bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systemic Absorption from Oral Vancomycin: Check the Dose!
Authors: Coutsouvelis John , Witney Kate A , Corallo Carmela E , Spelman Denis 
Published: April 2015

ABSTRACTBackgroundOral vancomycin is increasingly being used to treat Clostridium difficile infection. The extent of systemic absorption of oral vancomycin is unpredictable and usually minimal. However, in the presence of factors, such as renal impairment, or if high doses are used for prolonged periods, systemic absorption may occur, resulting in therapeutic levels of vancomycin.AimTo describe a case of systemic absorption of oral vancomycin.Clinical detailsA 69 year‐old female with neutropenia and severe diarrhoea was admitted to the intensive care unit after an episode of hypotension due to hypovolaemia and septic shock. Fecal cultures were positive for C. difficile infection and she was started on oral vancomycin 500 mg 6‐hourly. Serum creatinine at this time was 161 micromol/L. The clinical pharmacist identified the high dose of oral vancomycin being used and the potential problem with its absorption and recommended monitoring levels. After 7 days of treatment at this dose, the last 6 with normal creatinine, a spot level indicated a systemic vancomycin level of 5 mg/L.OutcomeOn the return of a negative C. difficile culture, oral vancomycin was ceased after 9 days of treatment.ConclusionThe literature does not support oral vancomycin doses above 125 mg 6‐hourly for the initial treatment of C. difficile‐associated diarrhoea.
Hospital Pharmacist‐Led Lipid Clinic for Surgical Patients with Peripheral Vascular Disease at a Regional Australian Hospital
Authors: Weeks Greg R , Fyfe Rachel , Amerena John , George Johnson 
Published: April 2015

ABSTRACTAimTo report patient and pharmacist experiences with a pharmacist‐led lipid clinic for surgical patients with PVD.MethodA pharmacist completed a non‐medical prescribing course and tutelage under a cardiologist to enhance consultation and lipid management skills. Eligible patients were randomised into control or intervention groups. The intervention group was reviewed by the pharmacist during four 6‐weekly visits, and given lifestyle advice, lipid levels measured, and (if required) statins were initiated or adjusted. The control group was given dietary advice, a booklet on cholesterol management and lipid levels measured at baseline and 6 months. The intervention group completed a questionnaire on their experiences. The pharmacist's reflections on their role were also recorded.ResultsOf the 8 intervention group patients who completed the study, 5 reduced their low‐density lipoprotein (LDL) levels below 2 mmol/L, 2 reduced their LDL to 2 and 2.1 mmol/L, and 1 maintained their LDL at 2 mmol/L (mean 1.8, range 1.3–2.1). The entire control group (n = 6) had elevated LDL levels (mean 2.9 mmol/L, range 2.3–3.9). Statins were initiated or adjusted in 4 intervention group patients. Participants were highly satisfied with their pharmacist consultations. The pharmacist was positive about the training, self confidence and ability to answer questions, and less positive about the clinic setting, usefulness of the algorithm and point‐of‐care cholesterol testing.ConclusionA suitably trained hospital pharmacist can undertake extended roles with a prescribing element. However, the patient group and setting require careful consideration.
Lifelong Learning: Views of Australian Pharmacy Interns
Authors: Stupans Ieva 
Published: April 2015

ABSTRACTBackgroundLifelong learning is critical for the professional practice of pharmacists. Lifelong learning can be described as a philosophy recognising that learning occurs throughout one's life. Pharmacists' concept of lifelong learning has not been investigated, with most literature focused only on one aspect of lifelong learning – continuing professional development.AimTo explore pharmacy interns' understanding of lifelong learning.MethodThematic analysis of interviews with interns from an Australian university was undertakenResultsThere were 2 major findings. The very narrow definition of lifelong learning adopted by the interns, i.e. it was viewed as continuing professional development and the need to keep up‐to‐date. The intern period was described as a period of intense learning.ConclusionPharmacy interns appear to be focused on continuing professional development rather than lifelong learning. This may reflect disciplinary contextualisation of university graduate attributes or the focus of activity during the intern period.
Prevalence of Potentially Harmful Drug Interactions in Older People in Australian Aged‐Care Facilities
Authors: Dolton Michael J , Pont Lisa , Stevens Gerard , McLachlan Andrew J 
Published: April 2015

ABSTRACTBackgroundOlder people living in aged‐care facilities are prescribed more medications than those living in their own homes. Thus, increasing their risk of potentially harmful drug interactions. Few studies have investigated potential drug interactions in residents of aged‐care facilities.AimTo determine the prevalence of potentially harmful drug interactions in long‐term residents of aged‐care facilities.MethodPotentially harmful drug interactions were investigated using dispensing data from residents of 26 aged‐care facilities who received one or more medications from July 2008 to June 2010. Drug interactions analysed were chosen based on their inclusion at the highest severity rating in at least 3 of 4 international drug information resources. Data were compared to findings from a cohort of Australian veterans.ResultsPotentially harmful drug interactions were identified for 6.1% of the 3876 residents included in the study. A substantially higher incidence than previously reported in Australian veterans (1.5%) and certain overseas populations. Interactions involving warfarin, amiodarone, verapamil, lithium and methotrexate had the highest prevalence in aged‐care residents, and generally a higher prevalence than in the Australian veteran population.ConclusionPotentially harmful drug interactions were more prevalent in aged‐care residents than in an Australian veteran population.
Adherence to Prophylaxis Guidelines for Symptomatic Venous Thromboembolism at a Darwin Hospital
Authors: De Zylva Joseph B , Naunton Mark , Szabo Ferenc , Dettwiller Pascale 
Published: April 2015

ABSTRACTAimTo investigate adherence to venous thromboembolism (VTE) prophylaxis guidelines in patients who developed VTE within 90 days of hospital discharge.MethodInpatients diagnosed with VTE (January 2007 to December 2009) were identified retrospectively from the medical records coding department. Patients were ineligible if they were outpatients, admitted to another hospital in the 3 months prior to the diagnosis of VTE, or if the diagnosis was not confirmed via a Doppler ultrasound or computed tomography pulmonary angiogram scan. A single cycle audit measured adherence to the guidelines by comparing prophylaxis delivered to eligible patients prior to the diagnosis of VTE to the prophylaxis recommended by the hospital guidelines.Results59 medical and surgical patients were eligible (median age 62 years; interquartile range 23 to 84) and 59% (n = 35) were male. Adherence to VTE prophylaxis guidelines was investigated for 59 patients who developed VTE associated with their current indexed admission (n = 32) or within 90 days of discharge (n = 27). Adherence to VTE prophylaxis for high‐risk patients who developed VTE was: 50% for pharmacological prophylaxis and 57% for mechanical prophylaxis in surgical patients, and 63% for pharmacological prophylaxis and 26% for mechanical prophylaxis in medical patients.ConclusionNearly half of the patients had not received appropriate VTE prophylaxis prior to developing VTE.
Two National Surveys of Hospital Pharmacy Technician Activities to Support the Review of National Qualifications
Authors: O'Leary Karen M 
Published: April 2015

ABSTRACTAimTo explore if the 2006 Certificates III and IV in Hospital/Health Services Pharmacy Support qualifications meet workplace requirements and to make recommendations on the changes needed so that the qualifications meet workplace requirements.Method2 national web‐based surveys were undertaken of Australian hospital pharmacy technicians/assistants (HPT) and hospital pharmacy managers.ResultsDistribution activities are the core business of the majority of HPT. A minority undertake extemporaneous compounding or support clinical pharmacy activities, which are considered advanced practice activities and covered in the Certificate IV qualification. Most of the 10 management activities undertaken by HPT are not supported by the current qualifications. The number of HPT performing these activities highlights a gap in the current qualifications.ConclusionThe day‐to‐day activities undertaken by HPT validates the need for, the content of and competencies obtained via the Certificates III and IV in Hospital/Health Services Pharmacy Support. There is room to improve the content and relevance of both qualifications.
Drug Treatments in Development for Alzheimer's Disease
Authors: Woodward Michael C 
Published: April 2015

ABSTRACTNew therapies are needed to combat the symptoms and underlying disease processes in the dementias. A rapid increase in our understanding of the risk factors for dementia and the underlying pathologies has not been matched with new effective therapies. In this review, potential new symptomatic and disease‐modifying therapies will be described. Most are directed at modifying the amyloid cascade that seems to be the primary pathogenic feature of Alzheimer's disease, other targets include tau pathology, inflammation, neurogenesis and oxidative stress. Some of these therapies may be beneficial for other dementias. It is sobering that in 2012 we only have 4 drugs that are modestly effective for the features of one dementia.
Adverse Drug Reactions during Hospital Stay: Evaluation of a Model for Informing Patients
Authors: Graudins Linda V , Hopper Ingrid , Treseder Rowena J , Lord Julie AV , Dooley Michael J 
Published: April 2015

ABSTRACTBackgroundInforming patients about their adverse drug reactions (ADRs) and involving them in their medication management should decrease repeat ADRs. An innovative model for informing patients about their ADRs has been in place at an Australian health network. The health network's ADR Review Committee reviews the ADR reports, assigns causality and makes recommendations. Patients are sent a letter about their ADR along with an alert card.AimTo evaluate the existing ADR model.MethodOver a 6‐month period, patients who had an ADR report reviewed by the ADR Review Committee were contacted by telephone within 4 weeks of the review and asked questions about the ADR information sent to them. Patients' discharge summaries were concurrently reviewed for ADR information. Feedback about the model was also sought from the hospital's consumer groups.ResultsOf the 89 ADR reports reviewed, 76 patients were eligible, and 55 (72%) patients consented to participate in the survey. 50 (91%) patients recalled the name of the causative drug, 53 (96%) recalled the reaction, 48 (87%) recalled the ADR Review Committee's recommendation, 28 (50%) had an alert card in their wallet, and 29 (52%) had shown or were intending to show the letter to their doctor, but only 3 to their pharmacist. 95% of respondents would recommend this model to other hospitals. 35 (63%) patients wanted the letter sent directly to their doctor. Of the 54 discharge summaries reviewed, the ADR was documented in 43 (80%), details of the reaction in 43 (80%) and specific management advice in 10 (19%). Feedback from the hospital's consumer groups (n = 15) was positive and informed improvements to the model.ConclusionThe ADR model was well received by patients, who retained the information sent. Patient feedback was used to improve the format and content of the ADR information sent. This model could be adapted by other acute and ambulatory settings to facilitate communication between health professionals and patients to avoid repeat ADRs.
Preparation Method and Stability of a Temozolomide Suspension: A Pilot Study
Authors: Ambados Fotios , Crea Joe , Chin May , Lee Su‐Gil 
Published: April 2015

ABSTRACTAimTo investigate a compounding process for temozolomide 10 mg/mL suspension from capsules without using a mortar and pestle; and the stability of the suspension under refrigeration (2 to 8 °C) and at room temperature (22 to 23 °C).MethodTemozolomide 10 mg/mL suspension was prepared using a modified formulation and method to contain the product in the final container and limit operator exposure to cytotoxic powder or residue. Decontamination was undertaken of work and finished product surfaces. Samples were stored at room temperature and under refrigeration. Both samples were protected from light and stored in identical polypropylene containers. High‐pressure liquid chromatography was used to assay the potency of the suspension.ResultsThe sample refrigerated and protected from light exhibited little or no chemical degradation for 22 days. At room temperature, the concentration fell below the acceptable concentration after 8 days. An acceptable product was produced which re‐suspended evenly when shaken.ConclusionPreliminary results indicate that temozolomide 10 mg/mL suspension prepared via this method, refrigerated, protected from light and stored in polypropylene containers may be stable for up to 22 days.
Urinary Alkalinisation with Oral Sodium Bicarbonate for Patients at Risk of Contrast‐Induced Nephropathy
Authors: To The‐Phung , Chahadi Fahd , Freeman Melanie , Pan Mary , Farouque Omar , Mount Peter 
Published: April 2015

ABSTRACTBackgroundIntravenous sodium bicarbonate is used to reduce the risk of contrast‐induced nephropathy (CIN). Intravenous sodium bicarbonate is inconvenient and requires inpatient hospital resources, while oral sodium bicarbonate is less costly and easy‐to‐use.AimTo determine whether oral sodium bicarbonate has a similar effect on urinary pH as intravenous sodium bicarbonate in patients at risk of CIN.MethodThis sequential crossover study was conducted in patients from the cardiology and renal units scheduled for a non‐emergency contrast‐enhanced procedure. Participants received intravenous sodium bicarbonate 150 mmol/L at 3 mL/kg/h, 1 hour prior, then 1 mL/kg/h during and for 6 hours after the procedure. Participants returned to the hospital 2 to 3 weeks after their procedure to receive oral sodium bicarbonate capsules (16 times 840 mg, 160 mmol) over 7 hours with 1 L of water. Urinary pH was measured before and after the administration of intravenous and oral sodium bicarbonate.Results9 participants completed the study. Mean urinary pH after oral sodium bicarbonate was 6.6 (SD 0.6) versus 6.9 (SD 0.5) for intravenous sodium bicarbonate. The mean change in urinary pH was 0.9 (SD 0.7) with oral sodium bicarbonate versus 0.8 (SD 0.5) for intravenous sodium bicarbonate. The difference in change in urinary pH was not statistically significant (p = 0.5).ConclusionOral sodium bicarbonate has a similar effect on urinary pH as intravenous sodium bicarbonate in patients at risk of CIN.
Documentation of Warfarin Education provided to Hospital Patients: A Clinical Audit
Authors: Nasser Sayeed , Cecchele Romana , Touma Simone , Han Priscilla , Nair Kim , Vizgoft Jason , Murdoch Veronica , Mullan Judy , Bajorek Beata 
Published: April 2015

ABSTRACTBackgroundEffective management of warfarin therapy is often challenged by its complex pharmacology and preventable adverse events. One strategy to ensure safe warfarin use is provision of comprehensive warfarin education to patients.AimTo review the provision of warfarin education to hospital patients prescribed warfarin and to describe patient characteristics that may impact on warfarin education.MethodA prospective study was undertaken at 2 large Australian metropolitan hospitals. Provision of warfarin education was identified by auditing the medication charts and clinical notes of hospitalised older patients (≥ 65 years). Patients were also interviewed to confirm whether they recalled receiving warfarin education during their hospital stay.ResultsData were collected for 96 patients with a mean age of 74 (SD 13) years. Most patients (78%) were admitted to medical wards, were taking warfarin for atrial fibrillation (56%), and had started warfarin prior to admission (54%). 36% of patients had provision of warfarin education documented in medication charts and clinical notes, and in most cases warfarin education was provided by a pharmacist. Of the 68 patients available for interview, only 47% recalled receiving warfarin education; in the majority of cases they cited pharmacists as providers of the education.ConclusionThere is a need to improve documentation and provision of warfarin education to hospital patients.
How do Clinical Pharmacists spend their Working Day? A Time‐and‐Motion Study
Authors: de Clifford Jan‐Marie , Blewitt Peter , Lam Skip S , Leung Benjamin K 
Published: April 2015

ABSTRACTBackgroundOur health service is introducing an electronic medication management system (eMMs). Obtaining baseline data on the work patterns of pharmacists will allow assessment of the impact of the eMMs on pharmacists' work patterns.AimTo quantify the time clinical pharmacists spend on various activities over their working day prior to the implementation of an eMMs.MethodDuring this continuous observational time‐and‐motion study (23 November to 17 December 2009), clinical pharmacists assigned to general medical and surgical wards were shadowed by two independent observers over their entire working days. A customised Access application was used to log times and calculate average times spent on each activity. Other data collected included time from admission to interview and opportunities for medication chart review.Results9 pharmacists were observed for 265.3 hours over 30 separate pharmacist observation days. Clinical activities (56% of total time) included professional communication (20%), medication chart review (9.6%), medication history interview (9.5%), clinical review (9.1%), providing information to patients/carers (5.5%), ascertaining discharge drugs required (1.6%), and obtaining drug information (0.5%). Non‐clinical activities (44% of total time) included social activities/breaks (13%), meetings (6.9%), ordering/distribution (6.6%), discharge dispensing (6.3%), walking between wards/pharmacy (5.2%), looking for something (3.1%), and other activities (2.8%). On an average day, each pharmacist reviewed 21 of a possible 38 medication charts (55%), spent 20 minutes on clinical interventions and completed 4.5 medication history interviews. Average time from admission to interview was 67 hours. 18% of pharmacists' time was taken up with discharge/transfer of patients. Most patients 130/141 (93%) at discharge did not require further medication history clarification.ConclusionThis study provides baseline data for comparison of the impact of the eMMs on pharmacist workflow.
Stability of Dispersible Aspirin Tablets Repacked into Dosette Boxes
Authors: Mylrea Martina , Robertson Sherryl , Haywood Alison , Glass Beverley 
Published: April 2015

ABSTRACTBackgroundAlthough guidelines indicate that dispersible aspirin tablets should not be repacked into dose administration aids, it is common practice especially among older people.AimTo determine the stability of acetylsalicylic acid (ASA) in aspirin tablets repacked into Dosette boxes.MethodDispersible aspirin 300 mg tablets were removed from their primary (foil) packaging, and repacked as whole and split (halved) tablets into Dosette boxes under 4 storage conditions: refrigeration (2–8 °C), controlled room temperature (25 °C; 60% relative humidity [RH]), accelerated (40 °C; 75% RH), and ‘in‐use’ with natural variations in daylight exposure and internal temperature fluctuations (23–26 °C; 45–60% RH) for 1 week. The high performance liquid chromatography method developed was validated for accuracy, precision, linearity and range, sensitivity, robustness and specificity, and the suitability of extraction media evaluated.ResultsLinearity (r2 > 0.999), precision (relative standard deviation < 2%) accuracy (recovery: 95–102%) and selectivity for the high performance liquid chromatography method were confirmed. The ASA content remained within specifications (95–105% of labelled amount) for all except the accelerated storage condition, with 93% of the ASA remaining. The split tablets did not display any additional ASA degradation when compared to the whole tablets under the same conditions.ConclusionWhile the ASA content of the dispersible aspirin tablets remained within specifications at room temperature, there were changes in the physical appearance under accelerated storage conditions.
Stability of Amoxycillin, Clindamycin and Meropenem in Peritoneal Dialysis Solution
Authors: Tran Minh D , Sharley Nicholas , Ward Michael 
Published: April 2015

ABSTRACTAimTo determine the stability of amoxycillin, clindamycin and meropenem in peritoneal dialysis solution containing glucose 2.5% at 37 °C over 6 hours.MethodA stability‐indicating high‐performance liquid chromatography assay was used to determine the concentration of amoxycillin, clindamycin and meropenem in peritoneal dialysis solution (Dianeal PD‐4). Antibiotic solutions (amoxycillin 1 g, clindamycin 300 mg, meropenem 1 g) were prepared in 2 L peritoneal dialysis bags and stored at 37 °C. These were analysed at 0, 3 and 6 hours. A degradation profile was constructed for each antibiotic using linear regression and concentration remaining at 6 hours was calculated.ResultsClindamycin and meropenem retained at least 90% or greater of the original concentration in the peritoneal dialysis solution over 6 hours, while amoxycillin displayed marginal stability.ConclusionClindamycin and meropenem are stable for 6 hours in peritoneal dialysis solution containing 2.5% glucose. Amoxycillin's stability was marginal, which could be improved with a modified formulation.
Clinical Pathway for Monthly Pulse Intravenous Cyclophosphamide Therapy for Lupus Nephritis
Authors: Mirkov Sanja , Thein Hla 
Published: April 2015

ABSTRACTAimTo assess the outcomes of monthly pulse intravenous cyclophosphamide (IV CYC) therapy for lupus nephritis and to identify factors contributing to suboptimal outcomes.MethodHistorical study of clinical and laboratory data. Statistical analysis consisted of one sample paired 2‐tailed t‐test and qualitative analysis of textual data.Results16 patients received 17 courses of monthly pulse IV CYC from April 2004 to January 2008 (118 doses, median dose 1025 mg or 563 mg/m2, median cumulative dose 6960 mg or 3824 mg/m2). Mean urinary protein decreased from 7.35 g/24 h pre therapy to 1.17 g/24 h (p = 0.01) after completion. Mean serum albumin increased from 25 to 35 g/L (p = 0.006). Mean serum creatinine was 105 μmol/L pre‐therapy and 122 μmol/L after treatment (p = 0.3). 9 patients achieved complete remission, 4 patients achieved partial remission, 2 patients progressed to end‐stage renal failure and 1 patient did not respond to treatment. 1 patient was lost to follow‐up. 9 out of 118 (8%) nadir white blood cell counts were below 3×109/L and neutrophils were below 2×109/L. 24 hospital admissions were due to the adverse effects of IV CYC. System deficiencies were identified relating to clinical documentation, monitoring laboratory data, patient support and coordinated care.ConclusionAlthough pulse IV CYC was effective, it was associated with serious adverse effects resulting in hospital admissions. The clinical pathway designed aims to improve efficiency and safety of pulse IV CYC for lupus nephritis.