bluuebunny/crossref_metadata_2025_split huggingface dataset:
Targeting Gentamicin Therapeutic Ranges During the First Week of Life in Infants in Neonatal Intensive Car
Authors: Yeung Melinda Y , Smyth John P 
Published: March 2016

Background: The absence of published recommendations for optimum dosing of gentamicin in premature neonates led us to develop dosing schedules for the neonatal population based on post‐conceptional age, and to audit the results periodically. Our previous study results supported the use of a gentamicin loading dose as well as higher maintenance doses at longer dose intervals. However, areas for improvement were identified.Aim: To further refine gentamicin dosing schedules to improve therapeutic range targeting during the first week of life in infants in the Neonatal Intensive Care Unit.Method: A revised gentamicin dosing schedule was formulated and instituted during an 8‐month period in 1999‐2000. All infants > 35 weeks gestation received a loading dose of 5 mg/kg with a maintenance dose of 4 mg/kg (increased from 3.5 mg/kg during a 7‐month period in 1999) every 48 hours for infants >30 weeks gestation, and every 36 hours for those 30‐34 weeks gestation. Infants <34 weeks gestation were given 4 mg/kg every 36 hours without a loading dose. Blood samples for trough concentration measurement were taken immediately before the second dose and those for peak concentration 30 minutes after the completion of the 1‐hour infusion of the second dose. As the majority of the infants received gentamicin shortly after birth, analysis was performed on the data collected during the first few days of life. The results from this dosing schedule were compared with our previous data from 1999.Results: Two hundred and eleven pairs of serum gentamicin peak and trough concentrations in 1999 and 120 pairs in 1999‐2000 were eligible for analysis. The 1999‐2000 gentamicin dosing schedule resulted in 100% of trough and 88.2% of peak concentrations falling within the targeted ranges in infants >30 weeks gestation and 79.5% of trough and 88.6% of peak concentrations falling within the respective targeted ranges in infants <37 weeks gestation. In infants 30‐34 weeks gestation there were similar results for both dosing schedules. Overall, 88.3% of serum gentamicin trough concentrations and 85.8% of peak concentrations were within the targeted ranges during the first postnatal week using the 1999‐2000 schedule.Conclusion: The results of this study suggest improved gentamicin therapeutic concentration targeting using the 1999‐2000 dosing schedule. A larger study is required to confirm the statistical significance of our findings.
A Study to Determine the Importance of Ward Pharmacists Reviewing Discharge Prescription
Authors: Whitty Jennifer A , Green Bruce , Cottrell W Neil 
Published: March 2016

Objective: To evaluate the potential impact on appropriateness of discharge medication if discharge prescriptions were reviewed by the ward pharmacist before being dispensed.Method: Over a four‐week period discharge prescriptions were reviewed by either the ward pharmacist involved in the patient's care (cases) or a dispensary pharmacist who had no knowledge of the patient's care (controls). A second review with the availability of patient records was carried out to identify additional queries that should have been raised prior to dispensing.Results: Fifty‐five prescriptions (29 case, 26 control) containing 279 items (140 case, 139 control) were reviewed. Forty‐four queries (23 case, 21 control) were found on initial checking of the prescription, 12 more queries (1 case, 11 control) were found on the second review of the prescription. There were 13 potentially clinically significant queries in the case group, 12 (92%) were made during initial prescription review. There were 23 potentially clinically significant queries in the control group, only 12 (52%) were made on initial prescription review. Changes to the prescription resulting from potentially clinically significant queries prior to dispensing occurred in 19 (79%) queries (10 case, 83%; and 9 control, 75% ). Of queries raised prior to dispensing in the control group, 18 involved contacting hospital staff for resolution where they could have been resolved using the inpatient prescription chart, notes or the patient themselves. This compared to only one in the case group.Conclusion: Review of discharge prescriptions by the ward pharmacist involved in the patient's care optimises the appropriateness of discharge medication and the efficiency of the discharge process.
Development and Use of an Independent Drug Information Centre in India
Authors: Lakshmi PK , Gayathridevi S 
Published: March 2016

The Karnataka State Pharmacy Council established its Drug Information Centre in August 1997 to disseminate unbiased drug information to healthcare professionals. In March 2000, we undertook activities to promote the services provided by the drug information centre to health professionals and to patients. This has resulted in a dramatic increase in the number of queries corning into the centre from all client groups.In 2000‐01, almost half of the enquiries (47%) came from pharmacists, 30% from doctors and 19% from patients. Queries requiring patient counselling and literature searches were most common, followed by requests for information on product availability and identification, contraindications and safety, and the drug profile. Electronic databases were the most useful drug information resource.
Early Experience with the Use of Celecoxib in a Child and Adolescent Population
Authors: Lie Henry KH , Turner Sean C 
Published: March 2016

Objective: To describe the use of celecoxib, a new selective cyclo‐oxygenase 2 (COX‐2) inhibitor, in a child and adolescent population.Method: A twelve‐month retrospective analysis of the use of celecoxib within a major paediatric teaching hospital was undertaken. Data collected for each patient included patient demographics, indication for use, length of treatment, dose administered and reported adverse effects.Results: Twelve patients received celecoxib over a 12‐month period. These patients can be divided into subgroups, including those with existing haematological disorders e.g. von Willebrand's disease with co‐existing morbidities of joint swelling and pain, and those patients who had previously reported adverse events to non‐selective non‐steroidal anti‐inflammatory drugs. Doses used in six children aged 12 years of age or less ranged from 2.4 to 6.3 mg/kg/day. The remaining patients were adolescents and were prescribed adult doses. In all patients celecoxib was well tolerated.Conclusion: Celecoxib appears to have a role in child and adolescent therapy. However, this role is not well established and it is essential that large, well‐designed studies to determine the dose, safety, efficacy and place of celecoxib in the treatment of children and adolescents be undertaken.
Improving Concordance Between Use of Proton Pump Inhibitors and Prescribing Guidelines
Authors: Mackenzie Fraser D , Pillans Peter I , Radford James M , Claes Mitchell T , Flemin Ann‐Marie 
Published: March 2016

Objective: To determine the effect of a request form, together with removal of proton pump inhibitors (PPIs) from ward stock, on concordance between use of PPIs and prescribing guidelines, and compare the results with a previous non‐interventional audit.Design: Drug utilisation review.Setting: 800‐bed metropolitan hospital.Participants: 101 patients with a completed PPI request form. Data were compared to a previous audit undertaken on 253 patients in 1999.Main outcome measures: Recorded upper gastrointestinal pathology; compliance with prescribing guidelines; PPI usage data.Results: The proportion of patients appropriately investigated increased from 72% (183/253) in 1999 to 92% (93/101, p = 0.004 ). Compliance with prescribing criteria increased from 23% (57/253) in 1999 to 43% (43/101, p = 0.003). PPI usage decreased by 30% compared with the corresponding quarter of 1999.Conclusions: The removal of PPIs from ward imprest along with the introduction of a PPI request form was associated with a significant improvement in compliance with prescribing guidelines, an increase in the proportion of patients appropriately investigated, and a reduction in PPI usage.
Smoking Cessation Program Using Nicotine Patches Linking Hospital to the Community
Authors: Vial Robyn J , Jones Terry E , Ruffin Richard E , Gilbert Andrew L 
Published: March 2016

Objective: To compare the quit rates achieved by participants in a smoking cessation program, initiated in hospital using nicotine patches and continued in either the community pharmacy or hospital setting, with quit rates in a minimal intervention group.Setting: The medical and surgical units at The Queen Elizabeth Hospital (TQEH), a major teaching hospital located in the western suburbs of Adelaide, South Australia.Participants: Inpatients aged over 18 years who smoked 10 or more cigarettes per day. Of 306 smokers screened, 102 were enrolled.Study Procedures: Participants were randomised to either the minimal intervention arm (n = 33), the hospital‐based program (n = 35), or the community pharmacy‐based program (n = 34). The minimal intervention group received written materials and advice about quitting. The two intervention arms started with a consultation with the research pharmacist and participants were commenced on nicotine patches and were followed after discharge with weekly counselling visits with either the researcher in an outpatient clinic or a community‐based pharmacist. Patches were supplied for $15.00 per week for up to 16 weeks. Exhaled carbon monoxide measurements to confirm abstinence were performed whenever possible. Continuous and point prevalence of abstinence from smoking were assessed 3, 6 and 12 months after enrolment.Results: There was a statistically significant difference in the point prevalence of abstinence between groups at 12 months with 38%, 24% and 4.6% abstinence in the hospital, community pharmacy and minimal intervention arms respectively (X2 = 7 .145, df = 2, p = 0.031 ). The differences seen in continuous abstinence at 12 months (24%, 19% and 4.6% respectively) did not reach statistical significance.Conclusion: A hospital‐based smoking cessation program initiated with nicotine patches was equally effective whether continued by hospital‐ or community‐based pharmacists and was superior to minimal intervention without nicotine patches.
Non‐Sedating Antihistamines for Premedication in Ambulatory Oncology Patients
Authors: Siderov Jim , Wendel Nan , Davis Ian D 
Published: March 2016

Background: Antihistamines are commonly used as premedication against anaphylactic events associated with paclitaxel and rituximab. Commonly, intravenous (IV) H1‐receptor antihistamines are used.Objective: To report our experience with the use of loratadine, an oral, non‐sedating H1‐receptor antihistamine, in ambulatory care patients receiving premedication for either paclitaxel or rituximab.Method: Records of all patients who received loratidine in our ambulatory oncology day treatment centre were reviewed retrospectively.Results: Seventy‐one cycles (20 paclitaxel, 51 rituximab) of therapy were administered using loratadine as premedication. One patient who commenced loratadine reverted to IV promethazine following a rash reaction to rituximab. All other patients tolerated therapy well. There were no anaphylactic or infusion‐related problems.Conclusion: Loratadine 10 mg is well tolerated in ambulatory care patients receiving premedication for either paclitaxel or rituximab and should be considered in all ambulatory patients requiring an H1‐receptor antihistamine where sedation is not appropriate.
National Survey of Australia's Community Pharmacies in 2002: Rationale and Methodology
Authors: Berbatis Con G 
Published: March 2016

Aim: To describe the rationale and methods for a national study of pharmacy practice activities performed in Australia's community pharmacies. The purpose is to produce a reference set of data on Australia's community pharmacies for subsequent national and international comparisons.Background: There is no standard reference database of Australian pharmacy practice services against which changes can be monitored or international comparisons made. The lack of national data restricts the ability of pharmacy bodies to plan, quantify and rationally develop policies.Study Design: A national survey of respondents in stratified 15% random samples of Australia's community pharmacies was undertaken. The stratification was based on categories 1 to 6 of PHARIA 2001. An advisory panel of representatives of national pharmacy bodies and experienced pharmacy researchers was formed to guide the study and monitor the results. The survey instrument was constructed to maximise response rates and minimise measurement, coverage, non‐response and sampling errors. The project was publicised in a variety of pharmacy publications early in 2002 to make pharmacists aware of the project and to encourage participation. Multiple contacts and mixed‐mode surveys by telephone, mail, facsimile and Internet will be used in the selected pharmacies to achieve a 75% response rate. Survey items have been divided into sections of 1. pharmacy and staff characteristics, 2. the types of services (e.g. general, pharmacy care, specialised activities), and 3. technical facilities used in health‐related activities. Analysis of the items in each section and the associations between them will quantify the rates of, and factors related to, the provision and distribution of pharmacy services in Australia.
The Use of ACE‐Inhibitors after Myocardial Infarction
Authors: Overland Victoria , Cottrell W Neil , Tett Susan E 
Published: March 2016

Background: There is good evidence that angiotensin‐converting enzyme (ACE)‐inhibitors are beneficial after myocardial infarction (MI). However, it is not known how widely this evidence is used in practice and whether all eligible patients receive this therapy.Aim: To assess the usage of ACE‐inhibitors in patients after MI in a large teaching hospital.Method: A one‐month prospective analysis, combined with a three‐month retrospective analysis, was conducted at the Royal Brisbane Hospital (RBH) in February‐March 2000. Patients admitted with an MI or who had been diagnosed with an MI during admission from November 1999 to March 2000 were identified from the coronary care unit (CCU) records. Inpatient medication charts and outpatient records were then reviewed. Information collected included: ACE‐inhibitor use, doses, reasons for prescribing/not prescribing ACE‐inhibitors, and ACE‐inhibitor prescribers (cardiologists or general physicians).Results: Forty‐four patients with an MI were included in the study, 28 of whom were prescribed ACE‐inhibitors (64%). Twenty‐four of the 28 patients on ACE‐inhibitors were prescribed perindopril. The major reason given for prescribing ACE‐inhibitors was signs of congestive cardiac failure. All ACE‐inhibitors initiated in patients after MI at RBH were ordered by cardiologists.Conclusion: ACE‐inhibitors were prescribed appropriately in 88% of patients who met criteria for their use. This high percentage of appropriate prescribing was encouraging. Re‐evaluation as part of an ongoing quality assurance activity could be used to ensure this is maintained.
Survival Following Severe Aluminium Phosphide Poisoning
Authors: Pajoumand Abdolkarim , Jalali Nasser , Abdollah Mohammad , Shadnia Shahin 
Published: March 2016

Aim: To describe the treatment and successful outcome of a patient who had taken an amount of aluminium phosphide that would normally be lethal.Case report: A 47‐year‐old woman was admitted two hours after ingesting 16.8 g of aluminium phosphide with suicidal intent. Treatment consisted of: gastric lavage with potassium permanganate solution; intravenous bicarbonate, magnesium and calcium; and oral bicarbonate and coconut oil. Supportive therapy in intensive care was also provided. Her clinical course included hypotension, metabolic acidosis and liver dysfunction.Discussion: Aluminium phosphide produces phosphine gas and is used to control rodents in grain storage facilities. This patient had apparently ingested what would normally be a lethal amount of aluminium phosphide and had signs and symptoms of severe toxicity. She survived following rapid treatment and supportive care. Recommended measures to limit absorption and phosphine toxicity may have contributed to survival.
Incompatibility between Calcium and Sulfate Ions in Solutions for Injection
Authors: Ambados Folios 
Published: March 2016

Objective: To investigate the potential physical compatibility of magnesium sulfate injection with calcium‐containing injections in various infusion solutions and to demonstrate that gross visual inspection alone, is often inadequate in determining the safety of an admixture.Method: Magnesium sulfate (49.3%) injection was added to various infusion solutions followed by either calcium chloride (10%) injection or calcium gluconate (10%) injection. Admixtures were examined for the presence of haze, precipitation, gas evolution or colour change. Solutions which appeared free from incompatibility after 24 hours, were further examined microscopically to verify the absence of precipitate.Results: Incompatibility between magnesium sulfate and calcium chloride injections was observed in the majority of the admixtures. Calcium gluconate injection demonstrated a lower potential to interact with magnesium sulfate injection, but still showed evidence of incompatibility in a number of the admixtures when examined microscopically.Conclusion: The combination of magnesium sulfate and calcium chloride or gluconate injections should be avoided in infusion solutions other than total parenteral nutrition (TPN). Magnesium chloride should be substituted for magnesium sulfate injection when admixture, or infusion via Y‐site with calcium‐containing injections, is required.The physical compatibility of IV solutions should not be based upon a single visual inspection performed shortly after admixture. All results obtained after inspection with the naked eye should be verified microscopically.
Preventing Falls Among Older People—Current Practice and Attitudes Among Community Pharmacists
Authors: van Beurden Eric , Barnett Lisa M , Molyneux Maxine , Eakin Elizabeth G 
Published: March 2016

Objective: Falls among older people are a major cause of injury and death in Australia. Urgent action is required if we are to stem the ‘epidemic’ increase in falls as our population ages. This paper describes current practice and attitudes of community pharmacists in Northern Rivers, New South Wales, in relation to preventing falls.Method: Community pharmacists in the Northern Rivers area of New South Wales were surveyed to determine their current activities to reduce the risk of falls in older clients and to gauge awareness of the successful 1992‐96 falls prevention program‐‘Stay on Your Feet’.Results: Response rate was 79% (53/67). Seventy‐two per cent reported that they urge ‘most’ or ‘almost all’ older clients to bring in out‐of‐date medications for disposal, 66% give them falls prevention advice at least ‘sometimes’, 57% refer at least ‘some’ older clients to allied health practitioners for assessment or treatment of falls risk, and 92% are interested in receiving more written information regarding falls prevention.Conclusion: The findings suggest that while community pharmacists are both ready and keen to play a role in future falls prevention initiatives, their current involvement varies considerably. Specific ways in which they might further help to reduce falls are: regularly checking the potential of client medications to contribute to falls, giving more verbal or written advice, promoting ‘falls safe’ products, referring older clients to allied health practitioners for assessment or treatment of falls risk, and training staff to provide falls prevention advice.
Audit of Celecoxib and Rofecoxib Use: St Vincent's Public Hospital, Darlinghurst
Authors: Slader Cassandra A , Welch Susan A 
Published: March 2016

Objectives: To review the usage of the cyclo‐oxygenase‐2 selective inhibitors (COX‐2 inhibitors)‐celecoxib and rofecoxib‐at St Vincent's Public Hospital (SVH), in relation to the existing SVH Formulary Guidelines and also ‘good clinical practice’ as defined from considerations of the literature.Method: Clinical pharmacists at SVH identified all patients receiving celecoxib or rofecoxib‐on admission, ceased at the point of admission, or commenced during admission‐over an eight‐week period (May‐June 2001). Data were collected from clinical notes and structured patient interviews.Results: Sixty‐five patients were included (29–92 years, 66% <65 years). A COX‐2 inhibitor was commenced for three patients, continued for 68% (44/65), and ceased either at the point of admission or during admission for 28% (18/65). Reasons for cessation included gastrointestinal bleed, acute renal failure, and haemorrhagic cerebrovascular accident. Change to a COX‐2 inhibitor was patient‐initiated for 21% and as aresult of side effects of previous medication for 8%. History of gastrointestinal ulceration was documented for 18% (12/65) of patients. An additional 18% (12/65) were considered at high risk of ulceration. Anti‐hypertensive medications were concomitantly prescribed in 43% of cases. Forty patients (62%) had impaired renal function (creatinine clearance >70 mL/min ). Of those patients continuing COX‐2 inhibitor therapy, 79% (37/47) were in accordance with current SVH guidelines. If precautions relating to concomitant hypertension, renal impairment and gastrointestinal safety were also considered, 46% of patients were treated in accordance with ‘good clinical practice’.Conclusion: This audit has identified that the SVH guidelines would benefit from review to encourage more appropriate use of COX‐2 inhibitors in all patient groups. In addition, we feel ongoing education of general practitioners is required, regarding the risk of COX‐2 inhibitor use in patients with hypertension and renal dysfunction.
Evaluation of Academic Detailing Within a Coordinated Care Trial
Authors: McDonald Paula K , Winkle C Ann , Askew Deborah 
Published: March 2016

Background: Academic detailing has been identified as an intervention that modifies health professionals' practice, particularly prescribing.Aim: To assess the impact of academic detailing on general practitioners' (GPs) prescribing for heart failure, and chronic pain associated with osteoarthritis, in an elderly population.Method: This was a quasi‐experimental study embedded within a coordinated care trial, with a 12‐month follow‐up. 1151120 (96%) of GPs invited to participate received academic detailing visits by experienced teaching‐hospital clinical pharmacists between July 1998 and July 1999. The pharmacological management of two conditions was addressed: heart failure in Phase 1, and chronic pain associated with osteoarthritis in Phase 2. Data from the Pharmaceutical Benefits Scheme (PBS) were analysed for changes in prescribing. The perceptions of the GP and pharmacist were also assessed.Results: Consistent with key messages, non‐steroidal anti‐inflammatory drug (NSAID) use decreased in Phase I, and in Phase 2long‐acting NSAID use decreased and low‐dose tricyclic antidepressant use increased. Inconsistent with key messages of Phase 1, angiotensin converting enzyme inhibitor prescribing for heart failure did not change. GPs and pharmacists were highly satisfied with the project.Conclusion: Academic detailing visits to GPs were partly successful in changing prescribing practices for heart failure, and pain management of osteoarthritis. Initiatives such as this may strengthen professional links between pharmacists and GPs and benefit patients through enhanced quality use of medicines.