bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Penicillin Allergy on Antibiotic Prescribing Patterns and Costs
Authors: Irawati Lyna , Hughes Jeffery D , Keen Neil J , Golledge Clayton L , Joyce Andrew W 
Published: April 2015

ABSTRACTBackgroundAntibiotic treatment for patients with community‐acquired pneumonia (CAP) and previous history of penicillin allergy varies widely and can be more costly than for those with no history of penicillin allergy.AimTo assess the influence of documented penicillin allergy on antibiotic prescribing for patients with CAP in an Australian hospital, and the clinical and financial consequences arising from changes to prescribing patterns.MethodThe medical records of all patients 18 years and older admitted with CAP over a 15‐week period were reviewed. The severity of patients' penicillin allergies was assessed through interview using a structured questionnaire and two groups formed: those with and without penicillin allergy. The antibiotic selections and treatment costs (drug plus accommodation costs) were then compared for the two groups.Results155 patients were reviewed (84 females, 71 males) with a mean age of 68 years (SD 18). Of these, 27 (17%) had documented penicillin allergies, of which 12 were classified as Severity 1 (anaphylaxis, urticaria), 12 as Severity 2 (rash, itch) and 3 as intolerance (gastrointestinal upset). Patients with a penicillin allergy were more likely to receive a cephalosporin, a macrolide and/or an aminoglycoside. This approach was in accordance with the recommendations of the Therapeutic Guidelines: Antibiotic (published in 2000), however the choice of cephalosporin in all cases was not. A history of penicillin allergy increased length of stay (p = 0.054) and total cost of admission (p = 0.051).ConclusionAdherence of antibiotic prescribing to the Therapeutic Guidelines: Antibiotic for patients with penicillin allergies is variable. Patients labelled with penicillin allergy had greater drug costs and total admission costs. Thorough history taking to identify patients with true allergy versus intolerance may increase appropriate use of penicillins and reduce the use of more costly and potentially toxic alternative antibiotics.
Pharmaceutical Review: Resource Implications for the Pharmacy Component in Australian Public Hospitals
Authors: O'Leary Karen M , Allinson Yvonne M 
Published: April 2015

ABSTRACTBackgroundPharmaceutical review requires a facility‐wide approach and multidisciplinary collaboration between all involved in the use of medicines. Standards of practice for clinical pharmacy services and distribution of medicines, provide a blueprint for two activity groups provided by pharmacy services that contribute to pharmaceutical review.AimTo explore the pharmacy components required to deliver pharmaceutical review in Australian public hospitals and examine the resource implications to meet these objectives.MethodWorkforce data were collected from a questionnaire sent to hospital pharmacy managers in 2005. Respondents were asked to detail the pharmacist full‐time equivalents (FTEs) devoted to clinical, distribution and management activities. They were also asked to detail clinical service delivery models and the number of beds at their facility according to clinical pharmacy categories. Ratios of the number of pharmacists to clinical pharmacy bed type were used to calculate the national workforce requirements estimated after extrapolation.ResultsApproximately 768 pharmacist FTEs would be required to provide a basic clinical pharmacy service (3 clinical pharmacy activities: accurate medication history, assessment of current medication management, provision of medicines information to patients) for all patients in Australian public hospitals; approximately 1300 pharmacist FTEs would be required for a comprehensive clinical pharmacy service. This equates to 58 minutes of pharmacist time during an inpatient stay, for each overnight admission. At least 40% of clinical pharmacy services are required for general medical type beds and this should be considered when identifying the skills base required in the hospital pharmacy workforce.ConclusionRetaining the current highly skilled pharmacist workforce and attracting pharmacists into the hospital sector to fill vacant establishment positions is the first step. The number of establishment positions will then need to be increased nationally to fully deliver pharmaceutical review in Australia's public hospitals.
Promoting Safe Use of Paracetamol in Children
Authors: Graudins Linda V , Gazarian Madlen 
Published: April 2015

ABSTRACTParacetamol is one of the most widely used analgesics and the most common medicine given to children in Australia. Its safety and efficacy when appropriately used is well established and its effects in acute overdose are well known to health professionals. However, gaps in knowledge of parents/carers of young children about its safe use are less recognised and may lead to unintentional misuse and harm. This paper aims to help bridge this knowledge gap and promote safe use of paracetamol in children. By using illustrative cases to highlight this problem, discussing the relevant literature, providing a parent/carer counselling checklist and resources for health professionals.
Angioedema Possibly Associated with Ezetimibe
Authors: Shah Krupa , Taylor Simone E , Cranswick Miriam , Chan Robert K 
Published: April 2015

ABSTRACTBackgroundAngioedema has been reported during ezetimibe post‐marketing surveillance; no causality has been established.AimTo describe a case of delayed angioedema possibly associated with ezetimibe therapy.Clinical detailsA 64‐year‐old female presented with angioedema and urticaria developing progressively over 2 days, 3 months after starting ezetimibe. She had no respiratory compromise, infectious symptoms or swelling of the tongue or pharynx. She was moderately distressed, and vital signs were normal. She was not taking an ACE inhibitor, angiotensin II antagonist, aspirin or NSAID. She denied complementary medicine use or change in diet. She had no previous drug, food, or food additive allergies and no family history of angioedema. Standard laboratory tests were within normal limits.OutcomeSwelling responded to prednisolone and promethazine. Ezetimibe, the suspected precipitant was discontinued. Swelling resolved 4 days after presentation. 10 months after ceasing ezetimibe, she had no further episodes of angioedema or urticaria.ConclusionClose monitoring and reporting of future cases of ezetimibe‐associated angioedema will be required to fully characterise the nature of this potential adverse drug reaction.
Possible Role for Clinical Pharmacists in Identifying Pharmacogenomic Interventions
Authors: Toy Alana C , Anderson Barbara A , McKinnon Ross A , Gilbert Andrew L 
Published: April 2015

ABSTRACTBackgroundIndividualised drug therapy is important in contemporary pharmacy practice. Pharmacogenomics is one way of individualising therapy to maximise efficacy and minimise toxicity, based on patients' genetic data.AimTo assess clinical pharmacists' understanding of pharmacogenomics and their ability to identify interventions.MethodStructured interviews were conducted with 9 clinical pharmacists, practising in a private hospital setting, to identify: level of understanding of pharmacogenomics; drugs encountered that display significant inter‐patient variability; and whether a literature review could confirm that dugs identified are likely to have a genetic basis for their variability.ResultsFindings of this pilot study show that although pharmacists had a negligible understanding of pharmacogenomics, they acknowledged the importance of its integration into clinical practice and the need for education. Pharmacists identified a number of drugs which displayed inter‐patient variability—the drugs were subsequently confirmed by a literature search to be affected by genetic polymorphisms.ConclusionFor pharmacogenomics to be successfully implemented in practice, there is a need for education of pharmacists. Pharmacists saw pharmacogenomics as a beneficial technology that could improve patient outcomes.
Prolonged Antibiotic Therapy for Recurrent Urinary Tract Infections in Aged‐Care Residents: Time to Change the Dogma?
Authors: Wee Jayne S , Hughes Jeffery D , Lee Andy H , Joyce Andrew W 
Published: April 2015

ABSTRACTAimTo determine whether the duration of therapy and antibiotic dosage prescribed affected the recurrence rates and times between recurrent urinary tract infection (UTI) episodes among elderly women in residential aged‐care facilities.MethodA 2‐year retrospective cohort study was conducted in 6 aged‐care facilities. Eligibility criteria were females aged ≥ 60 years in residential aged‐care for at least 6 months. Poisson regression and survival frailty modelling were used to analyse the recurrence rates and times between successive UTI episodes.ResultsOf the 200 eligible subjects, 35 (18%) had 1 UTI episode and 57 (29%) had recurrent UTI episodes during the follow‐up period. The majority (72%) of the total 269 UTI episodes were either diagnosed by midstream urine culture plus dipstick analysis, or midstream urine culture only. On average, 5 antibiotics courses with a duration of 13.5 doses were prescribed. Apart from prior history of UTI and residential status, the incidence of recurrent UTI was positively associated with the duration of antibiotic treatment (adjusted RR = 1.05; 95%CI 1.02–1.09) and antibiotic courses prescribed (adjusted RR = 1.14, 95%CI 1.09–1.20). The median time between successive UTI episodes was 125 days (95%CI 90–160). Treatment duration and antibiotic exposure did not significantly affect the recurrence times.ConclusionProlonging antibiotic therapy neither reduced the incidence of recurrent UTI nor increased the time between recurrent UTI episodes. The findings do not support antibiotic treatment guidelines currently adopted in practice and suggest the need for a prospective randomised trial.
Classification of Findings in the Home Medicines Reviews of Post‐Discharge Patients at Risk of Medication Misadventure
Authors: Nguyen Andrew , Yu Kevin , Shakib Sepehr , Doecke Christopher J , Boyce Merelyn , March Geoff , Anderson Barbara A , Gilbert Andrew L , Angley Manya T 
Published: April 2015

ABSTRACTBackgroundThe risk of medication misadventure for patients is greatest during times of change, particularly on discharge from hospital. Patients at high risk of medication misadventure post‐discharge should be identified and provided with interventions to ensure the quality use of medicines and positive health outcomes. Home medicines reviews (HMRs) can be used to improve patient health outcomes and reduce the risk of medication misadventure.AimTo describe the impact of issues raised in post‐discharge HMRs, organised via a hospital medication liaison service.MethodHMR reports of participants were evaluated. Issues identified by the accredited pharmacist in each HMR report were classified as either a ‘pharmacist intervention’ delivered during the HMR or ‘information given’ that was previously unknown to the medical team. A potential clinical impact of these issues was assigned and the overall clinical significance of all the issues identified in each HMR report was ranked.ResultsIn 21 HMR reports, 98 issues were identified, with the mean per HMR report of 4.7 ±2.2. Of the 98 issues, 25 were classified as ‘pharmacist intervention’ and 73 were classified as ‘information given‘. On 2 occasions, a potential clinical impact of 4 (potentially life‐saving) was allocated to an issue identified in the HMR report. 90% of issues identified in the HMR reports were ranked as clinically significant.ConclusionThis pilot demonstrated that a liaison pharmacist was able to implement a hospital medication liaison model for patients at risk of medication misadventure. Evidence suggests that an HMR conducted post‐discharge can identify clinically significant medication‐related issues.
Retention and Recruitment of Oncology Pharmacists
Authors: Gilbar Peter , Davis Jill , McLauchlan Robert , O'Leary Karen M 
Published: April 2015

ABSTRACTBackgroundA noticeable turnover of staff through the specialty of oncology pharmacy has been observed nationally. Literature searches failed to identify research directly relating to oncology pharmacist retention. Studies in pharmacists and non‐pharmacist oncology staff have determined that, while patient care and contact, personal accomplishment and satisfaction are important, stress levels and lack of professional support were factors considered when leaving the profession.AimTo explore why pharmacists choose to remain in or leave the specialty of oncology pharmacy and identify strategies to ensure retention of current staff and aid recruitment of new oncology pharmacists.MethodElectronic surveys designed to obtain retrospective quantitative and qualitative data were sent to: current oncology pharmacists; former oncology pharmacists; and directors of pharmacy at institutions with oncology services. Participants were identified through databases of the Society of Hospital Pharmacists of Australia, Clinical Oncological Society of Australia, and International Society of Oncology Pharmacy Practice.ResultsReasons for pharmacists remaining in oncology generally related to job satisfaction issues (closely associated with clinical involvement). Reasons for leaving included stress levels, staffing issues, lack of recognition from hospital management and remuneration. Strategies for retaining staff should include improved pay structure, opportunities for professional development and continuing education, peer support, availability of suitably trained staff to cover periods of leave, positive feedback and support from hospital management, and devising methods for reducing work‐related stress.ConclusionImplementation of information gained from this study will facilitate recruitment and retention of experienced, well‐trained oncology staff.
Incidence of Vancomycin‐Induced Red Man Syndrome in a Women's and Children's Hospital
Authors: Chui Sin Yan , Onishko Christine , Turner Sean , Coulthard Kingsley , McKinnon Ross 
Published: April 2015

ABSTRACTBackgroundRed man syndrome (RMS) is an adverse reaction to vancomycin. Symptoms include rash, itch, hypotension, hypothermia, angioedema and respiratory distress. The incidence of RMS in the paediatric population is unclear.AimTo estimate the incidence of RMS in a women's and children's hospital, focusing on the paediatric population, and to identify risk factors.MethodPatients at a women's and children's hospital receiving IV vancomycin were identified during a 2‐month period and their case notes were reviewed for documented RMS symptoms.Results21 patients (5 days to 24 years of age) were identified, and 37 vancomycin courses were investigated. RMS symptoms occurred in 8/21 (38%) patients and in 8/37 (22%) vancomycin courses. 4 patients experienced a rash only, mostly an itchy, urticarial rash on the face and/or limbs. 4 patients experienced RMS without a rash: 2 had hypotension; 1 had bradycardia; and 1 had hypothermia, hypotension and bradycardia. None of the reactions were life‐threatening, and none resulted in cessation of vancomycin. 3/4 patients who experienced a rash received antihistamines, whereas none of the 4 patients who experienced RMS without a rash received antihistamines.ConclusionRMS is common and unpredictable. Cardiovascular symptoms can occur without accompanying dermatological symptoms. There may be potential for greater use of antihistamine prophylaxis and treatment for RMS.
Managing Extemporaneous Oral Liquids in Practice
Authors: Haywood Alison , Glass Beverley 
Published: April 2015

ABSTRACTOral liquid preparations are often the dosage form of choice in paediatric and geriatric populations. Many drugs are not available in oral liquid dosage forms because of the complexity of formulating liquids and the small market size. Pharmacists are often challenged with the extemporaneous preparation of oral liquids from commercially available products. Most problems associated with the stability of these preparations have been attributed to interactions between the drug substance and excipients (tablet and formulation) rather than the degradation of the drug substance by standard routes. However, a review of 83 such dosage forms revealed that only 7.2% exhibited stability concerns. To address these challenges pharmacists may consider the management plan for oral liquid dosage forms presented in this paper to ensure the provision of safe, effective and quality drug products to patients.
Reporting the Real Value of a Hospital Pharmacy Service
Authors: Thornton Penny 
Published: April 2015

ABSTRACTBackgroundHospital pharmacy managers have to account for the expenditure of millions of dollars of public funds for drugs provided in healthcare delivery. There appeared to be variation in the method of reporting drug expenditure data in Australian hospitals.AimTo investigate the reporting practices used by hospital pharmacy departments to account for their drug expenditure.MethodPharmacy managers of Australia's major metropolitan and rural hospitals were surveyed for their financial reporting practices. These baseline data were then compared to the financial reporting methods used by UK hospital pharmacy managers (a comparable public health provider). Hospital administrators were also interviewed to determine their ideal drug expenditure report.ResultsThe baseline survey consisted of 93 responses and demonstrated that varying types of financial reporting are used with a primary focus on gross expenditure and high‐cost drug use with variable definition. Few drug expenditure reports considered cost per patient treated. Other pharmacy services delivered adjacent to this expenditure were separately reported.ConclusionSignificant variation was identified in reporting hospital drug expenditure data. The disparate models of financial reporting in Australia are in contrast with the unified UK model. A reporting template is proposed that will provide a means of identifying key variation in expenditure alongside service delivery.
Scope of Pharmacy Services to the Emergency Department
Authors: Welch Susan A , Graudins Linda V 
Published: April 2015

ABSTRACTAimTo determine the scope of pharmacy services offered by Australian emergency medicine (EM) pharmacists, and to use the data to develop the SHPA Practice Standards for EM.MethodQualitative data were obtained from a survey that was e‐mailed to EM pharmacists and state‐based quality use of medicine groups about the type and extent of pharmacy services to the emergency department (ED).ResultsThe survey was distributed to 22 hospitals known to have an EM pharmacist, with a response rate of 82% (18/22) and 92 hospitals via the quality use of medicine groups. No further EM pharmacists were identified via the quality use of medicine groups. The majority (94%) of EM pharmacists took medication histories on admission and 89% reported adverse drug reactions. 78% (14/18) regularly contacted community health professionals about patients admitted to the ED. 39% (7/18) had conducted ED‐related research. Other services included: patient counselling, preventing medication‐related problems on discharge, protocol development, provision of drug information, stock control, and staff and student education.ConclusionWorking in the ED is a relatively new professional activity for pharmacists. EM pharmacists are involved in the quality and safe use of medicines, by providing continuity of pharmaceutical care from community to the ED and to the wards with regards to medicines management, as well as a wide range of services to patients and staff in the ED. The survey responses were incorporated into the SHPA Practice Standards for EM.
Community Pharmacy's Role in Promoting Healthy Behaviours
Authors: Joyce Andrew W , Sunderland V Bruce , Burrows Suzanne , McManus Alexandra , Howat Peter , Maycock Bruce 
Published: April 2015

ABSTRACTMany have commented on the potential of community pharmacy as a health promotion setting, due to accessibility, high level of use, and the respect afforded to pharmacists. Community pharmacy could be a setting through which to address risk and protective health behaviours relevant to Australia's National Health Priority Areas. However, apart from some studies on smoking cessation, there is scant evidence on its involvement in other healthy behaviours. This paper discusses how to increase research and interventions on healthy behaviours in community pharmacy. This includes placing community pharmacy's role within a broader health promotion context, expanding community expectations of pharmacists, and addressing barriers to performing a health promotion role.
Serial Point‐Prevalence Studies to Investigate Hospital Antimicrobial Prescribing
Authors: Ho Lisa , Melvani Sharmila 
Published: April 2015

ABSTRACTAimTo investigate antimicrobial prescribing patterns using a validated point‐prevalence approach and to identify intervention targets to optimise antimicrobial use.Method3 prospective point‐prevalence studies were conducted over 4‐day periods in April 2005, September 2005 and April 2006 at a tertiary hospital using a previously published method. Clinical pharmacists used a standardised data collection form on an allocated day to record details of all patients who were prescribed systemic antimicrobials (antivirals, antifungals, antibacterials) and the total number of patients seen. The appropriateness of the IV route was assessed using pre‐defined criteria.ResultsOver the 3 study periods 1515 drug charts were reviewed. Of these, 508 (34%) patients were prescribed 832 antimicrobial courses. The mean patient age was 67.5 (SD 32.3) years and 55% were males. Treatment accounted for 730 (88%) courses and prophylaxis for 102 (12%). The most frequently prescribed antimicrobials were ceftriaxone (9.7%) and amoxycillin/clavulanate (7.5%). The most commonly prescribed antimicrobial classes were penicillins (26%) and cephalosporins (20%). 342 (41%) courses were restricted antimicrobials and 85% of these had appropriate approval. 478 (58%) courses were given IV with clinical pharmacists identifying that 2.9% of these could have been given orally.ConclusionSerial point‐prevalence studies proved to be an effective tool for examining baseline patterns of antimicrobial use. This efficient and reproducible tool would be appropriate for other hospitals to use as a component of their antimicrobial usage monitoring.
Pharmacists Investigating Adverse Penicillin Responses—Pilot Study
Authors: Roberts Jason A , Hsu Millie , Allen Karen , Willis Jennifer , Barras Michael 
Published: April 2015

ABSTRACTBackgroundPenicillins are used first‐line for many infections and are commonly associated with adverse drug responses. Pharmacists can take a detailed adverse drug response history and provide such information to prescribers.AimTo investigate and quantify the nature of adverse penicillin responses of hospital inpatients and to develop a tool to enable pharmacists to provide recommendations on potential rechallenge of patients with a history of adverse response to penicillin.MethodPatients were administered a structured interview to classify the true nature of their documented adverse penicillin responses. A literature review was undertaken to develop a flowchart to enable pharmacists to advise on penicillin rechallenge in patients with a history of adverse response to penicillin.Results84 patients were identified and 49 (58%) met the inclusion criteria. Of these 18% had either a true penicillin allergy or were not able to recall the nature of their reaction. Of the 49 patients interviewed, 82% could be rechallenged with a penicillin. The literature review identified publications that allowed the development of a flowchart to assist pharmacists in evaluating reactions and recommending future therapy for these patients.ConclusionIn this small cohort, a significant proportion of patients were considered appropriate for rechallenge with penicillins. Knowledge of the sequelae of previous exposure to penicillins can inform decisions should a penicillin be indicated for treatment. The flowchart will allow pharmacists to make recommendations to the patient's medical team.