bluuebunny/crossref_metadata_2025_split huggingface dataset:
Australian Hospital Pharmacists' Experiences of a UK Non‐Medical Prescribing Course
Authors: Weeks Greg R , Marriott Jennifer , George Johnson 
Published: April 2015

ABSTRACTBackgroundLegislative change and a university course to credential pharmacist prescribers are needed to move the pharmacist prescribing agenda forward in Australia. Non‐medical prescribing courses in the UK aim to produce safe and competent prescribers who understand the prescribing process, know their limitations and practice within their area of competence. As no equivalent course exists in Australia there was interest in exploring whether a UK non‐medical prescribing course could be adopted for the Australian environment.AimTo pilot a UK non‐medical prescribing course for Australian hospital pharmacists and to elicit participants' views on non‐medical prescribing and experiences of the training.MethodThe Department of Pharmacy Practice, Monash University hosted a non‐medical prescribing course accredited by the Royal Pharmaceutical Society of Great Britain to credential pharmacists as supplementary and independent prescribers. 15 hospital pharmacists undertook the course over 9 months from September 2008. Participating pharmacists were either undertaking or planning to undertake advanced practitioner roles. Pharmacists' views on prescribing and credentialling were explored in 3 focus groups. Focus group discussions were audio‐recorded and transcribed verbatim and thematically analysed using NVivo 8.ResultsParticipants identified positive themes of their understanding of non‐medical prescribing and where it could lead, i.e. growth in self‐confidence to undertake a new role and improved competency in communication and consultation skills. Negative themes related to legislative constraints, acceptance by other health professionals, assessment requirements for the Period of Learning in Practice and university documentation. Participants also stressed the need for the course to be customised to the Australian setting.ConclusionThis first experience of a course to develop pharmacist prescribing was positive but challenging and can assist the future development of an accredited Australian course for pharmacist prescribers.
Helicobacter pylori Eradication Regimens: Is there a Difference?
Authors: Khu Jia Vui , Lim Li Lin 
Published: April 2015

ABSTRACTBackgroundThe Singapore Ministry of Health's guidelines for Helicobacter pylori eradication recommend several regimens as first‐line treatment.AimTo evaluate the eradication rates of H. pylori at the National University Hospital with the regimens recommended by the Singapore Ministry of Health's guidelines.MethodSingle centre retrospective study of patients with H. pylori infection. Patients who had an urea breath test from August 2007 to August 2008 were identified from the hospital's database. Patients were included in the analysis if they were also identified to have had histology and urease tests before and after the H. pylori eradication regimens. Patients' H. pylori eradication regimens were identified and verified from the computerised patient support system and iPharm.Results802 patients who had an urea breath test during the study period were identified and 337 patients were excluded from the analysis as they did not meet the inclusion criteria. 465 patients were included in the final analysis. Standard triple therapy (amoxycillin, clarithromycin, proton pump inhibitor) yielded an eradication rate of 83% (n = 385), 100% (n = 10) and 78% (n = 18) when given for 7, 10 and 14 days, respectively. Metronidazole‐based triple therapy had a low eradication rate of 48% (n = 29). Quadruple therapy (proton pump inhibitor, bismuth, metronidazole, tetracycline) had an eradication rate of 100% (n = 6) and 75% (n = 8) when used as first‐line and second‐line therapy, respectively.ConclusionStandard triple therapy (clarithromycin, amoxycillin, omeprazole) for 7 days should be considered first‐line. Quadruple therapy (metronidazole, bismuth, tetracycline, omeprazole) should be considered for patients with penicillin and/or clarithromycin allergy and those who fail to eradicate H. pylori with standard triple therapy.
Quality of Discharge Summaries sent by a Regional Hospital to General Practitioners
Authors: Karaksha Abdullah A , Hattingh H Laetitia , Hall Tony 
Published: April 2015

ABSTRACTBackgroundA comprehensive hospital discharge summary sent to the patient's general practitioner (GP) in a timely manner can ease patient transition between care settings.AimTo investigate the quality of discharge summaries sent by a regional hospital to GPs; and to evaluate GPs' satisfaction with the medication list contained in the discharge summary.MethodA questionnaire was mailed to a sample of 80 Gold Coast GPs who had made more than five referrals to the Gold Coast Hospital during June 2009.Results18 responses (23% response rate) were received from September to October 2009. The majority (67%) of GPs received discharge summaries from the hospital and they were mostly in an electronic format with attached medication lists. The reasons for changing medications were not well explained and the timeframe for receiving summaries was considered unsatisfactory. Overall, the majority of GPs were satisfied with the quality of the discharge summaries.ConclusionGPs mostly received the discharge summaries and the majority received them electronically. The majority of GPs indicated that the medication lists were often attached to the discharge summaries and changes to medications recorded.
Do Health Professionals on Respiratory Wards Know How to Use Inhalers?
Authors: Nguyen Yvonne BN , Wainwright Craig , Basheti Iman A , Willis Margaret , Bosnic‐Anticevich Sinthia Z 
Published: April 2015

ABSTRACTBackgroundCorrect inhaler technique is crucial in the management of asthma and chronic obstructive pulmonary disease. Little is known about the feasibility of training hospital health professionals and respiratory inpatients in the correct use of inhalers.AimTo evaluate health professionals' baseline inhaler techniques on a respiratory ward; to assess the impact of training on their inhaler techniques; and to evaluate the impact of the training on service delivery to respiratory inpatients.MethodStudy conducted on the respiratory ward of a major New South Wales metropolitan hospital with a focus on training health professionals on correct inhaler techniques in four phases over 6 months.ResultsPrior to training, none of the pharmacists (n = 11) or nurses (n = 16) demonstrated correct inhaler techniques. Post training, significantly more pharmacists and nurses demonstrated correct inhaler techniques. Post training, there was a statistically significant increase in the number of respiratory inpatients who had their inhaler techniques assessed. This increase was sustained over 6 months.ConclusionHospital pharmacists and respiratory nurses require training in the correct use of inhalers. Post training, more respiratory inpatients had their inhaler techniques checked by pharmacists and nurses.
Engaging Pharmacists in Adverse Medication Incident Reporting: Pilot of a Streamlined Reporting Application
Authors: Garrett Tim , Reeves Diane , Went David 
Published: April 2015

ABSTRACTBackgroundMedication‐related harm is a major cause of morbidity in hospitalised patients. Incident reporting is a core initiative in improving this safety risk.AimTo describe the impact of a purpose‐built incident reporting application; and to investigate the influence of clinical duties/pharmacists' characteristics on incident reporting at an area health service.MethodFollowing implementation of the incident reporting application at the area health service, data (volume and severity on incidents by therapeutic group, error type, medication) were extracted for a 12‐month period. Pharmacists concurrently completed a data collection form to record ‘time in clinical areas’ and profile their clinical activities.ResultsPost‐implementation, 2887 incident reports were recorded by 29 pharmacists; a 20‐fold increase from baseline. The 2887 incident reports included 4106 error types for 43 therapeutic groups comprising 388 different medications. ‘Prescribing errors on admission’ (n = 562), incidents relating to ‘anticoagulants, antithrombotics’ (n = 457) and 23 medications were most commonly reported (p , 0.05). No significant differences emerged for the severity of incident by error type, therapeutic group or medication. There was no difference between ‘high’ and ‘low’ reporting pharmacists for most characteristics, such as time in clinical areas, profile of clinical activities, grade and years of experience.ConclusionStreamlining incident reporting and actively engaging pharmacists can reduce safety risk as well as highlight the professional role of pharmacists in improving patient safety. Workplace safety culture and individual beliefs in the reporting process need to be explored further.
Frequency and Nature of Medication‐Related Problems in Elderly Indian Inpatients
Authors: Joseph Jinta , Ramesh Madhan , Harugeri Anand , Parthasarathi Gurumurthy , Basavanagowdappa Hathur 
Published: April 2015

ABSTRACTBackgroundGeriatrics is an emerging clinical specialty in India. Although studies on medication use in the elderly have been conducted in India, data on medication‐related problems (MRP) in the hospitalised elderly population are limited.AimTo determine the prevalence, nature and predictors of MRP, and the significance of pharmacists' interventions following identification of MRP in elderly inpatients.MethodA prospective active surveillance study conducted over 9 months (July 2008 to March 2009) on the medical wards of JSS Hospital, Mysore, India. Patients 60 years and over that were admitted to the medical wards were evaluated. Pharmacists' interventions following identification of MRP were recorded and their potential clinical significance assessed. The organ systems affected and the management of MRP were investigated. Predictors of MRP were identified using bivariate analysis and subsequent multivariate logistic regression.Results411 patients were evaluated and 352 MRP were identified in 230 (56%) patients. Adverse drug reactions were the major (53%) MRP. Cardiovascular drugs accounted for 37% of MRP. Insulin (9.4%) was the most frequently implicated drug. MRP commonly involved the nervous system (19%). In 47% of cases, the drug was discontinued as a management strategy. The majority of pharmacists' interventions (314; 90%) were moderate or major in their level of clinical significance. Age was an influential predictor of MRP (OR 2.1; 95%CI 1.1–4.2; p = 0.03).ConclusionAround half of the hospitalised elderly experienced an MRP. Pharmacists can contribute to geriatric inpatient care by reducing adverse consequences of MRP through early detection and providing advice in managing MRP.
Drug Use Evaluation Services in Australia and New Zealand: a Neglected Area of Research?
Authors: Avent Minyon L , Pattullo Champika , Dines Amanda , Martin Jennifer , Kubler Paul 
Published: April 2015

ABSTRACTAimTo describe the drug use evaluation (DUE) models used in hospitals in Australia and New Zealand.Method18 hospitals in Australia and New Zealand were identified as having DUE pharmacist positions and 15 were willing to participate in the survey. DUE pharmacists were surveyed about the DUE process, structure, service implementation and their job descriptions.Results47% (7/15) of DUE pharmacists reported to the Director of Pharmacy, 33% (5/15) to the Drug and Therapeutics Committee and 20% (3/15) to the Director of Clinical Pharmacology. 73% (11/15) of DUE pharmacists were located in the hospital's pharmacy department. On average, a 0.8 full‐time equivalent (range 0.2 to 2.5) pharmacist was dedicated to DUE activities per hospital with an average of 0.2 full‐time equivalent (range 0 to 0.8) assigned to clinical activities. 79% (12/15) of hospitals only funded DUE pharmacist positions; 7% (1/15) funded combined pharmacist and pharmacy technician positions; 7% (1/15) funded combined pharmacist and rotating pharmacy intern positions; and 7% (1/15) funded clinical pharmacologist, nurse and pharmacist positions. 20% (3/15) of hospitals had a DUE subcommittee to coordinate DUE activities. All of the hospitals reported their DUE results to the Drug and Therapeutics Committees.ConclusionA variety of DUE models exist in hospitals in Australia and New Zealand. Successful DUE services had a multidisciplinary approach with support and collaboration from medical, pharmacy, nursing and administrative staff.
Barriers to Medication Adherence in Chronic Heart Failure Patients during Home Visits
Authors: Toh Cjeng T , Jackson Bruce , Gascard Debra J , Manning Alison R , Tuck Emily J 
Published: April 2015

ABSTRACTAimTo identify barriers to medication adherence in chronic heart failure patients during home visits; and to find solutions to address medication non‐adherence.MethodThis was an observational study of home visits by the chronic heart failure pharmacist that was made after referral from a multidisciplinary chronic heart failure service. The reasons for medication non‐adherence and solutions to overcome them were recorded in 66 consecutive chronic heart failure patients. Barriers to medication adherence and subsequent interventions (education, counselling, motivational interviews), hospital readmissions, length of stay, mortality and cause of death were analysed 3 months after the first home visit.ResultsMain reasons for medication non‐adherence were poor and/or complex medication instructions (71%), running out of medications (33%) and adverse drug reactions (20%). Interventions included education and counselling (100%), reducing dosing frequency (64%) and introducing dose administration aids (32%). 10 complex chronic heart failure patients (15%) required multiple home visits, motivational interviews and telephone coaching. Hospital readmissions, average length of stay for readmissions and deaths due to chronic heart failure 3 months after the first home visit were 4.5%, 6.3 days and 3%, respectively.ConclusionMultiple strategies were necessary to overcome barriers to medication adherence in chronic heart failure patients. Home visits by the pharmacist optimised medication adherence, thus potentially minimising unplanned hospital admissions.
Creation of a Temperature Stability Database for Refrigerated Medications
Authors: Davis Sharon R , Anderson Elizabeth A 
Published: April 2015

ABSTRACTAimTo create a database of refrigerated medications along with comprehensive data on their stability when stored outside the recommended conditions; and to develop an educational tool for managing cold chain emergencies at the hospital.MethodPhase 1: a searchable database was created with fields on product stability, stored temperatures and storage conditions. Phase 2: the database was populated with the products' stability data from various sources, such as literature searches, approved product information and pharmaceutical companies. Phase 3: focus groups were held with the hospital's stakeholders (nurses, pharmacists, pharmacy technicians) to develop an educational tool for managing cold chain emergencies.ResultsOf the 36 pharmaceutical companies contacted, 29 responded (response rate 81%) and provided ‘extra’ stability data for 28 products (n = 150; 19%). Pursuant to issues raised by the pharmaceutical companies about concerns of breaching the registration conditions of their products and misinterpretation of the provided in‐house stability data, a stakeholder meeting was held with the Therapeutic Goods Administration. At the meeting, the need for short‐term ‘end of shelf life’ real‐time stability studies for refrigerated products was discussed. An educational tool was designed based on a survey of local practices at the hospital pertaining to monitoring refrigerators used to store medications.ConclusionCreation of the database has resulted in a critical analysis of the existing stability data on refrigerated medications. Hospital staff lack guidance on the selection, monitoring and maintenance of refrigerators used to store medications, and to manage cold chain emergencies. There is an opportunity for professional pharmacy organisations to provide this guidance.
Hospital Pharmacists and Behavioural Change Theory: Who, Why and How?
Authors: Mutavdzic André 
Published: April 2015

ABSTRACTEndeavouring to change the practice of doctors, colleagues and patients is common practice for pharmacists. Pharmacists are not trained in the humanities and the approaches used by them to change practice, such as educational campaigns, are often intuitive and not always successful. Approaches that are based on behavioural theory and tested models of behavioural change may have a greater probability of success. In this article the theory of planned behaviour, social cognitive theory and the transtheoretical model of behavioural change and their application to these efforts are discussed. Although this article focuses mainly on attempting to change doctors' behaviours, the principles can be applied to other groups.
Conception and Beyond: Using Population‐Based Record Linkage to Monitor Long‐Term Effects of Medications Used During Pregnancy
Authors: Grzeskowiak Luke E , Gilbert Andrew L , Morrison Janna L 
Published: April 2015

ABSTRACTOne of the biggest challenges health professionals face when counselling patients about medication use in pregnancy is accessibility to evidence‐based information on the risks or benefits associated with treatment. There is inadequate information available regarding the immediate and long‐term effects of medications used by pregnant women on the mother and the fetus. Novel surveillance techniques using population‐based record linkage could enable better identification, quantification and understanding of long‐term risks or benefits of medications used during pregnancy. The technology, data and expertise are available to make it happen.
Contemporary Therapies for Depression in Older People
Authors: Mock Phoebe , Norman Trevor R , Olver James S 
Published: April 2015

ABSTRACTMajor depressive disorder is common in the elderly and is associated with significant morbidity and disability, as well as increased risk of mortality. Extensive literature is extant examining the efficacy and tolerability of the earlier antidepressants but there are comparatively fewer trials examining the newer antidepressants, the so‐called ‘third generation’ antidepressants with a variable mode of action. This article reviews the literature published in the past 10 years on the efficacy and tolerability of the new antidepressants – escitalopram, venlafaxine, duloxetine and mirtazapine – used in treating depression of old age. There are no published data for the newly released desvenlafaxine in the elderly population. Due to the limited number of published trials and their highly heterogeneous nature, specific treatment recommendations for depression in older people are not supported by solid empirical evidence. Clearly, further studies on the management of depression in older people are needed in order to develop reliable and practical guidelines.
Low‐Dose Nebulised Epoprostenol in the Management of Acute Respiratory Distress Syndrome
Authors: Somasundaram Radhika , Ghelani Dhaval 
Published: April 2015

ABSTRACTAimTo report a case of acute respiratory distress syndrome (ARDS) caused by Escherichia coli urosepsis with shock that resulted in multiple organ failure and refractory hypoxaemia successfully treated with low‐dose nebulised epoprostenol.Clinical detailsA 64‐year‐old female with a history of hypertension and dyslipidaemia underwent elective cystoscopy for the removal of an ureteric stent and subsequently developed hypotension followed by fever. This was attributed to E. coli urosepsis with shock and resulted in multiple organ failure and refractory hypoxaemia with the development of bilateral pulmonary infiltrates, suggestive of ARDS. Hypoxia and pulmonary infiltrates progressed despite administration of non‐invasive ventilation followed by intermittent positive pressure ventilation. The patient was subsequently started on continuous nebulised low doses of epoprostenol 2 to 4 ng/kg/min. The nebulised epoprostenol was continued for approximately 48 hours with significant improvement in oxygenation.ConclusionNebulised epoprostenol, as a rescue therapy for refractory hypoxaemia caused by ARDS may be a reasonable therapeutic strategy, although further evidence to support its impact on outcomes is required.
Complementary and Alternative Medicines Use in Patients on Warfarin and Matched Controls: A Retrospective Cohort Study
Authors: Khan Munad , Taylor David McD , Taylor Simone E , Jao Kathy , Chae John , Harding Andrew M , Mitchell Elise 
Published: April 2015

ABSTRACTAimTo investigate complementary and alternative medicines (CAM) knowledge and use in patients on warfarin and matched controls, and the association between CAM use and adverse events (bleeding or clotting).MethodA retrospective cohort study was undertaken in the emergency department of a Melbourne hospital. Patients in the warfarin and control groups were those taking/not taking warfarin, respectively (groups matched for age and gender). An investigator‐administered questionnaire was used to collect data on CAM knowledge and use, and bleeding/clotting events during the previous 6 months. The international normalised ratio (INR) data during the previous 6 months were obtained from medical and pathology records.Results246 warfarin and 246 control group patients were enrolled. Approximately 50% in each group indicated that they knew of the potential for CAM–drug interactions. Only 60 (24%) patients in the warfarin group reported having been advised about CAM use. Compared to controls, a similar proportion of warfarin patients reported CAM use (29% vs 37%; p = 0.07) and significantly fewer used a CAM known to interact with warfarin (‘interacting CAM‘) (11% vs 19%; p = 0.03). In the warfarin group, CAM users and non‐users reported a similar number of events below and above their therapeutic INR range and when the INR exceeded 5. CAM users in the warfarin group tended to have more abnormal bleeding events (42% vs 30%; p = 0.06) but a similar number of clotting events (9% vs 10%; p = 0.8) than CAM non‐users. Warfarin patients who used ‘interacting CAM’ had significantly more clotting events than those who used CAM not known to interact with warfarin (18% vs 2%; p = 0.02).ConclusionCAM knowledge in people on warfarin was poor. ‘Interacting CAM' used concomitantly with warfarin may be associated with increased rates of clotting events.