bluuebunny/crossref_metadata_2025_split huggingface dataset:
Introducing a Daily Patient Report for Clinical Pharmacists
Authors: Ryan David M 
Published: April 2015

ABSTRACTFinding current and relevant data from the various information technology systems throughout a hospital can be a time consuming and tedious. Patient demographics, diagnosis, laboratory results and medication use data are stored across many different information systems and these must all be accessed individually. A report was designed to bring all the information together and, after a trial period, was introduced to our clinical pharmacists. Further enhancements have been made to flag abnormal laboratory results and patients receiving warfarin. The report also calculates an estimated creatinine clearance for every patient based on their most recent serum creatinine concentration and ideal body weight. The report has reduced the amount of time pharmacists spend retrieving patient information.
Complementary Medicines Use by Australian Veterans
Authors: Ientile Clare S , Sorensen Lene , Lemanski Lindsay , Roberts Michael S 
Published: April 2015

ABSTRACTAimTo determine the prevalence of complementary medicines use by Australian war veterans.MethodThe presence and use of complementary medicines and conventional medicines were recorded during home visits of 1082 veterans and war widow(er)s in five Australian states.Results405 (37%) veterans had complementary medicines. Vitamins and minerals were most common (88%), followed by supplements (21%) and herbals (18%). GPs had documented complementary medicines use for 59% of the 405 veterans. 31% of the veterans were at risk of potential interactions.ConclusionComplementary medicines are growing in popularity and pharmacists should be responsible for understanding their risks and benefits, and provide education to enhance the quality use of all medicines.
Impact of COX‐2 Inhibitors in Thai Orthopaedic Outpatients
Authors: Phosri Jitsuda , Kulsomboon Vithaya , Kiatying‐Angsulee Niyada 
Published: April 2015

ABSTRACTBackgroundPrescribing of cyclo‐oxygenase ‐2 inhibitors (coxibs) has had an economic impact on patients and overall healthcare costs in Thailand.AimTo analyse the pattern of coxib use and to determine the cost impact of inappropriate use.MethodA random retrospective sample was selected from two months of prescribing data. There were 519 prescriptions for coxibs and 594 prescriptions for conventional non‐steroidal anti‐inflammatory drugs (NSAIDs). Appropriate use was based on the UK National Institute for Clinical Excellence criteria.Results208 (40%) patients receiving coxibs and 113 (19%) patients receiving conventional NSAIDs were at high risk for upper gastrointestinal adverse effects. Of those receiving coxibs, 112 (22%) received coxibs alone and 159 (31%) also received gastro‐protective agents. The cost of inappropriate use of coxibs in patients at a low risk of gastrointestinal effects was 2.4 million Baht/year. The excess cost, adjusted for the most commonly prescribed conventional NSAIDs (diclofenac 25 mg, Voltaren 25 mg, and ibuprofen 400 mg), were 3.4, 1.1 and 3.2 million Baht/year, respectively.ConclusionInappropriate use of coxibs resulted in excessive expenditure and specific pharmacy intervention would be required to reduce the cost impact.
Establishing the Role of a Clinical Pharmacy Technician
Authors: Turner Sarah J , Lam Skip S , Leung Benjamin K , Toh Cjeng T 
Published: April 2015

ABSTRACTAimTo demonstrate quantitatively the range and extent of a clinical pharmacist's activities that can be delegated to pharmacy technicians without compromising patient care.MethodAll activities undertaken by the clinical pharmacist were evaluated and reassigned to the technicians if they met strict criteria. A job description for the technician was developed and approved by management and staff pharmacists. Data were collected and assessed prospectively for three staffing models: original model (1 pharmacist:30 beds, no technician); initial model (1 pharmacist:45 beds, 1 technician); and revised model (1 pharmacist:40 beds, 1 technician). The following key performance indicators were collected by clinical pharmacists before and after implementing the new models: number of clinical interventions recorded; number of medication history interviews completed; time lapsed after admission before a medication history interview is completed; and a surrogate indicator of pharmacy workload.ResultsThe initial model showed a negative outcome in all areas and resulted in the model being revised. The revised model demonstrated that there was no negative difference in the key performance indicators compared with the original model.ConclusionWard pharmacy technicians can assist pharmacists in achieving optimum patient care and quality use of medicines.
Pharmacist Prescribing: Views of Australian Hospital Pharmacists
Authors: Hanes Carissa A , Bajorek Beata V 
Published: April 2015

ABSTRACTAimTo explore the views of a sample of Australian hospital pharmacists on prescribing privileges.MethodThe study involved a questionnaire and a focus group discussion for hospital pharmacists and teacher practitioners. Participants could participate in either or both of these activities.Results15 pharmacists completed the questionnaire and 8 participated in the focus group discussion. Several models of pharmacist prescribing (discharge and specialist settings) were seen to be appropriate and useful to Australian practice. 93% of pharmacists noted that prescribing privileges would enable them to provide more efficient/improved pharmaceutical care; 64% that prescribing would result in reduced healthcare costs; and all noted physician opposition as a barrier. Pharmacists indicated that they already prescribed on an ‘unofficial’ basis. Training and accreditation beyond registration was deemed necessary by all pharmacists.ConclusionHospital discharge or specialist settings may be most appropriate to pilot pharmacist prescribing in Australia. Further research on a larger scale is needed to provide a base of evidence before this practice is pursued.
Thiopurines for Inflammatory Bowel Disease: Role of Pharmacogenetics
Authors: Hadithy Asmar FY Al , Naunton Mark , Brouwers Jacobus RBJ 
Published: April 2015

ABSTRACTThere is a growing interest in the use of thiopurines for inflammatory bowel disease. Pharmacogenetic insights suggest that the genetic profile of thiopurine S‐methyltransferase and inosine triphosphate pyrophosphatase may affect the clinical response to thiopurines. This is a review on the pharmacogenetics of these enzymes and highlights difficulties that impede prior‐to ‐treat pharmacogenetic testing for the thiopurines in practice.
Hypothermia Associated with Olanzapine
Authors: Chu Kwok‐Pui Jody , Nyfort‐Hansen Karin 
Published: April 2015

ABSTRACTBackgroundHypothermia is a rarely reported and under‐recognised adverse reaction to antipsychotics. Although the mechanism of antipsychotic‐induced hypothermia is not fully understood, antipsychotics that are more potent antagonists at 5‐HT2 than at dopamine2 receptors appear more likely to cause hypothermia.AimTo describe a case of hypothermia possibly associated with olanzapine.Clinical featuresA 94‐year‐old woman was admitted to hospital with acute confusion and hypothermia (31.9 °C). Her medical history included hypothyroidism, and delusions and hallucinations, for which olanzapine had been prescribed 4 days before admission. On admission she was found to have hypercalcaemia, iron deficiency, normal free thyroxine, raised thyroid stimulating hormone, evidence of recent exposure to pesticides, and a generalised erythematous rash.OutcomeWithdrawal of olanzapine 4 days after admission was associated with an increase in body temperature (36–37 °C) and resolution of her confusion and rash.ConclusionClinicians should consider the possibility of drug‐induced illness in hypothermic patients who are taking antipsychotics.
Influence of the National Hospital Pharmaceutical Strategy on the Assessment of New Medicines in New Zealand Public Hospitals
Authors: Tordoff June M , Norris Pauline T , Kennedy Julia M , Reith David M 
Published: April 2015

ABSTRACTBackgroundIn 2002, New Zealand's Pharmaceutical Management Agency (PHARMAC) began implementing the National Hospital Pharmaceutical Strategy (NHPS) with the assessment of new medicines as a key area of focus.AimTo determine the influence of the NHPS on processes for assessing new medicines in New Zealand public hospitals.MethodIn July 2002, and in July 2004, a questionnaire‐based, cross‐sectional survey was undertaken of the processes used for assessing new medicines in all New Zealand public hospitals that employed one or more pharmacists.ResultsFor both surveys a 97% response rate was achieved, 75% of hospitals used formal assessment processes, 93% had multidisciplinary Medicine and Therapeutics Committees, and over 75% of new medicine applications were approved by these committees and budget holders. 16 hospitals used application forms in 2002 and 18 in 2004. In both surveys over 75% of forms required efficacy, safety and cost data. By 2004, questions on cost effectiveness and prescribing restrictions significantly increased (p ≤ 0.05), more supplementary questions were asked (p ≤ 0.001), and 11 hospitals introduced questions from a PHARMAC template. By 2004, pharmacy/pharmacology departments and clinicians provided more pharmacoeconomic data for assessments than in 2002.ConclusionThe NHPS appears to have influenced the assessment of new medicines in New Zealand public hospitals. In both surveys, hospitals used formal assessment processes and key considerations were efficacy, safety and acquisition cost. By 2004, cost‐effectiveness became an important consideration, more hospitals used application forms, forms were more complex and use of pharmacoeconomic data increased.
Patients' Understanding of Drug Allergy and Documentation—Is There a Link?
Authors: Sim Lily , Barras Michael , Cottrell Neil 
Published: April 2015

ABSTRACTBackgroundRe‐exposure to a drug to which one is allergic is a preventable adverse drug event. There is a reliance on the patient to provide accurate information on their allergies for the purpose of complete documentation.AimTo investigate the relationship between patients' understanding of their drug allergy and documentation of their allergy status in their hospital records.MethodA structured interview of inpatients identified whether they had a drug allergy. Patients were then assessed on their ability to distinguish the symptoms of an allergic reaction from those of an adverse effect and stratified into groups based on their level of understanding. Review of drug charts and medical records identified both the presence and quality of documentation.ResultsOf the 250 patients interviewed, 95 (38%) had previously experienced a true allergic reaction to a drug. A good understanding of the symptoms associated with an allergic reaction was demonstrated by 48 (51%). 50 (53%) patients had their allergy documented on their medication chart and 69 (73%) in their medical records. 18 (19%) patients had no documentation of their allergy status. There was a trend that good understanding of allergy may lead to improved completeness of documentation but this did not reach statistical significance.ConclusionPatients' understanding of drug allergy improved the quality of documentation. System changes need to ensure proper training of staff to take and record drug allergies.
Ximelagatran Cost Effectiveness for Stroke Prevention in Atrial Fibrillation
Authors: Valiya Shabnam N , Bajorek Beata V 
Published: April 2015

ABSTRACTBackgroundThe benefit of warfarin for stroke prevention in non‐valvular atrial fibrillation has been demonstrated in various clinical trials. Warfarin has a narrow therapeutic window and carries a significant risk of bleeding. Ximelagatran is a new oral antithrombotic with predictable plasma concentrations and excellent bioavailability.AimTo compare the costs and benefits of ximelagatran to that of warfarin and aspirin.MethodIn a preliminary cost‐effectiveness analysis, the costs and clinical consequences of warfarin, aspirin and ximelagatran were compared. The principal outcome was measured in the form of an incremental cost‐effectiveness ratio. A decision analysis model was constructed to map the expected outcomes of three treatment alternatives. Sensitivity analysis tested the robustness of the data.ResultsWarfarin appeared to be most cost effective in this clinical setting. The incremental cost‐effectiveness ratio indicated that the use of ximelagatran in preference to warfarin would cost an additional $272 000/patient/year. Likewise the use of ximelagatran in preference to aspirin would cost an additional $13 000/patient/year.ConclusionXimelagatran appears to be cost effective in a small group of high‐risk patients. This may have implications for the development of treatment guidelines in this clinical setting.
Drug Information Services: Hospital Pharmacists' Utilisation and Opinion
Authors: Crank Mariana Y 
Published: April 2015

ABSTRACTAimTo evaluate utilisation of the NSW Medicines Information Centre and other drug information services, and to determine if on‐site drug information resources are meeting the needs of pharmacists in NSW public hospitals.MethodA questionnaire was formulated following a literature review and distributed to all NSW public hospital pharmacies. The survey inquired on recent use of the NSW Medicines Information Centre's services, if services were meeting needs, and the use of drug information resources apart from those available on‐site .Results57% of hospital pharmacies in NSW completed the survey. 63% of pharmacists felt that their drug information needs were not met by resources accessible on‐site . 80% of rural hospital pharmacists noted that on‐site resources did not meet their drug information needs.ConclusionDespite the increase in access to electronic drug information resources, NSW public hospital pharmacists rely on external drug information services (such as the NSW Medicines Information Centre) to meet their needs.
Providing HIV Education for Health Professionals in India
Authors: Duncan Alison J , Crowe Suzanne 
Published: April 2015

ABSTRACTAlthough around 5 million people in India have HIV/AIDS, there is limited access to information, diagnostic facilities and drugs. In recent years there has been an increase in the use of antiretroviral therapy in line with WHO global initiatives. A team from an Australian HIV centre provided education for nurses and laboratory technicians at urban and rural locations in India in 2005. The aim was to ensure that the antiretroviral therapy which would become more widely available was used correctly, to optimise response and limit the potential for antiviral resistance. The workshops were rewarding and participants requested further education opportunities and a wider range of topics.
Mirtazapine‐Induced Lower Limb Oedema
Authors: Das Rabindranath , Shankar P Ravi , Dhungana Krishna 
Published: April 2015

ABSTRACTAimTo describe a case of lower limb oedema possibly associated with the use of mirtazapine.Clinical featuresA 31‐year‐old male suffering from depression for the previous 6 years was changed from fluoxetine 20 mg daily to mirtazapine 37.5 mg daily. After 10 days he presented with fever, sore throat and swollen legs. Haematology and biochemistry results were normal.OutcomeThe oedema subsided within 5 days following the withdrawal of mirtazapine. A score of 5 was obtained using the Naranjo criteria suggesting that the reaction was probably due to mirtazapine. Serum mirtazapine levels were not measured and rechallenge was not undertaken.ConclusionThe lower limb oedema described was probably caused by mirtazapine.
Acute Adrenal Insufficiency—Withholding of Medicines in the Peri‐Operative Period
Authors: Poulson Louise K 
Published: April 2015

ABSTRACTBackgroundPatients with adrenal insufficiency cannot respond to stress by increasing secretion of endogenous cortisol and need supplemental steroid to avoid an acute adrenal crisis.AimTo describe a case of acute adrenal insufficiency due to withholding of oral cortisone during the peri‐operative period.Clinical featuresA 68‐year‐old male deteriorated during his hospital admission for septic arthritis. He was known to have panhypopituitarism following the resection of a pituitary adenoma. During admission, his regular doses of oral cortisone were withheld due to a pre‐operative nil‐by ‐mouth order. He became symptomatic of glucocorticoid deficiency and was subsequently treated with IV hydrocortisone.OutcomeThe patient recovered after receiving glucocorticoid replacement therapy.ConclusionPharmacists should ensure accurate drug histories are taken and provide guidance on medication management through the development of multidisciplinary pre‐operative guidelines.
Medication Regimen Complexity and Adherence in Patients at Risk of Medication Misadventure
Authors: George Johnson , Vuong Tam , Bailey Michael J , Kong David CM , Marriott Jennifer L , Stewart Kay 
Published: April 2015

ABSTRACTBackgroundDosage forms, dosing frequencies and additional instructions contribute to regimen complexity, which in turn is known to influence treatment outcomes.AimTo evaluate the relationship between complexity of medication regimens and adherence in patients at risk of medication misadventure.MethodA modified Morisky scale was administered to inpatients during their hospital stay. Complexity of the medication regimens at the time of hospital discharge was assessed using the Medication Regimen Complexity Index.ResultsThe 310 subjects had a mean age of 72 years and were using a mean of 10.4 prescribed medications. High adherence was self‐reported by 198 (64%) patients. Unintentional nonadherent behaviour was evident in 80 (26%) patients, while 51 (17%) patients admitted making intentional deviations from the recommended treatment. The reliability of the Morisky scale was poor (α = 0.38; 0.26–0.49). Patients who stopped taking their medicine when feeling worse had significantly less complex (p = 0.01) 'additional instructions' (median 4; 1–12) than those who did not stop their medicines (median 6; 0–18). This association was independent of age, gender and other medication regimen features. There were no significant differences between medication regimen features of patients who were forgetful, careful, and who stopped their medications when feeling better and their respective counterparts.ConclusionPatients using medications with less complex additional instructions were more likely to stop taking their medicine when feeling worse. Interventions designed to improve adherence by reducing regimen complexity are unlikely to be effective in all patients, especially in those with intentional nonadherence.
Snapshot of the Australian Public Hospital Pharmacy Workforce in 2005
Authors: O'Leary Karen M , Allinson Yvonne M 
Published: April 2015

ABSTRACTA workforce questionnaire was sent to 198 Australian public hospitals with more than 50 beds. This report details the data returned from 99 (50%) public hospital pharmacy services and compares the results to earlier studies performed at the same time of year in 2001 and 2003. Key findings of the 2005 snapshot of the hospital pharmacy workforce in public hospitals in Australia are that:
overall 69.95 of the 972.27 (7%) of establishment pharmacist full‐time equivalent positions were vacant—an improvement from the 2003 figure of 10%;
1 in 3 hospital pharmacists work part‐time;
almost 1 in 3 hospital pharmacists have a postgraduate qualification;
number of pre‐registration positions available has remained steady despite an increase in the number of pharmacy graduates;
percentage of hospital pharmacy technicians with formal qualifications as a pharmacy technician or pharmacist has increased to over 45%;
66 respondents indicated the need for additional 154.68 pharmacists full‐time equivalent (or an increase of 16%) in the next two years. The majority of these related to extending clinical pharmacy services and the ongoing introduction of the Pharmaceutical Benefits Scheme in public hospitals.
Development of a Mentoring Module to Enhance an Online National Pharmacy Preceptor Training Program
Authors: Simpson Maree D , Leversha Anne , Marriott Jennifer L , Taylor Susan , Bull Rosalind M , Howarth Helen D , Galbraith Kirstie J , Dalton Lisa D , Best Dawn L , Rose Miranda 
Published: April 2015

ABSTRACTAn online Australian Pharmacy Preceptor Education Program was developed to enable pharmacists to access education and support to assist with their responsibilities as preceptors. The program was designed to improve the effectiveness of their supervision while enhancing their satisfaction with the role. Mentoring is also an important aspect of professional involvement with students and graduates. The importance of mentoring to succession planning, professional satisfaction and self esteem was recognised and a mentoring module was also developed for inclusion in the program. This paper describes mentoring as a practice, the process of developing the mentoring module and provides an overview of its content.
Artemether‐Lumefantrine and Primaquine for Mixed Plasmodium falciparum and ovale Malaria
Authors: Chan Esther W 
Published: April 2015

ABSTRACTAimTo present a case of uncomplicated mixed Plasmodium falciparum and ovale malaria requiring treatment with artemether‐lumefantrine and primaquine.Clinical featuresA 40‐year‐old female presented with a mixed infection of uncomplicated P. falciparum and ovale. Treatment was commenced with oral quinine sulphate 600 mg, 8‐hourly which was changed to artemether‐lumefantrine and primaquine. A glucose‐6‐phosphate‐dehydrogenase test revealed deficiency, necessitating an alteration of the primaquine regimen.DiscussionMalaria infections are often initially treated with quinine if the infective species is not known or if the infection is mixed. Oral quinine remains useful in the treatment of uncomplicated P. falciparum malaria, however the six‐dose regimen of artemether‐lumefantrine is an effective alternative.ConclusionThis case highlights the benefits of artemether‐lumefantrine for mixed‐uncomplicated malaria and the use of primaquine for eradication of liver stages for P. ovale infections.
A Novel Medicines Management Pathway
Authors: Blennerhassett Jenny D , Cusack Brigitte M , Smith Carlene D , Green Louise , Tribe Kate L 
Published: April 2015

ABSTRACTBackgroundA novel medicines management pathway for patients with chronic heart failure was developed and commenced at the Prince of Wales Hospital in 2002.AimTo evaluate whether the novel medicines management pathway facilitated by the community liaison pharmacist and medication management review facilitator helped implementation of home medicines reviews and improved medication management.MethodA survey of general practitioners, community pharmacists, accredited pharmacists and patients was conducted.ResultsGeneral practitioners, community pharmacists and accredited pharmacists reported that the collaboration between the community liaison pharmacist and the medication management review facilitator improved the hospital and community link, and home medicines review implementation. Most patients noted they learnt something new about their medicines and that they could ask more questions of their general practitioner and pharmacist.ConclusionThis model improved communication between hospital and community and implementation of home medicines reviews in heart failure patients.