bluuebunny/crossref_metadata_2025 huggingface dataset:
Daily consumption of a mangosteen‐based drink improves in vivo antioxidant and anti‐inflammatory biomarkers in healthy adults: a randomized, double‐blind, placebo‐controlled clinical trial
Authors: Xie Zhuohong , Sintara Marsha , Chang Tony , Ou Boxin
Published: April 2015

Mangosteen (Garcinia mangostana) is a tropical fruit cultivated mainly in Southeast Asia. Recent studies have shown mangosteen has many health benefits. In this study, we aimed to determine the effects of a mangosteen‐based beverage on antioxidant and anti‐inflammatory and immunity biomarkers in plasma of healthy adults. A randomized, double‐blind, placebo‐controlled clinical trial was conducted using 60 participants, 30 men, and 30 women, ages 18–60. Participants were randomly divided into two groups, placebo and mangosteen groups, with the same number of male and female participants in each group. The trial duration was 30 days. ORAC as an antioxidant biomarker was measured in both groups. It was found that after the 30‐day trial, the group given the mangosteen‐based drink formula showed 15% more antioxidant capacity in the bloodstream than did the placebo group. As for the inflammatory biomarkers, in the mangosteen group, between the preintervention and postintervention, the C‐reactive protein level significantly decreased by 46%, while no significant decreases for the same biomarker was observed in the placebo group. Immunity biomarkers IgA, IgG, IgM, C3 and C4 were not affected in either group. In addition, the effects on hepatic function (Aspartate Aminotransferase and Alanine Aminotransferase) and kidney function (creatinine) were investigated. Our results indicated that after the 30‐day consumption of the beverage, there were no side effects on human hepatic and kidney functions. The outcome of this study showed that the mangosteen‐based formula significantly increases antioxidant capacity and possesses anti‐inflammatory benefits with no side effects on immune, hepatic, and renal functions for long‐term consumption.
Benefits and drawbacks of open partial horizontal laryngectomies, Part B: Intermediate and selected advanced stage laryngeal carcinoma
Authors: Succo Giovanni , Crosetti Erika , Bertolin Andy , Lucioni Marco , Arrigoni Giulia , Panetta Valentina , Sprio Andrea E. , Berta Giovanni N. , Rizzotto Giuseppe
Published: April 2015

Background

Cancer of the larynx in the intermediate/advanced stage still presents a major challenge in terms of controlling the disease and preserving the organ. Among therapeutic options, open partial horizontal laryngectomy is proposed as a function‐sparing surgical technique.

Methods

We analyzed the clinical outcomes of 555 patients with laryngeal cancer staged pT3 to pT4a who underwent open partial horizontal laryngectomy.

Results

Five‐year overall survival (OS), disease‐free survival (DFS), locoregional control, local control, laryngectomy‐free survival, and laryngeal function preservation rates were 84.6%, 84.2%, 86.3%, 90.6%, 93.3%, and 91.2%, respectively. DFS, locoregional control, and laryngeal function preservation rates were significantly affected by pT4a staging (68.1%, 71.7%, and 78.0%, respectively), whereas pN+ influenced only DFS (≤72.6%) and locoregional control (≤79.6%).

Conclusions

Open partial horizontal laryngectomy with a modular approach can be considered effective in terms of prognostic and functional results in intermediate‐stage and selected advanced‐stage laryngeal cancers, even with subglottic extension. © 2015 Wiley Periodicals, Inc. Head Neck 38: E649–E657, 2016
Salvage surgery for locally recurrent oropharyngeal cancer
Authors: Patel Samip N. , Cohen Marc A. , Givi Babak , Dixon Benjamin J. , Gilbert Ralph W. , Gullane Patrick J. , Brown Dale H. , Irish Jonathan C. , de Almeida John R. , Higgins Kevin M. , Enepekides Danny , Huang Shao Hui , Waldron John , O'Sullivan Brian , Xu Wei , Su Susie , Goldstein David P.
Published: April 2015

Background

There are limited data on whether recurrent human papillomavirus (HPV)‐associated oropharyngeal squamous cell carcinoma (SCC) is associated with higher surgical salvage rates. The purpose of this study was to determine the success rate of salvage surgery for locally recurrent oropharyngeal cancer and factors influencing the outcome, including p16 status.

Methods

All patients who underwent salvage surgery for locally recurrent or persistent oropharyngeal cancer after (chemo)radiotherapy between 2000 and 2012 were included. The Kaplan–Meier analysis was used to determine overall survival (OS) and recurrence‐free survival (RFS). Univariable analysis was performed using Cox proportional hazards regression.

Results

Thirty‐four patients underwent salvage surgery. Five patients (14.7%) were tracheostomy dependent and 22 (64.7%) were gastrostomy tube dependent after salvage surgery. Postoperative complications occurred in 15 patients. RFS after salvage surgery was 28% and 19% at 3 and 5 years, respectively. The presence of nodal disease at the time of local recurrence, close or positive margins, and lymphovascular invasion were the only factors associated with worse survival on univariable analysis. HPV status based on p16 testing was not associated with either OS or RFS.

Conclusion

Surgical salvage for oropharyngeal SCC after failure of radiotherapy (+/‐ chemotherapy) is feasible. Patients who may benefit from surgery include those without regional recurrence and/or those in whom negative margins can be obtained. However, patients may be tracheotomy or gastrostomy tube dependent. The p16 status did not seem to have prognostic impact in the salvage setting; however, larger series are required to assess this relationship. © 2015 Wiley Periodicals, Inc. Head Neck 38: E658–E664, 2016
A hydrologic assessment of a saline‐spring fen in the Athabasca oil sands region, Alberta, Canada – a potential analogue for oil sands reclamation
Authors: Wells Corey M. , Price Jonathan S.
Published: April 2015

Canada's post‐mined oil sands will have a higher concentration of salts compared with freshwater peatlands that dominate the landscape. While rare, naturally occurring saline wetlands do exist in Alberta's Boreal Plains and may function as analogues for reclamation, however, little is known about their hydrology. This paper investigates the geochemical and hydrologic characteristics of a natural saline‐spring peatland in Alberta's oil sands region. The fen is located within a saline groundwater discharge area connected to the erosional edge of the Grand Rapids Formation. Na+(195–25,680 mgl−1) and Cl−(1785–56,249 mg l−1) were the dominant salts, and the fen transitioned sharply to freshwater along its margins because in part of subsurface mineral ridges that restricted shallow groundwater exchange. Salinity decreased from hypersaline to brackish along the local groundwater flow path but no active spring outlets were observed over the two‐year study. Vertical groundwater discharge was minimal because of the very low permeability of the underlying sediments. Subsurface storage was exceeded during periods of high flow, resulting in flooding and surface runoff that was enhanced by the ephemerally connected pond network. These findings have implications for reclamation, as mechanisms such as subsurface mineral ridges may function as effective saline groundwater‐control structures in the post‐mined environment. Incorporating saline wetlands into regional monitoring networks will help to better quantify natural discharge, which has implications for belowground wastewater storage related toin situbitumen extraction. Copyright © 2015 John Wiley & Sons, Ltd.
Transcriptional regulation of tenascin‐W by TGF‐beta signaling in the bone metastatic niche of breast cancer cells
Authors: Chiovaro Francesca , Martina Enrico , Bottos Alessia , Scherberich Arnaud , Hynes Nancy E. , Chiquet‐Ehrismann Ruth
Published: April 2015

Tenascin‐W is a matricellular protein with a dynamically changing expression pattern in development and disease. In adults, tenascin‐W is mostly restricted to stem cell niches, and is also expressed in the stroma of solid cancers. Here, we analyzed its expression in the bone microenvironment of breast cancer metastasis. Osteoblasts were isolated from tumor‐free or tumor‐bearing bones of mice injected with MDA‐MB231‐1833 breast cancer cells. We found a fourfold upregulation of tenascin‐W in the osteoblast population of tumor‐bearing mice compared to healthy mice, indicating that tenascin‐W is supplied by the bone metastatic niche. Transwell and co‐culture studies showed that human bone marrow stromal cells (BMSCs) express tenascin‐W protein after exposure to factors secreted by MDA‐MB231‐1833 breast cancer cells. To study tenascin‐W gene regulation, we identified and analyzed the tenascin‐W promoter as well as three evolutionary conserved regions in the first intron. 5′RACE analysis of mRNA from human breast cancer, glioblastoma and bone tissue showed a single tenascin‐W transcript with a transcription start site at a noncoding first exon followed by exon 2 containing the ATG translation start. Site‐directed mutagenesis of a SMAD4‐binding element in proximity of the TATA box strongly impaired promoter activity. TGFβ1 induced tenascin‐W expression in human BMSCs through activation of the TGFβ1 receptor ALK5, while glucocorticoids were inhibitory. Our experiments show that tenascin‐W acts as a niche component for breast cancer metastasis to bone by supporting cell migration and cell proliferation of the cancer cells.
PRENATAL REFLECTIVE FUNCTIONING IN PRIMIPAROUS WOMEN WITH A HIGH‐RISK PROFILE
Authors: Smaling Hanneke J.A. , Huijbregts Stephan C.J. , Suurland Jill , Van Der Heijden Kristiaan B. , Van Goozen Stephanie H.M. , Swaab Hanna
Published: April 2015

The concept of maternal reflective functioning (RF) has been gaining increasing interest as a possible intermediate mechanism in associations between a wide range of psychosocial risk factors and poor child outcomes. The purpose of the present study was to determine which psychosocial risk factors are linked to prenatal RF in a high‐risk (HR) group of primiparous women. Differences in prenatal RF between the HR group and a low‐risk (LR) control group also were examined. The sample consisted of 162 women (M = 22.22 years, SD = 2.39; 83 classified as HR). RF was coded from the Pregnancy Interview (A. Slade, 2007a). Risk status was assessed by means of the Mini‐International Neuropsychiatric Interview‐plus (M.I.N.I.‐plus; D.V. Sheehan et al., 1997) and several questionnaires. HR women demonstrated significantly lower RF quality than did the LR group. Regression analyses indicated that maternal education, size of social support network, and substance use during pregnancy were the strongest predictors of prenatal RF for the HR group. The results suggest that maternal RF potentially could be an important target for those prevention and intervention programs that aim to reduce adverse psychosocial development in offspring of HR mothers.
Adverse Drug Reaction Reporting: Attitudes of Australian Hospital Pharmacists and Doctors
Authors: Nita Yunita , Batty Kevin T , Plumridge Richard J
Published: April 2015

Aim

To determine the level of knowledge of the Australian adverse drug reaction (ADR) reporting system in hospital pharmacists and doctors, and the factors that influence ADR reporting.

Method

A self‐administered anonymous, postal questionnaire was sent to 803 doctors in Western Australia and 1323 hospital pharmacists between June and September 2001.

Results

Response rates from doctors and pharmacists were 35% and 43%, respectively. Pharmacists were more likely than doctors to know how to report ADRs (98% vs 57%; p < 0.001) and to support screening of ADR reports before submission to the Adverse Drug Reactions Advisory Committee (ADRAC) (80% vs 68%; p = 0.003). Factors that encouraged ADR reporting were serious or unusual ADRs or reactions to new drugs. Factors that discouraged ADR reporting were trivial or well known reactions, an uncertain association or insufficient time. Hypothetical ADRs (n = 10) that should have been reported to ADRAC were more likely to be reported by pharmacists (mean = 6.6; 95% CI = 6.4–6.7) than doctors (mean = 5.2; 95% CI = 4.9–5.5; p < 0.001).

Conclusion

Hospital pharmacists are familiar with the ADR reporting system and are more likely than doctors to report ADRs to ADRAC. An appropriately resourced team approach could reduce barriers to ADR reporting and improve the quality and quantity of post‐marketing surveillance data in Australia.
Evaluation of a Weight‐Based Heparin Dosing Protocol
Authors: Slader Simon AA , Welch Susan A , Finckh Andrew , Brien Jo‐anne E
Published: April 2015

Aim

To describe the anticoagulant effect, as assessed by initial activated partial thromboplastin time (APTT) results and time taken to reach the target APTT range, using a weight‐based heparin protocol. A secondary aim was to assess the level of concordance with the protocol.

Method

Records of 50 patients admitted to the coronary care unit via the emergency department during a relevant 2‐month period with a preliminary diagnosis of unstable angina, myocardial infarction, chest pain or ischaemic heart disease and commenced on intravenous heparin, were retrospectively reviewed.

Results

The initial APTT was documented for 98% (49/50) of patients. The proportion of initial APTTs > 100 seconds was 12% (6/49). Initial APTTs were within the therapeutic range (60–85 seconds) for 27% (13/49) of patients. The initial APTT was subtherapeutic (< 60 seconds) in 47% (23/49) of patients. The median time to a therapeutic APTT was 12.2 hours and the median time to the first measurement of APTT was 7.3 hours. The heparin order documented on the medication chart was concordant with the protocol 36% (18/50) of the time. There was no patient weight recorded on the medication chart 28% (14/50) of the time, and an incorrect starting heparin rate prescribed 18% (9/50) of the time. The desired APTT range was specified in 74% (37/50) of records reviewed. Overall, the rate was adjusted according to the protocol 70% (35/50) of the time.

Conclusion

The evaluation of application of the weight‐based heparin protocol has identified opportunities for practice improvement. Subsequent interventions include linking heparin prescribing protocol details with the existing electronic information systems at the point‐of ‐care.
Evaluation of Drug Use Indicators in Private Hospitals
Authors: Jackson John K , Boyd Roger GD , Mackey Paul F
Published: April 2015

Background

Indicators to assess and improve the quality use of medicines have been published but not specifically evaluated in the private hospital sector.

Aim

To assess the applicability of the New South Wales Therapeutic Advisory Group drug use indicators in private hospitals.

Method

Standard criteria were used in 13 private hospitals to assess the applicability of the complete set of process indicators plus a selection of the impact and outcome indicators.

Results

The majority of the process indicators were useful, however, there was wide variation in the extent to which the activities described by the various indicators had been implemented. Most facilities reported little difficulty in using the impact and outcome indicators that they chose to assess, although some hospitals were not able to apply particular indicators due to staffing factors, types of patients or service capability. Inhibiting factors included the absence of employed medical personnel, inadequate patient numbers and the level of clinical pharmacy service.

Conclusion

The New South Wales Therapeutic Advisory Group drug use indicators are applicable in the private hospital sector although there are limitations due to the nature of some private hospitals. Continued use of indicators is recommended and modification of some indicators may be beneficial.
Evaluation of a Drug Information Service in a South Indian Teaching Hospital
Authors: Rao Padma GM , Gore Sapna , V Deepa
Published: April 2015

Aim

To evaluate the service provided by a drug information centre in a teaching hospital in Manipal, India.

Method

Records of drug information responses were analysed over a 6‐month period. Inquiries were categorised by type and resources required. A random selection of 50 responses (25 judgmental and 25 non‐judgmental) was rated for quality according to international guidelines. To evaluate outcomes, a feedback questionnaire was distributed to hospital clinicians.

Results

395 inquires were received. Most were from physicians and were received during ward rounds. The most common questions related to adverse reactions (25%), drug therapy (22%) and dosage or administration (11%). Tertiary resources (textbooks) were used to answer 62% of inquiries. All non‐judgmental responses were of acceptable quality (rating 3 or more). 22 of the 25 judgmental questions were rated as ‘good’ to ‘excellent’ and the other 3 were ‘adequate‘. 50 of 75 (67%) feedback questionnaires were returned. 90% of respondents were aware of the centre and 97% had received an appropriate answer within an acceptable time.

Conclusion

The drug information centre was well used by health professionals and provided a high level of service. There was some scope for improvement with judgmental questions.
Superwarfarin Poisoning
Authors: Eaton Vaughn , Kaesler Sally B
Published: April 2015

A 36‐year‐old female presented to hospital with a significantly elevated international normalised ratio (INR). In the following days, her INR continued to fluctuate after repeated doses of parenteral phytomenadione (vitamin K1), fresh frozen plasma and Prothrombinex (human coagulation factors II, IX and X). The patient denied taking warfarin, which was confirmed by a standard plasma warfarin assay. A range of tests were performed and 18 days after admission, brodifacoum was isolated from her blood. Brodifacoum is the commonest type of ‘superwarfarin’; a rodenticide developed in the 1970s to overcome warfarin resistance in rats. Treatment of ‘superwarfarin’ ingestion includes monitoring of INR and treatment with phytomenadione as the coagulopathy may persist for months.1–3 Common causes of ‘superwarfarin’ poisoning include accidental ingestion (usually in children),1,4,5 attempted suicide1,3,6,7 and deliberate self‐poisoning with denial (Munchausen syndrome).1,8
Stability of Flucloxacillin in Elastomeric Infusion Devices
Authors: Carroll Julia A
Published: April 2015

Background

Stability of antibiotic infusion solutions must be maintained for home infusion therapy. No published data were available to support extended stability of flucloxacillin infusions during storage and administration via elastomeric infusion devices.

Aim

To determine the stability of high‐dose flucloxacillin in 10 mL/h elastomeric infusion devices after storage for 6 days at 2–8 °C and then temperatures expected during administration.

Method

Three infusors were prepared for each arm of the study. Each contained 12 g flucloxacillin diluted to 240 mL with 0.9% sodium chloride. Flucloxacillin concentrations were determined after storage at 2–8 °C for 6 days, 2–8 °C for 6 days and then 31 °C for up to 24 hours, and 2–8 °C for 6 days, 31 °C for 17 hours and then 37 °C for 7 hours.

Results

Flucloxacillin retained 94% of the initial concentration after 6 days at 2–8 °C and at 31 °C for 24 hours but only 87% when the temperature was raised to 37 °C for 7 hours.

Conclusion

Flucloxacillin at a nominal concentration of 50 g/L is stable in elastomeric infusion devices at 2–8 °C for 6 days and then at 31 °C for 24 hours.
Lithium Erythrocyte Concentration and Neurological Toxicity in Bipolar Disorder
Authors: Ahmadi‐Abhari Seyed Ali , Farhoodian Ali , Noroozian Maryam , Ghaeli Padideh , Dashti‐Khavidaki Simin , Sadeghi Mandana , Dehpour Ahmad‐Reza , Fahimi Fanak
Published: April 2015

Aim

To investigate the relationship between lithium‐induced neurotoxicity and plasma lithium concentration, erythrocyte lithium concentration, and lithium ratio.

Method

The relationship between lithium‐induced adverse effects and three laboratory indices (plasma lithium concentration, erythrocyte lithium concentration, lithium ratio) were assessed in 18 patients with bipolar type 1 disorder. Adverse effects after 6 weeks therapy were assessed with the Extrapyramidal Symptom Rating Scale (ESRS1–4), Abnormal Involuntary Movement (AIMS) and Mini Mental Status Examination (MMSE) and the clinical evaluation of tandem walk, rapid alternative test, tremor, myoclonus and muscle force.

Results

Median erythrocyte lithium concentration in patients with increased or new incidence of impaired rapid alternative test was significantly high. Changes in ESRS1, ESRS4 and total ESRS had positive correlations with erythrocyte and plasma lithium concentrations. ESRS2 and AIMS had better correlations with erythrocyte lithium concentrations. There was no relationship between erythrocyte concentration, plasma concentration or lithium ratio and worsening of tremor, reduced muscular tone, myoclonus or impaired tandem walk.

Conclusion

Lithium erythrocyte concentration may help to predict susceptibility to neurological toxicity better than plasma concentration. This could help identify patients who will not be good candidates for lithium due to predictable adverse effects.
Impact of Increased Clinical Pharmacy Activities
Authors: Toh Cjeng T , Lam Skip S , Leung Benjamin K
Published: April 2015

Aim

To assess the impact of increased time spent on clinical pharmacy activities in an Australian hospital.

Method

During the control period, a pharmacist provided both clinical services and discharge dispensing to a 30‐bed medical ward and a 15‐bed surgical ward. In the test period, the same pharmacist provided only clinical services to the medical ward. The number and type of clinical interventions for patients in the medical ward were compared for the two periods.

Results

The number of patients discharged, mean length of stay and total number of discharge drug orders were similar in the control and test periods (96 vs 97, 6.4 vs 7.0, 635 vs 633 respectively). The profile, type and complexity of patients in both groups were also similar. In the test period, clinical interventions increased by 57%, the time from admission to first pharmacist interview was reduced from 3.51 (SD 4.10) to 1.28 (SD 1.30) days (p < 0.005), clinical interventions were resolved earlier at pharmacist admission interviews (50% vs 28%, p < 0.001) and inpatient pharmacist rounds (28% vs 2%), resulting in fewer clinical interventions (19% vs 71%, p < 0.001) at discharge. The commonest types of clinical interventions were drugs not prescribed when clinically indicated and prescribing of incorrect doses or strength.

Conclusion

An improved pharmacist‐to ‐bed ratio resulted in patients receiving correct drug therapies earlier in their inpatient stay. Fewer clinical interventions encountered at discharge facilitated the dispensing process.
Community Education Program on Oral Antidiabetes Medicines
Authors: Hogue Valerie W , Lee Euni
Published: April 2015

More than 8 million Americans have been diagnosed with diabetes. Healthy People 2010, a health prevention initiative in the US, included an objective to increase the proportion of people with diabetes who receive formal diabetes education. Consistent with the national objective, a program was developed to provide education on self‐management of the disease and to improve patient knowledge of oral antidiabetes medicines at a community pharmacy health education resource centre in Washington DC. Difficulties in providing comprehensive education on oral antidiabetes medicines with existing diabetes education programs are discussed. The content, sequence of the educational program, and the components of additional pharmaceutical care services are also described.
Oral Antineoplastic Chemotherapy
Authors: Gilbar Peter J , Carrington Christine V
Published: April 2015

Although most cancer medicines are administered parenterally, there has been an increase in the availability of oral antineoplastics. Oral antineoplastics offer several advantages, including ease of administration, convenience and cost savings. Disadvantages may include reduced patient supervision, concordance issues, inappropriate patient selection and unpredictable bioavailability. A number of safety issues, including storage and prevention of medication errors, must also be addressed. Safe handling techniques must be optimised to minimise occupational exposure. Pharmacists are in an ideal position to educate patients/carers to ensure concordance to therapy and guarantee the safe and effective use of oral antineoplastics.
Renal Failure and Acute Interstitial Nephritis Associated with NSAIDs
Authors: Ho Lisa , Lim Andy KH , Tanner Francine
Published: April 2015

Background

Non‐steroidal anti‐inflammatory drugs (NSAIDs) are a recognised cause of acute interstitial nephritis. Some NSAIDs are freely available as over‐the ‐counter preparations. There are potential serious consequences with prolonged unsupervised self‐medication with NSAIDs.

Aim

To describe two cases of renal failure involving over‐the ‐counter use of NSAIDs, with a focus on interstitial nephritis.

Clinical features

Both patients obtained over‐the ‐counter NSAIDs and self‐medicated without supervision. One patient was taking ibuprofen for chronic pain and subsequently started taking diclofenac, as recommended by his chiropractor. The second patient started taking ibuprofen for severe, unrelenting pain. The aetiology of the pain was not diagnosed prior to admission. Both patients presented with systemic symptoms and renal failure. Acute interstitial nephritis was proven on biopsy and the suspected offending NSAIDs were ceased in both cases. In both cases renal function improved after cessation of NSAIDs.

Conclusion

Primary care pharmacists should inform patients of the potential adverse effects of NSAIDs and advise them to seek a diagnosis for their pain if prolonged use is contemplated.
Systemic Absorption of Low‐Dose Oral Vancomycin
Authors: Brouwer Deas M , Corallo Carmela E , Coutsouvelis John
Published: April 2015

Background

The absorption of oral vancomycin is usually minimal. However, in the presence of renal impairment and inflammatory disorders of the intestinal mucosa, it may be absorbed to a significant extent. Case reports and literature reviews suggest that this is generally not an issue unless doses of vancomycin above 2 g/day are used for prolonged periods.

Aim

To describe a case of persistently high serum vancomycin levels associated with low oral doses of vancomycin.

Clinical features

A 59 year‐old obese woman with neutropenic sepsis and renal impairment was treated with intravenous meropenem and vancomycin. Oral vancomycin 125 mg 6‐hourly was commenced for antibiotic‐associated diarrhoea due to Clostridium difficile. Intravenous vancomycin was ceased after 4 doses because serum levels were > 20 mg/L. Serum vancomycin levels remained > 16 mg/L for over a week, even after reducing the oral dose from 500 mg to 300 mg/day.

Outcome

Vancomycin levels steadily decreased after ceasing oral vancomycin in the presence of worsening renal function.

Conclusion

Significant absorption of low doses of oral vancomycin may occur resulting in therapeutic levels. The extent of absorption is unpredictable, therefore monitoring of serum vancomycin levels is recommended in at risk patients.
Pharmacological Treatment of Challenging Neuropsychiatric Symptoms of Dementia
Authors: Woodward Michael C
Published: April 2015

Neuropsychiatric symptoms of dementia can be challenging to patient and carers, and affect the majority of people with dementia at some stage. Symptoms including agitation, aggression, and psychosis may respond to non‐pharmacological therapy. If pharmacotherapy is required the family and carers should be informed and involved in defining treatment goals and monitoring progress. The best current evidence is for atypical antipsychotics with two randomised controlled trials supporting the use of risperidone. However, there are concerns about an increased risk of stroke and death from atypical antipsychotics. Other drug classes have less supportive evidence for efficacy, but may be appropriate for specific symptoms. In all cases, attempts should be made to minimise the dose of the drug and cease it entirely after a time.
Minimising Medication Mishap: Introducing a Warfarin Safety Strategy
Authors: Lubliner Mark , Cole‐Sinclair Merrole , Kenneally Anne , Street Alison , Van De Vreede Melita , Walsh Michael K
Published: April 2015

Anticoagulants have been implicated in up to 10% of all adverse drug events. In 2001, The Alfred established a Medication Safety Committee and identified warfarin therapy as a patient safety priority. Through process mapping and consultation, opportunities for error were identified throughout the warfarin prescribing, dispensing and administration processes. Clinicians considered review of prothrombin international normalised ratio results and routine warfarin dosing at 2000 hours as the most significant risk to patients. This was because warfarin was frequently prescribed by after‐hours staff who were not familiar with the patient's history or changes in their clinical condition or medication. Clinicians participated in the development and implementation of a warfarin safety strategy that involved changing the dosing to 1600 hours and alert stickers affixed to drug charts by pharmacists to identify patients prescribed warfarin. This program was effective in improving staff management of inpatients receiving warfarin. It also demonstrated the importance of an effective change management strategy in establishing a sense of urgency in clinicians regarding safety, and engagement in process analysis, risk identification and the development of simple and practical safety strategies.
Pharmacist‐Initiated Electronic Discharge Prescribing for Cardiology Patients
Authors: Birdsey Garth H , Weeks Greg R , Bortoletto Diana A , Black Alexander JR
Published: April 2015

Aim

To determine whether pharmacist‐initiated electronic discharge prescribing would decrease discharge times for selected cardiology patients and improve the accuracy of prescribing by limiting deviations from the intended therapeutic plan.

Method

A cardiology project team identified system issues impeding patient flow through the ward, including the discharge medication pathway. The stages of the medication pathway were mapped before and after the intervention of pharmacist‐initiated electronic discharge prescribing. The accuracy of prescribing in both phases of the study was measured against evidence‐based standards agreed by the cardiology unit.

Results

39 patients were recruited in phase 1 (usual practice) and 35 patients in phase 2 (pharmacist‐initiated discharge prescriptions). The time from a decision to discharge a patient to the completed prescription reaching the patient was significantly reduced from a median of 190 minutes to 50 minutes in the intervention arm (p < 0.0001). However, this result did not translate into patients leaving the hospital earlier. In phase 1, 26% of prescriptions (n = 39) contained at least one error, including 19 clinically significant omissions. In phase 2, no omissions were made but the signing doctor made two changes to the pharmacist‐initiated prescriptions that were unrelated to the evidence‐based standards.

Conclusion

This pilot study has shown that an experienced pharmacy specialist using an electronic discharge prescribing system can significantly reduce the time elements of the discharge medication pathway. In addition, errors of omission that deviate from evidence‐based practice are reduced. This practice model can be extended to other specialist areas.
What's in a Name? Lack of Pronunciation in Consumer Medicine Information
Authors: Siderov Jim
Published: April 2015

Antineoplastic drugs entail significant risks. Even modest deviation from prescribed doses can result in unwanted toxicity. Well‐informed patients are a vital link in the safety chain to prevent errors, with verbal communication an essential tool. Good communication is of great importance when dealing with similar sounding names. Errors in prescribing can result where a patient mispronounces the medication they are taking. The purpose of this review was to determine if a pronunciation guide was available in the Consumer Medicine Information for antineoplastic drugs available in Australia. Of the 145 drugs available for review, a Consumer Medicine Information was available in 88% of cases. A pronunciation guide was available for 17% of generic and 2.3% of trade names. Of the oral drugs, a pronunciation guide was available for 7.6% of generic and 3.0% of trade names. Practitioners involved in the preparation of Consumer Medicine Information should consider the inclusion of a pronunciation guide for medicines.
Therapeutic Errors reported to the Victorian Poisons Information Centre—Pilot Study
Authors: Taylor David McD , Robinson Jeffrey , MacLeod Dawson , Braitberg George
Published: April 2015

Aim

To analyse a sample of therapeutic errors reported to the Victorian Poisons Information Centre.

Method

A retrospective series of 102 cases of therapeutic error reported in March 2005 were examined. Data were extracted from the Victorian Poisons Information Centre database.

Results

Of the 102 cases of therapeutic error, females (64%) and adults (72%) predominated. Most errors (91%) occurred in patients' homes. 87 (85%) cases did not require medical attention. In 68 (67%) cases, the subject made the error and in almost all (93%) cases the error involved oral drug administration. Most (84%) subjects were asymptomatic at the time of the call. In total, 125 drugs were taken in error and 11 (11%) subjects made multiple errors. The predominant drug classes were analgesics, anti‐inflammatory drugs, cardiac drugs, antipsychotics and antidepressants. An incorrect dose was taken in 47 (46%) cases and drugs were taken too early in 12 (12%) cases. An incorrect administration route was used in 9 (9%) cases. Incorrect labelling, formulating and packaging accounted for 4 (4%) errors.

Conclusion

Although most errors reported during the study were unlikely to cause harm, a large prospective study is indicated to clarify error patterns and inform prevention strategies.
Factors Influencing Adherence to Molecular Therapies in Haematology‐Oncology Outpatients
Authors: Larizza Maria A , Dooley Michael J , Stewart Kay , Kong David CM
Published: April 2015

Aim

To identify factors influencing adherence to oral molecular therapies in haematology‐oncology outpatients.

Method

Patients prescribed imatinib and thalidomide participated in the study. A quantitative questionnaire incorporating validated assessment tools and developed from issues raised in the literature was used to collect data about demographic characteristics, motivations and perceptions, impact of social environment, and aspects of medication regimens. These factors were assessed for association with adherence to molecular therapies, estimated using the Morisky score.

Results

24 patients were recruited, all of whom reported high or moderate adherence to oral molecular therapies based on their Morisky score. Adherence was positively related with age (Rho = +0.510; p = 0.011) and overall patient satisfaction with hospital services and support from family and friends (Rho = +0.609; p = 0.003). There were a number of social environment factors which were found to have a significant inverse relationship with adherence to molecular therapies including: forgetting to take the medication, change in daily routine, feeling sick/ill, wanting to avoid adverse effects and having problems taking medication at certain times. The overall impact of a patient's social environment was found to contribute negatively to adherence (Rho = −0.542; p = 0.017).

Conclusion

Factors affecting adherence to molecular therapies can be assessed by pharmacists, allowing implementation of strategies to encourage adherent behaviour in difficult circumstances.
Preventing Potassium Problems Permanently: Eliminating Concentrated Potassium Chloride Errors
Authors: Lubliner Mark , Van de Vreede Melita
Published: April 2015

Background

IV potassium chloride is potentially one of the most dangerous medications, and accidental bolus administration of concentrated potassium chloride is well documented. In 2001, The Alfred identified this as a key patient safety priority.

Aim

To identify potential sources of error associated with concentrated potassium chloride and introduce an effective and practical risk reduction strategy to prevent inadvertent accidental administration.

Method

Root‐cause analysis was used to identify factors that contributed to a serious incident involving inadvertent administration of concentrated potassium. The application of a well‐recognised error prevention framework facilitated the development and implementation of a risk‐reduction strategy. This involved the elimination of concentrated potassium chloride ampoules from hospital wards, their substitution with clinically appropriate pre‐mixed potassium chloride preparations, and standardisation of potassium chloride prescribing units.

Results

At The Alfred, concentrated potassium chloride ampoules were removed from all general wards and substituted with a commercially prepared solution containing potassium chloride 30 mmol/1000 mL. A pre‐mixed solution containing 10 mmol/100 mL, appropriate for use in fluid‐restricted patients, was developed and introduced through collaboration with another major teaching hospital and a manufacturer. All potassium chloride doses are now prescribed in millimoles, not grams.

Conclusion

The Alfred's potassium chloride safety strategy has been effective in reducing the risks associated with inadvertent administration of concentrated potassium, through the elimination of concentrated potassium from all general wards and the development and introduction of an alternative potassium formulation that is appropriate for use in fluid‐restricted patients.
Extended Roles for Pharmacists in Warfarin Therapy: Identifying Opportunities for Pharmacist Prescribing
Authors: Khoo Amy , Bajorek Beata V
Published: April 2015

Background

Warfarin has traditionally posed a challenge to clinicians because of its narrow therapeutic index. Extended roles for pharmacists may address some of the problems in warfarin management. International experience has involved anticoagulation clinics in which pharmacists have authority to engage in collaborative prescribing activities with physicians.

Aim

To identify opportunities for pharmacist prescribing activities in warfarin management within the hospital setting.

Method

Pharmacists from a Sydney teaching hospital were recruited. The first stage involved an audit of pharmacists' interventions in patients receiving warfarin. Stage two involved a focus group discussion to further explore these issues.

Results

9 pharmacists saw 41 warfarinised patients over the 5‐day data collection period. Pharmacists saw reason to intervene in the warfarin therapy of 19 (46%) of these patients and a prescribing activity was involved in 16 (84%) of these interventions. Despite these ample opportunities to prescribe, pharmacists felt limited in their ability to use these opportunities. Lack of information about the patient, workloads, medicolegal responsibility, and the need for further training and experience, were cited as the main reasons pharmacists were hesitant to prescribe. It was also suggested that the outpatient setting may be more appropriate to trial a pharmacist prescribing role.

Conclusion

There are ample opportunities for pharmacist prescribing in the area of warfarin management. However, practice change is needed before such a role can be taken up in the hospital setting.
Risk and Severity of Akathisia Following Administration of Metoclopramide in the Emergency Department
Authors: Leow Fiona HP , Knott Jonathan C , Hassan Fariza Abu , Taylor David McD , Udayasiri Ruwangi
Published: April 2015

Background

Metoclopramide is a commonly used drug in the emergency department for managing nausea, vomiting and migraines. There are currently no reported studies of the rates of metoclopramide‐induced akathisia in the emergency department.

Aim

To determine the risk and severity of metoclopramide‐induced akathisia.

Method

This was an observational study of emergency department patients who were administered metoclopramide parenterally and matched controls who were administered parenteral medications not known to cause akathisia (e.g. normal saline or antibiotics). Akathisia was assessed by a blinded interviewer at least one hour after drug administration, using a modified version of the Prince Henry Hospital Akathisia Rating Scale.

Results

232 patients were enrolled, 26 were excluded due to missing data or protocol violations. 99 were in the control group and 107 in the metoclopramide group. The mean age was 45.4 ± 19.4 years and 109/206 (53%) were male. 18 patients (16.6%, 95%CI 10.5–25.6) who received metoclopramide developed akathisia compared to 9 patients (9.1%, 95%CI 4.5–17.0) who received a control drug; the risk ratio was 1.85 (95%CI 0.87–3.92, p = 0.10).

Conclusion

This study showed a trend towards an increased incidence of akathisia following metoclopramide administration in the emergency department. As this is a commonly administered drug in emergency departments, staff should be aware of the potential for akathisia to develop and should consider monitoring patients for this adverse effect.
Pharmacist Prescribing Activities—an Electronic Survey on the Opinions of Australian Pharmacists
Authors: Kay Olivia C , Bajorek Beata V , Brien Jo‐anne E
Published: April 2015

Aim

To identify Australian pharmacists' awareness of their international colleagues' prescribing practices and explore their views about the feasibility and utility of pharmacist prescribing privileges within the scope of their current practice.

Method

Members of the AusPharmList, Australian Association of Consultant Pharmacy and The Society of Hospital Pharmacists of Australia were invited by e‐mail to participate in a community pharmacist, consultant pharmacist or hospital pharmacist electronic survey. These surveys were designed to elicit views concerning: dependent and independent prescribing; resource availability to support pharmacist prescribing; ability to justify prescribing decisions; and limitations of pharmacist prescribing.

Results

Of the 268 surveys completed (response rate 6.4%), 45% of respondents were aware of their international colleagues' prescribing activities. 74% agreed that pharmacists should be granted dependent prescribing authority, while 52% agreed that pharmacists should be granted independent prescribing authority. The majority (88%) indicated they could identify their own limitations and 86% believed they could justify their prescribing decisions as dependent prescribers. 73% believed they would benefit from prescribing authority in their daily scope of practice.

Conclusion

In 2004, awareness of international developments in pharmacist prescribing was not extensive among the respondents. However, many identified areas where they would benefit from dependent prescribing activities in their daily scope of practice.
Urticarial Skin Reaction Induced by Oral Clonidine
Authors: Paudel Raju , Kishore PV , Mishra Pranaya , Palaian Subish , Dwari Binayak C
Published: April 2015

Background

Clonidine is a centrally acting antihypertensive known to cause dermatological adverse reactions. Urticaria is rarely reported.

Case details

Oral clonidine was given to control supine hypertension in a patient receiving fludrocortisone for postural hypotension associated with therapy for Parkinson's disease. After one week, she developed erythematous, blanching, itchy papules and plaques, initially in the extremities and later becoming generalised, together with perioral oedema. Clonidine was ceased and the condition resolved as previous drug therapy was reintroduced. This reaction was considered to be of moderate severity, probably induced by clonidine, and not preventable.

Conclusion

Clonidine can cause urticarial reactions and clinicians should be alert for this possibility when commencing therapy.
SHPA Standards of Practice for Hospital Pharmacy Outpatient Services
Authors: Burridge Nicolette , Chow Alice , Cording Andrew
Published: April 2015

These are standards of professional practice and not standards prepared or endorsed by Standards Australia. They are not legally binding.
Medication Safety Series
Authors: Thornton Penny
Published: April 2015

This series brings you up‐to‐date information about medication safety issues and strategies to prevent medication errors. It draws on Australian Incidents and also US experience, including (with permission) material from ISMP Medication Safety Alert! a bulletin published by the Institute for Safe Medication Practices, USA . This series is coordinated through the Committee of Specialty Practice in Medication Safety (Chair, Rosemary Burke, Director of Pharmacy, Concord Hospital, NSW). Australian incidents are collated and editorial recommendations made by Penny Thornton (Federal Councillor, SHPA, and Pharmacy Services Manager, The Children's Hospital, NSW; e‐mail: pennyt2@chw.edu.au).
Workforce and Service Delivery Analysis across New Zealand Hospital Pharmacy Departments
Authors: Plant Elizabeth A , Norris Pauline T , Tordoff June M
Published: April 2015

Background

There is a lack of baseline data about the workforce, and services provided by hospital pharmacists in New Zealand.

Aim

To determine the composition of the hospital pharmacy workforce in New Zealand and the level of service provided

Method

A questionnaire was sent to chief pharmacists at all 30 public hospitals employing a pharmacist in November 2001, and repeated in November 2003. Data were requested on staff numbers, vacancies, staff experience, training, validation, and pharmacy services provided. Results were analysed for all hospitals, and within groups.

Results

25 hospitals (83%) responded in both years. Hospitals varied widely in their funded and actual staffing levels and in the services delivered. Services (drug distribution, ward pharmacy, patient counselling, drug information, formulary and treatment guideline development) were provided to a greater extent and with more favourable staffing levels in the large hospitals. The median number of beds per full‐time equivalent pharmacist was 50 but the variation across the hospitals was considerable with a range of 30 to 394 beds/full‐time equivalent pharmacist in 2003. Overall, pharmacist vacancy rate of 24% in 2001 had decreased to 15% by 2003.

Conclusion

This study demonstrated a wide variation in workforce and service delivery within and across hospitals, with the differences not necessarily relating to hospital size or type. Staff vacancies appeared high and recruitment and retention were considered key workforce issues.