bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initial Experience with a Paediatric Pharmacy E‐Mail Network
Authors: Kunac Desiree L , Thrner Sean 
Published: March 2016

Background: The unique characteristics associated with paediatric pharmacy practice led to the launch of an e‐mail network in January 1999. It aimed to facilitate communication and timely exchange of information between pharmacists on paediatric‐related issues.Aim: To outline the utility and assess the activity of the e‐mail network over the first 18 months of operation and to determine the future direction of the group.Method: A retrospective review of electronic activities was performed to assess the activity of the e‐mail list for the first 18 months of operation. User satisfaction was determined by an e‐mail survey of all subscribers and the future direction of the network drawn from analysis of this information.Results: For the first six months the network consisted of 15 New Zealand (NZ) based pharmacists, with 23 new enquiries and 60 replies circulated. After 18 months, 65 practitioners subscribed with representatives from NZ (22), Australia (42) and England (1). A corresponding increase in activity was noted over the 12‐ to 18‐month period with 80 new enquiries and 170 associated replies. Of the 148 new enquiries over the 18‐month period, the most frequently raised topics related to dosage and administration (27%), formulation (19%), useful resources and information (15%) and availability and supply of medicines (14%). Nearly 60% related to off‐label or unlicensed use of medicines. The majority of respondents to the user satisfaction survey indicated that they found the network convenient, useful and valuable. To ensure rapid communication with archiving of messages, use of a mailing list named ‘Paedpharm’ has been established. Future developments being considered are inclusion of individual members overseas and links with other established paediatric groups.Conclusion: The paediatric pharmacy e‐mail network has grown into a convenient, valuable and useful tool for informal exchange of information with paediatric colleagues.
A Survey of Long‐Term Antiarrhythmic Therapy in Elderly Patients with Atrial Fibrillation
Authors: Bajorek Beata V , Krass Ines , Ogle Susan J , Duguid Margaret J , Shenfield Gillian M 
Published: March 2016

Aim: To investigate the use of long‐term antiarrhythmic (rhythm‐control [RHY] and rate‐control [RAC]) therapy for the management of atrial fibrillation (AF) in elderly patients.Method: Data were collected retrospectively from the medical records of 255 patients with AF who were ≥65 years of age and were admitted to Royal North Shore Hospital in the period 1 July 1996 to 30 June 1997.Results: Overall, 192 (75%) patients were discharged on antiarrhythmic therapy for the long‐term management of AF. Sixty‐six patients (26%) received RHY only, 90 (35%) received RAC only, 36 (14%) were prescribed the combination of RHY + RAC therapy, and 63 (25%) received no therapy. Patients ≥80 years of age were equally likely to receive longterm antiarrhythmic therapy as those >80 years (74% versus 77%, p = 0.65), but a significantly lower proportion of them received RHY only than in those >80 years (17% versus 34%, p = 0.001). The preferred option in older patients was RAC only (42% ). Cardiology patients were more likely to receive RHY ± RAC therapy (53%) than Aged Care (16%) or General Medicine patients (16%; p > 0.05). Logistic regression analysis indicated that old age and medical specialty were significant predictors for the choice of agent: patients ≥80 years were 2.2 times more likely to receive RAC only in preference to RHY only therapy than their younger counterparts (p = 0.044).Conclusion: Long‐term rhythm‐control therapy (e.g. amiodarone, sotalol) is potentially underutilised in AF patients ≥80 years of age. Reliance on the use of rate‐controlling agents such as digoxin persists in clinical practice.
Are E‐codes the Answer to Identifying Adverse Drug Reactions?
Authors: Hutchinson Katrina A , Eaton Vaughn S 
Published: March 2016

Objectives: To assess the value of E‐codes in the identification and documentation of unpredictable adverse drug reactions.Method: Clinical codes for adverse effects of drugs assigned at separation (E‐codes), were retrospectively reviewed for a 3‐month period. These codes were assessed for accuracy and to determine whether they identified predictable or unpredictable adverse drug reactions. Accurate E‐codes were given a severity rating and the type of adverse effect recorded. A subsequent trial over 18 months involved a daily review ofEcodes assigned at separation. When an E‐code identified an unpredictable reaction that was not properly documented, the medical team were contacted and encouraged to complete an alert sheet.Results: During a 3‐month period 1.9% of separations were assigned an E‐code. Of the 175 clinical codes that were confirmed as accurate, 41 (23%) were classified as unpredictable. Of these only 5 had a completed alert sheet. During the 18‐month period when E‐codes were reviewed daily, 66 unpredictable reactions were identified. Of these, 23 (35%) had a completed alert sheet.Conclusion: Reviewing clinical codes is time consuming and the accuracy of the codes depends on adequate documentation. Despite these limitations, clinical codes are a useful tool to assist in the identification and documentation of adverse drug reactions.
The Extended Role of the Clinical Pharmacist in the Management of Heart Failure and Acute Coronary Syndromes
Authors: Coombes Ian D , Sanders Daniela CJ , Thiele Justine M , Cottrell W Neil , Stowasser Danielle A , Denaro Charles , Scott Ian A 
Published: March 2016

Aim: To discuss the evidence‐based rationale behind the use of clinical pharmacists in the Brisbane Cardiac Consortium Clinical Support Systems Project (CSSP), and detail the pharmacist‐specific interventions that have been implemented.Background: Congestive heart failure (CHF) and acute coronary syndrome (ACS) are two commonly encountered conditions in hospitalised patients, and are associated with a significant morbidity and mortality. Despite the existence of effective therapies such as angiotensin converting enzyme inhibitors, P‐blockers and lipid lowering agents a dissonance persists between evidence‐based recommendations and routine practice. Multiple factors are responsible for this evidence‐practice gap which results in potentially unnecessary admissions due to suboptimally treated disease. These factors include inappropriate drug prescribing and poor patient compliance which, in varying measures, are attributable to inadequate communication of treatment plans to patients and their carers, general practitioners and community pharmacists.Intervention: Research pharmacists optimise pharmaceutical care using a model that spans all stages of patient care. These pharmacists are involved in admission assessment, optimisation of inpatient therapy, discharge education, implementation of self management plans, enhanced medication liaison and post discharge follow up.Recommendations: Available evidence and experience gained from this project may support further development of specialised clinical pharmacist positions attached to multidisciplinary teams and may be applicable to other chronic diseases.
The First Graduate Cohort at Charles Sturt University: What Impact on the Rural Pharmacist Shortage?
Authors: Simpson Maree D , Wilkinson Jenny M 
Published: March 2016

Objective: This paper reports a descriptive study of the first cohort of graduates from a non‐metropolitan university. The objective was to elucidate students' future practice intentions.Methods: A questionnaire was developed and administered to students in their second and third year of study in the Bachelor of Pharmacy course offered at Charles Sturt University. An abridged version of the questionnaire was administered to final year students the following year as part of an ongoing research activity.Results: Whilst still in the early years of their course, students indicated a strong preference for a rural, community site for their pre‐registration year. By the end of 2000, 62% of all graduates, and 88% of female graduates, had accepted preregistration training placements in non‐metropolitan locations. The pre‐registration practice location for one in six of this first cohort was a hospital pharmacy, an increase from the 10% who declared in the 1999 survey that they were intending to do their pre‐registration year in a hospital.Conclusion: The vast majority of students who complete their undergraduate training at a non‐metropolitan university express the desire to practise in non‐metropolitan sites during their studies. After graduation, this intention is confirmed by choice of practice location.
Infliximab in Refractory Behcet's Disease
Authors: Maxwell David J 
Published: March 2016

Objective: To describe the use of infliximab in a patient with refractory Behcet's disease (BD).Clinical features: The patient, a 39‐year‐old woman, had been suffering from BD for over 15 years. Previous therapy, including cyclophosphamide, methotrexate, interferon alpha‐ 2a and steroids, was not controlling her symptoms of severe cutaneous/oral/genital ulcers, uveitis, iritis, chronic sinusitis, diarrhoea, abdominal cramps and severe joint pain. A trial of infliximab, an anti‐tumour necrosis factor alpha (TNFα) monoclonal antibody, was commenced to control the symptoms.Outcome: A course of IV infliximab at 3 mg/kg was administered at weeks zero, two and six. During this period progress was measured using various indices, including the Health Assessment Questionnaire (HAQ) Disability Index and the Arthritis Impact Measurement Scale (AIMS) Anxiety Score, as well as a personal diary. The patient described almost immediate relief from diarrhoea and abdominal cramps. At the end of the six week treatment period, both the HAQ Disability Index and AIMS Anxiety score had decreased from 2.1 and 4.6 respectively, to zero, and the patient reported relief from joint pain, and healing of oral and genital ulcers. Six weeks after treatment finished the patient suffered a relapse of ulcers, joint pain and abdominal symptoms. Maintenance infliximab was commenced at 3 mg/kg IV every eight weeks.Discussion: This case, and other published reports describing short‐term use of infliximab in BD, suggest that infliximab may be suitable for the treatment of refractory BD. However maintenance therapy may be required to achieve long‐term symptom control in some patients, such as the one described in this report.
Association between Self‐Reported Adherence to HIV Therapy and Disease Markers
Authors: Yin Connie , Rayner Craig R , Read Tim , Fairley Christopher K 
Published: March 2016

Introduction: Non‐adherence to highly active antiretroviral therapy (HAART) in HIV is widely accepted as a major cause of treatment failure. As a measure of adherence, all patients prescribed HAART at the Melbourne Sexual Health Clinic fill in a simple questionnaire documenting the number of doses per day and the number of doses missed in the last 4, 7 and 28 days.Objective: To investigate the association between mean HIV‐RNA viral load (VL), CD4 antigen count, the number of doses per day, and the 4‐day, 7‐day and 28‐day self‐reported adherence (SRA), and reasons for missed doses.Method: Data were collected for patients attending the clinic from May 2001 until January 2002. SRA [100‐ 100 x (number of doses missed + number of prescribed doses for that period)], number of doses per day, CD4 counts and VL results were averaged within patients. Statistical analyses were performed using classification and regression tree (CART) analysis, a multi variable non‐parametric tree‐based modelling technique.Results: 139 patients were evaluable for analysis of VL and 195 for analysis of CD4 counts. Mean (range) SRAs were: 4 days, 97.5% (45.8‐100%); 7 days, 97.7% (57.1‐100%); and 28 days, 98.1% (62.5‐100% ). The mean number of doses per day was 2.2 (range 1‐5). The average 28‐day SRA and number of doses/day were significantly associated with VL.Conclusion: Average 28‐day SRA and the number of doses per day were associated with VL. Reasons for non‐adherence were consistent with reasons cited in the literature. Further exploration of issues, including recall bias, are required before these results may be applied routinely in the clinical setting.
Prevalence of Complementary and Alternative Medicine Use by Adults with Cystic Fibrosis
Authors: Burrows Judith A , Bajramovic Jasmina , Bell Scott C 
Published: March 2016

Background: Limited data are available about the extent of use of complementary and alternative medicine (CAM) in people with cystic fibrosis (CF).Aim: To determine the extent of use of CAM therapies and CAM therapists in an adult population with CF. Expenditure on CAM and patient perceptions about CAM were also assessed.Method: An interview‐based questionnaire was developed, tested and administered by pharmacists.Results: 83 adult CF patients (42 females, age 16‐44 years) were surveyed. 61% had visited a CAM practitioner at some time and 26% were currently visiting at least one practitioner (most commonly masseuses and naturopaths). 70% of patients reported they had taken a CAM in the past and 45% were currently taking CAM therapies (mean 3.5, range 1‐19). The proportion of females who had consulted a CAM therapist (70% vs 48%) and taken CAM (84% vs 53%) was significantly greater than males. 39% of patients had informed their doctors of their use of CAM. 10% of patients spent more on CAM than on conventional therapy and 10% also spent over $500 annually in consultations with CAM therapists.Conclusion: The use of CAM therapists and therapies in young adults with CF was considerable, but comparable to studies in the general population. While the majority believed that conventional medicine was more beneficial than CAM therapy, some spent considerable amounts of money on CAM and many believed that such therapies had a place in therapy.
Survey of Women's Attitudes to Complementary Medicines
Authors: Biddle Ruth A , Simpson Maree D , Wilkinson Jenny M 
Published: March 2016

Aim: To assess the attitudes of women to complementary medicines.Method: A questionnaire covering demographic information and 30 questions related to complementary medicines was developed. The questionnaire was distributed to women resident in Wollongong, NSW, Australia by mail (n = 785), with a further 793 distributed to complementary and conventional healthcare practices within the same postal zones.Results: The overall response rate was 31%. Respondents indicated that they are open to new alternatives in health (92% ), that the potential of alternative medicines is largely undiscovered (65%), that complementary medicines are more than placebos (81%) and that they can be used in conjunction with conventional medicines (79% ). Respondents also recognised the potential for interactions between complementary medicine and conventional drugs (66%). Eighty per cent disagreed with the statement that complementary medicines had nothing to offer them. Those visiting complementary practitioners viewed complementary medicines more favourably than those using conventional medical practices.Conclusion: This study has shown that women are generally open to complementary medicines and see them as a valuable addition to conventional health care. We have also shown that women recognise the potential limits of these medicines and trust the advice of pharmacists. This highlights the need for pharmacists and other healthcare professionals to be knowledgeable and non‐judgmental when providing advice about complementary medicines.
Workload Statistics in Cytotoxic Preparation—Is a One‐for‐One Approach Enough?
Authors: Siderov Jim , Bayles Maryann 
Published: March 2016

The preparation of chemotherapy dose forms has changed over time. Advances in cancer therapy and new drug technology have resulted in an increase in the complexity of drug regi mens and drug preparation . We set out to retrospectively test a complexity score (CS) to determine the complexity of workload in a cytotoxic preparation facility and compare this with the number of items prepared per year.A CS for every possible cytotoxic dose form was developed. All cytotoxic dose forms prepared by the Austin & Repatriation Medical Centre pharmacy department were included in the review. The CS was tallied for each year and compared with the number of cytotoxic dose forms prepared per year. The results show that while the number of items prepared per year fluctuated, the CS increased each year. Over the four‐year period, the number of items increased by 2%, while the complexity score per item increased by 8%.Hospital and pharmacy managers must not simply base their assessment of staffing requirements on the number of cytotoxic dose forms prepared each year. They must also include aspects of the complexity involved in the preparation of these items.
Audit of Selective and Non‐Selective Non‐Steroidal Anti‐Inflammatory Drug Use in Rural General Practice
Authors: Cutts Christopher , La Caze Adam B , Tett Susan E 
Published: March 2016

Aim: To identify the demographics and risk factors in a selected patient population prescribed non‐selective and cyclo‐oxygenase‐2 (COX‐2) selective non‐steroidal anti‐inflammatory drugs (NSAIDs).Method: A structured clinical self‐audit form was distributed in January to March 2001 to 155 interested general practitioners (GPs) in rural Queensland.Results: Seventy‐one GPs participated in the audit and contributed 1417 patient records‐790 patients had received nonselective NSAIDs and 627 had received COX‐2 inhibitors (celecoxib or rofecoxib). Patients who received COX‐2 inhibitors were significantly older, more likely to have clinically important concomitant illness, and more likely to be taking medication known to interact with NSAIDs. They were also twice as likely to have two or more risk factors for adverse effects. The most common reasons for switching from an NSAID to a COX‐2 inhibitor were reported to be a previous side effect from an NSAID (primarily related to gastrointestinal effects) or the doctor's perception of the superior efficacy of COX‐2 inhibitor therapy.Conclusions: This study has shown that COX‐2 inhibitors were used in a distinctly different patient population compared to non‐selective NSAIDs. There were significant variations in the demographics and number of risk factors‐for example, cardiovascular and renal‐between the two identified populations. These differences may be due to doctors selecting COX‐2 inhibitors for patients at high risk of gastrointestinal complications. However, the prescribing pattern may also be partly due to misconceptions about the relative safety and efficacy of COX‐2 inhibitor drugs.
Adverse Drug Reactions in Paediatrics: Are We Getting the Full Picture?
Authors: Carter Kylie L Easton , Chapman Colin B , Brien Jo‐anne E 
Published: March 2016

Aim: To investigate the frequency of adverse drug reactions (ADRs) occurring within the paediatric inpatient population of three hospitals and to obtain an estimate of the degree of under‐reporting with ADR monitoring methods commonly employed in hospitals.Method: All paediatric patients admitted to wards of three hospitals, excluding oncology patients, were considered for inclusion. Adverse drug reactions arising within the inpatient population were identified using two methods: spontaneous monitoring and retrospective intensive monitoring. An independent panel reviewed information collected on reactions and established the likelihood of an association between drug administration and the reported reaction. The frequency, causality, clinical significance and preventability of ADRs arising amongst inpatients, along with an estimate of the degree of under‐reporting of monitoring methods utilised was then determined.Results: Of the 17 432 eligible patients, 41 (0.2%, 95% CI 0.1‐0.3%) were determined by an independent panel to have experienced ADRs while inpatients of these hospitals. Causality was ranked as probable (31.7%) and possible (68.3%). The majority ( 48.8%) of cases were allocated a clinical significance classification of moderate, and 9.8% of all ADRs were considered preventable. Only 8.0% and 54.8% of cases identified via prospective intensive monitoring were detected using spontaneous monitoring and retrospective intensive monitoring respectively.Conclusion: The frequency of ADRs arising within the inpatient population in this study was substantially lower than in previous reports. Under‐reporting associated with the monitoring methods employed primarily contributed to this difference. Calls for greater surveillance of paediatric ADRs should therefore be heeded and acted upon by the relevant governing bodies.
Evaluation of Home‐Based Follow‐Up of High‐Risk Elderly Patients Discharged from Hospital
Authors: Naunton Mark , Peterson Gregory M 
Published: March 2016

Objective: To evaluate pharmacist‐conducted follow‐up at home of high‐risk elderly patients discharged from hospital.Method: A randomised controlled study, in which medical patients admitted to hospital and fulfilling high‐risk criteria (including age 60 years or older and prescribed four or more regular medications) were randomly assigned to an intervention or control group. Patients in the intervention group were visited at home by a pharmacist five days after discharge. The pharmacist educated patients on their medications, encouraged compliance, assessed for drugrelated problems, intervened when appropriate and communicated all relevant findings to community health professionals. The intervention group patients were revisited at home 90 days after discharge to evaluate the outcomes of interventions made on day 5. Patients in the control group were visited at home by a pharmacist 90 days after discharge and provided with an identical comprehensive medication reviewResults: One hundred and twenty‐one patients completed the study. There were no significant differences between the two groups in key clinical and demographic parameters at baseline. A median of three drug‐related problems were identified in each intervention group patient at the five day home visit. Ninety days after discharge this had declined to one, compared to two for the control group patients (p > 0.0001). In the intervention group, compliance had improved and was significantly higher than for the control group after 90 days (p > 0.0001). There was a significant decline in the use of nonsteroidal anti‐inflammatory drugs by the intervention group patients. Forty‐five per cent of the control group patients had unplanned readmissions to hospital during the 90 days following discharge compared to 28% of the intervention group patients (p = 0.05). The intervention program was well‐received by patients and their general practitioners. Recommendations from the pharmacist were implemented by general practitioners in 79% of cases.Conclusion: A pharmacist‐conducted follow‐up at home of high‐risk elderly patients discharged from hospital is valuable in identifying and addressing drug‐related problems and reducing the risk of readmission to hospital.