bluuebunny/crossref_metadata_2025 huggingface dataset:
Summer evapotranspiration in western Siberia: a comparison between eddy covariance and Penman method formulations
Authors: Fleischer Elisa , Bölter Jana , Klemm Otto
Published: April 2015

Evapotranspiration is difficult to quantify because of the many factors and complex processes that influence it. Several empirical methods have been developed over the years to estimate potential evapotranspiration based on easily available parameters. Directly measured data of actual evapotranspiration have been rather sparse in the past and still need to be improved in particular regions like western Siberia. The transition zone between the warm temperate and cold temperate continental climates is very sensitive to climate change, and water stress is an increasingly important issue in these regions with a highly dynamic agricultural activity. So there is a growing need to estimate actual evapotranspiration. Widely usable approximations are needed. In this study, the values of potential evapotranspiration computed with the original version, and eight modifications of the Penman formulation were compared and related to the actual evapotranspiration measured by eddy covariance over a grassland area in western Siberia. The original 1948 and 1963 Penman formulations are best for estimating potential evapotranspiration in the transition zone between the forest steppes and the pre‐taiga. A nearly linear relationship between the potential and actual evapotranspiration was found. A simple modification of the Penman equation (i.e. the multiplication of the result by a factor of 0.47) is suggested for approximating the actual evapotranspiration based on standard meteorological data for the region.

The original Penman formulation is most robust and will provide the widest applicability in the future under changing climate and environmental conditions. In this context, it is further recommended not to neglect the ventilation term of the Penman equation, which is often assumed to be negligibly small. A detailed correlation analysis showed that under dry soil conditions, the vegetation largely contributed to the actual evapotranspiration and, in contrast to widely held expectations, that the Penman equation is best adapted to vegetated surfaces. Copyright © 2015 John Wiley & Sons, Ltd.
The pyruvate dehydrogenase complex in cancer: An old metabolic gatekeeper regulated by new pathways and pharmacological agents
Authors: Saunier Elise , Benelli Chantal , Bortoli Sylvie
Published: April 2015

Cancer cells exhibit an altered metabolism which is characterized by a preference for aerobic glycolysis more than mitochondrial oxidation of pyruvate. This provides anabolic support and selective growth advantage for cancer cells. Recently, a new concept has arisen suggesting that these metabolic changes may be due, in part, to an attenuated mitochondrial function which results from the inhibition of the pyruvate dehydrogenase complex (PDC). This mitochondrial complex links glycolysis to the Krebs cycle and the current understanding of its regulation involves the cyclic phosphorylation and dephosphorylation by specific pyruvate dehydrogenase kinases (PDKs) and pyruvate dehydrogenase phosphatases (PDPs).
Induction of CD4+ and CD8+ anti‐tumor effector T cell responses by bacteria mediated tumor therapy
Authors: Stern Christian , Kasnitz Nadine , Kocijancic Dino , Trittel Stephanie , Riese Peggy , Guzman Carlos A. , Leschner Sara , Weiss Siegfried
Published: April 2015

Facultative anaerobic bacteria like E. coli can colonize solid tumors often resulting in tumor growth retardation or even clearance. Little mechanistic knowledge is available for this phenomenon which is however crucial for optimization and further implementation in the clinic. Here, we show that intravenous injections with E. coli TOP10 can induce clearance of CT26 tumors in BALB/c mice. Importantly, re‐challenging mice which had cleared tumors showed that clearance was due to a specific immune reaction. Accordingly, lymphopenic mice never showed tumor clearance after infection. Depletion experiments revealed that during induction phase, CD8+ T cells are the sole effectors responsible for tumor clearance while in the memory phase CD8+ and CD4+ T cells were involved. This was confirmed by adoptive transfer. CD4+ and CD8+ T cells could reject newly set tumors while CD8+ T cells could even reject established tumors. Detailed analysis of adoptively transferred CD4+ T cells during tumor challenge revealed expression of granzyme B, FasL, TNF‐α and IFN‐γ in such T cells that might be involved in the anti‐tumor activity. Our findings should pave the way for further optimization steps of this promising therapy.
Impact of an Educational Program on Antibiotic Use in Paediatric Appendectomy Procedures
Authors: Angalakuditi Mallik , Sunderland V Bruce , Roberts Malcolm J , Turner Sean , Lilley Brian J
Published: April 2015

Aim

To evaluate antibiotic use in paediatric appendectomy procedures.

Method

Demographic, clinical and antibiotic prescribing data for patients who had appendectomies were reviewed in two paediatric hospitals retrospectively (pre‐intervention). The data was analysed against standard guidelines for abdominal surgery. A multifaceted education strategy was designed and administered only in the case hospital. A post‐intervention evaluation was conducted in both hospitals (case and control).

Results

207 cases and 224 controls were evaluated. There was no significant difference (p > 0.05) between gender, age and length of stay between the groups. Post‐intervention, appropriateness of theatre antibiotics changed from 0 to 65% (cases) and from 52.9% to 53.3% (controls). The appropriateness of ward antibiotics changed from 48 to 84.7% (cases) and 76.4 to 71.4% (controls). The total antibiotic dosage appropriateness changed from 0 to 58.2% (cases) and 12 to 3.8% (controls).

Conclusion

Antibiotic use significantly improved following the multifaceted educational intervention.
Introducing a Daily Patient Report for Clinical Pharmacists
Authors: Ryan David M
Published: April 2015

Finding current and relevant data from the various information technology systems throughout a hospital can be a time consuming and tedious. Patient demographics, diagnosis, laboratory results and medication use data are stored across many different information systems and these must all be accessed individually. A report was designed to bring all the information together and, after a trial period, was introduced to our clinical pharmacists. Further enhancements have been made to flag abnormal laboratory results and patients receiving warfarin. The report also calculates an estimated creatinine clearance for every patient based on their most recent serum creatinine concentration and ideal body weight. The report has reduced the amount of time pharmacists spend retrieving patient information.
Medication Safety Series
Authors: Thornton Penny
Published: April 2015

This series is compiled by Rosemary Burke, Chair, SHPA Committee of Specialty Practice in Medication Safety, and Director of Pharmacy, Concord Hospital, NSW, and edited by Penny Thornton, Federal Councillor, SHPA, and Pharmacy Services Manager, The Children's Hospital at Westmead, NSW. It brings you up‐to‐date information about medication safety issues and strategies to prevent medication errors. The section draws on Australian incidents and also US experience, including (with permission) material from ISMP Medication Safety Alert!, a bulletin published by the Institute for Safe Medication Practices, USA .
Complementary Medicines Use by Australian Veterans
Authors: Ientile Clare S , Sorensen Lene , Lemanski Lindsay , Roberts Michael S
Published: April 2015

Aim

To determine the prevalence of complementary medicines use by Australian war veterans.

Method

The presence and use of complementary medicines and conventional medicines were recorded during home visits of 1082 veterans and war widow(er)s in five Australian states.

Results

405 (37%) veterans had complementary medicines. Vitamins and minerals were most common (88%), followed by supplements (21%) and herbals (18%). GPs had documented complementary medicines use for 59% of the 405 veterans. 31% of the veterans were at risk of potential interactions.

Conclusion

Complementary medicines are growing in popularity and pharmacists should be responsible for understanding their risks and benefits, and provide education to enhance the quality use of all medicines.
Impact of COX‐2 Inhibitors in Thai Orthopaedic Outpatients
Authors: Phosri Jitsuda , Kulsomboon Vithaya , Kiatying‐Angsulee Niyada
Published: April 2015

Background

Prescribing of cyclo‐oxygenase ‐2 inhibitors (coxibs) has had an economic impact on patients and overall healthcare costs in Thailand.

Aim

To analyse the pattern of coxib use and to determine the cost impact of inappropriate use.

Method

A random retrospective sample was selected from two months of prescribing data. There were 519 prescriptions for coxibs and 594 prescriptions for conventional non‐steroidal anti‐inflammatory drugs (NSAIDs). Appropriate use was based on the UK National Institute for Clinical Excellence criteria.

Results

208 (40%) patients receiving coxibs and 113 (19%) patients receiving conventional NSAIDs were at high risk for upper gastrointestinal adverse effects. Of those receiving coxibs, 112 (22%) received coxibs alone and 159 (31%) also received gastro‐protective agents. The cost of inappropriate use of coxibs in patients at a low risk of gastrointestinal effects was 2.4 million Baht/year. The excess cost, adjusted for the most commonly prescribed conventional NSAIDs (diclofenac 25 mg, Voltaren 25 mg, and ibuprofen 400 mg), were 3.4, 1.1 and 3.2 million Baht/year, respectively.

Conclusion

Inappropriate use of coxibs resulted in excessive expenditure and specific pharmacy intervention would be required to reduce the cost impact.
Establishing the Role of a Clinical Pharmacy Technician
Authors: Turner Sarah J , Lam Skip S , Leung Benjamin K , Toh Cjeng T
Published: April 2015

Aim

To demonstrate quantitatively the range and extent of a clinical pharmacist's activities that can be delegated to pharmacy technicians without compromising patient care.

Method

All activities undertaken by the clinical pharmacist were evaluated and reassigned to the technicians if they met strict criteria. A job description for the technician was developed and approved by management and staff pharmacists. Data were collected and assessed prospectively for three staffing models: original model (1 pharmacist:30 beds, no technician); initial model (1 pharmacist:45 beds, 1 technician); and revised model (1 pharmacist:40 beds, 1 technician). The following key performance indicators were collected by clinical pharmacists before and after implementing the new models: number of clinical interventions recorded; number of medication history interviews completed; time lapsed after admission before a medication history interview is completed; and a surrogate indicator of pharmacy workload.

Results

The initial model showed a negative outcome in all areas and resulted in the model being revised. The revised model demonstrated that there was no negative difference in the key performance indicators compared with the original model.

Conclusion

Ward pharmacy technicians can assist pharmacists in achieving optimum patient care and quality use of medicines.
Medication Safety Series
Authors: Thornton Penny
Published: April 2015

The series are compiled by Rosemary Burke, Chair, SHPA Committee of Specialty Practice in Medication Safety, and Director of Pharmacy, Concord Hospital, NSW, and edited by Penny Thornton, Federal Councillor, SHPA, and Pharmacy Services Manager, The Children's Hospital at Westmead, NSW. It brings you up‐to‐date information about medication safety issues and strategies to prevent medication errors. The section draws on Australian incidents and also US experience, including (with permission) material from ISMP Medication Safety Alert!, a bulletin published by the Institute for Safe Medication Practices, USA .
Pharmacist Prescribing: Views of Australian Hospital Pharmacists
Authors: Hanes Carissa A , Bajorek Beata V
Published: April 2015

Aim

To explore the views of a sample of Australian hospital pharmacists on prescribing privileges.

Method

The study involved a questionnaire and a focus group discussion for hospital pharmacists and teacher practitioners. Participants could participate in either or both of these activities.

Results

15 pharmacists completed the questionnaire and 8 participated in the focus group discussion. Several models of pharmacist prescribing (discharge and specialist settings) were seen to be appropriate and useful to Australian practice. 93% of pharmacists noted that prescribing privileges would enable them to provide more efficient/improved pharmaceutical care; 64% that prescribing would result in reduced healthcare costs; and all noted physician opposition as a barrier. Pharmacists indicated that they already prescribed on an ‘unofficial’ basis. Training and accreditation beyond registration was deemed necessary by all pharmacists.

Conclusion

Hospital discharge or specialist settings may be most appropriate to pilot pharmacist prescribing in Australia. Further research on a larger scale is needed to provide a base of evidence before this practice is pursued.
Thiopurines for Inflammatory Bowel Disease: Role of Pharmacogenetics
Authors: Hadithy Asmar FY Al , Naunton Mark , Brouwers Jacobus RBJ
Published: April 2015

There is a growing interest in the use of thiopurines for inflammatory bowel disease. Pharmacogenetic insights suggest that the genetic profile of thiopurine S‐methyltransferase and inosine triphosphate pyrophosphatase may affect the clinical response to thiopurines. This is a review on the pharmacogenetics of these enzymes and highlights difficulties that impede prior‐to ‐treat pharmacogenetic testing for the thiopurines in practice.
Hypothermia Associated with Olanzapine
Authors: Chu Kwok‐Pui Jody , Nyfort‐Hansen Karin
Published: April 2015

Background

Hypothermia is a rarely reported and under‐recognised adverse reaction to antipsychotics. Although the mechanism of antipsychotic‐induced hypothermia is not fully understood, antipsychotics that are more potent antagonists at 5‐HT2 than at dopamine2 receptors appear more likely to cause hypothermia.

Aim

To describe a case of hypothermia possibly associated with olanzapine.

Clinical features

A 94‐year‐old woman was admitted to hospital with acute confusion and hypothermia (31.9 °C). Her medical history included hypothyroidism, and delusions and hallucinations, for which olanzapine had been prescribed 4 days before admission. On admission she was found to have hypercalcaemia, iron deficiency, normal free thyroxine, raised thyroid stimulating hormone, evidence of recent exposure to pesticides, and a generalised erythematous rash.

Outcome

Withdrawal of olanzapine 4 days after admission was associated with an increase in body temperature (36–37 °C) and resolution of her confusion and rash.

Conclusion

Clinicians should consider the possibility of drug‐induced illness in hypothermic patients who are taking antipsychotics.
Influence of the National Hospital Pharmaceutical Strategy on the Assessment of New Medicines in New Zealand Public Hospitals
Authors: Tordoff June M , Norris Pauline T , Kennedy Julia M , Reith David M
Published: April 2015

Background

In 2002, New Zealand's Pharmaceutical Management Agency (PHARMAC) began implementing the National Hospital Pharmaceutical Strategy (NHPS) with the assessment of new medicines as a key area of focus.

Aim

To determine the influence of the NHPS on processes for assessing new medicines in New Zealand public hospitals.

Method

In July 2002, and in July 2004, a questionnaire‐based, cross‐sectional survey was undertaken of the processes used for assessing new medicines in all New Zealand public hospitals that employed one or more pharmacists.

Results

For both surveys a 97% response rate was achieved, 75% of hospitals used formal assessment processes, 93% had multidisciplinary Medicine and Therapeutics Committees, and over 75% of new medicine applications were approved by these committees and budget holders. 16 hospitals used application forms in 2002 and 18 in 2004. In both surveys over 75% of forms required efficacy, safety and cost data. By 2004, questions on cost effectiveness and prescribing restrictions significantly increased (p ≤ 0.05), more supplementary questions were asked (p ≤ 0.001), and 11 hospitals introduced questions from a PHARMAC template. By 2004, pharmacy/pharmacology departments and clinicians provided more pharmacoeconomic data for assessments than in 2002.

Conclusion

The NHPS appears to have influenced the assessment of new medicines in New Zealand public hospitals. In both surveys, hospitals used formal assessment processes and key considerations were efficacy, safety and acquisition cost. By 2004, cost‐effectiveness became an important consideration, more hospitals used application forms, forms were more complex and use of pharmacoeconomic data increased.
Patients' Understanding of Drug Allergy and Documentation—Is There a Link?
Authors: Sim Lily , Barras Michael , Cottrell Neil
Published: April 2015

Background

Re‐exposure to a drug to which one is allergic is a preventable adverse drug event. There is a reliance on the patient to provide accurate information on their allergies for the purpose of complete documentation.

Aim

To investigate the relationship between patients' understanding of their drug allergy and documentation of their allergy status in their hospital records.

Method

A structured interview of inpatients identified whether they had a drug allergy. Patients were then assessed on their ability to distinguish the symptoms of an allergic reaction from those of an adverse effect and stratified into groups based on their level of understanding. Review of drug charts and medical records identified both the presence and quality of documentation.

Results

Of the 250 patients interviewed, 95 (38%) had previously experienced a true allergic reaction to a drug. A good understanding of the symptoms associated with an allergic reaction was demonstrated by 48 (51%). 50 (53%) patients had their allergy documented on their medication chart and 69 (73%) in their medical records. 18 (19%) patients had no documentation of their allergy status. There was a trend that good understanding of allergy may lead to improved completeness of documentation but this did not reach statistical significance.

Conclusion

Patients' understanding of drug allergy improved the quality of documentation. System changes need to ensure proper training of staff to take and record drug allergies.
Ximelagatran Cost Effectiveness for Stroke Prevention in Atrial Fibrillation
Authors: Valiya Shabnam N , Bajorek Beata V
Published: April 2015

Background

The benefit of warfarin for stroke prevention in non‐valvular atrial fibrillation has been demonstrated in various clinical trials. Warfarin has a narrow therapeutic window and carries a significant risk of bleeding. Ximelagatran is a new oral antithrombotic with predictable plasma concentrations and excellent bioavailability.

Aim

To compare the costs and benefits of ximelagatran to that of warfarin and aspirin.

Method

In a preliminary cost‐effectiveness analysis, the costs and clinical consequences of warfarin, aspirin and ximelagatran were compared. The principal outcome was measured in the form of an incremental cost‐effectiveness ratio. A decision analysis model was constructed to map the expected outcomes of three treatment alternatives. Sensitivity analysis tested the robustness of the data.

Results

Warfarin appeared to be most cost effective in this clinical setting. The incremental cost‐effectiveness ratio indicated that the use of ximelagatran in preference to warfarin would cost an additional $272 000/patient/year. Likewise the use of ximelagatran in preference to aspirin would cost an additional $13 000/patient/year.

Conclusion

Ximelagatran appears to be cost effective in a small group of high‐risk patients. This may have implications for the development of treatment guidelines in this clinical setting.
Drug Information Services: Hospital Pharmacists' Utilisation and Opinion
Authors: Crank Mariana Y
Published: April 2015

Aim

To evaluate utilisation of the NSW Medicines Information Centre and other drug information services, and to determine if on‐site drug information resources are meeting the needs of pharmacists in NSW public hospitals.

Method

A questionnaire was formulated following a literature review and distributed to all NSW public hospital pharmacies. The survey inquired on recent use of the NSW Medicines Information Centre's services, if services were meeting needs, and the use of drug information resources apart from those available on‐site .

Results

57% of hospital pharmacies in NSW completed the survey. 63% of pharmacists felt that their drug information needs were not met by resources accessible on‐site . 80% of rural hospital pharmacists noted that on‐site resources did not meet their drug information needs.

Conclusion

Despite the increase in access to electronic drug information resources, NSW public hospital pharmacists rely on external drug information services (such as the NSW Medicines Information Centre) to meet their needs.
Providing HIV Education for Health Professionals in India
Authors: Duncan Alison J , Crowe Suzanne
Published: April 2015

Although around 5 million people in India have HIV/AIDS, there is limited access to information, diagnostic facilities and drugs. In recent years there has been an increase in the use of antiretroviral therapy in line with WHO global initiatives. A team from an Australian HIV centre provided education for nurses and laboratory technicians at urban and rural locations in India in 2005. The aim was to ensure that the antiretroviral therapy which would become more widely available was used correctly, to optimise response and limit the potential for antiviral resistance. The workshops were rewarding and participants requested further education opportunities and a wider range of topics.
Mirtazapine‐Induced Lower Limb Oedema
Authors: Das Rabindranath , Shankar P Ravi , Dhungana Krishna
Published: April 2015

Aim

To describe a case of lower limb oedema possibly associated with the use of mirtazapine.

Clinical features

A 31‐year‐old male suffering from depression for the previous 6 years was changed from fluoxetine 20 mg daily to mirtazapine 37.5 mg daily. After 10 days he presented with fever, sore throat and swollen legs. Haematology and biochemistry results were normal.

Outcome

The oedema subsided within 5 days following the withdrawal of mirtazapine. A score of 5 was obtained using the Naranjo criteria suggesting that the reaction was probably due to mirtazapine. Serum mirtazapine levels were not measured and rechallenge was not undertaken.

Conclusion

The lower limb oedema described was probably caused by mirtazapine.
Acute Adrenal Insufficiency—Withholding of Medicines in the Peri‐Operative Period
Authors: Poulson Louise K
Published: April 2015

Background

Patients with adrenal insufficiency cannot respond to stress by increasing secretion of endogenous cortisol and need supplemental steroid to avoid an acute adrenal crisis.

Aim

To describe a case of acute adrenal insufficiency due to withholding of oral cortisone during the peri‐operative period.

Clinical features

A 68‐year‐old male deteriorated during his hospital admission for septic arthritis. He was known to have panhypopituitarism following the resection of a pituitary adenoma. During admission, his regular doses of oral cortisone were withheld due to a pre‐operative nil‐by ‐mouth order. He became symptomatic of glucocorticoid deficiency and was subsequently treated with IV hydrocortisone.

Outcome

The patient recovered after receiving glucocorticoid replacement therapy.

Conclusion

Pharmacists should ensure accurate drug histories are taken and provide guidance on medication management through the development of multidisciplinary pre‐operative guidelines.
Medication Regimen Complexity and Adherence in Patients at Risk of Medication Misadventure
Authors: George Johnson , Vuong Tam , Bailey Michael J , Kong David CM , Marriott Jennifer L , Stewart Kay
Published: April 2015

Background

Dosage forms, dosing frequencies and additional instructions contribute to regimen complexity, which in turn is known to influence treatment outcomes.

Aim

To evaluate the relationship between complexity of medication regimens and adherence in patients at risk of medication misadventure.

Method

A modified Morisky scale was administered to inpatients during their hospital stay. Complexity of the medication regimens at the time of hospital discharge was assessed using the Medication Regimen Complexity Index.

Results

The 310 subjects had a mean age of 72 years and were using a mean of 10.4 prescribed medications. High adherence was self‐reported by 198 (64%) patients. Unintentional nonadherent behaviour was evident in 80 (26%) patients, while 51 (17%) patients admitted making intentional deviations from the recommended treatment. The reliability of the Morisky scale was poor (α = 0.38; 0.26–0.49). Patients who stopped taking their medicine when feeling worse had significantly less complex (p = 0.01) 'additional instructions' (median 4; 1–12) than those who did not stop their medicines (median 6; 0–18). This association was independent of age, gender and other medication regimen features. There were no significant differences between medication regimen features of patients who were forgetful, careful, and who stopped their medications when feeling better and their respective counterparts.

Conclusion

Patients using medications with less complex additional instructions were more likely to stop taking their medicine when feeling worse. Interventions designed to improve adherence by reducing regimen complexity are unlikely to be effective in all patients, especially in those with intentional nonadherence.
Snapshot of the Australian Public Hospital Pharmacy Workforce in 2005
Authors: O'Leary Karen M , Allinson Yvonne M
Published: April 2015

A workforce questionnaire was sent to 198 Australian public hospitals with more than 50 beds. This report details the data returned from 99 (50%) public hospital pharmacy services and compares the results to earlier studies performed at the same time of year in 2001 and 2003. Key findings of the 2005 snapshot of the hospital pharmacy workforce in public hospitals in Australia are that:

overall 69.95 of the 972.27 (7%) of establishment pharmacist full‐time equivalent positions were vacant—an improvement from the 2003 figure of 10%;

1 in 3 hospital pharmacists work part‐time;

almost 1 in 3 hospital pharmacists have a postgraduate qualification;

number of pre‐registration positions available has remained steady despite an increase in the number of pharmacy graduates;

percentage of hospital pharmacy technicians with formal qualifications as a pharmacy technician or pharmacist has increased to over 45%;

66 respondents indicated the need for additional 154.68 pharmacists full‐time equivalent (or an increase of 16%) in the next two years. The majority of these related to extending clinical pharmacy services and the ongoing introduction of the Pharmaceutical Benefits Scheme in public hospitals.
Development of a Mentoring Module to Enhance an Online National Pharmacy Preceptor Training Program
Authors: Simpson Maree D , Leversha Anne , Marriott Jennifer L , Taylor Susan , Bull Rosalind M , Howarth Helen D , Galbraith Kirstie J , Dalton Lisa D , Best Dawn L , Rose Miranda
Published: April 2015

An online Australian Pharmacy Preceptor Education Program was developed to enable pharmacists to access education and support to assist with their responsibilities as preceptors. The program was designed to improve the effectiveness of their supervision while enhancing their satisfaction with the role. Mentoring is also an important aspect of professional involvement with students and graduates. The importance of mentoring to succession planning, professional satisfaction and self esteem was recognised and a mentoring module was also developed for inclusion in the program. This paper describes mentoring as a practice, the process of developing the mentoring module and provides an overview of its content.
Artemether‐Lumefantrine and Primaquine for Mixed Plasmodium falciparum and ovale Malaria
Authors: Chan Esther W
Published: April 2015

Aim

To present a case of uncomplicated mixed Plasmodium falciparum and ovale malaria requiring treatment with artemether‐lumefantrine and primaquine.

Clinical features

A 40‐year‐old female presented with a mixed infection of uncomplicated P. falciparum and ovale. Treatment was commenced with oral quinine sulphate 600 mg, 8‐hourly which was changed to artemether‐lumefantrine and primaquine. A glucose‐6‐phosphate‐dehydrogenase test revealed deficiency, necessitating an alteration of the primaquine regimen.

Discussion

Malaria infections are often initially treated with quinine if the infective species is not known or if the infection is mixed. Oral quinine remains useful in the treatment of uncomplicated P. falciparum malaria, however the six‐dose regimen of artemether‐lumefantrine is an effective alternative.

Conclusion

This case highlights the benefits of artemether‐lumefantrine for mixed‐uncomplicated malaria and the use of primaquine for eradication of liver stages for P. ovale infections.
SHPA Standards of Practice for the Distribution of Medicines in Australian Hospitals
Authors: O'Leary Karen , Burke Rosemary , Kirsa Sue
Published: April 2015

These are standards of professional practice and not standards prepared or endorsed by Standards Australia. They are not legally binding.
A Novel Medicines Management Pathway
Authors: Blennerhassett Jenny D , Cusack Brigitte M , Smith Carlene D , Green Louise , Tribe Kate L
Published: April 2015

Background

A novel medicines management pathway for patients with chronic heart failure was developed and commenced at the Prince of Wales Hospital in 2002.

Aim

To evaluate whether the novel medicines management pathway facilitated by the community liaison pharmacist and medication management review facilitator helped implementation of home medicines reviews and improved medication management.

Method

A survey of general practitioners, community pharmacists, accredited pharmacists and patients was conducted.

Results

General practitioners, community pharmacists and accredited pharmacists reported that the collaboration between the community liaison pharmacist and the medication management review facilitator improved the hospital and community link, and home medicines review implementation. Most patients noted they learnt something new about their medicines and that they could ask more questions of their general practitioner and pharmacist.

Conclusion

This model improved communication between hospital and community and implementation of home medicines reviews in heart failure patients.
Experience with Drotrecogin in Two Australian Hospitals
Authors: Mackenzie Fraser D , Pillans Peter I , Cook David A , Dixon Alexander E , Kubler Paul A
Published: April 2015

Background

Drotrecogin alfa (activated) is a recombinant human activated protein C approved to reduce mortality in patients with severe sepsis. In the PROWESS study, a 28‐day mortality rate of 24.7% was observed in septic patients treated with drotrecogin compared to 30.8% in the placebo group.

Aim

To compare experience in inpatients with sepsis with the published experience and assess compliance with Queensland Hospitals Drug Advisory Committee prescribing protocol.

Method

A retrospective review was conducted using data obtained from patients treated with drotrecogin over a 2‐year period at two Brisbane hospitals. Data collection included patient demographics, presenting condition, past medical history, medications, compliance with the prescribing protocol, clinical outcome and safety.

Results

22 patients were treated with drotrecogin. The mean age was 48.7 years (range 17–81). All patients complied with the protocol inclusion criteria, had evidence of serious infection, required mechanical ventilation and had 2 or more organ failures. 6 patients (27%) died during the 28‐day post‐administration period. A number of patients had significant co‐morbidities including 4 with cirrhosis and 3 with cancer. Patients often received the drug despite having conditions listed as precautions and relative contraindications. There were 2 confirmed cases of serious bleeding complications.

Conclusions

Treatment outcomes were comparable to the original trial results, despite the selection of more critically ill patients. All patients met strict inclusion criteria, but consideration of relative contraindications and co‐morbidities could be improved.
Acceptability of Videoconference Technology for the Delivery of Continuing Education to Rural Pharmacists
Authors: McNamara Kevin P
Published: April 2015

Aim

To investigate whether a rural continuing education (CE) program delivered by videoconference can enhance access to, and uptake of, CE among pharmacists and determine their satisfaction with videoconference for the delivery of CE.

Method

A postal survey was sent to 33 registered pharmacists in south‐west Victoria and south‐east South Australia who had attended at least one videoconference CE session organised in that region.

Results

Respondents worked in different areas of pharmacy, and 40% worked in more than one area of pharmacy. The use of videoconference facilities has increased access to and participation in CE generally, and most participants (88%) have found it to be an acceptable medium for delivery. Increased access to high‐quality CE opportunities, and reduced travel time for CE were seen as the principal benefits of the medium. Negative aspects included technical glitches, organisational issues, and the time‐lag in voice transmission. Overall, most participants were happy to receive a substantial proportion of their contact CE using this medium.

Conclusions

Videoconference technology is a valuable tool for the delivery of carefully structured CE sessions in rural and remote areas with an appropriate information technology infrastructure.
Dosing of Key Renally Cleared Drugs in the Elderly—Time to be Wary of the eGFR
Authors: Roberts Gregory W
Published: April 2015

Background

The Cockroft‐Gault and Modification of Diet in Renal Disease (MDRD) approaches are commonly used to estimate renal function. An optimised version of the Cockroft‐Gault equation also exists. The MDRD approach occasionally generates renal function estimates that are vastly different from the Cockroft‐Gault approach. Due to its ready availability, prescribers are beginning to use the MDRD approach for dosing of renally cleared drugs, despite contrary recommendations.

Aim

To examine differences in renal function estimates between the MDRD against the Cockroft‐Gault and optimised Cockroft‐Gault approaches for a group of elderly hospitalised patients. To examine factors driving these differences and if these differences cause clinically significant differences in the dosing of enoxaparin and gentamicin.

Method

Renal function for 1067 inpatients was calculated. Patients were grouped into quartiles based on the proportional difference between the MDRD against the Cockroft‐Gault and optimised Cockroft‐Gault approaches, respectively. Clinically significant dosing was defined as 2 mg/kg instead of 1 mg/kg for enoxaparin, and ≥ 75% difference for gentamicin dosing.

Results

As the proportional difference in renal function estimates between the MDRD and the Cockroft‐Gault approach increased, patients were progressively older and lighter (p < 0.01). As the difference increased compared to the optimised Cockroft‐Gault version, patients were progressively older, shorter, lighter and female (p < 0.01). Enoxaparin and gentamicin doses from the MDRD approach led to significantly greater doses in 8% and 23% of patients respectively compared to Cockroft‐Gault, and 15% and 37% of patients respectively compared to the optimised Cockroft‐Gault approach. This occurred predominantly in very elderly patients (> 80 years).

Conclusion

The use of MDRD to calculate drug doses in an elderly population leads to greatly increased doses being prescribed compared to the currently recommended approach of using Cockroft‐Gault. This is largely in older patients, who are most at risk of experiencing adverse effects from increased doses. The appropriateness of MDRD for drug dosing in an elderly hospitalised population needs to be assessed urgently, against the possibility that it greatly overestimates renal function in these patients.
Taking Pharmacy on Tour in Vanuatu
Authors: Sanburg Amanda LC
Published: April 2015

Remote villages and health facilities in Vanuatu are visited to help train pharmacy officers, update remote area nurses on pharmaceutical issues and provide community education about appropriate use of medicines and general health issues. Limited communications and irregular visits by medical staff makes a visit by the principal pharmacist and a trainee an occasion for the community. Updates for nurses include latest treatments for common conditions such as malaria, pneumonia, and non‐communicable diseases which are increasing in these communities. Training includes blood glucose machines, repair of medical equipment and cold chain management. Touring allows the trainee pharmacy officers to observe first‐hand the needs of the remote communities. They learn how to assist clinic nurses with their stock ordering and store management. Direct involvement in the medical care of some patients has reinforced their knowledge of drug treatments.
Beta‐Blockers for Treatment of Heart Failure in the Elderly
Authors: Zimmet Hendrik , Krum Henry
Published: April 2015

Pharmacotherapy for heart failure focuses on neurohormonal blocking strategies using predominantly angiotensin converting enzyme inhibitors and beta‐blockers, both conferring improved outcomes in patients with systolic chronic heart failure. Despite this, there is ongoing underutilisation of beta‐blockers in this context in clinical practice. Advanced age is cited as a common reason for non‐prescription of beta‐blockers. The concerns are usually perceived reduced efficacy and tolerability of the drug class. However, beta‐blockers are an efficacious and well‐tolerated treatment in most heart failure patients and recent studies suggest that these benefits extend to the elderly patient population. It is critical to ensure that these findings are translated into practice and that all appropriate patients receive these drugs.
Feasibility of Monitoring Biochemical and Haemodynamic Effects of Angiotensin Converting Enzyme Inhibitors
Authors: Young Janice , Asghar Muhammad N , Yee Julie , Kremer Lisa
Published: April 2015

Background

Angiotensin converting enzyme (ACE) inhibitors reduce mortality and morbidity in heart failure, post‐myocardial infarction and in those at high cardiovascular risk. However, recognised adverse effects contribute to hospital admissions.

Aim

To determine the feasibility of pharmacists collecting clinical data for ACE inhibitor prescribing and to inform the development of a hospital prescribing indicator set to measure the quality of monitoring for ACE inhibitors.

Method

A paper‐based survey was conducted over 8 weeks. All patients admitted to a medical ward who were admitted on or started on ACE inhibitors were included. Data were collected prospectively and included serum creatinine, urea and potassium, and blood pressure measurements. These data were reviewed and compared against the parameter set for the indicator prepared.

Results

29 patients were included in the analysis and cilazapril was most frequently prescribed (17, 57%). Blood pressure was recorded less frequently in new patients (7.7 vs 17.8). Creatinine was above normal on 47 (52%) occasions and 13 patients had an elevated level on at least one occasion. Creatinine was measured on average 3.1 times during the admission. Urea was measured for 15 (52%) patients, not measured for 14 patients and was measured for only one patient before prescribing an ACE inhibitor for the first time. Potassium was checked less frequently in new patients (average 2.5 vs 3.6 times per admission).

Conclusion

This study confirmed that it is possible for pharmacists to collect and collate clinical and prescribing data as part of a routine monitoring program for inclusion in a hospital prescribing indicator set. Data can be collected, analysed and reported back to clinical teams in a short time. The results suggest that inpatients receiving ACE inhibitors are adequately monitored for adverse biochemical effects.
Neonatal Epilepsy Associated with Maternal Ingestion of Blue Cohosh
Authors: MacPherson Ross D , Kilminster Ian
Published: April 2015

Aim

To describe a case of neonatal epilepsy associated with maternal ingestion of blue cohosh.

Clinical details

A 32‐year‐old female consumed a mixture of blue cohosh, raspberry leaf and squaw vine for 4 days in late pregnancy to hasten the onset of labour. After delivery, the neonate showed signs consistent with status epilepticus which was confirmed by electroencephalogram and treated accordingly.

Outcome

The neonatal epilepsy settled with conventional treatment and there were no long‐term sequelae.

Conclusion

Evidence of adverse effects associated with complementary and alternative medicines continues to accumulate. Patients must be specifically questioned about their use of complementary and alternative medicines. This case report suggests a possible association between blue cohosh and neonatal epilepsy.
Medication Safety Series
Authors: Thornton Penny
Published: April 2015

This series brings you up‐to‐date information about medication safety issues and strategies to prevent medication errors. It draws on Australian incidents and US experience, including (with permission) material from ISMP Medication Safety Alert! a bulletin published by the Institute for Safe Medication Practices, USA . This series is coordinated through the Committee of Specialty Practice in Medication Safety (Chair, Rosemary Burke, Director of Pharmacy, Concord Hospital, NSW). Australian incidents are collated and editorial recommendations made by Penny Thornton (Federal Councillor, SHPA, and Pharmacy Services Manager, The Children's Hospital, NSW; e‐mail: pennyt2@chw.edu.au).
Pharmacoeconomics: a Reliable Tool for Decisions on New Medicines?
Authors: Chesney Kate , Barazanchi Noora , Billy Ruth , Koo Jessica , Rabih Nancy , Slaimankhel Jamila , Tordoff June M
Published: April 2015

Aim

To provide a literature‐based review of the reliability of pharmacoeconomics as a tool for decisions on new medicines.

Method

Medline and Embase databases were searched. Articles published in English in peer‐reviewed journals were selected according to relevance, and bibliographies searched for other relevant articles. All articles were assessed for information and opinions on the use of pharmacoeconomics, methodology and quality of studies, and reliability in decision‐making.

Results

Over 1000 articles were retrieved and 120 selected for review. The review indicated that, although pharmacoeconomics is increasingly used in decision‐making, its methodology is still developing. Methodological guidelines, well‐established in some countries, can improve the quality of studies, but there is scope for improvement in adherence to guidelines. To improve confidence in pharmacoeconomics, studies need to be peer‐reviewed by experts before publication. Bias, unintentional or otherwise, can be found in all types of economic analysis and needs to be considered. To avoid bias, methodological guidelines should be closely adhered to, and all financial interests and sources of funding disclosed. There is a need to educate users to understand economic analysis, recognise any inherent bias, and assess the quality of the studies they intend to use.

Conclusion

Providing methodological guidelines are followed, methodology is transparent, and bias is minimised, pharmacoeconomics can be a reliable tool to assist in decisions on the introduction of new medicines.
Stability Implications of Repackaging Paracetamol Tablets into Dose Administration Aids
Authors: Haywood Alison , Mangan Martina , Glass Beverley
Published: April 2015

Background

Despite the widespread use of dose administration aids (DAAs) there is little available data on the stability of drugs during repackaging or storage in these devices.

Aim

To investigate the physicochemical stability of paracetamol tablets repackaged in DAAs.

Method

Physicochemical stability studies were performed on a commonly used paracetamol tablet directly after heat‐sealing in a DAA frequently employed in practice, then at ambient (25 °C; 60% relative humidity) and accelerated (40 °C; 75% relative humidity) conditions, over a 3‐month period. Physical characteristics of the tablets (weight uniformity, physical appearance, thickness, hardness, friability, disintegration, dissolution rates) were evaluated at time = 0, directly after heat‐sealing, 1 month and 3 months. Chemical stability was confirmed by high performance liquid chromatography (HPLC). The results were compared to control samples stored in the original packaging at the various environmental conditions studied.

Results

All compendial requirements for physicochemical stability were met for both ambient and accelerated conditions over the 3‐month period. Chemical stability of paracetamol content fell within the required range of 95–105% of the labelled amount, for all environmental conditions.

Conclusion

This study provides evidence on the stability of paracetamol tablets in a DAA, to support pharmacists in making sound clinical and operational decisions regarding the repackaging of paracetamol in these devices.
Survey of Clopidogrel Use in a Teaching Hospital
Authors: Armenores Paul , Wiltshire Stephanie L , Tonkin Anne L , Shakib Sepehr
Published: April 2015

Aim

To develop guidelines for clopidogrel prescribing and survey its use to ascertain the need for changes in prescribing patterns.

Method

Guidelines were developed after a literature review. Prescribing patterns were assessed by a cross‐sectional survey which investigated the therapy of inpatients identified taking clopidogrel at a teaching hospital over a 2‐month period. Measures of concordance were indications for clopidogrel, contraindications to NSAIDs, timing and range of clopidogrel dosage and associated use of aspirin.

Results

Data were collected from 69 patients. 29 (42%) were taking clopidogrel for secondary prevention of ischaemic heart disease—14 for appropriate indications. 23 (33%) were given clopidogrel before and/or following percutaneous coronary intervention—11 had an appropriate combined aspirin and clopidogrel loading dose, and 20 had appropriate combined long‐term therapy. 15 (22%) received clopidogrel for secondary prevention of cerebrovascular disease and 7/15 had appropriate indications. 2 (2.9%) patients with peripheral vascular disease and 1 (1.4%) with chronic atrial fibrillation were treated directly with clopidogrel. 3 (4.3%) patients had unknown indications.

Conclusions

A large proportion of clopidogrel prescribing did not have a good evidence base. For safety and economic reasons, prescribers need to be made aware of current evidence and recommendations.