bluuebunny/crossref_metadata_2025 huggingface dataset:
Haemaccel (Polygeline) Reactions: Anaphylaxis or Anaphylactoid?
Authors: Kong Fabian
Published: March 2016

Haemaccel (polygeline) is frequently used as a plasma expander in the critical care setting. Allergic reactions to polygeline occur infrequently and may manifest as hypotension, bronchospasm, dyspnoea, or skin reactions including facial oedema. A marked increase in reactions during 1999 prompted investigation of the possible mechanism. Review of reports suggested an association with perioperative use and concomitant use of angiotensin converting enzyme inhibitors. A change in the manufacturing process was later identified as the probable cause of many of the recent reactions and the production process has since been modified. Diligent reporting of adverse drug reactions is an essential means of alerting clinicians and drug companies to potentially new causes of previously reported reactions.
Evaluation of an Automated Drug Distribution System in an Australian Teaching Hospital: Part 1. Implementation
Authors: Martin E Dean , Burgess Naomi G , Doecke Christopher J
Published: March 2016

Evaluation of the role of automated drug distribution systems and other technologies in enhancing pharmacy practice and medication management in the hospital setting have been reported in the North American literature since the early 1990s. The availability of such technology in Australia has been limited and as such its application in local practice settings has not been evaluated.
Evaluation of an Automated Drug Distribution System in an Australian Teaching Hospital
Authors: Martin E Dean , Burgess Naomi G , Doeck Christopher J
Published: March 2016

Aim: To assess an automated drug distribution system implemented on four wards of a large teaching hospital.

Method: Pyxis Medstation System 2000 Rx was configured and installed in four inpatient care areas at Royal Adelaide Hospital. These consisted of a medical ward, a surgical ward and two intensive care areas. The system was assessed over the seven weeks immediately following implementation and was compared to the previous systems of individual patient dispensing and imprest drug supplies. The process was assessed in terms of drug inventory, drug distribution, pharmacy staff requirements, missed doses, clinical interventions and nurse satisfaction.

Results: The number of pharmaceutical line items available in patient care areas was increased by 324% using the controlled storage and delivery of the automated system. Over 95% of required items were available at ward level during the trial. Pharmacists' time was reduced by 46% and technicians' time was increased by 36%. The overall staff costs increased by 2.5%. Missed doses declined from 29% to 24%. The prescription turnaround time for items in Medstations was decreased by 88% compared to pharmacy‐based dispensing. Dispensing interventions by pharmacists increased by 16%. Most nurses (91 % ) in the wards preferred the automated system and 54% of nurses in the intensive care areas thought the system should be adopted.

Conclusion: Automated drug distribution was successfully implemented and demonstrated increased efficiency of drug supply and improved accountability. If implemented more widely, the system could allow pharmacists to focus on improving pharmaceutical care through increased clinical activities.
Multicentre Pilot Study of a Standard Approach to Document Clinical Pharmacy Activity
Authors: Dooley Michael J , McLennan Danielle N , Galbraith Kirsten J , Burgess Naomi G
Published: March 2016

Aim: To describe the pilot implementation of guidelines for the standard documentation of clinical pharmacy activities in clinical practice settings in a range of Australian hospitals.

Methods: Twenty‐eight hospital pharmacies participated in the study conducted over a 5‐day period in June 1999. Pharmacists recorded patient‐specific clinical activities as defined in the set of documentation guidelines, documented their experience and provided feedback during and at the end of the study period. Participants were also asked to provide suggestions on potential performance indicators for clinical pharmacy and to comment on four proposed indicators.

Results: 18 402 clinical activities were documented by 85 pharmacists. The most frequent clinical activities performed (% of total activities) were medication order review (53%), clinical review (21 % ), medication history interview (8%) and patient medication counselling (7%). The definitions were deemed to be suitable for most activities. With the exception of clinical review, there was general agreement that the proposed methods of quantifying the activities were suitable. Respondents provided qualitative feedback regarding the definitions and quantification methods. Most respondents thought it would be possible to collect data for the four indicators proposed.

Conclusion: A set of guidelines developed for defining and quantifying patient‐specific clinical pharmacist activities was successfully implemented and utilised in a range of Australian hospitals. The guidelines will be further refined and submitted for consideration and ratification by The Society of Hospital Pharmacists of Australia.
Drug Therapy of Heart Failure in the Elderly
Authors: Jones Elizabeth F
Published: March 2016

Heart failure has many causes, but in the elderly is frequently due to ischaemic heart disease, hypertension or valve lesions. Management principles are similar to those for younger patients. However, in the very elderly, it may not be appropriate to persist with aggressive therapy aimed at mortality reduction at the expense of significant adverse effects. Accurate diagnosis of the mechanism of heart failure is essential to allow rational prescribing and to minimise the adverse effects of inappropriate drug use. This article discusses the approach to diagnosis and the spectrum of agents currently available for treatment of heart failure, and their limitations in the elderly.
The Role of the Clinical Pharmacist in Poison‐Related Admissions in a Secondary Care Hospital
Authors: Kaleemuddin Mohammed , Sankham Rajendran D , Bhojraj Suresh
Published: March 2016

Objective: To assess the value of a clinical pharmacy program to optimise the management of poison‐related admissions to a secondary care hospital in Ootacamund, India.

Methods: A baseline study was carried out to determine the types of poisoning encountered at the hospital. Agrochemicals and other locally available chemicals were surveyed and a simple method for identification of poisons developed. Protocols for the management of poisoning were developed and physicians and nurses were educated on the use of protocols and identification methods. Outcome measures were assessed.

Results: During the 13‐month program, there were 292 poisoning cases. Poisoning due to agrochemicals caused the majority of admissions ( 178 cases). All but four cases were found to be of poisoning with homicidal intent. Clinical pharmacist intervention reduced the number of unidentified poisons from 24% to 7.1 %. The overall death rates in the three periods were 10%, 13% and 9.7%. None of three patients admitted with paraquat poisoning survived in the pre‐intervention period; however, eight patients survived this condition in the postintervention period. The mean number of drugs used per patient declined from 5.5 to 4.1 and the mean length of patient stay at the hospital decreased from 6.2 to 4.1 days.

Conclusion: Clinical pharmacist involvement improved the identification of poisons and treatment protocols for poisoning. The program could have contributed to reduced fatalities and improved therapeutic outcomes for survivors.
Delirium in the Hospitalised Elderly
Authors: Moran Juli A , Dorevitch Michael I
Published: March 2016

Delirium is a clinically diagnosed, diffuse brain disorder characterised by a variety of cognitive and behavioural disturbances. It is a common and serious problem in a hospital setting and frequently remains unrecognised in elderly patients. Delirium is usually caused by multiple factors, many of which are preventable. There is an inverse relationship between patient vulnerability and the severity of insult required to induce delirium. Although previously considered to be a self‐limiting condition, complete reversibility is the exception rather than the rule. The prognosis is often poor, with significant inpatient mortality, substantially increased care costs and the need for additional home care, rehabilitation and long‐term residential care.
Participating in an International Pharmacist Exchange Program
Authors: Deidun Danielle M
Published: March 2016

This paper describes an exchange between two paediatric pharmacists in Australia and the UK. Main areas of interest are highlighted and similarities and differences between paediatric pharmacy practice in the two countries are discussed.
Clinical Pharmacy in 2020: an Alternative Future for Clinical Pharmacy in a Rural Setting
Authors: Lum Elaine PM
Published: March 2016

This paper paints one of many possible futures for clinical pharmacy in the year 2020, the role of the pharmacist in that scenario, and the steps required to achieve that reality. In particular, the future of clinical pharmacy in the rural setting will be offered.

An emerging issues analysis of global and national trends that are driving change will be used to critique the present. This is complemented by a causal layered analysis (CLA) of problems and issues that arise in rural pharmacy practice. CLA is a tool developed by futurists to explore current issues and paradigms at several different levels of knowing. A vision of rural clinical pharmacy will be offered, using the CLA as a template. Broad strategies to guide the move from current reality to the preferred future are briefly outlined.
Vancomycin Continuous Infusion: a Cohort of 23 Intensive Care Unit Patients
Authors: Matthews Zachariah
Published: March 2016

Objective: To observe the phannacokinetic impact of administering vancomycin by continuous infusion in selected patients in the Royal Prince Alfred Hospital (RPAH) General Intensive Care Unit.

Method: A retrospective review was performed of patients given vancomycin by continuous infusion in the General Intensive Care Unit over a four‐year period from June 1996 to May 2000.

Results: Twenty‐six critically ill patients treated with continuous infusion vancomycin were identified. Twenty‐three of the 26 patients also received a regimen of vancomycin by intermittent dosing during the same admission to the unit. The pharmacokinetic data for these 23 patients are presented. The results of this review support the findings of previous studies that vancomycin given by continuous infusion achieves a better phannacokinetic profile than intermittent dosing.
Review of a Drug Information Service in an Indian Teaching Hospital
Authors: Nibu P , Ramesh M , Parthasarathi G
Published: March 2016

Aim: To describe a review of drug information activities in a teaching hospital in Mysore, India.

Method: Drug information enquiry forms were reviewed for a 6‐month period. Randomly selected enquiries were audited by experienced clinical pharmacists.

Results: 370 enquiries were handled at an average of 62 per month. Most enquiries were from doctors (52%) and postgraduate medical students (30% ). Questions most frequently related to administration/dosage (30%) and adverse drug reactions (27% ). Standard textbooks were used for 64% of enquiries. Of the 16 enquiries directly audited, 15 were rated as good or excellent and 1 as ‘can improve’.

Conclusions: The service was well used. In developing countries, it is important to establish independent drug information centres beginning with basic resources. Output should be monitored with quality assurance programs.
Fall‐Related Hospital Admissions in Elderly Patients: Contribution of Medication Use
Authors: Andrew Hilary P , Gilbar Peter J , Wiedmann Rachael J , Groves Catherine F
Published: March 2016

To determine the incidence of falls in elderly patients and possible association with medication use.
The Medication Chart as an Integral Tool in the Pharmaceutical Care Plan
Authors: Wilcox Carole , Duguid Margaret J
Published: March 2016

Aim: To develop a practical guide for pharmacists for the provision of clinical pharmacy services that would: 1. facilitate the delivery of a uniform standard of care; and 2. enhance communication between pharmacists and other members of the medication team.

Method: A generic pharmaceutical care plan based on the ‘SHPA Standards of Practice for Clinical Pharmacy’ was developed as an appropriate framework for the model. The plan is outcome oriented. It uses the patient's medication chart to document clinical information and activities and follows the patient from admission to discharge. The medication chart was chosen as the medium for documenting pharmaceutical care following a survey of the medical staff. Previously this information was recorded in patient profiles in individual pharmacists' ward folders.

Results: Major outcomes included a change in clinical practice, improved discharge planning, visibility of the pharmacists' contribution to patient care, and an increase in the pharmacists' profile within the hospital. The plan also proved to be a useful tool for performance management and education purposes, and was well accepted by pharmacists.

Conclusion: A formalised pharmaceutical care plan is a practical and efficient model for providing and documenting clinical pharmacy services. Using the medication chart as the medium for documenting clinical services supports continuity of care in the hospital, improves productivity and streamlines the discharge process.
Stability and Compatibility of Morphine, Midazolam and Bupivacaine Combinations for Intravenous Infusion
Authors: La Forgia Simon P , Sharley Nicholas A , Burgess Naomi G , Doeck Christopher J
Published: March 2016

Aim: To establish the stability and compatibility of morphine and midazolam, and morphine, midazolam and bupivacaine infusions prepared at the Royal Adelaide Hospital.

Method: A validated stability indicating high performance liquid chromatography (HPLC) method was developed to measure the concentrations of each compound in the infusions over a 42‐day study period. Visual inspection and pH measurement were also carried out on each study day.

Results: Midazolam concentration decreased to 86.0% of initial concentration in the morphine and midazolam infusion bags and to 86.3% of the initial concentration in the morphine, midazolam and bupivacaine infusion bags by day 42 of the study. The concentration of midazolam was reduced in both combinations to the 90% acceptable level for stability at day 28. There was no significant decrease in morphine or bupivacaine concentration in either solution during the study period.

The drug combinations were compatible to visual inspection over the 42‐day study period showing no change in colour and clarity or any precipitation.

Conclusion: Based on these results the infusions tested in this study are chemically stable for up to 28 days. Therefore when protected from light and stored at 22 ± 2°C the expiry date for these products can be set at 28 days.
Snapshot of Hospital Pharmacy Workforce in Australia
Authors: Leary Karen M O' , Allinson Yvonne M , Kirsa Sue W , Jackson John K , Burgess Naomi G
Published: March 2016

To provide a snapshot of current staff utilisation, a questionnaire was sent to 248 Australian hospitals with an identified hospital pharmacy service. The data returned from 101 hospital pharmacy services provided a snapshot of where hospital pharmacists are currently working, what they spend their time doing, and the role of pre‐registration pharmacists and pharmacy support staff in providing hospital pharmacy services.

Key findings of the responses from these 101 hospital pharmacy services showed that in 2000‐2001:

1. 129.16 of the 929.46 pharmacists establishment full‐time equivalent positions (14%) were vacant;

2. one in three hospital pharmacists worked part time;

3. one in three hospital pharmacists had a postgraduate qualification; and

4. on average 41 % of pharmacists' time was devoted to clinical services, 39% to distribution services and 16% to management activities.

The full report is available at: http://www.shpa.org.au/documents/snapshotworkforce.pdf
A Randomised Controlled Trial of Medication Liaison Services—Patient Outcomes
Authors: Stowasser Danielle A , Collins David M , Stowasser Michael
Published: March 2016

Objectives: To evaluate the effects of a Medication Liaison Service (MLS) on quality of medication‐related information associated with hospital admission, risk of drug misadventure and other patient outcomes, and health resource utilisation.

Method: Patients were randomly selected from eight acute wards (servicing 12 medical and five surgical units) and an orthopaedic pre‐admission clinic at two major hospitals. Subjects were randomly assigned to an intervention (MLS) or control group. For each patient in the MLS group a clinical pharmacist attached to the MLS contacted the general practitioner and community pharmacist in order to prepare a comprehensive medication history. Prior to discharge, the MLS clinical pharmacist, in consultation with the hospital medical staff, prepared a discharge communication which included a list of medications on admission and discharge, corresponding therapy changes, intended duration of therapy, sources of supply, allergies and adverse drug reactions, new therapeutic devices, medication‐related problems and actions required by the general practitioner. This information was forwarded to the patient's general practitioner and community pharmacist within 24 hours of discharge. Patient outcomes were evaluated 30 days after discharge using a mailed questionnaire and review of medical files.

Results: Of 240 patients recruited, 113 were randomised to the MLS group and 127 to the control group. During hospital admission a significantly greater proportion of MLS subjects experienced a clinical pharmacist intervention (MLS 68% vs control 44%) and more subjects had at least one change to their therapy (MLS 97% vs control 90%), with more interventions (mean MLS 1.43 [SD 1.5] vs control 0.77 [SD 1.1]) and more medication changes per subject (mean MLS 3.75 [SD 2.6] vs control 3.10 [SD 2.3]). There was no significant effect on length of stay or mortality. In the 30 days following discharge there were fewer réadmissions per subject in the MLS group (mean 0.12 [SD 0.4] vs 0.46 [SD 1.9]) but this difference did not quite reach statistical significance (p = 0.055). The MLS group had significantly fewer healthcare professional visits per subject (mean MLS 7.54 [SD 7.4] vs control 9.94 [SD 10]). In an assessment of functional health status, MLS subjects improved for 7 of 8 factors (significantly so for two), and tended to improve more than controls in all factors except vitality.

Conclusion: MLS was associated with improved patient outcomes and a greater number of inpatient clinical pharmacy interventions and medication changes intended to optimise therapy. There was also a tendency for reduced readmissions, a significant decrease in community healthcare professional visits, and significant improvements in functional health status score.
A Randomised Controlled Trial of Medication Liaison Services—Acceptance and Use by Health Professionals
Authors: Stowasser Danielle A , Collins David M , Stowasser Michael
Published: March 2016

Objectives: To determine the acceptance and utility of a Medication Liaison Service (MLS) by hospital and community healthcare professionals. The MLS aimed to improve the quality and transfer of medication‐related information associated with hospital admission.

Method: 240 patients were randomly selected from acute wards and a pre‐admission clinic (PAC) at two major hospitals and randomly assigned to MLS (n = 113) or control (n = 127) groups. General practitioners (GPs) and community pharmacists attending each intervention patient were asked to anonymously complete a survey to assess acceptance and utility of the MLS 30 days post‐discharge. Hospital resident medical officers (RMOs, n = 12) exposed to the MLS while working in the PAC were also surveyed.

Results: Surveys were returned from 76% of GPs, 84% of community pharmacists and 83% of RMOs. The comprehensiveness of medication information was rated as ‘good’ or ‘excellent’ by 100% of RMOs, 92% of GPs and 89% of community pharmacists. Timeliness was rated as at least ‘adequate’ by all but one GP and one community pharmacist. Over 70% of GPs utilised the information provided in patient care and GPs reported making 52 interventions to drug therapy as a result of MLS information. While only 11 interventions were made by community pharmacists, 70% requested routine access to the MLS information. Problems with storage and retrieval of information were factors limiting the utility of MLS information provided on discharge.

Conclusion: MLS information was rated highly by RMOs, GPs and community pharmacists in terms of comprehensiveness and timeliness. The MLS facilitated medication management decisions and the majority of users requested routine access to the service in the future.
General Practitioner Acceptance of Medication Review in Sydney Nursing Homes
Authors: Smith Margaret A , Simpson Judy M , Benrimoj Shalom I
Published: March 2016

Objectives: To conduct a one‐off medication review in nursing homes, ascertain the medication problems and determine why recommendations made by the pharmacist conducting the review were not implemented by general practitioners.

Setting: Fourteen nursing homes in the Northern Sydney area that did not already have a pharmacist reviewing medication charts agreed to participate.

Method: Twenty‐one general practitioners were recruited, each with at least eight residents in the participating nursing homes. The medication charts of 202 residents were reviewed once by an independent, accredited pharmacist, who then discussed potential problems with the resident's general practitioner. The number of changes, and reasons for changes to drug therapy were detailed from the time of notification of the review to the time the review was undertaken (six weeks), and also at the six‐week follow‐up. For the latter period, changes recommended by the reviewer were distinguished from those made by the general practitioner independently of the pharmacist. A comparison of community pharmacy and nursing home records was also undertaken.

Results: General practitioners made 148 changes to drug therapy in 60 of the 202 residents in the six‐week period between notification and commencement of the review. Clinical reasons were evident for almost all these changes. The mean numbers of regular and ‘as required’ medications per resident on the day of the review were 3.9 and 1.5 respectively. A median reduction of 0.5 doses of regular medication per resident was observed (P > 0.001). The reviewing pharmacist made 280 recommendations and 141 (50%) of these were accepted by the general practitioners. Pathology tests and clinical signs assessments (e.g. blood pressure measurement) were recommended by the pharmacist on 129 occasions, but only 44 (34%) of these were accepted by the general practitioners. Changes to therapy occurred in 69 residents. Only 21% of the medication records in the nursing home were identical to the community pharmacy medication records.

Conclusion: General practitioners were often reluctant to change drug therapy or respond to the pharmacist's recommendation for ordering blood tests when residents were clinically stable. Government pressure on the medical profession to reduce ‘over‐servicing’ and doctors reluctance to implement an intervention that could upset the ‘status quo’ in a frail elderly resident, presented dilemmas for the pharmacist in the quest for high quality prescribing.
Improving Decision Outcomes of Drug and Therapeutics Committees
Authors: Tan Ee Lyn , Day Richard O , Brien Jo‐anne E
Published: March 2016

Objective: To investigate the activities of the Drug and Therapeutics Committee (DTC) in Australian hospitals, a survey was conducted to determine the performance indicators being used, the application of the collected indicator data, barriers to indicator use, principal function of the DTC and resources available to the DTC.

Method: A questionnaire was sent to 300 Directors of Pharmacy in Australian hospitals. The questionnaire could be returned via reply‐paid envelope or fax. Those not responding within two weeks of mail‐out were followed‐up. Returned questionnaires were de‐identified, collated and analysed.

Results: The response rate was 73.3%. Of these, 127 had an in‐house DTC. The final dataset comprised 125 responses (two incomplete questionnaires excluded). The most common principal function of DTCs was ‘ensuring patient safety’ (84%). Only 16% of respondents used indicators developed specifically for DTC performance evaluation. Data collected were primarily for accreditation.

Conclusion: There are barriers to fully utilising available performance indicators. Most indicator data collected are for accreditation purposes. Generally, there are a lack of resources available to support DTC operations. This may have contributed to barriers to indicator use. DTC principal functions have expanded beyond those of formulary management.
A Review of the Clinical Pharmacy Services in Kasturba Hospital, India
Authors: Nair Nibu P , Rao Padma GM
Published: March 2016

Providing clinical pharmacy services for better patient care has only recently been recognised in developing countries like India. This report focuses on the activities of the recently established Department of Pharmacy Practice, which offers clinical pharmacy services to Kasturba Hospital, Manipal, India. The activities include ward round participation, drug information services, adverse drug reaction reporting and monitoring, patient counselling, and periodic publication of newsletters. The department has prepared various forms to document the activities. A nine‐month experience of clinical pharmacy services in Kasturba Hospital, Manipal, revealed an increased utilisation of clinical pharmacy services across this hospital. Such services are essential for developing countries like India where many drug‐related problems exist.
Publication Rate of Abstracts Presented at The Society of Hospital Pharmacists of Australia 24th Federal Conference
Authors: Dooley Michael J , Singh Sanjay
Published: March 2016

Aim: To assess the publication rate of abstracts presented at the 24th Federal Conference of The Society of Hospital Pharmacists of Australia (SHPA) held in November 1999.

Method: Abstracts of posters and papers presented at the conference were sourced from the proceedings booklet. Publication status of abstracts was determined by search in MEDLINE, International Pharmaceutical Abstracts (IPA) and by a manual search of all editions of the Journal of Pharmacy Practice and Research (formerly The Australian Journal of Hospital Pharmacy). Comparison was made between the rate of publication of paper and poster presentations and also between collaborative and non‐collaborative work.

Results: Of the 187 papers and posters presented at the conference, 21 were subsequently identified as published, representing an overall publication rate of 11.2%. Of the 82 papers presented, 15 (18.3%) were published while only 6 (5.7%) of the 105 presented posters were published. The percentage of collaborative paper and poster abstracts published was 36.1% (13 of 36) and 8% (2 of 25) respectively. Only 4.3 % (2 of 46) of the non‐collaborative paper abstracts and 5.0% (4 of 80) of the non‐collaborative poster abstracts were published. There were 9 manuscripts that were published in The Australian Journal of Hospital Pharmacy (now known as the Journal of Pharmacy Practice and Research).

Conclusion: The publication rate of abstracts presented at the 24th Federal Conference of The Society of Hospital Pharmacists of Australia held in Perth, Western Australia in November 1999 was 11.2%. Abstracts were more likely to be published if the work was collaborative and presented as a paper.
Survey of Job Satisfaction among Pharmacists in Thailand
Authors: Plianbangchang Pinyupa
Published: March 2016

Aim:To determine the level and contributing factors for job satisfaction among Thai pharmacists.

Method:The study was conducted using a self‐administered, mailed questionnaire. The sample was randomly selected from all registered pharmacists in Thailand. Factors hypothesised to contribute to job satisfaction were: achievement in working life, good relationship with supervisor, good relationship with colleagues, good relationship with friends, appropriate work schedule, involvement in clinical activities, good work environment, satisfactory salary, job security, and career commitment.

Results:The final response rate was 47.4% (61011287). Mean overall job satisfaction level was 29.9 (SD 4.6) out of a possible 40 points (75%). Stepwise regression analysis found that achievement in working life, involvement in clinical activities, appropriate work schedule, good relationships with colleagues, and satisfactory salary, together explained 52% of the total variability in job satisfaction.

Conclusion:Thai pharmacists reported a reasonable level of job satisfaction. The strongest predictor for job satisfaction was achievement in working life. The results obtained from this research could be used to improve the work atmosphere in order to maximise job satisfaction for Thai pharmacists.
The Emergence of Pharmacogenomics
Authors: McKinnon Ross A , Ward Michael B
Published: March 2016

The role of heredity in modifying individual response to drugs and other chemicals has been known for more than six decades. More recently, the Human Genome Project, and various technical innovations emerging from it, have dramatically accelerated the depth of this knowledge. The collective term now given to this field is ‘pharmacogenomics’. The rapid emergence of pharmacogenomics provides many exciting opportunities for achieving better health outcomes and, in particular, offers enormous potential for markedly improving drug therapy, through rational drug selection and prediction of susceptibility to adverse events or toxicity. It is envisaged that the implementation of pharmacogenomic programs will provide clinicians with greater certainty of a desired outcome, including the avoidance of underdosing, overdosing, misdosing and adverse drug reactions. Importantly, pharmacogenomics also offers the pharmaceutical industry potential economic advantages through improved drug selection and streamlined clinical trial protocols. This review provides a background to the development and conduct of pharmacogenomic research and highlights examples where pharmacogenomics is likely to have a significant clinical impact on the pharmacokinetics of drugs.
Survey of Implementation Levels and Pharmacy Requirements for the Continuum of Quality Use of Medicines between Hospital and Community
Authors: O'Leary Karen M , Allinson Yvonne M , Stowasser Danielle A , Dowling Helen
Published: March 2016

Aim: To investigate the hospital pharmacy resources required and other associated implications of implementing the National Guidelines to Achieve the Continuum of Quality Use of Medicines between Hospital and Community, prepared by the Australian Pharmaceutical Advisory Council.

Method: An electronic questionnaire was sent to 248 hospital pharmacy services across Australia. One section was devoted to the implementation of the guidelines for overnight admi ssions. Respondents were asked to indicate the level of compliance with each of the seven principles of the guidelines and to estimate the number of pharmacists and pharmacy support staff that would be required to fully meet the guidelines at their hospital.

Results: Responses were received from 101 hospital pharmacy services. The involvement of hospital pharmacists in meeting the principles varied. Only three respondents indicated that their hospital fully met all seven principles of the guidelines for the majority of overnight admissions. Respondents indicated that transfer of information on medication usage is of limited benefit unless the information is complete, accurate, provided within a reasonable or necessary time, and provided between the appropriate healthcare professionals who were responsible for each patient's care. They also highlighted differences in the service level currently delivered to various patient groups: elective and non‐elective patients, patients admitted and discharged during normal business hours and those outside these hours, and patients perceived as ‘high risk’. Based on respondents' estimates, 867 pharmacists and 512 pharmacy support staff full‐time‐equivalent positions would be required to fully meet the guidelines for overnight admissions in these 101 hospitals.

Conclusion: This study indicates that the guidelines are only partially implemented in Australian hospitals. A substantial increase in the number of pharmacists, support staff, and funding would be required for the hospital pharmacy service component to adequately support hospitals' implementation of the guidelines.
Home Pharmacy Service: Three Years Experience
Authors: Cheong Elizabeth A , Ng Kingsley
Published: March 2016

A home pharmacy service was established in 1998 as part of Post Acute Community Care, a multidisciplinary community health service in western Sydney. Services provided include medication review, liaison with health professionals, home visits for medication management, protocol development and implementation, and staff education and training. Home pharmacy services were provided on 860 occasions (759 patients) between July 1998 and June 2001. Medication reviews resulted in 774 clinical interventions of which 481 (62%) required consultation with the prescriber. Home anticoagulation and parenteral therapy minimised hospital admissions by enabling 307 patients with deep vein thrombosis and 280 patients requiring parenteral therapy to be treated at home. A patient satisfaction survey indicated a high level of satisfaction with the service. Home pharmacy service can make a significant contribution to the continuum of care between hospital and home. Home medication management can help patients manage their medications safely and effectively at home.
RAIN, SMOG, FOG and Printed Educational Material
Authors: Mullan Judy R , Crookes Patrick A , Yeatman Heather R
Published: March 2016

Patient education is central to the practice of all health professionals. Pharmacists often use printed educational material, such as consumer medicine information, as adjuncts to verbal communication and education of patients about their medications. A relatively large proportion of the Australian population have low literacy skills and cannot read or understand written patient educational materials which are typically written at levels equivalent to year 9 and above. By using simple readability assessment tools such as RAIN, SMOG or FOG and the UK's Department of Health ‘Toolkit for producing patient information’ health professionals can ensure that printed educational materials are simple and easily read by a wide patient population. These measures will ensure that pharmacists can become more effective educators to improve patients' medication knowledge and understanding, which will assist with optimising compliance and overall therapeutic outcomes.
Factors Influencing Adverse Drug Reaction Reporting in New South Wales Teaching Hospitals
Authors: Kelly Maria , Kaye Karen I , Davis Sharon R , Shenfield Gillian M
Published: March 2016

Aim: To identify predisposing and enabling factors which influence adverse drug reaction reporting by medical, nursing and pharmacy staff in New South Wales teaching hospitals.

Method: A questionnaire was distributed to all doctors, nurses and pharmacists in four New South Wales teaching hospitals. Health promotion concepts were used to provide a framework for interpreting results.

Results: 4808 questionnaires were distributed and 1125 (23% response rate) were returned. Approximately 16% of respondents reported that they had reported an adverse drug reaction at least once to the Australian Adverse Drug Reactions Advisory Committee. 82% routinely asked patients about previous adverse drug reactions on admission and 95% of these respondents documented the adverse drug reaction in the medical record. Only 36% knew how to report an adverse drug reaction in their hospital. Most claimed awareness of recognised goals of adverse drug reaction reporting but many also identified erroneous goals. They were more likely to report an adverse drug reaction if it was serious or related to a new product. Predisposing factors relating to knowledge were identified as barriers to reporting by about one‐third of respondents. Factors relating to attitudes and beliefs were not identified as barriers. Disabling factors included excessive workload, forms not readily available and insufficient data.

Conclusion: Knowledge appears to be a greater influence on adverse drug reaction reporting than attitudes and beliefs. Simple enabling processes, such as making forms more accessible or encouraging computerised reporting, might result in more reports. Educational initiatives should target nurses and junior medical officers.
Expanding the Role of a Pharmacy Technician in a Private Hospital
Authors: Maslanka Edyta , Leach Helen J
Published: March 2016

Aim: To describe the introduction and expansion of the support roles of a pharmacy technician in an acute‐care private hospital.

Process: Additional responsibilities to support the Pharmacistin‐ Charge included: administrative roles, pharmacy committee secretarial tasks, assistance with financial reporting, inventory checking and maintaining a technician's operating manual.

Outcomes: The new tasks have been included into departmental procedures and have led to improved job satisfaction due to increased variety of tasks and enhanced recognition of skills.

Conclusion: Additional support roles for pharmacy technicians could be considered in other private hospitals. This could be enhanced by a uniform work classification and continuing education support.
Snapshot of the Australian Public Hospital Pharmacy Workforce in 2003
Authors: O'Leary Karen M , Allinson Yvonne M
Published: March 2016

Aim: To update the survey of the Australian hospital pharmacy workforce undertaken in 2001.

Method: A questionnaire was sent to 303 Australian hospitals with an identified hospital pharmacy service. Data returned from 128 public hospital pharmacy services were analysed and compared to the earlier study.

Results: Key findings were:

1. 107 (10%) of the 1054 establishment pharmacist full‐time equivalent positions were vacant (an improvement from 14%);

2. the vacancy rate for pharmacists had decreased in South Australia (23 to 2%) and increased in Queensland (11 to 17%);

3. 1 in 3 hospital pharmacists worked part‐time;

4. 1 in 3 hospital pharmacists had postgraduate qualifications;

5. the number of pre‐registrant positions had increased with the greatest growth in New South Wales;

6. less than 40% of pharmacy technicians had any formal qualification; and

7. more than half of the hospital pharmacy services were planning to introduce new services in the next 2 years; mostly related to improving clinical services and medication safety. This would require an additional 100 pharmacist positions.

Conclusion: The percentage of vacant positions had fallen slightly since the earlier survey. While there had been some improvement in the vacant establishment pharmacist full‐time equivalent positions, over 100 pharmacist positions remain unfilled. Ongoing retention and recruitment strategies to meet anticipated demand and further reduce the number of vacancies in hospital pharmacy will be required.
Preparation and characterization of baru (Dipteryx alata Vog) nut protein isolate and comparison of its physico‐chemical properties with commercial animal and plant protein isolates
Authors: Nunes Ângela A , Favaro Simone P , Miranda Cesar H B , Neves Valdir A
Published: March 2016

BACKGROUND

The Brazilian leguminous tree locally known in the Cerrado Biome as baru (Dipteryx alata Vog), provides a healthy edible oil source. The proteinaceous cake remaining after oil extraction could be transformed into new products to foodstuff development, such as protein concentrates and isolates, adding value to the production chain. In this study, it is described the preparation and characterization of baru nut protein isolate (BPI) from deffated baru flour, and measurements of its functional, nutritional, and thermal properties, in comparison to the more common vegetable (soybeans) and animal (casein and albumin) protein sources of the food industry.

RESULTS

BPI presented higher protein content than soybean, casein and albumin commercial protein isolates, despite losses of albumins and low molecular weight globulins during the isolation procedure. Thermodynamics studies suggested that BPI has a well‐conserved protein arrangement and lower thermostability than the other protein sources. BPI showed high in vitro digestibility and suitable and desirable functional properties such as water and oil absorption capacity, emulsifying activity, and foam formation and stability at mild and neutral pH.

CONCLUSION

BPI could be used either as a substitute ingredient in oily food formulations or in the development of new products of its own. © 2016 Society of Chemical Industry
Interaction of sine‐Gordon solitons in the model with attracting impurities
Authors: Ekomasov Evgenii G. , Gumerov Azamat M. , Murtazin Ramil R.
Published: March 2016

We study properties of the localized solutions to the sine‐Gordon equation excited on the attractive impurity by a moving kink. The cases of one‐dimensional and two‐dimensional spatially extended impurities are considered. For the case of one‐dimensional impurity the possibility of excitation of the first even and odd high‐amplitude impurity modes by the moving kink is demonstrated. By linearizing the sine‐Gordon equation the dispersion relations for the small‐amplitude localized impurity modes were obtained. The numerically obtained dispersion relations in the case of low oscillation amplitudes are in a good agreement with the results of analytical calculations. For the case of two‐dimensional impurity we show the possibility of excitation of the nonlinear high‐amplitude waves of new type called here a breathing pulson and a breathing 2D soliton. We suggest analytical expressions to model these nonlinear excitations. The breathing pulson and breathing 2D soliton are long‐lived and can be of both symmetric and asymmetric type depending on the impurity type. The range of the impurity parameters where the breathing pulson and breathing 2D soliton can be excited was determined. The dependencies of the oscillation frequency and the amplitude of the excited impurity modes on the impurity parameters are reported. Copyright © 2016 John Wiley & Sons, Ltd.
Ultra‐high resolution band‐selective HSQC for nanomole‐scale identification of chlorine‐substituted 13C in natural products drug discovery
Authors: Wang Xiao , Duggan Brendan M. , Molinski Tadeusz F.
Published: March 2016

Ultra‐high resolution band‐selective HSQC (bsHSQC) has been employed for detection of 35Cl–37Cl isotope shifted 13C NMR signals for assignment of regioisomerism in bromo‐chloro natural products. Optimum pulse sequence and instrumental parameters for maximization of detection of the isotope shifts were explored. The chlorine isotope shifts (Δδ) were detected within crosspeaks and were shown to vary with hybridization of 13C, substitution of 13C, presence of β‐chloro substituents, and their relative configuration. Deconvolution of Cl‐substituted CH bsHSQC crosspeaks may provide other useful information, including a potentially MS‐independent method for quantitating 37Cl/35C isotopic fractionation during the biosynthesis of halogenated natural products. Copyright © 2016 John Wiley & Sons, Ltd.
Linearized state‐based peridynamics for 2‐D problems
Authors: Sarego G. , Le Q. V. , Bobaru F. , Zaccariotto M. , Galvanetto U.
Published: March 2016

In this work, the authors formulate a 2‐D linearized ordinary state‐based peridynamic model of elastic deformations and compute the stiffness matrix for 2‐D plane stress/strain conditions. This model is then verified by testing the recovery of elastic properties for given Poisson's ratios in the range 0.1–0.45. The convergence behavior of peridynamic solutions in terms of the size of the nonlocal region by comparison with the classical (local) mechanics model is also discussed. The degree to which the peridynamic surface effect influences the recovery of elastic properties is examined, and stress/strain recovery values are found to have a definite influence on the results. The technique used here can provide the basis for applying 2‐D peridynamic models to the study of fatigue failure and quasi‐static fracture problems. Copyright © 2016 John Wiley & Sons, Ltd.
Patterns and prevalence of medication use across the menstrual cycle among healthy, reproductive aged women
Authors: Johnson Kristen A. , Sjaarda Lindsey A. , Mumford Sunni L. , Garbose Rebecca A. , Schliep Karen C. , Mattison Donald , Perkins Neil J. , Wactawski‐Wende Jean , Schisterman Enrique F.
Published: March 2016

Purpose

The purpose of this study is to characterize the patterns of medication intake in healthy, reproductive‐age women not using hormonal contraception.

Methods

Two hundered fifty‐nine healthy, premenopausal women (18–44 years of age) enrolled in the BioCycle Study (2005–2007) were followed over two menstrual cycles. Women were excluded if they were currently using oral contraceptives or other chronic medications. Over‐the‐counter and prescription medication use among participants was evaluated daily throughout the study via a diary assessing type of medication, dosage, units, and frequency. Medications were categorized as allergy, antibiotics, central nervous system (CNS), cold and cough, gastrointestinal, musculoskeletal, and pain medication based on primary active ingredient. Medication use within each category was assessed across standardized 28‐day cycles to evaluate differences in use across cycle phases (i.e., early, middle, and late).

Results

Medication use was reported by 73% of participants. The most and least frequently used medications, respectively, were pain (69%) and musculoskeletal medications (1%). Pain, CNS, and antibiotic medication use varied significantly across the cycle, with pain and CNS medication more frequently reported during menses and antibiotics more frequently during the luteal phase. Allergy, cold and cough, gastrointestinal, and musculoskeletal medication use did not vary across the cycle.

Conclusions

Patterns of medication use among reproductive age women vary across the menstrual cycle for certain types of medications, particularly in pain (e.g., Ibuprofen), antibiotics (e,g, Amoxicillin), and CNS (e.g., Adderall) medications. Future studies involving use of these types of medication in premenopausal women may need to consider the relationship of their use to the menstrual cycle. Copyright © 2016 John Wiley & Sons, Ltd.