bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phenotyping for Thiopurine Therapy in Clinical Practice
Authors: Dooley Michael J , Dixon Barbara , Poole Susan G , Chiang Cherie , Whitlock Alison , Schneider Hans 
Published: April 2015

ABSTRACTAimTo quantify the uptake of thiopurine methyltransferase (TPMT) phenotyping in patients on thiopurines.MethodA retrospective audit was undertaken to identify all patients initiated on thiopurines from 1 August 2003 to 31 May 2006 at a tertiary referral hospital. All patients dispensed azathioprine, mercaptopurine and thioguanine were identified from computerised dispensing records. TPMT phenotype test results were obtained from the hospital's pathology service for the period 1 July 2003 to 30 June 2006.ResultsOf the 287 patients initiated on thiopurines, 21 (8.8%) had TPMT activity measured. Thiopurines were widely prescribed across a number of medical disciplines with the largest usage in the transplant units − 88 lung transplant recipients and 3 dual heart and lung transplant recipients. Only one transplant recipient had TPMT activity measured. In the dermatology unit, 47% of patients receiving thiopurines underwent TPMT phenotyping.ConclusionThe uptake of TPMT phenotyping in patients on thiopurines was low and variable depending on the clinical unit. Further efforts to increase the uptake of TPMT phenotyping before initiation of thiopurine therapy are warranted.
Pharmacokinetics and Bioavailability of Hydromorphone Nasal Spray
Authors: Lim Stephen CB , Paech Michael J , Goy Raymond , Liu Yandi , Zhang Guicheng , Yao Meicun , Doherty Dorota A 
Published: April 2015

ABSTRACTAimTo evaluate the pharmacokinetics and bioavailability of two formulations of intranasal hydromorphone hydrochloride in adult postoperative patients.MethodIn an open‐label, randomised, crossover study a convenience sample of adult postoperative patients received intravenous hydromorphone 1 mg and intranasal hydromorphone 2 mg (with and without chitosan).ResultsPharmacokinetic data sets from 19 patients showed intranasal hydromorphone produced detectable serum levels within 2 minutes of administration, with mean bioavailability of 49.5% (without chitosan) and 67.5% (with chitosan). Mean peak serum concentrations were 0.92 ng/mL (without chitosan) and 1.16 ng/mL (with chitosan). Summed pain intensity differences suggest that intravenous hydromorphone produced a better clinical response.ConclusionThe bioavailability of intranasal hydromorphone is approximately 0.6 of intravenous hydromorphone. Adding chitosan to the intranasal solution did not significantly increase the bioavailability of hydromorphone.
Value of Medication Reconciliation in Reducing Medication Errors on Admission to Hospital
Authors: McLeod Susan E , Lum Elaine , Mitchell Charles 
Published: April 2015

ABSTRACTAimTo review the literature and report on the prevalence of medication history taking errors occurring on admission to hospital when medications are prescribed or reordered, and the value of medication reconciliation in detecting these errors.MethodOvid Medline and PubMed databases were searched for articles published from 1966 to March 2008 that related to: medication errors on or during hospital admission; value of medication history taking and reconciliation on admission; and systems for reducing medication errors and adverse drug events. The Ovid Medline search identified 461 articles of which 20 were used. The PubMed search identified 119 articles, of these, 7 not found in the Ovid Medline search were used. References from the identified papers revealed a further 6 articles. Web sites of patient safety organisations were also searched and generated 8 articles. A total of 41 articles were used in the review.ResultsMedication history taking errors occur during transition points such as admission, transfer and discharge to hospital. The cited studies reviewing medication history errors are qualitative, study different population groups, use different methods to obtain medication history and do not always rate the clinical importance of the error. These limitations account for the range of medication history errors found in the cited studies (27–65%). Medication errors and subsequent adverse drug events are detected and reduced by a standardised process of reconciliation. Numerous large scale hospital initiatives in the US have outlined the implementation of a reconciliation process and the subsequent reduction in medication errors, adverse drug events and resultant economic benefits. Strategies for improving the medication reconciliation process include the use of a standardised form, improved communication, multidisciplinary approach, use of computerised physician or prescriber order entry with decision support and home medication lists.ConclusionObtaining a detailed medication history and performing medication reconciliation reduces the incidence of medication errors and subsequent adverse drug events.
Medications in Pregnancy: Impact on Time to Lactogenesis after Parturition
Authors: Kong Ming‐Shu , Bajorek Beata 
Published: April 2015

ABSTRACTBackgroundAlthough the many factors that affect the initiation of lactation have been identified, the impact of medications on lactogenesis remains largely unknown.AimTo explore the impact of medications used during pregnancy on time to lactogenesis after parturition.MethodData were collected prospectively from women admitted to a metropolitan Sydney hospital for parturition. Information was obtained via a short interview with each patient, as well as from medical notes, drug charts and infant feeding charts.ResultsThe average time to lactogenesis was 68.9 hours (range 22.5–126). 39% of women experienced delayed lactogenesis. Observational results showed that the use of some medications during pregnancy may impact on the time to lactogenesis. Cigarette smoking during pregnancy and prolonged stage II vaginal delivery may also increase the time to lactogenesis.ConclusionSeveral medications used during pregnancy may impact on time to lactogenesis but the biological plausibility is unknown.
Stability of a Formulated N‐acetylcysteine Capsule for Prevention of Contrast‐Induced Nephropathy
Authors: To The‐Phung , Ellis Andrew G , Ching Michael S , Shilson Alan D , Kong David CM , Garrett Kent 
Published: April 2015

ABSTRACTBackgroundN‐acetylcysteine is used as prophylaxis to prevent contrast‐induced nephropathy.AimTo investigate the stability of a formulated N‐acetylcysteine capsule for prevention of contrast‐induced nephropathy.MethodGelatine capsules containing N‐acetylcysteine and lactose were stored at 2–8 °C, 18–25 °C and 40 °C, with and without desiccant, at ambient and high humidity (~75%). Capsule stability was assessed using high performance liquid chromatography to measure N‐acetylcysteine and N,N‐diacetylcystine (breakdown product) on Days 0, 3, 7, 14, 28, 84, 168, 252, 336 and 420 of storage.ResultsAt 40 °C and high humidity the capsules showed severe physical degradation and hydrogen sulphide odour, and loss of N‐acetylcysteine was around 30–40% by 420 days. Under all other storage conditions, the N‐acetylcysteine content was stable up to 420 days (± 2% change from initial content), irrespective of humidity. The presence of desiccant did not significantly affect stability and the presence of N,N‐diacetylcystine barely exceeded the European Pharmacopoeia limit of 0.5%.ConclusionThe formulated N‐acetylcysteine capsule was stable for 420 days when stored at 2–8 °C, 18–25 °C and 40 °C.
Oxycodone as a Component of Multimodal Analgesia Post‐Caesarean Section in Australia and New Zealand
Authors: Seaton Suzette M , Reeves Mark 
Published: April 2015

ABSTRACTBackgroundThere is a perception that oral oxycodone is becoming a popular choice for post‐caesarean section analgesia. There are a lack of published data quantifying the use of oxycodone and other drugs for post‐caesarean section analgesia in Australasian practice.AimTo determine the use of oxycodone and other drugs for multimodal analgesia post‐caesarean section and to evaluate the compatibility of these drugs with breastfeeding.MethodFellows of the Australian and New Zealand College of Anaesthetists from 41 Australian and New Zealand obstetric units were invited to participate in an online survey on analgesic preference (drug, route of administration, dosing schedule) post‐caesarean section and whether breastfeeding considerations influenced their choice of analgesics.Results25 participants (response rate 61%) completed the survey. All of the responding obstetric units used multimodal analgesic protocols, which included oral and rectal paracetamol and non‐steroidal anti‐inflammatory drugs. Survey responses indicated that 50% of women in metropolitan hospitals and 95% of women in rural and regional hospitals would receive oral or rectal oxycodone post‐caesarean section. Approximately, 15% of women would be asked about their intention to breastfeed. 6% of anaesthetists would modify their choice of analgesic if the patient was breastfeeding.ConclusionThe obstetric units preferred oral and rectal analgesics over parenteral opioids and non‐steroidal anti‐inflammatory drugs. There was a high use of oxycodone for post‐caesarean section analgesia. The analgesics chosen were largely compatible with breastfeeding.
Surface Contamination of Cytotoxic Chemotherapy Preparation Areas in Australian Hospital Pharmacy Departments
Authors: Siderov Jim , Kirsa Sue , McLauchlan Robert 
Published: April 2015

ABSTRACTBackgroundStudies from Europe, the US and Australia have shown measurable levels of cytotoxic contamination in health facilities. Cytotoxic drug residue has been detected in the air and on surfaces in preparation areas even though work was undertaken in biological safety cabinets. Several studies have found substantial levels of surface contamination in pharmacy drug preparation and administration areas. At the time this study was conducted there were no published Australian studies investigating surface contamination when cytotoxic drug safety cabinets are in use.AimTo determine if surface contamination with cytotoxic drugs occurs when cytotoxic drug safety cabinets are used by pharmacy personnel to prepare cytotoxic chemotherapy.MethodA multicentre study conducted at 10 hospital pharmacy departments in metropolitan Melbourne. All sites were tested to measure the amount of cytotoxic contamination present using cyclophosphamide as a surrogate marker for all cytotoxic drugs. Surface wipe sampling was performed at specified locations within the cytotoxic suites.ResultsCyclophosphamide contamination was detected in 78% of samples taken within the cytotoxic drug safety cabinet, with 100% contamination detected in the sump. Positive results were also found in 89% of floor samples (cleanroom and anteroom) and 67% of checking benches.ConclusionCytotoxic drug contamination was detected on a variety of surfaces in the cytotoxic drug preparation areas that used cytotoxic drug safety cabinets. The potential risk of exposure to cytotoxic drugs exists in the workplace despite adherence to the recommended safe handling guidelines.
Solid Medication Dosage Form Modification at the Bedside and in the Pharmacy of Queensland Hospitals
Authors: Nissen Lisa M , Haywood Alison , Steadman Kathryn J 
Published: April 2015

ABSTRACTBackgroundSolid medication dosage forms are regularly modified to aid medication delivery to patients that are unable to swallow them.AimTo identify medications that are commonly modified in Queensland hospitals at the bedside and in the pharmacy and to identify how these modifications are made.MethodA self‐report survey was sent to 97 hospitals of varying sizes in metropolitan and rural areas across Queensland.ResultsMost (n = 31; 79%) of the responding hospitals reported that medications were modified at the bedside. 73 different medications were modified at the bedside. Most of the tablets or capsules had standard‐release characteristics. 8 hospitals crushed modified‐release dosage forms and 11 hospitals crushed medications with a narrow therapeutic index. At the bedside, 88% of medications were modified for adult use, mostly by crushing multiple tablets together (84% of hospitals) using a pestle and mortar (87%) and mixing into jam (72%) or water (64%). Only 7 hospitals reported modifications in the pharmacy (many small hospitals do not employ a pharmacist). 17 medications modified in the pharmacy were all modified for children because of the lack of commercial preparations.ConclusionCommercial medication dosage forms are altered in Queensland hospitals, including medications for which serious adverse effects may arise from the delivery of toxic or subtherapeutic doses. Pharmacists can contribute to the education of nurses to raise awareness of problems resulting from altering medication dosage forms. Education of doctors is also needed to raise awareness of prescribing alternative dosage forms that may either be commercially available or prepared by the pharmacy as an extemporaneous preparation.
Management of Medicines in Chronic Illness: Views of Community Pharmacists in New South Wales
Authors: Lehnbom Elin C , Boxall Anne‐marie , Russell Lesley M , Brien Jo‐anne E 
Published: April 2015

ABSTRACTBackgroundHealthcare reforms are needed to meet the predicted increase in the chronic disease burden. A multidisciplinary team approach has been extensively evaluated and shown to improve health outcomes. There is also support for including pharmacists in these teams. Pharmacists have valuable insight, from a medication perspective, to improve the management of patients with chronic illness.AimTo explore the perceptions of community pharmacists regarding the incentives, barriers and solutions in managing the medication regimens of patients with chronic illness.MethodSemi‐structured group discussions and individual interviews were conducted in October and November 2008 with community pharmacists working in Western Sydney and the Blue Mountains.ResultsCommunity pharmacists struggle to provide optimal care for patients with chronic illness. Identified reasons include poor communication with patients and health professionals, lack of care coordination and continuity of care. Many patients were thought to struggle financially when managing a chronic illness, which negatively influenced their adherence to medication regimens and recommendations on lifestyle changes. Better teamwork and communication, possibly through co‐locating health professionals under one roof were suggested by pharmacists as possible solutions.ConclusionPharmacists have a good understanding of patients' social circumstances but lack relevant clinical data. Community pharmacists are willing to take a greater role in the management of patients with chronic illness.
Stability of Methoxyflurane Loaded Penthrox Inhaler
Authors: Crankshaw David P 
Published: April 2015

ABSTRACTBackgroundMethoxyflurane (MEOF), a non‐narcotic inhalational anaesthetic, administered with the Penthrox Inhaler is effective in managing acute pain. Despite widespread use by ambulance services, its use in emergency departments and hospital wards has been limited. MEOF storage to minimise evaporation would facilitate pre‐filling inhalers for multiple treatment use.AimTo ascertain if Penthrox Inhalers loaded with MEOF can be stored for extended periods without appreciable loss of MEOF.Method18 Penthrox Inhalers were loaded with MEOF 3 mL and weighed over 87 hours. 6 inhalers were left in the open, 6 inhalers stored in the packing boxes and 6 inhalers sealed in low‐density polyethylene bags inside the packing boxes.ResultsPenthrox Inhalers in the polyethylene bags retained over 95% of the MEOF after 25 hours and over 80% after 87 hours. Inhalers stored in the packing boxes retained 15% of the MEOF after 25 hours while inhalers left in the open lost 50% of the MEOF after 5 hours with less than 1% remaining after 25 hours.ConclusionPenthrox Inhalers loaded with MEOF and stored in low‐density polyethylene bags inside the packing boxes can be effective for over 3 days without appreciable loss of MEOF.
Coordinated Strategies to Attract Pharmacists to the Public Hospital Sector in Victoria
Authors: O'Leary Karen , Newman Suzanne , Yeung Sally , Wright Sue 
Published: April 2015

ABSTRACTA 2001 census of Victoria's public hospitals reported that 8% of the 443.5 pharmacist full‐time equivalent positions were vacant. The funding of a pharmacist project officer by the Victorian Department of Human Services enabled the identification and implementation of recruitment strategies. Subsequent workforce analyses highlighted links between high vacancy rates and reduced job satisfaction with staff retention. Also identified was the importance of hospital‐based training in recruiting newly qualified pharmacists to the public hospital sector. Since 2001, there has been an estimated increase of 185 to 200 full‐time equivalent pharmacist positions in Victoria's public hospitals and the vacancy rate has also improved (8% to 3%). Hospital‐based training is a successful strategy to recruit newly qualified pharmacists and pro‐actively addressing the vacancy rate is an effective retention strategy.
Management of Older People with Chronic Obstructive Pulmonary Disease
Authors: Malipatil Vivek , McDonald Christine F 
Published: April 2015

ABSTRACTWorldwide, chronic obstructive pulmonary disease ranks among the most common chronic diseases and with the population ageing, its prevalence is predicted to increase. Established interventions that improve mortality include smoking cessation, and oxygen therapy in patients with significant hypoxaemia. Pharmacotherapy aims to alleviate symptoms, improve exercise tolerance and quality of life, and prevent and manage exacerbations. Although most medications are delivered via the inhaled route, adverse effects can manifest systemically. The likelihood of systemic adverse effects increases in the elderly and caution should be exercised in patients with comorbidities, such as cardiovascular disease. When indicated, combination therapies can offer superior efficacy over monotherapy. Assessment and education to ensure appropriate delivery device selection and use are integral to optimal care.
Management of Over‐Anticoagulation in Warfarinised Hospital Patients
Authors: Bajorek Beata V , Yau Leanne , Lee Kevin , Zulueta Wayne 
Published: April 2015

ABSTRACTAimTo determine the number of warfarinised hospital patients experiencing over‐anticoagulation; to identify how over‐anticoagulation is managed and whether local guidelines are adhered to.Method2 prospective one‐week clinical audits were conducted in 2005 (Audit 1) and 2008 (Audit 2). The medical notes, drug charts and anticoagulation charts of warfarinised patients admitted to hospital were reviewed. The following data were collected: medical histories, warfarin regimen, international normalised ratio results, clinical events and over‐anticoagulation clinical management and treatment options.ResultsData were collected for 58 patients (Audit 1: n = 30; Audit 2: n = 28). At least one‐third of all patients experienced over‐anticoagulation (Audit 1: 53%; Audit 2: 36%). Haemorrhagic events occurred in 40% of patients in Audit 1 and 18% in Audit 2 (p = 0.06) – not all were associated with elevated international normalised ratios. Most cases of over‐anticoagulation were managed by withholding warfarin doses and one case (Audit 2) required Prothrombinex. Drug interactions were the most common risk factor (> 50% of patients) for over‐anticoagulation in both audits. Problems with documentation were more prevalent in Audit 1 than in Audit 2.ConclusionOver‐anticoagulation is a common occurrence in warfarinised hospital patients. Hospital over‐anticoagulation management practices need to be reviewed to ensure safe and efficacious anticoagulation.
Identification of Adverse Drug Reactions Using the ICD‐10 Australian Modification Clinical Coding Surveillance
Authors: Hodgkinson Marisa R , Dirnbauer Nicole J , Larmour Ian 
Published: April 2015

ABSTRACTBackgroundAdverse drug reactions (ADRs) pose a significant burden on patients and the health system. ADR reporting contributes to data that guide patient safety strategies. Despite numerous strategies aimed to improve ADR reporting rates, ADRs continue to be under‐reported.AimTo compare the effectiveness and efficiency of identifying institutional ADRs using the International Classification of Diseases 10th Revision Australian Modification (ICD‐10‐AM) clinical coding surveillance and spontaneous reporting.MethodMedical records of multi‐day (staying overnight or longer) inpatient separations (single patient encounter resulting in discharge) assigned an ADR‐related ICD‐10‐AM code were retrospectively reviewed to verify if an ADR had occurred and whether the codes assigned were appropriate. ADR reports received via the spontaneous reporting system were also reviewed. ADRs were assessed for causality, seriousness and type of reaction. The drugs, type of adverse reactions involved and the resource implications of this reporting method were also investigated.ResultsICD‐10‐AM coding surveillance and spontaneous reporting resulted in an ADR reporting rate of 3.3% and 0.4% of inpatient separations, respectively. ICD‐10‐AM coding surveillance was more likely to identify type A ADRs than spontaneous reports although there were no significant differences in seriousness or causality. The ICD‐10‐AM codes assigned were appropriate in 94% of cases, with the omission of drugs being the most common discrepancy.ConclusionThe ICD‐10‐AM coding surveillance is an effective and efficient method of improving ADR reporting by utilising data collected for administrative purposes.
Snapshot of the Australian Public Hospital Pharmacy Workforce in 2007
Authors: O'Leary Karen M , Allinson Yvonne M 
Published: April 2015

ABSTRACTIn 2007, a workforce questionnaire was sent to 236 Australian public hospitals with more than 50 beds. This report details the data received from 108 public hospital pharmacy services and compares the results to the earlier surveys performed at the same time of year in 2001, 2003 and 2005. Key findings of the 2007 snapshot of the Australian public hospital pharmacy workforce are that:
overall, 84 of the 1256 (7%) establishment pharmacist full‐time equivalent positions were vacant (similar to 2005);
there has been a considerable increase in establishment pharmacist full‐time equivalent positions in public hospitals in the past 2 years. 35 respondents indicated the need for additional 133 pharmacist full‐time equivalent positions (or an increase of 11%) in the next 2 years. The majority of these positions were needed because of the expansion of clinical services, improving pharmaceutical review initiatives and the introduction of the Pharmaceutical Benefits Scheme.
30 of the 84 vacancies are in New South Wales (vacancy rate 11%). New South Wales also has a substantial gap between the actual and required number of pharmacist full‐time equivalent positions and a relatively low number of establishment pharmacist full‐time equivalent positions;
on average pharmacists spent (similar to 2005) 47% of their time providing clinical services, drug information services, and training and education; 38% of their time acquiring, manufacturing and dispensing medicines; and 15% of their time managing the medicine and personnel resources of the pharmacy service and hospital‐wide activities, such as institutional drug policy management;
the number of available pharmacy intern positions has only increased slightly despite a large increase in the number of pharmacy graduates; and
the percentage of hospital pharmacy technicians with formal qualifications as a pharmacy technician or overseas pharmacist has increased to over 50% (26% Certificate 111, 11% Certificate 1V, 13% with other qualifications).