gibson L Michelle , Verrinder Adrian
Published: March 2016

Background: Men are notorious for not attending to their health and seeking health advice, especially in rural areas.

Aim: To ascertain the role community pharmacists can play in men's health in rural Victoria.

Method: Self‐administered, closed‐response written questionnaires were sent to community pharmacists and men in the Loddon‐Mallee region of Victoria.

Results: The men and pharmacists agreed that community pharmacies could be a useful men's health resource. Half the men thought that the only advice pharmacists gave concerned prescription medications. Men said that the gender of a pharmacist would not affect them seeking advice, yet among their criteria for making pharmacies more ‘men friendly’ was the provision of more male pharmacists and pharmacy assistants. Both men and pharmacists saw information leaflets as a valuable resource. The men and pharmacists agreed that the service to men could be improved with provision of more information, counselling, education sessions, referral and collaboration with other health professionals, men's health events and some risk factor screening. Pharmacists were confident and reported success in counselling men in some areas (e.g. smoking cessation) but not others (e.g. alcohol use). Some constraints to improving pharmacy services to men were identified including time constraints, lack of remuneration and training.

Conclusion: Rural pharmacies could become a useful men's health resource. Time, lack of remuneration and training may be the main constraints.

J Pharm Pract Res 2004; 34: 285–7.
Understanding the Medicines Management Pathway
Authors: Stowasser Danielle A , Allinson Yvonne M , O'Leary M
Published: March 2016

The medicines management pathway describes the cognitive and physical steps involved in the use of medicines, with a focus on the consumer. There are 9 steps and 3 background processes. The steps and processes are interdependent and influence each other. Documentation of the pathway provides a framework to identify how the steps are related, the potential for any errors and safety system improvements. The pathway is applicable to all medicines, independent of the setting, health professionals involved and funding source. An understanding of the pathway and human factors associated with each step are necessary to ensure safe, effective and efficient use of medicines. The pathway can assist consumers and health professionals to understand their role and how their actions can improve medicine safety. Hospital pharmacists have an established role at all steps. With more professional services being offered via community and other pharmacy practice settings, the medicines management pathway concept will play an increasingly greater role across the continuum of care.

J Pharm Pract Res 2004; 34: 293–6.
Furoxan‐Bearing Micelles for Nitric Oxide Delivery
Authors: Hasegawa Urara , Wang Tengjiao , Chen Jerry J. Y. , Uyama Hiroshi , van der Vlies André J.
Published: March 2016

Furoxans, or 1,2,5‐oxadiazole‐N‐oxides, are a class of nitric oxide (NO)‐donating compounds that release NO in response to thiol‐containing molecules. In this study, polymeric micelles bearing furoxan moieties are prepared from an amphiphilic block copolymer consisting of a hydrophobic furoxan‐bearing block and a hydrophilic poly(N‐acryloylmorpholine) block. The block copolymer is prepared using a combination of the reversible addition–fragmentation chain transfer polymerization and the copper‐catalyzed Huisgen cycloaddition techniques. The block copolymers form spherical micelles with a diameter of 50 nm by self‐assembly in water. The micelles release NO in response to cysteine and show improved stability against hydrolytic decomposition. Furthermore, the micelles show a synergistic anti‐proliferative effect with ibuprofen in human colon cancer cells.

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Noise correction in gene expression data: a new approach based on subspace method
Authors: Alharbi Nader , Ghodsi Zara , Hassani Hossein
Published: March 2016

We present a new approach for removing the nonspecific noise from Drosophila segmentation genes. The algorithm used for filtering here is an enhanced version of singular spectrum analysis method, which decomposes a gene profile into the sum of a signal and noise. Because the main issue in extracting signal using singular spectrum analysis procedure lies in identifying the number of eigenvalues needed for signal reconstruction, this paper seeks to explore the applicability of the new proposed method for eigenvalues identification in four different gene expression profiles. Our findings indicate that when extracting signal from different genes, for optimised signal and noise separation, different number of eigenvalues need to be chosen for each gene. Copyright © 2016 John Wiley & Sons, Ltd.
Exact controllability for 1‐D quasilinear wave equations with internal controls
Authors: Zhuang Kaili
Published: March 2016

For 1‐D quasilinear wave equations with different types of boundary conditions, based on the theory of the local exact boundary controllability, using an extension method, the author establishes the exact controllability in a shorter time by means of internal controls acting on suitable domains. In particular, the exact controllability can be realized only by internal controls, and the control time can be arbitrarily small. Copyright © 2016 John Wiley & Sons, Ltd.
Nursing documentation of pressure ulcers in nursing homes: comparison of record content and patient examinations
Authors: Hansen Ruth‐Linda , Fossum Mariann
Published: March 2016

Aim

The aim of this study was to describe the accuracy and quality of nursing documentation of the prevalence, risk factors and prevention of pressure ulcers, and compare retrospective audits of nursing documentation with patient examinations conducted in nursing homes.

Design

This study used a cross‐sectional descriptive design.

Method

A retrospective audit of 155 patients' records and patient examinations using the European Pressure Ulcer Advisory Panel form and the Braden scale, conducted in January and February 2013.

Results

The prevalence of pressure ulcers was 38 (26%) in the audit of the patient records and 33 (22%) in patient examinations. A total of 17 (45%) of the documented pressure ulcers were not graded. When comparing the patient examinations with the patient record contents, the patient records lacked information about pressure ulcers and preventive interventions.
Comparative Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin‐Tazobactam or Cefepime: A Retrospective Cohort Study
Authors: Hammond Drayton A. , Smith Melanie N. , Painter Jacob T. , Meena Nikhil K. , Lusardi Katherine
Published: March 2016

Study Objective

The combination of vancomycin and piperacillin‐tazobactam has been associated with an increased risk of acute kidney injury (AKI) in non–critically ill patient populations, but it is still unknown if this association exists in critically ill patients. The objective of this study was to compare the incidence ofAKIdevelopment during therapy or within 72 hours after completion of therapy in adult critically ill patients who received vancomycin with concomitant piperacillin‐tazobactam or cefepime.

Design

Retrospective cohort study.

Setting

Medical, surgical, and neuroscience intensive care units (ICUs) within a single tertiary care hospital.

Patients

A total of 122 critically ill patients who received at least 48 hours of combination therapy with vancomycin and piperacillin‐tazobactam (49 patients) or vancomycin and cefepime (73 patients) during anICUadmission between September 2012 and December 2014.

Measurements and Main Results

The primary outcome wasAKIdevelopment, as determined by the Acute Kidney Injury Network criteria, during combination therapy or within 72 hours of completion of combination therapy. The inverse probability of the treatment‐weighting (IPTW) approach was used to account for potential treatment selection bias.AKIincidence was assessed in the unadjusted and propensity score–weighted cohorts. Of the 122 patients, 37 patients (30.3%) developedAKI. In the unadjusted analysis, the incidence ofAKIwas similar in the piperacillin‐tazobactam group compared with the cefepime group (32.7% vs 28.8%, p=0.647). The average treatment effect between the groups was not significant, showing no association between β‐lactam choice andAKI(β = −0.004, p=0.958). Secondary outcomes wereICUlength of stay, hospital length of stay,AKIduration, and need for renal replacement therapy. The choice of β‐lactam was not a significant predictor of any of these outcomes:ICUlength of stay (β = 0.436, p=0.780), hospital length of stay (β = 3.819, p=0.125),AKIduration (β = −4.027, p=0.283), and need for renal replacement therapy (β = 2.828, p=0.161).

Conclusion

After adjusting for propensity to receive each of the treatment choices, no significant difference was found in the incidence ofAKIdevelopment or other outcomes between the groups. The previously described finding that concomitant vancomycin and piperacillin‐tazobactam increasesAKIin non–critically ill patients may not be generalizable to the critically ill population. Prospective evaluation of this hypothesis is warranted.
Influence of Carbon Matrix Dimensions on the Electrochemical Performance of Germanium Oxide in Lithium‐Ion Batteries
Authors: Wei Xiang , Li Weihan , Zeng Linchao , Yu Yan
Published: March 2016

Germanium dioxide (GeO2) has recently demonstrated high theoretical capacity and is being considered as the most promising candidate to substitute commercial carbon‐based anodes of lithium‐ion batteries. Nevertheless, practical application of GeO2 materials to lithium‐ion batteries is greatly hampered by the huge volume variation during cycling. Herein, the GeO2 dispersions in different carbon matrices (i.e., 0D mesoporous carbon microspheres, 1D carbon nanotube, 2D reduced graphene oxide) are prepared by a simple route. In a comparison of these three composites, GeO2 embedded in 0D mesoporous carbon microspheres (denoted as GeO2@MCS) shows the best electrochemical performance regarding cyclability (852 mA h g−1 at a rate of 0.5 A g−1 after 100 cycles) and rate capability (269 mA h g−1 at 10 A g−1 after 50 cycles). The improved electrochemical performance arises from the novel structure that combines a variety of advantages: easy access of electrolyte and short transport path of Li+ , and high conductivity transport of electrons through the 3D interconnected channels of MCS matrix. What is more, the 3D interconnected pores of MCS could effectively accommodate the huge volume change of GeO2 during cycling and maintain perfect electrical conductivity throughout the electrode.
Model building on the non‐factorisable type IIA orientifold
Authors: Seifert Alexander , Honecker Gabriele
Published: March 2016

We construct global semi‐realistic supersymmetric models with intersecting D6‐branes on the non‐factorisable orientifold . The non‐factorisable structure gives rise to differences compared to the factorisable case: additional conditions for the three‐cycles to be Lagrangian and extra constraints on the wrapping numbers for building fractional cycles.
Light management in flexible thin‐film solar cells on transparent plastic substrates
Authors: Wilken Karen , Paetzold Ulrich W. , Meier Matthias , Ablayev Gani M. , Terukov Evgeny I. , Prager Nicole , Fahland Matthias , Finger Friedhelm , Smirnov Vladimir
Published: March 2016

Maintaining efficient light management is an essential part for obtaining high efficiency flexible thin‐film solar cells. Transparent plastic films like polyethylene terephthalate (PET) are a cost efficient substrate alternative but also impose additional constraints on the light management approaches available. In this study, we investigate and compare two approaches to prepare substrates with light scattering characteristics. We have developed low temperature ZnO:Al layers, which are fully compatible with PET substrates, and are textured by wet‐chemical methods. These low temperature textured ZnO:Al layers implemented in amorphous silicon solar cells on glass substrates result in similar efficiencies as highly optimized high temperature‐etched ZnO:Al layers. Nanoimprint lithography was used as an alternative light management approach and we show that an improved solar cell performance can be achieved on flexible PET substrates with both methods. Besides the effect on solar cell performance, pros and cons of both approaches with respect to flexibility in choice of materials and textures, fabrication process, stress evolution, and reproducibility are discussed.
Justifying the small‐world phenomenon via random recursive trees
Authors: Mehrabian Abbas
Published: March 2016

We present a new technique for proving logarithmic upper bounds for diameters of evolving random graph models, which is based on defining a coupling between random graphs and variants of random recursive trees. The advantage of the technique is three‐fold: it is quite simple and provides short proofs, it is applicable to a broad variety of models including those incorporating preferential attachment, and it provides bounds with small constants. We illustrate this by proving, for the first time, logarithmic upper bounds for the diameters of the following well known models: the forest fire model, the copying model, the PageRank‐based selection model, the Aiello‐Chung‐Lu models, the generalized linear preference model, directed scale‐free graphs, the Cooper‐Frieze model, and random unordered increasing k‐trees. Our results shed light on why the small‐world phenomenon is observed in so many real‐world graphs. © 2016 Wiley Periodicals, Inc. Random Struct. Alg., 50, 201–224, 2017