bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unanswered Health‐Related Questions in Community Pharmacy: Frequency, Nature and Consequences
Authors: Gordon Jennifer , Calabretto Jean‐Pierre , Sorich Michael J 
Published: April 2015

ABSTRACTBackgroundMedical practice research suggests that deficits in information exchange can have implications, such as misunderstandings and non‐adherence to treatment. There has been little investigation into the implications of unanswered health‐related questions in community pharmacy, especially for professional pharmacy practice and quality use of medicines.AimTo investigate the frequency of consumers leaving community pharmacies with unanswered health‐related questions, the nature of the unanswered questions and the impact on consumers.MethodConsumers exiting participating community pharmacies (convenience sample) were interviewed using a semi‐structured tool to capture information on the frequency, nature and consequences of unanswered health‐related questions. Data recorded from the interviews were thematically analysed.ResultsOver the 5 week study period, of the 87 participants interviewed, 18 (20%) had come into the pharmacy with a health‐related question and 6 (33%) left with their question unanswered. Of the 47 participants who were asked about past instances of unanswered questions, 7 (15%) reported incidents they could recall. The nature of the unanswered questions mainly focused on potential or perceived medication‐related adverse effects, and information on which to select medicines or treatment. A number of unanswered questions were considered to have potential for negative health consequences if not followed up.ConclusionOn occasion, consumers leave community pharmacies with unanswered questions, which could have consequences for the quality use of medicines. Further research is needed to establish the prevalence and significance of unanswered health‐related questions in community pharmacy.
‘You Look Like a 240 mg’: Gentamicin Dosing at a Sydney Hospital
Authors: Johnston Claire F , Carroll Peter R , Matthews Slade T , Mitchell Sarah J , Hilmer Sarah N 
Published: April 2015

ABSTRACTBackgroundGentamicin, an aminoglycoside antibiotic, is used to treat gram‐negative bacterial infections. In the current Therapeutic Guidelines: Antibiotic, the recommendations for gentamicin have changed, i.e. the initial dose for empirical treatment, subsequent dose calculations and maximum duration of therapy.AimTo investigate the pattern of gentamicin utilisation and adherence to local gentamicin dosing guidelines.MethodA cross‐sectional audit was conducted of available medication charts for inpatients (n = 51) administered gentamicin at a Sydney hospital over a 2 month period. For comparison, patients were stratified according to age into younger (18 to 59 years) or older (≥60 years) groups.ResultsOf the 51 patients evaluated, only 11 (8 younger, 3 older) had their weight recorded and they received significantly lower gentamicin doses than the recommended dose based on their age and weight. 11 patients received multiple doses of gentamicin with an average of 2.6 (range 2 to 4) days of therapy. The most common dose was gentamicin 240 mg.ConclusionThere was significant under‐dosing of gentamicin in patients of all ages who had their weight recorded. Future studies are needed to investigate the impact of gentamicin underdosing on clinical outcomes.
Low Adherence to Vancomycin Guidelines at an Australian Paediatric Hospital
Authors: Lie Katherine , Mees Alison , Ford Violet , McCauley Louise , Roberts Malcolm , Clifford Rhonda M 
Published: April 2015

ABSTRACTBackgroundWith increasing bacterial resistance, and the emergence of vancomycin‐resistant methicillin‐resistant Staphylococcus aureus, it is imperative that vancomycin is used appropriately in hospitals.AimTo investigate adherence to hospital guidelines for vancomycin dosing and therapeutic drug monitoring.MethodA retrospective audit of vancomycin use was conducted for all inpatients (1 month to 18 years) at a paediatric hospital over an 8 month period. Data from medical records were compared with the hospital guidelines to ascertain adherence to vancomycin dosing and therapeutic drug monitoring.Results167 patients received vancomycin and 173 courses of vancomycin prescribed to 124 eligible patients were reviewed. 28% of vancomycin courses adhered to all aspects of the guidelines. Oncology clinicians prescribed 50% of vancomycin courses and adhered to audit criteria in 43% of cases. The most common deviation from the guidelines was under‐dosing of vancomycin.ConclusionAdherence to hospital vancomycin guidelines was poor. Under‐dosing was the most significant deviation and is of concern, as subtherapeutic vancomycin dosing has the potential to extend the duration of illness, contribute to adverse health outcomes and increase selection of resistant bacteria.
Exploring Medication Risk among Older Residents in Supported Residential Services: A Cross‐Sectional Study
Authors: Lee Cik Yin , George Johnson , Elliott Rohan A , Chapman Colin B , Stewart Kay 
Published: April 2015

ABSTRACTBackgroundOlder residents in supported residential services (SRS) are often on multiple medications and may be at risk of medication misadventure. Their medication risk and uptake of medication reviews by pharmacists has not been investigated.AimTo investigate medication use, risk factors for medication misadventure and uptake of home medicines review (HMR) among older residents in SRS.MethodA pre‐piloted postal survey was distributed to 361 residents from 14 SRS in Victoria. The questionnaire included validated items on medication risk, medication use, health information and uptake of HMR. The questionnaire was completed by residents, SRS care staff or family members.ResultsOf the 77 respondents (21% response rate) aged 53 to 98 years, 73 (95%, 95%CI 90–100) reported taking prescribed medications. Risk factors for medication‐related problems were present in 56 respondents (73%; 95%CI 63–83) and included: ≥ 5 regular medications (n = 41; 53%; 95%CI 42–64), ≥ 3 comorbidities (n = 31; 40%; 95%CI 29–51), medications with low therapeutic index (n = 15; 20%; 95%CI 11–28), recent hospitalisations (n = 12; 16%; 95%CI 7.5–24), recent changes to medication regimens (n = 10; 13%; 95%CI 5.5–21) and ≥ 12 tablets/capsules a day (n = 9; 12%; 95%CI 4.5–19). Of these at‐risk respondents, only 3 (5.4%; 95%CI 0.4–11) reported receiving an HMR in the previous 12 months.ConclusionHigh prevalence of medication use and medication‐related risk factors, but low awareness and uptake of HMR were identified among SRS residents.
Implementing a Pharmacist Charting Service in the PreAdmission Clinic
Authors: Cao Bei Yin , Chow Clara , Elliott Phillip , MacPherson Ross D , Crane Jenny , Bajorek Beata V 
Published: April 2015

ABSTRACTAimTo implement a pharmacist charting service in the preadmission clinic (PAC) and describe a preparatory process for the initiation of this service.MethodStage 1: a proposal for a pharmacist charting service in the PA C was devised via an iterative process with an advisory panel. Stage 2: feedback on the proposal was obtained from key staff via a survey comprising 15 linear scale statements (0 = strongly disagree to 10 = strongly agree) and open–ended questions. Stage 3: baseline data were collected on existing PAC service outcomes, e.g. consultation times, accuracy of medication charts.ResultsStage 1: a service protocol was developed following positive feedback. Stage 2: most staff strongly agreed that a pharmacist charting service would improve the efficiency and workflow in the PAC (median 8; n = 19) and that PAC pharmacists were competent and skilled to chart medications (median 9). Pharmacists perceived that the proposed service would increase their workload (median 10), consultation times (median 9) and medicolegal responsibilities (median 7) while the opposite was reported by the doctors (median 2, 2, and 3, respectively). Stage 3: mean baseline consultation times for pharmacists and doctors were 18.6 and 25 minutes, respectively. Most (95%) of the 56 analysed medication charts were incomplete (at least 1 piece of information missing) while 41% had at least one or more inaccuracies.ConclusionThere are benefits of a pharmacist charting service. This is the first step toward exploring models for pharmacist prescribing.
Facilitating Medication Misadventure Risk Assessment in the Emergency Medical Unit
Authors: Kumar Nitesh , Knowler Christopher B , Strumpman Dana , Bajorek Beata V 
Published: April 2015

ABSTRACTBackgroundThe risk of medication misadventure is heightened in emergency settings. Identifying at‐risk patients is integral to minimising medication‐related adverse events.AimTo pilot a medication misadventure risk assessment tool to identify at‐risk patients most likely to benefit from targeted intervention by an emergency department pharmacist.MethodA prospective descriptive study was undertaken in an emergency medical unit over 2 weeks (June to July 2009). Patients were included if they were over 70 years of age, took 3 5 regular medications, had 3 3 comorbidities, and/or were newly started on warfarin or had been admitted to the emergency department as a result of a medication‐related adverse event. Nurses were encouraged to use the medication misadventure risk assessment tool for all patients admitted to the emergency medical unit. The pharmacist provided targeted interventions to all patients who were identified as being at‐risk by the nurses. The pharmacist also verified the accuracy of the risk assessments undertaken by the nurses using this tool. Main outcome measures were the sensitivity and specificity of the tool and the reliability of the nurses' risk assessment.ResultsNurses completed 115 medication risk assessments for 194 patients. The risk assessments were accurately completed in all but 10 patients. Of the 36 (31%) patients assessed as high risk, 18 required pharmacist intervention. Of the 79 patients assessed as low risk, 3 required pharmacist intervention. The tool was useful in identifying at‐risk patients (specificity 78%, 95%CI 69–85; sensitivity 83%, 95%CI 60–94).ConclusionNurses in the emergency department used the risk assessment tool to identify patients at risk of medication misadventure and facilitate targeted interventions by pharmacists.
Prevalence of Potentially Inappropriate Medication Use in Elderly Hospitalised Patients
Authors: Widagdo Imaina S , Nyfort‐Hansen Karin , Kowalski Stefan R 
Published: April 2015

ABSTRACTBackgroundThe Beers criteria are used to identify potentially inappropriate medications (PIMs) in the elderly. Few studies have examined the Beers criteria in elderly hospitalised patients in Australia.AimTo identify the prevalence of PIM use in elderly patients admitted to an Australian hospital using the 2003 Beers criteria.MethodA prospective cross‐sectional study of 100 elderly inpatients was undertaken using the Beers criteria to identify and compare PIM on admission and discharge. Logistic regression analysis examined the risk factors for PIM use.Results42% of patients had at least one PIM on admission compared to 39% at discharge. The most common PIMs were amitriptyline, senna, amiodarone and benzodiazepines (nitrazepam and diazepam). Excluding senna, the prevalence decreased to 36% at admission and 24% at discharge. At admission (including and excluding senna), PIM was not significantly associated with age, gender, living arrangements, number of comorbidities and number of medications. At discharge, PIM (including senna) was significantly associated with age (OR 1.1; 95%CI 1.02–1.3; p = 0.02), female gender (OR 3.6; 95%CI 1.3–10; p = 0.01) and number of medications (OR 1.2; 95%CI 1.0–1.3; p = 0.02). When senna was excluded PIM at discharge was only significantly higher in female patients (OR 5.4; 95%CI 1.7–16.9; p = 0.004).ConclusionThe Beers criteria detected a high prevalence of PIM use in elderly hospitalised patients.
Intravenous Olanzapine for Acute Agitation in the Emergency Department
Authors: Chan Esther W , Knott Jonathan C , Taylor David McD , Kong David CM 
Published: April 2015

ABSTRACTBackgroundDespite the lack of supporting evidence, olanzapine intramuscular (IM) injection continues to be used via the unapproved intravenous (IV) route for the management of acute agitation in the emergency setting.AimTo report the management of acute agitation using IV olanzapine via 4 representative cases in the emergency department (ED).Clinical details and outcomeIV olanzapine was used in 4 adult patients. Hospital security alerts were called in each case, mobilising security and ED staff. De‐escalation strategies were employed and chemical restraints were administered as a last resort. IV olanzapine was used as the initial, second or last drug to chemically manage the agitation. Olanzapine was used alone or in combination with benzodiazepines and/or other antipsychotics. No adverse events were observed and vital signs remained within normal ranges. Sedation was noted from 30 minutes post olanzapine administration. There were relapses of agitation which required further sedation. No clinical trials have reported on the safety of IV olanzapine for the management of acute agitation specifically in the ED.ConclusionThere is little evidence of efficacy or safety to support the use of IV olanzapine in the ED.
Bayesian Optimisation of Tobramycin Dosing in Paediatric Patients with Cystic Fibrosis
Authors: Barras Michael , Alraman Hana , Kirkpatrick Carl MJ , Harris Margaret , Dakin Carolyn , Jess Katrina , Pilbeam Melissa , Norris Ross LG 
Published: April 2015

ABSTRACTBackgroundIn children with cystic fibrosis (CF), tobramycin concentrations are monitored via the area under the plasma concentration time curve (AUC) approach. Currently, a minimum of 2 plasma concentrations of tobramycin within one dosing interval are required to estimate the AUC, which is costly, painful and blood collection is often difficult to coordinate.AimTo evaluate the accuracy of tobramycin AUC estimated using 1 plasma concentration compared to AUC based on 2 plasma concentrations calculated using Bayesian software.MethodData were collected from paediatric patients with CF prescribed once daily intravenous tobramycin. Each patient had 2 blood samples taken within a dosing interval (according to usual practice at the hospital) on 2 separate occasions during their admission. Data on tobramycin dosing and concentration, and patient demographics from the first occasion were entered into the Bayesian software, TCIWorks, to establish an individual patient's pharmacokinetic model. Data from the second occasion were then also entered into TCIWorks to estimate 2 AUCs – from 1 (AUC1) and 2 (AUC2) plasma concentrations. The accuracy of each patient's AUCs (AUC1 and AUC2) were then evaluated using a Bland‐Altman analysis to describe bias relative to the mean of the two values. To show the benefits of good quality data when using TCIWorks, data were obtained and analysed from 2 patient groups. For group A patients, accurate sampling and administration times of the tobramycin infusion were obtained prospectively. Group B consisted of patients from group A plus additional patients who had data collected from a retrospective medical chart review.ResultsData were collected for 30 paediatric patients with CF − 14 in group A and 16 additional patients in group B. In group A, there was no significant bias relative to the mean of the values for AUC1 and AUC2 (mean bias 1; 95%CI −4.9–6.9). A similar result was seen in group B (mean bias −0.7; 95%CI −10–8.6) indicating that the 2 estimates of tobramycin AUC (using 1 and 2 blood samples) are not significantly different. Conclusion: Once an individual paediatric patient's tobramycin pharmacokinetic model is determined with two blood samples using TCIWorks, only one blood sample is required to estimate an AUC for tobramycin.
Direct–to–Consumer Advertising of Prescription Medicines on the Internet: An Australian Consumer Perspective
Authors: Gu Phoebe , Williams Kylie A , Aslani Parisa , Chaar Betty B 
Published: April 2015

ABSTRACTBackgroundIn Australia there are strict regulations in place to protect the consumer from direct–to–consumer advertising (DTCA) of prescription medicines. However, the degree of infallibility of these restrictions is unclear.AimTo investigate the DTCA encountered by Australian consumers when searching the Internet for common health‐ or medicine‐related questions.Method2 health topics, weight loss and impotence, were chosen and explored from 2 perspectives – the health condition and a commonly used medicine (brand name). Key words were chosen to simulate the language and search style of a consumer. The first 10 hits from each search were evaluated using the validated DISCERN scale, and a descriptive report of each web site was conducted with a specific focus on evidence for DTCA.ResultsOf the 70 web sites visited, 10 sites originating from the USA or New Zealand exhibited DTCA. The scale and intensity of DTCA varied between search topics and strategies and ranged in appearance from simple, pictorial advertising to subtle forms of persuasive language. DTCA of some pharmaceuticals was often hidden within disease awareness campaigns, ePharmacy web pages and online communities.ConclusionAustralian consumers are exposed to DTCA of prescription medicines on the Internet. Clearly, DTCA restrictions in Australia are not infallible. Australian policy makers in the interests of public health must take measures to address the gaps.
Post‐Registration Learning Trends of Community Pharmacists
Authors: Clifford Rhonda M , Ram Pretisha L , Lakos Anneika , Gudka Sajni , Seubert Liza J , Schneider Carl R , Gregory Lesley AH 
Published: April 2015

ABSTRACTBackgroundSome Australian pharmacists use continuing education to maintain knowledge and acquire new information. There has been a progression from continuing education to continuing professional development (CPD) – a mandatory requirement for pharmacists in all jurisdictions of Australia.AimTo identify post‐registration learning trends of community pharmacists in Western Australia.MethodA questionnaire was developed and administered by face–to–face interviews with community pharmacists in metropolitan Perth. Pharmacists registered for less than 12 months and pharmacists working in hospitals were excluded.Results103 pharmacists were approached with a response rate of 95%. Journals (41%), reference books (23%) and the Internet (18%) were the most commonly used educational resources cited by pharmacists. Keeping scientific information up‐to‐date (39%) and gathering practical knowledge (22%) were the leading motivators for pharmacists to participate in continuing education. Factors that hindered participation in continuing education included lack of time (34%), family commitments (21%) and business commitments (21%). 79% of pharmacists agreed with the concept of mandatory CPD. 47% of pharmacists suggested that the primary sanction for not complying with mandatory CPD should be counselling to determine reasons for non‐compliance.ConclusionCommunity pharmacists preferred educational resources that were easily accessible at convenient times. Most pharmacists were able to fulfil the requirements of CPD, however, further educational support and promotion would ensure the successful uptake of CPD by community pharmacists in Western Australia.
Revisiting Guidelines and Inappropriate use of Ticarcillin/ Clavulanate at an Australian Teaching Hospital
Authors: Patterson Tina H , Unwin Sean , Looke David FM , Pillans Peter I , Loy Lynette M 
Published: April 2015

ABSTRACTAimTo assess adherence to local ticarcillin/clavulanate prescribing guidelines; to examine the appropriateness of non‐compliant prescribing; and to identify patterns of prescribing that could be improved.MethodA convenience sample of patients prescribed ticarcillin/clavulanate was prospectively identified by ward pharmacists over a 9‐week period. Their medication charts were retrospectively reviewed by the drug use evaluation pharmacist and data collected on patient demographics, diagnosis, previous penicillin allergy, microbiology, treatment type and compliance with local guidelines. Ticarcillin/clavulanate use that was considered inappropriate was analysed for costs.ResultsOf the 100 patients included in the audit, half were prescribed ticarcillin/clavulanate outside of local guidelines. In this non‐compliant group, approximately two thirds (65%) of patients were considered to have been treated appropriately. The majority of these patients were being managed for diabetic foot infections. Prescribing in only 18% of cases was considered to be neither compliant with the guidelines or appropriate. Pharmacoeconomic analysis suggests that efforts to improve prescribing may result in cost savings.ConclusionThere was widespread use of ticarcillin/ clavulanate outside of the local guidelines. In many cases, non‐compliant prescribing was considered appropriate.
Impact of Pharmaceutical Reforms on Non‐Prescription Medication Management in Post‐Natal Women Following Discharge from Hospital
Authors: Whennan Lisa D , Grzeskowiak Luke E 
Published: April 2015

ABSTRACTBackgroundPharmaceutical reforms were introduced to South Australia in 2007 and resulted in significant changes to the provision of medications on discharge for postnatal women. Women are required to pay for each medication provided on discharge, where previously these were free of charge.AimTo determine whether postnatal women discharged from the Women's and Children's Hospital purchased recommended non‐prescription medications.MethodPostnatal women who delivered over a 3‐week period (May to June 2010) completed a short questionnaire during a home visit by a midwife in the days following discharge. The questionnaire collected data on demographics, as well as on medications supplied on discharge, whether non‐prescription medications were recommended to be purchased post‐discharge and whether these medications were purchased.Results70 questionnaires were returned and analysed (response rate 30%). 110 non‐prescription medications were recommended for purchase post‐discharge; 42 were not purchased because they were present at home. Of the remainder, 42 (62%) were purchased and 26 (38%) were not purchased. The most common reason for medications not being purchased was that it was no longer required (59%). Medications purchased most often included iron (83%) and vitamin D (100%), while those purchased least often included urinary alkalinisers (33%) and fibre supplements (44%).ConclusionPharmaceutical reforms do not appear to have had an adverse impact on non‐prescription medication management in postnatal women. The majority of non‐prescription medications were purchased as recommended post‐discharge.