bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a Carbon Paste Electrode Modified with Reduced Graphene Oxide and an Imidazole Derivative for Simultaneous Determination of Biological Species of N‐acetyl‐L‐cysteine, Uric Acid and Dopamine
Authors: Benvidi Ali , Dalirnasab Sudabeh , Jahanbani Shahriar , Tezerjani Marzieh Dehghan , Ardakani Mohammad Mazloum , Mirjalili Bi‐Bi Fatemeh , Zare Reza
Published: March 2016

In this work, the modified carbon paste electrode (CPE) with an imidazole derivative 2‐(2,3 dihydroxy phenyl) 4‐methyl benzimidazole (DHPMB) and reduced graphene oxide (RGO) was used as an electrochemical sensor for electrocatalytic oxidation of N‐acetyl‐L‐cysteine (NAC). The electrocatalytic oxidation of N‐acetyl‐L‐cysteine on the modified electrode surface was then investigated, indicating a reduction in oxidative over voltage and an intensive increase in the current of analyte. The scan rate potential, the percentages of DHPMB and RGO, and the pH solution were optimized. Under the optimum conditions, some parameters such as the electron transfer coefficient (α) between electrode and modifier, and the electron transfer rate constant) ks) in a 0.1 M phosphate buffer solution (pH=7.0) were obtained by cyclic voltammetry method. The diffusion coefficient of species (D) 3.96×10−5 cm2 s−1 was calculated by chronoamperometeric technique and the Tafel plot was used to calculate α (0.46) for N‐ acetyl‐L‐cysteine. Also, by using differential pulse voltammetric (DPV) technique, two linear dynamic ranges of 2–18 µM and 18–1000 µM with the detection limit of 61.0 nM for N‐acetyl‐L‐cysteine (NAC) were achieved. In the co‐existence system of N‐acetyl‐L‐cysteine (NAC), uric acid (UA) and dopamine (DA), the linear response ranges for NAC, UA, and DA are 6.0–400.0 µM, 5.0–50.0 µM and 2.0–20.0 µM, respectively and the detection limits based on (C=3sb/m) are 0.067 µM, 0.246 µM and 0.136 µM, respectively. The obtained results indicated that DHPMB/RGO/CPE is applicable to separate NAC, uric acid (UA) and dopamine (DA) oxidative peaks, simultaneously. For analytic performance, the mentioned modified electrode was used for determination of NAC in the drug samples with acceptable results, and the simultaneous determination of NAC, UA and DA oxidative peaks was investigated in the serum solutions, too.
An Electrochemical Study of the Surface Hybridization Process of Morpholino‐DNA: Thermodynamics and Kinetics
Authors: He Yakai , Zhang Jing , Ruffin Sade , Ji Lina , Wang Kang , Levicky Rastislav , Xia Xinghua
Published: March 2016

Morpholino (MO) is a neutral analogue of DNA, which shows promise in the development of DNA biosensors and diagnostic devices. The present study explores the hybridization process of a surface‐attached MO 22‐mer with 10‐mer and 20‐mer DNA targets on a gold electrode. The melting process of the MO‐DNA duplex at the electrode/buffer interface is recorded using cyclic voltammetry. These results show that the length of target DNA, the binding location of the target DNA on the surface‐immobilized MO chain, and electrostatic forces from neighbouring duplexes all modulate the stability and hybridization kinetics of the DNA targets with the MO probes. Melting temperatures for immobilized MO‐DNA duplexes are found to be insensitive to ionic strength, provided the duplexes do not have a linker. Although the melting temperature does not shift appreciably with ionic strength, the maximum hybridization yield does. This somewhat surprising observation is considered to originate from an electrostatic limit on the extent of attainable hybridization. It is also reported that hybridization tends to initiate at the upper half of MO probes.
Towards an Integrated Microneedle Total Analysis Chip for Protein Detection
Authors: Miller Philip , Moorman Matthew , Manginell Ron , Ashlee Carlee , Brener Igal , Wheeler David , Narayan Roger , Polsky Ronen
Published: March 2016

Real‐time monitoring of an individual’s physiologic state without constant observation by a healthcare professional necessitates the construction of an autonomous remote diagnostic device that is capable of performing a wide range of diagnostic functions. For many applications, assessing the immediate physiologic state of an individual as he or she is continuously exposed to diverse environments would require complex dynamic chemical processing scenarios that are capable of real time readouts. We seek to answer these problems by combining in vivo microneedle platforms with multifunctional lab‐on‐chip electrode arrays that are capable of detecting a wide variety of relevant biomarkers. The results presented here provide an important proof‐of‐concept demonstration of integration of microneedles with a microchip platform containing fluidic channels and electrode transducers. As shown by immunoassay detection of myoglobin and troponin, such a device may be used to extract interstitial fluid and monitor biologically important molecules.
Lung cancer in never smokers in the UK Million Women Study
Authors: Pirie Kirstin , Peto Richard , Green Jane , Reeves Gillian K. , Beral Valerie ,   for the Million Women Study Collaborators
Published: March 2016

To assess directly the effects of various risk factors on lung cancer incidence among never smokers, large prospective studies are needed. In a cohort of 1.2 million UK women without prior cancer, half (634,039) reported that they had never smoked. Mean age at recruitment was 55 (SD5) years, and during 14 (SD3) years of follow‐up, 0.2% (1,469) of these never smokers developed lung cancer. Cox regression was used to estimate relative risks (RRs) of lung cancer for 34 potential risk factors, of which 31 were nonsignificant (p > 0.05). The remaining three risk factors were associated with a significantly increased incidence of lung cancer in never smokers: non‐white vs. white ethnicity (RR = 2.34, 95% CI 1.55–3.52, p < 0.001), asthma requiring treatment vs. not (RR = 1.32, 1.10–1.58, p = 0.003) and taller stature (height ≥ 165 cm vs. <160 cm: RR = 1.16, 1.03–1.32, p = 0.02). There was little association with other sociodemographic, anthropometric or hormonal factors, or with dietary intakes of meat, fish, fruit, vegetables and fiber. The findings were not materially affected by restricting the analyses to adenocarcinomas, the most common histological type among never smokers.
Motion‐free endoscopic system for brain imaging at variable focal depth using liquid crystal lenses
Authors: Bagramyan Arutyun , Galstian Tigran , Saghatelyan Armen
Published: March 2016

We present a motion‐free system for microendoscopic imaging of biological tissues at variable focal depths. Fixed gradient index and electrically tunable liquid crystal lenses (TLCL) were used to build the imaging optical probe. The design of the TLCL enables polarization‐independent and relatively low‐voltage operation, significantly improving the energy efficiency of the system. A focal shift of approximately 74 ± 3 µm could be achieved by electrically controlling the TLCL using the driving frequency at a constant voltage. The potential of the system was tested by imaging neurons and spines in thick adult mouse brain sections and in vivo, in the adult mouse brain at different focal planes. Our results indicate that the developed system may enable depth‐variable imaging of morpho‐functional properties of neural circuitries in freely moving animals and can be used to investigate the functioning of these circuitries under normal and pathological conditions.

magnified image
Role of PTHrP(1‐34) Pulse Frequency Versus Pulse Duration to Enhance Mesenchymal Stromal Cell Chondrogenesis
Authors: Fischer Jennifer , Ortel Marlen , Hagmann Sebastien , Hoeflich Andreas , Richter Wiltrud
Published: March 2016

Generation of phenotypically stable, articular chondrocytes from mesenchymal stromal cells (MSCs) is still an unaccomplished task, with formation of abundant, hyaline extracellular matrix, and avoidance of hypertrophy being prime challenges. We recently demonstrated that parathyroid hormone‐related protein (PTHrP) is a promising factor to direct chondrogenesis of MSCs towards an articular phenotype, since intermittent PTHrP application stimulated cartilage matrix production and reduced undesired hypertrophy. We here investigated the role of frequency, pulse duration, total exposure time, and underlying mechanisms in order to unlock the full potential of PTHrP actions. Human MSC subjected to in vitro chondrogenesis for six weeks were exposed to 2.5 nM PTHrP(1‐34) pulses from days 7 to 42. Application frequency was increased from three times weekly (3 × 6 h/week) to daily maintaining either the duration of individual pulses (6 h/day) or total exposure time (18 h/week; 2.6 h/day). Daily PTHrP treatment significantly increased extracellular matrix deposition regardless of pulse duration and suppressed alkaline‐phosphatase activity by 87%. High total exposure time significantly reduced cell proliferation at day 14. Pulse duration was critically important to significantly reduce IHH expression, but irrelevant for PTHrP‐induced suppression of the hypertrophic markers MEF2C and IBSP. COL10A1, RUNX2, and MMP13 expression remained unaltered. Decreased IGFBP‐2, ‐3, and ‐6 expression suggested modulated IGF‐I availability in PTHrP groups, while drop of SOX9 protein levels during the PTHrP‐pulse may delay chondroblast formation and hypertrophy. Overall, the significantly optimized timing of PTHrP‐pulses demonstrated a vast potential to enhance chondrogenesis of MSC and suppress hypertrophy possibly via superior balancing of IGF‐ and SOX9‐related mechanisms. J. Cell. Physiol. 231: 2673–2681, 2016. © 2016 Wiley Periodicals, Inc.
Use of Antipsychotics for the Treatment of Behavioral Symptoms of Dementia
Authors: Greenblatt H. Karl , Greenblatt David J.
Published: March 2016

Antipsychotic medications are widely used in the management of behavioral and psychological symptoms of dementia. While nonpharmacological interventions should be the first‐line treatment for behavioral symptoms of dementia, these are often unfeasible and/or ineffective. Conventional and atypical antipsychotic agents appear to have modest to moderate clinical efficacy in the treatment of these symptoms, though it is unclear which individual agents are most effective. No conclusive evidence exists that any available alternative medications are safer and more effective than antipsychotics. A number of studies have shown an increased risk of mortality associated with antipsychotics in patients with behavioral symptoms of dementia, though the observed risk increase may be partially confounded by illness severity and/or preexisting health determinants. The mechanisms of increased mortality risk are not fully established, but are likely to involve cardiovascular events. It is probable, though not certain, that conventional antipsychotics are associated with a greater number of poor outcomes than atypical antipsychotics. In certain patients with refractory behavioral symptoms, antipsychotics are a viable treatment option. Key considerations for antipsychotic prescribing for this population are published in regulatory guidelines, and include minimization of dosage and duration of treatment, continuous reevaluation of symptoms, and involvement of caregivers.
Loss of skeletal muscle during neoadjuvant chemotherapy is related to decreased survival in ovarian cancer patients
Authors: Rutten Iris J.G. , van Dijk David P.J. , Kruitwagen Roy F.P.M. , Beets‐Tan Regina G.H. , Olde Damink Steven W.M. , van Gorp Toon
Published: March 2016

Background

Malnutrition, weight loss, and muscle wasting (sarcopenia) are common among women with advanced ovarian cancer and have been associated with adverse clinical outcomes and survival. Our objective is to investigate overall survival (OS) related to changes in skeletal muscle (SM) for patients with advanced ovarian cancer treated with neoadjuvant chemotherapy and interval debulking.

Methods

Ovarian cancer patients (n = 123) treated with neoadjuvant chemotherapy and interval debulking in the area of Maastricht (the Netherlands) between 2000 and 2014 were included retrospectively. Surface areas of SM and adipose tissue were defined on computed tomography at the level of the third lumbar vertebra. Low SM at baseline and SM changes during chemotherapy were compared with Kaplan Meier curves, and Cox‐regression models were applied to test predictors of OS.

Results

Median OS for patients who lost SM (n = 83) was 916 ± 99 days, which was significantly different from median OS for patients who maintained or gained SM (n = 40), which was 1431 ± 470 days (P = 0.004). Loss of SM was also a significant predictor of OS in multivariable Cox‐regression analysis (hazard ratio 1.773 (95%CI: 1.018–3.088), P = 0.043). Low baseline SM did not influence survival.

Conclusions

Patients with ovarian cancer have a worse survival when they lose SM during neoadjuvant chemotherapy. Evaluation of low SM at a specific time point is not prognostic for OS. External and prospective validation of these findings is imperative. Nutritional, pharmacological, and/or physical intervention studies are necessary to establish whether SM impairment can be prevented to prolong ovarian cancer survival.
Anaphylactic Shock Following Intravenous Vitamin K1
Authors: Corallo Carmela E , Gillett Mark
Published: March 2016

Aim: To describe a case of anaphylactic shock following the intravenous administration of vitamin K1

Clinical features: A 64‐year‐old male was admitted to intensive care following repair of an aortic abdominal aneurysm. Intravenous amiodarone, ceftriaxone, vancomycin and metronidazole were commenced without incident. During the administration of intravenous vitamin K1 (phytomenadione, Konakion) the patient developed a rash, hypotension and severe bronchospasm.

Outcome: The patient recovered following paralysis, manual ventilation, and standard medication for anaphylaxis.

Conclusion: Intravenous administration of vitamin K1 and other drugs solubilised with polyoxyl 35 castor oil occasionally causes severe anaphylactic shock. A new colloidal formulation may reduce the hazards of intravenous vitamin K1 administration.

Aust J Hosp Pharm 1997; 27: 146–7.
Compatibility and Stability of Drug Adjuvants and Morphine Tartrate in 10 mL Polypropylene Syringes
Authors: Targett Paul L , Keefe Patrick A , Merridew Colin G
Published: March 2016

Objective:Analgesics and a number of other adjuvant drugs are often given by subcutaneous infusions in palliative care. We studied the physical compatibility and chemical stability of adjuvant drugs with morphine tartrate in solutions stored in 10 mL polypropylene syringes. Two formulations were examined:
A — morphine tartrate 400 mg, droperidol hydrochloride 2 mg, dexamethasone sodium phosphate 8 mg, hyoscine butylbromide 20 mg and midazolam hydrochloride 8 mg, (volume 10 mL); and
B — morphine tartrate 40 mg, droperidol hydrochloride 2 mg, dexamethasone sodium phosphate 8 mg, hyoscine butylbromide 20 mg, midazolam hydrochloride 5 mg and sodium chloride 0.9% for injection to 10 mL.

Method: The solutions were stored in the dark, at either 21–23°C or 4–8°C, for two weeks. At intervals of two to three days the concentrations of the drugs were measured in duplicate samples from each of three syringes using a stability‐indicating high performance liquid chromatography assay (HPLC). Physical compatibility was assessed visually.

Results: At 4–8°C all drugs in both formulations remained stable throughout the study period. At 21–23°C midazolam retained greater than 90% of its initial concentration for only 12 days (formulation A) and 5 days (formulation B). All other drugs remained stable in both formulations for two weeks. There was no visible change in the appearance of any solution stored at 4–8°C, whereas at 21–23°C, a slight straw colour developed in formulation A over two weeks. At neither storage temperature did the pH of any solution vary by more than 0.2 from initial values.

Conclusion: The two formulations tested were stable over the two‐week study period at 4–8°C. When stored at 21–23°C there was significant degradation of midazolam in both formulations. Based on this work, it would appear acceptable practice to supply palliative care patients with prefilled syringes of these formulations with a shelf‐life of up to 14 days with directions for storage at 4–8°C.

Aust J Hosp Pharm 1997; 27: 207–12.
Checking Prescriptions Before Dispensing
Authors: O'Shea Timothy J
Published: March 2016

To determine the value of pharmacists checking prescriptions against medication charts before dispensing.
The Accuracy of a Paediatric Dosing Device
Authors: Monk Paula M , Ball Patrick A
Published: March 2016

A device commonly supplied by pharmacies for measuring paediatric oral liquid medicines was examined for accuracy in the hands of different operators and with liquid medicines of different characteristics. The device provided acceptable accuracy with water, but not with glycerol or paracetamol suspension. It may not be suitable for use with viscous liquids.
Anticoagulation in Older People
Authors: Thurlow Peter J
Published: March 2016

The increased incidence, morbidity and mortality of thrombotic or thromboembolic events in older people necessitates an aggressive anticoagulant approach. However this needs to be tempered by the increased haemostatic risks with increasing age.
Optimisation of Drug Delivery 3. Sustained/Controlled‐Release Oral Drug Delivery
Authors: Benson Heather AE , Prankerd Richard J
Published: March 2016

The present article reviews in detail some mechanisms by which modification of drug release from oral dosage forms can be achieved. Biopharmaceutical and physicochemical characteristics of drugs suitable for modified release are outlined. Design considerations for sustained‐release and delayed‐release devices are then reviewed.
A Cup of Tea, My Pharmacist and Me Can Extended Communication Make the Difference?
Authors: Colgan Janice E
Published: March 2016

This project sought to demonstrate that quality of medication use can be improved by extending the professional roles of hospital and community pharmacists acting in concert to select at‐risk groups, and by adopting a team approach with other relevant healthcare practitioners each contributing to the pharmacist/patient interactive process.
Optimisation of Drug Delivery: 4. Transdermal Drug Delivery
Authors: Benson Heather AE , Prankerd Richard J
Published: March 2016

This article reviews the current status and possible future directions for transdermal drug delivery. Skin penetration is briefly discussed and chemical and physical enhancer methods to increase skin penetration are outlined. Design considerations for transdermal drug delivery systems and products available in Australia are reviewed.
Wound Management in Older People
Authors: Fergusson James AE , MacLellan Donald G
Published: March 2016

Wound management has witnessed revolutionary changes over the past few years. Research has revealed an enormous amount of information on the science of tissue repair and the range of modern moist wound pharmaceuticals has grown exponentially. Despite these improvements, patients still languish for months and even years with unhealing wounds due to inferior wound management. The majority of these patients are in the older population and have requirements for special consideration of their wound healing capacity. In reviewing wound management in older people, it is hoped that health professionals will be able to redouble their efforts to achieve optimum healing rates.
Optimisation of Drug Delivery: 5. Pulmonary Drug Delivery
Authors: Benson Heather AE , Prankerd Richard J
Published: March 2016

This article reviews the origins, current status and possible future directions for drug delivery by the pulmonary route. Deposition of drugs in the lungs is briefly discussed and methods to improve pulmonary bioavailability are outlined. Design aspects of pulmonary drug delivery systems and products available in Australia are reviewed.
Development of a Manual of Indicators for Drug Use in Australian Hospitals
Authors: Rowe Leanne , Weekes Lynn M
Published: March 2016

Indicators are measurement tools that assist healthcare practitioners to evaluate, and potentially improve, the level and quality of care and services provided to patients and other customers. For example, an indicator can measure the percentage of changes in prescribing following a pharmacy intervention.
Methadone Programs, Harm Reduction, Chronic Diseases and Hospital Pharmacists
Authors: Berbatis Con G
Published: March 2016

Hospital pharmacists have lagged behind their community colleagues in their involvement with methadone programs. In this paper, I report important developments in the area of harm reduction (with emphasis on methadone programs) and draw important analogies between treating addiction and chronic diseases. Opportunities for hospital pharmacists to sytematically introduce new activities are evident in these growing areas of health care.
Drug Management in the Palliative Care of Older People
Authors: Lightfoot Tim C
Published: March 2016

The elderly patient with advanced cancer frequently suffers from a multiplicity of symptoms and comorbidities. These, in combination with the physiological effects of ageing, predispose such patients to adverse effects of drugs frequently used in palliative care. An understanding of the altered pharmacokinetic and side effect profiles of these drugs in the elderly is required to optimise patient management. The application of these principles to selected drugs is discussed.
Patterns of Analgesic Prescribing for Patients with Chronic Non‐Malignant Pain in NSW
Authors: Bramley‐Moore Susan R , Wodak Alex D , Day Richard O , Lauchlan Roberta L
Published: March 2016

To describe the patterns of opioid analgesic use for the treatment of chronic, non‐malignant pain in NSW. The hypothesis examined was that some prescribing for this condition was inappropriate.
Ketamine in Chronic Pain: A Review
Authors: Davis Sharon R
Published: March 2016

Ketamine is a dissociative anaesthetic agent that has been used clinically for a wide range of indications for over 25 years. Recently there has been interest in the mechanism of its analgesic effect and its utility in the treatment of pain caused by chronic disease, especially neuropathic pain. Despite the popularity of ketamine as a single oral dose especially in paediatric analgesia, the drug has not often been given orally on a continuous basis for any indication. This article reviews the published evidence for ketamine in chronic pain.
Optimisation of Drug Delivery 6. Modified‐Release Parenterals
Authors: Benson Heather AE , Prankerd Richard J
Published: March 2016

This article reviews the origins, current status and possible future directions for drug delivery using modifiedrelease parenteral products, including implants. The physicochemical bases for modified drug release profiles, their advantages and disadvantages, and their application to specific drugs are outlined. Design aspects of injectable modified‐release products available in Australia are reviewed.
Clinical Pharmacy Input into a Respiratory Rehabilitation Program
Authors: Alderman Christopher P
Published: March 2016

Multidisciplinary respiratory rehabilitation programs have been recognised as a useful tool for the long‐term management of chronic obstructive airways disease, and are commonly directed at alleviating symptoms and addressing issues such as secondary deconditioning and emotional sequelae associated with chronic respiratory disease. There is very little specific literature outlining the role for clinical pharmacists in the provision of these programs. Aspects of a multidisciplinary respiratory rehabilitation program are described here, with a particular emphasis on the clinical pharmacy component addressing quality use of medicines issues for patients affected by chronic respiratory disease.
Hospital Pharmacists and the Challenge of Quality
Authors: Larmour Ian , Creber Elizabeth S , Manser Allan J , Wong Emma M , Wood Mary J
Published: March 2016

This review outlines an approach to quality enhancement in hospital pharmacy practice. Quality programs require planning, organisation, monitoring, correction of problems, and feedback to clients, customers and staff. Standards to be attained must be carefully selected and acceptable to all relevant staff. Peer review is useful for pharmacists working outside the department (e.g. ward pharmacists). Quality circles involve all relevant staff working in a particular area with a specific problem to be solved. Pharmacy departments should have an overall quality plan with long‐term and short‐term goals which compliment the hospital's quality improvement program. The financial cost of implementing quality programs in hospital pharmacy should be considered in the context of the cost of ‘quality failure’ to the hospital.
Medication Alert Cards to Minimise Antidepressant Drug Interactions
Authors: Alderman Christopher P
Published: March 2016

Some of the newer antidepressants, such as the selective serotonin reuptake inhibitors and nefazodone, are associated with potentiaily serious drug interactions. Some medication alert cards were developed to decrease the likelihood that patients treated with antidepressant agents wiii be adversely affected by drug interactions.
Pharmaceutical Calculations Student Evaluation of Computer‐Assisted Learning
Authors: Pappas Arthur , Cesnik Branko , Roller Louis , Sorgetti Len
Published: March 2016

Objectives:To evaluate a networked computer‐based module consisting of a Tutorial Program covering 14 topics on pharmaceutical calculations and a Test Program with 271 multiple choice questions assessing knowledge of each of the topics. First‐year pharmacy students used the program for 74 days in 1996 and 127 days in 1997.

Study Procedure:Forty‐eight students (1996 group) were evaluated by questionnaire two months after program release. Data were collected on module use for both 1996 and 1997 release periods.

Results:Highorvery highratings were provided by 72‐83% of respondents for the Tutorial Program objectives and by 72‐76% of respondents for the Test Program objectives. From 70 to 87% of respondents considered the modulebetterormuch betterthan other study methods. About 74% perceived the package to have beenusefulorvery usefulin improving their overall knowledge of the subject and 80% gave the same rating as a final exam preparation. The average class mark for 1996 and 1997 final exams increased significantly but our study cannot directly attribute that result to the module.

Conclusions:Students responded to this module very enthusiastically. It was evident from their feedback that they derived significant benefit from this comprehensive resource that also allowed the flexibility of independent revision.
A Quality Assurance Audit for an Aseptic Dispensing Facility
Authors: Richards Catherine V
Published: March 2016

Aim: To adapt UK quality assurance guidelines for aseptic preparation services for use in an Australian hospital pharmacy.

Method: The UK guidelines were compared with current New South Wales and Australian standards and an audit document prepared for local use.

Result: An internal audit was performed and highlighted some areas for improvement. External audits are planned.

Conclusion: A comprehensive quality assurance audit document has been prepared for aseptic dispensing. When all criteria are met it will be possible to extend the expiry of stable, aseptically prepared products.
A Guide to Pharmacy Technicians on Safe Handling of Cytotoxics
Authors: Oldman Robyn
Published: March 2016

Aim: To review the safe handling of drugs with mutagenic or cytotoxic properties and create guidelines for pharmacy technicians.

Conclusions: It is evident from this review that both pharmacists and technicians involved in the production of mixtures and injectables for oncology patients need a sound knowledge of actions and uses of cytotoxics, necessary training in safe handling, safe storage and response in case of spills. The pharmacy department should have written procedures and educational programs to accomplish these requirements. Occupational Health and Safety issues are an important factor in the handling of cytotoxics. Personnel who are regularly exposed to cytotoxic drugs during sterile production should have periodic blood tests, and those experiencing adverse effects consult a medical officer.
Management of Chronic Pain in Older People
Authors: Workman Barbara S
Published: March 2016

Chronic pain is common in older people as a result of the accumulation of chronic disease processes with age. However, pain is not a normal consequence of physiological ageing alone. Epidemiological data on chronic pain in older people show increasing prevalence to age 70 years and a high prevalence in some subgroups such as those living in residential care who tend to be frail, with multiple medical problems.

Management of chronic pain requires a diagnosis of the source(s) of pain and an understanding of the impact other medical, physical and psychological problems may have on making the diagnosis and implementing treatment. Physiological changes with ageing may also affect the choice of therapy in the elderly.

Analgesics and other pharmacological therapies are of prime importance and best used in a regimen to suit individual lifestyles. Combined with physical, functional, and psychological strategies, the aim of pain management is to achieve optimum reduction in pain sensation, improvement in independence and help the older person achieve a good quality of life.
Drug Information Services in Victoria: Please Don't Follow This Leader
Authors: Saunders Alan
Published: March 2016

One day recently I arrived home from work and picked up the day's mail. Nothing extraordinary about that.
Drug Use Evaluation ofVancomycin Based on Hospital Policy and Published Guidelines
Authors: Rayner Craig R , Ioannides‐Demos Lisa L , Vujovic Olga , Spelman Denis , Spicer W John , Tong Nicholas , Krum Henry
Published: March 2016

To evaluate the appropriateness of vancomycin inpatient use at a tertiary referral teaching hospital against existing hospital guidelines and other published guidelines on vancomycin usage (the US Hospital Infection Control Practices Advisory Committee [HICPAC]) guidelines, and the Victorian Drug Usage Advisory Committee [VDUAC] guidelines).
Reducing Inappropriate Prescribing of Vancomycin
Authors: Radford James M , Whitby Michael , Looke David , Cardiff Lynda
Published: March 2016

To determine the success of institutional guidelines combined with a restrictive policy and an educational program in limiting inappropriate prescribing of vancomycin.
Hospital Pharmacy Practice Its Place in the Future
Authors: Sansom Lloyd N
Published: March 2016

As a South Australian, I am especially proud to be associated with this meeting and I would like to thank the organising committee for inviting me to speak.
Extravasation of High‐Dose Methotrexate A Case about Nothing
Authors: Ang Tzin‐Siu , Siderov Jim
Published: March 2016

The effective management of cytotoxic drug extravasation is limited by the lack of published data on which to base treatments. Methotrexate (MTX) is an antineoplastic agent used in a wide variety of tumours. However, there are no published data on the sequelae from extravasation of high‐dose MTX. These two case reports give some insight into the sequelae from high‐dose MTX extravasation, and some guidance on treatment.
Time Utilisation Study of Pharmacy Support Staff in Western Australia
Authors: Parkinson Alison M , Burford Oksana J
Published: March 2016

To determine the time spent on various tasks performed by pharmacy assistants and technicians, and to relate those tasks to educational requirements for each staff category.
Controversies in Vaccination with Measles, Mumps, Rubella (MMR) Vaccine
Authors: Bailey Murray
Published: March 2016

Many people remember the extensive adverse publicity surrounding pertussis vaccine in the 1970s which led to public concern about the safety of vaccines. Subsequently, follow‐up indicated no causal link between pertussis vaccination and brain damage although the risk of recurrent collapse (shock‐like syndrome or so‐called hypotonic‐hyporesponsive episode) with a benign outcome, after such vaccination is higher than the background rate
Precipitation of Potassium Sulphate During TPN Solution Admixture
Authors: Ambados Fotios , Brealey John
Published: March 2016

Total parenteral nutrition (TPN) solutions are diverse multicomponent pharmaceuticals of variable content with a considerable potential for physicochemical interaction between additives. 1 Monovalent cations do not usually lead to incompatibilities, 2 unless the solubility product of a salt is exceeded then precipitation will occur.
First‐Aid Treatment of Dermal Exposure to Hydrofluoric Acid
Authors: Beulke Suzanne H
Published: March 2016

Hydrofluoric acid (HF) is a highly toxic acid that is widely used in industry (in cleaning and etching of glass, metal, silicone, stone and porcelain; in the production of fluorides, plastics, germicides and insecticides; and in enamelling and galvanising iron, pickling stainless steel, analytical and dye chemistry, brewing, etc.) as well as in household products (alloy wheel cleaners, rust‐and water‐stain removers).
Computer‐Assisted Exam Revision by Pharmacy Students
Authors: Pappas Arthur , Cesnik Branko , Sorgetti Len
Published: March 2016

Objectives:Various versions of a computer program were developed and evaluated between 1994 and 1997 to assist first year students independently revise for a final examination. With the ongoing upgrade of hardware at the Victorian College of Pharmacy over this period, the software was piloted on stand‐alone machines followed by extensive use in a networked environment (N) and finally on disk (D) to enable home use.

Study Procedure:Improved versions of the software were implemented over the four years. Each group of students that was exposed to the software was surveyed by questionnaire between one to two months after release. Data on program use was collected for both 1995 and 1996 networked versions.

Results:Students were asked to rate various aspects of the program. High or very high ratings were given for the objectives of each version: N[1995] (68‐92%); N[1996] (66‐94%) and D (79‐98%). The programs were rated better or much better than paper‐based exams: N[1995] (69‐91%); N[1996] (77‐90%) and D (58‐93%). The number of program features were increased with each new version and most students rated them as useful or very useful.

Conclusions:Overall, students responded very positively to this program as a mode of independent revision. The limitation of campus computer access (15 computers to serve all students) was greatly reduced when the program was available on floppy disk. We believe that the wide range of program features increased the value and attraction of this mode for selftesting.
Survey of Pharmacy Services and Drug Usage in Victorian Public Hospital HITH Programs
Authors: Ioannides-Demos Lisa L
Published: March 2016

Objective: To determine the extent of pharmacy services and drug usage for Hospital‐in‐the‐Home (HITH) programs in Victoria.

Method: In 1997, 42 Victorian hospital pharmacies with HITH services were surveyed by a questionnaire on services and drug usage over the previous six months.

Results: Of the 29 hospital pharmacies which responded, 5 were not providing services, 16 provided 6‐month drug usage data and 15 provided drug expenditure data. Pharmacy staffing varied from a dedicated HITH pharmacist actively involved in patient management to no pharmacy involvement beyond drug dispensing. The range of pharmacy services provided included: preparation of intravenous additives; development of drug and administration protocols; care plans (including allergy and anaphylaxis procedures); supply of information regarding drug stability, storage and appliances, and consumer medicine information; patient counselling; therapeutic drug monitoring; and dosing advice.

The data on drug usage and pharmaceutical expenditure was compromised by the inability of some pharmacies to identify HITH patients and inconsistent inclusion of non‐drug items. The range of drugs dispensed to HITH patients was broad, reflecting concurrent medical conditions and individual hospital practices. The most commonly dispensed parenteral drugs were ceftriaxone, cephazolin, dalteparin, flucloxacillin and vancomycin — reflecting the most common indications for HITH.

Conclusion: HITH is an emerging alternative to inhospital patient management resulting in more patients being managed in the community. This creates an opportunity for hospital‐based health professional services to go beyond the hospital boundaries. Unlike the US, pharmacy services in HITH in Victoria are still evolving.
Optimisation of Drug Delivery: 11. Delivery of Therapeutic Peptides and Proteins
Authors: Prankerd Richard J , Benson Heather AE
Published: March 2016

This review describes the problems of using peptides and proteins as therapeutic agents, approaches used in overcoming these problems and alternatives to the oral route of administration.
The Quality Use of Nimodipine: Assessing the Impact of Consensus Guidelines
Authors: Rofail Serena , Poulier M Vittoria , Broad Joanna M
Published: March 2016

To determine the extent of appropriate nimodipine prescribing at the Royal Brisbane Hospital, to develop guidelines for optimising its use, and to assess the impact of these guidelines.
Urinary Tract Infection in the Elderly
Authors: Yates Mark
Published: March 2016

Urinary tract infections (UTIs) are common and carry significant morbidity and subsequent healthcare costs. Urinary tract infection describes a spectrum of disease from bacteriuria to pyelonephritis. This article will explore the terminology, clinical presentation and treatment of this common disorder in the elderly.
Management Challenges in Large Rural Hospital Pharmacy Departments
Authors: Jestrimski Kerry W
Published: March 2016

To understand how pharmacy managers in large hospitals distant from capital cities cope with the current and predicted shortages of pharmacists.
Unexpected Orthostatic Hypotension with Venlafaxine
Authors: Wiese Michael D , Alderman Christopher P
Published: March 2016

We conducted a drug usage evaluation of venlafaxine for the treatment of depression. Orthostatic hypotension occurred unexpectedly in 13 of the 18 patients studied (72%) and was more severe at the initiation of treatment and when the dose was increased. All patients with a history of hypertension or ischaemic heart disease or who were taking antihypertensives or nitrate vasodilators had worsening postural variation in blood pressure during ven1afaxine treatment.
Adverse Drug Reactions as an Educational Tool
Authors: Harding Andrew M , Alvarez Stephanie J , Larmour Ian
Published: March 2016

Adverse drug reactions (ADRs) have been recorded in hospitals for many years. But what happens to all the valuable information that is collected? This article describes a process where the ADRs are used as a tool for education.
Health Promoting Medications in Older People
Authors: Guthridge Jacinta M , Leon Flicker
Published: March 2016

As we approach the new millennium, greater emphasis will need to be placed on preventive strategies that improve the quality oflife in people who survive to old age. This review focuses on medications that may be beneficial in the primary prevention of a number of common conditions that affect older people, where evidence already exists of significant benefit. These common diseases include infectious diseases, cardiovascular and cerebrovascular disease, and osteoporosis.
Pharmaceuticals as New Technology: the Driving Forces
Authors: Bailey Murray
Published: March 2016

Technological change within society now includes the development, introduction, promotion and management of new drug therapy. This was not always the case as the previous ‘object‐centred’ view of technology considered that drug therapy development was external to social relationships and as it was therefore ‘outside human control’ could not correctly be considered as technology. The annual growth in recurrent government expenditure on pharmaceuticals has risen from 6.6% (1984–85 to 1989–90) to 8.2% (1989–90 to 1995–96).
Identifying Drug‐Related ReadmissionsIs There a Better Way of Assessing the Contribution of Adverse Medication Events?
Authors: Stowasser Danielle A , Staatz Christine E , Stowasser Michael , Coombes Judith A , Collins David M
Published: March 2016

To evaluate previously reported approaches (review of International Classification of Diseases 9th edition \ICD‐9] and diagnosis related group \DRG] codes, and review of medical files) and a new method (review of recent medication changes) of assessing the contribution of adverse drug events (ADEs) to unplanned readmissions.
Medication Incident Prevention: The Medication Chart Competition as an Educational Strategy
Authors: Burke Rosemary A
Published: March 2016

Medication errors or incidents can cause morbidity and mortality in hospitalised patients. One strategy to prevent medication errors is to raise awareness of errors. The use of a competition to raise awareness of potential errors and to target future educational interventions has proven successful at the Wollongong & Port Kembla Hospitals
Nitrous Oxide Abuse in a Community Setting: Case Report
Authors: Alderman Christopher P , Nyfort‐Hansen Karin
Published: March 2016

Nitrous oxide abuse by healthcare practitioners such as dentists and anaesthetists has been extensively described, but recreational use in community settings also occurs. Described here is the case of a 37‐year‐old woman abusing nitrous oxide from charger cartridges for a whipped cream dispenser. The medical and neuropsychiatric sequelae of nitrous oxide abuse are discussed with reference to features observed in this case.
Cytochrome P450 3. Clinically Significant Drug Interactions
Authors: McKinnon Ross A , Evans Allan M
Published: March 2016

Recent advances in cytochrome P450 research have provided insights into the precise human cytochrome P450 complement, the role of individual P450 enzymes in drug metabolism and the various factors modulating P450 activity. Resulting from these advances is a clearer understanding of many established drug‐drug and drug‐food interactions, and an enhanced capacity to predict interactions likely to occur with newly introduced drugs. This final article in the three‐part cytochrome P450 series describes our current understanding of drug interactions involving cytochrome P450 enzymes and highlights several clinically important examples.
A Review of the Prophylaxis and Treatment of Postoperative Nausea and Vomiting
Authors: Scott‐Walker Trudie M , Ball Patrick A , Berry Paul R
Published: March 2016

Aim: To review the literature relating to the treatment and prevention of postoperative nausea and vomiting (PONV).

Method: Literature searches were conducted using Medline, International Pharmaceutical Abstracts and Embase. Reference lists were also checked for additional relevant articles.

Results: The 5‐HT3 antagonists are popular because they are well tolerated. Droperidol is commonly used but dose has been an important issue given its dose‐dependent adverse effect profile. Metoclopramide is commonly used but with many disappointing results in formal trials. Transdermal hyoscine may have a promising future in the prophylaxis of PONV. Dexamethasone and clonidine are relatively new agents used for PONV but are promising. Midazolam may be useful in the treatment of protracted, resistant PONV.

Conclusion: Further study of many of these drugs is required, especially with regard to their use in the treatment of established PONV.
Serotonergic and Dopaminergic Agents Facilitate Rehabilitation Following Hypoxic Brain Injury
Authors: To Thé‐Phung , Tierney Joan T , Hopwood Malcolm J
Published: March 2016

Introduction: Patients with hypoxic brain injury are susceptible to a variety of neurobehavioural disorders with manifestations that may include apathy, difficulties in initiation and deficits in arousal and attention. In some patients these manifestations are disabling enough to impede rehabilitation and on their own may prevent a return to independent community living.

Aim: To illustrate the use of serotonergic and dopaminergic agents to facilitate rehabilitation by treatment of deficits in initiation and arousal following hypoxic brain injury.

Method: Retrospective review of two case histories.

Clinical Features: Two young men had required long‐term hospitalisation following hypoxic brain injury secondary to failed hanging attempts. One was mute, chair bound, incontinent of urine and faeces, grossly adynamic and with almost vegetative features. The other was grossly adynamic but able to walk with a broad‐based shuffling gait and had limited verbal communication. Standard methods of rehabilitation, including the use of traditional pharmacotherapy such as tricyclic antidepressants and antipsychotics were ineffective.

Outcome: Both patients showed substantial improvement in alertness, initiation and attention following treatment with fluoxetine, amantadine and bromocriptine. They became more active, participated in more activities and, most importantly, were able to make use of the rehabilitation program. These previously institutionalised patients have returned to the community with some degree of independence.

Conclusion: Clinical observations, experience and anecdotal reports suggest that serotonergic and dopaminergic agents may facilitate rehabilitation following hypoxic brain injury. Controlled studies are required to assess the efficacy of these agents.
Hypertension and Bradycardia Associated with High‐Dose Dexamethasone in a Premature Infant with Borderline Hyponatraemia
Authors: Yeung Melinda Y , Smyth John P
Published: March 2016

Background: High‐dose dexamethasone in premature infants has been effective in improving short‐term respiratory status and reducing the time of ventilation. However, these high doses have commonly been associated with hypertension and left ventricular hypertrophy. Rare cases of bradycardia have also been reported.

Case Report: We present a case of a premature female infant who developed blood pressure elevation and reduced heart rate after six doses of dexamethasone when her serum sodium concentration was 139 mmol/L. Blood pressure increased further and significant bradycardia occurred after a second course of dexamethasone (2 doses) when serum sodium concentration was 130 mmol/L. Her normal heart rate returned after ceasing dexamethasone. Subsequently she developed tachycardia.

Discussion: Angiotensin II increases blood pressure and attenuates the baroreceptor response. High angiotensin II concentrations are known to be associated with low gestational age and low serum sodium. In combination these effects may lead to significant baroreceptor‐mediated bradycardia. A biphasic effect on the chronotropic response has also been seen in foetal lambs treated with dexamethasone. We postulate that lower doses of dexamethasone and maintaining a serum sodium concentration higher in the normal range may reduce the risk of hypertension and cardiac arrhythmia.
Drug‐Associated Diarrhoea and Constipation in Older People; 2. Constipation
Authors: Ratnaike Ranjit N , Milton Austin G , Nigro Olimpia
Published: March 2016

Diarrhoea and constipation are common side effects of many drugs. In older persons, these iatrogenic consequences compound the increased prevalence of acute and chronic illness. An awareness of diarrhoea and constipation as complications of drug therapy in this age group and the use of preventative measures wherever practical may significantly improve the quality of life of the patient. It is important to understand the mechanisms whereby medications may cause diarrhoea and constipation and to periodically review drug use in the elderly.

This second part of the review explains the mechanisms of drug‐induced constipation and presents examples of drugs commonly associated with this abnormality of bowel function.