bluuebunny/crossref_metadata_2025_split huggingface dataset:
A self medication scheme for elderly patients improves compliance with their medication regimens
Authors: Wood S I , Calvert R T , Acomb C , Kay E A 
Published: February 2011

Abstract
This study of elderly patients discharged from hospital looked at the effect of a self medication (SM) scheme on compliance with drug regimens. Patients from four medical wards for the elderly were recruited. Those from two wards participated in a SM scheme (18 subjects). Patients from the other wards (15) acted as controls. Two weeks after discharge, compliance was significantly better in the SM group. Only 6 per cent (one patient) made serious errors compared with 47 per cent of controls. After three months only 11 patients in each group remained in the study but compliance in SM patients was still better than in controls. The study highlighted the extremely poor ability of the elderly to manage their medicines at home. This was illustrated by problems cited by patients in the non-self medicating group.
Generic substitution by hospital pharmacists in Thailand
Authors: Charupatanapong N , Rascati K L 
Published: February 2011

Abstract
The generic substitution rate by hospital pharmacists in three university affiliated outpatient hospitals in Bangkok, Thailand, was examined and the cost savings from substitution were determined using a retrospective audit of prescription forms.
A total of 3,750 prescriptions was audited (1,250 from each hospital). Of the prescriptions studied, 51.2 per cent were written for generic products, 14.5 per cent were written for brand name products obtainable from a single source and 34.2 per cent were written for brand name products obtainable from multiple sources. For multiple source brand name prescriptions, pharmacists substituted generic products 15 per cent of the time. The mean price for the multiple source brand name product was US$5.2 and the mean price of the generic substitute was $2.5, an average saving of $2.7.
The substitution rate for regular (paying) patients was 9 per cent, while the substitution rate for government assistance (poor) patients was 40 per cent. Substitution rates for the three individual hospitals were 16 per cent, 21 per cent and 9 per cent.
The authors conclude that when substitution occurs savings are substantial, but that there is potential for additional substitutions to be made.
An evaluation of Enpharm, a computer assisted learning program for pharmacists
Authors: Mottram D R , Rowe P H , Stanley I M 
Published: February 2011

Abstract
Enpharm is a computer assisted learning program for pharmacists. It is based on case studies which occur in community practice. Pharmacists using the program respond to cases presented by free-text entry, then compare their input with that of a peer group of 76 community pharmacists.
There has been a high level of demand for the package. Many of the packages requested are used by pharmacists other than those making the original request. This paper presents an analysis of 100 evaluation questionnaires that were sent out with the package then returned to the authors. The analysis focused on the profile of users, when the program was used and pharmacists' perceptions of the value of Enpharm as a method of continuing education.
Pharmacists using the program were mainly in full-time community practice. Half used a work-based computer, the other half used a computer at home. Difficulties in loading the software were rare and were confined to incompatibilities with hardware or to corruption of software during transit. Patterns of use varied but the majority spent between 16 and 30 minutes, on average, per session. The case studies were perceived as being realistic to community practice and although, in general, no new ideas were evident, the cases provided a valuable refresher on the points raised.
Enpharm was judged overwhelmingly to be a form of continuing education which would be of benefit to other pharmacists.
Expert systems in pharmacy practice
Authors: Stork M W , Greene R J 
Published: February 2011

Abstract
This paper introduces expert systems and considers the advantages and disadvantages of their use in pharmacy. It describes how the future pharmacist is likely to be assisted by an expert system for diagnosis and patient management, and details a pharmacy system which accesses doctors' records and prescription databases, relieving the pharmacist of much clerical work and even some clinical activities. The provision of expert systems for public use and the potential for computer aided learning is also discussed. However, the legal aspects of expert system use remain to be clarified. Two prototype systems being developed at King's College, London, are described.
Identifying prediction factors for unplanned hospitalisation of an elderly population using classification and regression tree (CART) analysis
Authors: Passmore P R , Kailis S G , Marshall G A 
Published: February 2011

Abstract
Accurate prediction of those elderly people who are at a high risk of unplanned hospitalisation may assist pharmacists and other health care providers to target health care initiatives more specifically. A prospective study of 84 elderly persons, suffering from either ischaemic heart disease or obstructive airways disease, or both, was conducted to identify health-related factors that may be used to predict unplanned hospitalisation. Non-invasive factors, including the sickness impact profile (SIP) health status measure scores, drug consumption, demographic data, smoking history and disease/symptoms experience were determined. For hospitalised patients the overall SIP score was significantly higher (18.93) than for those non-hospitalised (10.54). The physical dimension score (20.76) and the psychosocial dimension score (16.74) were also both significantly higher in the hospitalised than the non-hospitalised group (10.85 and 9.44, respectively). The number of medicines used was higher (8.2) in the hospitalised group than in the non-hospitalised group (6.3). Logistic regression determined that the overall SIP score was highly predictive (P&lt;0.01) of unplanned hospitalisation. Classification and regression tree (CART) analysis was used to determine the mix of health-related factors that could best classify subjects as being at either a high or low risk for unplanned hospitalisation within the six month prospective study period. A selected CART-generated decision protocol determined that the health-related parameters that enabled a useful prediction for unplanned hospitalisation were overall SIP score, the person's age, whether the person lived alone and smoking history. Seventy-nine per cent of those hospitalised and 91 per cent of those non-hospitalised had been correctly predicted. The results of this study show that it is possible to predict unplanned hospitalisation of elderly people in a retirement village setting by using previously measured non-invasive health related parameters in a decision protocol to determine their category of risk.
Referral of clients by community pharmacists in primary care consultations
Authors: Smith Felicity J 
Published: February 2011

Abstract
In responding to symptoms presented by clients, community pharmacists have a number of options open to them, including giving advice to seek the assistance of another health professional (ie, a referral). The objective of this study was to investigate the referral patterns of community pharmacists in primary care consultations. The analysis was performed on 716 tape-recorded consultations between pharmacists and clients collected in a random sample of community pharmacies in London. Fifteen per cent of clients were referred to another practitioner, usually their general medical practitioner. Information on the cases that pharmacists referred is provided. There was a wide variation in referral rates depending on the nature of the presenting symptoms. Pharmacists' referral patterns tended to be determined by the characteristics of the symptoms presented. A situation in which some pharmacists routinely refer a high proportion of clients irrespective of the nature of the symptoms was not apparent. The symptoms referred by pharmacists may or may not be those which other primary health carers feel they should see. A co-ordinated, safe and appropriate role as a filter to other practitioners could contribute to improvements in the effectiveness and efficiency of primary care.
Junior doctors' satisfaction with the ward pharmacy service in the Hammersmith and Queen Charlotte's special health authority
Authors: Nicholls J , Batty R , Jacklin A 
Published: February 2011

Abstract
A questionnaire was drawn up to ascertain junior doctors' satisfaction with the ward pharmacy service in the Hammersmith and Queen Charlotte's special health authority, London. The questionnaire was designed for face to face interviews lasting not more than 10 minutes. The interviews were taped and the interviewer was not known to the doctors. The survey took place in January, 1992. Forty three out of 135 senior house officers, registrars and senior registrars employed by the special health authority were randomly selected for interview and 26 (60 per cent) of these were seen. Eighty five per cent of doctors thought the service was better than average and most doctors were satisfied with aspects of the service such as prescription monitoring, advice received from and friendliness of ward pharmacists. Only one doctor rated the service as worse than that in other hospitals in which he had worked. Fifteen doctors suggested increased liaison or contact between ward pharmacists and doctors would make the service better. A number of issues have been raised concerning the service which have been addressed and we intend to repeat the survey in the future.
Prescribing patterns and drug costs: Effects of formulary recommendations and community pharmacists' information campaigns
Authors: Ekedahl Anders , Petersson Bengt-Åke , Eklund Per , Rametsteiner Gerhard , Melander Arise 
Published: February 2011

Abstract
In the health care districts of Lund and Orup (Lund-Orup) in southern Sweden, prescription recommendations for both primary and secondary health care are made by one local formulary committee. A revised formulary was introduced in 1989, and information on the most important changes was distributed to all prescribing physicians in the area with the new formulary. In an information campaign aimed only at district physicians (general practitioners) in Lund-Orup, community pharmacists initiated and maintained verbal discussions on the changed recommendations, particularly those concerning low-price brands of erythromycin, doxycycline, naproxen and combined amiloride/hydrochlorothiazide. One year and two years later they supplied feedback on compliance with the recommendations. Other prescribers in Lund-Orup received written information on the formulary changes but no verbal information.
Prescription surveys during that time indicated that the district physicians had rapidly accepted the new guidelines; compared with the other physicians they showed greater increases in prescription volume of the recommended low-price brands and higher compliance rates with the recommendations. The overall cost reduction for the four preparations during 1989–91 was approximately SEK3m,* of which almost 25 per cent (SEK700,000) was attributable to the extra savings due to the higher compliance rates among district physicians. Not only do these figures exceed the costs of the information campaign; there was a return in reduced costs of several times the investment. It appears that a verbal information campaign providing district physicians with data on formulary recommendations and savings is a realistic means of reducing drug expenditure.
Attitudes of pharmacists, medical practitioners and nurses towards the development of domiciliary and other community pharmacy services
Authors: Begley S , Livingstone C , Williamson V , Hodges N 
Published: February 2011

Abstract
Surveys were undertaken to determine both the current extent of provision of non-dispensing services by community pharmacists, and pharmacists' attitudes, together with those of medical practitioners and district/practice nurses, towards the development of domiciliary and other community pharmacy services. Five out of a list of 10 professional services were available on the premises in the majority of pharmacies. Approximately 65 per cent of pharmacists undertook prescription collection and medicine delivery and 43 per cent provided domiciliary patient counselling at least once a week. Medical practitioners and nurses expressed high levels of support for the majority of the established services; the exceptions were blood pressure testing and cholesterol monitoring for both of which only 30 per cent of each group were in favour. Most pharmacists were willing, in principle, to train for and to provide a domiciliary service which would include counselling on the use and storage of medicines and the supply or fitting of appliances; support for these services was high among medical practitioners and nurses (85–88 per cent). The proportions of pharmacists who were willing, after training, to provide domiciliary management of total parenteral nutrition, pain control and chemotherapy were 68, 85 and 36 per cent, respectively, but medical practitioners and nurses generally were not in favour of these extended roles. The length of professional registration and frequency of contact with pharmacists were both factors which significantly influenced the level of support by medical practitioners but not by nurses.
Performance based assessment in pharmacy education
Authors: Collett J H , Rees J A , Mylrea S , Crowther I 
Published: February 2011

Abstract
An objective structured procedure using simulated patients has been developed for assessing the abilities of pharmacy students to interview and counsel patients presenting ailments considered to be representative of those encountered in community pharmacy. Structured marking schedules have been used in the assessment. The results of the assessment can be used to determine the strengths and weaknesses of the students in patient interviewing skills. Results from semi-structured interviews and anonymously completed evaluation questionnaires have shown the procedure to be acceptable to students and examiners.
Effect of patient education in post-operative patients using patient controlled analgesia
Authors: Berwick S J , Lannigan N A , Ratcliff A 
Published: February 2011

AbstractPatient controlled analgesia (PCA) is an effective method of postoperative pain control. Patients are required to operate the device in order to control their pain and it is therefore important that they receive an adequate explanation of its use.This study compared a group of patients who received intensive pre- and postoperative counselling on the use of PCA with a group who received the usual explanation from anaesthetists.No difference in pain control, as measured by nurse recorded pain scores, was detected but some evidence of a reduced incidence of side effects of therapy, particularly nausea and vomiting, was observed in the counselled group. Patients' overall satisfaction with post-operative pain relieving treatment was increased in the group who had been counselled.The study indicates that improved patient education leads to a more satisfied patient who is less likely to have unanswered concerns about the use of PCA and who might be less likely to experience side effects associated with this therapy.
Stability of injections containing diamorphine and midazolam in plastic syringes
Authors: Allwood M C , Brown P W , Lee M 
Published: February 2011

Abstract
The stability of mixtures containing diamorphine hydrochloride, 10 or 500mg, and midazolam, 10 or 75mg, in 15ml water for injections, stored in three piece plastic syringes, was investigated using a stability-indicating HPLC method. Results indicated that diamorphine showed greater degradation than midazolam, which was relatively stable over the study period of 14 days at ambient temperature. Rates of degradation of diamorphine were estimated by linear regression analysis. The estimated values for the time to reach 10 per cent degradation in solutions containing 10 mg and 500mg diamorphine were 15.9 and 22.2 days, respectively. There was no evidence of physical incompatibility in any of these mixtures. It is recommended from these data that mixtures containing diamorphine hydrochloride and midazolam within the concentration ranges tested, and diluted in water for injections, may be assigned shelf lives of 14 days when stored at ambient temperature.
In their own words: Community pharmacists and their health education role
Authors: Benson M A , Cribb A 
Published: February 2011

Abstract
During the past decade, there has been much discussion about the role of the community pharmacist in health education. This paper is based upon interviews with a small sample of practising community pharmacists. It reports on their perceptions of the nature of their health education role, the practicalities of implementing this role and the obstacles that need to be overcome.
The pharmacists were clear about their health education role as it related to advice on prescribed medicines. However, they were uncertain about other aspects of the health education role. These uncertainties are related to their education in a biomedical and functionalist paradigm together with ethical concerns about interference in the lifestyles of patients. Both these aspects influence the manner in which pharmacists communicate.
The paper discusses the need for further advances towards patient orientated pharmacy, which is the essential direction for a health education role.
Drugs prescribed for people aged 85 and over living in their own homes in an area of inner London
Authors: Smith Felicity J , Farquhar Morag , Bowling Ann P 
Published: February 2011

Abstract
This study investigated drugs prescribed for people aged 85 and over and living in their own homes in an area of inner London, and explored associations between drug use and other factors including use of general medical practitioner (GP) services, mobility, mortality and self-perceived health. Data were collected by structured interview of 630 participants in their own homes, with a follow-up interview of survivors three years later.
Respondents were taking a mean of 2.2 different drugs; 23 per cent were taking no prescribed drugs and 11 per cent were taking five or more. Of those on two or more drugs, 45 per cent were taking potentially interacting combinations. Although respondents on more drugs were more likely to have seen their GP recently, some on many different drugs had not. Nearly 15 per cent reported some sort of difficulty with their medication.
There was no significant difference between the mean number of drugs prescribed, at the begining of the study, for survivors and for non-survivors. However, there was an inverse relationship between prescribed medication and mobility, self-perceived health and satisfaction with other aspects of life. Very elderly people living in their own homes, like those in institutions, will frequently be on drug regimens that should be monitored regularly for drug-related problems. Because of rising numbers, the provision of a cost-effective service would require the identification of those most likely to experience problems with their medication.
Effect of caffeine-free beverages on elderly hospitalised patients
Authors: Stephens C M , Hankey C , Wynne H A 
Published: February 2011

Abstract
The objectives of the study were to determine whether, by providing caffeine-free tea and coffee, plasma caffeine concentrations would fall in elderly hospitalised patients, and whether, as a result, sleep profiles and urinary incontinence would be altered.
Twenty-eight patients in two wards of an elderly care hospital received caffeine-containing or caffeine-free tea and coffee for consecutive three week periods in a study which was blinded to patients, nurses and investigator. Median caffeine concentration (μg/ml) was stable between the run in period at 2.3 (range 0–5.8) and the caffeine-containing period at 1.6 (range 0.4–6.0), but fell significantly to 0 (range 0–0.7), during the caffeine-free period (P&lt;0.001). In spite of significantly lowered caffeine concentrations, no change in sleep patterns or urinary incontinence was noted. Of 12 patients with sleep problems a benefit to sleep quality was reported by two individuals, one of whom was prescribed hypnotics from which she subsequently successfully withdrew.
Gentamicin dosing in neonates: evaluation of a dosing protocol
Authors: Lacey Ruth , Aldous Diane , Peterson Gregory , Cooper Gabrielle 
Published: February 2011

Abstract
A study was carried out to examine the dosing of gentamicin and to investigate some of the determinants of serum gentamicin concentrations in neonates at the Royal Hobart hospital, Tasmania, Australia, and to examine the appropriateness of the current dosing protocol (that of the Royal Children's hospital, Melbourne). Clinical and demographic data were retrospectively collected from the records of 39 neonates who had received therapy with gentamicin for suspected or proven septicaemia during the period May to September, 1993. Peak and trough serum concentrations of gentamicin were measured, at least 36 hours after starting therapy. The mean gestational age (± SD) of the sample was 32.3 ± 4.9 weeks, and 30 patients were male. The mean dosage of gentamicin was 4.0 ± 1.3mg/kg/day and the median duration of therapy was 4 days (range 2 to 22 days). Trough serum concentrations of gentamicin ranged from 0.6 to 6.0mg/L (mean 1.9 ± 1.0mg/L), with 35.9 per cent being 2.0mg/L or higher. Peak serum concentrations ranged from 4.3 to 12.9 mg/L (mean 6.1 ± 1.5 mg/L), with 89.7 per cent being between 5.0 and 8.0mg/L. The peak and trough serum concentrations were significantly related, while the total daily dosage of gentamicin and the resulting peak and trough serum concentrations were not significantly related. The trough serum concentration of gentamicin was significantly related to the serum creatinine concentration. Patients who had been dosed correctly according to the protocol were less likely to have a potentially toxic trough serum concentration of gentamicin. Those administered gentamicin every 12 hours tended to have higher serum trough concentrations of the drug than those who received it either 18- or 24-hourly.
This study has confirmed that excessive serum concentrations of gentamicin occur frequently in neonates, a situation which may be improved by greater usage of an 18-hourly dosing regimen and prompt adjustment of dosage according to renal function.