bluuebunny/crossref_metadata_2025_split huggingface dataset:
Afatinib after Disease Progression with Gefitinib in Advanced Adenocarcinoma of the Lung
Authors: Belz Stephen A , Grima Geoffrey J 
Published: April 2015

ABSTRACTBackgroundNon‐small cell lung cancer (NSCLC) is the most common form of lung cancer and comprises 75% to 85% of all lung cancer diagnoses. Epidermal growth factor receptor (EGFR) mutation positive disease comprises 10% of patients in the USA and is higher in people of Asian ancestry. Gefitinib and erlotinib are reversible tyrosine kinase inhibitors (TKIs) approved for advanced or metastatic disease but utility is limited by the emergence of resistance. Afatinib, an irreversible TKI, is under investigation for people who have developed TKI resistance.AimTo report a case of a patient with EGFR mutation positive NSCLC who developed resistance to gefitinib and was treated with afatinib.Clinical detailsA 61‐year‐old female presented with history of cough, malaise and anorexia that had not resolved with antibiotics and increased doses of inhaled corticosteroid. The only other medical history of note was gastro‐oesophageal reflux disease, lupus (mild arthralgia) and irritable bowel syndrome. A CT scan showed unusual lesions throughout the lungs. Bronchial washing (left upper lobe), bronchoalveolar lavage, bronchial brushing (left upper lobe) and transbronchial biopsy were consistent with adenocarcinoma. Biopsy of a right scapular lesion confirmed metastatic adenocarcinoma of the lung. The tumour was found to be positive for an EGFR mutation.Outcomes: After 12 months of therapy, the patient experienced disease progression and afatinib was commenced. After 1 month of treatment, respiratory symptoms and energy levels began to improve. CT imaging showed stable disease. The patient is being followed up on a monthly basis.ConclusionEmerging resistance to reversible TKIs poses a significant problem. Oral irreversible TKIs such as afatinib may offer an effective treatment option with minimal lifestyle interruptions and a predictable toxicity profile.
Management of Obesity in Older People
Authors: Haywood Cilla , Proietto Joe 
Published: April 2015

ABSTRACTObesity rates are on the rise in most developed countries. This phenomenon is also seen in people over the age of 65 years. Although obesity in older people is believed to be protective in some instances (the obesity paradox), there is evidence that obesity in older age can increase the risk of disability. Modest weight loss achieved with hypocaloric diets and exercise is safe and efficacious in improving physical function. Good quality evidence for other obesity management measures in older people, such as bariatric surgery, very low energy diets and anti‐obesity medications are lacking, as is pharmacokinetic data. We review current evidence for management of obesity in older people and the role of anti‐obesity medications.
Capturing Pharmacy Activities Using Barcode Technology
Authors: Samios Peter A 
Published: April 2015

ABSTRACTBackgroundRecording pharmacy activities beyond clinical pharmacist interventions is challenging. Traditional methods of manual data collection are cumbersome and time consuming. Technology, such as barcode scanners, has the potential to provide a portable, reproducible and simplified approach to data collection. Allied health disciplines at St Vincent's Hospital, Sydney successfully switched from manually collecting daily activity data to an electronic system using barcode technology (Activity BarCoding).AimTo introduce Activity BarCoding into the pharmacy department and collect data on daily pharmacy activities.MethodActivity BarCoding software was installed and barcode scanners were purchased. Based on the Society of Hospital Pharmacists of Australia's definitions, pharmacy activities were divided into: clinical care, management, distribution services, research, and teaching and training. Sub‐categories were developed for each activity type, as well as interventions to describe clinical activity. Barcodes were produced for all activities. After a 6‐month development phase, implementation began in June 2011. The system was rolled out over 18 months to all pharmacy staff. 12 months after implementation, pharmacists were surveyed about their perceptions of the Activity BarCoding system.ResultsDuring November 2012, 39 users recorded 5809.5 hours of activity − 22% (1279.3 h) clinical care, 44% (2573.7 h) distribution services, 13% (777.5 h) management, 2% (96.6 h) research and 1% (61.5 h) teaching and training. Inpatient and outpatient dispensary activities accounted for 40% (1033.5 h) and 28% (712.5 h) of the distribution hours, respectively. Of the 20 users surveyed, 55% disagreed and 15% strongly disagreed that data collection was too labour intensive.ConclusionActivity BarCoding was successfully introduced into the pharmacy department to collect data on daily pharmacy activities. The system was flexible, easy to use and integrated well into a busy work place.
Stability of Paracetamol Tablets Repackaged in Dose Administration Aids for prn Use: Implications for Practice
Authors: Kockler Jutta , Robertson Sherryl , Hope Denise , Haywood Alison , Glass Beverley 
Published: April 2015

ABSTRACTBackgroundParacetamol tablets are often repackaged into dose administration aids (DAAs) for prn use. Pharmacists have limited information regarding the long‐term stability of prn medicines stored in DAAs for extended periods due to infrequent dosing. According to current guidelines, in the absence of specific data, medicines should not be stored in a DAA for longer than 8 weeks.AimTo determine the physicochemical stability of paracetamol tablets repackaged into DAAs and stored for 12 months.MethodParacetamol (Panamax) tablets were removed from primary packaging, repackaged into DAAs (Multi Dose Webster‐pak) and stored under ambient (25 °C; 60% relative humidity) and accelerated (40 °C; 75% relative humidity) conditions for 12 months. Physical characteristics of the tablets, such as appearance, weight uniformity, thickness, hardness, friability, disintegration and dissolution rates were evaluated at baseline, 3, 6 and 12 months. Chemical stability was confirmed by high performance liquid chromatography.ResultsAll compendial requirements for physical stability were met for tablets stored under ambient and accelerated conditions over the 12‐month period. Chemical stability was confirmed, with paracetamol content in the tablets within the British Pharmacopoeial range of 95% to 105% of the labelled amount.ConclusionThis study provides data on the stability of paracetamol tablets repackaged into DAAs and stored under ambient and accelerated conditions for 12 months. Pharmacists will be able to make risk–benefit assessments and recommend a 12‐month expiry on paracetamol prn DAAs.
Antimicrobial Prescribing in a Rapid Assessment Medical Unit – A Multi‐Phase Pilot Study
Authors: Koning Sonia I , Rhodes Jessica , Rofe Olivia C , Sundararajan Vijaya , O'Reilly Mary , Koning Sonia I 
Published: April 2015

ABSTRACTBackgroundIncreased awareness of antimicrobial resistance has resulted in the introduction of institutional antimicrobial stewardship programs.AimTo evaluate antimicrobial prescribing in a Rapid Assessment Medical Unit (RAMU) after the introduction of an antimicrobial stewardship pharmacist (ASP) and antimicrobial stewardship team (AST); and to review acceptance rates of recommendations on antimicrobial prescribing made by a ward pharmacist, ASP and AST.MethodData were collected over a 4‐week period for all patients admitted to the RAMU and prescribed antimicrobials. Weeks 1 and 4 acted as controls. During Week 2 the ASP and during Week 3 the AST reviewed the restricted antimicrobials prescribed daily. Recommendations were recorded concurrently and medication charts were reviewed to determine if these were accepted. Appropriateness of antimicrobial prescribing was assessed retrospectively over the 4 weeks by the ASP and an infectious diseases physician.Results137 patients were eligible and 344 antimicrobials were evaluated. Antimicrobial prescribing varied over the 4 weeks but improved significantly with the ASP (vs standard care; p = 0.006) and AST reviews (vs standard care; p = 0.03). Treating teams were more likely to accept recommendations made by the AST than the ward pharmacist or the ASP.ConclusionIntroduction of a AST in a RAMU improved antimicrobial prescribing. Recommendations made by the AST were accepted more often than those made by a pharmacist with or without formal infectious disease training.
Post‐Operative Warfarin Re‐Initiation – Modelling Loading Dose Strategy
Authors: Roberts Gregory W , Quinn Steven , Druskeit Tina , Helboe Trine , Jørgensen Lisbeth E , Johansen Cathrine 
Published: April 2015

ABSTRACTBackgroundGuidelines recommend re‐initiating post‐operative warfarin at the previous maintenance dose. This results in prolonged re‐establishment of a therapeutic international normalised ratio (INR). Modelling warfarin initiation and subsequent INR response using previously published data indicated that re‐initiation with twice the maintenance dose for 3 days may provide a rapid alternative.AimTo compare the time to a stable therapeutic INR for conventional maintenance dose re‐initiation of warfarin with a loading dose strategy.MethodWarfarin maintenance doses were adjusted by using the standardised maintenance dose – a theoretical dose resulting in an INR of 2.5. The test group was re‐initiated on warfarin doses twice their standardised maintenance dose on Days 1, 2 and 3 and on Day 4 reverted to their maintenance dose. The guideline group was re‐initiated on warfarin doses equivalent to their standardised maintenance dose on these days.ResultsThe test group (n = 17) achieved a therapeutic INR more rapidly than the guideline group (n = 23; p < 0.001) with median times to therapeutic INR of 3 and 6 days respectively. After 3 doses the test group INR on Day 4 was in the therapeutic range (2.1±0.4) and significantly higher than the guideline group (1.7±0.5; p = 0.002). No patient in the test group experienced an elevated INR (maximum INR 3.3).ConclusionINR response to the warfarin re‐initiation dose was dependent on the magnitude of the induction dose relative to the maintenance dose. The loading dose strategy achieved a stable therapeutic INR more rapidly than conventional practice. Prospective investigation in surgical patients is needed to confirm its clinical applicability.
Audit of the Use of a Smart Infusion Pump's Drug Libraries
Authors: Tan Ivy SP , Dinh Nhi T , Kong Raymond E , MacMillan Kent B , McGain Forbes , Kong Raymond E , McGain Forbes 
Published: April 2015

ABSTRACTBackgroundLack of compliance with drug libraries among users of smart infusion pumps undermines the efforts to prevent intravenous medication errors. There are little data on drug library use in Australian clinical practice and the barriers to compliance and effective use remain uncertain.AimTo evaluate the use of a smart infusion pump's drug libraries and to identify barriers to effective drug library use.MethodPrescription and programming details of the infusions administered via Alaris IV pumps at a health service were audited. Data were used to assess compliance with and use of the drug libraries. In the event of non‐compliance or incorrect use of a drug library, a consented interview was conducted with the nurse to identify barriers.ResultsOf the 86% (95%CI 83–89) of infusions administered via a drug library, 11% (95%CI 9.1–14) were programmed incorrectly. Interviews with nurses revealed several reasons for non‐compliance, e.g. difficulty in using smart infusion pump technology, composition of the drug library. Incorrect drug library use was mainly attributed to failure to check programming during change of nursing shift, change of clinical area or change to a new fluid bag.ConclusionDespite high compliance with correct drug library use, 11% of infusions were programmed incorrectly due to incorrect selection of a drug library or therapy or both. The interviews revealed concerns with understanding smart pump technology and deficiencies in routine checks of drug library programming.
Electronic Medication Information Sources: Understanding the Needs and Preferences of Health Professionals
Authors: Baysari Melissa T , Lehnbom Elin C , Richardson Katrina , O'Reilly Benison , Heywood Maureen , Melocco Teresa 
Published: April 2015

ABSTRACTBackgroundTo improve the accessibility and usability of local medication information, the pharmacy department at the study hospital consolidated the electronic medication information and restructured the manner in which it is presented to clinicians.AimTo examine the electronic medication information needs of clinicians and to explore their preferences and views on the proposed ‘new’ medication information repository.MethodDoctors (n = 12), nurses (n = 15) and pharmacists (n = 8) from the study hospital participated either in a 30‐minute focus group or semi‐structured interview.ResultsDoctors and nurses did not use the local medication information and viewed the new medication information repository as not very useful. Users identified a range of issues related to the design and layout of the new repository. Clinicians are unlikely to use information if it is not visible during their work processes.ConclusionElectronic medication information needs and preferences of clinicians were identified as well as areas where redesign of electronic medication information sources is needed. It is not possible to meet the electronic medication information needs and preferences of all clinical users of a system or application.
Case for Pharmacist Administered Vaccinations in Australia
Authors: Bushell Mary‐Jessimine A , Yee Kwang Choon , Ball Patrick A , Ball Patrick A 
Published: April 2015

ABSTRACTBackgroundPharmacists in Portugal, New Zealand, the UK and USA are able to administer vaccines. Despite international trends, current jurisdictional regulations prevent Australian pharmacists from administering vaccines.AimTo assess if there is a case for pharmacist administered vaccination (PAV) in Australia.DiscussionStudies and government data indicate suboptimal uptake of some vaccines in Australia. Over the past two decades, PAV services have been introduced successfully in some developed countries. Available literature revealed PAVs provided significant benefits in these countries, such as increased vaccination uptake and subsequent decreased disease burden and associated cost benefits. PAVs are in line with Australian government policy and priorities. The pharmacy profession, guided by peak professional bodies, has demonstrated a willingness to embrace PAVs based on appropriate competencies and broadening health delivery options to the public.ConclusionThere is a case for PAV services in Australia. It is not possible to adopt an overseas model of PAVs in Australia without significant modification to its unique immunisation program, which incorporates a different funding and governance system.
QCT Volumetric Bone Mineral Density and Vascular and Valvular Calcification: The Framingham Study
Authors: Chan Jimmy J , Cupples L Adrienne , Kiel Douglas P , O'Donnell Christopher J , Hoffmann Udo , Samelson Elizabeth J 
Published: April 2015

Abstract

There is increasing evidence that bone and vascular calcification share common pathogenesis. Little is known about potential links between bone and valvular calcification. The purpose of this study was to determine the association between spine bone mineral density (BMD) and vascular and valvular calcification. Participants included 1317 participants (689 women, 628 men) in the Framingham Offspring Study (mean age 60 years). Integral, trabecular, and cortical volumetric bone density (vBMD) and arterial and valvular calcification were measured from computed tomography (CT) scans and categorized by sex-specific quartiles (Q4 = high vBMD). Calcification of the coronary arteries (CAC), abdominal aorta (AAC), aortic valve (AVC), and mitral valve (MVC) were quantified using the Agatston Score (AS). Prevalence of any calcium (AS &gt;0) was 69% for CAC, 81% for AAC, 39% for AVC, and 20% for MVC. In women, CAC increased with decreasing quartile of trabecular vBMD: adjusted mean CAC = 2.1 (Q4), 2.2 (Q3), 2.5 (Q2), 2.6 (Q1); trend p = 0.04. However, there was no inverse trend between CAC and trabecular vBMD in men: CAC = 4.3 (Q4), 4.3 (Q3), 4.2 (Q2), 4.3 (Q1); trend p = 0.92. AAC increased with decreasing quartile of trabecular vBMD in both women (AAC = 4.5 [Q4], 4.8 [Q3], 5.4 [Q2], 5.1 [Q1]; trend p = 0.01) and men (AAC = 5.5 [Q4], 5.8 [Q3], 5.9 [Q2], 6.2 [Q1]; trend p = 0.01). We observed no association between trabecular vBMD and AVC or MVC in women or men. Finally, cortical vBMD was unrelated to vascular calcification and valvular calcification in women and men. Women and men with low spine vBMD have greater severity of vascular calcification, particularly at the abdominal aorta. The inverse relation between AAC and spine vBMD in women and men may be attributable to shared etiology and may be an important link on which to focus treatment efforts that can target individuals at high risk of both fracture and cardiovascular events. © 2015 American Society for Bone and Mineral Research.
Reproducibility of Serum Potassium Values in Serum From Blood Samples Stored for Increasing Times Prior to Centrifugation and Analysis
Authors: Harper Aaron , Lu Chuanyong , Sun Yi , Garcia Rafael , Rets Anton , Alexis Herol , Saad Heba , Eid Ikram , Harris Loretta , Marshall Barbara , Tafani Edlira , Pincus Matthew R. 
Published: April 2015

GoalsThe goal of this work was to determine if immediate versus postponed centrifugation of samples affects the levels of serum potassium.MethodsTwenty participants donated normal venous blood that was collected in four serum separator tubes per donor, each of which was analyzed at 0, 1, 2, or 4 hr on the Siemens Advia 1800 autoanalyzer.ResultsCoefficients of variation (CVs) for potassium levels ranged from 0% to 7.6% with a mean of 3 ± 2%. ANOVA testing of the means for all 20 samples showed a P‐value of 0.72 (>0.05) indicating that there was no statistically significant difference between the means of the samples at the four time points. Sixteen samples were found to have CVs that were ≤5%. Two samples showed increases of potassium from the reference range to levels higher than the upper reference limit, one of which had a 4‐hr value that was within the reference or normal range (3.5–5 mEq/l). Overall, most samples were found to have reproducible levels of serum potassium.ConclusionsSerum potassium levels from stored whole blood collected in serum separator tubes are, for the most part, stable at room temperature for at least 4 hr prior to analysis. However, some samples can exhibit significant fluctuations of values.
A Pilot Study of Maudsley Family Therapy With Group Dialectical Behavior Therapy Skills Training in an Intensive Outpatient Program for Adolescent Eating Disorders
Authors: Johnston Jennifer A. Y. , O'Gara Jesine S. X. , Koman Stuart L. , Baker Christina Wood , Anderson Drew A. 
Published: April 2015

ObjectiveThe goal of this study was to provide pilot clinical data on the effectiveness of an intensive outpatient treatment model for adolescent eating disorders that combines Maudsley‐based family therapy and group dialectical behavior therapy skills training.MethodMeasures of physical and psychological status were gathered upon admission, discharge, and at 3 follow‐up intervals.ResultsAdolescents who completed the program gained a significant amount of weight and experienced a significant decrease in eating disorder psychopathology. At the 1‐year follow‐up, 64% of adolescents were weight restored and menstruating normally. Measures of eating disorder psychopathology continued to improve up to a year after treatment.ConclusionsThis pilot, multimodal program warrants further investigation and may be an effective intermediate level of care treatment option for adolescent eating disorders.
HPLC‐ESI‐MS/MS of brain neurotransmitter modulator lobeline and related piperidine alkaloids in Lobelia inflata L
Authors: Kursinszki László , Szőke Éva 
Published: April 2015

There is a renewed interest in lobelia alkaloids because of their activity on the central nervous system. Lobeline, the most active of them, a nicotinic receptor ligand and neurotransmitter transporter inhibitor, is a candidate pharmacotherapy for metamphetamine abuse. In the present work, high‐performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry in positive ion mode was used for investigating the alkaloid profile in Lobelia inflata L. Chromatographic separations were achieved on a Gemini C6‐phenyl reversed‐phase column providing good peak shape and improved selectivity. Being mostly 2,6‐disubstituted piperidines, lobelia alkaloids presented abundant [M + H]+ ions with typical fragmentation. Identification was possible from a few specific ions, especially those resulting from excision of one of the substituents.Based on fragmentation pattern of lobeline as reference compound, 52 alkaloids were identified in the aqueous methanolic extract of L. inflata in contrast to the previously known some 20. Structural variability of these alkaloids identified arises basically from their substituents which can be phenyl‐2‐ketoethyl‐ or phenyl‐2‐hydroxyethyl units as well as their methyl‐, ethyl‐ or propyl‐ homologues attached in different combinations. Several propyl homologue lobelia alkaloids and five hydroxypiperidine derivatives were found in the plant at the first time. In addition to 8‐O‐esters of 2‐monosubstituted piperidine alkaloids previously reported by us in L. inflata, a 3‐hydroxy‐3‐phenylpropanoic acid ester of hydroxyallosedamine ring‐substituted was also identified as a new natural product. High‐performance liquid chromatography‐electrospray ionization tandem mass spectrometry can be successfully applied to Lobeliacae plant samples in the routine screening for new and known bioactive constituents, quality control of the crude drug, lobelia herba, alkaloid production studies, breeding and chemotaxonomy. Copyright © 2015 John Wiley & Sons, Ltd.
Phosphatase activity and its relationship with physical and chemical parameters during vermicomposting of filter cake and cattle manure
Authors: Busato Jader Galba , Papa Gabriella , Canellas Luciano Pasqualoto , Adani Fabrizio , de Oliveira Aline Lima , Leão Tairone Paiva 
Published: April 2015

AbstractBACKGROUNDRecycling of phosphorus (P) from organic residues (ORs) is important to develop environmentally friendly agriculture. The use of this P source depends on phosphatase enzymes, which can be affected by a chain of parameters during maturation of ORs. In this study the phosphatase activity levels throughout vermicomposting of filter cake (FC) and cattle manure (CM) were correlated with different physical and chemical parameters in an effort to increase the knowledge about recycling of P from ORs.RESULTSFC presented higher total nitrogen content (TNC), total organic carbon (TOC), humic acid (HA) content, water‐soluble P (WSP), phosphatase activities and nanopore volume than CM during vermicomposting. Decreases in TOC of CM resulted from carbohydrate mineralization, which was not observed for FC. CM showed increased hydrophobic index during vermicomposting while FC showed a slight decrease.CONCLUSIONPhosphatase activities correlated positively with TOC, pH and WSP and negatively with HA content for both vermicomposts. Nanopore volume was negatively correlated with phosphatase activities for FC but not for CM. No correlations between hydrophobicity and phosphatase activities were found for FC. Increased hydrophobicity throughout vermicomposting of CM could be partially associated with decreases in phosphatase levels. © 2015 Society of Chemical Industry