bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role for Aspirin after Total Hip Replacement?
Authors: Chan Esther W 
Published: April 2015

ABSTRACTBackgroundDeep vein thrombosis can occur in up to 60% of patients following major orthopaedic surgery. Routine prophylaxis against thromobembolic complications is now the standard of care in this setting. Pharmacological agents used include unfractionated heparin, low molecular weight heparin, factor Xa inhibitors (fondaparinux), vitamin K antagonists and aspirin.AimTo review the evidence and discuss the use of aspirin as thromboprophylaxis following elective total hip replacement, and consider its use in adult patients who refuse low molecular weight heparin.MethodA literature search was conducted to identify clinical studies, meta‐analyses and clinical practice guidelines evaluating the use of aspirin as thromboprophylaxis following elective total hip replacement.ResultsNo large trials of acceptable quality which specifically compared aspirin with placebo following total hip replacement were identified. Clinical practice guidelines, meta‐analyses and one clinical trial assessed aspirin against placebo or other agents used in thromboprophylaxis in major orthopaedic surgery, including elective total hip replacement.ConclusionThere is insufficient evidence to support the use of aspirin alone as thromboprophylaxis following elective total hip replacement.
Modelling Drug Loss during Intravenous Infusion to Premature Neonates
Authors: Anh Andrew VQ , Norris Ross LG , Charles Bruce G 
Published: April 2015

ABSTRACTBackgroundOur experience has suggested that not all the drug dose put into an IV infusion reached the bloodstream of neonates.AimTo use sparse‐data modelling to estimate how much of a continuously infused dose of caffeine, gentamicin, phenobarbitone and vancomycin was delivered. To use the results to develop a modified infusion protocol to minimise drug losses.MethodVarious drug infusions were prepared in duplicate (test, control). The test set was delivered through an in vitro infusion system identical to that used in the neonatal intensive care nursery. Samples were collected after flushing the system twice with 1.5 mL of normal saline. Each experiment was replicated 4 times for each drug. Drug concentrations were measured by enzyme immunoassay. Recovery and variability during flushing was described as a function of the normal saline flushing volume using an asymptotic mono‐exponential accumulation model.Results53% of phenobarbitone, 60% of caffeine, 92% of gentamicin, and 99% of vancomycin doses were recovered. There was considerable variability in the recovery of phenobarbitone.ConclusionCurrent infusion protocols appear inadequate for delivery of drugs to neonates and may result in suboptimal therapy. It is recommended that the administration set be completely primed with the drug and any additional volume of normal saline required, then flushed with a further 2 mL of normal saline to obtain a minimum 90% recovery of these drugs.
Potential Interactions between Drugs Taken by Emergency Department Patients of an Australian Hospital
Authors: Hassan Fariza Abu , Taylor David McD , Leow Fiona HP , Doolan Gabrielle , Knott Jonathan C 
Published: April 2015

ABSTRACTBackgroundWhile drug interactions are reported to be common, there are no published reports of the prevalence of such interactions among Australian emergency department (ED) patients.AimTo determine the prevalence and characteristics of potential drug interactions among Australian ED patients, the drugs most frequently involved and identify high‐risk patient groups.MethodAn analytical cross‐sectional survey of 409 patients who were taking at least two drugs. Drug lists were compiled from a range of resources. Analyses of potential interactions were made using Micromedex Drug‐Reax software. Multivariate analysis was used to determine factors associated with potential drug interactions.Results855 potential drug interactions were identified among 254 (62.1%, 95%CI 57.2–66.8) patients. The mean number of potential interactions among all patients was 2.1 ± 2.7 per patient. The most common potential interactions were between angiotensin converting enzyme inhibitors and loop diuretics (11.3% of patients at risk), beta‐blockers and antidiabetics (7.3%) and frusemide and aspirin (9.1%). Drugs most commonly involved were aspirin (27.7% of potential interactions), beta‐blockers (11.1%) and warfarin (9.9%). Only the number of drugs taken correlated significantly with the number of potential interactions (p < 0.001).ConclusionThe possibility of potential drug interactions should be considered when prescribing and ED pharmacists should target patients on multidrug regimens for specific evaluation.
Wound Dressings Update
Authors: Weller Carolina , Sussman Geoff 
Published: April 2015

ABSTRACTThe availability of different types of wound dressings has increased in the last decade. Wound care practitioners have at their disposal an extensive range of dressings. Emerging dressing types include interactive/bioactive dressings and tissue‐engineered skin substitutes. There is no one dressing that is suitable for the management of all types of chronic wounds and few are suited for the treatment of a single wound during all stages of the healing cycle. Successful wound management depends on an understanding of the healing process combined with knowledge of the properties of the various dressings available. Without such knowledge and careful assessment of all the factors that effect healing, dressing selection is likely to be arbitrary and ineffective, wasteful both in terms of time and physical resources. This article is an overview of some of the first‐line and second‐line interactive/bioactive dressings available. A synopsis of wound assessment and wound bed preparation will aid in choosing the appropriate dressings. It will also touch on advanced technologies including tissue‐engineered skin substitutes.
Unnecessary Medicines Stored in Homes of Patients at Risk of Medication Misadventure
Authors: Vuong Tam , Marriott Jennifer L 
Published: April 2015

ABSTRACTBackgroundThe storage of unnecessary medicines poses safety concerns including patient confusion, inappropriate medication use and unintentional ingestion by children. Consumer storage and wastage of medicines is of concern to health practitioners and the Australian government.AimTo describe, quantify, establish safety concerns, and estimate the cost of unnecessary medicines stored in patients' homes.MethodPatients discharged from two hospitals in 2002 who were part of a study of a community liaison pharmacy service, had their unnecessary medicines removed (with permission) during the home visit. Details of removed medicines, including costs, were recorded and analysed.ResultsA mean of 4.6 medicines/patient (range 1–21) that had expired or no longer required were removed from the homes of 85 patients. A quarter of the items had expired at the time of collection. There were significant alterations to, or deficiencies in, the removed medicines. The mean cost of medicines removed was $65/patient.ConclusionPatients place themselves at increased risk of medication misadventure by storing unnecessary medicines in their homes. As well as creating risks to the safety of patients and children, this practice results in wastage of health resources.
Risk Analysis of Errors in Prescribing, Dispensing and Administering Medications within a District Hospital
Authors: Parke John 
Published: April 2015

ABSTRACTAimTo investigate errors in prescribing, dispensing and administering medications, determine the origin of the error and analyse the risks according to established risk‐rating matrices.MethodErrors detected by pharmacists were recorded and combined with errors recorded by nurses and doctors. Errors were classified by type of event, source of report and professional group responsible for the occurrence. Errors were evaluated against two risk‐rating matrices developed by Queensland Health and Standards Australia.ResultsReported errors occurred at the rate of 1.8% of drugs prescribed over the period from admission to discharge. There were no dispensing errors reported during the study period. Nurses reported 150 incidents and pharmacists detected 275. In the majority of cases it was possible to identify the node in the medication‐use process that was associated with the error (35% administering and 53% prescribing) but this was not possible in 12% of cases. The two largest categories of errors were incorrect dose prescribed (29%) and dose not recorded as given (28%). There was a marked difference in risk profile between the two risk‐rating matrices.ConclusionThe majority of errors were due to performance lapses or lack of knowledge. The difference in risk profiles suggests that hospitals should adopt a uniform risk‐rating matrix for benchmarking purposes. To avoid underestimates of hospital error rates, a reporting system that can interface with pharmacy information‐management systems needs to be developed.
Are Patients on Long‐Term Corticosteroids Receiving Bone Loss Therapy?
Authors: Rofail Serena , Barras Michael A 
Published: April 2015

ABSTRACTAimTo evaluate the quality of medicine use in the primary prevention, secondary prevention and treatment, of osteoporosis in patients who require prolonged oral corticosteroids.MethodA prospective evaluation of inpatients, who were receiving corticosteroids, during a 7‐week period at a tertiary referral hospital was undertaken. Patients receiving at least prednisolone 5 mg for greater than 3 months were examined via a detailed patient interview and investigation of medical records. The type of treatment, indication and presence of other risk factors for osteoporosis were documented.Results51 patients were identified: 32 (63%) were being treated for the prevention or treatment of corticosteroid‐induced osteoporosis; 4 (8%) for primary prevention and 28 (55%) for secondary prevention and treatment. The remaining 19 (37%) were not on any treatment. Only 15 (29%) patients were receiving optimal therapy, as described by Australian standards.ConclusionA significant proportion of patients taking prolonged oral corticosteroids were not receiving adequate therapy for the prevention and treatment of corticosteroid‐induced osteoporosis.
Victorian Hospital Pharmacy Technician Workforce Survey
Authors: O'Leary Karen M , Harding Andrew , Rocca Joanne 
Published: April 2015

ABSTRACTAimTo collect data to assist in the preparation of a revised enterprise bargaining agreement and award for Victorian hospital pharmacy technicians.MethodAn electronic questionnaire was sent to a representative at each hospital pharmacy service in Victoria who then circulated the questionnaire within their department for completion by every person employed as a hospital pharmacy technician.ResultsThe survey confirmed that Victorian hospital pharmacy technicians undertake an extensive range of activities. Findings of note included: 28% had more than 10 years experience as a hospital pharmacy technician; 24% had less than 2 years experience; 32% had, or were undertaking Certificate III or IV in Health Service Assistance qualifications. Respondents working in hospitals with less than 200 beds were more likely to have Certificate III in Health Service Assistance qualifications. 47% of the 126 respondents indicated that they support clinical pharmacy activities as part of their day‐to‐day activities. 76% were paid award rates. Technicians paid above award rates had the following characteristics: more than 5 years experience; Certificate III or IV in Health Service Assistance qualifications; employed as grade 2 technicians; work in metropolitan hospitals and work in hospitals with less than 200 beds. 40% were involved in supporting clinical pharmacy and 40% undertook management activities. Respondents estimated that in total they spent 80% of their time on distribution services; 9% of their time on management services and 10% supporting clinical pharmacy services.ConclusionThis survey demonstrated that in Victoria there is a disconnection between the work performed by hospital pharmacy technicians, their qualifications and their remuneration. It is hoped that a revised enterprise bargaining agreement and award will provide incentives and a career structure that encourages many to pursue formal qualifications.
Problems with Medication Use in the Elderly: An Australian Perspective
Authors: Elliott Rohan A 
Published: April 2015

ABSTRACTPharmacotherapy is an essential component of medical care for older patients, and around two‐thirds of Australians over the age of 60 years use 4 or more drugs. Although polypharmacy is a well‐known risk factor for adverse drug events, use of multiple drugs may be unavoidable in the elderly with multiple comorbidities. While there have been concerns about inappropriate prescribing, polypharmacy and non‐adherence, it is now recognised that there are a broader range of drug‐related problems that need to be addressed. These include suboptimal monitoring of drugs, poor medication management in patients' homes, under‐prescribing and poor communication between health professionals. This is a review of the Australian literature on problems with medication use in the elderly, with guidelines for improving the quality of medicine use in this population.
Stability of Mixtures Formulated from Warfarin Tablets or Powder
Authors: Sharley Nicholas A , Yu Annie MC , Williams Desmond B 
Published: April 2015

ABSTRACTBackgroundAlthough warfarin is a commonly prescribed oral anticoagulant, published data on the stability of mixtures prepared from warfarin tablets are limited.AimTo investigate the stability of mixtures formulated using Coumadin tablets, Marevan tablets or warfarin sodium clathrate.MethodA stability indicating high performance liquid chromatography (HPLC) method was developed to determine the concentration of warfarin. Warfarin sodium clathrate was forcibly degraded and injected into the HPLC system to ascertain lack of interference from degradation product peaks from the warfarin peak. Warfarin mixtures (1 mg/mL) were prepared in triplicate from Coumadin tablets, Marevan tablets and warfarin sodium clathrate using compound hydroxybenzoate solution APF as a preservative. A four‐level calibration was used. On each study day each sample was injected into the HPLC system in duplicate together with quality control standards and blanks. Warfarin concentrations were calculated from the linear regression equation derived from the calibration curve.ResultsThe method was stability indicating as the degradation peaks did not interfere with the principal peak and UV spectral confirmation was used to identify the warfarin peak. All mixtures retained at least 98% of their original concentration over the 28‐day study period.ConclusionWarfarin mixtures can be formulated by either suspending crushed tablets or preparing a solution from warfarin sodium clathrate. Compound hydroxybenzoate solution APF can be used as the preservative. A 28‐day shelf‐life can be assigned to the products.
Measuring the Time Required to Provide Components of Clinical Pharmacy Services
Authors: Stuchbery Peter , Kong David CM , DeSantis Giovanna N , Lo SK 
Published: April 2015

ABSTRACTAimTo determine the time spent by pharmacists on components of clinical pharmacy services using chosen recording tools.MethodA 4‐week study was conducted at an acute general hospital in early 2006. Pharmacists completed Pharmaceutical Clinical Pathway (PCP) forms and recorded the time needed for its completion. Other activities not associated with completing PCP forms (e.g. medication chart review, clinical review, adverse drug reaction monitoring, therapeutic drug monitoring, provision of drug information) and the time needed to complete these were recorded on Clinical Activity Data Sheets (CADS). Finally, pharmacists recorded their interventions (and the time involved) directly into the Riskman database.Results204 PCP forms were completed. Pharmacists completed the medication history component of the PCP form and recorded the time in 92% of completed forms. The most commonly recorded time for this component of the PCP form was 6 to 10 minutes. There were 418 CADS completed with the most recorded activities being clinical review (355 occasions) and medication chart review (351 occasions). The least recorded activity was adverse drug reaction monitoring (20 occasions). The time for these activities was recorded on more than 97% of CADS completed with mean times ranging from 4.9 minutes (therapeutic drug monitoring) to 6.9 minutes (provision of drug information). 202 interventions were entered into the Riskman database and the time was recorded for 98% of these (mean time 8.8 minutes).ConclusionThe chosen recording tools measured the times required for the provision of a range of activities provided by a clinical pharmacy service.
Psychotropic Medication Use in Older People
Authors: Hopwood Malcolm J 
Published: April 2015

ABSTRACTOlder people have high rates of mental health disorders such as mood and anxiety disorders, bipolar affective disorder, psychotic disorders, and dementia. All of these disorders are associated with significant morbidity and mortality and have been historically under‐recognised and under‐treated. Recent advances in psychopharmacology have brought great benefit to many young patients with these conditions where they are supported by a clear evidence base. To date, this evidence base has been incompletely developed for older people leaving the prescriber with many difficult decisions. There is moderate and growing evidence supporting the use of antidepressants in this population. The use of mood stabilisers and antipsychotics for indications other than the behavioural and psychological symptoms of dementia currently occurs in the absence of effective evidence.
Reporting Purchasers of Pseudoephedrine Products to Police: New Zealand Community Pharmacists' Experiences
Authors: Sheridan Janie , Kairuz Therese , Butler Rachael 
Published: April 2015

ABSTRACTBackgroundPseudoephedrine is the precursor of choice for the illicit manufacture of methamphetamine, much of which is obtained through purchases of pseudoephedrine products from community pharmacies.AimTo investigate issues surrounding data collection by community pharmacists in New Zealand on purchasers of pseudoephedrine products and its provision to police.MethodQuestionnaires were mailed to a random sample of 50% of community pharmacies in New Zealand, with a second mailing to non‐responders.ResultsThere was a response rate of 63%. 95% of pharmacists limited the quantity of pseudoephedrine products sold on each occasion. 45% asked for identification from all purchasers. Requesting/collecting identification resulted in various problems such as dealing with aggressive customers, and requiring time to attend court cases as a result of data provided to police. A major issue identified was the lack of feedback from police on information that had been provided. Nonetheless, there was support amongst pharmacists to continue to collect this information.ConclusionAlthough there were a number of problems encountered by pharmacists, many of these can be overcome.
Using Personal Digital Assistants for a Pharmacist Intervention Monitoring Database: Cost Analysis
Authors: To Timothy HM , Spurling Lisa K , Mangoni Arduino A , Eaton Vaughn S 
Published: April 2015

ABSTRACTBackgroundClinical pharmacists play an important role in inpatient care; however, their contribution and resultant cost savings are often difficult to define and quantify.AimTo evaluate the use of the pharmacist intervention monitoring (PIM) tool on personnel digital assistants (PDAs) in documenting pharmacy interventions, quantify pharmacy interventions in cost savings, and demonstrate their contribution to inpatient care.MethodThe study was undertaken on 3 hospital wards over 4 weeks. 2 clinical pharmacists prospectively recorded all interventions, defined as any action that directly resulted in a change to patient management, monitoring or therapy. The interventions likely to affect length‐of‐stay were reviewed by a panel who estimated the likely change in length‐of‐stay, and thus savings in bed‐days and potential cost.Results179 interventions were documented from a review of 204 drug charts. 22 interventions (12%) prevented major harm, 86 (49%) moderate harm, 65 (36%) minor harm and 6 (3%) were of no clinical significance. 63 interventions were likely to have affected length‐of‐stay, with an estimated 40.3 bed‐days saved, and calculated savings of $13 685.ConclusionThis pilot demonstrated the usability of the PIM tool to document clinical interventions by pharmacists on PDA, and provided evidence of the cost‐effectiveness of a clinical pharmacy service.
Australian Electronic Medication Management Policy and Systems
Authors: Ryan Michael J 
Published: April 2015

ABSTRACTAimTo investigate and describe the policies and activities of Commonwealth and state/territory health departments in regard to electronic medication management (EMM); and to evaluate the EMM systems available to Australian hospitals for usability, functional capabilities and system readiness.MethodA literature review of EMM systems was conducted, governments were contacted to gather data on policy and initiatives related to EMM systems, and vendor EMM systems were evaluated using ‘key principles' and ‘core features' criteria related to knowledge base, database, functionality and usability, and organisational aspects.ResultsThere is an abundance of data demonstrating the benefits of EMM systems but also an increasing number of reports of lessons learnt from their implementation. The Commonwealth sees its role as encouraging the adoption of electronic records and standardised ways of describing health products and terminology. The states and territories have approached EMM systems in various ways, from considering EMM as part of a state‐wide e‐Health strategy (Vic., SA, Qld, NSW), to trialling EMM or part EMM systems (SA, NT), to developing business cases or watching developments in other states (Tas., WA, ACT). 11 vendor EMM systems were evaluated using a continuous scale.ConclusionThere is good evidence of benefits with EMM systems, but there are many change management issues which need to be addressed. The Commonwealth appears focused on standards and interoperability. There is slow progress in a number of states towards EMM systems. There are a number of developed and proved vendor EMM systems available to Australian hospitals.
Pharmacological Management of Pain in Older People
Authors: Katz Benny 
Published: April 2015

ABSTRACTThe prevalence of pain increases with advancing age. Pain is often undiagnosed or under‐treated in older patients, particularly those with cognitive impairment, communication problems or residents of aged‐care facilities. The most definitive approach to the management of pain is to treat the underlying cause. As this is often not feasible in the elderly, the emphasis then shifts to symptom control. Pharmacological approaches form the mainstay of therapy. They are convenient and often cost‐effective, and may be used alone, or in combination with physical and psychological therapies.