bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experience with Drotrecogin in Two Australian Hospitals
Authors: Mackenzie Fraser D , Pillans Peter I , Cook David A , Dixon Alexander E , Kubler Paul A 
Published: April 2015

ABSTRACTBackgroundDrotrecogin alfa (activated) is a recombinant human activated protein C approved to reduce mortality in patients with severe sepsis. In the PROWESS study, a 28‐day mortality rate of 24.7% was observed in septic patients treated with drotrecogin compared to 30.8% in the placebo group.AimTo compare experience in inpatients with sepsis with the published experience and assess compliance with Queensland Hospitals Drug Advisory Committee prescribing protocol.MethodA retrospective review was conducted using data obtained from patients treated with drotrecogin over a 2‐year period at two Brisbane hospitals. Data collection included patient demographics, presenting condition, past medical history, medications, compliance with the prescribing protocol, clinical outcome and safety.Results22 patients were treated with drotrecogin. The mean age was 48.7 years (range 17–81). All patients complied with the protocol inclusion criteria, had evidence of serious infection, required mechanical ventilation and had 2 or more organ failures. 6 patients (27%) died during the 28‐day post‐administration period. A number of patients had significant co‐morbidities including 4 with cirrhosis and 3 with cancer. Patients often received the drug despite having conditions listed as precautions and relative contraindications. There were 2 confirmed cases of serious bleeding complications.ConclusionsTreatment outcomes were comparable to the original trial results, despite the selection of more critically ill patients. All patients met strict inclusion criteria, but consideration of relative contraindications and co‐morbidities could be improved.
Acceptability of Videoconference Technology for the Delivery of Continuing Education to Rural Pharmacists
Authors: McNamara Kevin P 
Published: April 2015

ABSTRACTAimTo investigate whether a rural continuing education (CE) program delivered by videoconference can enhance access to, and uptake of, CE among pharmacists and determine their satisfaction with videoconference for the delivery of CE.MethodA postal survey was sent to 33 registered pharmacists in south‐west Victoria and south‐east South Australia who had attended at least one videoconference CE session organised in that region.ResultsRespondents worked in different areas of pharmacy, and 40% worked in more than one area of pharmacy. The use of videoconference facilities has increased access to and participation in CE generally, and most participants (88%) have found it to be an acceptable medium for delivery. Increased access to high‐quality CE opportunities, and reduced travel time for CE were seen as the principal benefits of the medium. Negative aspects included technical glitches, organisational issues, and the time‐lag in voice transmission. Overall, most participants were happy to receive a substantial proportion of their contact CE using this medium.ConclusionsVideoconference technology is a valuable tool for the delivery of carefully structured CE sessions in rural and remote areas with an appropriate information technology infrastructure.
Dosing of Key Renally Cleared Drugs in the Elderly—Time to be Wary of the eGFR
Authors: Roberts Gregory W 
Published: April 2015

ABSTRACTBackgroundThe Cockroft‐Gault and Modification of Diet in Renal Disease (MDRD) approaches are commonly used to estimate renal function. An optimised version of the Cockroft‐Gault equation also exists. The MDRD approach occasionally generates renal function estimates that are vastly different from the Cockroft‐Gault approach. Due to its ready availability, prescribers are beginning to use the MDRD approach for dosing of renally cleared drugs, despite contrary recommendations.AimTo examine differences in renal function estimates between the MDRD against the Cockroft‐Gault and optimised Cockroft‐Gault approaches for a group of elderly hospitalised patients. To examine factors driving these differences and if these differences cause clinically significant differences in the dosing of enoxaparin and gentamicin.MethodRenal function for 1067 inpatients was calculated. Patients were grouped into quartiles based on the proportional difference between the MDRD against the Cockroft‐Gault and optimised Cockroft‐Gault approaches, respectively. Clinically significant dosing was defined as 2 mg/kg instead of 1 mg/kg for enoxaparin, and ≥ 75% difference for gentamicin dosing.ResultsAs the proportional difference in renal function estimates between the MDRD and the Cockroft‐Gault approach increased, patients were progressively older and lighter (p < 0.01). As the difference increased compared to the optimised Cockroft‐Gault version, patients were progressively older, shorter, lighter and female (p < 0.01). Enoxaparin and gentamicin doses from the MDRD approach led to significantly greater doses in 8% and 23% of patients respectively compared to Cockroft‐Gault, and 15% and 37% of patients respectively compared to the optimised Cockroft‐Gault approach. This occurred predominantly in very elderly patients (> 80 years).ConclusionThe use of MDRD to calculate drug doses in an elderly population leads to greatly increased doses being prescribed compared to the currently recommended approach of using Cockroft‐Gault. This is largely in older patients, who are most at risk of experiencing adverse effects from increased doses. The appropriateness of MDRD for drug dosing in an elderly hospitalised population needs to be assessed urgently, against the possibility that it greatly overestimates renal function in these patients.
Taking Pharmacy on Tour in Vanuatu
Authors: Sanburg Amanda LC 
Published: April 2015

ABSTRACTRemote villages and health facilities in Vanuatu are visited to help train pharmacy officers, update remote area nurses on pharmaceutical issues and provide community education about appropriate use of medicines and general health issues. Limited communications and irregular visits by medical staff makes a visit by the principal pharmacist and a trainee an occasion for the community. Updates for nurses include latest treatments for common conditions such as malaria, pneumonia, and non‐communicable diseases which are increasing in these communities. Training includes blood glucose machines, repair of medical equipment and cold chain management. Touring allows the trainee pharmacy officers to observe first‐hand the needs of the remote communities. They learn how to assist clinic nurses with their stock ordering and store management. Direct involvement in the medical care of some patients has reinforced their knowledge of drug treatments.
Beta‐Blockers for Treatment of Heart Failure in the Elderly
Authors: Zimmet Hendrik , Krum Henry 
Published: April 2015

ABSTRACTPharmacotherapy for heart failure focuses on neurohormonal blocking strategies using predominantly angiotensin converting enzyme inhibitors and beta‐blockers, both conferring improved outcomes in patients with systolic chronic heart failure. Despite this, there is ongoing underutilisation of beta‐blockers in this context in clinical practice. Advanced age is cited as a common reason for non‐prescription of beta‐blockers. The concerns are usually perceived reduced efficacy and tolerability of the drug class. However, beta‐blockers are an efficacious and well‐tolerated treatment in most heart failure patients and recent studies suggest that these benefits extend to the elderly patient population. It is critical to ensure that these findings are translated into practice and that all appropriate patients receive these drugs.
Feasibility of Monitoring Biochemical and Haemodynamic Effects of Angiotensin Converting Enzyme Inhibitors
Authors: Young Janice , Asghar Muhammad N , Yee Julie , Kremer Lisa 
Published: April 2015

ABSTRACTBackgroundAngiotensin converting enzyme (ACE) inhibitors reduce mortality and morbidity in heart failure, post‐myocardial infarction and in those at high cardiovascular risk. However, recognised adverse effects contribute to hospital admissions.AimTo determine the feasibility of pharmacists collecting clinical data for ACE inhibitor prescribing and to inform the development of a hospital prescribing indicator set to measure the quality of monitoring for ACE inhibitors.MethodA paper‐based survey was conducted over 8 weeks. All patients admitted to a medical ward who were admitted on or started on ACE inhibitors were included. Data were collected prospectively and included serum creatinine, urea and potassium, and blood pressure measurements. These data were reviewed and compared against the parameter set for the indicator prepared.Results29 patients were included in the analysis and cilazapril was most frequently prescribed (17, 57%). Blood pressure was recorded less frequently in new patients (7.7 vs 17.8). Creatinine was above normal on 47 (52%) occasions and 13 patients had an elevated level on at least one occasion. Creatinine was measured on average 3.1 times during the admission. Urea was measured for 15 (52%) patients, not measured for 14 patients and was measured for only one patient before prescribing an ACE inhibitor for the first time. Potassium was checked less frequently in new patients (average 2.5 vs 3.6 times per admission).ConclusionThis study confirmed that it is possible for pharmacists to collect and collate clinical and prescribing data as part of a routine monitoring program for inclusion in a hospital prescribing indicator set. Data can be collected, analysed and reported back to clinical teams in a short time. The results suggest that inpatients receiving ACE inhibitors are adequately monitored for adverse biochemical effects.
Neonatal Epilepsy Associated with Maternal Ingestion of Blue Cohosh
Authors: MacPherson Ross D , Kilminster Ian 
Published: April 2015

ABSTRACTAimTo describe a case of neonatal epilepsy associated with maternal ingestion of blue cohosh.Clinical detailsA 32‐year‐old female consumed a mixture of blue cohosh, raspberry leaf and squaw vine for 4 days in late pregnancy to hasten the onset of labour. After delivery, the neonate showed signs consistent with status epilepticus which was confirmed by electroencephalogram and treated accordingly.OutcomeThe neonatal epilepsy settled with conventional treatment and there were no long‐term sequelae.ConclusionEvidence of adverse effects associated with complementary and alternative medicines continues to accumulate. Patients must be specifically questioned about their use of complementary and alternative medicines. This case report suggests a possible association between blue cohosh and neonatal epilepsy.
Pharmacoeconomics: a Reliable Tool for Decisions on New Medicines?
Authors: Chesney Kate , Barazanchi Noora , Billy Ruth , Koo Jessica , Rabih Nancy , Slaimankhel Jamila , Tordoff June M 
Published: April 2015

ABSTRACTAimTo provide a literature‐based review of the reliability of pharmacoeconomics as a tool for decisions on new medicines.MethodMedline and Embase databases were searched. Articles published in English in peer‐reviewed journals were selected according to relevance, and bibliographies searched for other relevant articles. All articles were assessed for information and opinions on the use of pharmacoeconomics, methodology and quality of studies, and reliability in decision‐making.ResultsOver 1000 articles were retrieved and 120 selected for review. The review indicated that, although pharmacoeconomics is increasingly used in decision‐making, its methodology is still developing. Methodological guidelines, well‐established in some countries, can improve the quality of studies, but there is scope for improvement in adherence to guidelines. To improve confidence in pharmacoeconomics, studies need to be peer‐reviewed by experts before publication. Bias, unintentional or otherwise, can be found in all types of economic analysis and needs to be considered. To avoid bias, methodological guidelines should be closely adhered to, and all financial interests and sources of funding disclosed. There is a need to educate users to understand economic analysis, recognise any inherent bias, and assess the quality of the studies they intend to use.ConclusionProviding methodological guidelines are followed, methodology is transparent, and bias is minimised, pharmacoeconomics can be a reliable tool to assist in decisions on the introduction of new medicines.
Stability Implications of Repackaging Paracetamol Tablets into Dose Administration Aids
Authors: Haywood Alison , Mangan Martina , Glass Beverley 
Published: April 2015

ABSTRACTBackgroundDespite the widespread use of dose administration aids (DAAs) there is little available data on the stability of drugs during repackaging or storage in these devices.AimTo investigate the physicochemical stability of paracetamol tablets repackaged in DAAs.MethodPhysicochemical stability studies were performed on a commonly used paracetamol tablet directly after heat‐sealing in a DAA frequently employed in practice, then at ambient (25 °C; 60% relative humidity) and accelerated (40 °C; 75% relative humidity) conditions, over a 3‐month period. Physical characteristics of the tablets (weight uniformity, physical appearance, thickness, hardness, friability, disintegration, dissolution rates) were evaluated at time = 0, directly after heat‐sealing, 1 month and 3 months. Chemical stability was confirmed by high performance liquid chromatography (HPLC). The results were compared to control samples stored in the original packaging at the various environmental conditions studied.ResultsAll compendial requirements for physicochemical stability were met for both ambient and accelerated conditions over the 3‐month period. Chemical stability of paracetamol content fell within the required range of 95–105% of the labelled amount, for all environmental conditions.ConclusionThis study provides evidence on the stability of paracetamol tablets in a DAA, to support pharmacists in making sound clinical and operational decisions regarding the repackaging of paracetamol in these devices.
Survey of Clopidogrel Use in a Teaching Hospital
Authors: Armenores Paul , Wiltshire Stephanie L , Tonkin Anne L , Shakib Sepehr 
Published: April 2015

ABSTRACTAimTo develop guidelines for clopidogrel prescribing and survey its use to ascertain the need for changes in prescribing patterns.MethodGuidelines were developed after a literature review. Prescribing patterns were assessed by a cross‐sectional survey which investigated the therapy of inpatients identified taking clopidogrel at a teaching hospital over a 2‐month period. Measures of concordance were indications for clopidogrel, contraindications to NSAIDs, timing and range of clopidogrel dosage and associated use of aspirin.ResultsData were collected from 69 patients. 29 (42%) were taking clopidogrel for secondary prevention of ischaemic heart disease—14 for appropriate indications. 23 (33%) were given clopidogrel before and/or following percutaneous coronary intervention—11 had an appropriate combined aspirin and clopidogrel loading dose, and 20 had appropriate combined long‐term therapy. 15 (22%) received clopidogrel for secondary prevention of cerebrovascular disease and 7/15 had appropriate indications. 2 (2.9%) patients with peripheral vascular disease and 1 (1.4%) with chronic atrial fibrillation were treated directly with clopidogrel. 3 (4.3%) patients had unknown indications.ConclusionsA large proportion of clopidogrel prescribing did not have a good evidence base. For safety and economic reasons, prescribers need to be made aware of current evidence and recommendations.
Lipophilicity of Beta‐Adrenocepter Antagonists: A New Classification Scheme for Clinical Use
Authors: Northfield Susan E , Manallack David T 
Published: April 2015

ABSTRACTBackgroundThe lipophilic nature of beta‐adrenoceptor antagonists (beta‐blockers) has clinical importance as it influences pharmacokinetics, pharmacodynamics, cardioprotective actions, and adverse effects.AimTo explore the lipophilicity of a series of beta‐blockers at physiological pH (logD7.4) and to compare their characteristics.MethodThe lipophilicity of each compound at physiological pH (logD7.4) was predicted and compared to available experimental data.ResultsAn initial comparison undertaken of logP values for 30 selected beta‐blockers against calculated logD7.4 estimates gave a good correlation (r2 = 0.92; s = 0.37) indicating that the rank order of lipophilicities differs little between the neutral species and appropriate charge state at pH 7.4. Similarly, for a set of 21 beta‐blockers with measured logD7.4 values, a good correlation was observed against calculated logD7.4 estimates (r2 = 0.95; s = 0.25). Of interest was a subset of ten beta‐blockers in clinical use which have an associated lipophilicity classification listed in the Therapeutic Guidelines: Cardiovascular. Amendments may be required to this three‐class scheme in the light of the present results.ConclusionA new classification scheme is proposed comprising four lipophilic beta‐blocker classes. This new proposal could be applied clinically to make appropriate choices for patients with regard to cardioprotective effects and reducing adverse effects.
New South Wales Private Hospitals and Their Pharmacy Services
Authors: Moles Rebekah J , Brien Jo‐anne E , Benrimoj Shalom I 
Published: April 2015

ABSTRACTAimTo explore the relationship pharmacy has with private hospitals and identify areas that can be targeted for improvement.MethodInformation about each hospital's characteristics, e.g. bed size, location, specialty services, were gathered and semi‐structured, in‐depth interviews were conducted with pharmacists servicing private hospitals. Information was gathered about the types of pharmaceutical services provided to the hospitals and the models of service provision. 82 private hospitals were identified in NSW during the study period. Data for 72 (88%) hospitals were gathered. 51 pharmacies were involved, demonstrating that some pharmacies serviced more than one hospital. 53 interviews were conducted, involving these 51 pharmacies across the state.ResultsThe majority of pharmacies were off‐site community pharmacies (80%). 10 hospitals (14%) had an on‐site pharmacy and 6% of hospitals had a mixed pharmacy model. The range of pharmacy services provided to each hospital varied greatly. Overall, clinical services appeared to be underdeveloped with only a third of hospitals having pharmacists review drug charts or provide patient counselling; however, some pharmacists appeared to provide a comprehensive service.ConclusionThis study provided insight into the relationships private hospitals have with pharmacy. It also identified areas within the private hospital sector that may need improvement with respect to pharmacy services. It provided background to research on the development, implementation and evaluation of professional pharmacy services for private hospital patients.
Drug Use Evaluation of Ondansetron in Postoperative Nausea and Vomiting
Authors: Zolezzi Monica , Forbes Alison , Bradshaw‐Leung Hilary , Aprea Sara , Barnes Monique , Clunie Laura , Fusha Bekim , Tawadrous John 
Published: April 2015

ABSTRACTBackgroundPostoperative nausea and vomiting (PONV) may prolong patient recovery time and increase the cost of their care. Ondansetron is an effective treatment for PONV, but is more expensive than other antiemetics. The Auckland District Health Board (ADHB) PONV guidelines are a stepwise approach to anti‐emetic prescribing in which ondansetron is the last choice.AimTo investigate the patterns of ondansetron prescribing in the management of PONV at Auckland City Hospital and whether its use was in accordance with the ADHB PONV guidelines.MethodA retrospective drug use evaluation of patients for whom ondansetron was prescribed, and who were admitted postoperatively to 20 adult medical and surgical wards.Results303 patients were recruited over a 4‐week period, of whom 256 surgical patients were considered. Adherence with the ADHB PONV guidelines was higher when a reminder (an antiemetic sticker) was used than when it was not used (84% vs 76%). Use of the sticker increased the proportion of patients for whom other anti‐emetics were prescribed. There was poor identification of patients at risk of PONV and consequently limited use of prophylactic antiemetics in this group.ConclusionAlthough the use of antiemetic stickers was low, overall adherence to the ADHB PONV guidelines was encouraging. A number of steps were often omitted when an antiemetic sticker was not used and a significant proportion of patients received ondansetron first‐line.
Identification of Potential and Actual Breaches in the Cold‐Chain within a Tertiary Hospital
Authors: Dubrava Suzanne , Tait Paul A , Humphris Mary‐Ann 
Published: April 2015

ABSTRACTBackgroundVaccines are biologicals that need a strict storage environment from the time of manufacture to ensure that they are potent at the time of administration. The National Vaccine Storage Guidelines (NVSG) provide clear directives for appropriate vaccine storage within healthcare institutions.AimTo compare current hospital vaccine storage and transport practices to NVSG.MethodAreas within the hospital where vaccines were stored were identified. A senior staff member from each area was asked a series of questions about their cold‐chain management. A temperature logging device recorded the temperature for 24 hours on different shelves within each refrigerator and a visual inspection was made of each refrigerator and its environs. The temperature of vaccines transported from pharmacy stores to a ward was also monitored.Results4 of the 12 refrigerators examined failed to meet the temperature requirements and only 1 refrigerator fully met the NVSG criteria. Temperatures recorded in purpose‐built vaccine refrigerators were outside the required range for 4.5% of the period monitored and domestic refrigerators were outside the range for 34% of the period. Temperatures varied more between shelves in domestic refrigerators than in purpose‐built refrigerators.ConclusionPotential breaks in the cold‐chain were identified. The issues were addressed through the promotion of the NVSG throughout the hospital and the introduction of purpose‐built refrigerators in areas with a high level of vaccine use.
Developing Clinical Practice Guidelines for the Medication Management of Acute Behavioural Disturbance
Authors: Wheeler Amanda J , Sheridan Janie , Robinson Gail , Branford David , Holmes Nicola J 
Published: April 2015

ABSTRACTThis paper describes the development process of a concise, portable clinical practice guideline for the medication management of acute behavioural disturbance in adult psychiatric inpatients in Auckland, New Zealand. It was developed to aid psychiatry registrars and is a decision aid only. A literature search identified evidence‐based reviews and guidelines implemented elsewhere. This formed the basis for development of a locally relevant tool, finalised for implementation by a process of consensus agreement. This clinical practice guideline was developed collaboratively over 2 years in response to local need. Development was requested by junior medical staff and actively supported by clinical leaders. The guideline resulted from a review of the evidence for medication management of acute behavioural disturbance and adaptation of the UK National Institute for Clinical Excellence guidance in combination with local consensus agreement.