bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral Antineoplastic Chemotherapy
Authors: Gilbar Peter J , Carrington Christine V 
Published: April 2015

ABSTRACTAlthough most cancer medicines are administered parenterally, there has been an increase in the availability of oral antineoplastics. Oral antineoplastics offer several advantages, including ease of administration, convenience and cost savings. Disadvantages may include reduced patient supervision, concordance issues, inappropriate patient selection and unpredictable bioavailability. A number of safety issues, including storage and prevention of medication errors, must also be addressed. Safe handling techniques must be optimised to minimise occupational exposure. Pharmacists are in an ideal position to educate patients/carers to ensure concordance to therapy and guarantee the safe and effective use of oral antineoplastics.
Renal Failure and Acute Interstitial Nephritis Associated with NSAIDs
Authors: Ho Lisa , Lim Andy KH , Tanner Francine 
Published: April 2015

ABSTRACTBackgroundNon‐steroidal anti‐inflammatory drugs (NSAIDs) are a recognised cause of acute interstitial nephritis. Some NSAIDs are freely available as over‐the ‐counter preparations. There are potential serious consequences with prolonged unsupervised self‐medication with NSAIDs.AimTo describe two cases of renal failure involving over‐the ‐counter use of NSAIDs, with a focus on interstitial nephritis.Clinical featuresBoth patients obtained over‐the ‐counter NSAIDs and self‐medicated without supervision. One patient was taking ibuprofen for chronic pain and subsequently started taking diclofenac, as recommended by his chiropractor. The second patient started taking ibuprofen for severe, unrelenting pain. The aetiology of the pain was not diagnosed prior to admission. Both patients presented with systemic symptoms and renal failure. Acute interstitial nephritis was proven on biopsy and the suspected offending NSAIDs were ceased in both cases. In both cases renal function improved after cessation of NSAIDs.ConclusionPrimary care pharmacists should inform patients of the potential adverse effects of NSAIDs and advise them to seek a diagnosis for their pain if prolonged use is contemplated.
Systemic Absorption of Low‐Dose Oral Vancomycin
Authors: Brouwer Deas M , Corallo Carmela E , Coutsouvelis John 
Published: April 2015

BackgroundThe absorption of oral vancomycin is usually minimal. However, in the presence of renal impairment and inflammatory disorders of the intestinal mucosa, it may be absorbed to a significant extent. Case reports and literature reviews suggest that this is generally not an issue unless doses of vancomycin above 2 g/day are used for prolonged periods.AimTo describe a case of persistently high serum vancomycin levels associated with low oral doses of vancomycin.Clinical featuresA 59 year‐old obese woman with neutropenic sepsis and renal impairment was treated with intravenous meropenem and vancomycin. Oral vancomycin 125 mg 6‐hourly was commenced for antibiotic‐associated diarrhoea due to Clostridium difficile. Intravenous vancomycin was ceased after 4 doses because serum levels were > 20 mg/L. Serum vancomycin levels remained > 16 mg/L for over a week, even after reducing the oral dose from 500 mg to 300 mg/day.OutcomeVancomycin levels steadily decreased after ceasing oral vancomycin in the presence of worsening renal function.ConclusionSignificant absorption of low doses of oral vancomycin may occur resulting in therapeutic levels. The extent of absorption is unpredictable, therefore monitoring of serum vancomycin levels is recommended in at risk patients.
Pharmacological Treatment of Challenging Neuropsychiatric Symptoms of Dementia
Authors: Woodward Michael C 
Published: April 2015

ABSTRACTNeuropsychiatric symptoms of dementia can be challenging to patient and carers, and affect the majority of people with dementia at some stage. Symptoms including agitation, aggression, and psychosis may respond to non‐pharmacological therapy. If pharmacotherapy is required the family and carers should be informed and involved in defining treatment goals and monitoring progress. The best current evidence is for atypical antipsychotics with two randomised controlled trials supporting the use of risperidone. However, there are concerns about an increased risk of stroke and death from atypical antipsychotics. Other drug classes have less supportive evidence for efficacy, but may be appropriate for specific symptoms. In all cases, attempts should be made to minimise the dose of the drug and cease it entirely after a time.
Minimising Medication Mishap: Introducing a Warfarin Safety Strategy
Authors: Lubliner Mark , Cole‐Sinclair Merrole , Kenneally Anne , Street Alison , Van De Vreede Melita , Walsh Michael K 
Published: April 2015

ABSTRACTAnticoagulants have been implicated in up to 10% of all adverse drug events. In 2001, The Alfred established a Medication Safety Committee and identified warfarin therapy as a patient safety priority. Through process mapping and consultation, opportunities for error were identified throughout the warfarin prescribing, dispensing and administration processes. Clinicians considered review of prothrombin international normalised ratio results and routine warfarin dosing at 2000 hours as the most significant risk to patients. This was because warfarin was frequently prescribed by after‐hours staff who were not familiar with the patient's history or changes in their clinical condition or medication. Clinicians participated in the development and implementation of a warfarin safety strategy that involved changing the dosing to 1600 hours and alert stickers affixed to drug charts by pharmacists to identify patients prescribed warfarin. This program was effective in improving staff management of inpatients receiving warfarin. It also demonstrated the importance of an effective change management strategy in establishing a sense of urgency in clinicians regarding safety, and engagement in process analysis, risk identification and the development of simple and practical safety strategies.
Pharmacist‐Initiated Electronic Discharge Prescribing for Cardiology Patients
Authors: Birdsey Garth H , Weeks Greg R , Bortoletto Diana A , Black Alexander JR 
Published: April 2015

ABSTRACTAimTo determine whether pharmacist‐initiated electronic discharge prescribing would decrease discharge times for selected cardiology patients and improve the accuracy of prescribing by limiting deviations from the intended therapeutic plan.MethodA cardiology project team identified system issues impeding patient flow through the ward, including the discharge medication pathway. The stages of the medication pathway were mapped before and after the intervention of pharmacist‐initiated electronic discharge prescribing. The accuracy of prescribing in both phases of the study was measured against evidence‐based standards agreed by the cardiology unit.Results39 patients were recruited in phase 1 (usual practice) and 35 patients in phase 2 (pharmacist‐initiated discharge prescriptions). The time from a decision to discharge a patient to the completed prescription reaching the patient was significantly reduced from a median of 190 minutes to 50 minutes in the intervention arm (p < 0.0001). However, this result did not translate into patients leaving the hospital earlier. In phase 1, 26% of prescriptions (n = 39) contained at least one error, including 19 clinically significant omissions. In phase 2, no omissions were made but the signing doctor made two changes to the pharmacist‐initiated prescriptions that were unrelated to the evidence‐based standards.ConclusionThis pilot study has shown that an experienced pharmacy specialist using an electronic discharge prescribing system can significantly reduce the time elements of the discharge medication pathway. In addition, errors of omission that deviate from evidence‐based practice are reduced. This practice model can be extended to other specialist areas.
What's in a Name? Lack of Pronunciation in Consumer Medicine Information
Authors: Siderov Jim 
Published: April 2015

ABSTRACTAntineoplastic drugs entail significant risks. Even modest deviation from prescribed doses can result in unwanted toxicity. Well‐informed patients are a vital link in the safety chain to prevent errors, with verbal communication an essential tool. Good communication is of great importance when dealing with similar sounding names. Errors in prescribing can result where a patient mispronounces the medication they are taking. The purpose of this review was to determine if a pronunciation guide was available in the Consumer Medicine Information for antineoplastic drugs available in Australia. Of the 145 drugs available for review, a Consumer Medicine Information was available in 88% of cases. A pronunciation guide was available for 17% of generic and 2.3% of trade names. Of the oral drugs, a pronunciation guide was available for 7.6% of generic and 3.0% of trade names. Practitioners involved in the preparation of Consumer Medicine Information should consider the inclusion of a pronunciation guide for medicines.
Therapeutic Errors reported to the Victorian Poisons Information Centre—Pilot Study
Authors: Taylor David McD , Robinson Jeffrey , MacLeod Dawson , Braitberg George 
Published: April 2015

ABSTRACTAimTo analyse a sample of therapeutic errors reported to the Victorian Poisons Information Centre.MethodA retrospective series of 102 cases of therapeutic error reported in March 2005 were examined. Data were extracted from the Victorian Poisons Information Centre database.ResultsOf the 102 cases of therapeutic error, females (64%) and adults (72%) predominated. Most errors (91%) occurred in patients' homes. 87 (85%) cases did not require medical attention. In 68 (67%) cases, the subject made the error and in almost all (93%) cases the error involved oral drug administration. Most (84%) subjects were asymptomatic at the time of the call. In total, 125 drugs were taken in error and 11 (11%) subjects made multiple errors. The predominant drug classes were analgesics, anti‐inflammatory drugs, cardiac drugs, antipsychotics and antidepressants. An incorrect dose was taken in 47 (46%) cases and drugs were taken too early in 12 (12%) cases. An incorrect administration route was used in 9 (9%) cases. Incorrect labelling, formulating and packaging accounted for 4 (4%) errors.ConclusionAlthough most errors reported during the study were unlikely to cause harm, a large prospective study is indicated to clarify error patterns and inform prevention strategies.
Factors Influencing Adherence to Molecular Therapies in Haematology‐Oncology Outpatients
Authors: Larizza Maria A , Dooley Michael J , Stewart Kay , Kong David CM 
Published: April 2015

ABSTRACTAimTo identify factors influencing adherence to oral molecular therapies in haematology‐oncology outpatients.MethodPatients prescribed imatinib and thalidomide participated in the study. A quantitative questionnaire incorporating validated assessment tools and developed from issues raised in the literature was used to collect data about demographic characteristics, motivations and perceptions, impact of social environment, and aspects of medication regimens. These factors were assessed for association with adherence to molecular therapies, estimated using the Morisky score.Results24 patients were recruited, all of whom reported high or moderate adherence to oral molecular therapies based on their Morisky score. Adherence was positively related with age (Rho = +0.510; p = 0.011) and overall patient satisfaction with hospital services and support from family and friends (Rho = +0.609; p = 0.003). There were a number of social environment factors which were found to have a significant inverse relationship with adherence to molecular therapies including: forgetting to take the medication, change in daily routine, feeling sick/ill, wanting to avoid adverse effects and having problems taking medication at certain times. The overall impact of a patient's social environment was found to contribute negatively to adherence (Rho = −0.542; p = 0.017).ConclusionFactors affecting adherence to molecular therapies can be assessed by pharmacists, allowing implementation of strategies to encourage adherent behaviour in difficult circumstances.
Preventing Potassium Problems Permanently: Eliminating Concentrated Potassium Chloride Errors
Authors: Lubliner Mark , Van de Vreede Melita 
Published: April 2015

ABSTRACTBackgroundIV potassium chloride is potentially one of the most dangerous medications, and accidental bolus administration of concentrated potassium chloride is well documented. In 2001, The Alfred identified this as a key patient safety priority.AimTo identify potential sources of error associated with concentrated potassium chloride and introduce an effective and practical risk reduction strategy to prevent inadvertent accidental administration.MethodRoot‐cause analysis was used to identify factors that contributed to a serious incident involving inadvertent administration of concentrated potassium. The application of a well‐recognised error prevention framework facilitated the development and implementation of a risk‐reduction strategy. This involved the elimination of concentrated potassium chloride ampoules from hospital wards, their substitution with clinically appropriate pre‐mixed potassium chloride preparations, and standardisation of potassium chloride prescribing units.ResultsAt The Alfred, concentrated potassium chloride ampoules were removed from all general wards and substituted with a commercially prepared solution containing potassium chloride 30 mmol/1000 mL. A pre‐mixed solution containing 10 mmol/100 mL, appropriate for use in fluid‐restricted patients, was developed and introduced through collaboration with another major teaching hospital and a manufacturer. All potassium chloride doses are now prescribed in millimoles, not grams.ConclusionThe Alfred's potassium chloride safety strategy has been effective in reducing the risks associated with inadvertent administration of concentrated potassium, through the elimination of concentrated potassium from all general wards and the development and introduction of an alternative potassium formulation that is appropriate for use in fluid‐restricted patients.
Extended Roles for Pharmacists in Warfarin Therapy: Identifying Opportunities for Pharmacist Prescribing
Authors: Khoo Amy , Bajorek Beata V 
Published: April 2015

ABSTRACTBackgroundWarfarin has traditionally posed a challenge to clinicians because of its narrow therapeutic index. Extended roles for pharmacists may address some of the problems in warfarin management. International experience has involved anticoagulation clinics in which pharmacists have authority to engage in collaborative prescribing activities with physicians.AimTo identify opportunities for pharmacist prescribing activities in warfarin management within the hospital setting.MethodPharmacists from a Sydney teaching hospital were recruited. The first stage involved an audit of pharmacists' interventions in patients receiving warfarin. Stage two involved a focus group discussion to further explore these issues.Results9 pharmacists saw 41 warfarinised patients over the 5‐day data collection period. Pharmacists saw reason to intervene in the warfarin therapy of 19 (46%) of these patients and a prescribing activity was involved in 16 (84%) of these interventions. Despite these ample opportunities to prescribe, pharmacists felt limited in their ability to use these opportunities. Lack of information about the patient, workloads, medicolegal responsibility, and the need for further training and experience, were cited as the main reasons pharmacists were hesitant to prescribe. It was also suggested that the outpatient setting may be more appropriate to trial a pharmacist prescribing role.ConclusionThere are ample opportunities for pharmacist prescribing in the area of warfarin management. However, practice change is needed before such a role can be taken up in the hospital setting.
Risk and Severity of Akathisia Following Administration of Metoclopramide in the Emergency Department
Authors: Leow Fiona HP , Knott Jonathan C , Hassan Fariza Abu , Taylor David McD , Udayasiri Ruwangi 
Published: April 2015

ABSTRACTBackgroundMetoclopramide is a commonly used drug in the emergency department for managing nausea, vomiting and migraines. There are currently no reported studies of the rates of metoclopramide‐induced akathisia in the emergency department.AimTo determine the risk and severity of metoclopramide‐induced akathisia.MethodThis was an observational study of emergency department patients who were administered metoclopramide parenterally and matched controls who were administered parenteral medications not known to cause akathisia (e.g. normal saline or antibiotics). Akathisia was assessed by a blinded interviewer at least one hour after drug administration, using a modified version of the Prince Henry Hospital Akathisia Rating Scale.Results232 patients were enrolled, 26 were excluded due to missing data or protocol violations. 99 were in the control group and 107 in the metoclopramide group. The mean age was 45.4 ± 19.4 years and 109/206 (53%) were male. 18 patients (16.6%, 95%CI 10.5–25.6) who received metoclopramide developed akathisia compared to 9 patients (9.1%, 95%CI 4.5–17.0) who received a control drug; the risk ratio was 1.85 (95%CI 0.87–3.92, p = 0.10).ConclusionThis study showed a trend towards an increased incidence of akathisia following metoclopramide administration in the emergency department. As this is a commonly administered drug in emergency departments, staff should be aware of the potential for akathisia to develop and should consider monitoring patients for this adverse effect.
Pharmacist Prescribing Activities—an Electronic Survey on the Opinions of Australian Pharmacists
Authors: Kay Olivia C , Bajorek Beata V , Brien Jo‐anne E 
Published: April 2015

ABSTRACTAimTo identify Australian pharmacists' awareness of their international colleagues' prescribing practices and explore their views about the feasibility and utility of pharmacist prescribing privileges within the scope of their current practice.MethodMembers of the AusPharmList, Australian Association of Consultant Pharmacy and The Society of Hospital Pharmacists of Australia were invited by e‐mail to participate in a community pharmacist, consultant pharmacist or hospital pharmacist electronic survey. These surveys were designed to elicit views concerning: dependent and independent prescribing; resource availability to support pharmacist prescribing; ability to justify prescribing decisions; and limitations of pharmacist prescribing.ResultsOf the 268 surveys completed (response rate 6.4%), 45% of respondents were aware of their international colleagues' prescribing activities. 74% agreed that pharmacists should be granted dependent prescribing authority, while 52% agreed that pharmacists should be granted independent prescribing authority. The majority (88%) indicated they could identify their own limitations and 86% believed they could justify their prescribing decisions as dependent prescribers. 73% believed they would benefit from prescribing authority in their daily scope of practice.ConclusionIn 2004, awareness of international developments in pharmacist prescribing was not extensive among the respondents. However, many identified areas where they would benefit from dependent prescribing activities in their daily scope of practice.
Urticarial Skin Reaction Induced by Oral Clonidine
Authors: Paudel Raju , Kishore PV , Mishra Pranaya , Palaian Subish , Dwari Binayak C 
Published: April 2015

ABSTRACTBackgroundClonidine is a centrally acting antihypertensive known to cause dermatological adverse reactions. Urticaria is rarely reported.Case detailsOral clonidine was given to control supine hypertension in a patient receiving fludrocortisone for postural hypotension associated with therapy for Parkinson's disease. After one week, she developed erythematous, blanching, itchy papules and plaques, initially in the extremities and later becoming generalised, together with perioral oedema. Clonidine was ceased and the condition resolved as previous drug therapy was reintroduced. This reaction was considered to be of moderate severity, probably induced by clonidine, and not preventable.ConclusionClonidine can cause urticarial reactions and clinicians should be alert for this possibility when commencing therapy.
Workforce and Service Delivery Analysis across New Zealand Hospital Pharmacy Departments
Authors: Plant Elizabeth A , Norris Pauline T , Tordoff June M 
Published: April 2015

ABSTRACTBackgroundThere is a lack of baseline data about the workforce, and services provided by hospital pharmacists in New Zealand.AimTo determine the composition of the hospital pharmacy workforce in New Zealand and the level of service providedMethodA questionnaire was sent to chief pharmacists at all 30 public hospitals employing a pharmacist in November 2001, and repeated in November 2003. Data were requested on staff numbers, vacancies, staff experience, training, validation, and pharmacy services provided. Results were analysed for all hospitals, and within groups.Results25 hospitals (83%) responded in both years. Hospitals varied widely in their funded and actual staffing levels and in the services delivered. Services (drug distribution, ward pharmacy, patient counselling, drug information, formulary and treatment guideline development) were provided to a greater extent and with more favourable staffing levels in the large hospitals. The median number of beds per full‐time equivalent pharmacist was 50 but the variation across the hospitals was considerable with a range of 30 to 394 beds/full‐time equivalent pharmacist in 2003. Overall, pharmacist vacancy rate of 24% in 2001 had decreased to 15% by 2003.ConclusionThis study demonstrated a wide variation in workforce and service delivery within and across hospitals, with the differences not necessarily relating to hospital size or type. Staff vacancies appeared high and recruitment and retention were considered key workforce issues.
Adherence to Disease Management Interventions for COPD Patients: Patients' Perspectives
Authors: George Johnson , Kong David CM , Santamaria Nick M , Ioannides‐Demos Lisa L , Stewart Kay 
Published: April 2015

ABSTRACTBackgroundThe management of chronic obstructive pulmonary disease (COPD) requires a disease management approach—a combination of pharmacotherapy, pulmonary rehabilitation and behavioural changes. Patient adherence to therapy has been found to be poor, with a negative influence on outcomes.AimTo explore factors associated with adherence to disease management interventions from COPD patients' perspectives.MethodA subset of 28 patients with moderate to severe COPD participating in a community‐based randomised controlled trial were interviewed in depth about their health beliefs, attitudes to and experiences with their disease and its management, and their relationships with health professionals. The interviews were transcribed verbatim and analysed thematically.ResultsPatients with a range of sociodemographic backgrounds and varying disease severity were interviewed. Adherence to disease management programs in COPD was found to be a complex process driven by health beliefs and experiences related to patient, treatment, disease, and health professionals. 15 major themes related to adherent behaviour were identified. The balance between reservations in following treatment recommendations and motivating factors for following those recommendations was likely to determine decisions to adhere to disease management programs.ConclusionThe study highlighted the importance of consultation with the patient in the management of COPD. Treatment recommendations that fitted into patients' existing routines were more likely to be successful. Health professionals could enhance adherence by being empathic, by improving patient knowledge about the disease and faith in the treatment, and by reducing their concerns about the treatment.