bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determining Clinical Pharmacy Workload by Patient Disease Classification in Medical and Surgical Patients
Authors: Stuchbery Peter , Kong David CM , DeSantis Giovanna N , Lo Sing Kai 
Published: April 2015

ABSTRACTAimTo determine the time needed to provide clinical pharmacy services to individual patient episodes for medical and surgical patients and the effect of patient presentation and complexity on the clinical pharmacy workload.MethodDuring a 5‐month period in 2006 at two general hospitals, pharmacists recorded a defined range of activities that they provided for patients, including the actual times required for these tasks. A customised database linked to the two hospitals' patient administration systems stored the data according to the specific patient episode number. The influence of patient presentation and complexity on the clinical pharmacy activities provided was also examined.ResultsThe average time required by pharmacists to undertake a medication history interview and medication reconciliation was 9.6 (SD 4.9) minutes. Interventions required 5.7 (SD 4.6) minutes, clinical review of the medical record 5.5 (SD 4.0) minutes and medication order review 3.5 (SD 2.0) minutes. For all of these activities, the time required for medical patients was greater than for surgical patients and greater for ‘complicated' patients. The average time required to perform all clinical pharmacy activities for 1071 completed patient episodes was 14.4 (SD 10.9) minutes and was greater for medical and ‘complicated' patients.ConclusionThe time needed to provide clinical pharmacy services was affected by whether the patients were medical or surgical. The existence of comorbidities or complications affected these times. The times required to perform clinical pharmacy activities may not be consistent with recently proposed staff ratios for the provision of a basic clinical pharmacy service.
Incidence of Venous Thromboembolism and Thromboprophylaxis after Total Hip or Knee Arthroplasty
Authors: Buchan Dona S , Bajorek Beata 
Published: April 2015

ABSTRACTBackgroundDespite numerous guidelines and consensus statements on venous thromboembolism (VTE) prophylaxis, there appears to be a large gap between evidence and practice.AimTo identify the incidence of VTE, thromboprophylaxis practice, VTE risk factors, and bleeding complications in patients undergoing elective total hip or knee arthroplasty.MethodPatients who underwent elective total hip or knee arthroplasty from 1 January 2004 to 31 December 2005 were identified retrospectively from medical records at two hospitals. A clinical case audit was performed and data collected on the 3‐month incidence of VTE, thromboprophylaxis practice, VTE risk factors and bleeding episodes.ResultsVTE incidence was 13% (in‐hospital incidence 9.3% and 3‐month readmission incidence 3.3%) and was significantly higher at Hospital 1 for unilateral total knee arthroplasty (p = 0.02) and unilateral total hip arthroplasty (p = 0.02). At both hospitals the 3‐month incidence of VTE was 16% post unilateral total knee arthroplasty compared to 7.7% post unilateral total hip arthroplasty (p = 0.06). 99% of patients received appropriate pharmacological prophylaxis and of these 87% received an appropriate dose. 17 patients (55%) that developed VTE had one or more risk factors. There were 23 cases (9.3%) of minor bleeding and 4 cases (1.6%) of major bleeding.ConclusionVTE incidence was higher than that quoted in the literature, which may reflect high usage of pre‐discharge deep vein thrombosis screening in the study population. There is a need to develop and disseminate management algorithms for elective total hip or knee arthroplasty in the local setting.
Liposomal Amphotericin and Caspofungin: Salvage Therapy for Invasive Aspergillosis in Hepatic Failure
Authors: Ho Lisa 
Published: April 2015

ABSTRACTBackgroundInvasive aspergillosis is a life‐threatening condition associated with severe morbidity and mortality. There are limited data on the treatment of invasive aspergillosis in solid organ transplant recipients.AimTo describe a case of invasive pulmonary aspergillosis in a patient with hepatic failure secondary to paracetamol overdose who subsequently underwent liver transplantation.Clinical DetailsA 33‐year‐old female was admitted with fulminant hepatic failure secondary to paracetamol overdose who subsequently underwent liver transplantation. She developed invasive pulmonary aspergillosis prior to transplantation. Her infection progressed despite initial treatment with liposomal amphotericin. Caspofungin was added to her therapy and she improved. Her antifungal was later changed to oral voriconazole.OutcomesInvasive pulmonary aspergillosis responded to the combination therapy of liposomal amphotericin and caspofungin.ConclusionAntifungal therapy of invasive aspergillosis in solid organ transplant recipients is complex and challenging. Treatment with liposomal amphotericin and caspofungin may be considered as salvage therapy for liver transplant recipients with invasive Aspergillus fumigatus and renal failure.
Beliefs and Attitudes that Influence Reporting of Clinical Interventions by Pharmacists
Authors: Garrett Tim , Reeves Diane 
Published: April 2015

ABSTRACTBackgroundPharmacist interventions improve patient outcomes and highlight the profession's contribution to the healthcare team. Under‐reporting of interventions is common and result from a variety of interrelated workplace barriers and individual beliefs and attitudes.AimTo investigate the barriers to pharmacists' recording clinical interventions via the Incident Information Management System within an area health service.MethodAll pharmacists within the area health service were surveyed to explore their opinions about intervention reporting and to identify potential barriers and incentives to reporting. Responses were also analysed for aspects relating to the type/severity and frequency of clinical interventions reported.ResultsPharmacists are most likely to report actual interventions and those of a greater clinical severity than near‐misses or those of lesser significance. Approximately, only 20% of serious interventions were reported into the Incident Information Management System. Significant barriers to reporting interventions were time constraints, lack of feedback, difficulties with the reporting software and poor computer access. Respondents had a strong belief that interventions were an important part of a pharmacist's role (98%) and that they improve patient outcomes (92%). However, the pharmacists had a lesser belief in the value of reporting these activities (p < 0.005).ConclusionDespite pharmacists attributing importance to clinical interventions, this activity was not well reported. The most important barriers were time constraints and technological limitations. An awareness of these barriers can assist in the development of work practices and technological solutions to improve clinical intervention reporting.
Compliance with Paracetamol Prescribing Policies at a Sydney Hospital
Authors: Mitchell Sarah J , Murnion Bridin P , Matthews Slade T , Hilmer Sarah N 
Published: April 2015

ABSTRACTBackgroundDespite being marketed as a safe non‐opioid analgesic there are concerns about paracetamol's potential to cause hepatotoxicity. The NSW Health paracetamol policy mandates review of all hospital inpatient orders 48 hours after starting paracetamol and dose reduction for older patients.AimTo assess hospital staff's knowledge and attitude of and their compliance with the NSW Health paracetamol policy and the complementary hospital paracetamol guideline.MethodsA cross‐sectional audit of 14 wards at a 560‐bed hospital was conducted over one week to evaluate compliance with the NSW Health and the hospital paracetamol guidelines. An anonymous questionnaire was used to assess the hospital staff's awareness of these guidelines.Results274 patients were eligible to participate in the audit. Most patients (n = 196; 75%) were prescribed paracetamol with regular paracetamol the most common prescription. Patients prescribed paracetamol were less likely to have their liver function tests measured than patients not prescribed paracetamol. Most (73%) patients aged 65 years and over were prescribed reduced doses of paracetamol (less than 4 g/day) in accordance with the NSW Health and the hospital guidelines. Hospital staff's awareness of these guidelines was low and was highest among pharmacy staff.ConclusionCompliance with and knowledge of the NSW Health and hospital paracetamol guidelines were limited and varied between hospital staff. Innovative methods for dissemination of information crucial for safe and efficacious use of medicines are required.
Hospital Supply of Off‐label Immunomodulatory Drugs
Authors: O'Connor Kate , Burke Rosemary , Riminton Sean 
Published: April 2015

ABSTRACTBackgroundThere has been an increase in the demand for new immunomodulatory drugs for the treatment of immune‐mediated inflammatory diseases. Many of these indications represent the off‐label use of immunomodulatory drugs.AimTo evaluate the spectrum of requests, clinical outcomes and costs for the hospital‐approved, off‐label use of immunomodulatory drugs.MethodA list of all new individual patient use approvals at a Sydney teaching hospital (February 2005 to June 2006) was obtained and the approved immunomodulatory drugs were selected for audit. A literature review was conducted to determine the level of evidence available for the approved immunomodulatory drugs.Results61 individual patient use approvals for off‐label immunomodulatory drugs were analysed. The most commonly requested drugs were infliximab (n = 22), mycophenolate (n = 13), rituximab (n = 10) and cyclosporin (n = 7). These drugs were initiated for treatment of a heterogeneous group of serious medical disorders. 10 hospital departments initiated the requests. The cost of new approvals was $458 301, accounting for 61% of the total cost of $749 236 for off‐label immunomodulatory drugs within the study period. The most expensive drugs were rituximab, infliximab and mycophenolate. Efficacy reports were available for 64% of approvals and a favourable therapeutic response was observed in 74% of cases. 4 deaths occurred and significant treatment‐related adverse events were noted in 24% of cases. High‐level evidence supported the use of immunomodulatory drugs for 41 individual patient use approvals.ConclusionOff‐label use of immunomodulatory drugs was diverse and supported by good evidence in over 50% of cases. Methods used to assess the response to immunomodulatory drugs were suboptimal and non‐standardised. Formalising the supply of immunomodulatory drugs may enable aggregation of data to inform future decisions and resource allocation.
Midazolam Metabolism: Implications for Individualised Dosing?
Authors: Roberts Jason A , Coulthard Mark G , Addison Russell S , Foot Carole , Lipman Jeffrey 
Published: April 2015

ABSTRACTAimTo compare the clearance of midazolam and its metabolites in critically ill paediatric and adult patients.MethodA prospective study conducted in paediatric and adult intensive care units. Patients over 2 years of age receiving midazolam for therapeutic sedation were eligible for enrolment. Midazolam and its metabolite concentrations were determined in plasma and urine.ResultsThe median (interquartile range) steady‐state concentrations observed in the paediatric and adult groups were 90 mg/L (48–135) and 253 mg/L (148–404), respectively (p = 0.90). The median daily doses were 1.8 mg/kg (0.6–2.2) and 1.9 mg/kg (0.6–2.7), respectively (p = 0.84). Midazolam clearance in paediatric and adult patients was 1.1 mL/kg/min (0.9–3.8) and 2.9 mL/kg/min (0.9–3.8), respectively. Analysis of clearances by age identified two peaks in midazolam and its metabolites occurring around 12 years of age and at 45 years of age. Neither midazolam nor its metabolites appeared to accumulate in blood after long courses of treatment (> 3 days).ConclusionA conclusion that could be drawn from this study is that some of midazolam's pharmacokinetic variability may be explained by age‐related changes in metabolism. These findings require validation in a larger study.
Paracetamol and Ibuprofen for Paediatric Pain and Fever
Authors: Tucci Joe , Bandiera Emily , Darwiche Rima , Medos Zeljko , Nashed Robert , Trinh David 
Published: April 2015

ABSTRACTAimTo review the literature on the pharmacology and pharmacokinetics of paracetamol and ibuprofen pertaining to their use for paediatric pain and fever.Data sourcesA literature search was conducted using the PubMed database service on the National Centre for Biotechnology Information web page.Study selectionData from original studies on paediatric pharmacogenomics, pharmacokinetics and pharmacology of paracetamol and ibuprofen were included in the analysis.ResultsMore published studies are required to comprehensively define the pharmacology and phamacokinetics of paracetamol and ibuprofen in paediatrics.ConclusionAn understanding of drug metabolic processes during ontogeny may enable predictions about the capacity of children to cope with medications. Pharmacogenomic screening may help elucidate the inter‐individual variation in drug metabolism and pharmacokinetics.
Timeliness and Clinical Impact of Hospital‐Initiated Medication Reviews
Authors: Lövgren Suzanna , Clark Robyn A , Angley Manya , Ponniah Anne P , Colley Desmond , Shakib Sepehr 
Published: April 2015

ABSTRACTBackgroundMedication‐related problems often occur in the immediate post‐discharge period. To reduce medication misadventure the Commonwealth Government funds home medicines reviews (HMRs). HMRs are initiated when general practitioners refer consenting patients to their community pharmacists, who then engage accredited pharmacists to review patients' medicines in their homes.AimTo determine if hospital‐initiated medication reviews (HIMRs) can be implemented in a more timely manner than HMRs; and to assess the impact of a bespoke referral form with comorbidity‐specific questions on the quality of reports.MethodEligible medical inpatients at risk of medication misadventure were referred by the hospital liaison pharmacist to participating accredited pharmacists post‐discharge from hospital. Social, demographic and laboratory data were collected from medical records and during interviews with consenting patients. Issues raised in the HIMR reports were categorised: intervention/action, information given or recommendation, and assigned a rank of clinical significance.ResultsHIMRs were conducted within 11.6 ± 6.6 days post‐discharge. 36 HIMR reports were evaluated and 1442 issues identified – information given (n = 1204), recommendations made (n = 88) and actions taken (n = 150). The majority of issues raised (89%) had a minor clinical impact. The bespoke referral form prompted approximately half of the issues raised.ConclusionHIMRs can be facilitated in a more timely manner than post‐discharge HMRs. There was an associated positive clinical impact of issues raised in the HIMR reports.
Complementary Medicines: Hospital Pharmacists' Attitude, Knowledge and Information Seeking Behaviour
Authors: Brown Jared A , Roufogalis Basil D , Williamson Margaret 
Published: April 2015

ABSTRACTBackgroundThe use of complementary medicines (CM) is increasing in the community. Hospital pharmacists need to expand their knowledge of CM and have access to and become familiar with reliable information sources.AimTo ascertain hospital pharmacists' knowledge on adverse effects of CM; and to investigate their information seeking practices and preferred sources of reliable information on CM.MethodAnonymous self‐administered surveys were sent to a stratified random sample of pharmacists across Australia. The questionnaire was designed to address five areas on CM: experience and attitude, knowledge, information use, preference for information sources and demographics.Results388 eligible responses were received (23% response rate). 81 respondents were hospital pharmacists. Around half of the hospital pharmacists sought information on CM at least monthly. The most frequently sought information was drug interactions, contraindications and adverse effects. A variety of sources were used to find the information, with the most popular being the Internet and MIMS, however, the most useful were specific web sites and drug information phone services. Only 36% of hospital pharmacists knew that hepatotoxicity is a potential adverse effect of black cohosh and 38% knew that glucosamine can interact with warfarin.ConclusionMany Australian hospital pharmacists had a limited knowledge on the adverse effects of common CM. Although hospital pharmacists often seek information on CM, many were unable to or unaware of where to access reliable information.
Paedpharm: Paediatric Pharmacy Network
Authors: Graudins Linda V , Turner Sean , Kunac Desiree 
Published: April 2015

ABSTRACTBackgroundUp‐to‐date data on paediatric therapeutics, such as off‐label use of medicines, availability of unlicensed formulations and medication protocols are often not available. The paediatric pharmacy network (Paedpharm) was launched in 1999 to support paediatric pharmacists and provide a network for the exchange of information.AimTo describe Paedpharm subscribers; to assess utility and activity of the network; and to identify improvements to be made.MethodA 7‐question survey was e‐mailed to Paedpharm subscribers. Data on Paedpharm posts (2000 to 2008) were obtained from the University of Otago. The posts for a 18‐month period (January 2007 to July 2008) were retrospectively reviewed to characterise the utility and activity of the network.ResultsOf the 168 Paedpharm subscribers, 100 subscribers replied to the survey (60% response rate). 89% of subscribers worked in public hospitals and 77% specialised in paediatrics. 70% of subscribers had used Paedpharm to help inform a treatment decision. There were 9107 posts from August 2000 to December 2008 and 987 posts for the 18‐month period (January 2007 to July 2008), of which 415 were new topics. The most popular topics were availability of products (21%) and protocols/guidelines (20%). The most popular therapeutic categories were nutrition/blood (16%) and antimicrobials (13%).ConclusionPaedpharm continues to be a valued service for pharmacists from a variety of paediatric specialties. Subscribers use the network for queries, formulating therapeutic guidelines and sharing information.
Impact of a New Insulin Chart on Hospitalised Patients with Diabetes
Authors: Lehnbom Elin C , Welch Susan A , Ludington Jane E , Bryant Wendy , Brien Jo‐anne E 
Published: April 2015

ABSTRACTBackgroundHospitalised patients with diabetes often have poor glycaemic control. To improve the management of hospitalised patients with diabetes, a new insulin chart incorporating documentation of blood glucose levels was developed and introduced at St Vincent's Hospital, Sydney.AimTo evaluate the impact of a new insulin chart on the management of hospitalised patients with diabetes.MethodA retrospective study comparing the management of three groups of hospitalised diabetic patients. The use of insulin and management of hypoglycaemic events before and after the introduction of the new insulin chart were compared. Clinical data were collected from medical records from April 2004 to April 2005. Chi‐square tests were performed to analyse the data for significant differences.ResultsPost‐implementation of the new insulin chart, patients seen by the endocrine team were more frequently ordered regular insulin (p < 0.017) than patients not managed by the endocrinologists. The number of omitted doses of regular insulin remained unchanged. Poor cross‐referencing of the insulin and standard medication charts may have been a contributing factor. Post‐implementation, significantly more hypoglycaemic events were treated according to the hospital's protocol (p < 0.001). Staff satisfaction with the new insulin chart was high except for some doctors' dissatisfaction with the chart when ordering regular insulin.ConclusionIntroduction of the new insulin chart had a positive impact on the management of hypoglycaemic events. Other aspects of diabetes management, such as the number of patients on regular insulin and insulin dose omissions were suboptimal.
Visual Thematic Analysis of Children's Illustrations to Improve Receptiveness to Pictorial Asthma Action Plans
Authors: Pascuet Elena , Vaillancourt Régis , Collins Michael A , Moore Anne‐Marie , Scoular Douglas , Gaboury Isabelle , Ullyot Nora , Stewart Carolyn 
Published: April 2015

ABSTRACTBackgroundWritten asthma action plans are an important component of asthma self‐management. However, these action plans may be difficult for patients with low health literacy, especially children, to understand. The addition of illustrations to health information can improve comprehension, recall and treatment adherence, which can lead to improved disease management.AimTo discern the perceptions of the somatic symptoms of paediatric patients with chronic asthma and aspects of their asthma management.MethodPaediatric patients with chronic asthma aged 5 to 13 years who were either inpatients or outpatients of a Canadian paediatric hospital were asked to draw 2 pictures relating to how they felt when their asthma was well‐controlled and how they felt during an asthma attack. The illustrations were evaluated using established visual theme categories. Following theme development, study team members individually analysed the pictures.Results104 pictures drawn by 53 paediatric participants were analysed. Well‐controlled asthma was commonly depicted by smiling faces (53%), sunshine (33%) and children playing sports outdoors (25%). During an asthma attack, images of sad expressions (60%), children unable to play or confined (28%), children coughing (22%), and lung pain or tightness (19%) were common.ConclusionPaediatric patients' perceptions of their asthma was highly emotional. To improve comprehension and be effective, illustrations added to health information must be specific to the audience.
Support Needed by Pharmacy Students in Experiential Placements: Stakeholders' Expectations
Authors: Owen Susanne M , Stupans Ieva , Ryan Greg , McKauge Leigh M , Woulfe Jim 
Published: April 2015

ABSTRACTBackgroundFrom July 2010, Australian state and territory pharmacy registration boards will be replaced by a national body that will register health professionals and also accredit university pharmacy programs. Traditionally, assessment during the pharmacy internship year and national examination provide consistency at the post‐graduation stages, but the endpoints of university programs have been derived within state and territory contexts.AimTo determine the skills needed to gain competence within university pharmacy programs; and to identify the levels of support required by early and late placement students.MethodStudents, academics and professional/registration/preceptors were involved in state and territory focus groups. 140 participants completed a chart about their expectations regarding levels of supervising preceptor support required by students during experiential placements. Manual collation and comparative analysis was undertaken for early and late placement students.ResultsEarly placement students were consistently viewed by all stakeholder groups as needing assistance or minimal assistance. For late placement students, there were wide variations in responses in regard to levels of support expectations for competency functional areas and within and across state and territory groups, especially among academics from various institutions.ConclusionThere is variability across states and territories with respect to competency development in academic programs. This may present challenges within a national accreditation and registration context.