bluuebunny/crossref_metadata_2025_split huggingface dataset:
New System to Administer Drugs via the Central Venous Catheter in Newborn Infants
Authors: PL Simon , Tan Ailee , Quek Belinda , Ang Peisan 
Published: March 2016

Background: Administering intravenous medications to the premature baby is often difficult because of the lack of peripheral venous access. Routine administration of these medications via the central venous catheter (eVC) poses a high risk of eve‐related sepsis.Aim: To describe a new method of aseptic drug delivery linked to the eve and to describe our initial experience in 32 neonates.Description: The drug‐manifold system is aseptically prepared under laminar flow conditions, and then linked aseptically to the parenteral nutrition solution and to the eve. This closed system is not disrupted until the next change of solutions 24 hours later. Drugs are administered at the appropriate times by turning the stopcocks without disrupting the closed system.Application: A total of 32 neonates received drugs administered by this system for an average duration of 12.9 ± 12.7 (SD) days. Drugs delivered included benzylpenicillin, ampicillin, gentamicin, cefotaxime, amikacin, aminophylline and vancomycin. Two cases of bacteraemia were identified; this represents 4.8 infections/ 1000 days of usage of this new system. This compares favourably with our infection rate before the new system was introduced.Conclusion: A new system of aseptic drug delivery linked to the eve in neonates was found to be safe and useful with few complications.
Using Genetic Algorithms on a PC to Compile Staff Rosters
Authors: Snowdon Graeme M , Elliott Phillip 
Published: March 2016

Aim: We aimed to develop an automated staff rostering system for pharmacy staff working on Saturday rotations that was fair to all concerned, required minimal input and was simple to modify as needs changed.Method: The roster was prepared on a 33 MHz 486 IBM personal computer (PC) in the spreadsheet package Microsoft Excel v4, using Evolver 2.0, the genetic algorithm add‐on for Excel.Results: A staff roster was prepared in the form of a spreadsheet that could be adjusted to meet the constraints of annual leave, rostered days off and many more variables. The genetic algorithm software, linked to the spreadsheet, automatically produced an acceptable roster with no timetable clashes.Conclusion: Pharmacy staff favour the new system since many variables can be assessed with little manual input. A workable roster that is fair and equitable can be easily obtained.
Testing the Surefuser: A Disposable Subcutaneous Infusion Pump
Authors: Huppatz Clare , Parker Deborah , Maddocks Ian 
Published: March 2016

Objective: To assess the accuracy of a new mechanical infusion pump, Nipro SurefuserSetting: Daw House, a hospice unit located at Repatriation General Hospital, Daw Park, South Australia.Method: Three Surefuser infusion devices were assessed on the bench top over a three‐day period. A flowcontrol tubing was chosen that would deliver 50 mL of 0.9% sodium chloride in 72 hours at a rate of0.7 mLI h. Devices were fitted with extension tubing and a 25‐gauge butterfly needle. One Surefuser device was attached to a healthy volunteer for a three‐day trial. The infused volume was indirectly measured every 12 hours throughout the trials and the ambient temperature was also recorded.Results: Mean flow rates for the three Surefuser devices assessed on the benchtop were 0.63 mL/h, 0.71 mL/h and 0. 7 4 mL/h. Temperatures for these trials ranged between 18.3°C and 28.6°C. The mean flow rate of the Surefuser device attached to the volunteer was 0.88 mL/h.Conclusions: The manufacturer claims that the Surefuser is accurate within ±10%, at a constant temperature of 32°C. The average rates as measured on the benchtop support this claim. It is unclear what the effect of temperature was on the infusion rate, although it appeared to make only a minor difference. The Surefuser is simple to operate and convenient to work with. The accuracy is acceptable in palliative care and future studies should be trialed in a clinical setting. The major drawback is the cost — a single, disposable unit costs approximately $53.00.
Intravenous Phenoxybenzamine for Acute Hypertension of Phaeochromocytoma A Case Report
Authors: Fisquet Paul 
Published: March 2016

Objective: To illustrate the use of IV phenoxybenzamine (not commercially available in Australia) in a patient presenting with acute phaeochromocytoma which was unsatisfactorily controlled with other agents, including IV phentolamine.Clinical features: The patient was a 52‐year‐old female who presented for an elective total abdominal hysterectomy and bilateral salpingo‐oophorectomy. During the operation her blood pressure rose precipitously and she had an episode of myocardial ischaemia. A presumptive diagnosis of phaeochromocytoma was made and subsequently proven. Postoperatively she was admitted to ICU on infusions of phentolamine and glyceryl trinitrate.Case progress and outcome: By day 4 her phentolamine infusion had increased to 80 mg/h with frequent boluses required. When a phenoxybenzamine infusion was substituted for the phentolamine the blood pressure rapidly came under control and the patient could be transferred to the medical ward. She was discharged with her symptoms well controlled on oral medication to await surgical removal of the phaeochromocytoma.Conclusion: IV phenoxybenzamine may successfully treat acutely ill patients with phaeochromocytoma unresponsive to other agents.
A Survey of Drug Audit Practices and Promotion of Quality Prescribing in Australian Hospitals with a Focus on Psychotropic Drugs
Authors: Fellows Linda , Hughes Jeffery D 
Published: March 2016

Objective: To gain an insight into current practice of drug audit/drug usage evaluation (DUE) in Australian hospitals with a particular focus on psychotropic drugs.Method: All Australian hospitals with greater than 150 beds were surveyed by questionnaire to ascertain the level of drug audit activity and the strategies used to support quality prescribing. Twenty‐two pharmacists from 18 different hospitals in 5 States participated in a structured follow‐up interview.Results: Pharmacists from 73 (49%) of the 150 hospitals surveyed responded. Drug audit activity varied widely across hospitals and did not necessarily relate to the size or demographics of the hospital. While there was increasing use of well‐structured DUE, simple one‐day ‘snapshots’ of drug usage were also common. Interviewees reported that the focus of DUE was primarily on cost containment, with a secondary element of quality prescribing. Pharmacists were closely involved, but little training or additional resources were provided for these activities. Successful DUE was seen to depend heavily on hospital culture and in particular on the support of key clinicians and senior managers. Psychotropic drug audit was not a high priority for DUE outside the stand‐alone psychiatric institutions. Lack of resources and incentives coupled with inadequate information technology have limited DUE progress.Conclusion: There is recognition in Australian hospitals that DUE is a valuable tool for improving prescribing practice. To progress DUE it is critical to advance and standardise hospital computer systems and in particular to introduce electronic prescribing. In addition there is scope to improve policy agendas relating to accreditation requirements and national standards to enhance the development of DUE.
Strategy for Identification of ‘Near Miss’ Events and Improving Dispensing Accuracy
Authors: Dooley Michael J , Streater Jacqui , Wilks Justin J 
Published: March 2016

Aim: To develop a non‐punitive system to maximise dispensing accuracy that incorporated an analysis of near‐miss events.Method: The Dispensing Accurately and Near Miss Program (DANMP) was implemented at the Peter MacCallum Cancer Institute (PMCI) in mid‐2000. It consists of two dispensing modules and a near‐miss reporting system. The program is non‐punitive and does not attempt to be quantitative but rather facilitates powerful reminders of system‐based limitations and reinforces the need to continually review and modify practice. The program was implemented with support from all members of staff and was reflective of a department culture focused on quality and patient care.Results: The program has been incorporated into routine orientation of staff and is a standard agenda item at pharmacy staff meetings. Even though the PMCI is a specialist oncology institute the dispensing process is generic and hence the program may be applied to other pharmacy settings.
Quality of Prescribing for Elderly Inpatients at Nine Hospitals in Victoria, Australia
Authors: Elliott Rohan A , Woodward Michael C , Oborne C Alice 
Published: March 2016

Objective: To assess the quality of prescribing for elderly inpatients at nine acute and subacute public hospitals in Victoria, Australia.Method: Prescribing was assessed cross‐sectionally by reviewing prescriptions for all inpatients aged 65 years and over on participating units on the days of audit. Patients admitted less than 24 hours prior to audit were excluded. Evidence‐based prescribing indicators were used to assess quality of prescribing using patients' medication charts and hospital medical records.Results: Prescriptions for 1416 patients (median age 81 years, 57% female) were reviewed. The median number of medications prescribed was eight (0‐22). Thirty‐four per cent of items were prescribed by trade name; 37% of medication charts did not have patients' adverse drug reaction status recorded; 15% of ‘when required’ items had no frequency or maximum dose specified; 33% of sulphonylurea hypoglycaemic prescriptions were for long‐acting agents; 36% of paracetamol prescriptions allowed doses <4 g/day to be administered; 28% of allopurinol prescriptions were for doses ≥300 mg; 80% of benzodiazepine prescriptions and 32% of neuroleptic prescriptions were considered inappropriate; 48% of metformin prescriptions were for patients with renal impairment; 35% of patients with atrial fibrillation and no contraindication to warfarin or aspirin were not prescribed either of these drugs; and 26% of patients with ischaemic heart disease and no contraindication were not prescribed aspirin.Conclusion: A range of inappropriate prescribing practices for elderly hospital inpatients were identified. These included poor documentation, over‐prescribing, inappropriate drug selection, inappropriate dose selection, and under‐prescribing. Strategies are required to improve the quality of hospital prescribing.
Prevalence and Predictors of Complementary Medicine Usage in Diabetes: Fremantle Diabetes Study
Authors: Clifford Rhonda M , Batty Kevin T , Davis Wendy , Davis Timothy ME 
Published: March 2016

Aim: To evaluate the use of complementary medicines (CMs) by diabetic patients, and to investigate whether these CMs could affect diabetes control, related comorbidities and existing therapeutic regimens.Method: Three hundred and fifty‐one diabetic patients were interviewed regarding their use of CMs. A literature search was conducted to assess the potential impact of CMs on diabetes control and related comorbidities. The subjects were a convenience sample of consecutive patients from the Fremantle Diabetes Study attending their annual review. The main outcome measures were the prevalence and range of CMs used by diabetic patients and the potential requirement for additional monitoring.Results: Eighty‐three out of 351 (23.6%) diabetic patients had consumed at least one CM in the previous year, the most common being vitamin C. These patients were of a similar age but more likely to be female (59% versus 41% males; p=0.02) compared with those not taking CMs. Glycaemic control was similar in the two groups. CM use was associated independently with female gender, Anglo‐Celt ethnicity, and keeping a home blood glucose monitoring diary. Based on a comprehensive literature search, 42% of the CMs potentially necessitated additional patient monitoring or could be considered inappropriate for diabetic patients.Conclusion: CM use is common amongst patients with diabetes, especially, female Anglo‐Celts. CMs have the potential to interfere with diabetes control or related comorbidities. Our data indicate the need for patient disclosure of CM use, adequate monitoring for CM‐related adverse events and greater consumer protection perhaps through tighter regulation of CM sources.
5‐HT3 Antagonists in the Treatment of Postoperative Nausea and Vomiting
Authors: Pham Louise , Langford Jane , Williams Kylie 
Published: March 2016

Background: Postoperative nausea and vomiting (PONV) can affect up to 30% of patients. While the use of antiemetics for prophylaxis has been extensively reported there is less evidence of their efficacy for the treatment of PONV.Aim: To review the evidence and discuss the use of 5‐hydroxytryptamine type 3 (5‐HT3) antagonists for the treatment of PONV in Australia.Method: A literature search was conducted to identify clinical studies evaluating the effects of 5‐HT3 antagonists in the treatment of PONV.Results: In four studies various doses of 5‐HT3 antagonists were compared and in five studies a single dose of 5‐HT3 antagonist was assessed against another antiemetic or placebo, or both.Conclusion: These studies indicate that 5‐HT3 antagonists are effective and safe in the treatment of PONV.
Stability and Compatibility of Alfentanil Hydrochloride and Morphine Sulfate in Polypropylene Syringes
Authors: Sharley Nicholas A , Burgess Naomi G 
Published: March 2016

Aim: To establish the chemical stability and physical compatibility of alfentanil hydrochloride and morphine sulfate in polypropylene syringes for patient controlled analgesia at the Royal Adelaide Hospital.Method: A stability indicating high pressure liquid chromatography (HPLC) method was developed and validated. Concentrations of alfentanil hydrochloride and morphine sulfate stored in polypropylene syringes were measured over a sixmonth period. Sample syringes were stored under refrigeration (2‐8°C) and at room temperature (22±1°C). Visual inspection for macro particulate matter was undertaken using an Allen viewer. Stability was defined as maintaining at least 90% of the day zero concentration. Quality control standards were assayed on each study day to determine intra‐ and inter‐day precision and accuracy.Results: Morphine sulfate content remained at 99% of initial concentration after 182 days at both storage conditions. Alfentanil hydrochloride content remained at 100% of initial concentration after 182 days at both storage conditions. No particulate matter was visible in sample syringes throughout the study period.Conclusion: Alfentanil hydrochloride and morphine sulfate in polypropylene syringes are chemically stable and physically compatible for 180 days in the concentrations studied, when protected from light and stored either under refrigeration (2‐8°C) or room temperature (22±1°C). An expiry date of six months can be applied, facilitating efficient manufacturing and clinical evaluation in the management of acute pain.
Bioequivalence: How, Why, and What Does it Really Mean?
Authors: Pearce Gregory A , McLachlan Andrew J , Ramzan Iqbal 
Published: March 2016

Aim: To review the pharmacokinetic and pharmacodynamic principles of bioequivalence testing of medicines administered orally to achieve a systemic effect. This includes methods used to estimate bioequivalence, practical implications of the expected variability in drug concentration‐time profiles from bioequivalent formulations and other sources of variability which influence drug absorption and therapeutic response.Method: The impact of sample size, pharmacokinetic variability and expected differences in relative bioavailability are examined with respect to relevant literature and using simulations. The variability in drug concentration‐time profiles following different formulations of the same active ingredient is compared to other sources of variability affecting drug delivery to its site of action.Results: The use of comparative drug concentration‐time profiles to establish the bioequivalence of two orally administered formulations is based on well‐established and thoroughly tested scientific principles. Formulations with variability in drug concentration‐time profiles greater than 10% are unlikely to satisfy the statistical standards defining bioequivalence. Inter and intra batch‐to‐batch variability in active substance content of oral formulations limits specifying dissolution rate and plasma concentration ranges defining therapeutic effect of specific drugs may exceed the limits applied to defining bioequivalence and hence may contribute to differences in patient response after administration of different medicinal products. These standards are within the scope of other sources of variability which limit the predictability of therapeutic response to blood levels for individual patients. These include acceptable levels of variability of the amount of active ingredient within and between batches, tablet dissolution rates and poorly defined therapeutic blood levels for many drugs.Conclusion: The methods used to determine bioequivalence have stood the test of time. The criteria used to assess bioequivalence mean that the differences in actual drug concentration‐time profiles obtained with a generic or originator formulation are small and certainly less variable than other factors that contribute to variability in response.
Psychosocial Pathways Linking Adverse Childhood Experiences to Mental Health in Recently Deployed Canadian Military Service Members
Authors: Lee Jennifer E.C. , Phinney Brigitte , Watkins Kimberley , Zamorski Mark A. 
Published: March 2016

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

Flexible sensors capable of detecting large strain are very useful for health monitoring and sport applications. Here a strain sensor is prepared by applying a thin layer of conducting polymer, polypyrrole (PPy), onto the fiber surface of an elastic fibrous membrane, electrospun polydimethylsiloxane (PDMS). The sensor shows a normal monotonic resistance response to strain in the range of 0–50%, but the response becomes “on‐off switching” mode when the strain is between 100 and 200%. Both response modes are reversible and can work repeatedly for many cycles. This unique sensing behavior is attributed to overstretching of the polypyrrole coating, unique fibrous structure, and elasticity of PDMS fibers. It may be useful for monitoring the states where motions are only allowed in a particular range such as joint rehabilitation.
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Resting‐state connectivity predicts levodopa‐induced dyskinesias in Parkinson's disease
Authors: Herz Damian M. , Haagensen Brian N. , Nielsen Silas H. , Madsen Kristoffer H. , Løkkegaard Annemette , Siebner Hartwig R. 
Published: March 2016

ABSTRACTBackgroundLevodopa‐induced dyskinesias are a common side effect of dopaminergic therapy in PD, but their neural correlates remain poorly understood.ObjectivesThis study examines whether dyskinesias are associated with abnormal dopaminergic modulation of resting‐state cortico‐striatal connectivity.MethodsTwelve PD patients with peak‐of‐dose dyskinesias and 12 patients without dyskinesias were withdrawn from dopaminergic medication. All patients received a single dose of fast‐acting soluble levodopa and then underwent resting‐state functional magnetic resonance imaging before any dyskinesias emerged. Levodopa‐induced modulation of cortico‐striatal resting‐state connectivity was assessed between the putamen and the following 3 cortical regions of interest: supplementary motor area, primary sensorimotor cortex, and right inferior frontal gyrus. These functional connectivity measures were entered into a linear support vector classifier to predict whether an individual patient would develop dyskinesias after levodopa intake. Linear regression analysis was applied to test which connectivity measures would predict dyskinesia severity.ResultsDopaminergic modulation of resting‐state connectivity between the putamen and primary sensorimotor cortex in the most affected hemisphere predicted whether patients would develop dyskinesias with a specificity of 100% and a sensitivity of 91% (P < .0001). Modulation of resting‐state connectivity between the supplementary motor area and putamen predicted interindividual differences in dyskinesia severity (R2 = 0.627, P = .004). Resting‐state connectivity between the right inferior frontal gyrus and putamen neither predicted dyskinesia status nor dyskinesia severity.ConclusionsThe results corroborate the notion that altered dopaminergic modulation of cortico‐striatal connectivity plays a key role in the pathophysiology of dyskinesias in PD. © 2016 International Parkinson and Movement Disorder Society
Development of Quantum Chemical Method to Calculate Half Maximal Inhibitory Concentration (IC50)
Authors: Bag Arijit , Ghorai Pradip Kr. 
Published: March 2016

AbstractTill date theoretical calculation of the half maximal inhibitory concentration (IC50 ) of a compound is based on different Quantitative Structure Activity Relationship (QSAR) models which are empirical methods. By using the Cheng‐Prusoff equation it may be possible to compute IC50, but this will be computationally very expensive as it requires explicit calculation of binding free energy of an inhibitor with respective protein or enzyme. In this article, for the first time we report an ab initio method to compute IC50 of a compound based only on the inhibitor itself where the effect of the protein is reflected through a proportionality constant. By using basic enzyme inhibition kinetics and thermodynamic relations, we derive an expression of IC50 in terms of hydrophobicity, electric dipole moment (μ) and reactivity descriptor (ω) of an inhibitor. We implement this theory to compute IC50 of 15 HIV‐1 capsid inhibitors and compared them with experimental results and available other QASR based empirical results. Calculated values using our method are in very good agreement with the experimental values compared to the values calculated using other methods.