bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successful Integration of a Clinical Pharmacist into a Disease Management Unit
Authors: Stell Robyn , Bonollo Marco , Fiddes Kaylene , Dooley Michael J 
Published: April 2015

ABSTRACTAimTo evaluate the impact of integrating a clinical pharmacist into a disease management unit to provide a clinical pharmacy review service for patients in the outpatient clinic and at home.MethodThis pilot study consisted of two phases—service planning, and implementation and evaluation. The service planning phase involved multidisciplinary consultation on the clinical pharmacist role. After completion of the service planning phase and service implementation, the service was evaluated for a 4‐month period through quantification of accuracy of the medication list on attendance at the outpatient clinic, number and type of medication problems identified by the pharmacist and number and type of interventions undertaken by the pharmacist.ResultsThe clinical pharmacy review service was implemented in October 2005 and evaluation of the service continued until January 2006. 122 patients were seen by the pharmacist in the 4‐month period. The accuracy of the medication list increased from 12 to 24% pre‐implementation to 91 to 94% postimplementation. Of the patients interviewed by the pharmacist, 49% of the outpatient clinic patients and 83% of the home visit patients were identified as having medication‐related problems. 66 medication‐related problems were identified by the pharmacist at the home visits and 47 in the unit's outpatient clinic.ConclusionThe success of the pilot resulted in the implementation and evaluation of the impact of integrating a clinical pharmacist to a disease management unit. The demonstrated positive outcomes have resulted in the ongoing provision of the clinical pharmacy review service with expansion to other clinics.
Renal Effects of High‐Dose Tobramycin and Vancomycin Impregnated Bone Cement
Authors: Campbell David G , Nyfort‐Hansen Karin 
Published: April 2015

ABSTRACTBackgroundBone cement impregnated with high doses of aminoglycosides is used to treat infection associated with joint arthroplasty.AimTo examine serum tobramycin and creatinine concentrations in patients who received high‐dose tobramycin and vancomycin impregnated bone cement during revision joint arthroplasty.MethodThis was a prospective cohort case series of 10 patients aged 58 to 82 years undergoing revision joint arthroplasty with high‐dose tobramycin and vancomycin impregnated bone cement. Serum tobramycin and creatinine concentrations were monitored post surgery.ResultsSterile tobramycin 3.6 g and vancomycin 1.0 g powder was mixed into each 40 g of Palacos bone cement, resulting in total maximum doses of tobramycin 7.2 g and vancomycin 2.0 g. At the time of hospital discharge renal function was unchanged in 9 patients. A 75‐year‐old male patient with preexisting renal impairment developed significant and persistent worsening of his renal function.ConclusionBone cement impregnated with high doses of aminoglycosides should be used with caution in patients with a history of renal impairment.
Inter‐Regional Collaboration for Errors and Near Misses with Unfractionated Heparin
Authors: Loe Elizabeth A , Parsotam Nirasha , Blumgart Anne F , Jansen Lenore J 
Published: April 2015

ABSTRACTBackgroundUnfractionated heparin is a high‐risk medication, as serious adverse events may result from errors of use. Different practices and protocols for unfractionated heparin are used at the three district health boards in Auckland. Concern about the inadequacies of heparin use prompted a collaborative evaluation of adherence to unfractionated heparin protocols and to aid the formulation of solutions for process improvement.AimTo evaluate the three district health boards' compliance with unfractionated heparin protocols, and to identify issues with prescribing and administration and the occurrence of adverse events.MethodA retrospective audit of all patients started on unfractionated heparin at the three district health boards was undertaken from March to June 2005. An audit tool was developed to evaluate compliance with 6 criteria of prescribing and administration common to each hospital protocol and data were collected on indication and occurrence of adverse events.Results61 patients were audited. 51% had a baseline activated partial thromboplastin time (aPTT) measured, 39% had an aPTT measured at 6 hours, 80% received a heparin loading dose (90% as per protocol), 85% received maintenance infusion dose and rate as per protocol and 35% had failed to reach target aPTT at 72 hours. None of the 6 criteria achieved 100% compliance.ConclusionCompliance with the specified protocols was low. Systems changes have been identified that can improve the safety and effectiveness of unfractionated heparin use.
Stability of Venlafaxine Hydrochloride Liquid Formulations Suitable for Administration via Enteral Feeding Tubes
Authors: Rosa Nicholas F De , Sharley Nicholas A 
Published: April 2015

ABSTRACTBackgroundVenlafaxine hydrochloride tablets have been discontinued and the extended‐release capsules are the only formulation available in Australia. The extended‐release capsule releases venlafaxine from pellets within the capsule. These pellets cannot be flushed through a syringe or enteral feeding tube as they adhere to the plastic.AimTo develop a liquid formulation of venlafaxine hydrochloride suitable for enteral feeding and to determine an evidence‐based shelf‐life for the formulation.MethodHigh performance liquid chromatography was used for the analytical procedure. Venlafaxine hydrochloride was subjected to forced degradation at elevated temperatures under acidic, basic and oxidative conditions. Degradation products and formulation excipients were analysed with high performance liquid chromatography to verify the presence of any interfering peaks. Two venlafaxine liquid formulations were prepared in triplicate using Efexor‐XR capsules. Each sample, a blank, and a quality control sample were analysed in duplicate on each study day. Four calibration standards were used and sample venlafaxine hydrochloride concentrations were calculated from the linear regression equation derived from the calibration set.ResultsThe chromatogram exhibited appropriate separation of the respective peaks for venlafaxine, degradation product, and formulation excipients, and can be considered stability indicating. All samples retained above 94% of the original venlafaxine content throughout the 30‐day study period.ConclusionVenlafaxine hydrochloride liquid formulations can be prepared from Efexor‐XR capsules that is stable for 30 days when stored at room temperature.
Assessing Flucloxacillin Contamination and Decontamination—A Laboratory Study
Authors: Lee Su‐Gil , Jankewicz Ganyk J , Lee Nae‐Woo 
Published: April 2015

ABSTRACTBackgroundFlucloxacillin is a widely used antibiotic but data are lacking on the risks associated with occupational exposure.AimTo evaluate flucloxacillin stability; to identify an effective decontamination reagent for flucloxacillin; and to identify glove material that will prevent flucloxacillin permeation.MethodDecontamination reagents used for flucloxacillin wipe sampling and degradation/stability tests included: isopropanol 50% and 70%, ethanol 60% and 100%, benzalkonium chloride 0.1% (Pine O Cleen), sodium hypochlorite 0.5% (Chloroclens), sodium hydroxide 0.03M and distilled water. Short‐term (0 to 90 minutes) and daily degradation (0 to 6 days) of flucloxacillin in these media and flucloxacillin recovery from surface wipe sampling was investigated using high pressure liquid chromatography with ultraviolet detection. Flucloxacillin permeation was tested using disposable, powder‐free latex and nitrile gloves in a disposable test cell to which solution was applied on one side of the glove material and wiped from the other side after 3 hours.ResultsThis analytical method for assessing flucloxacillin contamination has a limit of detection of 0.1 μg/mL. Distilled water was the most suitable solvent as degradation of flucloxacillin was minimal. Sodium hypochlorite 0.5%, followed by sodium hydroxide 0.03M and benzalkonium chloride 0.1%, were the most effective decontamination reagents. No permeation of flucloxacillin was detected through the latex or nitrile gloves after a 3 hour period.ConclusionA method for assessing occupational exposure to flucloxacillin is described in this paper. Sodium hypochlorite 0.5% was the most effective decontamination reagent for flucloxacillin. Both the latex and nitrile gloves prevented flucloxacillin permeation for up to 3 hours.
Assessment of Risk Associated with Medication‐Related Problems in Elderly Outpatients
Authors: Elliott Rohan A , Woodward Michael C 
Published: April 2015

ABSTRACTBackgroundThe Society of Hospital Pharmacists of Australia's (SHPA) Standards of Practice for Clinical Pharmacy provide a risk‐classification system for interventions made by pharmacists in hospital inpatients. These standards are based on Australian standards for risk management, where risk is based on an estimate of the likelihood and consequences of an adverse outcome from a medication‐related problem, if no intervention was made.AimTo adapt and validate the SHPA risk‐classification system for use in geriatric ambulatory care and to explore differences in classifications of risk made by pharmacists and geriatricians.MethodThe SHPA risk‐classification system was modified, piloted and reviewed by experts to assess face validity. 113 medication‐related problems identified by an outpatient clinical pharmacist in aged care were independently classified by a senior clinical pharmacist, a geriatrician and the outpatient clinical pharmacist. When there was disagreement, the case was discussed and consensus reached. A random sample of 30 medication‐related problems, stratified by consensus risk classification was classified by a second geriatrician.ResultsFace validity of the adapted risk‐classification system was established. Agreement between pharmacists on medication‐related problem risk was moderate and agreement between pharmacists and geriatricians was fair. Risk of adverse outcomes was rated lower by geriatricians than pharmacists. Consensus was easily reached through case discussion.ConclusionA system for classifying risk associated with pharmacist‐identified medication‐related problems in geriatric ambulatory care was developed. Differences were identified between pharmacists and geriatricians in the way medication‐related risks are perceived. Classification of pharmacist‐identified medication‐related problems/interventions may need to be based on consensus between at least one doctor and pharmacist.
Impact of Nurse Education on the Incidence of Omitted Medication Doses in Hospital Inpatients
Authors: O'Shea Timothy J , Spalding Ann R , Carter Fiona A 
Published: April 2015

ABSTRACTBackgroundA significant number of medication doses are omitted in hospitals because of the inability of nurses to source the medication and their lack of awareness of the significance of omitting medication doses.AimTo investigate the impact of nurse education on the incidence of omitted medication doses in hospital inpatients.MethodA prospective study at a 174‐bed hospital comparing the incidence of omitted medication doses before and after the introduction of a nurse education program (education sessions, ward posters, questionnaires). Omitted medication doses were categorised as ‘drug not available’, ‘chart not signed’, ‘withheld’, ‘refused by patient’ or ‘nil orally’.ResultsAudits of over 40 000 medication administration records were undertaken – 20 154 medication doses were reviewed for 99 patients pre‐intervention and 24 337 medication doses were reviewed post‐intervention. 4.2% of medication doses were not administered as prescribed pre‐intervention compared to 2.9% post‐intervention (p < 0.001).ConclusionThe interventions highlighting the importance of not omitting doses and the availability of information on how to obtain medications were effective in reducing the number of omission errors.
Rapidly Progressive Severe Amiodarone‐Induced Hypothyroidism in an Elderly Female
Authors: Ghiculescu Razvan A , Martin Jennifer 
Published: April 2015

ABSTRACTBackgroundAmiodarone‐induced hyperthyroidism has been extensively reported in the Australian and international literature. However, amiodarone‐induced hypothyroidism, although much less common, is also seen in clinical practice.AimTo describe a case of rapidly progressive severe amiodarone‐induced hypothyroidism complicated by myxoedema, cognitive decline and peripheral neuropathy in an elderly female.Clinical DetailsAn elderly female presented with a 3 to 6 month history of fatigue, cold intolerance and constipation. Her medical history was significant for type 2 diabetes, ischaemic heart disease and moderate mitral regurgitation complicated by severe left atrial dilatation and chronic atrial fibrillation.OutcomesHer amiodarone was stopped and thyroxine commenced at 25 microgram daily. One week after admission her energy levels had improved to the point where she could safely manage at home. 6 months after amiodarone cessation she was euthyroid on thyroxine replacement and remained in rate controlled atrial fibrillation.ConclusionPrescribers are reminded of the risk of serious thyroid morbidity associated with amiodarone use. Current recommendations include evaluation of risk against benefit with prolonged amiodarone therapy and periodic screening for early toxicity.
Pharmacological Treatment of Frailty in the Elderly
Authors: Campbell Stephen , Szoeke Cassandra 
Published: April 2015

ABSTRACTThe geriatric frailty syndrome can be characterised by a loss of physiological reserve in a variety of organ systems and an independent association with disability and mortality. The high cost of this condition in terms of decreased quality of life and an increased need for medical and personal care makes it an important focus for the development of effective pharmacological treatments. Several of these treatments have been trialled and have focused on the decreased levels of catabolic hormones seen in advancing age. Despite some improvement in muscle and tissue bulk, most of these treatments have failed to improve physical function in the elderly. In this review we examine the evidence for the pharmacological treatment of frailty in the elderly and provide recommendations for its management.
Pharmaceutical Reforms: Clinical Pharmacy Ward Service versus a Medical Team Model
Authors: Poh Eng Whui , Nigro Olimpia , Avent Minyon L , Doecke Christopher J 
Published: April 2015

ABSTRACTBackgroundThe Australian Pharmaceutical Advisory Council's (APAC) Guiding principles to achieve continuity in medication management were developed to advocate the continuum of pharmaceutical care for hospital inpatients. As part of the Australian Health Care Agreements, pharmaceutical reforms that include implementation of the APAC guidelines are underway. Clinical pharmacy services at the Royal Adelaide Hospital do not fully comply with the APAC guidelines.AimTo assess whether key APAC guiding principles are achievable on a medical ward with one full‐time equivalent clinical pharmacist.MethodTwo clinical ward pharmacy models were investigated. A clinical pharmacy ward service was compared to a medical team model. Patients admitted to a general medical ward were included in the two phases of the study. In Phase A (4 weeks), the clinical pharmacist serviced a 30‐bed medical ward and in Phase B (4 weeks) the same clinical pharmacist serviced the same 30‐bed medical ward and also provided an extended hours service in the emergency department. During both phases all patients received a medication history interview, ongoing clinical review and discharge medication counselling.Results246 patients were admitted to the general medical ward during the study period – 138 in Phase A and 108 in Phase B. 109 (79%) patients were reviewed in Phase A and 83 (77%) patients in Phase B. As a result of the medication history interviews, incorrectly charted medications were amended in 48 (7%) interventions in Phase A and 20 (6%) interventions in Phase B. 207 interventions (Phase A: 129; Phase B: 78) were documented during clinical reviews. Discharge medication counselling was provided to 30 (60%) patients in Phase A and 27 (49%) patients in Phase B.ConclusionThe key APAC guiding principles were partly achievable using the two models investigated. For either model, an increase in staffing resources would be necessary to comply with the APAC guidelines.
Paclitaxel Exposure and its Effective Decontamination
Authors: Lee Su‐Gil , Ambados Fotios , TkaczukPhD Michael , Jankewicz Ganyk 
Published: April 2015

ABSTRACTBackgroundApart from generic guidelines for the safe handling of cytotoxic drugs in pharmacy departments, there is no specific published literature pertaining to cleaning procedures and inadvertent exposure to paclitaxel.AimTo examine occupational exposure to paclitaxel; to identify an effective decontamination reagent; and to determine suitable glove type for skin protection.Method8 decontamination reagents were tested for paclitaxel degradation. Air sampling filters, Ghost Wipes and cotton wipes were tested under different storage conditions (room temperature, ≤ 4 °C) for 3 days. Disposable latex and nitrile gloves were tested for paclitaxel permeation using a one‐inch ASTM standard test cell. Environmental (airborne and surface) monitoring was carried out in the cytotoxic compounding and work areas. High performance liquid chromatography and photo‐ionisation detector were used for sample analysis and glove permeation tests, respectively.ResultsIsopropanol 50% and ethanol 60% demonstrated the least degradation (< 2%) of paclitaxel in 80 minutes. Sodium hypochlorite 0.5% w/v showed the greatest degradation (> 99%) of paclitaxel in 20 minutes. Sample wipes should be stored at ≤ 4 °C until analysis. Paclitaxel and sodium hypochlorite 0.5% w/v did not permeate through the latex and nitrile gloves after 4 hours of continuous exposure. No paclitaxel was detected in airborne and surface wipe samples.ConclusionNo detectable paclitaxel was measured within the cytotoxic compounding area. Sodium hypochlorite 0.5% w/v is a suitable decontamination reagent for paclitaxel surface contamination. Wearing either latex or nitrile gloves can prevent contamination when handling paclitaxel.
Pre‐Admission and Post‐Hospital Management of Heart Failure in Patients not Enrolled in Specialist Programs
Authors: Borgstedt Johanna , Clark Robyn A , Morran Jennifer L , Colley Desmond , Shakib Sepehr 
Published: April 2015

ABSTRACTAimTo review the management of heart failure in patients not enrolled in specialist multidisciplinary programs.MethodA prospective clinical audit of patients admitted to hospital with either a current or past diagnosis of heart failure and not enrolled in a specialist heart failure program or under the direct care of the cardiology unit.Results81 eligible patients were enrolled (1 August to 1 October 2008). The median age was 81 ± 9.4 years and 48% were male. Most patients (63%) were in New York Heart Association Class II or Class III heart failure. On discharge, 59% of patients were prescribed angiotensin converting enzyme inhibitors and 43% were prescribed beta‐blockers. During hospitalisation, 8.6% of patients with a past diagnosis of heart failure were started on an angiotensin converting enzyme inhibitor and 4.9% on a beta‐blocker. There was evidence of suboptimal dosage on admission and discharge for angiotensin converting enzyme inhibitors (19% and 7.4%) and beta‐blockers (29% and 17%). The results compared well with international reports regarding the under‐treatment of heart failure.ConclusionThe demonstrated practice gap provides excellent opportunities for the involvement of pharmacists to improve the continuation of care for heart failure patients discharged from hospital in the areas of medication management review, dose titration and monitoring.
Professional Transgressions by Australian Pharmacists
Authors: Penm Jonathan , Chaar Betty B 
Published: April 2015

ABSTRACTBackgroundInvestigating professional transgressions by pharmacists will aid to minimise their occurrence and ensure that the public's trust and well‐being are not compromisedAimTo compare the definition of professional transgression in all Australian pharmacy acts; to identify the characteristics of pharmacists most likely to transgress; to identify the most prevalent transgressions; and to identify the justification provided by pharmacists for committing transgression.MethodDefinitions of professional transgression, commonly referred to as ‘professional misconduct’, were identified from all Australian pharmacy acts and then compared. Disciplinary hearings brought before the pharmacy regulatory bodies were collected and the demographic data of the pharmacists involved, transgressions committed and the justifications provided for committing them were identified and analysed.ResultsProfessional transgression was defined differently in each state using a combination of terms, such as a lack of skill, experience, knowledge, care and judgement. Cases from 1990 to 2002 were analysed with 195 cases adjudged guilty. Of those cases that provided adequate detail, the majority of pharmacists found guilty were male (89%), worked in community pharmacy (97%) and were proprietors (64%). The most common misconduct was inappropriate supply of medications. Reasons cited for professional misconduct included human error, lack of knowledge, management skills, personal issues and intentional transgression.ConclusionAustralian pharmacy acts require a unified definition of professional transgression to ensure pharmacists are treated equally. Adopting a systems approach may prevent unintentional transgressions from occurring in the future.
Myalgia in Patients on High‐Dose and Low‐to‐Moderate Dose Statin Therapy
Authors: Gujral Gina R , Cottrell W Neil , Barras Michael 
Published: April 2015

ABSTRACTBackgroundStatin use has been associated with muscle toxicity and clinically significant muscle symptoms.AimTo investigate if high‐dose statin users have a greater incidence of myalgia than low‐to‐moderate dose statin users.MethodA questionnaire‐based interview of participants at a hospital and community pharmacy in Brisbane. Data were gathered on the history of statin use, presence of myalgia, analgesic use and self‐reported adherence. Participants were excluded if they had a chronic degenerative musculoskeletal condition, such as rheumatoid arthritis or osteoarthritis.Results192 participants were included in the study – 65 (34%) in the low‐to‐moderate dose group and 127 (66%) in the high‐dose group. Excluding participants with a pre‐existing painful condition (n = 72), myalgia was reported by 24 (37%) patients in the low‐to‐moderate dose group and 42 (33%) in the high‐dose group (p = 0.22). 8 (12%) patients in the low‐to‐moderate dose group used analgesics compared to 24 (19%) in the high‐dose group (p = 0.34). Adherence in both groups was the same when assessed using the Morisky scale.ConclusionThere was no significant difference in myalgia between the high and low‐to‐moderate dose statin groups. The incidence of myalgia in statin users was higher than reported in previous studies.