bluuebunny/crossref_metadata_2025 huggingface dataset:
Extemporaneous Dispensing: Opinions of Victorian Community Pharmacists
Authors: Pappas Arthur
Published: March 2016

To determine estimates ofthe type and extent of extemporaneous dispensing undertaken by Victorian community pharmacists and to analyse their views on related issues.
The Older Traveller
Authors: Giles Michelle L , Ruff Tilman A
Published: March 2016

The overseas traveller requires accurate, detailed information regarding malaria prophylaxis, traveller's diarrhoea and immunisation requirements. Much of the general travel advice and preventative measures to avoid traveller's diarrhoea and mosquito bites are applicable to all age groups. However, the impact of physiological changes with age and existing com orbidities must be considered when advising older travellers. No change in dose of antimalarial prophylaxis is recommended in older people although there may be a moderate increase in adverse effects when given with other medications. The elderly may be considered for prophylactic antibiotics against traveller's diarrhoea. Impending travel provides an opportunity to check immunisation status in older people and administer the required vaccinations.
Drug Usage Evaluation of Antimicrobial Therapy for Community‐Acquired Pneumonia
Authors: Radford James M , Cardiff Lynda M , Pillans Peter I , Fielding David IK , Looke David FM
Published: March 2016

To review antimicrobial therapy of community‐d pneumonia (CAP) at the Princess Alexandra Hospital and compare management with institutional guidelines.
In‐Line Intravenous Filtration in Neonates Help not Hindrance
Authors: Kunac Desireé L , Ball Patrick A , Broadbent Roland S
Published: March 2016

This study was conducted to audit and document the practical aspects and cost implications of the use of inline intravenous (IV) filtration in neonates, using the Pall ELD96 0.2 μ filter and the TNA1E 1.2μ filter.
Progesterone to Prevent Postnatal Depression
Authors: FitzGerald Kate H , Belke Tanya
Published: March 2016

To review the use of progesterone in the prevention of postnatal depression and to present a case report.
National Survey of Clinical Activity Documentation Practices
Authors: McLennan Danielle N , Dooley Michael J
Published: March 2016

To determine the clinical activity documentation practices in Australian hospital pharmacy departments, and to gauge familiarity and utility of the pharmacy‐specific ICD‐10‐AM codes.
Pharmacological Management of Osteoporosis in 2000
Authors: Ebeling Peter R
Published: March 2016

Elderly patients with either low bone density or a prior low trauma fracture should be considered for therapeutic intervention to prevent further fragility fractures. Oestrogen replacement therapy remains the first choice for prevention of bone loss in early postmenopausal women with low bone density. However, in older postmenopausal women with existing fractures, oestrogen may not be acceptable or tolerated. In this group, low‐dose oestrogen combined with calcium supplementation increases bone density and may be better tolerated. Other treatment options to prevent fragility fractures are firstly, the potent aminobisphosphonate, alendronate; secondly, the selective oestrogen receptor modulating drug, raloxifene; and thirdly, the less potent bisphosphonate, etidronate, or the active form of vitamin D, calcitriol.
Targeting Gentamicin Concentrations in Babies: The Younger the Baby, the Larger the Loading Dose and the Longer the Dose Interval
Authors: Yeung Melinda Y , Smyth John P
Published: March 2016

To improve therapeutic range targeting of serum gentamicin concentrations in the newborn.
Drug‐Associated Diarrhoea and Constipation in Older People 1. Diarrhoea
Authors: Ratnaike Ranjit N , Milton Austin G , Nigro Olimpia
Published: March 2016

Diarrhoea and constipation are common side effects of many drugs. In the elderly, such drug‐related iatrogenic conditions compound the increased prevalence of acute and chronic illness. In older persons, an awareness of diarrhoea and constipation as complications of drug therapy and the use of preventative measures wherever practical may significantly increase 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.

The first part of this review explains the mechanisms involved in drug‐induced diarrhoea and gives examples of drugs commonly involved.
Transient, Profound Thrombocytopenia in a Premature Infant: Is this a Ranitidine‐Induced Immune Reaction?
Authors: Yeung Melinda Y , Smyth John P
Published: March 2016

Case Report: A female infant was delivered at 31‐weeks gestation for suspected chorioamnionitis. Maternal antenatal dexamethasone had been given one hour prior to delivery to hasten foetal lung maturation. From day 11 to 19, the infant received ranitidine for gastric hyperacidity (pH > 4). On day 16, her blood culture was positive for Staphylococcus epidermidis and her C‐reactive protein (CRP) was slightly elevated. She was treated with vancomycin and cefotaxime. On day 19, when she had become clinically well, profound thrombocytopenia (8 x 109 IL), eosinophilia (3 x 109 /L) and borderline neutropenia (1 x 109/L) occurred in the presence of highly elevated CRP (132 mg/L). For this she received multiple platelet transfusions. Ranitidine was ceased on day 19. On day 20, leukopenia and neutropenia had resolved when the last dose of cefotaxime was given. Eosinophil count normalised by day 21 and platelet count by day 25.

Discussion: This phenomenon was similar to that reported in ranitidine‐treated adults during acute illness. Although premature infants are generally thought to be incapable of druginduced allergic reactions, the foetal immune system can be activated by intrauterine infections. Glucocorticoid therapy during mid to late gestation could heighten the immune sensitivity in premature infants. This infant's antenatal history and postnatal events could possibly have predisposed her to hypersensitivity to antigenic stimulation.
Development of a Home Infusion Program for the Treatment of Children with Primary Pulmonary Hypertension
Authors: Bogovic Antun , Carberry Janet , Parkins Paola , Rose Michelle L
Published: March 2016

Background: Primary pulmonary hypertension is a rare, debilitating disease with a poor prognosis and few treatment options. Long‐term intravenous epoprostenol is used in adults but there is limited experience in paediatric patients.

Aim: To describe the program for the administration of epoprostenol for children and adolescents at the Royal Children's Hospital.

Method: A protocol for assessment, treatment, education and monitoring of patients was developed by the cardiology and pharmacy departments. Epoprostenol is given through a central venous line via a portable infusion pump with a 100 mL medication cassette. Infusions are commenced in Intensive Care and training is provided in a cardiac ward. Regular outpatient review and dosage increments are required.

Results: Home infusions of epoprostenol have been established in three patients.

Conclusion: Long‐term epoprostenol treatment is complex and expensive. Beraprost, an orally active prostacyclin analogue, may be an alternative therapy in some patients with less severe disease.
A Review of Pharmacy Services in Australian Collocated Hospitals
Authors: Wyer Stewart L
Published: March 2016

Introduction: A collocation involves the development of a private hospital on the campus of a public hospital‐usually a teaching hospital. There is a wide range of collocation models. The aim of this project was to review and compare pharmacy services provided at collocated hospitals across Australia.

Method: With the support of the 1999 Amgen Pharmacy Management Grant, visits were made to both the public and private pharmacy departments at nine collocated hospitals, and pertinent issues were discussed with the director of pharmacy or their equivalent at each site.

Results: The private hospital pharmacy service can be operated by either the private hospital owner (Catholic hospitals); or the public hospital pharmacy department (with either a separate or fully integrated department); or a private partnership (with either an on‐site or off‐site pharmacy). Compared to their public counterparts, the private hospital pharmacists service significantly smaller institutions (average beds‐147 v. 464). The private pharmacies are, on average, operated from significantly smaller on‐site premises (average floor space 90 m2 v. 611 m2), and with lower staffing levels (beds/pharmacist: 49.1 v. 25.3 and beds/total staff: 27.3 v. 14.2). The private and public pharmacies are open for similar periods each week (58.2 v. 60.3 hours). Both private and public pharmacies rely heavily on computers and information technology to provide services (0.7 v. 0.7 computer terminals per staff member). Private pharmacies provide a similar range of general clinical services to those offered by public pharmacies e.g. both perform basic medication chart review. With one exceptkm, fees for professional and technical pharmacy services are charged by private pharmacies not owned and operated by the private hospital.

Conclusion: Several structural and functional arrangements exist for the private hospital pharmacy services provided at a number of collocated public and private hospitals in Australia. A variety of factors, some outside the control of pharmacy management, influence the design of the private hospital pharmacy service.
Promoting Rational Prescribing by Emergency Department Junior Medical Officers
Authors: Welch Susan A , Novy Michael , Preisz Paul , Quinn David I , Whicker Sue D , Brown Sue‐Ellen , Day Richard O
Published: March 2016

Aim: To promote rational antibiotic and analgesic prescribing by junior medical officers (JMOs) for non‐inpatients attending an emergency department (ED).

Method: JMOs were surveyed to determine factors influencing prescribing in the ED and the approach to management of commonly encountered conditions that might require antibiotics or analgesics. The ED was supplied with a prescription pad that included a summary ‘clinical condition’ page to be completed by the prescribing medical officer. A panel comprising an emergency physician, clinical pharmacologist, microbiologist, general practitioner, senior medical registrar, emergency department clinical pharmacist and a JMO reviewed all IMO‐completed summary clinical condition pages with the corresponding analgesic and/or antibiotic prescriptions that were written over a three‐week period. The appropriateness of each prescription was rated following a consensus approach from ‘1’: ‘appropriate’ to ‘4’: ‘inappropriate’.

A two‐week educational campaign followed the data collection period and included promotion of guidelines for appropriate analgesic and antibiotic prescribing in the ED and ‘in‐service’ discussions and lectures to all medical staff.

The prescription review and survey were repeated to assess the effects of the education and review of prescribing practices. Feedback was given to the JMOs detailing number of antibiotic and analgesic prescriptions and appropriateness before and after education.

Results: One hundred and thirty‐four ‘non‐inpatient’ prescriptions were collected before education and 90 afterwards. The majority of prescriptions were graded ‘1’ before and after education with a reduction in prescriptions graded ‘4’ after the education. Antibiotic prescribing improved more markedly than analgesic prescribing. Although there was a trend towards improvement in prescribing of antibiotics this did not reach statistical significance, probably due to the small sample size. A surrogate marker of improvement was that the use of guidelines increased during the study. The JMOs supported the program very enthusiastically.

Conclusion: A method has been developed to educate JMOs on therapeutics in the ED that led to a trend in improvement in prescribing of antibiotics but little change in analgesic prescribing. The program was very well accepted by the JMOs.
Indicators of Prescribing Quality for Elderly Hospital Inpatients
Authors: Elliott Rohan A , Woodward Michael C , Oborne C Alice
Published: March 2016

Objectives: To develop a set of indicators of prescribing quality for elderly patients in Australian hospitals.

Methods: Based on a set of indicators developed in the UK, indicators were developed and piloted at nine hospitals in Victoria. Indicators fell into three groups: a) summarising general prescribing activity, b) assessing prescribing based on prescription data only, and c) assessing prescribing based on prescription and clinical data. Following pilot audits, the indicators were reviewed, and indicators that were impractical or flawed were dropped. To assess inter‐rater reliability, a selection of prescriptions were assessed by two pharmacists. Audit results for three indicators were fed back to participating hospitals at meetings attended by medical, nursing and pharmacy staff, and also in writing. To evaluate hospital staff perceptions of the audits and feedback of audit results, a questionnaire was sent to staff at six hospitals.

Results: Twenty‐four indicators were developed and applied to prescriptions for 1416 patients. Following pilot audits, review of the indicators resulted in deletion of five, resulting in a final set of 19 indicators. For prescriptions reviewed by two pharmacists (n = 66), assessment agreed in 85% of cases (K = 0.7), indicating good inter‐rater reliability. Responses to the questionnaire (n = 22, 20%) were positive. All respondents felt that audit and multidisciplinary feedback using the indicators had raised awareness amongst the prescribing team regarding the topics presented, and 77% felt it would result in better prescribing.

Conclusion: Nineteen indicators were developed to objectively and reliably assess, monitor, benchmark and improve prescribing for elderly hospital inpatients.
Novel Use of Placebo Tablets in the Treatment of Choking Phobia
Authors: Hambridge John A , Macdonald Jenny J , Barker Brent J
Published: March 2016

Background: Choking phobia is a specific phobia characterised by fear and avoidance of swallowing. If related to the swallowing of medications, this phobia may have profound implications for the management of a disease state. Cognitive behavioural therapy is well recognised as an effective treatment for specific phobias, but there are few reports of its use for choking phobias.

Case Report: We report the use of cognitive behavioural therapy to treat a 24‐year‐old woman with reflux nephropathy who was unable to comply with her treatment regimen due to a choking phobia. Oral placebo solid dosage forms were successfully utilised in graded exposure‐based therapy.

Discussion: No other case reports describe the use of placebo medications as a tool in a desensitisation protocol for choking phobia. Whilst the treatment itself was reasonably straightforward, there was difficulty in the procurement of placebo medications at reasonable cost. Although this case represents the extreme end of medication compliance, it highlights the advantage of multidisciplinary team involvement in problem solving. This resulted in better patient care and also in a more cost‐effective and acceptable dosing regimen.
Initial Experience with a Paediatric Pharmacy E‐Mail Network
Authors: Kunac Desiree L , Thrner Sean
Published: March 2016

Background: The unique characteristics associated with paediatric pharmacy practice led to the launch of an e‐mail network in January 1999. It aimed to facilitate communication and timely exchange of information between pharmacists on paediatric‐related issues.

Aim: To outline the utility and assess the activity of the e‐mail network over the first 18 months of operation and to determine the future direction of the group.

Method: A retrospective review of electronic activities was performed to assess the activity of the e‐mail list for the first 18 months of operation. User satisfaction was determined by an e‐mail survey of all subscribers and the future direction of the network drawn from analysis of this information.

Results: For the first six months the network consisted of 15 New Zealand (NZ) based pharmacists, with 23 new enquiries and 60 replies circulated. After 18 months, 65 practitioners subscribed with representatives from NZ (22), Australia (42) and England (1). A corresponding increase in activity was noted over the 12‐ to 18‐month period with 80 new enquiries and 170 associated replies. Of the 148 new enquiries over the 18‐month period, the most frequently raised topics related to dosage and administration (27%), formulation (19%), useful resources and information (15%) and availability and supply of medicines (14%). Nearly 60% related to off‐label or unlicensed use of medicines. The majority of respondents to the user satisfaction survey indicated that they found the network convenient, useful and valuable. To ensure rapid communication with archiving of messages, use of a mailing list named ‘Paedpharm’ has been established. Future developments being considered are inclusion of individual members overseas and links with other established paediatric groups.

Conclusion: The paediatric pharmacy e‐mail network has grown into a convenient, valuable and useful tool for informal exchange of information with paediatric colleagues.
Victorian Poisons Information Centre‐25 Years in the Royal Children's Hospital Pharmacy Department
Authors: Hender Elizabeth A , Kainey Suzanne H
Published: March 2016

The Victorian Poisons Information Centre has been based in the Pharmacy Department at the Royal Children's Hospital in Melbourne for 25 years. This article outlines changes in childhood poisoning and service development, and challenges for the future. Mortality from childhood poisoning has decreased with most serious poisonings now involving medicines. Inducing emesis is no longer recommended in the treatment of poisoning. Information sources are now CD‐ROM and Internet based. The Centre has developed a web site to allow users an alternative means of access. A national telephone number for poisons information centres has facilitated inclusion of the number on product labels and advertising of the service. Challenges for the future include developing a relationship with clinical toxicologists, ensuring users understand the benefits of ringing the Centre rather than accessing information on the Internet, enhancing interaction between Australian poisons information centres, and undertaking relevant research.
A Survey of Long‐Term Antiarrhythmic Therapy in Elderly Patients with Atrial Fibrillation
Authors: Bajorek Beata V , Krass Ines , Ogle Susan J , Duguid Margaret J , Shenfield Gillian M
Published: March 2016

Aim: To investigate the use of long‐term antiarrhythmic (rhythm‐control [RHY] and rate‐control [RAC]) therapy for the management of atrial fibrillation (AF) in elderly patients.

Method: Data were collected retrospectively from the medical records of 255 patients with AF who were ≥65 years of age and were admitted to Royal North Shore Hospital in the period 1 July 1996 to 30 June 1997.

Results: Overall, 192 (75%) patients were discharged on antiarrhythmic therapy for the long‐term management of AF. Sixty‐six patients (26%) received RHY only, 90 (35%) received RAC only, 36 (14%) were prescribed the combination of RHY + RAC therapy, and 63 (25%) received no therapy. Patients ≥80 years of age were equally likely to receive longterm antiarrhythmic therapy as those >80 years (74% versus 77%, p = 0.65), but a significantly lower proportion of them received RHY only than in those >80 years (17% versus 34%, p = 0.001). The preferred option in older patients was RAC only (42% ). Cardiology patients were more likely to receive RHY ± RAC therapy (53%) than Aged Care (16%) or General Medicine patients (16%; p > 0.05). Logistic regression analysis indicated that old age and medical specialty were significant predictors for the choice of agent: patients ≥80 years were 2.2 times more likely to receive RAC only in preference to RHY only therapy than their younger counterparts (p = 0.044).

Conclusion: Long‐term rhythm‐control therapy (e.g. amiodarone, sotalol) is potentially underutilised in AF patients ≥80 years of age. Reliance on the use of rate‐controlling agents such as digoxin persists in clinical practice.
Are E‐codes the Answer to Identifying Adverse Drug Reactions?
Authors: Hutchinson Katrina A , Eaton Vaughn S
Published: March 2016

Objectives: To assess the value of E‐codes in the identification and documentation of unpredictable adverse drug reactions.

Method: Clinical codes for adverse effects of drugs assigned at separation (E‐codes), were retrospectively reviewed for a 3‐month period. These codes were assessed for accuracy and to determine whether they identified predictable or unpredictable adverse drug reactions. Accurate E‐codes were given a severity rating and the type of adverse effect recorded. A subsequent trial over 18 months involved a daily review ofEcodes assigned at separation. When an E‐code identified an unpredictable reaction that was not properly documented, the medical team were contacted and encouraged to complete an alert sheet.

Results: During a 3‐month period 1.9% of separations were assigned an E‐code. Of the 175 clinical codes that were confirmed as accurate, 41 (23%) were classified as unpredictable. Of these only 5 had a completed alert sheet. During the 18‐month period when E‐codes were reviewed daily, 66 unpredictable reactions were identified. Of these, 23 (35%) had a completed alert sheet.

Conclusion: Reviewing clinical codes is time consuming and the accuracy of the codes depends on adequate documentation. Despite these limitations, clinical codes are a useful tool to assist in the identification and documentation of adverse drug reactions.
Metered‐Dose Inhaler with Spacer versus Nebuliser for Acute Exacerbation of Asthma—A Literature Review
Authors: Al‐Sallami Hesham S , Ball Patrick A , Davey Andrew K
Published: March 2016

This article reviews the current literature regarding the use of metered‐dose inhalers (MDI) combined with spacers compared to nebulisers for the administration of medications in the treatment of asthma, particularly acute exacerbations.
Review of Information Resources on the Use of Medication in Breastfeeding Women
Authors: Cutts Christopher , Sims Sarah A
Published: March 2016

Breastfeeding is established as the most favoured approach to feeding infants and it is preferable that it is continued for as long as possible and without interruptions. Medication use during breastfeeding is relatively common. Pharmacists and other health professionals frequently have to determine the appropriateness of treating a lactating mother and the risk to the infant. A range of information resources is available to aid this decision. This paper reviews a selection of information resources, particularly standard reference textbooks. Other information sources are briefly discussed. These include online information, tertiary texts and policy statements. This analysis highlights the fact that no individual resource is ideal.
The Extended Role of the Clinical Pharmacist in the Management of Heart Failure and Acute Coronary Syndromes
Authors: Coombes Ian D , Sanders Daniela CJ , Thiele Justine M , Cottrell W Neil , Stowasser Danielle A , Denaro Charles , Scott Ian A
Published: March 2016

Aim: To discuss the evidence‐based rationale behind the use of clinical pharmacists in the Brisbane Cardiac Consortium Clinical Support Systems Project (CSSP), and detail the pharmacist‐specific interventions that have been implemented.

Background: Congestive heart failure (CHF) and acute coronary syndrome (ACS) are two commonly encountered conditions in hospitalised patients, and are associated with a significant morbidity and mortality. Despite the existence of effective therapies such as angiotensin converting enzyme inhibitors, P‐blockers and lipid lowering agents a dissonance persists between evidence‐based recommendations and routine practice. Multiple factors are responsible for this evidence‐practice gap which results in potentially unnecessary admissions due to suboptimally treated disease. These factors include inappropriate drug prescribing and poor patient compliance which, in varying measures, are attributable to inadequate communication of treatment plans to patients and their carers, general practitioners and community pharmacists.

Intervention: Research pharmacists optimise pharmaceutical care using a model that spans all stages of patient care. These pharmacists are involved in admission assessment, optimisation of inpatient therapy, discharge education, implementation of self management plans, enhanced medication liaison and post discharge follow up.

Recommendations: Available evidence and experience gained from this project may support further development of specialised clinical pharmacist positions attached to multidisciplinary teams and may be applicable to other chronic diseases.
The First Graduate Cohort at Charles Sturt University: What Impact on the Rural Pharmacist Shortage?
Authors: Simpson Maree D , Wilkinson Jenny M
Published: March 2016

Objective: This paper reports a descriptive study of the first cohort of graduates from a non‐metropolitan university. The objective was to elucidate students' future practice intentions.

Methods: A questionnaire was developed and administered to students in their second and third year of study in the Bachelor of Pharmacy course offered at Charles Sturt University. An abridged version of the questionnaire was administered to final year students the following year as part of an ongoing research activity.

Results: Whilst still in the early years of their course, students indicated a strong preference for a rural, community site for their pre‐registration year. By the end of 2000, 62% of all graduates, and 88% of female graduates, had accepted preregistration training placements in non‐metropolitan locations. The pre‐registration practice location for one in six of this first cohort was a hospital pharmacy, an increase from the 10% who declared in the 1999 survey that they were intending to do their pre‐registration year in a hospital.

Conclusion: The vast majority of students who complete their undergraduate training at a non‐metropolitan university express the desire to practise in non‐metropolitan sites during their studies. After graduation, this intention is confirmed by choice of practice location.
Biofilms that Impact on Human Health
Authors: Whiteley Reginald K , Pajkos Aniko , Vickery Karen
Published: March 2016

Bacteria that form biofilms by attaching to surfaces and secreting a polymeric matrix have an enormous impact in everyday life. In medicine, biofilms form on medical implants and within human tissue as in cystic fibrosis; in industry they cover equipment surfaces. Biofilms protect their inhabitants from various adverse environmental conditions including biocides and antibiotics. Bacteria residing in biofilms can be many times more resistant to antimicrobials than their free‐floating counterparts. While the mode of biofilm formation is largely understood, the means of eliminating and controlling them once formed is still the subject of research. Biofilms encountered in medicine are especially challenging owing to the sensitive nature of the human tissue and medical devices. In this paper we discuss biofilm development, its impact on human health and the problems that are associated with biofilm control.
Infliximab in Refractory Behcet's Disease
Authors: Maxwell David J
Published: March 2016

Objective: To describe the use of infliximab in a patient with refractory Behcet's disease (BD).

Clinical features: The patient, a 39‐year‐old woman, had been suffering from BD for over 15 years. Previous therapy, including cyclophosphamide, methotrexate, interferon alpha‐ 2a and steroids, was not controlling her symptoms of severe cutaneous/oral/genital ulcers, uveitis, iritis, chronic sinusitis, diarrhoea, abdominal cramps and severe joint pain. A trial of infliximab, an anti‐tumour necrosis factor alpha (TNFα) monoclonal antibody, was commenced to control the symptoms.

Outcome: A course of IV infliximab at 3 mg/kg was administered at weeks zero, two and six. During this period progress was measured using various indices, including the Health Assessment Questionnaire (HAQ) Disability Index and the Arthritis Impact Measurement Scale (AIMS) Anxiety Score, as well as a personal diary. The patient described almost immediate relief from diarrhoea and abdominal cramps. At the end of the six week treatment period, both the HAQ Disability Index and AIMS Anxiety score had decreased from 2.1 and 4.6 respectively, to zero, and the patient reported relief from joint pain, and healing of oral and genital ulcers. Six weeks after treatment finished the patient suffered a relapse of ulcers, joint pain and abdominal symptoms. Maintenance infliximab was commenced at 3 mg/kg IV every eight weeks.

Discussion: This case, and other published reports describing short‐term use of infliximab in BD, suggest that infliximab may be suitable for the treatment of refractory BD. However maintenance therapy may be required to achieve long‐term symptom control in some patients, such as the one described in this report.
Association between Self‐Reported Adherence to HIV Therapy and Disease Markers
Authors: Yin Connie , Rayner Craig R , Read Tim , Fairley Christopher K
Published: March 2016

Introduction: Non‐adherence to highly active antiretroviral therapy (HAART) in HIV is widely accepted as a major cause of treatment failure. As a measure of adherence, all patients prescribed HAART at the Melbourne Sexual Health Clinic fill in a simple questionnaire documenting the number of doses per day and the number of doses missed in the last 4, 7 and 28 days.

Objective: To investigate the association between mean HIV‐RNA viral load (VL), CD4 antigen count, the number of doses per day, and the 4‐day, 7‐day and 28‐day self‐reported adherence (SRA), and reasons for missed doses.

Method: Data were collected for patients attending the clinic from May 2001 until January 2002. SRA [100‐ 100 x (number of doses missed + number of prescribed doses for that period)], number of doses per day, CD4 counts and VL results were averaged within patients. Statistical analyses were performed using classification and regression tree (CART) analysis, a multi variable non‐parametric tree‐based modelling technique.

Results: 139 patients were evaluable for analysis of VL and 195 for analysis of CD4 counts. Mean (range) SRAs were: 4 days, 97.5% (45.8‐100%); 7 days, 97.7% (57.1‐100%); and 28 days, 98.1% (62.5‐100% ). The mean number of doses per day was 2.2 (range 1‐5). The average 28‐day SRA and number of doses/day were significantly associated with VL.

Conclusion: Average 28‐day SRA and the number of doses per day were associated with VL. Reasons for non‐adherence were consistent with reasons cited in the literature. Further exploration of issues, including recall bias, are required before these results may be applied routinely in the clinical setting.
Prevalence of Complementary and Alternative Medicine Use by Adults with Cystic Fibrosis
Authors: Burrows Judith A , Bajramovic Jasmina , Bell Scott C
Published: March 2016

Background: Limited data are available about the extent of use of complementary and alternative medicine (CAM) in people with cystic fibrosis (CF).

Aim: To determine the extent of use of CAM therapies and CAM therapists in an adult population with CF. Expenditure on CAM and patient perceptions about CAM were also assessed.

Method: An interview‐based questionnaire was developed, tested and administered by pharmacists.

Results: 83 adult CF patients (42 females, age 16‐44 years) were surveyed. 61% had visited a CAM practitioner at some time and 26% were currently visiting at least one practitioner (most commonly masseuses and naturopaths). 70% of patients reported they had taken a CAM in the past and 45% were currently taking CAM therapies (mean 3.5, range 1‐19). The proportion of females who had consulted a CAM therapist (70% vs 48%) and taken CAM (84% vs 53%) was significantly greater than males. 39% of patients had informed their doctors of their use of CAM. 10% of patients spent more on CAM than on conventional therapy and 10% also spent over $500 annually in consultations with CAM therapists.

Conclusion: The use of CAM therapists and therapies in young adults with CF was considerable, but comparable to studies in the general population. While the majority believed that conventional medicine was more beneficial than CAM therapy, some spent considerable amounts of money on CAM and many believed that such therapies had a place in therapy.
Survey of Women's Attitudes to Complementary Medicines
Authors: Biddle Ruth A , Simpson Maree D , Wilkinson Jenny M
Published: March 2016

Aim: To assess the attitudes of women to complementary medicines.

Method: A questionnaire covering demographic information and 30 questions related to complementary medicines was developed. The questionnaire was distributed to women resident in Wollongong, NSW, Australia by mail (n = 785), with a further 793 distributed to complementary and conventional healthcare practices within the same postal zones.

Results: The overall response rate was 31%. Respondents indicated that they are open to new alternatives in health (92% ), that the potential of alternative medicines is largely undiscovered (65%), that complementary medicines are more than placebos (81%) and that they can be used in conjunction with conventional medicines (79% ). Respondents also recognised the potential for interactions between complementary medicine and conventional drugs (66%). Eighty per cent disagreed with the statement that complementary medicines had nothing to offer them. Those visiting complementary practitioners viewed complementary medicines more favourably than those using conventional medical practices.

Conclusion: This study has shown that women are generally open to complementary medicines and see them as a valuable addition to conventional health care. We have also shown that women recognise the potential limits of these medicines and trust the advice of pharmacists. This highlights the need for pharmacists and other healthcare professionals to be knowledgeable and non‐judgmental when providing advice about complementary medicines.
Workload Statistics in Cytotoxic Preparation—Is a One‐for‐One Approach Enough?
Authors: Siderov Jim , Bayles Maryann
Published: March 2016

The preparation of chemotherapy dose forms has changed over time. Advances in cancer therapy and new drug technology have resulted in an increase in the complexity of drug regi mens and drug preparation . We set out to retrospectively test a complexity score (CS) to determine the complexity of workload in a cytotoxic preparation facility and compare this with the number of items prepared per year.

A CS for every possible cytotoxic dose form was developed. All cytotoxic dose forms prepared by the Austin & Repatriation Medical Centre pharmacy department were included in the review. The CS was tallied for each year and compared with the number of cytotoxic dose forms prepared per year. The results show that while the number of items prepared per year fluctuated, the CS increased each year. Over the four‐year period, the number of items increased by 2%, while the complexity score per item increased by 8%.

Hospital and pharmacy managers must not simply base their assessment of staffing requirements on the number of cytotoxic dose forms prepared each year. They must also include aspects of the complexity involved in the preparation of these items.
Audit of Selective and Non‐Selective Non‐Steroidal Anti‐Inflammatory Drug Use in Rural General Practice
Authors: Cutts Christopher , La Caze Adam B , Tett Susan E
Published: March 2016

Aim: To identify the demographics and risk factors in a selected patient population prescribed non‐selective and cyclo‐oxygenase‐2 (COX‐2) selective non‐steroidal anti‐inflammatory drugs (NSAIDs).

Method: A structured clinical self‐audit form was distributed in January to March 2001 to 155 interested general practitioners (GPs) in rural Queensland.

Results: Seventy‐one GPs participated in the audit and contributed 1417 patient records‐790 patients had received nonselective NSAIDs and 627 had received COX‐2 inhibitors (celecoxib or rofecoxib). Patients who received COX‐2 inhibitors were significantly older, more likely to have clinically important concomitant illness, and more likely to be taking medication known to interact with NSAIDs. They were also twice as likely to have two or more risk factors for adverse effects. The most common reasons for switching from an NSAID to a COX‐2 inhibitor were reported to be a previous side effect from an NSAID (primarily related to gastrointestinal effects) or the doctor's perception of the superior efficacy of COX‐2 inhibitor therapy.

Conclusions: This study has shown that COX‐2 inhibitors were used in a distinctly different patient population compared to non‐selective NSAIDs. There were significant variations in the demographics and number of risk factors‐for example, cardiovascular and renal‐between the two identified populations. These differences may be due to doctors selecting COX‐2 inhibitors for patients at high risk of gastrointestinal complications. However, the prescribing pattern may also be partly due to misconceptions about the relative safety and efficacy of COX‐2 inhibitor drugs.
Adverse Drug Reactions in Paediatrics: Are We Getting the Full Picture?
Authors: Carter Kylie L Easton , Chapman Colin B , Brien Jo‐anne E
Published: March 2016

Aim: To investigate the frequency of adverse drug reactions (ADRs) occurring within the paediatric inpatient population of three hospitals and to obtain an estimate of the degree of under‐reporting with ADR monitoring methods commonly employed in hospitals.

Method: All paediatric patients admitted to wards of three hospitals, excluding oncology patients, were considered for inclusion. Adverse drug reactions arising within the inpatient population were identified using two methods: spontaneous monitoring and retrospective intensive monitoring. An independent panel reviewed information collected on reactions and established the likelihood of an association between drug administration and the reported reaction. The frequency, causality, clinical significance and preventability of ADRs arising amongst inpatients, along with an estimate of the degree of under‐reporting of monitoring methods utilised was then determined.

Results: Of the 17 432 eligible patients, 41 (0.2%, 95% CI 0.1‐0.3%) were determined by an independent panel to have experienced ADRs while inpatients of these hospitals. Causality was ranked as probable (31.7%) and possible (68.3%). The majority ( 48.8%) of cases were allocated a clinical significance classification of moderate, and 9.8% of all ADRs were considered preventable. Only 8.0% and 54.8% of cases identified via prospective intensive monitoring were detected using spontaneous monitoring and retrospective intensive monitoring respectively.

Conclusion: The frequency of ADRs arising within the inpatient population in this study was substantially lower than in previous reports. Under‐reporting associated with the monitoring methods employed primarily contributed to this difference. Calls for greater surveillance of paediatric ADRs should therefore be heeded and acted upon by the relevant governing bodies.
Managing Pharmacy Beyond the Hospital Walls: Present and Future Services for Home Health Care
Authors: Roberts Malcolm J
Published: March 2016

Providing health care outside the physical environment of the treating hospital has been practised for many years. Pharmacy involvement in such systems has been variable, ranging from supply of basic medications to providing individualised dosage forms and clinical support. Patients may reside at home, often with care being shared with the general practitioner and community nursing and pharmacy services, or in a remote hospital or other institution. Models of pharmacy services to support such arrangements vary greatly, often reflecting local funding and structural arrangements for providing health care. Issues to be addressed when providing pharmacy services in such circumstances are identified and Australian resources for information and support are noted.
Prevention of Alzheimer's Disease and Other Dementias
Authors: Woodward Michael C
Published: March 2016

Alzheimer's disease (AD) affects 150 000 Australians and prevention is a high priority. Approaches to reduce the risk of AD and other dementias can be based on the risk factors that have been suggested from case‐control and longitudinal studies. There is some evidence of benefit from vitamin E supplements (and possibly also vitamin C), a well'balanced diet including adequate folate and vitamin B12, keeping physically and mentally alert, avoiding head injury, continuing moderate alcohol intake, avoiding excess aluminium exposure, avoiding smoking, and keeping elevated blood pressure, diabetes and other vascular risk factors under control. There are currently insufficient data to support the use of cholesterol'lowering agents, anti'inflammatory agents, oestrogen, caffeine, or ginkgo biloba to prevent dementia, but large prospective randomised placebo'controlled prevention trials are in progress for some of these agents and may alter these recommendations. Approaches in the future which look very promising are anti'amyloid vaccination and gene therapy. Targeting high risk groups, such as those with mild cognitive impairment, may increase the benefit of preventative approaches.
Evaluation of Home‐Based Follow‐Up of High‐Risk Elderly Patients Discharged from Hospital
Authors: Naunton Mark , Peterson Gregory M
Published: March 2016

Objective: To evaluate pharmacist‐conducted follow‐up at home of high‐risk elderly patients discharged from hospital.

Method: A randomised controlled study, in which medical patients admitted to hospital and fulfilling high‐risk criteria (including age 60 years or older and prescribed four or more regular medications) were randomly assigned to an intervention or control group. Patients in the intervention group were visited at home by a pharmacist five days after discharge. The pharmacist educated patients on their medications, encouraged compliance, assessed for drugrelated problems, intervened when appropriate and communicated all relevant findings to community health professionals. The intervention group patients were revisited at home 90 days after discharge to evaluate the outcomes of interventions made on day 5. Patients in the control group were visited at home by a pharmacist 90 days after discharge and provided with an identical comprehensive medication review

Results: One hundred and twenty‐one patients completed the study. There were no significant differences between the two groups in key clinical and demographic parameters at baseline. A median of three drug‐related problems were identified in each intervention group patient at the five day home visit. Ninety days after discharge this had declined to one, compared to two for the control group patients (p > 0.0001). In the intervention group, compliance had improved and was significantly higher than for the control group after 90 days (p > 0.0001). There was a significant decline in the use of nonsteroidal anti‐inflammatory drugs by the intervention group patients. Forty‐five per cent of the control group patients had unplanned readmissions to hospital during the 90 days following discharge compared to 28% of the intervention group patients (p = 0.05). The intervention program was well‐received by patients and their general practitioners. Recommendations from the pharmacist were implemented by general practitioners in 79% of cases.

Conclusion: A pharmacist‐conducted follow‐up at home of high‐risk elderly patients discharged from hospital is valuable in identifying and addressing drug‐related problems and reducing the risk of readmission to hospital.
Potential Support Roles for Pharmacy Technicians in Provision of Clinical Pharmacy Services
Authors: Carroll Margaret E , Galbraith Kirsten J , Dooley Michael J
Published: March 2016

Objectives: To determine the current and possible future utilisation of pharmacy technicians in clinical pharmacy support roles in Australia. To use the information to develop a set of potential support tasks for pharmacy technicians working under the supervision of clinical pharmacists.

Method: The Society of Hospital Pharmacists of Australia Committee of Specialty Practice in Clinical Pharmacy undertook a survey of Australian clinical pharmacy managers to determine current and possible future involvement of pharmacy technicians in components of clinical pharmacy activities described in The Society of Hospital Pharmacists of Australia Standards of Practice for Clinical Pharmacy. The survey was mailed to 275 hospital pharmacy departments in January 2002. A reference group of Australian pharmacists and technicians was then formed to consider the survey results and reach consensus on potential clinical pharmacy support activities suitable for technicians.

Results: The survey response rate was 46%. Respondents indicated that there is currently minimal pharmacy technician involvement in clinical pharmacy support roles, but many more roles were considered possible in the future. The reference group developed a list of potential tasks for pharmacy technicians working under the supervision of a pharmacist in clinical pharmacy support roles, including detection of new patient admissions; communication with internal health professionals; assistance in managing storage and retrieval of patients' own medications; data processing of adverse drug reaction reports; accessing, recording and screening specific laboratory and therapeutic drug monitoring data; retrieval of selected drug information; gathering of consumer medicine information leaflets; and preparation of information for transfer to community healthcare providers.

Conclusion: Although there is currently only limited involvement of pharmacy technicians in clinical pharmacy services, there is recognition by clinical pharmacy managers of many possible future roles. The reference group reached consensus on a selection of potential clinical pharmacy support tasks for pharmacy technicians working under the supervision of clinical pharmacists. The Committee of Specialty Practice in Clinical Pharmacy aims to incorporate these tasks into a revision of the The Society of Hospital Pharmacists of Australia Standards of Practice for Clinical Pharmacy.