bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stability of Frusemide Tablets Repackaged in Dose Administration Aids
Authors: Bowen Luke , Mangan Martina , Haywood Alison , Glass Beverley 
Published: April 2015

ABSTRACTBackgroundRepackaging tablets into a dose administration aid (DAA) requires that the pharmacist consider the stability of the active pharmaceutical ingredient and the excipients of the drug product. Frusemide is susceptible to photodegradation and is commonly repackaged into DAAs.AimTo evaluate the stability (chemical and physical) of frusemide tablets repackaged into DAAs.MethodFrusemide tablets repackaged into DAAs were evaluated for physicochemical stability over a period of 8 weeks at a controlled room temperature (25 ±2 °C) and other relevant in‐use conditions. In addition, photostability studies were performed according to the International Committee on Harmonisation (ICH) guidelines.ResultsChemical stability was confirmed for all storage conditions, including the ICH light conditions, with the frusemide content within the British Pharmacopoeial range of 95 to 105%. Although the physical stability was confirmed by all tests (weight uniformity, hardness, friability, disintegration, dissolution), storage in a simulated pharmacy environment after one week and exposure to ICH light conditions resulted in a yellow colouration of the tablets.ConclusionAlthough the chemical and physical stability of frusemide was within acceptable limits during the study, the discolouration of the tablets from light exposure is unacceptable. It is recommended that DAAs are stored protected from light immediately after repackaging with frusemide tablets, and that patients are counselled to store the DAA in a cool dark place.
General Practitioner Perceptions of Extended Pharmacy Services and Modes of Collaboration with Pharmacists
Authors: Van Connie , Krass Ines , Mitchell Bernadette 
Published: April 2015

ABSTRACTAimsTo explore the perceptions of Australian general practitioners (GPs) towards extended pharmacy services, and to investigate the modes and extent of collaboration between community pharmacists and GPs.MethodSemi‐structured face‐to‐face and telephone interviews were conducted on a purposive sample of GPs from Sydney and surrounding areas. The data were thematically analysed, using qualitative data analysis software.Results23/68 (34%) GPs approached, agreed to participate in the interviews. The respondents practised in different settings (private/medical centre/specialised settings, rural/suburban/city areas), had been in professional practice for periods ranging from 6 months to several decades and included both female and male practitioners. Support for pharmacist provision of services varied. GP perceptions were mostly positive for home medicines review (HMR), information provision and monitoring. However, most GPs did not favour pharmacists' provision of screening and immunisation services. Most respondents believed that GP‐pharmacist collaboration would be beneficial to both the patient and the GP. However, despite this, collaboration was minimal in all extended pharmacy services discussed except HMR.ConclusionHMR is the extended pharmacy service most widely accepted by GPs and has proved to be an effective platform for inter‐professional collaboration. Considering the factors that promote effective collaboration in HMR will position us better to improve the GP‐pharmacist collaboration crucial for expanding other extended pharmacy services.
Extemporaneous Compounding in Queensland Hospitals
Authors: Cook Graham K , Ling Joanna WH , Lee Robin 
Published: April 2015

ABSTRACTBackgroundExtemporaneous compounding is common pharmacy practice when commercially‐available registered products do not exist. While extemporaneously compounded preparations provide access to medication, there are concerns about the quality, safety and efficacy of these products.AimTo examine the extent and quality of extemporaneous compounding within Queensland public hospital pharmacy departments from an organisational perspective.MethodAn e‐mail questionnaire was sent to all Queensland public hospital pharmacy departments staffed by pharmacists requesting details of their extemporaneous dispensing activities. A computer search of manufactured formulations on the Queensland Health pharmacy information management system was used to supplement data obtained from the questionnaire.Results95 formulations were prepared by 28 hospital pharmacies. Different formulations of the same active ingredient were recorded in 7 instances. Stability data supporting assigned expiry dates was available for 74 (78%) preparations. Other issues with potential to impact on patient safety included extrapolation of stability data from other formulations and product type, multiple presentations and strengths of the same formulation, and the use of alternative dosage forms as a source for active ingredient in 70% of preparations (90% of mixtures and suspensions).ConclusionsThe results identified areas for improvement to the quality of extemporaneous compounding. These include use of stability data to assign expiry dates, standardisation of formulation, and use of raw material as a source of active ingredient. Utilisation by hospital pharmacies of a resourced, central manufacturing facility is identified as a potential vehicle to achieve these improvements.
Recombinant Erythropoietin for Anaemia of Prematurity—When Should Treatment Start?
Authors: Meyer Michael P 
Published: April 2015

ABSTRACTBackgroundRecombinant erythropoietin reduces blood transfusion requirements in preterm neonates weighing under 1000 g 30 days postpartum. The optimal timing of starting erythropoietin therapy to achieve this effect is unclear.AimTo ascertain the number of neonates receiving blood transfusions 30 days postpartum at an Auckland hospital.MethodIn this retrospective study, blood transfusion and donor requirements of a cohort of neonates starting treatment at 30 days of age were compared with a cohort treated at 14 days of age. Blood transfusion guidelines and treatment practices were the same for the two groups.ResultsThe two groups were comparable with regard to demographic characteristics. 16/26 (62%) neonates treated from 30 days and 14/35 (40%) neonates treated from 14 days received a blood transfusion 30 days postpartum. This 22% difference was not statistically significant. The number of neonates exposed to at least one new donor 30 days postpartum was reduced from 11/26 (42%) to 11/35 (31%) with earlier commencement of treatment (not statistically significant).ConclusionThere were trends suggesting that starting erythropoietin treatment from 14 days of age was beneficial in reducing blood transfusion and donor exposure compared to starting at 30 days. However, the differences were not statistically significant and definite conclusions cannot be reached.
Successful Introduction of Tallman Letters to Reduce Medication Selection Errors in a Hospital Network
Authors: Van de Vreede Melita , McRae Amy , Wiseman Meredith , Dooley Michael J 
Published: April 2015

ABSTRACTAimTo implement Tallman letters into the medication selection process at a hospital network, including dispensing and drug administration, to reduce errors associated with look‐alike sound‐alike (LASA) drugs.MethodThe 3 phases of the study were overseen by a working party consisting of pharmacists at the Alfred Hospital (May 2006 to May 2008). The 3 phases consisted of piloting Tallman letters in the pharmacy department, developing a LASA drug list appropriate to the hospital network, and implementing Tallman letters into the hospital network's medication selection process.ResultsA short LASA drug list was piloted in the inpatient dispensary for 6 months. When this was considered successful, a comprehensive LASA drug list was developed that consisted of 51 items to distinguish between generic names (n = 41), brand names (n = 6) and generic and brand name combinations (n = 4). Tallman letters were included into the pharmacy dispensing software. Finally, Tallman letters were implemented across the 3 hospitals in the network, i.e. 7 dispensaries and 40 ward medication storage areas.ConclusionTallman letters were successfully introduced and implemented into a hospital network. This was achieved with the expenditure of minimal resources and has improved safety by minimising the risk of selecting the wrong medication.
Daily Intravenous Chloride Load and the Acid‐Base and Biochemical Status of Intensive Care Unit Patients
Authors: Klemz Katja , Ho Lisa , Bellomo Rinaldo 
Published: April 2015

ABSTRACTBackgroundStudies have described the development of metabolic acidosis after the rapid intravenous administration of large amounts of chloride‐rich solutions. There are little data on the effect of daily intravenous fluid therapy within the intensive care unit.AimTo test the correlation between daily intravenous chloride load and the acid‐base and biochemical status of intensive care unit patients.MethodData were prospectively collected on the type and volume of intravenous fluids administered to intensive care unit patients over 24–hour cycles. Correlation was then tested between daily chloride load and the acid‐base and biochemical variables obtained from the first morning measurement of arterial blood gases on the following day.Results49 patients were audited. 30 (61%) patients had hyperchloraemia on intensive care unit admission with a median serum chloride level of 108 mmol/L (range 87–123); 32 (65%) patients had a negative base excess above −2 mEq/L and 11 (23%) patients had a bicarbonate level below 22 mmol/L. The median daily amount of chloride administered was 88.5 mmol (range 0–732). There was a statistically significant negative correlation between total chloride intake and serum bicarbonate (p < 0.0002), base excess (p < 0.0002), pH (p < 0.006), sodium chloride difference (p < 0.0001) and a positive correlation with serum chloride concentration (p < 0.006).ConclusionThe daily chloride load significantly influenced the acid‐base and biochemical status of intensive care unit patients. The higher the chloride load, patients are more likely to develop metabolic acidosis, hyperchloraemia and decreased sodium chloride difference.
Monitoring Physical Health and Adverse Effects in Children and Adolescents Prescribed Antipsychotics
Authors: Grzeskowiak Luke E , Ellis David P , Phillips Adam J , Angley Manya T 
Published: April 2015

ABSTRACTBackgroundThe adverse effects and long‐term health risks associated with antipsychotic use means that monitoring children and adolescents prescribed these medications is important.AimTo implement an evidence‐based chart and guideline to monitor physical health and adverse effects in children and adolescents prescribed antipsychotics in a range of practice settings; and to identify the barriers and benefits of implementation.MethodUsing an action research approach a pilot trial was undertaken to implement a chart and guideline in a range of practice settings. Patient and health professional resource kits and an information compact disc were produced to facilitate implementation. Barriers identified during implementation were doctor/health professional, patient‐related and environmental. Carer and doctor satisfaction questionnaires were administered to assess the implementation process and evaluate the quality and usefulness of the monitoring chart and guideline.Results10 doctors were recruited to participate in the implementation trial and 21 patients prescribed antipsychotics were enrolled. Monitoring data collected retrospectively from patients' case notes, such as weight/height measurements and haematological monitoring were congruent with the guideline in 41% and 29% of patients respectively. Carer and doctor satisfaction questionnaires indicated that the monitoring package was well received and raised awareness of potential adverse effects and the importance of monitoring.ConclusionThe monitoring package can bridge the evidence to practice gap regarding monitoring physical health and adverse effects in children and adolescents prescribed antipsychotics.
Medication Use by Australian War Veterans in Residential Aged‐Care Facilities
Authors: Roughead Elizabeth E , Gilbert Andrew L , Woodward Michael C 
Published: April 2015

ABSTRACTBackgroundThere has been concerns about the appropriateness of medication use in Australian residential aged‐care facilities. Data on overall medication use in aged‐care has been unavailable.AimTo examine medication use for Australian war veterans in residential aged‐care facilities.MethodAn observational study using the Department of Veterans' Affairs' pharmacy claims database was undertaken. Veterans resident in aged‐care facilities between April and June 2005 were included. Veterans using gastrointestinal, analgesic, psychotropic, antiinfective and cardiac drugs were assessed.ResultsAll 16 126 veterans (5% of the veteran population) identified as residing continuously in aged‐care facilities were included (average age 86 years). Those with low‐care needs (44%) were dispensed on average 9 (SD 5) different medicines, while those with high‐care needs (56%) were dispensed 8 (SD 5) different medicines. More than 50% of veterans were dispensed analgesics, predominantly paracetamol, and over 60% psychotropic drugs. In all, 35% were receiving antidepressants, proton pump inhibitors and antibacterials.ConclusionVeterans residing in aged‐care facilities are taking high levels of medications, particularly analgesics, psychotropics, antibacterials, laxatives and proton pump inhibitors, for which studies have demonstrated concerns about their appropriateness.
Intravenous Potassium Chloride Use in Hospitals: Current Practice
Authors: Van De Vreede Melita A , Wilson Sally G , Dooley Michael J 
Published: April 2015

ABSTRACTAimTo assess if current hospital practice reflected the Australian Council for Safety and Quality in Health Care's 2003 recommendation to remove potassium chloride ampoules from general wards; to identify where premixed potassium chloride infusions and ampoules are used; and if the lessons learnt and safety improvements introduced in 2003 had been sustained.Method25 hospitals in Victoria were surveyed by telephone interview in May/June 2006 regarding their use of intravenous potassium chloride. Hospitals surveyed included city and country, large and small.ResultsAll of the hospitals surveyed, apart from 2, had removed potassium chloride ampoules from their general wards at the time of the survey and 6 no longer stocked any potassium chloride ampoules. Potassium chloride ampoules tended to be used in specialty areas such as intensive care, cardiac and haematology/oncology, although this varied among hospitals. All of the hospitals were using premixed potassium chloride infusions. 23 hospitals had a potassium chloride administration policy.ConclusionThere was awareness in hospitals about the risks of intravenous potassium chloride but there was concern that staff would forget over time and hence the need for ongoing education. Further investigation into barriers to the use of premixed infusions needs to focus on specialist areas, which tend to be where potassium chloride ampoules are still used.
Co‐Dispensing of Contraindicated Drugs with Cisapride
Authors: Boyd Ian W , McEwen John , Calcino Lisa J , Zhang Judy Y , Walsh Robert L 
Published: April 2015

ABSTRACTAimTo measure the rate of co‐dispensing of contraindicated drugs with cisapride 12 months prior to and 12 months after a period of publicity; and to assess the impact of the publicity, the ‘Dear Healthcare Professional letters‘, changes to the product information and pharmaceutical benefits subsidy restrictions.MethodMedicare Australia's Pharmaceutical Benefits Scheme database was searched to identify a cohort of patients who had been dispensed both cisapride and a contraindicated drug in a 12‐month period before and after a period of publicity.ResultsThe number of patients dispensed cisapride fell from 42 319 in 1998 to 2849 in 2001 after the publicity, and significantly after the restriction was placed on cisapride as a pharmaceutical benefit in 2000. In 1998, 11% of patients were dispensed a contraindicated drug 30 days after cisapride dispensing and this figure fell to 9.7% in the 2001 cohort. When the analysis was restricted to the dispensing of the specific drugs that had been named in the publicity letters (‘named’ drugs), a contraindicated drug was dispensed to 3.3% in 1998 and 2.7% in 2001.ConclusionThe large fall in the use of cisapride from 1998 to 2001 was more likely due to the pharmaceutical benefits subsidy restrictions rather than the publicity or regulatory actions during 2000. While the proportion of patients who were dispensed a contraindicated drug showed a small fall, it was unlikely to be clinically significant. When the analysis was restricted to patients who were dispensed only a ‘named’ drug, the reduction from 1998 to 2001 was small and statistically insignificant. Sponsor‐initiated communication failed to ensure optimal prescribing and dispensing of drugs.
Australian Reports of Bleeding Complications Associated with Antithrombotic Drug Combinations
Authors: Ghiculescu Razvan A , Pillans Peter 
Published: April 2015

ABSTRACTBackgroundThe Australian Adverse Drug Reactions Advisory Committee (ADRAC) has received numerous reports of bleeding complications associated with the combined use of antithrombotic drugs (anticoagulants and/or antiplatelet drugs).AimTo review the ADRAC reports of major bleeding complications and determine the antithrombotic drug combinations implicated; and to establish the relevance of the voluntary ADRAC reporting data by comparing with published reports.MethodADRAC reports over a 6 year period from 1 January 2000 to 31 December 2006 were reviewed on the antithrombotic drugs involved, and the severity and nature of bleeding complications. Data were collated on patient demographics, and comorbidities.ResultsBleeding complications related to the combined use of antithrombotic drugs were described in 188 ADRAC reports over the 6 year period. 17.5% of the reports had a fatal outcome. The median age of patients was 76 years, 47% were men and the principal comorbid condition was renal impairment (8.5%). The antithrombotic drug combinations associated with the risk of mortality included aspirin and/or clopidogrel and heparins; aspirin and/or clopidogrel and warfarin; aspirin and/or clopidogrel co‐prescribed with heparins and glycoprotein IIb/IIIa inhibitors; aspirin and heparins co‐prescribed with tissue plasminogen activator drugs. Bleeding was reported to occur in the upper gastrointestinal tract (26%), central nervous system (21%) and retroperitoneal space (16%). Of the reports of cerebral haemorrhage, 14 reports (35%) were associated with mortality.ConclusionADRAC reports of major bleeding complications involving vital organs were associated with the combined use of anticoagulant and/or antiplatelet drugs and were frequently reported in older patients. These observations were supported by similar findings in published reports. These data highlight the risk associated with the use of antithrombotic drug combinations and the need for care in the clinical monitoring of patients.
Patient's Own Drugs and One‐Stop Dispensing: Improving Continuity of Care and Reducing Drug Expenditure
Authors: James C Robert , Leong Cherrie KY , Martin Robyn C , Plumridge Richard J 
Published: April 2015

ABSTRACTBackgroundThe use of patient's own drugs and one‐stop dispensing can reduce the risk of medication misadventure by refocusing pharmacy services from distributive functions to improving patient clinical review from admission to discharge. Changing practice to adopt these programs will contribute towards greater compliance with accepted standards of practice for appropriate, safe and effective use of medicines.AimTo estimate the cost savings associated with patient's own drugs and one‐stop dispensing using the Pharmaceutical Benefits Scheme.MethodPatient's own drugs use and hospital‐initiated drugs were recorded on 4 wards over a 26 day period and the costs determined.ResultsUse of patient's own drugs on the 4 wards resulted in estimated annual savings of 9.92% (percentage of total hospital drug expenditure).ConclusionPatient's own drugs and one‐stop dispensing can improve the continuity of care, quality use of medicines, and result in significant cost savings.
Developing an Outpatient Heart Failure Pharmacy Service
Authors: Hargraves Tracey‐Lea , Bennett Alexandra A , Brien Jo‐anne E 
Published: April 2015

ABSTRACTBackgroundHeart failure is a progressive disease with a high mortality rate and significant cost burden. Various roles have been proposed for pharmacists in the multidisciplinary outpatient care of heart failure patients. In 2002, an outpatient heart failure pharmacy service was established in the Heart Lung Clinic, St Vincent's Hospital, Sydney.AimTo describe the patients attending the Heart Lung Clinic on the days that the outpatient heart failure pharmacy service was available, including patients using the service; the pharmacy activities delivered to patients; and to measure patient satisfaction with the service.MethodData were collected prospectively over 4 weeks. Patient medical records were manually reviewed. Documented pharmacy activities were classified using the ICD‐10‐AM codes for pharmacy‐specific activities. A self‐administered patient satisfaction survey was used.ResultsOf the 46 patients included in the study (mean age 56 SD 16 years), 36 patients had heart failure as the primary diagnosis for referral. 11/36 patients had preserved left ventricular ejection fraction, 28 patients were prescribed angiotensin converting enzyme inhibitors, and 28 patients were prescribed beta‐blockers. 17 patients used the outpatient heart failure pharmacy service. Medication order review, clinical review and medication counselling were the most frequently documented pharmacy activities. 15/16 patient satisfaction surveys were returned. Mean satisfaction score was 4.64 (maximum score = 5).ConclusionData obtained were used to streamline the outpatient heart failure pharmacy service at the Heart Lung Clinic.
Vitamin B12 Deficiency in the Elderly using Metformin Long Term: Prevalence and Relationship to Putative Risk Factors
Authors: Sorich Wassana , Stranks Steve N , Kowalski Stefan R , Kuruvila Manoj T , Sorich Michael J 
Published: April 2015

ABSTRACTAimTo determine the prevalence of vitamin B12 deficiency in elderly patients using metformin long term and to assess putative risk factors for reduced vitamin B12 concentrations.MethodPatients using metformin for more than 2 years admitted to or reviewed in the Repatriation General Hospital from June to December 2006 were enrolled in this cross‐sectional study. The prevalence of vitamin B12 deficiency and the association between vitamin B12 deficiency and putative risk factors were determined.Results60 patients were recruited. Of the 53 patients not taking vitamin B12 supplements, 8 (15%; 95%CI 7.2–28.1) were vitamin B12 deficient (83–148 pmol/L). 7 patients taking vitamin B12 supplements had statistically significantly higher serum vitamin B12 concentrations and decreased B12 deficiency. Daily metformin dose was associated with a statistically significant negative correlation with vitamin B12 concentration and was statistically higher in vitamin B12‐deficient patients. Duration of metformin therapy, age and use of proton pump inhibitors or calcium supplements were not statistically significantly associated with vitamin B12 concentration or deficiency.ConclusionElderly patients taking metformin should be monitored for vitamin B12 status, especially those on high doses of metformin. Vitamin B12, but not calcium, supplements should be considered to prevent or correct deficiency.