bluuebunny/crossref_metadata_2025 huggingface dataset:
Genotypes of rubella virus and the epidemiology of rubella infections in the Democratic Republic of the Congo, 2004–2013
Authors: Pukuta Elizabeth , Waku‐Kouomou Diane , Abernathy Emily , Illunga Benoit Kebela , Obama Ricardo , Mondonge Vital , Dahl Benjamin A. , Maresha Balcha G. , Icenogle Joseph , Muyembe Jean‐Jacques
Published: March 2016

Rubella is a viral infection that may cause fetal death or congenital defects, known as congenital rubella syndrome (CRS), during early pregnancy. The World Health Organization (WHO) recommends that countries assess the burden of rubella and CRS, including the determination of genotypes of circulating viruses. The goal of this study was to identify the genotypes of rubella viruses in the Democratic Republic of the Congo (DRC). Serum or throat swab samples were collected through the measles surveillance system. Sera that tested negative for measles IgM antibody were tested for rubella IgM antibody. Serum collected within 4 days of rash onset and throat swabs were screened by real‐time RT‐PCR for rubella virus RNA. For positive samples, an amplicon of the E1 glycoprotein gene was amplified by RT‐PCR and sequenced. 11733 sera were tested for rubella IgM and 2816 (24%) were positive; 145 (5%) were tested for the presence of rubella RNA by real‐time RT‐PCR and 10 (7%) were positive. Seventeen throat swabs were analyzed by RT‐PCR and three were positive. Sequences were obtained from eight of the positive samples. Phylogenetic analysis showed that the DRC rubella viruses belonged to genotypes 1B, 1E, 1G, and 2B. This report provides the first information on the genotypes of rubella virus circulating in the DRC. These data contribute to a better understanding of rubella burden and the dynamics of rubella virus circulation in Africa. Efforts to establish rubella surveillance in the DRC are needed to support rubella elimination in Africa. J. Med. Virol. 88:1677–1684, 2016. © 2016 Wiley Periodicals, Inc.
Ward Stock and Unit‐Supply Drug Distribution: Influence on Nursing Time, Pharmacy Time and Medication Errors
Authors: McNally Karen M , Page Maxwell A , Sunderland V Bruce
Published: March 2016

Australian hospitals commonly use a variation of the ward stock (WS) or imprest system as the method of drug distribution. This study evaluated the existing WS method at Sir Charles Gairdner Hospital (SCGH) and compared it to a unit‐supply individual patient dispensing (USIPD) system. Comparisons of nursing time, pharmacy time and medication errors were made.
A Two‐Year Review of Risperidone Usage on an Acute‐Care, Adult Psychiatric Unit
Authors: Lim Jenette W‐J , Alderman Christopher P
Published: March 2016

To review the use of risperidone for all patients treated with this drug in the acute‐care adult psychiatry unit of a general teaching hospital during a two‐year period
Gentamicin Usage and Monitoring in a Sydney Teaching Hospital
Authors: Edwards Christina T , Briggs Donna , Howes Laurence G
Published: March 2016

Objective: To determine gentamicin usage and monitoring patterns at St George Hospital.

Method: A random audit was performed on the medical records of 200 patients who received gentamicin whilst in hospital between July 1994 and July 1995.

Results: The amount of gentamicin patients received per course of therapy ranged from 60 to 6080 mg (median 670 mg). A course of gentamicin therapy ranged from 1 to 27 days (median 4 days) and the total daily gentamicin dose ranged from 60 to 360 mg (median 160 mg). Once‐daily administration of gentamicin increased from 4.9% of gentamicin courses to 25.8% following the introduction of hospital guidelines outlining the benefits of once‐daily gentamicin usage. Serum gentamicin concentrations were monitored in 134 (67%) patients with assays being performed within the first two days of therapy in 65 (48.5%) of these patients. Elevated serum trough concentrations (≥2.0 mg/L) occurred in 40 patients; of these, 47.5% had levels between 2.0 and 4.0 mg/L (median 3.1 mg/L, range 2 to 11 mg/L). No clinically recognisable cases of gentamicin toxicity occurred. Significant independent predictors of elevated gentamicin concentrations were baseline serum creatinine levels(β = 0.353, p = 0.0001), duration of gentamicin therapy (β = 0.572, p = 0.008) and the total daily dose of gentamicin (β = 0.186, p = 0.02).

Conclusion: Once‐daily gentamicin use at this hospital is still below that recommended in the antibiotic policy/guidelines set by the hospital. The routine monitoring of gentamicin concentrations to reduce the risk of toxicity is of questionable value when gentamicin therapy is given once daily and the duration of therapy is restricted to less than seven days. Considerable savings could be made (approximately $63 000 per annum at St George Hospital) if suitable patients received once‐daily gentamicin dosing, and monitoring of gentamicin was deferred until the third day of therapy in patients with normal renal function.

Aust J Hosp Pharm. 1997; 27: 133–7.
Vancomycin Usage Review in the Era of Vancomycin‐Resistant Enterococci (VRE)
Authors: Radford James M , Whitby R Michael , Looke David FM , Coombes Judith A
Published: March 2016

Aim: To review vancomycin usage as an initial strategy for the control of VRE at the Princess Alexandra Hospital, a 900‐bed tertiary referral hospital.

Method: All vancomycin orders for inpatients were identified prospectively by clinical pharmacists for a five‐week period during March and April 1996. Clinical data and laboratory findings were collected from patient records, and if necessary the prescribing doctors were interviewed.

Criteria for appropriate prescribing were adapted from guidelines proposed by the Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention.

For the purposes of the review, patients were categorised into indications for vancomycin usage: empiric (prior to microbial confirmation), prophylactic and directed therapy (culture and sensitivity results available).

Results: One hundred and eight patients were prescribed vancomycin during the study period. Sixty‐three patients (58%) were given vancomycin for indications consistent with acceptable criteria. Of the 45 (42%) remaining patients treated inappropriately, 29 were empiric (10 incorrect indication, 15 extended duration, 3 non‐severe β‐lactam allergies, one incorrect dosage), 15 were for prophylaxis (13 extended duration, six incorrect indications, two non‐severe penicillin allergies), and one patient was treated for Clostridium difficile after positive toxin results.

Conclusions: This study has identified problems related to the prescribing of vancomycin in this hospital. The next step in the strategy to reduce the level of inappropriate use of vancomycin is the production of guidelines, education and the implementation of these guidelines for appropriate vancomycin usage. Although the level of inappropriate prescribing of vancomycin is lower than previously reported studies, the prudent use of vancomycin may reduce the incidence of resistant enterococci and in combination with efficient infection control practices may control the emergence of this problem.

Aust J Hosp Pharm 1997; 27: 140–3.
A Survey of Parenteral Therapy Services Provided to Home Patients by Australian Hospital Pharmacies
Authors: Capes David , Sunderland Bruce , Roberts Malcolm , Blackbourn Stephen , Ailakis John , Maher Michael
Published: March 2016

To investigate the practice of home health care in parenteral therapy services provided by Australian hospital pharmacies in 1995 and to assess the changes in these services since 1989.
Preliminary Formulation and Stability of a Spironolactone Oral Solution for Paediatric Use
Authors: McKnight David L , Emmott Nicole , Sunderland V Bruce , White Susan
Published: March 2016

To develop an oral solution of spironolactone for paediatric use of adequate stability to allow bulk manufacture.
Stability of Enalapril Solutions Prepared from Tablets in Sterile Water
Authors: Schlatter Jöel , Saulnier Jean‐Louis
Published: March 2016

To assess the stability of 0.1 and 1 mg/mL enalapril maleate oral solutions in sterile water for irrigation compounded from tablets and stored at room temperature.
Stability of Two Concentrations of Morphine Tartrate in 10 mL Polypropylene Syringes
Authors: Targett Paul L , Keefe Patrick A , Merridew Colin G
Published: March 2016

Objective: Analgesics are often given by subcutaneous infusions in palliative care. We studied the physical and chemical stability of two concentrations of morphine tartrate stored in 10 mL polypropylene syringes. Solutions containing 800 mg and 40 mg of morphine tartrate in 10 mL were prepared from commercially available ampoules and, where necessary, diluted to volume with 0.9% sodium chloride for injection.

Method: The solutions were stored in the dark, at 21– 230C or 4–8°C for three weeks. At intervals of two to three days the concentration of morphine was measured in duplicate samples from each of three syringes using a stability‐indicating high performance liquid chromatographic (HPLC) assay. Physical compatibility was assessed visually.

Results: At both storage temperatures, the test solutions retained greater than 90% of their initial concentrations of morphine tartrate throughout the study period. A slight straw colour developed in the 800 mg in 10 mL solution stored at 18–23°C. At neither storage temperatures did the pH of either solution vary by more than 0.2 from initial values.

Conclusion: Morphine tartrate, in the formulations tested, is stable when stored at 21–23°C and 4–8°C in polypropylene syringes for three weeks.
Evaluation of a Pharmacy Technician Training Program ‐ Early Trends
Authors: McFarlane Anne E , Kelly Maria , Maunsell Terry A , Tierney Johneen M , Young Carolyn E
Published: March 2016

Aim: To ascertain the views of students enrolled in a pharmacy technician training program.

Method: Questionnaires were sent to all students immediately after enrolling and also after completing the course. Students who failed to complete the course (or their mentor‐pharmacist) were contacted informally.

Results: Eighty entry questionnaires were distributed and 46 (58%) returned. The most common reason for enrolling was ‘to perform the job better’. Most students were unsure as to whether they would undertake further study after the current course. Sixteen forms were distributed to students who completed the entire course and 14 (88%) returned. On a scale of I to 5, rankings for difficulty, interest and relevance were 2.86, 4.39 and 4.61 respectively. Specific comments regarding content, advice for new students and departmental support were provided. Some students who failed to complete the course thought that the original decision to enrol was incorrect.

Conclusion: These preliminary results have provided valuable information which is being used to maximise the success of subsequent enrollees.
New System to Administer Drugs via the Central Venous Catheter in Newborn Infants
Authors: PL Simon , Tan Ailee , Quek Belinda , Ang Peisan
Published: March 2016

Background: Administering intravenous medications to the premature baby is often difficult because of the lack of peripheral venous access. Routine administration of these medications via the central venous catheter (eVC) poses a high risk of eve‐related sepsis.

Aim: To describe a new method of aseptic drug delivery linked to the eve and to describe our initial experience in 32 neonates.

Description: The drug‐manifold system is aseptically prepared under laminar flow conditions, and then linked aseptically to the parenteral nutrition solution and to the eve. This closed system is not disrupted until the next change of solutions 24 hours later. Drugs are administered at the appropriate times by turning the stopcocks without disrupting the closed system.

Application: A total of 32 neonates received drugs administered by this system for an average duration of 12.9 ± 12.7 (SD) days. Drugs delivered included benzylpenicillin, ampicillin, gentamicin, cefotaxime, amikacin, aminophylline and vancomycin. Two cases of bacteraemia were identified; this represents 4.8 infections/ 1000 days of usage of this new system. This compares favourably with our infection rate before the new system was introduced.

Conclusion: A new system of aseptic drug delivery linked to the eve in neonates was found to be safe and useful with few complications.
Using Genetic Algorithms on a PC to Compile Staff Rosters
Authors: Snowdon Graeme M , Elliott Phillip
Published: March 2016

Aim: We aimed to develop an automated staff rostering system for pharmacy staff working on Saturday rotations that was fair to all concerned, required minimal input and was simple to modify as needs changed.

Method: The roster was prepared on a 33 MHz 486 IBM personal computer (PC) in the spreadsheet package Microsoft Excel v4, using Evolver 2.0, the genetic algorithm add‐on for Excel.

Results: A staff roster was prepared in the form of a spreadsheet that could be adjusted to meet the constraints of annual leave, rostered days off and many more variables. The genetic algorithm software, linked to the spreadsheet, automatically produced an acceptable roster with no timetable clashes.

Conclusion: Pharmacy staff favour the new system since many variables can be assessed with little manual input. A workable roster that is fair and equitable can be easily obtained.
Optimisation of Drug Delivery 8. Mucosal Drug Delivery via the Nose and Mouth
Authors: Benson Heather AE , Prankerd Richard J
Published: March 2016

This article reviews the current status and possible future applications of drug delivery via the mucosal membranes of the nose and mouth. The anatomy of these sites is briefly discussed with respect to its influence on drug delivery. Current research into optimisation of drug delivery via these mucosal surfaces is reviewed.
Testing the Surefuser: A Disposable Subcutaneous Infusion Pump
Authors: Huppatz Clare , Parker Deborah , Maddocks Ian
Published: March 2016

Objective: To assess the accuracy of a new mechanical infusion pump, Nipro Surefuser

Setting: Daw House, a hospice unit located at Repatriation General Hospital, Daw Park, South Australia.

Method: Three Surefuser infusion devices were assessed on the bench top over a three‐day period. A flowcontrol tubing was chosen that would deliver 50 mL of 0.9% sodium chloride in 72 hours at a rate of0.7 mLI h. Devices were fitted with extension tubing and a 25‐gauge butterfly needle. One Surefuser device was attached to a healthy volunteer for a three‐day trial. The infused volume was indirectly measured every 12 hours throughout the trials and the ambient temperature was also recorded.

Results: Mean flow rates for the three Surefuser devices assessed on the benchtop were 0.63 mL/h, 0.71 mL/h and 0. 7 4 mL/h. Temperatures for these trials ranged between 18.3°C and 28.6°C. The mean flow rate of the Surefuser device attached to the volunteer was 0.88 mL/h.

Conclusions: The manufacturer claims that the Surefuser is accurate within ±10%, at a constant temperature of 32°C. The average rates as measured on the benchtop support this claim. It is unclear what the effect of temperature was on the infusion rate, although it appeared to make only a minor difference. The Surefuser is simple to operate and convenient to work with. The accuracy is acceptable in palliative care and future studies should be trialed in a clinical setting. The major drawback is the cost — a single, disposable unit costs approximately $53.00.
Optimisation of Drug Delivery 9. Mucosal Drug Delivery via the Eye, Vagina, Uterus and Rectum
Authors: Benson Heather AH , Prankerd Richard J
Published: March 2016

This article reviews the current status and possible future applications of drug delivery via the mucosal membranes of the eye, vagina and rectum, as well as a little of its history. The anatomy of each administration site is briefly discussed with respect to its influence on drug delivery. Current research into optimisation of drug delivery via these mucosal surfaces is reviewed.
Intravenous Phenoxybenzamine for Acute Hypertension of Phaeochromocytoma A Case Report
Authors: Fisquet Paul
Published: March 2016

Objective: To illustrate the use of IV phenoxybenzamine (not commercially available in Australia) in a patient presenting with acute phaeochromocytoma which was unsatisfactorily controlled with other agents, including IV phentolamine.

Clinical features: The patient was a 52‐year‐old female who presented for an elective total abdominal hysterectomy and bilateral salpingo‐oophorectomy. During the operation her blood pressure rose precipitously and she had an episode of myocardial ischaemia. A presumptive diagnosis of phaeochromocytoma was made and subsequently proven. Postoperatively she was admitted to ICU on infusions of phentolamine and glyceryl trinitrate.

Case progress and outcome: By day 4 her phentolamine infusion had increased to 80 mg/h with frequent boluses required. When a phenoxybenzamine infusion was substituted for the phentolamine the blood pressure rapidly came under control and the patient could be transferred to the medical ward. She was discharged with her symptoms well controlled on oral medication to await surgical removal of the phaeochromocytoma.

Conclusion: IV phenoxybenzamine may successfully treat acutely ill patients with phaeochromocytoma unresponsive to other agents.
Performance Indicators: Initial Queensland Public Hospitals' Data‐Set
Authors: Low John , Petrie Andrew F
Published: March 2016

To develop and test a set of performance indicators for use in Queensland public hospitals.
Assessment of a Nursing Home Medication Review Service Provided by Hospital‐Based Clinical Pharmacists
Authors: Elliott Rohan A , Thomson William A
Published: March 2016

To describe the first six months of a medication review service for residents of four nursing homes provided by hospital‐based clinical pharmacists using Commonwealth Government funding. To document the recommendations made, their impact on medication and pathology test expenditure, the cost and viability of providing the service, and opinions of medical and nursing staff regarding the reviews.
Anaesthesia in Older People
Authors: Leaver Antony S
Published: March 2016

Older people are presenting in increasing numbers for surgical procedures. The anaesthetist must be aware of the physiological changes produced by ageing and the various age‐related disease processes coexisting in the elderly. Significant changes to the pharmacokinetics and pharmacodynamics of most of the commonly administered anaesthetic drugs occur in older people. This has a direct impact upon the safe delivery of anaesthesia in this patient population. Subcutaneous infiltration of local anaesthetic drugs without sedation is the anaesthetic technique of choice but is only appropriate in certain minor surgical procedures. Otherwise, no one anaesthetic technique has been demonstrated to be superior in the older patient. Anaesthesia may be successfully administered to older people provided the anaesthetist carefully evaluates and optimises the patient's medical condition prior to surgery, modifies the anaesthetic accordingly, and pays close attention to detail.
A Survey of Drug Audit Practices and Promotion of Quality Prescribing in Australian Hospitals with a Focus on Psychotropic Drugs
Authors: Fellows Linda , Hughes Jeffery D
Published: March 2016

Objective: To gain an insight into current practice of drug audit/drug usage evaluation (DUE) in Australian hospitals with a particular focus on psychotropic drugs.

Method: All Australian hospitals with greater than 150 beds were surveyed by questionnaire to ascertain the level of drug audit activity and the strategies used to support quality prescribing. Twenty‐two pharmacists from 18 different hospitals in 5 States participated in a structured follow‐up interview.

Results: Pharmacists from 73 (49%) of the 150 hospitals surveyed responded. Drug audit activity varied widely across hospitals and did not necessarily relate to the size or demographics of the hospital. While there was increasing use of well‐structured DUE, simple one‐day ‘snapshots’ of drug usage were also common. Interviewees reported that the focus of DUE was primarily on cost containment, with a secondary element of quality prescribing. Pharmacists were closely involved, but little training or additional resources were provided for these activities. Successful DUE was seen to depend heavily on hospital culture and in particular on the support of key clinicians and senior managers. Psychotropic drug audit was not a high priority for DUE outside the stand‐alone psychiatric institutions. Lack of resources and incentives coupled with inadequate information technology have limited DUE progress.

Conclusion: There is recognition in Australian hospitals that DUE is a valuable tool for improving prescribing practice. To progress DUE it is critical to advance and standardise hospital computer systems and in particular to introduce electronic prescribing. In addition there is scope to improve policy agendas relating to accreditation requirements and national standards to enhance the development of DUE.
Strategy for Identification of ‘Near Miss’ Events and Improving Dispensing Accuracy
Authors: Dooley Michael J , Streater Jacqui , Wilks Justin J
Published: March 2016

Aim: To develop a non‐punitive system to maximise dispensing accuracy that incorporated an analysis of near‐miss events.

Method: The Dispensing Accurately and Near Miss Program (DANMP) was implemented at the Peter MacCallum Cancer Institute (PMCI) in mid‐2000. It consists of two dispensing modules and a near‐miss reporting system. The program is non‐punitive and does not attempt to be quantitative but rather facilitates powerful reminders of system‐based limitations and reinforces the need to continually review and modify practice. The program was implemented with support from all members of staff and was reflective of a department culture focused on quality and patient care.

Results: The program has been incorporated into routine orientation of staff and is a standard agenda item at pharmacy staff meetings. Even though the PMCI is a specialist oncology institute the dispensing process is generic and hence the program may be applied to other pharmacy settings.
Quality of Prescribing for Elderly Inpatients at Nine Hospitals in Victoria, Australia
Authors: Elliott Rohan A , Woodward Michael C , Oborne C Alice
Published: March 2016

Objective: To assess the quality of prescribing for elderly inpatients at nine acute and subacute public hospitals in Victoria, Australia.

Method: Prescribing was assessed cross‐sectionally by reviewing prescriptions for all inpatients aged 65 years and over on participating units on the days of audit. Patients admitted less than 24 hours prior to audit were excluded. Evidence‐based prescribing indicators were used to assess quality of prescribing using patients' medication charts and hospital medical records.

Results: Prescriptions for 1416 patients (median age 81 years, 57% female) were reviewed. The median number of medications prescribed was eight (0‐22). Thirty‐four per cent of items were prescribed by trade name; 37% of medication charts did not have patients' adverse drug reaction status recorded; 15% of ‘when required’ items had no frequency or maximum dose specified; 33% of sulphonylurea hypoglycaemic prescriptions were for long‐acting agents; 36% of paracetamol prescriptions allowed doses <4 g/day to be administered; 28% of allopurinol prescriptions were for doses ≥300 mg; 80% of benzodiazepine prescriptions and 32% of neuroleptic prescriptions were considered inappropriate; 48% of metformin prescriptions were for patients with renal impairment; 35% of patients with atrial fibrillation and no contraindication to warfarin or aspirin were not prescribed either of these drugs; and 26% of patients with ischaemic heart disease and no contraindication were not prescribed aspirin.

Conclusion: A range of inappropriate prescribing practices for elderly hospital inpatients were identified. These included poor documentation, over‐prescribing, inappropriate drug selection, inappropriate dose selection, and under‐prescribing. Strategies are required to improve the quality of hospital prescribing.
Prevalence and Predictors of Complementary Medicine Usage in Diabetes: Fremantle Diabetes Study
Authors: Clifford Rhonda M , Batty Kevin T , Davis Wendy , Davis Timothy ME
Published: March 2016

Aim: To evaluate the use of complementary medicines (CMs) by diabetic patients, and to investigate whether these CMs could affect diabetes control, related comorbidities and existing therapeutic regimens.

Method: Three hundred and fifty‐one diabetic patients were interviewed regarding their use of CMs. A literature search was conducted to assess the potential impact of CMs on diabetes control and related comorbidities. The subjects were a convenience sample of consecutive patients from the Fremantle Diabetes Study attending their annual review. The main outcome measures were the prevalence and range of CMs used by diabetic patients and the potential requirement for additional monitoring.

Results: Eighty‐three out of 351 (23.6%) diabetic patients had consumed at least one CM in the previous year, the most common being vitamin C. These patients were of a similar age but more likely to be female (59% versus 41% males; p=0.02) compared with those not taking CMs. Glycaemic control was similar in the two groups. CM use was associated independently with female gender, Anglo‐Celt ethnicity, and keeping a home blood glucose monitoring diary. Based on a comprehensive literature search, 42% of the CMs potentially necessitated additional patient monitoring or could be considered inappropriate for diabetic patients.

Conclusion: CM use is common amongst patients with diabetes, especially, female Anglo‐Celts. CMs have the potential to interfere with diabetes control or related comorbidities. Our data indicate the need for patient disclosure of CM use, adequate monitoring for CM‐related adverse events and greater consumer protection perhaps through tighter regulation of CM sources.
5‐HT3 Antagonists in the Treatment of Postoperative Nausea and Vomiting
Authors: Pham Louise , Langford Jane , Williams Kylie
Published: March 2016

Background: Postoperative nausea and vomiting (PONV) can affect up to 30% of patients. While the use of antiemetics for prophylaxis has been extensively reported there is less evidence of their efficacy for the treatment of PONV.

Aim: To review the evidence and discuss the use of 5‐hydroxytryptamine type 3 (5‐HT3) antagonists for the treatment of PONV in Australia.

Method: A literature search was conducted to identify clinical studies evaluating the effects of 5‐HT3 antagonists in the treatment of PONV.

Results: In four studies various doses of 5‐HT3 antagonists were compared and in five studies a single dose of 5‐HT3 antagonist was assessed against another antiemetic or placebo, or both.

Conclusion: These studies indicate that 5‐HT3 antagonists are effective and safe in the treatment of PONV.
Stability and Compatibility of Alfentanil Hydrochloride and Morphine Sulfate in Polypropylene Syringes
Authors: Sharley Nicholas A , Burgess Naomi G
Published: March 2016

Aim: To establish the chemical stability and physical compatibility of alfentanil hydrochloride and morphine sulfate in polypropylene syringes for patient controlled analgesia at the Royal Adelaide Hospital.

Method: A stability indicating high pressure liquid chromatography (HPLC) method was developed and validated. Concentrations of alfentanil hydrochloride and morphine sulfate stored in polypropylene syringes were measured over a sixmonth period. Sample syringes were stored under refrigeration (2‐8°C) and at room temperature (22±1°C). Visual inspection for macro particulate matter was undertaken using an Allen viewer. Stability was defined as maintaining at least 90% of the day zero concentration. Quality control standards were assayed on each study day to determine intra‐ and inter‐day precision and accuracy.

Results: Morphine sulfate content remained at 99% of initial concentration after 182 days at both storage conditions. Alfentanil hydrochloride content remained at 100% of initial concentration after 182 days at both storage conditions. No particulate matter was visible in sample syringes throughout the study period.

Conclusion: Alfentanil hydrochloride and morphine sulfate in polypropylene syringes are chemically stable and physically compatible for 180 days in the concentrations studied, when protected from light and stored either under refrigeration (2‐8°C) or room temperature (22±1°C). An expiry date of six months can be applied, facilitating efficient manufacturing and clinical evaluation in the management of acute pain.
Observations of Pharmacy Practice in HIV Treatment Centres in the United Kingdom
Authors: Maxwell David J
Published: March 2016

Clinical pharmacy practice was observed in HIV treatment centres in London and Oxford, UK during 2002. The responsibilities and services provided by pharmacists specialising in HIV medicine were similar to those of their counterparts in Australian hospitals. Notable differences included the practice of pharmacists writing electronic discharge prescriptions, the regular provision of consumer medicines information and the dispensing of pre‐packed medication to maintain patient confidentiality. In the UK, HIV drugs are supplied without charge compared to Australia where a copayment is required.
Bioequivalence: How, Why, and What Does it Really Mean?
Authors: Pearce Gregory A , McLachlan Andrew J , Ramzan Iqbal
Published: March 2016

Aim: To review the pharmacokinetic and pharmacodynamic principles of bioequivalence testing of medicines administered orally to achieve a systemic effect. This includes methods used to estimate bioequivalence, practical implications of the expected variability in drug concentration‐time profiles from bioequivalent formulations and other sources of variability which influence drug absorption and therapeutic response.

Method: The impact of sample size, pharmacokinetic variability and expected differences in relative bioavailability are examined with respect to relevant literature and using simulations. The variability in drug concentration‐time profiles following different formulations of the same active ingredient is compared to other sources of variability affecting drug delivery to its site of action.

Results: The use of comparative drug concentration‐time profiles to establish the bioequivalence of two orally administered formulations is based on well‐established and thoroughly tested scientific principles. Formulations with variability in drug concentration‐time profiles greater than 10% are unlikely to satisfy the statistical standards defining bioequivalence. Inter and intra batch‐to‐batch variability in active substance content of oral formulations limits specifying dissolution rate and plasma concentration ranges defining therapeutic effect of specific drugs may exceed the limits applied to defining bioequivalence and hence may contribute to differences in patient response after administration of different medicinal products. These standards are within the scope of other sources of variability which limit the predictability of therapeutic response to blood levels for individual patients. These include acceptable levels of variability of the amount of active ingredient within and between batches, tablet dissolution rates and poorly defined therapeutic blood levels for many drugs.

Conclusion: The methods used to determine bioequivalence have stood the test of time. The criteria used to assess bioequivalence mean that the differences in actual drug concentration‐time profiles obtained with a generic or originator formulation are small and certainly less variable than other factors that contribute to variability in response.
Psychosocial Pathways Linking Adverse Childhood Experiences to Mental Health in Recently Deployed Canadian Military Service Members
Authors: Lee Jennifer E.C. , Phinney Brigitte , Watkins Kimberley , Zamorski Mark A.
Published: March 2016

Multiple pathways have been suggested to account for the relationship of adverse childhood experiences (ACEs) and well‐being in adulthood, including interpersonal difficulties, the underestimation of one's sense of mastery, and a greater propensity to experience stressors later in life. This study was conducted to examine the association between ACEs and mental health in Canadian Armed Forces (CAF) personnel, and the possible mediating roles of social support, mastery, and combat stressors in that relationship. The study consisted of a prospective analysis involving 3,319 CAF members upon their return from an overseas deployment. Results were that ACEs were associated with poorer mental health (β = −.14, p < .001) and that approximately 42.6% of this relationship could be explained by the mediating effects of low social support, low mastery, and a greater number of combat stressors. The full model, including the covariates, ACEs, social support, mastery, and combat stressors as correlates of postdeployment mental health, was statistically significant with adjusted R2 = .28, F(9, 3309) = 141.96, p < .001. On the whole, results suggested that social support, mastery, and life stressors may be possible targets for interventions to minimize the impact of ACEs on later mental health in military personnel.
Polypyrrole‐Coated PDMS Fibrous Membrane: Flexible Strain Sensor with Distinctive Resistance Responses at Different Strain Ranges
Authors: Niu Haitao , Zhou Hua , Wang Hongxia , Lin Tong
Published: March 2016

Flexible sensors capable of detecting large strain are very useful for health monitoring and sport applications. Here a strain sensor is prepared by applying a thin layer of conducting polymer, polypyrrole (PPy), onto the fiber surface of an elastic fibrous membrane, electrospun polydimethylsiloxane (PDMS). The sensor shows a normal monotonic resistance response to strain in the range of 0–50%, but the response becomes “on‐off switching” mode when the strain is between 100 and 200%. Both response modes are reversible and can work repeatedly for many cycles. This unique sensing behavior is attributed to overstretching of the polypyrrole coating, unique fibrous structure, and elasticity of PDMS fibers. It may be useful for monitoring the states where motions are only allowed in a particular range such as joint rehabilitation.

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Resting‐state connectivity predicts levodopa‐induced dyskinesias in Parkinson's disease
Authors: Herz Damian M. , Haagensen Brian N. , Nielsen Silas H. , Madsen Kristoffer H. , Løkkegaard Annemette , Siebner Hartwig R.
Published: March 2016

Background

Levodopa‐induced dyskinesias are a common side effect of dopaminergic therapy in PD, but their neural correlates remain poorly understood.

Objectives

This study examines whether dyskinesias are associated with abnormal dopaminergic modulation of resting‐state cortico‐striatal connectivity.

Methods

Twelve PD patients with peak‐of‐dose dyskinesias and 12 patients without dyskinesias were withdrawn from dopaminergic medication. All patients received a single dose of fast‐acting soluble levodopa and then underwent resting‐state functional magnetic resonance imaging before any dyskinesias emerged. Levodopa‐induced modulation of cortico‐striatal resting‐state connectivity was assessed between the putamen and the following 3 cortical regions of interest: supplementary motor area, primary sensorimotor cortex, and right inferior frontal gyrus. These functional connectivity measures were entered into a linear support vector classifier to predict whether an individual patient would develop dyskinesias after levodopa intake. Linear regression analysis was applied to test which connectivity measures would predict dyskinesia severity.

Results

Dopaminergic modulation of resting‐state connectivity between the putamen and primary sensorimotor cortex in the most affected hemisphere predicted whether patients would develop dyskinesias with a specificity of 100% and a sensitivity of 91% (P < .0001). Modulation of resting‐state connectivity between the supplementary motor area and putamen predicted interindividual differences in dyskinesia severity (R2 = 0.627, P = .004). Resting‐state connectivity between the right inferior frontal gyrus and putamen neither predicted dyskinesia status nor dyskinesia severity.

Conclusions

The results corroborate the notion that altered dopaminergic modulation of cortico‐striatal connectivity plays a key role in the pathophysiology of dyskinesias in PD. © 2016 International Parkinson and Movement Disorder Society
Development of Quantum Chemical Method to Calculate Half Maximal Inhibitory Concentration (IC50)
Authors: Bag Arijit , Ghorai Pradip Kr.
Published: March 2016

Till date theoretical calculation of the half maximal inhibitory concentration (IC50 ) of a compound is based on different Quantitative Structure Activity Relationship (QSAR) models which are empirical methods. By using the Cheng‐Prusoff equation it may be possible to compute IC50, but this will be computationally very expensive as it requires explicit calculation of binding free energy of an inhibitor with respective protein or enzyme. In this article, for the first time we report an ab initio method to compute IC50 of a compound based only on the inhibitor itself where the effect of the protein is reflected through a proportionality constant. By using basic enzyme inhibition kinetics and thermodynamic relations, we derive an expression of IC50 in terms of hydrophobicity, electric dipole moment (μ) and reactivity descriptor (ω) of an inhibitor. We implement this theory to compute IC50 of 15 HIV‐1 capsid inhibitors and compared them with experimental results and available other QASR based empirical results. Calculated values using our method are in very good agreement with the experimental values compared to the values calculated using other methods.
Evaluation and surgery for stress urinary incontinence: A FIGO working group report
Authors: Medina Carlos A. , Costantini Elisabetta , Petri Eckhard , Mourad Sherif , Singla Ajay , Rodríguez‐Colorado Silvia , Ortiz Oscar Contreras , Doumouchtsis Stergios K.
Published: March 2016

Aims

To review available evidence regarding evaluation and treatment of stress urinary incontinence (SUI) and provide recommendations for management of urinary incontinence under specific conditions determined by the International Federation of Gynecology and Obstetrics (FIGO) Working Group.

Methods

The FIGO Working Group discussed the management of SUI during meetings and assessed the evidence. The search of evidence was performed using MEDLINE® and Cochrane databases as well as additional searches from societies and major organizations for additional guidelines and recommendations and hand searches from bibliographies. Initial searches from 1985 to December 31, 2012 extended until July 15, 2015. After review, recommendations are made based on levels of evidence according to the recommendations from Oxford EBM Center.

Results

Initial evaluation of SUI consists of history and physical examination; cough stress test, evaluation for urinary tract infections (UTI), assessment of urethral mobility, and post‐void residual volumes (LOE 5). Urodynamic studies are not necessary to evaluate patients with uncomplicated SUI (LOE 1a). Conservative treatment should be tried prior to surgery and more importantly in areas of low resources (LOE 5). Midurethral slings (MUS), pubovaginal (traditional suburethral) slings (PVS), and Burch colposuspension are effective in treating SUI (LOE 1a). Patients with SUI with ISD or UUI appear to have lower cure rates than patients without (LOE 2‐4). There are limited data on surgical outcomes under limited resources (LOE 5).

Conclusions

MUS, PVS, and Burch colposuspension are effective treatments for SUI. Evidence for recommendations to treat patients in underserved low resource areas is lacking. Neurourol. Urodynam. 36:518–528, 2017. © 2016 Wiley Periodicals, Inc.
An equi‐model matheuristic for the multi‐depot ring star problem
Authors: Hill Alessandro , Voß Stefan
Published: March 2016

In the multi‐depot ring star problem (MDRSP), a set of customers has to be connected to a set of given depots by ring stars. Such a ring star is a cycle graph, also called a ring, with some additional nodes assigned to its nodes by single star edges. Optional Steiner nodes can be used in the network as intermediate nodes on the rings. Depot dependent capacity limits apply to both, the number of customers in each ring star and the number of ring stars connected to a depot. The MDRSP asks for a network such that the sum of the edge costs is minimized. In this article, we present a matheuristic that iteratively refines a solution network in a locally exact fashion. In contrast to existing approaches, we define an equi‐model matheuristic. That is a refinement method in which the subproblems are modeled as smaller instances of the global problem. Hence the optimization model that is used to explore the various structural multi‐exchange neighborhoods in our algorithm is the MDRSP itself. A first class of neighborhoods considers local subnetworks for optimal improvements. Through an advanced modeling technique, we are able to refine arbitrary subnetworks of suitable size induced by simple node sets. A second class aims at globally restructuring the current network after the application of different contraction techniques. For both purposes, we develop an exact branch & cut algorithm for the MDRSP that efficiently solves the local optimization problems to optimality, if they are chosen reasonably in terms of size and complexity. The efficiency of the approach is shown by computational results improving known upper bounds for instance classes from the literature containing up to 1000 nodes. Ninety‐one percent of the known best objective values are improved up to 13% in competitive computational time. © 2016 Wiley Periodicals, Inc. NETWORKS, Vol. 67(3), 222–237 2016
Rational Design of Dual Active Sites in a Single Protein Scaffold: A Case Study of Heme Protein in Myoglobin
Authors: Shu Xiao‐Gang , Su Ji‐Hu , Du Ke‐Jie , You Yong , Gao Shu‐Qin , Wen Ge‐Bo , Tan Xiangshi , Lin Ying‐Wu
Published: March 2016

Rational protein design has been proven to be a powerful tool for creating functional artificial proteins. Although many artificial metalloproteins with a single active site have been successfully created, those with dual active sites in a single protein scaffold are still relatively rare. In this study, we rationally designed dual active sites in a single heme protein scaffold, myoglobin (Mb), by retaining the native heme site and creating a copper‐binding site remotely through a single mutation of Arg118 to His or Met. Isothermal titration calorimetry (ITC) and electron paramagnetic resonance (EPR) studies confirmed that a copper‐binding site of [3‐His] or [2‐His‐1‐Met] motif was successfully created in the single mutant of R118H Mb and R118M Mb, respectively. UV/Vis kinetic spectroscopy and EPR studies further revealed that both the heme site and the designed copper site exhibited nitrite reductase activity. This study presents a new example for rational protein design with multiple active sites in a single protein scaffold, which also lays the groundwork for further investigation of the structure and function relationship of heme/non‐heme proteins.
Agricultural Applications for Antimicrobials. A Danger to Human Health: An Official Position Statement of the Society of Infectious Diseases Pharmacists
Authors: Aitken Samuel L. , Dilworth Thomas J. , Heil Emily L. , Nailor Michael D.
Published: March 2016

The use of antibiotics in agriculture, particularly in food‐producing animals, is pervasive and represents the overwhelming majority of antibiotic use worldwide. The link between antibiotic use in animals and antibiotic resistance in humans is unequivocal. Transmission can occur by ingesting undercooked meats harboring resistant bacteria, by direct contact of animals by animal handlers, and by various other means. Antibiotics used in aquaculture and antifungals used in horticulture are also an evolving threat to human health. Regulations aimed at decreasing the amount of antibiotics used in food production to limit the development of antibiotic resistance have recently been implemented. However, further action is needed to minimize antibiotic use in agriculture. This article describes the extent of this current problem and serves as the official position of the Society of Infectious Diseases Pharmacists on this urgent threat to human health.
Platelet clinical proteomics: Facts, challenges, and future perspectives
Authors: García Ángel
Published: March 2016

In recent years, proteomics has been applied to platelet clinical research. Platelets are small enucleated cells that play a fundamental role in hemostasis. In a pathological context, unwanted platelet activation is related to various diseases, primarily thrombosis, but also cancer metastasis, inflammation, immunity, and neurodegenerative diseases. The absence of a nucleus is one of the reasons why proteomics can be considered an ideal analytical tool for platelet research. Indeed, platelet proteomics has allowed the identification of many novel signaling proteins and receptors, several of which are being pursued as potential therapeutic targets. Encouraged by this success, several research groups have recently initiated clinical proteomics studies covering diseases where platelets are involved in some way, such as coronary artery disease, storage pool diseases, uremia, cystic fibrosis, and Alzheimer disease. The goal was to identify platelet biomarkers and drug targets that can help to improve the treatment/diagnosis of the disease and provide further mechanistic evidences of the role platelets play in the pathology. The present article will comment on the recent progress of clinical proteomics in the context of platelet research, challenges, and perspectives for the future ahead.
Comparison of Physical, Thermal, and Thermomechanical Properties of Cotton/Epoxy Composite and Cotton/Vinyl Ester Composite Inhibitors
Authors: Shahedifar Vahideh , Masoud Rezadoust Amir , Amiri Amraei Iraj
Published: March 2016

The inhibition of a double‐base solid propellant is used to control and prevent the burning degree of the exposed area, which is due to longer burning time. In recent years, inhibition with cellulose derivatives has become popular, but these monolithic systems usually suffer from the drawback of a high erosion rate and demand high thickness and low burning time. In this research two composite inhibitors based on natural fibers were manufactured by filament winding technique and their physical, thermal, and thermomechanical properties were compared. In addition, a chlorinated flame retardant (CFR) as well as antimony trioxide were added in inhibitor compositions to control their burning processes. It was found that the cotton/epoxy composite inhibitor displays a compatible thermal expansion coefficient with the propellant and a high amount of residual char compared to cotton/vinyl ester composite. Also, it was understood that the moisture absorption resistance and thermal stability, i.e., initial decomposition temperature of cotton/vinyl ester specimen were better than cotton/epoxy specimen. Furthermore, density and the flame retardant performance of both composite inhibitors were similar. Additionally, the tan(δ) value obtained for cotton/epoxy composite was higher than that of cotton/vinyl ester composite indicating its good dissipation of vibrational energy.