bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medication Management of Adult Patients Admitted to Hospital with Epilepsy, Seizure or Convulsion
Authors: Walker Monique P , McGovern Trudy L , Hattingh Laetitia H , Hall Tony D 
Published: April 2015

ABSTRACTBackgroundAn inpatient medication chart review at the Gold Coast Hospital identified shortcomings with the prescribing and monitoring of antiepileptic medications.AimTo evaluate medication management of patients with epilepsy, seizure or convulsion; to map their transition through the health system; and to identify lifestyle behaviours that may lead to overt risks for seizure occurrence.MethodA retrospective observational audit of adult patients (16 years and over) admitted to hospital with a diagnosis of epilepsy, seizure or convulsion from 1 to 31 January 2012.ResultsMajority of the 62 episodes of care investigated involved patients who were discharged directly from the ED (68%). Only 30% of all patients discharged from an inpatient unit received a discharge medication record from a pharmacist. Non‐adherence with antiepileptic medications, alcohol and/or recreational drug use and prescription medication misuse were identified as overt risks for seizure occurrence.ConclusionValuable insights were gained into the management of seizure patients. The role of the ED pharmacist was reviewed to focus on high‐risk seizure patients. An increase in the provision of discharge medication records and patient education on the overt risks for seizure occurrence is needed.
Immunisation of Older People
Authors: Woodward Michael 
Published: April 2015

ABSTRACTOlder people are more prone to infections than younger people and prevention via effective vaccines is an important approach to reduce the burden of infections in this age group, especially as microorganisms are often resistant to antibiotics. While there is an emphasis on childhood vaccination, adult vaccination is also important as part of a whole‐of‐life approach. Influenza, pneumococcal, herpes zoster and tetanus vaccines are effective in older people as are other vaccines for those at high risk. Pertussis vaccination is recommended in older people to reduce the spread of infection to children. The Australian and New Zealand Society for Geriatric Medicine has revised their position statement on vaccination of older people. These recommendations, along fsupport these, are presented in this review.
Evaluation of Consumer Medicine Information Provision from an Outpatient Dispensary
Authors: Winter Samantha J , Harlow Margaret A , Abarno Anita C , Alderman Christopher P 
Published: April 2015

ABSTRACTBackgroundConsumer medicine information (CMI) has been available for prescription medications since 1993. Although provision is not mandated by legislation, CMI use can meet the professional obligations of pharmacy practice.AimTo identify obstacles to provision of CMI from an outpatient dispensary and to gain insight into the decision‐making processes used by pharmacists when supplying CMI.MethodData were collected from patients presenting prescriptions at an outpatient dispensary during a 2‐month capture period. CMI provision was self‐reported by pharmacists using a structured questionnaire and analysed to investigate the influence of therapeutic subgroups and dose intensity on CMI provision.Results165 patient interactions were assessed. In 100 cases (61%), patients were provided with CMI with their medicines. Concerns regarding patients' interpretation of CMI content (43%) and off‐label use of medicines (22%) were the main reasons cited by pharmacists for not supplying CMI. Older patients and those from culturally and linguistically diverse backgrounds were significantly less likely to receive CMI. Therapeutic subgroup analysis and medication dose intensities also influenced provision of CMI.ConclusionObstacles to provision of CMI from an outpatient dispensary included off‐label use of medicines and patients' interpretation of the CMI. Pharmacists' professional judgement was a key factor influencing provision of CMI.
Future Pharmacy‐Based Chlamydia Screening: Consumer Preference
Authors: Gudka Sajni , Misaghian Jila , Clifford Rhonda M 
Published: April 2015

ABSTRACTBackgroundChlamydia trachomatis is the most prevalent sexually transmitted infection in Australia and a serious public health concern. Barriers to screening for C. trachomatis include high costs, clinic waiting times, inconvenience, fear of medical procedures, stigma and lack of privacy. Advances in nucleic acid amplification techniques have enabled the choice of 2 self‐collected and non‐invasive sampling methods for detecting C. trachomatis: first‐void urine and low vaginal swab.AimTo determine whether women prefer first‐void urine or low vaginal swab for detecting C. trachomatis.MethodA self‐administered survey was piloted and refined. Women from a university and a shopping centre were invited to participate in the survey. The survey gathered data on demographics, previous experiences with sample collection and preference for a future pharmacy‐based chlamydia screening intervention. Participants completed the survey independently and sealed it in the envelope provided.ResultsMedian age of the 100 female participants was 22 (range 20–23) years. 58% preferred to collect first‐void urine and 42% preferred a low vaginal swab. Almost half of the women noted it would be easy to collect both samples. Of the 40 women with previous experience of collecting a first‐void urine sample, significantly more would prefer low vaginal swabs in the future (p = 0.02).ConclusionWomen did not prefer one method of sample collection over the other. Both sampling methods were either ‘very easy’ or ‘easy‘.
Compounding Practices in Queensland: Experiences and Perceptions of Pharmacists and Pharmacy Students
Authors: Lau Esther TL , Jones Anthea L , Kairuz Therése , Nissen Lisa M , Steadman Kathryn J 
Published: April 2015

ABSTRACTBackgroundChanges in the roles of the contemporary pharmacist has seen a decline in the number and variety of extemporaneously compounded dosage forms. Pharmacy curricula reflect this change with a reduction in the emphasis on extemporaneous compounding practice.AimTo elicit information about extemporaneously compounded dosage forms and perceptions of compounding practice from pharmacists and pharmacy students.MethodSelf‐administered surveys were mailed to 1063 pharmacists and offered online to 896 pharmacy undergraduates across the 4 years of a Bachelor of Pharmacy program in Queensland.Results382 (36%) pharmacists and 455 (51%) students completed the survey. Most pharmacists (96%) reported compounding a product in the 12 months prior to the survey, particularly semi‐solids (89%) and liquids (64%) for external use. Most pharmacies (> 96%) owned basic compounding equipment, such as a slab and spatula, mortar and pestle, and cylindrical/conical measures. Half of the pharmacies used mechanical rather than electronic balances. Students expressed greater confidence in their ability to use basic compounding equipment and to perform basic compounding tasks as they progressed through the 4‐year degree course. Pharmacists' views on students' ability to compound basic products at the end of their degree were generally similar to the proportion of final‐year students who reported they could confidently complete the task.ConclusionDespite a decline in extemporaneously compounded products in community pharmacy, pharmacy graduates need to be competent in compounding techniques.
Understanding Compliance to an Antibiotic Prescribing Policy: Perspectives of Policymakers and Prescribers
Authors: Teo Chee Kong , Baysari Melissa T , Day Richard O 
Published: April 2015

ABSTRACTBackgroundAntibiotic stewardship programs have been shown to reduce inappropriate institutional antibiotic use. There is no consensus on the strategies, e.g. formulary restrictions, that best improve appropriate use and reduce misuse of antibiotics.AimTo identify facilitators and barriers to compliance with an institutional antibiotic prescribing policy and to compare policymakers' perceptions about the facilitators and barriers that influence compliance with those held by prescribers.Method5 antimicrobial stewardship committee members (policymakers) and 15 prescribers from a large Sydney hospital participated in a semi‐structured interview. To gauge prescribers' knowledge of the institutional antibiotic policy, case scenarios were included in the interviews with prescribers. Interviews were continued until data saturation was reached. Recurrent themes were analysed and interpreted in terms of a well‐known conceptual framework of barriers to physician adherence to guidelines.ResultsAntimicrobial stewardship committee members identified lack of knowledge as the main barrier to compliance with the antibiotic prescribing policy. Despite reporting that they were aware of and agreed with the antibiotic prescribing policy, most prescribers did not comply with the policy and referred to clinical information sources when completing the case scenarios. Organisational hierarchies were frequently reported as a barrier by both participant groups. While prescribers considered inapplicability of the antibiotic prescribing policy as an important barrier, antimicrobial stewardship committee members attributed non‐compliance to the policy to prescriber autonomy and personal experience.ConclusionWe identified several barriers to compliance with the antibiotic prescribing policy, such as poor knowledge of policy specifics and medical hierarchies. Involving prescribers in policy development, giving them feedback about their prescribing, and improving existing collaboration and decision support platforms may further improve judicious antibiotic use.
Cetuximab Extravasation
Authors: Moloney Michael J , Kirsa Suzanne W , Thakerar Arti 
Published: April 2015

ABSTRACTBackgroundExtravasation of some cytotoxic drugs can cause pain, erythema, inflammation and tissue damage. There are proven procedures for managing extravasation of older cytotoxic drugs, such as doxorubicin. However, there are limited data for the newer cytotoxic drugs, such as cetuximab.AimTo describe a case of suspected cetuximab extravasation.Clinical detailsThe IV cannula of a 75‐year‐old male receiving cetuximab was partially dislodged. The patient reported pain and swelling at the administration site. It was established that approximately 1 mL of drug solution (equivalent to cetuximab 5 mg) had leaked into the perivascular tissue. Attempts to aspirate the leaked drug from the perivascular tissue was unsuccessful. Pain and swelling resolved within 30 minutes of the incident. Subsequent reviews confirmed no adverse effects at the extravasation site.OutcomesNo discernible amount of cetuximab could be aspirated, which suggests that the perivascular tissue was exposed to the drug without significant adverse effects. The short duration of reported pain and minimal adverse effects suggest cetuximab is not a vesicant or irritant.ConclusionThis case of suspected cetuximab extravasation resulted in a rapid resolution of symptoms, suggesting cetuximab is a neutral drug and not a vesicant or irritant.
Severe Infusion‐Related Reaction to Liposomal Amphotericin B
Authors: Wilson Rachael K , Connolly Michael J , Harrup Rosemary A 
Published: April 2015

ABSTRACTAimTo describe a case of severe infusion‐related reaction to liposomal amphotericin B (LAB).Clinical detailsA severely immunocompromised 58‐year‐old male with acute myeloid leukaemia experienced 2 infusion‐related adverse events when treated with LAB for a localised Fusarium solani fungal infection of the right forefoot. The initial adverse reaction to LAB was not serious. However, the second adverse reaction following a re‐challenge was serious. The patient had a poor prognosis because of the likelihood of further chemotherapy‐induced neutropenia and a potentially untreated disseminated fungal infection in light of planned chemotherapy.OutcomesLAB was successfully substituted with conventional amphotericin B to treat Fusarium solani infection. No adverse events were observed with conventional amphotericin B.ConclusionThe patient is suspected to have had a reaction to the lipid carrier of LAB.
Audit of General Practitioner Medication Lists for Older Patients at a Regional Hospital
Authors: Boyce Laura E , Knight Anne T 
Published: April 2015

ABSTRACTBackgroundComplete medication reconciliation is often difficult to achieve, particularly in the emergency department (ED). General practitioner (GP) medication lists may be used by some doctors for charting medications.AimTo determine the discrepancies in the medication history information between GP medication lists and the actual medication usage of older patients admitted via a regional ED.MethodA clinical audit was conducted over a 2‐week period at a small regional hospital. Patients 65 years and over, taking 3 or more medications prior to admission, admitted via the ED and with a national inpatient medication chart (NIMC) prepared by a medical officer were identified. Eligible patients were provided with medication reconciliation by a pharmacist. Discrepancies between the medication history obtained by the pharmacist, the GP medication list and the NIMC were assessed. The clinical significance of the discrepancies were classified using a severity assessment code matrix.Results48 patients were eligible and 75% had 1 or more discrepancy in their GP medication list. Almost half of the discrepancies were related to non‐current medications being recorded. Potential clinical significance of the discrepancies in 19% of patients was ‘moderate’ or ‘major‘.ConclusionWhile a GP medication list is a useful tool in the medication reconciliation process, it is not a complete representation of the patient's medications prior to admission.
Safe Prescribing and Preparation of Continuous Subcutaneous Infusions in a Regional Palliative Care Unit
Authors: Murnane Julie M , Passlow Claire A , Arnold Mark , McCormick Christopher P 
Published: April 2015

ABSTRACTAimTo design a safe process for prescribing and preparing medications for continuous subcutaneous infusion (CSCI) in a regional palliative care unit.MethodFollowing a literature review and finding little evidence of best prescribing practice for CSCI, a working party comprising medical, nursing and pharmacy staff was established to review existing practice. Dedicated CSCI medication chart labels (MCLs) were designed to be applied to the inpatient medication chart to improve safety and clarity. These labels were trialled for 3 months. Staff surveys were conducted before and after the trial to gauge their experiences with changed practice.ResultsSurveys were completed by 27 staff before and 25 staff after the trial. Staff reported the MCLs decreased confusion, decreased the potential for error when prescribing and preparing medications, and decreased wastage of time, medication and consumables. 22 of 25 staff were moderately or highly satisfied with the new CSCI MCL.ConclusionThe introduction of MCLs to optimise prescribing and preparation of CSCI was successfully implemented and accepted by medical, pharmacy and nursing staff.
Stability of Diluted Iron Polymaltose in PVC Infusion Bags
Authors: Patel Rahul P , Wanandy Troy , Loring Serena , Johns Cameron , Hutchinson Joseph , Shastri Madhur 
Published: April 2015

ABSTRACTBackgroundIn Australia, iron polymaltose (IPM) is the most commonly used parenteral iron therapy for iron deficiency anaemia. Intravenous IPM is prepared by diluting IPM injection with 0.9% sodium chloride. The stability of diluted IPM is not known beyond 24 hours. Therefore, diluted IPM must be prepared on a daily basis, resulting in substantial limitations and problems.AimTo determine the stability of diluted IPM in polyvinyl chloride (PVC) infusion bags at different storage conditions for up to 28 days.MethodIPM 2 mg/mL samples were prepared in 0.9% sodium chloride 500 mL PVC infusion bags. Infusion bags were kept in light protective bags or exposed to artificial light and stored at either 4 °C or 25 °C for up to 28 days. Aliquots were withdrawn immediately after preparation (Day 0) or after Days 1, 2, 3, 6, 7, 14, 21 and 28. Samples were analysed by high‐performance size‐exclusion chromatography to measure the changes in concentration or molecular weight profile of IPM before and after storage. Samples were also investigated for particle size distribution by dynamic light scattering and for the free iron content by ion chromatography.ResultsDiluted IPM remained physicochemically stable (with or without light protection) at room temperature or in the refrigerator for at least 28 days.ConclusionAseptically prepared IPM 2 mg/mL intravenous solution in 0.9% sodium chloride PVC infusion bags was stable for 28 days at room temperature or in a refrigerator.
WHO High 5s Project: Medication Reconciliation International Meeting
Authors: Graudins Linda V 
Published: April 2015

ABSTRACTMedication reconciliation is in the forefront of medication safety programs, both in Australia due in part to updated accreditation standards, and globally. The first international meeting for hospitals participating in the WHO's High 5s Project was convened in Geneva in October 2012. The meeting was attended by delegates from hospitals in 6 countries participating in 2 of the WHO patient safety initiatives: medication reconciliation and correct site surgery. Networking with European colleagues provided an opportunity to exchange ideas and collaborate to address common medication safety issues.
Oral Medication Administration in Patients with Restrictions on Oral Intake—A Snapshot Survey
Authors: To The‐Phung , Story David A , Booth Jane , Nielsen Fiona , Heland Melodie , Hardidge Andrew 
Published: April 2015

ABSTRACTAimTo determine clinical staff's understanding of managing oral medications in patients with restrictions on oral intake.MethodAn online survey was designed consisting of 4 scenarios featuring a patient who was fasting pre‐surgery, day 1 post‐surgery, nil‐by‐mouth after stroke or had a nasogastric feeding tube in situ. The target population was clinical staff (nursing, medical, pharmacy, dietetics, speech pathology) involved in the management of oral medications and/or patients' oral intake. Medications studied were: aspirin (Cartia) 100 mg mane; gliclazide (Diamicron MR) 60 mg mane; atorvastatin (Lipitor) 40 mg mane; metoprolol (Betaloc) 50 mg bd; levodopa/carbidopa (Sinemet CR) 200/50 tds; ginkgo 7500 complex mane. Respondents could choose to give, withhold, cease, contact someone for advice, change the formulation before giving or choose ‘other’ and make a comment.Results622 responses were received from clinical staff. When fasting, respondents would give metoprolol (65%) and levodopa (68%) but not aspirin (70%), gliclazide (63%), atorvastatin (50%) and ginkgo (65%). Approximately 10% of respondents would give oral medications to the nil‐by‐mouth patient. The consensus for the nasogastric feeding tube was to give all the medications via the tube, including modified‐ or controlled‐release medications.ConclusionThere appeared to be varying understanding of managing oral medications when patients have restrictions on oral intake. This is concerning as it has the potential to result in adverse patient outcomes.
Home Medicines Reviews: Extent of Uptake by High‐Risk Veterans
Authors: Ellett Lisa M Kalisch , Ramsay Emmae N , Barratt John D , Gilbert Andrew L , Roughead Elizabeth E 
Published: April 2015

ABSTRACTAimTo identify the characteristics of patients who receive home medicines reviews (HMRs).MethodA retrospective analysis was conducted of the Department of Veterans' Affairs administrative claims data. Veterans living in the community on 30 June 2009 were included if they had ≥ 1 medicines dispensed in the previous 12 months. The main outcome measure was the number of veterans who received an HMR. Log binomial regression analysis compared characteristics of HMR recipients and non‐recipients – age and gender; number of medicines, prescribers, dispensing pharmacies and hospitalisations in the previous year; and conditions where medicine use is potentially problematic, e.g. dementia.ResultsOf the 175 572 veterans included in the study, 6236 (3.6%) had received an HMR. The likelihood of having an HMR increased with age, number of medicines and number of GP visits. Women were 12% more likely to receive an HMR than men. Veterans who had received an HMR previously were 4 times more likely to have another HMR. Veterans with 1 to 4 hospitalisations were 10% more likely to receive an HMR than those who had not been hospitalised. The likelihood of having an HMR decreased with the number of dispensing pharmacies and specialist visits.ConclusionPatients who received HMRs had characteristics that placed them at risk of medication‐related problems. The uptake of HMRs was appropriate in our study population.
Prescribing Antipsychotics for Young People and Monitoring Physical Health and Adverse Effects
Authors: Ellis David , Angley Manya 
Published: April 2015

ABSTRACTBackgroundAntipsychotics are increasingly prescribed in young people for psychiatric and behavioural disorders.AimTo determine the appropriateness of antipsychotic prescribing in young people; to ascertain the usage of an antipsychotic monitoring program; and to determine congruence with the antipsychotic monitoring program.MethodA prospective 3‐month audit was conducted of patients aged < 18 years prescribed antipsychotics. Prescribing was deemed ‘appropriate’ if the diagnosis was listed as an indication for the antipsychotic in the Therapeutic Guidelines: Psychotropic and/or the Australian Medicines Handbook and within the recommended dose. For patients on an antipsychotic long term (>1 month), case notes were examined to determine if patients had a monitoring chart and if it was being used as recommended.ResultsMedical records of 60 young patients prescribed antipsychotics were reviewed. 41/70 (59%) antipsychotic prescriptions were congruent with Australian guidelines. Intellectual disability with comorbid psychiatric disorder/behavioural disturbance (20/70; 29%) was the most common indication followed by autism spectrum disorder with behavioural disturbance (13/70; 19%), and schizophrenia and related psychoses (10/70; 14%). Risperidone (36/70; 51%) was the most commonly prescribed antipsychotic. 54/60 patients were prescribed antipsychotics long term (>1 month) and it was deemed necessary they have a monitoring chart. Only 10/54 (19%) patients had an antipsychotic monitoring chart and only 4/54 (7.4%) patients were optimally monitored.ConclusionMost antipsychotics prescribed for the young people were congruent with Australian guidelines. In most instances of ‘inappropriate’ prescribing, there was evidence that ‘appropriate’ antipsychotics and doses were trialled and had been unsuccessful. Use of the antipsychotic monitoring program was low; strategies are needed to ensure monitoring occurs in this vulnerable population.