bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medication Information Transfer: An Exploratory Study in a Rural Queensland Community
Authors: Tan Amy CW , Emmerton Lynne M , Hattingh H Laetitia , Jarvis Victoria I 
Published: April 2015

ABSTRACTBackgroundInadequate or inaccurate transfer of medication information can challenge optimal medication management. Studies of medication information transfer typically involve the hospital–community interface in urban settings. There is little research on medication information transfer between community health services, between hospitals (rural and metropolitan) and rural community settings.AimTo explore medication information transfer issues faced by rural healthcare providers and their perspectives on initiatives to optimise the process.MethodSemi‐structured interviews were conducted with 49 health professionals in 4 towns in rural Queensland on issues surrounding medication supply and management. Interviews were recorded, transcribed verbatim and analysed thematically.ResultsSome of the issues identified included: discrepancies in medication records, lack of a coordinated system to communicate medication or prescription information between health professionals, and inadequate communication between secondary/tertiary facilities and rural primary care providers. According to the participants, the root causes of these challenges related to workforce issues and inefficiencies in communication and networking systems.ConclusionKey issues were identified relating to medication information transfer between healthcare providers and between healthcare settings, which impacted on optimal medication management for rural patients.
Development and Evaluation of an Hospital Pharmacy Generated Interim Residential Care Medication Administration Chart
Authors: Tran Tim , Elliott Rohan A , Taylor Simone E , Garrett Kent 
Published: April 2015

ABSTRACTBackgroundAn interim residential care medication administration chart (IRCMAC), usually handwritten by hospital medical officers, is provided by some hospitals to reduce the risk of medication administration delays and errors for patients discharged to residential care facilities (RCFs).AimTo describe a novel method for IRCMAC preparation; and to determine the percentage of patients discharged from hospital to RCFs who received an IRCMAC, the accuracy of the IRCMAC, and the time IRCMAC preparation added to the pharmacy discharge process.MethodSoftware and processes were developed to enable integration of IRCMAC preparation into the pharmacy discharge process, with auto‐population of the IRCMAC with patient, prescriber and medication data. The percentage of patients for whom RCF staff reported receiving an IRCMAC over a 3‐month study period was determined by telephone interview 24 to 72 hours post‐discharge. Accuracy was determined by retrospective comparison of a random sample of IRCMACs with pharmacist reviewed and reconciled discharge prescriptions to identify discrepancies. Time added to pharmacy discharge processes was recorded prospectively by pharmacy staff.ResultsRCF staff reported receiving IRCMACs for 214/226 (95%) patients discharged to 84 RCFs. The medication discrepancy rate (excluding nutritional supplements) in 76 randomly selected IRCMACs was 9/877 (1%). The IRCMAC took a mean of 8.7 (SD 4.1) minutes to prepare.ConclusionAccurate IRCMACs can be provided for a high percentage of patients discharged to RCFs by hospital pharmacists using a semi‐automated process linked to dispensing software.
Stability Study of a Thalidomide Suspension
Authors: Hopkins Ashley M , Sharley Nicholas A , Tang Cuong D 
Published: April 2015

ABSTRACTBackgroundThalidomide is being used increasingly for its immunomodulatory, anti‐inflammatory and anti‐angiogenic properties. Data on the stability of an oral liquid thalidomide formulation for use in patients with swallowing difficulties and enteral feeding tubes are lacking.AimTo determine the stability of a thalidomide 100 mg/10 mL suspension.MethodThalidomide 100 mg/10 mL suspension was formulated (in triplicate) using Thalomid capsules and stored at room temperature (22 ± 1 °C) for 31 days. Stability was assessed via high‐performance liquid chromatography (HPLC) on Days 7, 14, 21 and 31. Assay suitability was analysed via forced degradation products of thalidomide samples under acidic, basic and oxidative conditions.ResultsA validated thalidomide HPLC assay indicated that the original thalidomide content of the suspension remained within 5% throughout the 31‐day study period. After shaking, no visible changes in suspension consistency, colour or sedimentation were observed.ConclusionThe formulated thalidomide 100 mg/10 mL suspension when protected from light and stored at room temperature was stable for up to 31 days.
Immediate Post‐Administration Safety of Bolus Gentamicin
Authors: Roberts Gregory W , Harbi Ghaleb Al , Khalessi‐Rad Mona 
Published: April 2015

ABSTRACTAimTo compare the adverse effect profile in the 1‐hour post‐administration period for a 3‐minute gentamicin 40 mg/mL bolus with a 30‐minute gentamicin 1 mg/mL infusion.MethodAustralian guidelines recommend that IV gentamicin doses greater than 240 mg need to be diluted and infused over 20 to 120 minutes, while lower doses can be administered as a bolus using the undiluted injection solution (40 mg/mL) over 2 to 5 minutes. Patients receiving at least 2 gentamicin doses of 240 mg or greater were administered an undiluted IV bolus (40 mg/mL) over 3 minutes on one occasion and a 1 mg/mL infusion over 30 minutes on another in a randomised crossover design. Patients were assessed for pain, swelling and redness at the injection site, tinnitus, dizziness, headache and nausea at 0, 15, 30 and 60 minutes after administration of the gentamicin dose.Results47 patients completed the study. Mean administration rates in the bolus and infusion arms were 105 ± 27 mg/min and 12 ± 8.1 mg/min, respectively. During the bolus phase, more patients complained of increased pain at the injection site immediately after completion of the bolus dose (34% vs 9%, p < 0.01), but this effect had dissipated at the 15‐minute assessment (4% vs 4%). There were no differences in any other parameters at any of the assessment times.ConclusionBolus gentamicin of up to 480 mg (undiluted 40 mg/mL injection) administered over 3 minutes can be used as an alternative to a diluted gentamicin infusion, but may cause transient IV site pain.
Anticoagulation for Non‐Valvular Atrial Fibrillation in Older People
Authors: Grewal Jasmin , Farouque Omar 
Published: April 2015

ABSTRACTAtrial fibrillation (AF) is a common arrhythmia that increases in prevalence with advancing age. Systemic thromboembolism, a complication of AF and ischaemic stroke, is the most frequent clinical manifestation. The risk of stroke is increased in the presence of factors such as advancing age, heart failure, hypertension, diabetes and history of stroke. Long‐term anticoagulation with warfarin has been the standard treatment for stroke prevention in patients with AF. In older people anticoagulation is associated with an increased risk of bleeding. Therefore, managing AF in older people can be a clinical challenge because not only are they at a high risk of thromboembolism but also of bleeding. Stroke risk stratification schemes have been developed to guide assessment of risks versus benefits. Other considerations in older people include monitoring anticoagulation, and assessing falls risk, compliance and the potential for drug interactions. A range of novel oral anticoagulants, such as direct thrombin inhibitors and factor Xa inhibitors, have been developed. These anticoagulants have demonstrated advantages in safety, efficacy and convenience of use in large randomised clinical trials. These novel anticoagulants could provide alternatives to warfarin for preventing stroke in older people with AF.
Alternatives to Post‐Discharge Home Medication Reviews for High‐Risk Patients: Doctors' and Pharmacists' Views
Authors: Padhye Vaishali , Ponniah Anne P , Spurling Lisa K , Bong Xin Jou , Shakib Sepehr , Angley Manya , Angley Manya 
Published: April 2015

ABSTRACTBackgroundWe examined health professionals' views of a novel post‐discharge medication review model for high‐risk patients with 2 referral pathways – general practitioners (GPs) referring for home medicines reviews (HMRs) or hospital doctors referring for hospital‐initiated medication reviews (HIMRs).AimTo identify positive and negative aspects of the model, barriers and facilitators to implementation and to make recommendations for a post‐discharge home medication review program.Method23 semi‐structured interviews were conducted with key stakeholders – hospital doctors, GPs, accredited pharmacists, hospital pharmacists and community pharmacists. Data were analysed thematically based on a conceptual framework.ResultsThere was consensus that the availability of flexible pathways to post‐discharge home medication reviews was vital for patient care. Participants highlighted it was crucial that the patient's GP and community pharmacist are kept informed if the HIMR pathway was chosen. Barriers to implementation were time constraints experienced by health professionals to organise and conduct the review within 7 days post‐discharge and lack of awareness of the HMR process. Facilitators to implementation included existing positive working relationships and familiarity and support for the HMR process. Suggestions for future implementation included incorporating the liaison pharmacist role into the usual responsibilities of clinical pharmacists and educating medical interns about the model.ConclusionConsensus among medical and pharmacy stakeholders was that streamlined and flexible pathways to post‐discharge medication reviews would enhance quality use of medicines along the continuum of care.
Prescribing Benzodiazepines in Residential Aged‐Care Facilities
Authors: Blogg Lynda C , Suzuki Nao , Roberts Malcolm , Clifford Rhonda M , Clifford Rhonda M 
Published: April 2015

ABSTRACTBackgroundBenzodiazepines (BZDs) are used to treat sleep disturbances and behavioural and psychological symptoms of dementia in residents of aged‐care facilities. Older people are vulnerable to the adverse effects of BZDs. In Australia, guidelines exist for prescribing BZDs, however there are a lack of data comparing prescribing patterns with guidelines.AimTo review BZD prescribing patterns in residential aged‐care facilities and to compare these with best‐practice guidelines.MethodA cross‐sectional analysis of BZD prescribing for residents aged 65 years and over was undertaken in 6 aged‐care facilities. Data on patient demographics and BZD prescribing were obtained from medication charts, medical records and case notes. BZD prescribing patterns were compared to guidelines from the National Prescribing Service and Therapeutic Guidelines.ResultsPrescribing data for 193 residents were analysed. 71 (37%) residents were prescribed a BZD, mostly temazepam and oxazepam. The majority of prescriptions complied with the guidelines with respect to dose, but all exceeded the recommended duration of therapy. 55 (77%) residents had comorbidities for which guidelines recommended avoiding BZDs, such as a history of falls.ConclusionAlthough the choice and dose of BZD were appropriate, prescribing did not adhere to guidelines because of the extended duration of therapy. Residents with comorbidities where BZDs should be avoided were frequently prescribed a BZD.
Establishing Clinical Pharmacy Services in the Operating Suite
Authors: Booth Jane C , Garrett M Kent , Taylor Simone E , Trajceska Ljubica 
Published: April 2015

ABSTRACTDespite having well‐established clinical roles in many specialties, hospital pharmacists have not traditionally provided clinical services in the operating suite (OS). This paper describes the introduction of a clinical pharmacy service in the OS of a large metropolitan public hospital network. The initial focus of the service was on non‐clinical issues that were priorities for pharmacy and OS staff, such as medication supply, waste minimisation, expenditure, interdepartmental communication and legal compliance. Once ongoing funding for the positions was secured, cognitive clinical pharmacy services have become the focus. Benefits of the service have been demonstrated in medication safety, antibiotic stewardship and quality use of medicines. The 2 pharmacists have now become essential members of the OS. Work is underway to further develop pharmacists' roles in areas such as perioperative antimicrobial prescribing and perioperative management of patient's regular medication regimens to optimise the continuum of care.
Stability of Two Long‐Acting Insulin Formulations after 28 Days
Authors: Silva Matthew A , Chuong Monica , Kerr Stephen , Cabrera Adriana 
Published: April 2015

ABSTRACTBackgroundInsulin when stored according to manufacturers' recommendations offer at least 28 days of use after opening. A realistic understanding of room temperature storage at home includes exposure to heat and light. Pharmacy refill data suggest that patients tend to use opened insulin beyond 28 days. Insulin quality could be effected after 28 days when stored under uncontrolled conditions.AimTo evaluate the stability of two long‐acting insulin formulations, Humulin 70/30 and Levemir, after 28 days.MethodA high‐performance liquid chromatography assay was used to quantify insulin area under the curve (AUC) profiles as an indicator of insulin quality. Human recombinant insulin (Humulin) 70/30 and insulin detemir (Levemir) vials were stored in refrigerated (2–8 °C, 36–46 °F) and room temperature (22–24 °C, 72–75 °F) conditions for up to 42 days, emulating patient managed storage and use patterns. Samples were taken on opening (time 0) and vials were randomised and stored in refrigerated or at room temperature conditions. Samples were taken and evaluated at Days 7, 14, 21, 28, 35 and 42.ResultsHumulin 70/30 and Levemir generated chromatograms with characteristic peaks at 12 and 21 minutes. Refrigerated Humulin 70/30 and Levemir AUCs were compared to time 0 and no differences were found. By Day 35, some Humulin 70/30 samples at room temperature had changes in AUC (p = 0.002) and loss of symmetry when compared to time 0 and all samples at Day 42 had changes in AUC (p < 0.0001). A similar pattern occurred with Levemir; some samples at room temperature had changes in AUC (p = 0.005) and loss of symmetry when compared to time 0 and all samples at Day 42 had changes in AUC (p < 0.0001).ConclusionRoom temperature storage may effect Humulin 70/30 and Levemir AUCs and chromatograms by Day 42. Patients should be advised to store insulin in the refrigerator when possible and reminded that insulin quality can be effected by room temperature storage and beyond date use.
Paediatric Pharmacy in Australia: Where Have We Come From and Where Do We Need To Go?
Authors: Stacey Sonya R , Turner Sean C , Coulthard Kingsley P , Miller Hugh 
Published: April 2015

ABSTRACTPaediatric pharmacy has evolved swiftly over the last 40 years, with pharmacists across Australia working to improve the health of children at an individual and population level. A number of professional groups have been formed to share information, educate staff and lobby for change. Paediatric pharmacists in Australia need access to specialist training as is available to their international peers and other paediatric disciplines. Research and advocacy need to continue for better access to medicines and appropriate information resources to improve medicines use in children.
Cardiovascular Risk Reduction in the Extreme Elderly
Authors: Parikh Seema , Sharkey Kerith , Workman Barbara 
Published: April 2015

ABSTRACTAn American Heart Association statement on secondary prevention of coronary heart disease in the elderly reported that 50% of women and 70% to 80%) of men over 75 years have obstructive coronary artery disease. The total direct and indirect costs of cardiovascular disease and stroke in the US for 2007 was around $286 billion and annual costs are projected to rise to over $1 trillion by 2030. Significant emphasis is now placed on prevention and risk factor modification of cardiovascular disease. The proportion of the population aged 85 years and older (the ‘extreme elderly‘) is projected to increase to 151% by 2030. This review focuses on reducing risk in coronary heart disease and congestive heart failure in the extreme elderly. We review modifiable cardiovascular risk factors (hypertension, lipid profile, lifestyle modification), pharmacological strategies (statins, beta‐blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, aspirin) and the available evidence for their use in extreme old age. There is insufficient evidence to reach major conclusions with respect to cardiovascular risk reduction in the extreme elderly. Further trials involving older patients are needed before evidence‐based recommendations can be formulated for this population.
Pneumonia Severity Scores and Prescribing Antibiotics for Community‐Acquired Pneumonia at an Australian Hospital
Authors: Brett Jonathan , Lam Vincent , Baysari Melissa T , Milder Tamara , Killen Louise , Chau Anthony MT , McMullan Brendan , Harkness John , Marriott Deborah , Day Richard O 
Published: April 2015

ABSTRACTAimTo evaluate the use of pneumonia severity scores for diagnosing community‐acquired pneumonia (CAP) and to assess whether antibiotic prescribing was compliant with guidelines as determined by the calculated pneumonia severity score.MethodA retrospective chart review was undertaken of consecutive adults admitted via the emergency department with a diagnosis of CAP during a 6‐month period. Charts were reviewed for symptoms and radiographic evidence of pneumonia and for recorded pneumonia severity scores. Pneumonia severity scores were calculated using CORB, CURB‐65 and SMART‐COP for patients with available data and used to assess compliance with the Therapeutic Guidelines: Antibiotic.ResultsOf the 204 patients reviewed Of the 204 patients reviewed CURB‐65 and SMART‐COP scores for the remaining 68 patients, 13 (19%), 3 (4.4%) and 1 (3.6%) patients had severe pneumonia. 93% of patients received ceftriaxone. An average of 8% of patients were prescribed antibiotics compliant with the Therapeutic Guidelines: Antibiotic. Compliance varied with the pneumonia severity scoring tool used.ConclusionPneumonia severity scores were rarely calculated to guide treatment and antibiotic prescribing for CAP. Compliance with the Therapeutic Guidelines: Antibiotic was poor and varied with the pneumonia severity scoring tool used. An easy‐to‐use pneumonia severity score to guide patient admission and choice of antibiotic is needed.
Development of a Postgraduate Educational Program for Pharmacist Prescribers in New Zealand
Authors: Shaw John P , Print S Adele , Duffull Stephen B 
Published: April 2015

ABSTRACTBackgroundPharmacist prescribing is now well established in several western countries. In New Zealand, an independent prescribing authority for suitably experienced clinical pharmacists has been approved, subject to successful delivery of a postgraduate educational program.AimTo describe the development of an educational program for pharmacist prescribers in New Zealand and to reflect on its suitability in producing safe and competent pharmacist prescribers.MethodThe educational program was based on similar courses in the UK and adapted to the competency requirements of the Pharmacy Council of New Zealand. The 2‐semester program comprises 2 courses: Principles of Prescribing and Prescribing Practicum. A key feature of the Practicum is the requirement for 150 hours of prescribing practice supervised by a designated medical practitioner.ResultsThe educational program was delivered for the first time in 2012 with 14 students enrolled. 10 students passed at the first attempt and 4 students passed after repeating elements of the Practicum. The program has been granted conditional accreditation by the Australian Pharmacy Council.ConclusionAn educational program for pharmacist prescribers in New Zealand has been successfully developed and delivered. Graduates are eligible to register in the Pharmacist Prescriber Scope of Practice.
Should Pharmacists in Australia have Access to a Structured General Level Training Program?
Authors: Shah Simon S , Avent Minyon L , Coombes Ian D 
Published: April 2015

ABSTRACTHospital pharmacists in Australia do not have access to a formal or structured post‐registration training program to enhance practitioner development in order to offer improved, consistent and equitable patient care. Enrolling in a postgraduate course through an educational facility is one of few options available to gain further experience of different clinical areas. This option may only allow theoretical learning to occur and new knowledge and skills acquired may not be utilised in a timely manner, thus resulting in their loss. There are established rotational training programs across developed countries' pharmacy services. Ideally, Australia will develop a similar program as a component of professional development. We describe a proposed rotational training program for pharmacists including rotation to rural sites as part of a foundation program. Barriers to the development and implementation of a rotational training program have been identified, e.g. accommodation and transport costs, lack of a suitable funding model, lack of suitably trained pharmacists to conduct training and provide supervision. We propose that there is a need for a standardised rotational training program, which is supported by appropriate mentoring and a documented record of learning outcomes.
Probable Case of Ibuprofen‐Induced Neutropenia
Authors: Murphy Catherine E 
Published: April 2015

ABSTRACTBackgroundApproximately 6% of admissions to Australian hospitals are due to adverse drug events. This incidence increases to around 30% of admissions for elderly Australians. Neutropenia associated with ibuprofen is documented as a haematological side effect with an incidence of less than 1%.Clinical detailsA 44‐year‐old man presented to his GP with fever, cough, lymphadenopathy, mouth ulcers, night sweats and lack of energy. His neutrophil count was 0.07times109/L. He had taken 6 to 8 ibuprofen 400 mg tablets in the previous 24 hours to alleviate his symptoms. He had also used ibuprofen on an ‘as required’ basis for body aches during the 2 weeks prior to presentation.OutcomesThe patient was given filgrastim 300 micrograms daily. Piperacillin+tazobactam and gentamicin were also commenced. Bone marrow biopsy showed active normocellular marrow with ‘maturation arrest‘, consistent with a drug‐induced reaction. The patient was discharged 48 hours after presentation with 2 further doses of filgrastim. The patient was advised to avoid nonsteroidal anti‐inflammatory drug use in the future.ConclusionWhile ibuprofen is thought by many to be a safe over‐the‐counter medicine, it is not without life‐threatening side effects. The possibility of ibuprofen‐induced neutropenia should be considered in all cases of unexpected isolated neutropenia in patients taking this drug, with prompt referral to specialist care in cases of severe neutropenia or sepsis.