bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a Pharmacist‐Initiated E‐Script Transcription Service for Discharged Patients
Authors: deClifford Jan‐Marie , Lam Skip S , Leung Benjamin K 
Published: April 2015

ABSTRACTAimTo evaluate a pharmacist‐initiated e‐script transcription service for discharged patients.MethodA sequential prospective study of 2 groups of 40 eligible medical patients recruited from the neurology and respiratory wards. Pre‐implementation of the service, baseline data were collected from 40 consecutive medical patients. After the new service was implemented and allowing for a 2 week run‐in period, data were collected from a further 40 consecutive medical patients. The outcome indicators were the time taken to discharge patients and the number of prescribing errors.ResultsThe pharmacist‐initiated e‐script transcription service was successfully implemented. The discharge process was faster with the time taken from decision to discharge to actual discharge decreased by 34% (p = 0.02). The time spent by dispensing pharmacists in clarifying and amending discharge prescriptions decreased from 9.5 to 1.5 minutes per patient. The time spent by doctors in preparing discharge prescriptions fell from 15 to 2 minutes per patient. There were also fewer prescribing errors – number of errors decreased from 0.83 to 0.1 per patient (p = 0.0005) and from 0.0962 to 0.0137 per item (p = 0.011).ConclusionCombining a prescribing role with the medication safety elements of electronic prescribing and medication reconciliation has resulted in significant improvements in the quality, accuracy and timeliness of discharge prescriptions. The centralised discharge transcription service is transferable to a wide variety of health settings. The principles of workforce substitution and process change is important as the health system struggles to meet ever increasing demands.
Pattern of High‐Dose Prednisolone‐Induced Hyperglycaemia in COPD Exacerbations
Authors: Roberts Gregory W , Monteiro Vinia E 
Published: April 2015

ABSTRACTBackgroundHigh‐dose prednisolone is the mainstay of treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD). Hyperglycaemia is a dose‐related adverse effect of prednisolone. Recent evidence suggests that the presence of hyperglycaemia during COPD exacerbations may impair recovery. To develop a successful management strategy, more information is needed on the nature of prednisolone‐induced hyperglycaemia in COPD exacerbations.AimTo determine the characteristics of prednisolone‐induced hyperglycaemia in patients experiencing COPD exacerbations and receiving high‐dose prednisolone (20 mg or more daily).MethodA prospective study of patients hospitalised for COPD exacerbations and receiving high‐dose prednisolone. Eligible patients with COPD exacerbations and receiving highdose prednisolone were divided into 3 groups – diabetic, non‐diabetic and pre‐diabetic. The capillary blood glucose levels for the 3 groups were measured daily at 7 am, noon, 5 pm and 9 pm for up to 4 days of treatment. These blood glucose levels were compared with the retrospective blood glucose levels of diabetic patients hospitalised for reasons other than COPD exacerbations and not receiving prednisolone (control).ResultsCompared to the diabetic control group (n = 117), the mean daily blood glucose levels were 2 mmol/L higher in diabetic COPD patients receiving prednisolone (n = 7; p < 0.05). Pre‐diabetic COPD patients receiving prednisolone (n = 6), experienced a mean daily blood glucose level similar to that of the diabetic control group, while the non‐diabetic COPD patients (n = 6) were largely unaffected. In both diabetic and pre‐diabetic COPD patients there was a delayed blood glucose level peak at 5 pm that was 4 mmol/L higher than the 7 am blood glucose level (p < 0.05 for both). This pattern was not evident in the diabetic control group. In both the diabetic and pre‐diabetic COPD patients the recovery of blood glucose levels to baseline occurred within 24 hours.ConclusionPrednisolone‐induced hyperglycaemia influenced blood glucose levels in pre‐diabetic COPD patients to the same extent as diabetic COPD patients, while the non‐diabetic COPD patients were largely unaffected. The hyperglycaemic effect was transient, lasted for less than 24 hours and followed a distinct daily pattern.
Rapid Desensitisation of an Immunocompetent Patient with Cotrimoxazole Hypersensitivity
Authors: Walton Natalie , Krumins Daila 
Published: April 2015

ABSTRACTBackgroundHypersensitivity reactions to cotrimoxazole (trimethoprim+sulfamethoxazole) are common. Limited and varied data are available on desensitisation protocols for patients with cotrimoxazole hypersensitivity.AimTo report the successful rapid desensitisation of an immunocompetent patient with cotrimoxazole hypersensitivity.Clinical DetailsA 58‐year‐old male presented with multiple brain abscesses of unknown origin on a background of actinomycotic lung lesions. He was admitted to the intensive care unit in a critical state and started on multiple antibiotics. After limited clinical improvement intravenous cotrimoxazole was initiated. Although the patient's clinical signs improved, he developed a rash. Cotrimoxazole was ceased and the rash cleared. Once the patient was clinically stable, cotrimoxazole desensitisation was attempted over 6 hours using the protocol from Therapeutic Guidelines: Antibiotic.OutcomesThe patient was successfully desensitised and subsequently completed a 6‐month course of cotrimoxazole therapy. No further adverse reactions were reported.ConclusionCotrimoxazole desensitisation using the protocol from Therapeutic Guidelines: Antibiotic can allow treatment of patients with sulfamethoxazole hypersensitivity.
Hospital Pharmacy Dispensing Records for Pharmacoepidemiology Research into Late Gestation Exposure to Antidepressants
Authors: Grzeskowiak Luke E , Gilbert Andrew L , Morrison Janna L 
Published: April 2015

ABSTRACTAimTo determine the validity of electronic hospital pharmacy dispensing records as an indicator of late gestation exposure to antidepressants using medical records as the gold standard.MethodMedical records (gold standard) were reviewed for a consecutive sample of 400 women who delivered at a large maternity hospital during 2005. Data on antidepressants used in pregnancy from the medical records were compared with the electronic pharmacy dispensing records to ascertain sensitivity and specificity.ResultsAccording to the medical records, 12 (3%) women were identified as taking antidepressants during late gestation. The electronic pharmacy dispensing records correctly identified 9 women as exposed to antidepressants (sensitivity score 75%; 95%CI 43–95). No women were classified as exposed according to pharmacy dispensing records and classified as not exposed according to the medical records (specificity score 100%; 95%CI 99–100). 7 (1.8%) women were identified in the medical records as taking antidepressants but had either stopped prior to pregnancy or on finding out that they were pregnant. These patients were not identified in the pharmacy dispensing records.ConclusionElectronic hospital pharmacy dispensing records may provide an efficient alternative to paper records for identifying late gestation exposure to antidepressants, but will underestimate the exposure by 25%.
Identifying Temporal Changes to the Prescribing of Anti‐Arrhythmics for Atrial Fibrillation
Authors: Yip Annie , Bajorek Beata V 
Published: April 2015

ABSTRACTBackgroundThere are a paucity of data on the use of anti‐arrhythmics for atrial fibrillation (AF), particularly in view of new treatment guidelines recommending rate control over rhythm control.AimTo investigate the use of anti‐arrhythmics for AF in the local clinical setting.MethodA retrospective clinical audit of the medical records of 174 adult patients with primary or secondary AF was conducted at a large Sydney teaching hospital. Data were collected on patients' characteristics, medical history, factors affecting treatment choice and clinical outcomes.ResultsFor acute treatment of AF, 38 (22%) patients received rhythm control only, 30 (17%) received rate control only, and 42 (24%) received rate control plus rhythm control. For long‐term management of AF, 24 (14%) patients received rhythm control only, 42 (24%) received rate control only, and 28 (16%) received rate control plus rhythm control. The number of patients who attained sinus rhythm was higher in those receiving rhythm control drugs versus rate control drugs (84% vs 31%; p < 0.05). A decrease was observed in the number of patients on digoxin (41% vs 6%; p < 0.01) and amiodarone (26% vs 6%; p < 0.001). Factors identified as influencing treatment choice were age, heart rate, AF characteristics and comorbidities.ConclusionThere has been a temporal change in the use of anti‐arrhythmics for AF, reflecting changes to recommendations on the use of rhythm versus rate control drugs. These changes in prescribing patterns are reflective of current guidelines and evidence‐based practice.
Provision of Hospital Pharmacy Services for Clinical Drug Trials
Authors: Hynes Kay I , Rice Carol A 
Published: April 2015

ABSTRACTAimTo explore Australian hospital pharmacy services provided to clinical drug trials in 2007; and to compare the results with data from similar surveys conducted in 1989 and 1994.MethodQuestionnaires were sent to pharmacy managers of 301 public and private Australian hospitals.Results164 hospitals responded to the survey. The response rate (55%), demographics and number of hospitals conducting clinical drug trials (75%) did not differ significantly in 1989, 1994 and 2007. However, the number of hospital pharmacies reporting 30 or more clinical drug trials had more than tripled between 1989 (n = 11) and 2007 (n = 38). From 1994 to 2007 there was a 300% increase in the number of pharmacy departments who reported spending 20 hours/week or more on clinical trials. In 1994 and 2007, pharmacy departments with 30 or more clinical trials reported that they had a dedicated clinical trials pharmacist. By 2007, most hospital pharmacies (70%) were funded for over 50% of their clinical trials; a significant increase from 5% in 1989 and 32% in 1994. Most hospital pharmacies (78%) dispensed more than 75% of the investigational drugs within their hospitals. Pharmacist involvement in the review of trial protocols by membership of institutional human research ethics committees had tripled between 1989 (n = 14) and 2007 (n = 43).ConclusionSpecialisation and expertise to conduct clinical drug trials by hospital pharmacists is recognised by their increased involvement with human research ethics committees, increased funding to pharmacies, more specialist clinical trial pharmacists, and pharmacists dispensing drugs for clinical trials conducted in hospitals.
Treatment of Venous Thromboembolism in Older People
Authors: Ho Wai Khoon 
Published: April 2015

ABSTRACTThe incidence of venous thromboembolism increases markedly with age. Anticoagulation is effective in secondary prevention of venous thromboembolism but in older people, anticoagulation may be associated with increased risk of haemorrhage. Furthermore, given the high prevalence of renal impairment, there is risk of accumulation of renally cleared drugs (e.g. low molecular weight heparins, fondaparinux, some of the new anticoagulants). Older people tend to have more comorbidities and are on more medications which can potentially interact with anticoagulants. Older people are generally more sensitive to warfarin and require lower doses to maintain therapeutic anticoagulation. With the discovery of genetic polymorphisms that influence warfarin metabolism, dosing algorithms based on pharmacogenomics have been devised and are being evaluated to help improve the safety of anticoagulation.
Snapshot of Antimicrobial Stewardship in Australian Hospitals
Authors: Chen Alex WJ , Khumra Sharmila , Eaton Vaughn , Kong David CM 
Published: April 2015

ABSTRACTBackgroundThe diminishing investment into the development of new antimicrobials is of significant global concern. This, coupled with the emergence of anti‐infective drug resistance, highlights the need to both prolong and optimise the use of existing antimicrobials. Strategies or programs to optimise antimicrobial use fall under the broad heading of antimicrobial stewardship.AimTo identify the types of antimicrobial stewardship programs in existence in Australian hospitals and their perceived success.MethodDirectors of Pharmacy or their nominees (n = 281) working in Australian hospitals were surveyed to identify their institutional antimicrobial stewardship programs. Infectious disease clinicians, infection control nurses and hospital pharmacists were recruited for the qualitative interviews. They were interviewed until saturation of themes was identified. All of the interviews were transcribed verbatim and analysed for common themes.ResultsResponses were received from 80 Directors of Pharmacy or their nominees (29% response rate). The types of antimicrobial stewardship programs identified can be broadly grouped into: administration‐related; antimicrobial use and prescribing‐related; education and training‐related; and infection control and surveillance‐related. A variety of strategies are used to promote appropriate prescribing of antimicrobials, resulting in varying levels of perceived success, for example the use of Drug and Therapeutics Committees, formulary restrictions, locally developed antimicrobial guidelines and streamlining or de‐escalation of therapy. Clinical leadership, a multidisciplinary approach and the availability of enthusiastic and motivated individuals are critical to the success of antimicrobial stewardship programs.ConclusionAustralian hospitals have implemented a variety of antimicrobial stewardship programs with varying degrees of perceived success.
Medicine Management in Older People from Non‐English Speaking Backgrounds
Authors: Blennerhassett Jenny , Hilbers Julieanne 
Published: April 2015

ABSTRACTAimTo examine medicine management in older people from non‐English speaking backgrounds (NESB) after discharge from hospital.MethodA literature review, followed by focus group discussions with hospital clinicians. Patients 70 years and over from Greek, Chinese, Russian and English speaking backgrounds were interviewed. Case histories were developed based on the interviews and a review of the patients' medical records. Data were clustered and themes extracted. Educational resources were produced for clinicians comprising an action guide and a composite audiovisual case study. These resources were used in further focus group discussions with hospital clinicians to determine current practice for identifying and managing medication management risks for patients from NESB.ResultsMajor themes identified included: patients' lack of knowledge about medications and medication changes; interpreter services not used routinely; and inadequate communication between health professionals. There was little evidence of systematic, standardised processes for identifying people at risk of medicine mismanagement or for the implementation of actions to minimise risks.ConclusionThere is a need for effective communication about medications, particularly when patients are transferred from hospital to the community. For people from NESB, this also includes the use of interpreters and translated educational material. A patient journey map and medicine management action guide provides a framework for clinicians to optimise safe medicine management and continuity of care.
Retrospective Analysis of Emergency Readmissions to Rural and Regional Hospitals
Authors: Rothwell Michelle , Jukka Clare , Lum Elaine , Mitchell Charles , Kyriakides Peter 
Published: April 2015

ABSTRACTBackgroundAccording to the evidence, hospital readmissions within a month of discharge occur in approximately one‐third of older patients and that the majority of readmissions are preventable. Missing medication information at discharge was identified as a contributor to hospital readmissions.AimTo identify unplanned readmissions within 28 days of hospital discharge attributable to medications; to assess preventability; and in the medication‐related readmissions to identify the medication management information supplied to the GP on initial discharge and whether these patients were seen by a pharmacist during the initial stay and readmission.MethodRecords were analysed of patients who had an unplanned readmission within 28 days of discharge, aged 65 years and over, and on 3 or more medications at the time of discharge. A documented method developed for measuring causality, preventability and contribution of medications to the readmission was utilised.Results170 patients from 1 regional and 2 rural hospitals were included in the analysis. 39 (23%) readmissions were medication related and 34 (87%) of these were preventable. Dominant reasons for readmission were inadequate communication/monitoring (41%) and inappropriate/suboptimal pharmacological therapy at discharge (62%).ConclusionGaps in communicating medication management information across the hospital–community interface continue to contribute to avoidable unplanned readmissions.
Evidence on Optimal Prescribing and Medicines Use for Decision Makers: Scope and Application of the Rx for Change Database
Authors: Ryan Rebecca E , Weir Michelle , Leslie Bill , Worswick Julia , Lowe Dianne B , Hill Sophie J 
Published: April 2015

ABSTRACTRx for Change, a freely available online database, summarises the evidence on the impact of interventions to improve the quality of prescribing and medicines use. The database serves as a resource for decision makers seeking to find and use the evidence from systematic reviews on interventions to improve prescribing and medicines use by targeting the behaviours of health professionals and consumers. We describe a panel discussion held in 2010 on the database's scope and application. Panellists explored the ways decision makers might use the database to access the evidence as an input to decision making; and presented examples of the range of interventions on which evidence is assembled within the Rx for Change database and through which professional and consumer behaviours might be targeted to improve prescribing and medicines use.
Indicators of a Quality Clinical Placement in Pharmacy: Stakeholder Perspectives
Authors: Stupans Ieva , McKauge Leigh , Owen Susanne 
Published: April 2015

ABSTRACTBackgroundThe educative role of experiential workplace placements has been discussed in the context of many health professions. Quality assurance and enhancement strategies rely on evaluations that provide valid and reliable data, so that informed decisions can be made about improving learning for students. No research could be located in the literature to determine the gap between stakeholders' perceptions of the importance of indicators and their perceptions of whether these practices occur in experiential placements.AimTo develop indicators that can be used to describe a quality clinical placement; and to determine stakeholder perspectives on the occurrence of the indicators in Australian pharmacy student workplace placements.MethodA questionnaire was developed and administered to students, academics and placement preceptors.ResultsThe indicators for placement quality were perceived to be important. However, perceptions of the degree to which these indicators actually occurred on placement varied between the three stakeholder groups.ConclusionStakeholder groups are either not aware or do not necessarily understand the contribution of the other stakeholders to the placement process. This highlights the need for collaboration and recognition of the roles of all participants in quality placements.
Impact of a Pharmacist Intervention on Ambulatory Patients with Heart Failure: A Randomised Controlled Study
Authors: Korajkic Amela , Poole Susan G , MacFarlane Louise M , Bergin Peter J , Dooley Michael J 
Published: April 2015

ABSTRACTAimTo determine the impact of a pharmacist intervention on patient–guided diuretic dose adjustment in ambulatory patients with heart failure.MethodPatients with heart failure were randomised to usual care or usual care plus pharmacist intervention and followed for 3 months. Pharmacist intervention focused on patients improving self‐care, recognising symptoms of fluid retention, measuring weight daily and self‐adjusting diuretic dose using frusemide. The primary outcome was the number of appropriate weight‐titrated frusemide dose adjustments. Secondary outcomes included the number of patients who correctly self‐adjusted their frusemide dose, hospital readmissions due to fluid overload, heart failure‐related knowledge and understanding, and quality of life (using validated tools).Results70 patients were recruited: 35 usual care (control) and 35 usual care plus pharmacist intervention. The average number of appropriate weight‐titrated frusemide dose adjustments per patient per month in the control group was 0.32 ± 0.08 and in the intervention group was 0.85 ± 0.13 (p = 0.006). Hospital readmissions due to fluid overload was 31% in the control and 14% in the intervention groups (p = 0.04). There were significant differences between the groups regarding appropriate self‐adjusted frusemide doses, heart failure‐related knowledge and understanding, and quality of life.ConclusionA pharmacist intervention improved the ability of heart failure patients to self‐adjust their diuretic dose by using a flexible dosing regimen based on weight, resulting in quality of life improvement and a decrease in hospital readmissions due to fluid overload.
Cost‐Minimisation Analysis of Midazolam versus Droperidol for Acute Agitation in the Emergency Department
Authors: Chan Esther W , Knott Jonathan C , Liew Danny , Taylor David McD , Kong David CM 
Published: April 2015

ABSTRACTAimTo compare the costs of midazolam and droperidol for the management of acute agitation in the emergency department (ED).MethodA decision analysis model was used to undertake a cost‐minimisation analysis of resource utilisation in the ED of a Melbourne hospital. Data from acutely agitated patients who received midazolam (n = 74) or droperidol (n = 79) in a randomised clinical trial (February 2002 to April 2004) were reviewed.ResultsAll direct medical and non‐medical costs relating to the management of acute agitation in the ED were analysed. The average cost scenario was estimated for the 2 treatments. The model simulated 9 possible outcomes based on whether patients were ‘sedated’ or ‘not sedated’ and whether they required ‘re‐dosing’ or ‘no re‐dosing’. Hospitalisation cost incorporated multiple items as part of the average cost per service code for the ED length of stay. In the base case analysis, midazolam was associated with notably less overall drug costs (A$3.05 vs A$21.10), which contributed to less total treatment costs. The ‘expected’ median ED length of stay was marginally longer in the midazolam group (12 vs 11.8 hours), resulting in slightly higher hospitalisation costs (A$1370 vs A$1361). The midazolam group incurred higher median costs for pathology (A$78.60 vs A$61.60) and imaging (A$5.25 vs A$0.60). The cost of electrocardiograms was similar (A$27.10 vs A$28). With a cost advantage of A$59 per patient, midazolam was 3.8% less costly than droperidol (A$1496 vs A$1555).ConclusionMidazolam was marginally more cost saving than droperidol when used to manage acute agitation in the ED. Several challenges were identified that need to be overcome to enable future robust pharmacoeconomic studies.