bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypertension and Bradycardia Associated with High‐Dose Dexamethasone in a Premature Infant with Borderline Hyponatraemia
Authors: Yeung Melinda Y , Smyth John P 
Published: March 2016

Background: High‐dose dexamethasone in premature infants has been effective in improving short‐term respiratory status and reducing the time of ventilation. However, these high doses have commonly been associated with hypertension and left ventricular hypertrophy. Rare cases of bradycardia have also been reported.Case Report: We present a case of a premature female infant who developed blood pressure elevation and reduced heart rate after six doses of dexamethasone when her serum sodium concentration was 139 mmol/L. Blood pressure increased further and significant bradycardia occurred after a second course of dexamethasone (2 doses) when serum sodium concentration was 130 mmol/L. Her normal heart rate returned after ceasing dexamethasone. Subsequently she developed tachycardia.Discussion: Angiotensin II increases blood pressure and attenuates the baroreceptor response. High angiotensin II concentrations are known to be associated with low gestational age and low serum sodium. In combination these effects may lead to significant baroreceptor‐mediated bradycardia. A biphasic effect on the chronotropic response has also been seen in foetal lambs treated with dexamethasone. We postulate that lower doses of dexamethasone and maintaining a serum sodium concentration higher in the normal range may reduce the risk of hypertension and cardiac arrhythmia.
Drug‐Associated Diarrhoea and Constipation in Older People; 2. Constipation
Authors: Ratnaike Ranjit N , Milton Austin G , Nigro Olimpia 
Published: March 2016

Diarrhoea and constipation are common side effects of many drugs. In older persons, these iatrogenic consequences compound the increased prevalence of acute and chronic illness. An awareness of diarrhoea and constipation as complications of drug therapy in this age group and the use of preventative measures wherever practical may significantly improve the quality of life of the patient. It is important to understand the mechanisms whereby medications may cause diarrhoea and constipation and to periodically review drug use in the elderly.This second part of the review explains the mechanisms of drug‐induced constipation and presents examples of drugs commonly associated with this abnormality of bowel function.
Pharmacological Management of Benign Prostatic Hypertrophy and Prostate Cancer in Older Men
Authors: Moran Juli A , Street Philip R , Rogerson John W 
Published: March 2016

Benign prostatic hypertrophy (BPH) and prostate cancer are common conditions affecting older men. Treatment options for these conditions depend on the severity of symptoms, comorbidities and patient choice and include observation, medications and surgery.BPH is an important cause of lower urinary tract symptoms. Alpha‐adrenergic antagonists are useful for mild to moderate symptoms of BPH. Trans‐urethral resection of the prostate is the most effective treatment for the relief of symptoms and is the only treatment recommended for serious complications of the disease.After skin cancers, prostate cancer is the commonest malignancy in older males. Hormonal manipulation with luteinising hormone releasing hormone analogues and antiandrogens form the mainstay of treatment of metastatic prostate cancer.This article will review the use of drugs and their place in the overall management of these disorders.
Communication of Adverse Drug Reactions between the Hospital Health Care Team and General Practitioners: How Effective Is It?
Authors: Clark Leia M , Bellett Pamela K , Robinson Maxine 
Published: March 2016

Aim: To assess the communication format for adverse drug reaction (ADR) reports between the hospital and the general practitioner (GP).Method: The research group conducted a survey to evaluate the ADR reports sent from the hospital pharmacy department to the patient's GP. The survey, by questionnaire, sought to determine satisfaction with the format of the report and an indication of the usefulness of this report to the GP. Every GP who had received an ADR report in the previous 11 months was sent the questionnaire, a blank ADR report and a return envelope. A computer database was used to collate the results.Results: The survey was sent to 106 GPs; 47 replies were received, a response rate of 44%. Sixty‐eight per cent (32/47) remembered receiving the ADR report and all these GPs used the report in patient care plans. Fifty‐nine per cent (19/32) of GPs were not aware of the reported ADR from any other source. Four GPs (13%) had previously been aware of the reported ADR prior to the patient's admission to hospital although the hospital was not. Forty‐seven GPs commented on the format of the ADR report and the majority considered the format suitable and sufficiently detailed; however, 19% (6/32) felt the drug in question should be more clearly highlighted and 53% requested the report be typed.Conclusion: ADR reports from this Area Health Service are useful to GPs and well received by them. Improvement of communication of ADRs across the hospital‐community interface is required. The results of the survey will also form a platform for discussions with the Central Coast Division of GPs.
Management of Oesophageal Disease in the Elderly
Authors: Hebbard Geoffrey S , Heddle Richard , McClure Anna F 
Published: March 2016

Oesophageal disease becomes increasingly common with age and is therefore prevalent in the elderly (<70 yr). Oesophageal disease may present with symptoms related to the oesophagus‐dysphagia, odynophagia or chest pain‐and presents a number of management challenges related to the presence of comorbidities in this group. With the exception of infections and the occasional malignancy, diseases affecting the oesophagus are generally chronic, progressive and not amenable to curative therapy.Oesophageal diseases affecting the elderly may be grouped into gastrooesophageal reflux disease, motility disorders, malignancy, infection and drug‐induced oesophageal disease.This article reviews the use of drugs and their place in the overall management of these disorders.
Syndrome of Inappropriate Antidiuretic Hormone Secretion Secondary to Venlafaxine
Authors: Alderman Christopher P 
Published: March 2016

Objective: To present a case of syndrome of inappropriate antidiuretic hormone secretion secondary to treatment with venlafaxine.Clinical features: An 83‐year‐old woman developed significant hyponatraemia during treatment with venlafaxine 75 mg daily. Her serum sodium concentration declined to 125 mmol/L at the nadir. Fluid restriction failed to correct her hyponatraemia; however, a trial of demeclocycline 300 mg four times daily increased serum sodium to 138 mmol/L. Venlafaxine and demeclocycline were both subsequently discontinued and her serum sodium remained within the reference range without further intervention.Discussion: The relationship between syndrome of inappropriate antidiuretic hormone secretion and psychotropic therapy is extensively documented but most reports focus on the association between hyponatraemia and treatment with tricyclic antidepressants or selective serotonin reuptake inhibitors. This case provides additional evidence that venlafaxine may cause SIADH.
Constipation in Older People Pharmacological Management Issues
Authors: Woodward Michael C 
Published: March 2016

Constipation is a common complaint amongst older people although they are often concerned about features of constipation other than bowel action frequency. A careful assessment should be made, including a history, examination and appropriate investigations. Non‐pharmacological management often avoids the use of laxatives and includes adequate fibre, fluid and exercise.The laxatives most appropriate for older people include stimulants such as senna, bulking agents and osmotic agents such as polyethylene glycol plus electrolytes or sorbitol. Short‐term use is nearly always sufficient. Faecal impaction should be sought and managed before giving oral agents. Enemas and suppositories are usually appropriate for impaction and for excessive straining. Management of constipation with these measures will avoid long‐term use and abuse of laxatives.
Celecoxib Use and Overuse—Too Much ‘Celebration’?
Authors: Graudins Linda V , Gazarian Madlen 
Published: March 2016

Aim: To characterise indications for celecoxib use in a hospital population and to evaluate whether hospital prescribing of celecoxib was consistent with agreed hospital guidelines.Method: Data were collected for patients dispensed celecoxib over a 7‐week period (August to October 2000) at a large metropolitan teaching hospital. Clinical pharmacists used a standardised data collection form to collect prescribing information.Results: Of the 70 patients available for review, 50% had been prescribed celecoxib by their general practitioner prior to admission. All of these patients were prescribed celecoxib for rheumatoid arthritis, osteoarthritis or chronic pain conditions. Of the 35 patients prescribed celecoxib by hospital prescribers, only eight (23%) were considered to have an appropriate indication, as defined by existing hospital Pharmacy and Therapeutics Committee (PTC) guidelines. The largest category of inappropriate use in hospital was for acute pain (40%). A substantial proportion of patients (43%) were prescribed celecoxib as ‘first line’ rather than ‘second line’ therapy. Documentation of reasons for celecoxib use was poor in the majority of cases.Conclusion: This drug usage evaluation has identified substantial inappropriate use of celecoxib in hospital patients, suggesting limited awareness or acceptance of PTC guidelines by hospital prescribers. The inappropriate prescribing of cyclooxygenase‐2 specific inhibitors has both economic and safety implications and requires further intervention and evaluation.
Hospital Pharmacists Fail to Record Their Research in the Quality Use of Medicines Mapping Project
Authors: Dooley Michael J , Lu Phuong L 
Published: March 2016

Aim: To quantify the number of projects with a quality use of medicines (QUM) focus that were presented at the Society of Hospital Pharmacists of Australia 1999 Federal and 2000 Biennial Clinical conferences that have been entered in the Quality Use of Medicines Mapping Project (QUMmap).Methods: Published abstracts of contributed papers and posters were examined. Abstracts that had a major focus on improving or supporting QUM in Australia were considered suitable to have been entered in the database. The QUMmap was searched to determine if the projects had been contributed to the database.Results: 258 presentations were reviewed from both meetings; 226 (88%) were classified as suitable for inclusion and, of these, 9 (4.0%) were identified in the database.Conclusion: Only 4% of projects with a QUM focus presented at two major hospital pharmacy conferences had been entered in the QUMmap. Strategies need to be implemented to improve the rate of contributions. Individuals utilising the QUMmap could conclude that hospital pharmacists have a limited role in these activities and this could result in the omission of pharmacy as an important player in research and QUM activities.
Extemporaneous Prescribing: Whatever Happened to It? A Survey of Australian General Practitioners
Authors: Pappas Arthur , MacPherson Ross , Stewart Kay 
Published: March 2016

Objectives: Recent Australian and New Zealand studies have shown that dispensing of extemporaneous products by pharmacists has declined over recent years to only 1 to 2% of total prescriptions. The purpose of this study was to survey general practitioners (GPs) to identify the scope of extemporaneous prescribing, reasons for any limitations to such prescribing and their interest in further education.Method: A mail survey comprising eighteen questions was distributed by eleven Divisions of General Practice from five Australian States to 1138 GPs.Results: 318 replies were received which equated to aresponse rate of 28%. 52% of respondents were male with 87% from inner city/suburban practices. The primary source of instruction in extemporaneous prescribing was either experience (48%) or medical school (25%), and the majority (68%) either never or rarely prescribed extemporaneous preparations. The main reasons given were lack of product knowledge (78%) and items not being listed on the Pharmaceutical Benefits Scheme (29% ). When extemporaneous products were prescribed, the most common were topical (31% often or very often) and eye/ear/nose (16% often or very often). Despite the overall low level of extemporaneous prescribing, there was considerable interest (94% overall) in accessing information on these products with at least two‐thirds of respondents considering that the Internet would be a useful or very useful medium for accessing appropriate information.Conclusion: Although extemporaneous products are no longer commonly prescribed, the majority of GPs surveyed do not see these products as ‘a thing of the past’, and expressed a desire to learn more. There may be an opportunity for the medical and pharmaceutical professions to collaborate in maintaining this traditional area of practice.
Pharmacokinetics of Nasal Fentanyl
Authors: Lim Stephen (CB) , Paech Michael J , Sunderland V Bruce , Roberts Malcolm J , Banks Samantha L , Rucklidge Matthew WM 
Published: March 2016

Objective: To investigate the pharmacokinetics of intranasal fentanyl in adult post‐operative female patients.Method: Patients received both intravenous and intranasal fentanyl (approximately 50 µg) in a randomised cross‐over study.Results: Pharmacokinetic data sets from 19 patients showed intranasal fentanyl produced plasma levels within the therapeutic range within two minutes, with median bioavailability values of 55 % (pH 6 formulation) and 71% (pH 8 formulation) . Mean peak serum concentrations were 0.33 ng/mL (pH 6) and 0.37 ng/mL (pH 8) respectively, compared with 2.33 ng/mL after intravenous fentanyl.Conclusion: We conclude that the absorption of intranasal fentanyl is rapid, the bioavailability more than half that of intravenous administration and that the formulations studied are suitable for more extensive clinical evaluation.
Developing Key Competencies for a Clinical Pharmacy Education and Peer Review Program
Authors: Clifford Rhonda M , Plumridge Richard J 
Published: March 2016

Objectives: To describe a model for the development of a competency‐based clinical pharmacy training program using educational principles and practice change strategies.Method: The program development was guided by educational literature and advice from an educationalist and a staff development consultant. Clinical pharmacy competencies were identified in a series of consultant‐led staff forums. Performance indicators and evidence guides were established to measure attainment of each competency. Staff values were also identified and a practice change strategy devised. Instructional methods were devised which optimised progression to competent practice: reading, lectures, interactive tutorials, guided discussion, case presentations, case‐based training, simulation/role play and practice‐based learning. These were supported by interactive training through mentoring, individualised practice‐based learning using direct instruction, modelling (problem clarification), coaching (practice in problem solving), and facilitating (self evaluation).Conclusion: This model provides a sound approach to clinical pharmacy education as it is based on an accepted definition of competency and uses values established by staff combined with recognised educational principles and practice change strategies.
Assessment of Drug‐Related Problems and Clinical Pharmacists' Interventions in an Indian Teaching Hospital
Authors: Parthasarathi Gurumurthy , Ramesh Madhan , Kumar Jakka Krishna , Madaki Shivakumar 
Published: March 2016

Aim: To identify drug‐related problems (DRPs) at a major Indian teaching hospital, to assess the acceptance of recommendations made by clinical pharmacists and evaluate the level of involvement of pharmacists in drug therapy decisions.Method: A prospective study was conducted over a six‐month period in the medical wards of the Jagadguru Shri Shivarathreeshwara (JSS) Medical College Hospital, Mysore, India. A decision‐making model proposed by Campagna (and modified by Wood) was applied to evaluate pharmacists' involvement in drug therapy decisions.Results: Of the 245 DRPs identified, 237 involved active clinical pharmacist interventions. The most common DRPs were inappropriate dosage (31%), inappropriate drug selection (17%) and adverse drug reactions (13%). Ninety per cent of the pharmacists' recommendations were accepted and led to change in therapy in 79% of cases. Most of the interventions were classified (according to the decision‐making model) as corrective (78%) or proactive (19%).Conclusion: The incidence of DRPs identified in this study is higher than reported in some studies in developed countries. But the acceptance rate of clinical pharmacists' interventions was comparable to studies conducted in countries where clinical pharmacy is well‐developed and indicate the acceptance and recognition of clinical pharmacists as active members of the healthcare team at JSS Medical College Hospital.
Introducing a Multidisciplinary Medication Safety Program in a Major Hospital
Authors: Van de Vreede Melita A , Kenneally Anne L , Lubliner Mark 
Published: March 2016

Aim: To describe the introduction of a medication safety program in a major hospital.Method: Medication safety was identified as an organisational priority and a multidisciplinary Drug Management Committee convened to promote medication safety and reduce the potential for error. Methods included analysis of medication‐related incident reports and implementation of educational strategies and new processes.Outcomes: The following safety initiatives have been successfully implemented and sustained: warfarin prescribing and administration time was altered to avoid prescribing by after hours hospital medical officers; the use of potassium chloride ampoules has been reduced by introducing premixed potassium chloride infusion packs and will be further reduced by the introduction of 10mmol in 100mL premixed packs for fluid‐restricted patients. Other changes include medication imprest review and rationalisation, the introduction of a safe prescribing program for interns, and standardising protocols for drug infusions.Conclusion: The program has been successful because of strong executive support, an enthusiastic multidisciplinary team, application of quality improvement methods and extensive staff consultation and education.
Cell‐Based Therapies—A Role for Pharmacy Technicians
Authors: Burnett Donna , Dooley Michael J , Wall Dominic 
Published: March 2016

Aim: To develop pharmacy technician involvement in the manufacture of cell‐based therapies for the treatment of cancer.Method: A tripartite collaboration between the Centre for Blood Cell Therapies (CBCT), pharmacy department (Peter MacCallum Cancer Centre) and clinical trial sponsor was formalised. The skills required by pharmacy technicians as well as areas for specific background training were identified and didactic education sessions prepared. Plans were prepared for certified training at the clinical trial sponsor's manufacturing facility in Paris, France.Results: Two pharmacy technicians with extensive aseptic chemotherapy experience commenced the education program in January 2001 with initial didactic education in a range of areas. In February 2001, the selected pharmacy technicians and the senior scientist of the cell manipulation laboratory travelled to Paris, France for formal certified training and validation with the trial sponsor. The technicians successfully completed the training and validation process and are now qualified cell processing technologists. A final validation of the facilities and personnel was completed in July 2001 by the trial sponsor. Additional technicians have now been trained and the current involvement of pharmacy technicians in the CBCT is approximately 40 hours per week. In addition, a review of the remuneration for pharmacy technicians was undertaken and a six‐tier pay structure implemented.Conclusion: Pharmacy technicians can be readily trained to manufacture cell‐based therapies. This project has highlighted that pharmacy technicians have the experience, expertise and capacity to expand their roles within healthcare delivery.
Deprescribing: Achieving Better Health Outcomes for Older People through Reducing Medications
Authors: Woodward Michael C 
Published: March 2016

Older people are prescribed a disproportionate number of medications. Polypharmacy leads to reduced compliance, increases the risk of adverse drug effects and may lead to poor medication outcomes. There is considerable evidence of inappropriate as well as excessive prescribing for older people. Although there are risks, medication outcomes can be improved through deprescribing.The principles of deprescribing include reviewing all current medications, identifying medications to be ceased, substituted or reduced, planning a deprescribing regimen in partnership with the patient and frequently reviewing and supporting the patient. Medications to be used with caution will be discussed and practical deprescribing advice offered in this review.A clear understanding of the purpose and risk of medication by the prescribing team and the patient, and a considered deprescribing plan, can improve health outcomes in older people.
In‐Home Medication Reviews for War Veterans: Early Experience in Australia
Authors: Sorensen Lene , King Michelle A , Peck Robert , Roberts Michael S 
Published: March 2016

Objective: To evaluate the initial impact of in‐home medication reviews for war veterans by accredited pharmacists.Method: Medication use, health service use, and corresponding costs for 92 veterans and war widow(er)s were compared between a ‘before intervention’ period and ‘after intervention’ period via prescription database analysis. Inappropriate medication use according to Beers' criteria was also identified.Results: The intervention led to a higher number of medications initiated and ceased than medications continued. There was a statistically insignificant increase in the number of medications (12.6 to 13.9), and the mean health service cost ($1818.66 to $2123.26). There was an insignificant increase in the use of inappropriate medication according to Beers' criteria.Conclusion: This medication review service introduced the concept of medication reviews to the Australian domiciliary setting. In‐home medication reviews are now widely available to any Australian at risk of medication misadventure.