bluuebunny/crossref_metadata_2025 huggingface dataset:
Geriatric Pharmacy Specialisation: The CCGP Pathway to Australian Accreditation
Authors: Hansen Karin Nyfort , Kowalski Stefan
Published: March 2016

SHPA has signed a memorandum of agreement with the US Commission for Certification in Geriatric Pharmacy (CCGP), which will assist Australian pharmacists to achieve CCGP certification in geriatric pharmacy. In this paper two SHPA members provide details about the CCGP certification process and the resources that they found useful when preparing to sit for the CCGP exam. Benefits of certification include the application of new knowledge in daily clinical practice, and accreditation to provide medication review services to the elderly.
Quality of Medication Ordering at a Large Teaching Hospital
Authors: Coombes Ian D , Pillans Peter I , Storie William J , Radford James M
Published: March 2016

Objectives: To identify and quantify deficiencies in the prescribing/ordering of inpatient and discharge medications and determine strategies to address them.

Design and setting: A descriptive study in medical and surgical wards at a tertiary referral teaching hospital.

Patients: All available inpatients in 12 medical and 2 surgical wards on two consecutive days and all discharges on a single day.

Results: Medication orders for 230 inpatients and 68 discharge patients were audited. A total of 2978 inpatient orders were reviewed including 634 ‘once only’ doses, 1840 regular and 504 ‘as required’ medications. Errors in physician prescribing occurred at a frequency of 25/1000 prescriptions and included 48 (1.6%) incorrect, ambiguous or unspecified doses and four prescriptions where the specific oral form was not stated. In 14 (0.5%) cases, the dosing frequency specified was wrong, unclear or absent and there were three cases of duplication. Two patients were prescribed drugs to which they had a documented allergy. Details of previous adverse drug reactions were complete in only 14 of 62 (23%) patients. Of the 68 discharge prescriptions audited, orders for 49 of 329 regular medications (15%) had been unintentionally omitted (range 1‐8 medications per patient).

Conclusions: The audit identified limitations in the quality of prescribing/ordering which were in part due to deficiencies in the current medication chart and discharge summary. To address these limitations, the medication ordering system has been revised and a multidisciplinary educational program implemented to promote safe and explicit prescribing.
The Use of Complementary Medicines by Inpatients at St Vincent's Hospital Sydney
Authors: Welch Susan A
Published: March 2016

Aim: To survey the use of complementary medicines (CMs) by patients admitted to St Vincent's Hospital Sydney and identify potential interactions between CMs and other prescribed or over‐the‐counter medications.

Method: Patients seen by clinical pharmacists in St Vincent's Hospital Sydney over a 3‐week period in May 2000 were surveyed during the routine medication history. Patients taking CMs had their medication history recorded on the data collection form. Potential for interactions between the CM and the prescribed or over‐the‐counter medications was assessed.

Results: Five hundred and eleven patients had their medication history taken, 61 (12%) were taking 156 CMs at the time. Ninety‐one (58%) agents had been taken by 39 (64%) patients for more than one year. Patients ranged in age from 25 to 100 years with a median of 57 years. There was an even sex distribution, 30 females and 31 males. A high proportion (74, 47%) of the CMs had been self‐prescribed and 25 (41 %) patients took 103 (66%) CMs without the knowledge of their general practitioner. Twenty‐two (36%) patients continued taking a total of 47 (30%) CMs in hospital. Twenty‐four (51%) of the continued CMs were not charted. Eleven (18%) patients were also taking 20 medicines that could potentially interact with the CMs they were taking. Six patients were taking more than one potentially interacting substance.

Conclusion: Use of CMs by patients admitted to St Vincent's Hospital Sydney appears significant and warrants routine inclusion in the patient medication histories. Potential drug interactions were found to occur. Pharmacists need to be aware of potential interactions and have access to information about interactions between CMs and other medicines.
Ward Pharmacy Technicians Assist Clinical Pharmacists with Admissions
Authors: Leversha Anne , Ahlgren Karen L , Gray Megan J
Published: March 2016

A severe shortage of clinical pharmacists, especially in rural and remote areas, presents a challenge to the provision of comprehensive pharmaceutical care for hospital patients. At Latrobe Regional Hospital, Traralgon, an innovative ward role has been developed for pharmacy technicians to relieve the pharmacist of non‐clinical duties. For example, the assembling of complete and detailed information about patients' medication at admission involves non‐clinical tasks such as photocopying drug charts, collecting the patient's own medication that has been brought into hospital, listing the drugs which have been left at home, and informing patients ofthe hospital's policy with regard to medication. The training of technicians to carry out these tasks allows the pharmacist to concentrate on clinical issues. As a result, most of the patients are reviewed by the pharmacist within 24 hours of admission, clinical issues are addressed promptly, and the discharge process is efficient and comprehensive. Pharmacists, pharmacy technicians and nurses were surveyed to determine the impact the roster had on patient care, on the pharmacy and pharmacy staff, and on the ward.
Clinical Pharmacy: an Evolving Area of Pharmacy Practice in India
Authors: Elliott Rohan A
Published: March 2016

Prior to 1997, clinical pharmacy teaching and practice were virtually non‐existent in India. However, this changed as a result of a joint Indo‐Australian program of cooperation between the Repatriation General Hospital in South Australia and the JSS Colleges of Pharmacy in India. Postgraduate courses in clinical pharmacy practice and departments of clinical pharmacy have now been established at several colleges of pharmacy and hospitals respectively. In 2000 the Kamataka Lingayat Education Society (KLES) College of Pharmacy established a Department of Clinical Pharmacy at KLES Hospital in Belgaum, South India. This paper discusses the recent development of clinical pharmacy in India and describes the introduction of clinical pharmacy practice at KLES Hospital. It also reports on three pharmacy conferences held in India in 2000.
Use of the Pharmaceutical Benefits Scheme in Private Hospitals: 1. Associated Problems
Authors: Jackson John K
Published: March 2016

This is the first of two articles based on a project aimed at resolving problems associated with the use of the Pharmaceutical Benefits Scheme (PBS) in acute care private hospitals. The problems largely stem from a lack of integration between PBS prescribing requirements and hospital practice. The objective of the project was to develop a model in which PBS dispensing would be based on orders written on patients' drug therapy charts, eliminating the need for separate prescriptions. This article describes the problems and the second article describes the development and implementation of the model.
Concepts for Critical Appraisal of an Original Research Paper
Authors: Duffull Stephen B , Tett Susan
Published: March 2016

With the ever‐growing evidence base it is more difficult to keep abreast of relevant issues in health care. Studies are also becoming more complex in order to address specific research and clinical questions. Appropriate interpretation of these studies is paramount to a progressive practice in health care. This article presents an intellectual framework for the critical appraisal of an original research article.
Management of Hypertension in Older People
Authors: Harvey Penelope A , Woodward Michael C
Published: March 2016

Hypertension affects 30–50' of older people. It is an important reversible risk factor for cardiovascular morbidity and mortality. Multiple large intervention trials have established the efficacy of treating hypertension in people up to the age of 80. However, there is scant and discordant data regarding the benefits of treating hypertension in the very old. Hypertension in the elderly is characterised by specific pathophysiology that must be taken into account when devising a management plan.
Use of the Pharmaceutical Benefits Scheme in Private Hospitals: 2. An Alternative Model
Authors: Jackson John K , Ryan Michael J , Jeffery David M , Seale Robyn E , Benporath Cynthia H , Danby Rob W
Published: March 2016

Objective: This article describes a project aimed at resolving inefficiencies associated with the use of the Pharmaceutical Benefits Scheme (PBS) in private hospitals.

Method: Six alternative models were formulated and evaluated using quantitative and qualitative means. The preferred model was implemented for trial.

Data sources: Drug utilisation records from medical and pharmacy histories of almost 2500 patients in 5 private hospitals, and focus groups and questionnaire surveys of medical, nursing and pharmacy personnel were used.

Results: The model eliminated legal and operational problems associated with outstanding prescriptions, ensured patients received PBS subsidies to which they were entitled and was favoured by all stakeholder groups.

Conclusion: The model should be available for implementation in all hospitals using the PBS.
Drug Use Evaluation of Ipratropium at Two Tertiary Referral Hospitals
Authors: Matthews Jessica J , Poulier M Vittoria , Cardiff Lynda , Coombes Judith , Tett Susan E
Published: March 2016

Objective: To assess the appropriateness of ipratropium bromide prescribing in two tertiary referral hospitals.

Method: Criteria for optimal use were developed based on current literature and modified after consultation with respiratory physicians and clinical pharmacists. A prospective review of prescribing was performed over a 2‐month period to assess conformity to these criteria.

Results: Information was collected from 84 patients; 5% were receiving inhalers and 96% nebuliser therapy (one patient used both). 77% of patients (n = 65) had a principal diagnosis of chronic obstructive pulmonary disease, 14% (n = 12) asthma and 8% (n = 7) had neither diagnosis. 75% of patients were using ipratropium outside the guidelines. The major areas where the guidelines were not met were a lack of therapeutic justification, use of inappropriate doses, and use of an inappropriate delivery device. Feedback and educational interventions were designed and delivered based on the data obtained.

Conclusions: There was widespread use of ipratropium outside the developed guidelines. Interventions in specific areas could lead to significant improvements in the use of this high cost drug.
Targeting Gentamicin Therapeutic Ranges During the First Week of Life in Infants in Neonatal Intensive Car
Authors: Yeung Melinda Y , Smyth John P
Published: March 2016

Background: The absence of published recommendations for optimum dosing of gentamicin in premature neonates led us to develop dosing schedules for the neonatal population based on post‐conceptional age, and to audit the results periodically. Our previous study results supported the use of a gentamicin loading dose as well as higher maintenance doses at longer dose intervals. However, areas for improvement were identified.

Aim: To further refine gentamicin dosing schedules to improve therapeutic range targeting during the first week of life in infants in the Neonatal Intensive Care Unit.

Method: A revised gentamicin dosing schedule was formulated and instituted during an 8‐month period in 1999‐2000. All infants > 35 weeks gestation received a loading dose of 5 mg/kg with a maintenance dose of 4 mg/kg (increased from 3.5 mg/kg during a 7‐month period in 1999) every 48 hours for infants >30 weeks gestation, and every 36 hours for those 30‐34 weeks gestation. Infants <34 weeks gestation were given 4 mg/kg every 36 hours without a loading dose. Blood samples for trough concentration measurement were taken immediately before the second dose and those for peak concentration 30 minutes after the completion of the 1‐hour infusion of the second dose. As the majority of the infants received gentamicin shortly after birth, analysis was performed on the data collected during the first few days of life. The results from this dosing schedule were compared with our previous data from 1999.

Results: Two hundred and eleven pairs of serum gentamicin peak and trough concentrations in 1999 and 120 pairs in 1999‐2000 were eligible for analysis. The 1999‐2000 gentamicin dosing schedule resulted in 100% of trough and 88.2% of peak concentrations falling within the targeted ranges in infants >30 weeks gestation and 79.5% of trough and 88.6% of peak concentrations falling within the respective targeted ranges in infants <37 weeks gestation. In infants 30‐34 weeks gestation there were similar results for both dosing schedules. Overall, 88.3% of serum gentamicin trough concentrations and 85.8% of peak concentrations were within the targeted ranges during the first postnatal week using the 1999‐2000 schedule.

Conclusion: The results of this study suggest improved gentamicin therapeutic concentration targeting using the 1999‐2000 dosing schedule. A larger study is required to confirm the statistical significance of our findings.
Analysis of the Impact of Public Hospital Pharmaceutical Reforms on Discharge Medication Supply
Authors: Jackson John K
Published: March 2016

The use of the Pharmaceutical Benefits Scheme (PBS) for dispensing discharge prescriptions in public hospitals and the implementation of national guidelines to improve the quality of care of patients in transition between hospital and community have been proposed by the Commonwealth. Issues relevant to the implementation of these reforms include the financial risks to States and hospitals, the impact of PBS procedures on hospital practices and the availability of pharmacists. If implemented, the dual sources of pharmaceutical funding would remain, perpetuating the opportunities for cost shifting, and inequities in access would continue. An alternative reform could entail the Commonwealth funding all pharmaceuticals in hospitals using a model developed specifically to complement hospital practices. Support for hospitals to improve the quality of patient care should be provided regardless of the pharmaceutical funding model.
A Study to Determine the Importance of Ward Pharmacists Reviewing Discharge Prescription
Authors: Whitty Jennifer A , Green Bruce , Cottrell W Neil
Published: March 2016

Objective: To evaluate the potential impact on appropriateness of discharge medication if discharge prescriptions were reviewed by the ward pharmacist before being dispensed.

Method: Over a four‐week period discharge prescriptions were reviewed by either the ward pharmacist involved in the patient's care (cases) or a dispensary pharmacist who had no knowledge of the patient's care (controls). A second review with the availability of patient records was carried out to identify additional queries that should have been raised prior to dispensing.

Results: Fifty‐five prescriptions (29 case, 26 control) containing 279 items (140 case, 139 control) were reviewed. Forty‐four queries (23 case, 21 control) were found on initial checking of the prescription, 12 more queries (1 case, 11 control) were found on the second review of the prescription. There were 13 potentially clinically significant queries in the case group, 12 (92%) were made during initial prescription review. There were 23 potentially clinically significant queries in the control group, only 12 (52%) were made on initial prescription review. Changes to the prescription resulting from potentially clinically significant queries prior to dispensing occurred in 19 (79%) queries (10 case, 83%; and 9 control, 75% ). Of queries raised prior to dispensing in the control group, 18 involved contacting hospital staff for resolution where they could have been resolved using the inpatient prescription chart, notes or the patient themselves. This compared to only one in the case group.

Conclusion: Review of discharge prescriptions by the ward pharmacist involved in the patient's care optimises the appropriateness of discharge medication and the efficiency of the discharge process.
The Role of an Emergency Department Pharmacist
Authors: Harding Andrew M
Published: March 2016

This article outlines the role of the pharmacist as a member of the Emergency Department team six years after introducing the service. The pharmacist is involved in all areas of ‘normal’ clinical pharmacy practice, plus other areas specific to the Emergency Department. These include advice and support in emergency toxicology, reporting adverse drug reactions, and preparation of drugs during an arrest. Education is also a high priority and the pharmacist is often requested to provide presentations, help write protocols, and assist with professional development programs.
Development and Use of an Independent Drug Information Centre in India
Authors: Lakshmi PK , Gayathridevi S
Published: March 2016

The Karnataka State Pharmacy Council established its Drug Information Centre in August 1997 to disseminate unbiased drug information to healthcare professionals. In March 2000, we undertook activities to promote the services provided by the drug information centre to health professionals and to patients. This has resulted in a dramatic increase in the number of queries corning into the centre from all client groups.

In 2000‐01, almost half of the enquiries (47%) came from pharmacists, 30% from doctors and 19% from patients. Queries requiring patient counselling and literature searches were most common, followed by requests for information on product availability and identification, contraindications and safety, and the drug profile. Electronic databases were the most useful drug information resource.
Early Experience with the Use of Celecoxib in a Child and Adolescent Population
Authors: Lie Henry KH , Turner Sean C
Published: March 2016

Objective: To describe the use of celecoxib, a new selective cyclo‐oxygenase 2 (COX‐2) inhibitor, in a child and adolescent population.

Method: A twelve‐month retrospective analysis of the use of celecoxib within a major paediatric teaching hospital was undertaken. Data collected for each patient included patient demographics, indication for use, length of treatment, dose administered and reported adverse effects.

Results: Twelve patients received celecoxib over a 12‐month period. These patients can be divided into subgroups, including those with existing haematological disorders e.g. von Willebrand's disease with co‐existing morbidities of joint swelling and pain, and those patients who had previously reported adverse events to non‐selective non‐steroidal anti‐inflammatory drugs. Doses used in six children aged 12 years of age or less ranged from 2.4 to 6.3 mg/kg/day. The remaining patients were adolescents and were prescribed adult doses. In all patients celecoxib was well tolerated.

Conclusion: Celecoxib appears to have a role in child and adolescent therapy. However, this role is not well established and it is essential that large, well‐designed studies to determine the dose, safety, efficacy and place of celecoxib in the treatment of children and adolescents be undertaken.
Improving Concordance Between Use of Proton Pump Inhibitors and Prescribing Guidelines
Authors: Mackenzie Fraser D , Pillans Peter I , Radford James M , Claes Mitchell T , Flemin Ann‐Marie
Published: March 2016

Objective: To determine the effect of a request form, together with removal of proton pump inhibitors (PPIs) from ward stock, on concordance between use of PPIs and prescribing guidelines, and compare the results with a previous non‐interventional audit.

Design: Drug utilisation review.

Setting: 800‐bed metropolitan hospital.

Participants: 101 patients with a completed PPI request form. Data were compared to a previous audit undertaken on 253 patients in 1999.

Main outcome measures: Recorded upper gastrointestinal pathology; compliance with prescribing guidelines; PPI usage data.

Results: The proportion of patients appropriately investigated increased from 72% (183/253) in 1999 to 92% (93/101, p = 0.004 ). Compliance with prescribing criteria increased from 23% (57/253) in 1999 to 43% (43/101, p = 0.003). PPI usage decreased by 30% compared with the corresponding quarter of 1999.

Conclusions: The removal of PPIs from ward imprest along with the introduction of a PPI request form was associated with a significant improvement in compliance with prescribing guidelines, an increase in the proportion of patients appropriately investigated, and a reduction in PPI usage.
Smoking Cessation Program Using Nicotine Patches Linking Hospital to the Community
Authors: Vial Robyn J , Jones Terry E , Ruffin Richard E , Gilbert Andrew L
Published: March 2016

Objective: To compare the quit rates achieved by participants in a smoking cessation program, initiated in hospital using nicotine patches and continued in either the community pharmacy or hospital setting, with quit rates in a minimal intervention group.

Setting: The medical and surgical units at The Queen Elizabeth Hospital (TQEH), a major teaching hospital located in the western suburbs of Adelaide, South Australia.

Participants: Inpatients aged over 18 years who smoked 10 or more cigarettes per day. Of 306 smokers screened, 102 were enrolled.

Study Procedures: Participants were randomised to either the minimal intervention arm (n = 33), the hospital‐based program (n = 35), or the community pharmacy‐based program (n = 34). The minimal intervention group received written materials and advice about quitting. The two intervention arms started with a consultation with the research pharmacist and participants were commenced on nicotine patches and were followed after discharge with weekly counselling visits with either the researcher in an outpatient clinic or a community‐based pharmacist. Patches were supplied for $15.00 per week for up to 16 weeks. Exhaled carbon monoxide measurements to confirm abstinence were performed whenever possible. Continuous and point prevalence of abstinence from smoking were assessed 3, 6 and 12 months after enrolment.

Results: There was a statistically significant difference in the point prevalence of abstinence between groups at 12 months with 38%, 24% and 4.6% abstinence in the hospital, community pharmacy and minimal intervention arms respectively (X2 = 7 .145, df = 2, p = 0.031 ). The differences seen in continuous abstinence at 12 months (24%, 19% and 4.6% respectively) did not reach statistical significance.

Conclusion: A hospital‐based smoking cessation program initiated with nicotine patches was equally effective whether continued by hospital‐ or community‐based pharmacists and was superior to minimal intervention without nicotine patches.
Non‐Sedating Antihistamines for Premedication in Ambulatory Oncology Patients
Authors: Siderov Jim , Wendel Nan , Davis Ian D
Published: March 2016

Background: Antihistamines are commonly used as premedication against anaphylactic events associated with paclitaxel and rituximab. Commonly, intravenous (IV) H1‐receptor antihistamines are used.

Objective: To report our experience with the use of loratadine, an oral, non‐sedating H1‐receptor antihistamine, in ambulatory care patients receiving premedication for either paclitaxel or rituximab.

Method: Records of all patients who received loratidine in our ambulatory oncology day treatment centre were reviewed retrospectively.

Results: Seventy‐one cycles (20 paclitaxel, 51 rituximab) of therapy were administered using loratadine as premedication. One patient who commenced loratadine reverted to IV promethazine following a rash reaction to rituximab. All other patients tolerated therapy well. There were no anaphylactic or infusion‐related problems.

Conclusion: Loratadine 10 mg is well tolerated in ambulatory care patients receiving premedication for either paclitaxel or rituximab and should be considered in all ambulatory patients requiring an H1‐receptor antihistamine where sedation is not appropriate.
Management of Epilepsy in Older People
Authors: Kilpatrick Christine J , Lowe Adrian J
Published: March 2016

Epilepsy is a relatively common disorder among older people, with the incidence increasing significantly with age. In Australia, epilepsy is a major cause of disability in the elderly and, in the context of an ageing population, it is of increasing importance as a public health issue. The aetiology of epilepsy in older people and the spectrum of epilepsy and seizure type differs from the younger population. Making the diagnosis of epilepsy in the elderly poses particular difficulties. There are multiple medications available for the management of seizures, a number of which have been introduced only within the last decade, and have not been systematically studied in older people. Age‐related changes in metabolism, physiology, and pathology alter the pharmacokinetics of these medications, and these need to be taken into consideration when treating elderly patients with an antiepileptic drug. This article reviews the causes of seizures, issues regarding commencement of an antiepileptic drug, and age‐related changes in pharmacokinetics of these medications.
National Survey of Australia's Community Pharmacies in 2002: Rationale and Methodology
Authors: Berbatis Con G
Published: March 2016

Aim: To describe the rationale and methods for a national study of pharmacy practice activities performed in Australia's community pharmacies. The purpose is to produce a reference set of data on Australia's community pharmacies for subsequent national and international comparisons.

Background: There is no standard reference database of Australian pharmacy practice services against which changes can be monitored or international comparisons made. The lack of national data restricts the ability of pharmacy bodies to plan, quantify and rationally develop policies.

Study Design: A national survey of respondents in stratified 15% random samples of Australia's community pharmacies was undertaken. The stratification was based on categories 1 to 6 of PHARIA 2001. An advisory panel of representatives of national pharmacy bodies and experienced pharmacy researchers was formed to guide the study and monitor the results. The survey instrument was constructed to maximise response rates and minimise measurement, coverage, non‐response and sampling errors. The project was publicised in a variety of pharmacy publications early in 2002 to make pharmacists aware of the project and to encourage participation. Multiple contacts and mixed‐mode surveys by telephone, mail, facsimile and Internet will be used in the selected pharmacies to achieve a 75% response rate. Survey items have been divided into sections of 1. pharmacy and staff characteristics, 2. the types of services (e.g. general, pharmacy care, specialised activities), and 3. technical facilities used in health‐related activities. Analysis of the items in each section and the associations between them will quantify the rates of, and factors related to, the provision and distribution of pharmacy services in Australia.
Clinical Relevance of Cytokine‐Induced Changes in Drug Metabolism
Authors: Davey Andrew K
Published: March 2016

Cytokines are a group of potent peptides that regulate the immune response to a wide variety of stimuli including microbial agents, antigens and traumatic insult. In acute diseases involving a strong immune or inflammatory response, the metabolism of certain drugs is inhibited leading to increased and potentially toxic plasma concentrations. Investigations using hepatocytes and laboratory animals lend weight to the hypothesis that cytokines can regulate the level or activity of drug metabolising enzymes, in particular hepatic cytochrome P450 isoforms. Although these experimental tools may not precisely reflect the situation in human disease, it is apparent that cytokines can influence drug metabolism in many conditions involving an immunological component. Since cytokines are becoming increasingly used as therapeutic agents, or as targets for therapeutic intervention, their influence on drug metabolism will become clearer. In parallel with this increased understanding of the relationship between cytokines and drug metabolism, there will be an increased potential for cytokinedrug interactions.
Treatment of Primary Pulmonary Hypertension
Authors: Hirth Karen E , Williams Trevor J
Published: March 2016

Primary pulmonary hypertension (PPH) is a rare, serious and life threatening disease. Conventional treatments, including anticoagulation and non‐selective vasodilators, may increase survival. However the life expectancy and quality of life for these patients is generally poor. Newer treatments for PPH have become increasingly available in the last few years. Drugs such as epoprostenol, bosentan, treprostinil and sildenafil have now been licensed overseas and used in selected patients in Australia. There is great optimism that these drugs represent a very significant advance in the treatment of PPH.
Treatment of Dyslipidaemia in the Elderly
Authors: MacIsaac Richard J , Jerums George
Published: March 2016

Until recently, the benefits derived from treating dyslipidaemia in the elderly had not been established, as most trials demonstrating a reduction in events related to coronary heart disease have been biased towards younger patients. However, there is now evidence to suggest that age alone should no longer be considered a barrier to the instigation of lipid modifying therapies. Large clinical trials involving drugs of the statin class (HMG‐CoA reductase inhibitors) have shown that there is no diminution of the effects of statin therapy with advancing age, even for patients aged up to 80 years. Although it has not been proven in controlled trials, elderly patients may even derive a greater benefit compared to younger patients, as the absolute risk of coronary heart disease increases with age. Furthermore, the statins reduce the risk of stroke and possibly reduce the chances of developing dementia. This review summarises therapies available for treating dyslipidaemia and possible modifications required in managing elderly patients. Methods of assessing an individual's overall risk for coronary heart disease and the use of this risk assessment as a guide to the selection of patients for treatment are also discussed.
Ketamine as a Possible Cause of Delirium
Authors: Wein Simon , Spruyt Odette , Chapman Rebecca
Published: March 2016

This case is presented to illustrate two clinical points. The first point is the diverse manner in which delirium can present, especially in the medically ill population, particularly the ability to present with signs and symptoms of anxiety and depression either as a prodrome or in the ‘body’ of the presentation. The second point relates to the use of ketamine. While its role as an analgesic is yet to be definitively outlined in palliative care, its neuropsychiatric side effects are better described. This report reviews ketamine's potential uses and provides a cautionary tale.
The Use of ACE‐Inhibitors after Myocardial Infarction
Authors: Overland Victoria , Cottrell W Neil , Tett Susan E
Published: March 2016

Background: There is good evidence that angiotensin‐converting enzyme (ACE)‐inhibitors are beneficial after myocardial infarction (MI). However, it is not known how widely this evidence is used in practice and whether all eligible patients receive this therapy.

Aim: To assess the usage of ACE‐inhibitors in patients after MI in a large teaching hospital.

Method: A one‐month prospective analysis, combined with a three‐month retrospective analysis, was conducted at the Royal Brisbane Hospital (RBH) in February‐March 2000. Patients admitted with an MI or who had been diagnosed with an MI during admission from November 1999 to March 2000 were identified from the coronary care unit (CCU) records. Inpatient medication charts and outpatient records were then reviewed. Information collected included: ACE‐inhibitor use, doses, reasons for prescribing/not prescribing ACE‐inhibitors, and ACE‐inhibitor prescribers (cardiologists or general physicians).

Results: Forty‐four patients with an MI were included in the study, 28 of whom were prescribed ACE‐inhibitors (64%). Twenty‐four of the 28 patients on ACE‐inhibitors were prescribed perindopril. The major reason given for prescribing ACE‐inhibitors was signs of congestive cardiac failure. All ACE‐inhibitors initiated in patients after MI at RBH were ordered by cardiologists.

Conclusion: ACE‐inhibitors were prescribed appropriately in 88% of patients who met criteria for their use. This high percentage of appropriate prescribing was encouraging. Re‐evaluation as part of an ongoing quality assurance activity could be used to ensure this is maintained.
Doctors' Preference for the Location of a Drug Information Centre Leads to a Hospital‐Based Clinical Pharmacy Initiative in India
Authors: Lakshmi PK , Rao DA Gundu , Gore SB
Published: March 2016

This article describes the establishment of a department of clinical phannacy practice in a government hospital in Bangalore, India. Doctors' preferences were determined in a survey conducted during clinical meetings to introduce the concepts of clinical phannacy, drug information services and adverse drug reaction monitoring. There were 388 responses; only 22% of the doctors were aware of clinical phannacy services, 83% preferred a drug information service within a hospital (rather than an independent, external service), and none were aware of an adverse drug reaction monitoring program in their hospital. Based on the questionnaire and discussions with many doctors, a hospital‐based drug information centre was established in 2001. At the same time, a Department of Phannacy Practice was established jointly by Karnataka State Phannacy Council, Al‐Ameen College of Phannacy and Victoria Hospital. The hospital now has a Phannacy and Therapeutics Committee and an Adverse Drug Reactions Subcommittee. These groups have provided significant support to the phannacists' clinical activities.
Management of Osteoarthritis in Older People
Authors: Osborne Richard H , Chapman Adam B , McColl Geoffrey J
Published: March 2016

Osteoarthritis is a common cause of disability in the elderly. Management involves pharmacological and non‐pharmacological therapies, often in combination. Paracetamol is regarded as the drug of first choice in the management of pain, however anti‐inflammatory drugs or other analgesics should be considered if regular paracetamol fails. If conventional nonsteroidal anti‐inflammatory drugs or cyclo‐oxygenase‐2 specific inhibitors are prescribed, attention should be paid to gastrointestinal, hepatic, cardiac and renal risk factors. Recent research indicates that some complementary and alternative medicines (e.g. glucosamine) are effective and should be considered, particularly given their low side effect profile. The evidence around surgical procedures mostly supports arthroplasty (joint replacement) for severe, refractory knee osteoarthritis; however arthroscopy has generally been found to be ineffective. Physical therapies, weight loss and joint protection also have a place in management and given that osteoarthritis contributes to psychological morbidity, supportive programs such as the Arthritis Self‐Management Course should also be routinely recommended.
Survival Following Severe Aluminium Phosphide Poisoning
Authors: Pajoumand Abdolkarim , Jalali Nasser , Abdollah Mohammad , Shadnia Shahin
Published: March 2016

Aim: To describe the treatment and successful outcome of a patient who had taken an amount of aluminium phosphide that would normally be lethal.

Case report: A 47‐year‐old woman was admitted two hours after ingesting 16.8 g of aluminium phosphide with suicidal intent. Treatment consisted of: gastric lavage with potassium permanganate solution; intravenous bicarbonate, magnesium and calcium; and oral bicarbonate and coconut oil. Supportive therapy in intensive care was also provided. Her clinical course included hypotension, metabolic acidosis and liver dysfunction.

Discussion: Aluminium phosphide produces phosphine gas and is used to control rodents in grain storage facilities. This patient had apparently ingested what would normally be a lethal amount of aluminium phosphide and had signs and symptoms of severe toxicity. She survived following rapid treatment and supportive care. Recommended measures to limit absorption and phosphine toxicity may have contributed to survival.
Incompatibility between Calcium and Sulfate Ions in Solutions for Injection
Authors: Ambados Folios
Published: March 2016

Objective: To investigate the potential physical compatibility of magnesium sulfate injection with calcium‐containing injections in various infusion solutions and to demonstrate that gross visual inspection alone, is often inadequate in determining the safety of an admixture.

Method: Magnesium sulfate (49.3%) injection was added to various infusion solutions followed by either calcium chloride (10%) injection or calcium gluconate (10%) injection. Admixtures were examined for the presence of haze, precipitation, gas evolution or colour change. Solutions which appeared free from incompatibility after 24 hours, were further examined microscopically to verify the absence of precipitate.

Results: Incompatibility between magnesium sulfate and calcium chloride injections was observed in the majority of the admixtures. Calcium gluconate injection demonstrated a lower potential to interact with magnesium sulfate injection, but still showed evidence of incompatibility in a number of the admixtures when examined microscopically.

Conclusion: The combination of magnesium sulfate and calcium chloride or gluconate injections should be avoided in infusion solutions other than total parenteral nutrition (TPN). Magnesium chloride should be substituted for magnesium sulfate injection when admixture, or infusion via Y‐site with calcium‐containing injections, is required.

The physical compatibility of IV solutions should not be based upon a single visual inspection performed shortly after admixture. All results obtained after inspection with the naked eye should be verified microscopically.
Pharmacological Management of Alzheimer's Disease
Authors: Hecker Jane R , Snellgrov Carol A
Published: March 2016

With the ageing of the population, Alzheimer's disease (AD) represents an individual and public health problem of enormous significance. Research is ongoing worldwide in the search for more effective treatments, including drugs to slow or prevent progression in AD. Three cholinesterase inhibitor drugs (donepezil, rivastigmine and galantamine) are currently subsidised in Australia for the management of core cognitive symptoms in mild to moderate AD. Other drugs are available for the secondary management of behavioural and psychological symptoms associated with AD. This article reviews the pharmacological management of AD, treatment efficacy, side effects, and practical issues in drug use.
Preventing Falls Among Older People—Current Practice and Attitudes Among Community Pharmacists
Authors: van Beurden Eric , Barnett Lisa M , Molyneux Maxine , Eakin Elizabeth G
Published: March 2016

Objective: Falls among older people are a major cause of injury and death in Australia. Urgent action is required if we are to stem the ‘epidemic’ increase in falls as our population ages. This paper describes current practice and attitudes of community pharmacists in Northern Rivers, New South Wales, in relation to preventing falls.

Method: Community pharmacists in the Northern Rivers area of New South Wales were surveyed to determine their current activities to reduce the risk of falls in older clients and to gauge awareness of the successful 1992‐96 falls prevention program‐‘Stay on Your Feet’.

Results: Response rate was 79% (53/67). Seventy‐two per cent reported that they urge ‘most’ or ‘almost all’ older clients to bring in out‐of‐date medications for disposal, 66% give them falls prevention advice at least ‘sometimes’, 57% refer at least ‘some’ older clients to allied health practitioners for assessment or treatment of falls risk, and 92% are interested in receiving more written information regarding falls prevention.

Conclusion: The findings suggest that while community pharmacists are both ready and keen to play a role in future falls prevention initiatives, their current involvement varies considerably. Specific ways in which they might further help to reduce falls are: regularly checking the potential of client medications to contribute to falls, giving more verbal or written advice, promoting ‘falls safe’ products, referring older clients to allied health practitioners for assessment or treatment of falls risk, and training staff to provide falls prevention advice.
Audit of Celecoxib and Rofecoxib Use: St Vincent's Public Hospital, Darlinghurst
Authors: Slader Cassandra A , Welch Susan A
Published: March 2016

Objectives: To review the usage of the cyclo‐oxygenase‐2 selective inhibitors (COX‐2 inhibitors)‐celecoxib and rofecoxib‐at St Vincent's Public Hospital (SVH), in relation to the existing SVH Formulary Guidelines and also ‘good clinical practice’ as defined from considerations of the literature.

Method: Clinical pharmacists at SVH identified all patients receiving celecoxib or rofecoxib‐on admission, ceased at the point of admission, or commenced during admission‐over an eight‐week period (May‐June 2001). Data were collected from clinical notes and structured patient interviews.

Results: Sixty‐five patients were included (29–92 years, 66% <65 years). A COX‐2 inhibitor was commenced for three patients, continued for 68% (44/65), and ceased either at the point of admission or during admission for 28% (18/65). Reasons for cessation included gastrointestinal bleed, acute renal failure, and haemorrhagic cerebrovascular accident. Change to a COX‐2 inhibitor was patient‐initiated for 21% and as aresult of side effects of previous medication for 8%. History of gastrointestinal ulceration was documented for 18% (12/65) of patients. An additional 18% (12/65) were considered at high risk of ulceration. Anti‐hypertensive medications were concomitantly prescribed in 43% of cases. Forty patients (62%) had impaired renal function (creatinine clearance >70 mL/min ). Of those patients continuing COX‐2 inhibitor therapy, 79% (37/47) were in accordance with current SVH guidelines. If precautions relating to concomitant hypertension, renal impairment and gastrointestinal safety were also considered, 46% of patients were treated in accordance with ‘good clinical practice’.

Conclusion: This audit has identified that the SVH guidelines would benefit from review to encourage more appropriate use of COX‐2 inhibitors in all patient groups. In addition, we feel ongoing education of general practitioners is required, regarding the risk of COX‐2 inhibitor use in patients with hypertension and renal dysfunction.
Evaluation of Academic Detailing Within a Coordinated Care Trial
Authors: McDonald Paula K , Winkle C Ann , Askew Deborah
Published: March 2016

Background: Academic detailing has been identified as an intervention that modifies health professionals' practice, particularly prescribing.

Aim: To assess the impact of academic detailing on general practitioners' (GPs) prescribing for heart failure, and chronic pain associated with osteoarthritis, in an elderly population.

Method: This was a quasi‐experimental study embedded within a coordinated care trial, with a 12‐month follow‐up. 1151120 (96%) of GPs invited to participate received academic detailing visits by experienced teaching‐hospital clinical pharmacists between July 1998 and July 1999. The pharmacological management of two conditions was addressed: heart failure in Phase 1, and chronic pain associated with osteoarthritis in Phase 2. Data from the Pharmaceutical Benefits Scheme (PBS) were analysed for changes in prescribing. The perceptions of the GP and pharmacist were also assessed.

Results: Consistent with key messages, non‐steroidal anti‐inflammatory drug (NSAID) use decreased in Phase I, and in Phase 2long‐acting NSAID use decreased and low‐dose tricyclic antidepressant use increased. Inconsistent with key messages of Phase 1, angiotensin converting enzyme inhibitor prescribing for heart failure did not change. GPs and pharmacists were highly satisfied with the project.

Conclusion: Academic detailing visits to GPs were partly successful in changing prescribing practices for heart failure, and pain management of osteoarthritis. Initiatives such as this may strengthen professional links between pharmacists and GPs and benefit patients through enhanced quality use of medicines.
Clinical Pharmacy in a South Indian Government Maternity Hospital
Authors: Kumari Rajesh , Kethini Thejaswarup
Published: March 2016

Aim: To initiate clinical pharmacy services including drug information in an Indian government maternity hospital, and to measure the activity provided.

Method: Clinical pharmacy services were initiated and drug information was provided to doctors on request over eight months in a government maternity and childcare hospital. Services were provided to all pregnant women with co‐morbid diseases such as pre‐eclampsia and pregnancy‐induced hypertension.

Results: During the study period, 137 recommendations were made and 38 drug information queries answered. Drug information relating to: indications, pharmacokinetics and pharmacodynamics, adverse drug reactions, and drug interactions was provided for 2.6%, 26.4%, 28.9% and 15.7% of queries respectively. Our recommendations to amend drug treatment were accepted in 88.9% of cases.

Conclusion: Clinical pharmacy, including a drug information service, is well appreciated by physicians. Regular drug therapy monitoring and timely interventions are necessary to promote better maternal, foetal and neonatal health care.
Perceived Barriers by Hospital Pharmacists to Become Accredited to Perform Medication Reviews in the Home
Authors: Bennett Alexandra (Sasha) , Slader Cassandra A
Published: March 2016

Objectives: To gauge hospital pharmacists preparedness to become accredited to perform medication reviews, with a view to implementing a sustainable and innovative model of practice of hospital pharmacist‐led medication review for discharged patients and outpatients.

Method: Clinical pharmacists at St Vincent's Public Hospital, Darlinghurst, were requested to complete a semi‐structured questionnaire. The questionnaire asked pharmacists about their understanding of the medication review process, whether it was relevant to their current and future practice and their perceived barriers to accreditation. Pharmacists were also asked to rate their level of skill and/or confidence with a number of processes utilised in the medication review on a 5‐point Likert scale.

Results: Questionnaires were completed by sixteen pharmacists. Only one pharmacist was accredited, but was not currently performing medication reviews. Becoming accredited to perform medication reviews had been considered by eleven of the fifteen non‐accredited pharmacists. The barriers to accreditation cited included ‘lack of time’ and ‘affordability of accreditation courses’. Fifteen pharmacists noted that the medication review process was relevant to their current practice. The majority of pharmacists rated their proficiency and/or confidence with skills required to conduct medication reviews highly.

Conclusion: Most of the pharmacists surveyed noted that they had the necessary skills required to conduct medication reviews. Perceived barriers to accreditation were identified. The needs assessment is the first stage in a broader program to develop a sustainable, innovative and rewarding model of hospital pharmacist‐led medication review in the home.