bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Pharmacy in a South Indian Government Maternity Hospital
Authors: Kumari Rajesh , Kethini Thejaswarup 
Published: March 2016

Aim: To initiate clinical pharmacy services including drug information in an Indian government maternity hospital, and to measure the activity provided.Method: Clinical pharmacy services were initiated and drug information was provided to doctors on request over eight months in a government maternity and childcare hospital. Services were provided to all pregnant women with co‐morbid diseases such as pre‐eclampsia and pregnancy‐induced hypertension.Results: During the study period, 137 recommendations were made and 38 drug information queries answered. Drug information relating to: indications, pharmacokinetics and pharmacodynamics, adverse drug reactions, and drug interactions was provided for 2.6%, 26.4%, 28.9% and 15.7% of queries respectively. Our recommendations to amend drug treatment were accepted in 88.9% of cases.Conclusion: Clinical pharmacy, including a drug information service, is well appreciated by physicians. Regular drug therapy monitoring and timely interventions are necessary to promote better maternal, foetal and neonatal health care.
Perceived Barriers by Hospital Pharmacists to Become Accredited to Perform Medication Reviews in the Home
Authors: Bennett Alexandra (Sasha) , Slader Cassandra A 
Published: March 2016

Objectives: To gauge hospital pharmacists preparedness to become accredited to perform medication reviews, with a view to implementing a sustainable and innovative model of practice of hospital pharmacist‐led medication review for discharged patients and outpatients.Method: Clinical pharmacists at St Vincent's Public Hospital, Darlinghurst, were requested to complete a semi‐structured questionnaire. The questionnaire asked pharmacists about their understanding of the medication review process, whether it was relevant to their current and future practice and their perceived barriers to accreditation. Pharmacists were also asked to rate their level of skill and/or confidence with a number of processes utilised in the medication review on a 5‐point Likert scale.Results: Questionnaires were completed by sixteen pharmacists. Only one pharmacist was accredited, but was not currently performing medication reviews. Becoming accredited to perform medication reviews had been considered by eleven of the fifteen non‐accredited pharmacists. The barriers to accreditation cited included ‘lack of time’ and ‘affordability of accreditation courses’. Fifteen pharmacists noted that the medication review process was relevant to their current practice. The majority of pharmacists rated their proficiency and/or confidence with skills required to conduct medication reviews highly.Conclusion: Most of the pharmacists surveyed noted that they had the necessary skills required to conduct medication reviews. Perceived barriers to accreditation were identified. The needs assessment is the first stage in a broader program to develop a sustainable, innovative and rewarding model of hospital pharmacist‐led medication review in the home.
Design and Pilot of a Medication Review Clinic in a Dialysis Centre
Authors: Mirkov Sanja R , Ball Patrick A 
Published: March 2016

Objectives: The aim of this pilot study was to establish a Medication Review Clinic and undertake a preliminary evaluation of the benefits of providing this service to dialysis patients.Method: The Medication Review Clinic was piloted at the In‐Centre Dialysis Unit at Middlemore Hospital, Auckland, New Zealand, from April to October 2002. A clinical pharmacist conducted the medication reviews, identified drug‐related problems, provided medication education to the patients, updated medication profiles and liaised with primary care providers. A patient satisfaction survey was performed at the end of the study.Results: Ninety‐one medication reviews were conducted for 51 patients. Drug‐related problems were identified in 83% of the reviews. One hundred and thirty‐one drug‐related problems were identified by the pharmacist and accepted by the physician. Discrepancies were found between the medications that patients were taking and medications recorded in the In‐Centre Dialysis Unit and 53 adjustments of the medication records were made. The patient satisfaction survey showed that 89% of patients found the information provided by the pharmacist ‘useful’ or ‘very useful’ and 81% expressed a desire to talk to the pharmacist about their medications in future.Conclusion: The Medication Review Clinic provided regular, structured medication reviews. Actual and potential drugrelated problems were identified and clear and consistent information was provided to both patients and health professionals. According to the patient satisfaction survey, the Medication Review Clinic increased patient awareness of preventable drug‐related morbidity and helped improve the standards of medication use in dialysis patients (this will need to be confirmed). Future research will investigate the effect on the patient's quality of life and the number of drugrelated hospital admissions.
Pharmaceutical Care: Impact on Asthma Medication Use
Authors: Simpson Maree D , Burton Deborah L , Burton Mark A , Gissing Peter M , Bowman Scott L 
Published: March 2016

Background: Asthma has been recognised as a poorly managed disease state in Australia. Rural areas have been identified as being under‐serviced by health professionals. Pharmacists in rural areas are in a prime position to be involved in the provision of multidisciplinary asthma care.Aim: This study investigated the impact of spirometry screening on asthma management by pharmacists in rural areas.Method: A two‐group (intervention: n = 141, control: n = 46) multicentre study design was utilised. The control group was provided with a standard medication review while the intervention group received spirometry testing and a medication review. The study protocol required pharmacists to refer participants to a doctor if required, based on spirometry or medication review results. The researchers assessed asthma severity and adequacy of asthma medication.Results: Spirometry as an intervention attracted participants to the study pharmacies and provided an opportunity for pharmacists to screen and refer a group who may otherwise be overlooked. Medication review identified suboptimal therapy, potentially contraindicated drug combinations and adverse drug reactions.Conclusion: Spirometry adds benefit to the provision of pharmaceutical care for people with asthma. This may have additional significance in rural areas where access to other health services is limited.
Evaluation of Mycophenolate for Unregistered Indications
Authors: Sabet Parastoo , Maxwell David J , Brien Jo‐anne E 
Published: March 2016

Aim: To describe the use of mycophenolate mofetil for unregistered indications at St Vincent's Hospital, Sydney and to assess the financial impact.Method: A retrospective drug use evaluation was conducted over a 26‐month period. Adult patients prescribed mycophenolate mofetil for unregistered indications were identified through the pharmacy department's dispensing software, records of individual patient use approvals and patients' medical records.Results: 28 patients were available for analysis. The most frequent indications were systemic lupus erythematosus (43%) and vasculitis (18%). Other indications were Beh§et's disease, Wegener's granulomatosis, polymyositis, eczema, rheumatoid arthritis, connective tissue disorders and Sjogren's syndrome. During this period, 5.7% of mycophenolate mofetil acquisition costs were associated with unregistered indications.Conclusion: The use of mycophenolate mofetil for unregistered indications at St Vincent's Hospital was consistent with published experience.
Pulmonary and Hepatic Toxicity Due to Nitrofurantoin
Authors: Mackenzie Fraser D , Storie W John 
Published: March 2016

Aim: To present a case of combined pulmonary and hepatic toxicity due to nitrofurantoin.Clinical features: A 79‐year‐old female developed painless jaundice and exertional dyspnoea over an 8‐week period. A chest X‐ray and computerised tomography chest scan revealed interstitial lung disease with respiratory function tests showing a markedly reduced diffusing lung capacity for carbon monoxide (6.72 mL/min/mmHg). Liver function tests were markedly elevated, consistent with acute hepatitis, but returned to normal following cessation of the drug.Discussion: Combined hepatic and pulmonary toxicity due to nitrofurantoin is rare.1‐3 The mechanism for pulmonary toxicity is thought to be secondary to the generation of oxygen free radicals in combination with immune‐mediated injury. An immune mechanism is similarly thought to cause the hepatic toxicity.1
Evaluation of Therapeutic Drug Monitoring Services and Comparison of Two Models of Service Provision
Authors: Cocks Hillary J , Kevans Prue , Graham Robert , Brien Jo-anne E 
Published: March 2016

Objective: To investigate the impact of two therapeutic drug monitoring (TDM) service models at an acute‐care hospital.Design: Data were initially collected on the existing model at the hospital. This involved a clinical pharmacology registrar and a specialist pharmacist (TDM team) conducting daily TDM rounds. After a transition period, pharmacists conducted the TDM reviews. The two models were then compared for: the number and types of drug concentrations reviewed, and recommendations made; the method of communicating and documenting recommendations; acceptance rates; and the time required to provide the service. Staff satisfaction was gauged by an anonymous semi‐structured questionnaire completed by the pharmacists.Results: 172 recommendations were made by the TDM team and 146 by the pharmacists. Verbal recommendations were more frequently made by the pharmacists than by the TDM team (p < 0.05). Acceptance rates by physicians were significantly higher (p < 0.01) when pharmacists made recommendations. The pharmacists indicated that reviewing patients' drug concentrations was feasible and beneficial.Conclusion: This study has influenced the structure of clinical pharmacy and pharmacology services at the hospital and provided a basis for expansion of the TDM services.
Omitted Medication Doses: Frequency and Severity
Authors: Lawler Christopher , Welch Susan A , Brien Jo‐anne E 
Published: March 2016

Aims: To determine the number of omitted medication doses for hospital inpatients, identify the reasons and assess their severity.Method: The study involved intensive drug chart surveillance over a period of 5 days in two wards that included a wide range of medical and surgical specialties of a metropolitan teaching hospital. Inpatients receiving regular or once‐only medication for at least 5 days were monitored. A multidisciplinary committee assessed the severity of the omitted doses on a visual analogue scale of 0 to 10, where 0 is no potential harm to the patient and 10 is the potential for death.Results: Drug charts for 67 inpatients were audited. A total of 4887 doses were prescribed of which 369 (7 .6%) were recorded as dose omissions. In 273 of the 369 (74%) omitted doses, there were documented reasons for omission. 120 of the 369 doses omitted were scored for severity, with 86% (103/120) of these considered to have placed the patients at some risk of harm. No omitted doses were rated above 7 in severity.Conclusion: This study identified a substantial number of doses omitted, and a significant proportion of these were for no clear reason. The majority of the omitted doses were considered to have a potentially negative effect on the patient. Greater awareness of the extent of this problem has facilitated a collaborative effort, led by pharmacists, to improve the medication administration system.
Stakeholder Opinions on the Implementation of Drug and Therapeutics Committee Decisions
Authors: Tan Ee Lyn , Day Richard O , Brien Jo‐anne E 
Published: March 2016

Aim: To identify stakeholder recollections of intervention strategies used to implement Drug and Therapeutics Committee decisions and explore stakeholder opinions of the applicability of intervention strategies in an organisational setting.Method: A sample of stakeholders was invited to participate in focus group discussions. Discussions were audiotaped, transcribed verbatim and thematically analysed.Results: Themes arising from the focus groups included: face‐to‐face intervention strategies are more effective; published/printed materials had little effect; strategies need to be delivered at the point of care to be effective; implementation of decisions needs to be timely; and tailored strategies are more effective.Conclusion: These results could guide future implementation strategies for Drug and Therapeutics Committee decisions.
Tranquilliser Use in Elderly Psychiatric Patients
Authors: Ng Kwong H , Alderman Christopher P 
Published: March 2016

Aim: To examine characteristics of tranquilliser use in a small cohort of elderly psychiatric patients, and to analyse clinical correlates associated with tranquilliser dependence.Method: A structured interview was used to obtain medical and psychiatric history, medication usage data, and basic health service utilisation data. Anxiety symptoms were assessed using the Hamilton Anxiety Rating Scale, and tranquilliser dependence was evaluated using a separate validated questionnaire.Results: 29 patients with a mean age of 73.2 ± 7.3 years completed the study. Benzodiazepines were the most frequently encountered tranquillisers (n = 24, 82.8%), and temazepam was the most commonly used drug (n = 14). The mean weekly benzodiazepine usage expressed in diazepam equivalents was 74.0 ± 37.3 mg. 27 subjects (93.1 %) were found to have a clinically significant anxiety syndrome, with a mean Hamilton Anxiety Rating Scale score of31.8 ± 11.5. Of particular concern was the apparent high prevalence of tranquilliser dependence (n = 17, 58.6%). Current alcohol consumption was shown to be associated with tranquilliser dependence (p = 0.028), and the use of tranquillisers for more than 6 months was found to be associated with a significantly higher benzodiazepine dependence score (p = 0.008) and more extensive hospitalisation in the preceding 5 years (p = 0.028).Conclusion: This study provided some insight into the characteristics of tranquilliser use in a small sample of elderly Australians. Further studies are required to confirm these findings and provide direction for subsequent interventions.
Optimising the Medication Management Continuum in a Private Hospital
Authors: Leach Helen J 
Published: March 2016

Aim: To audit the discharge process in a private hospital setting with a focus on clarity of discharge instructions.Method: A form was developed to collect data relating to the discharge process. The pharmacists for the neurology, surgical and cardiology wards at The Melbourne Private Hospital collected data over a 2‐week period during December 2003.Results: Data relating to 270 patients discharged were collected. These data showed that discharge instructions were indicated on the drug chart in 52 (19%) cases. Discharge instructions were documented in the patient's case notes in 14 (5%) cases. Discharge prescriptions were written for submission to the Health Insurance Commission (as applicable), in 108 (40%) cases. Prescribers were contacted to clarify discharge instructions in 32 (12%) discharge episodes. Discharge medication requirements were established in consultation with the patient in 59 (22%) discharge episodes.Conclusion: The private hospital setting provides a number of challenges in obtaining complete and accurate information on discharge medication requirements. The pharmacist plays an important role in identifying the patient's discharge medication requirements and optimising the utilisation of the Pharmaceutical Benefits Scheme.
Community‐Acquired Pneumonia
Authors: Maxwell David J , Easton Kylie L 
Published: March 2016

Background: The National Prescribing Service is funding a project to improve patient outcomes through implementation of national guidelines for management of community‐acquired pneumonia (CAP). There is evidence that knowledge of and adherence to the CAP guidelines in the Therapeutic Guidelines: Antibiotic in Australian hospitals is suboptimal. These guidelines incorporate a pneumonia severity index (PSI) and all antibiotic recommendations are based on the PSI score.Aim: To provide a literature‐based overview of the current evidence and opinion regarding the management of CAP and the recommendations of the Therapeutic Guidelines: Antibiotic.Method: The literature review was conducted using Medline (1966‐present) and Embase (1980‐present) databases.Results: A range of CAP severity assessment tools, including the PSI, were identified. There were also a number of international CAP guidelines with different recommendations for treatment.Conclusion: Evidence and opinion supports the guidelines in the Therapeutic Guidelines: Antibiotic relating to the severity assessment tool and antibiotic choice. Judicious use of antibiotics for CAP is required to reduce bacterial resistance in hospitals and the community.
Processes for the Assessment and Introduction of New Medicines in New Zealand Hospitals
Authors: Tordoff June M , Norris Pauline T , Kennedy Julia M , Reith David M 
Published: March 2016

Aim: To determine the processes used for the assessment and introduction of new medicines in New Zealand public hospitals.Method: In July 2002, a questionnaire‐based, cross‐sectional survey was undertaken of the processes used to assess and introduce new medicines in all 30 public hospitals in New Zealand employing one or more pharmacists.Results: 29 hospitals (97%) responded. 22 hospitals (76%) used formal processes for the introduction of new medicines and 7 (24%) used informal processes. Formal processes were used more frequently by tertiary and secondary hospitals. 24/29 hospitals reported 261 applications for new medicines (median 6.5, range 1 to 66)—58% approved with restrictions, 22% with no restrictions, 10% rejected and 10% pending. Most decisions (79%) were made in 1 to 3 months. 27 hospitals (93%) had Medicine and Therapeutics Committees and 80% of decisions had input from the committee. Clinicians provided data on acquisition cost more frequently than on cost‐effectiveness. Provision of economic data appeared low, particularly for ‘cost per life year gained’ and ‘cost per quality adjusted life year’.Conclusion: The majority of hospitals used a formal process to introduce new medicines. Data on efficacy, safety and acquisition cost were considered important in decision making; the use of pharmacoeconomic data was limited.J Pharm Pract Res 2004; 34: 267–71.
Phenytoin Infusion Revisited: Stability and Administration
Authors: Milne Dianne J , Foo Josephine , Sharley Nicholas A , Milne Robert W 
Published: March 2016

Background Manufacturers of phenytoin injection recommend that it be given without dilution by direct IV injection. Direct IV injection presents well‐recognised side effects which can be minimised by giving phenytoin as an infusion.Aim: To assess the stability of Phenytoin Injection (DBL) in sodium chloride 0.9% prepared for infusion in Viaflex bags and a Buretrol extension set.Method: Admixtures containing 3, 6 and 10 mg/mL of phenytoin were prepared in sodium chloride 0.9% and stored in Viaflex bags, extension sets and beakers exposed to air (controls) for 6 hours. The concentration of phenytoin in the Viaflex bags was measured by UV absorption spectrophotometry. All the admixtures were inspected for microscopic particulate matter and the pH measured at intervals over 6 hours.Results: In the Viaflex bags there were no changes in the phenytoin concentration, minimal change in pH(< 0.1) and no particulate matter over 6 hours. In the extension sets and beakers, particulate matter was minimal at 2 hours and extensive beyond this time. There was an overall decrease of 0.30 and 0.32 pH units in samples from the extension sets and beakers.Conclusion: Phenytoin Injection (DBL) can be given as an IV infusion in sodium chloride 0.9% provided it is prepared in a Viaflex bag and infused within 2 hours of preparation.J Pharm Pract Res 2004; 34: 272–5.
Dissolution of Extemporaneous Paracetamol Capsules
Authors: Mukhtar Sadaf , Olsen Warren A , McLachlan Andrew J 
Published: March 2016

Aim: To investigate the dissolution characteristics of extemporaneously prepared capsules containing hypromellose and paracetamol tablets.Method: Capsules of varying sizes containing paracetamol (powdered tablets) with varying amounts of hypromellose (4–20% w/w) were extemporaneously prepared. Dissolution was investigated using a USP dissolution testing apparatus. Paracetamol dissolution was quantitated using UV absorption spectrophotometry. The impact of hypromellose content, tablet excipients, capsule size, content weight and mixing methods were investigated.Results: Over a 4‐hour period, paracetamol dissolution decreased with increasing hypromellose content. Paracetamol dissolution was 100% from capsules containing 4% hypromellose and 52 ± 3% from capsules containing 20% hypromellose. Reformulated tablets with different formulations resulted in different dissolution rates. The dissolution rate was faster from small capsules and slower from capsules with a lower content weight. The method used to mix the powders also had a significant effect on the dissolution rate.Conclusion: Modified‐release delivery systems can be extemporaneously prepared from reformulated tablets using hypromellose. Hypromellose content, tablet excipients, capsule size, content weight and mixing methods have an impact on the dissolution rate.J Pharm Pract Res 2004; 34: 276–81.
New Zealand Pharmacists and Pharmacist‐Only Medicines
Authors: Norris Pauline T 
Published: March 2016

Background: In New Zealand pharmacist‐only medicines are available over‐the‐counter and must be sold by pharmacists. This gives pharmacists an opportunity to counsel consumers and ensure that the medicine is appropriate.Aim: To assess New Zealand community pharmacists’ views about the requirements for the sale of pharmacist‐only medicines.Method: A questionnaire was sent to all community pharmacies in New Zealand. Responses to an open‐ended question about the requirements for the sale of pharmacist‐only medicines were analysed thematically.Results: Pharmacists largely agreed that it was appropriate to counsel consumers purchasing pharmacist‐only medicines. They identified a range of barriers: consumer attitudes and expectations; advertising; other pharmacists’ practice; practicalities of retail pharmacy; gender issues; and remuneration.Conclusion: There appeared to be a high level of support among pharmacists for professional involvement in the sale of pharmacist‐only medicines.J Pharm Pract Res 2004; 34: 282–4.
Public Health—Recognising the Role of Australian Pharmacists
Authors: Jackson John K , Sweidan Michelle , Spinks Jean M , Snell Beverley , Duncan Gregory J 
Published: March 2016

This article describes the philosophy of public health as it relates to the work of pharmacists. Individual patient care provided by pharmacists when supplying medicines is placed within a public health framework and existing public health roles performed by pharmacists are presented. Newly emerging public health roles and public health opportunities for pharmacists in developing countries are outlined. Education relevant to the practice of public health is discussed both as a component of pharmacy training and as a specific field of postgraduate education that pharmacists may pursue.J Pharm Pract Res 2004; 34: 290–2.