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Canning ML, Barras M, McDougall R, Yerkovich S, Coombes I, Sullivan C, Whitfield K. Defining quality indicators, pharmaceutical care bundles and outcomes of clinical pharmacy service delivery using a Delphi consensus approach. Int J Clin Pharm 2024; 46:451-462. [PMID: 38240963 DOI: 10.1007/s11096-023-01681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/28/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND Clinical pharmacy quality indicators are often non-uniform and measure individual activities not linked to outcomes. AIM To define a consensus agreed pharmaceutical care bundle and patient outcome measures across an entire state health service. METHOD A four-round modified-Delphi approach with state Directors of Pharmacy was performed (n = 25). They were asked to rate on a 5-point Likert scale the relevance and measurability of 32 inpatient clinical pharmacy quality indicators and outcome measures. They also ranked clinical pharmacy activities in order from perceived most to least beneficial. Based upon these results, pharmaceutical care bundles consisting of multiple clinical pharmacy activities were formed, and relevance and measurability assessed. RESULTS Response rate ranged from 40 to 60%. Twenty-six individual clinical pharmacy quality indicators reached consensus. The top ranked clinical pharmacy quality indicator was 'proportion of patients where a pharmacist documents an accurate list of medicines during admission'. There were nine pharmaceutical care bundles formed consisting between 3 and 7 activities. Only one pharmaceutical care bundle reached consensus: medication history, adverse drug reaction/allergy documentation, admission and discharge medication reconciliation, medication review, provision of medicines education and provision of a medication list on discharge. Sixteen outcome measures reached consensus. The top ranked were hospital acquired complications, readmission due to medication misadventure and unplanned readmission within 10 days. CONCLUSION Consensus has been reached on one pharmaceutical care bundle and sixteen outcomes to monitor clinical pharmacy service delivery. The next step is to measure the extent of pharmaceutical care bundle delivery and the link to patient outcomes.
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Affiliation(s)
- Martin Luke Canning
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, QLD, 4032, Australia.
| | - Michael Barras
- Princess Alexandra Hospital, Woolloongabba, Australia
- The University of Queensland, Woolloongabba, Australia
| | - Ross McDougall
- Pharmacy Department, The Prince Charles Hospital, Rode Rd, Chermside, QLD, 4032, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research, Casuarina, Australia
- Queensland University of Technology, Brisbane, Australia
| | - Ian Coombes
- The University of Queensland, Woolloongabba, Australia
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Clair Sullivan
- The University of Queensland, Woolloongabba, Australia
- Digital Metro North, Herston, Australia
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Nakagaki M, Kennedy GA, Gavin NC, Butler J, Clavarino A, Whitfield K. A randomised trial of topical polaprezinc to prevent oral mucositis in patients undergoing haematopoietic stem cell transplantation (ToPaZ study). Support Care Cancer 2023; 32:44. [PMID: 38112867 DOI: 10.1007/s00520-023-08235-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Oral mucositis (OM) is a common complication in haematopoietic stem cell transplantation (HSCT). Polaprezinc, an anti-ulcer drug, has been shown to be effective to prevent OM in several studies when administered topically and systemically. This study aimed to evaluate the effectiveness of topical polaprezinc in patients undergoing HSCT. METHODS This was an open-label randomised clinical trial comparing polaprezinc and sodium bicarbonate mouthwashes for the prevention of severe OM in HSCT patients. Adult patients who received conditioning regimens at moderate to high risk of developing OM were included. The primary endpoint was the incidence of severe (WHO grades 3-4) OM. The secondary endpoints included duration of grades 3-4 OM, incidence and duration of grades 2-4 OM, patient-reported pain and functional limitations. RESULTS In total, 108 patients (55 test arm and 53 control arm) were randomised. There was no difference in the incidence of grades 3 to 4 OM (35% test arm versus 36% control arm). The secondary endpoints were not significantly different. In both arms, patients reported more throat pain compared to mouth pain. CONCLUSIONS Topical polaprezinc had no effect in the prevention of OM in HSCT patients. Further research is required to evaluate the effects of systemic polaprezinc. The OM assessment tool needs to be reviewed as throat mucositis was a main issue in this study. TRIAL REGISTRATION ACTRN12320001188921 (Date Registered: 10th November 2020).
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Affiliation(s)
- Midori Nakagaki
- Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- School of Pharmacy, The University of Queensland, Brisbane, Australia.
| | - Glen A Kennedy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Nicole C Gavin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Jason Butler
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Karen Whitfield
- School of Pharmacy, The University of Queensland, Brisbane, Australia
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Halimi SN, Mirzaei A, Rowett D, Whitfield K, Luetsch K. Resilience and empathy in pharmacy interns: Insights from a three-year cohort study. Explor Res Clin Soc Pharm 2023; 12:100333. [PMID: 37823011 PMCID: PMC10562191 DOI: 10.1016/j.rcsop.2023.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
Background Resilience and empathy are important attributes for healthcare professionals to navigate challenging work environments and providing patient-centred care. Knowledge about pharmacists' levels of resilience and empathy, particularly during the early stages of their careers, is limited. Objectives To explore pharmacy interns' levels of resilience and empathy using the Connor-Davidson-Resilience-Scale-25 (CD-RISC-25) and the Kiersma-Chen-Empathy-Scale (KCES), examine potential associations with demographic characteristics and ascertain what challenges interns' resilience and which support mechanisms they identify. Methods Hard copies of the surveys were distributed to three cohorts during face-to-face intern pharmacy workshops from 2020 to 2022. Additionally, a qualitative questionnaire explored interns' experiences while completing an accredited internship program during the COVID-19 pandemic. Data were analysed using descriptive and inferential statistics, open-ended questions were analysed through qualitative and quantitative content analysis. Results Among 134 completed surveys, most respondents were female, aged 18-22, and worked in hospitals. The CD-RISC-25 mean score was 66.6 (SD 11.7) and the KCES mean was 84.3 (SD 9.23) indicative of intermediate levels of resilience and empathy. Resilience and empathy scores did not significantly differ between the three cohorts (p-value > 0.05), and both were not consistently correlated with each other (p-value > 0.05). No significant associations were found between demographic characteristics and resilience scores. However, age and pre-internship employment history showed a statistically significant association with empathy scores (p-value < 0.05), with younger age groups and those who worked part-time during undergraduate studies demonstrating higher levels of empathy. Challenges undermining interns' resilience included the COVID-19 pandemic, internship requirements, and feelings of inadequacy and inexperience. Conclusions This study showed that resilience and empathy scores among interns were at what can be regarded as intermediate levels, largely unaffected by the COVID-19 pandemic or cohort demographics. It highlights professional aspects and strategies which are professionally sustaining and may assist interns in navigating challenges to their resilience and empathy.
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Affiliation(s)
- Syafiqah Nadiah Halimi
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland 4102, Australia
- Kulliyyah of Pharmacy, International Islamic University Malaysia, 25710 Kuantan, Pahang Darul Makmur, Malaysia
| | - Ardalan Mirzaei
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, New South Wales 2006, Australia
| | - Debra Rowett
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia 5000, Australia
| | - Karen Whitfield
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland 4102, Australia
| | - Karen Luetsch
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland 4102, Australia
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Halimi SN, Rowett D, Whitfield K, Luetsch K. How early career pharmacists understand resilience - A qualitative study of experiences, challenges and strategies. Res Social Adm Pharm 2023; 19:486-494. [PMID: 36344335 DOI: 10.1016/j.sapharm.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Resilience assists healthcare professionals in negotiating challenges, remaining positive when experiencing adversity, and in constructively dealing with difficult work situations and environments. There is increasing research about how early career healthcare professionals, understand and maintain resilience but little is known about support early career pharmacists may need and value. AIMS To explore early career pharmacists' understanding of resilience, their strategies to enhance and maintain resilience as healthcare professionals and to identify resilience-fostering programmes they perceive could be implemented to support them. METHODS Three focus groups and 12 semi-structured interviews with a total of 15 hospital pharmacists and 10 community pharmacists (both less than 3 years post-registration) were conducted. An inductive thematic analysis of transcripts was performed to identify main themes and subthemes. RESULTS Pharmacists understood resilience as the capability to adapt to and learn from challenges and setbacks, which they can build through experience and exposure. Resilience in the workplace was challenged by their working environment and workload, which could lead to ego depletion, the transition from intern to registered pharmacist and working during the COVID-19 pandemic, which both added pressure and uncertainty to their role. Professional resilience was supported on individual, social and organisational levels and through self-care strategies. Pharmacists perceived mentorship and sharing experiences, experiential placements and constructive but challenging role play as potentially beneficial in building resilience during undergraduate studies and internship. DISCUSSION Pharmacists defined resilience constructively and identified challenges testing but also strategies supporting their resilience in the workplace. Workplaces can support pharmacists by monitoring workload and workplace relationships, creating opportunities for peer and mentor support and by allowing pharmacists to implement their personal, individualised resilience maintaining strategies. Early career pharmacists' experiences and insights would be valuable when considering the design and implementation of resilience-fostering programmes.
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Affiliation(s)
- Syafiqah Nadiah Halimi
- Kulliyyah of Pharmacy, International Islamic University Malaysia, 25710, Kuantan, Pahang Darul Makmur, Malaysia; School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland, 4102, Australia.
| | - Debra Rowett
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia.
| | - Karen Whitfield
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland, 4102, Australia.
| | - Karen Luetsch
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland, 4102, Australia.
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Hong L, Davies M, Whitfield K. Noradrenaline use for neonatal circulatory support. J Paediatr Child Health 2022; 58:2084-2090. [PMID: 36148864 DOI: 10.1111/jpc.16226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/25/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022]
Abstract
AIM Noradrenaline (NA) has been used in preterm and term infants for circulatory support due to conditions including sepsis and pulmonary hypertension of the newborn. Treatment in neonates varies widely between institutions and respective neonatologists. The aim of this study is to determine the indications, use and effects of NA in preterm and term infants requiring circulatory support at the Royal Brisbane and Women's Hospital neonatal intensive care unit. We also aim to determine whether there were any differences between neonates who survived versus those who died after NA treatment. METHODS Data were collected from Royal Brisbane and Women's Hospital neonatal unit database including preterm and term infants between 1 January 2016 and 31 May 2021. Analysis included indication for use, blood pressure response, perfusion parameters, haemodynamic indicators and adverse effects. RESULTS NA treatment was documented in 37 patients requiring treatment of cardiovascular compromise. In 11 (30%) of these infants the indication for use was due to sepsis, 19 (51%) infants had pulmonary hypertension of the newborn, and 7 (19%) infants were diagnosed with hypotension prior to NA administration. Infants who subsequently died (49%) represented a younger gestational age population and exhibited worse cardiac compromise prior to NA administration. Tachycardia occurred in 15 (31%) infants and 1 (2.7%) infant developed transient hypertension. Overall improvement in poor tissue perfusion was seen after NA use. CONCLUSION NA use in treating neonates requiring circulatory support appears to be effective. Further prospective trials into NA use as a first- or second-line inotropic agent would be valuable.
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Affiliation(s)
- Lisa Hong
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Mark Davies
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, Royal Brisbane Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Karen Whitfield
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
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Nakagaki M, Kennedy GA, Gavin NC, Clavarino A, Whitfield K. The incidence of severe oral mucositis in patients undergoing different conditioning regimens in haematopoietic stem cell transplantation. Support Care Cancer 2022; 30:9141-9149. [PMID: 36008731 PMCID: PMC9410738 DOI: 10.1007/s00520-022-07328-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/09/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Oral mucositis is a common complication during haematopoietic stem cell transplantation (HSCT). This study aimed to assess the incidence of severe mucositis in patients undergoing different HSCT regimens. METHODS This single-centre retrospective study reviewed daily oral assessment for 467 consecutive patients who underwent different transplant regimens for matched unrelated or related allogeneic HSCT with post-transplant methotrexate, haploidentical or mismatched HSCT with post-transplant cyclophosphamide (PTCy), or autologous HSCT. Oral care and cryotherapy with melphalan were used. Patient demographic data, oral mucositis WHO grade, use of total parenteral nutrition (TPN) and patient-controlled analgesia (PCA) were collected. RESULTS Grade 3-4 oral mucositis was common in myeloablative total body irradiation (TBI)-based regimens cyclophosphamide/ TBI (CyTBI) (71%) and fludarabine/ TBI (FluTBI) with PTCy (46%), as well as reduced-intensity fludarabine/melphalan (FluMel) (43%) and carmustine/etoposide/cytarabine/melphalan (BEAM) autologous HSCT (41%). In contrast, grade 3-4 oral mucositis was less common in reduced-intensity haploidentical regimen melphalan/fludarabine/TBI with PTCy (19%), all non-myeloablative regimens (0-9%) and high-dose melphalan autologous HSCT (26%). TPN and PCA use were correlated to oral mucositis severity. CONCLUSIONS Severe oral mucositis was associated with myeloablative TBI, methotrexate and melphalan in combination with methotrexate and in BEAM. Use of PTCy was preferable over methotrexate to prevent oral mucositis.
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Affiliation(s)
- Midori Nakagaki
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia ,School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Glen A. Kennedy
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia ,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Nicole C. Gavin
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia ,School of Medicine, The University of Queensland, Brisbane, Australia ,School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia ,School of Nursing, Queensland University of Technology, Brisbane, Australia
| | | | - Karen Whitfield
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia ,School of Pharmacy, The University of Queensland, Brisbane, Australia
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Whitfield K, Coombes I, Denaro C, Donovan P. Medication Utilisation Program, Quality Improvement and Research Pharmacist-Implementation Strategies and Preliminary Findings. Pharmacy (Basel) 2021; 9:pharmacy9040182. [PMID: 34842809 PMCID: PMC8628968 DOI: 10.3390/pharmacy9040182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022] Open
Abstract
Judicious use of medicines that considers evidence-based practice, together with cost-effectiveness, is a priority for all health care organisations. We describe an initiative to lead a Medication Utilisation Program, incorporating medication quality improvement and research activities. In August 2020 an advanced pharmacist position was implemented to lead the Program. The purpose was to provide oversight and facilitate initiatives promoting medication optimisation to create sustainable change in practice. A strategic plan was developed with key performance indicators. A governance structure was implemented with relevant reporting mechanisms. Strategic planning and collaboration with medical, nursing and allied health professionals has seen the successful implementation of seven codesigned medication-use evaluations and eight quality improvement projects centred around patient safety, quality and value-based care. Several research studies have been designed with subsequent commencement of pharmacists enrolled in university Research Higher Degree programs. Cost containment initiatives have realised potential savings approximating AUD 250,000. Educational programs included protocol design, ethics approvals and report writing. Key success criteria for a Medication Utilisation Program include dedicated pharmacist resources, structured governance and reporting mechanisms. Alignment of study complexity with staff experience and interdisciplinary collaboration are also critical.
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Affiliation(s)
- Karen Whitfield
- Department of Clinical Pharmacology, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia;
- School of Pharmacy, University of Queensland, 20 Cornwall Street, Brisbane, QLD 4102, Australia;
- Correspondence:
| | - Ian Coombes
- School of Pharmacy, University of Queensland, 20 Cornwall Street, Brisbane, QLD 4102, Australia;
- Department of Pharmacy, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia
| | - Charles Denaro
- Department of Internal Medicine & Aged Care, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia;
- Faculty of Medicine, University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
| | - Peter Donovan
- Department of Clinical Pharmacology, Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Brisbane, QLD 4029, Australia;
- Faculty of Medicine, University of Queensland, 288 Herston Road, Herston, QLD 4006, Australia
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Firman P, Whitfield K, Tan KS, Clavarino A, Hay K. The impact of an electronic hospital system on therapeutic drug monitoring. J Clin Pharm Ther 2021; 46:1613-1621. [PMID: 34328229 DOI: 10.1111/jcpt.13497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Australian hospitals have undergone a transformation with both a review and expansion of traditional roles of healthcare professionals and the implementation of an ieMR. The implementation of an ieMR brings large scale organizational change within the health system especially for staff with direct patient contact. This is changing the future of healthcare and the roles of healthcare professionals. There is minimal research on the impact of these electronic systems on the people and processes required to realise the improvements in patient care such as therapeutic drug monitoring (TDM) and the role of the pharmacist within the TDM process. The literature has discussed the use of computerised programs to assist with the interpretation of results and calculating of doses but the impact of an ieMR on the TDM process has not been discussed. This study undertook a retrospective analysis at an Australian tertiary hospital to investigate the impact of a digital hospital system on TDM within the facility. METHODS A 2-year retrospective audit was conducted on TDM at an Australian Tertiary Hospital. The periods were 2016 (a paper-based hospital) and 2018 (ieMR). Patients were identified using the pathology database. Patients were excluded if under the age of 18, in an outpatient setting or the emergency department. Progress notes, medication charts, ieMR and other relevant pathology were reviewed. They were assessed for appropriateness of the timing of collection, compliance to recommended TDM guidelines, and pharmacist documentation. RESULTS AND DISCUSSION A total of 2926 observations were included in the analysis. There was as similar percentage of appropriately collected samples between the paper-based system (2016) and the digital hospital system (2018) with 59% and 58% respectively. Results of logistic regression analysis models show the effect of year was not significant with regards to TDM for either a sample being appropriate or the dose adjustment being appropriate. Samples for TDM were more likely to be appropriate if the pharmacist had documented advice but less likely with regards to appropriate dose adjustment. This study considered the effect of introducing a hospital wide digital system on TDM processes. Overall, the results indicate no difference between the paper-based system and ieMR for appropriate samples and doses adjustments. WHAT IS NEW AND CONCLUSION To our knowledge, this is the first study of this kind looking at the impact of a digital hospital system on TDM. The introduction of a digital hospital system does not appear to have made improvement on the effective use of TDM. Inappropriate sampling as seen in this study can lead to ineffective clinical management of patients, inefficient use of time, and waste of financial resources. Further work is required to incorporate specific guidance and recommendations within the digital system to optimize TDM.
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Affiliation(s)
- Paul Firman
- The University of Queensland, Saint Lucia, Qld, Australia
| | | | - Ken-Soon Tan
- The University of Queensland Faculty of Medicine, Herston, Qld, Australia.,School of Medicine, Griffith University, Gold Coast, Qld, Australia
| | | | - Karen Hay
- QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
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Thai AA, Stuart E, Te Marvelde L, Milne RL, Knight S, Whitfield K, Mitchell P. Reply to the letter-to-the editor "Hospital volume and the case for centralisation of surgical services". Lung Cancer 2020; 142:140-141. [PMID: 32115257 DOI: 10.1016/j.lungcan.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/13/2020] [Indexed: 10/25/2022]
Affiliation(s)
- A A Thai
- Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
| | - E Stuart
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia; Cancer Strategy & Development, Department of Health and Human Services, 50 Lonsdale St, Melbourne, Victoria, 3000, Australia
| | - L Te Marvelde
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia; Cancer Strategy & Development, Department of Health and Human Services, 50 Lonsdale St, Melbourne, Victoria, 3000, Australia
| | - R L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - S Knight
- Department of Surgery, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
| | - K Whitfield
- Cancer Strategy & Development, Department of Health and Human Services, 50 Lonsdale St, Melbourne, Victoria, 3000, Australia
| | - P Mitchell
- Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
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Thai A, Stuart E, te Marvelde L, Milne R, Knight S, Whitfield K, Mitchell P. Hospital lung surgery volume and patient outcomes. Lung Cancer 2019; 129:22-27. [DOI: 10.1016/j.lungcan.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/03/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
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Barker C, Brown T, Hauser M, Thorpe R, Whitfield K. COPING AS A PREDICTOR OF HEALTH AMONG AFRICAN AMERICAN SIBLINGS; PRELIMINARY RESULTS FROM (SOLSAA). Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Barker
- Center for Biobehavioral Health Disparities Research
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Tan S, Gamaldo A, Sardina A, Andel R, Allaire J, Whitfield K. SELF-RATED HEALTH AMONG OLDER BLACKS AND PERFORMANCE ON PSYCHOMETRIC TESTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Tan
- Pennsylvania State University
| | | | - A Sardina
- University of North Carolina Wilmington
| | - R Andel
- University of South Florida, School of Aging Studies
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Affiliation(s)
- D Byrd
- WSU Institute of Gerontology
| | - R Thorpe
- Johns Hopkins Bloomberg School of Public Health
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Bergin R, Emery J, Bollard R, Falborg A, Jensen H, Weller D, Menon U, Vedsted P, Thomas R, Whitfield K, White V. Rural-Urban Variation in Time to Diagnosis and Treatment of Colorectal or Breast Cancer in Victoria, Australia. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.10700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Rural-urban disparities in cancer outcomes are found in many countries, though these vary by cancer type. In Victoria, Australia, survival is poorer for rural patients with colorectal cancer, but not breast cancer. Delayed diagnosis and treatment may contribute to disparities, but previous studies have not compared the timeliness of rural and urban pathways to treatment of these common cancers. Aim: We investigated whether time to diagnosis and treatment differed for rural and urban patients with colorectal or breast cancer in Victoria, Australia. Methods: Population-based, cross-sectional surveys examining events and dates on the pathway to treatment completed by patients aged ≥ 40 and approached within six months of diagnosis, their general practitioner (GP) and specialist. Data were collected from 2013 to 2014 as part of the International Cancer Benchmarking Partnership, Module 4. Six intervals were explored: patient (symptom to presentation), primary care (presentation to referral), diagnostic (presentation/screening to diagnosis), treatment (diagnosis to treatment), health system (presentation to treatment) and total intervals (symptom/screening to treatment). Rural-urban differences were examined for each cancer using quantile regression (50th, 75th and 90th percentiles) models including age, gender, health insurance and socioeconomic status. Results: 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 GPs and 370 specialists completed surveys. Compared with urban patients, symptomatic colorectal cancer patients from rural areas had a significantly longer total interval at all percentiles: 50th (18 days longer, 95% confidence interval (CI): 9-27), 75th (53, 95% CI: 47-59) 90th (44, 95% CI: 40-48). These patients also had longer health system intervals, ranging 7-85 days longer. This appeared mostly due to longer diagnostic intervals (range: 6-54 days longer). Results were similar when including screen-detected cases. In contrast, breast cancer intervals were similar for rural and urban patients, except the patient interval, which was shorter for rural patients. Conclusion: Consistent with variation in survival, we found longer total and diagnostic intervals for rural compared with urban patients with colorectal cancer, but not breast cancer. The lack of rural-urban differences observed for breast cancer suggest that inequities in the timeliness of colorectal cancer pathways can be ameliorated, and may improve clinical outcomes. Indeed, based on previous research, delays observed in this study could result in stage progression and hence reduced survival. From our results, interventions targeting the time from presentation to colorectal cancer diagnosis in rural populations should be pursued. Countries seeking to understand cancer disparities in their local context may also consider using a pathways approach to identify possible targets for policy intervention.
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Affiliation(s)
- R. Bergin
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - J. Emery
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - R. Bollard
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - A. Falborg
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - H. Jensen
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - D. Weller
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - U. Menon
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - P. Vedsted
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - R. Thomas
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - K. Whitfield
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
| | - V. White
- Cancer Council Victoria, Centre for Behavioural Research, Melbourne, Australia
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15
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Chynoweth J, Daveson B, McCambridge M, Coutts J, Zorbas H, Whitfield K. A National Priority: Improving Outcomes for Aboriginal and Torres Strait Islander People With Cancer Through an Optimal Care Pathway. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.97700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: Cancer survival rates in Australia are among the best in the world, yet Aboriginal and Torres Strait Islander (indigenous) people continue to experience disparities in the distribution and burden of cancer, and unwarranted variations in outcomes. Indigenous Australians are 40% more likely to die of cancer than non-Indigenous Australians. Cancer Australia developed the National Aboriginal and Torres Strait Islander Cancer Framework (the framework), which identified 7 national priorities to address disparities in cancer outcomes experienced by indigenous Australians. An ongoing collaboration with indigenous Australians was integral to developing this shared agenda. Priority 5 in the framework highlights the need to ensure indigenous Australians affected by cancer receive optimal and culturally appropriate treatment, services, and supportive and palliative care. Aim: To improve cancer outcomes for indigenous Australians through the development and national endorsement of a population-specific Optimal Care Pathway (OCP) to guide the delivery of consistent, safe, high-quality, culturally appropriate and evidence-based care. Strategy/Tactics: Cancer Australia formed a partnership with the Victorian Department of Health and Human Services (DHHS) to address Priority 5 and develop the OCP. The approach to development was underpinned by Cancer Australia's Model of Engagement for Aboriginal and Torres Strait Islander People and guided by the national Leadership Group on Aboriginal and Torres Strait Islander Cancer Control (Leadership Group). Program/Policy process: Cancer Australia, in collaboration with DHHS: • reviewed experiences of care and the framework's comprehensive evidence base • developed a draft OCP to complement tumor-specific pathways • facilitated an Expert Working Group, comprising indigenous health sector leaders and consumers to refine and validate the draft OCP • undertook national public consultation, including with the indigenous health sector and community, health professionals and professional colleges • received an indication of support to proceed to endorsement from the Leadership Group. Outcomes: The first population-specific OCP for Aboriginal and Torres Strait Islander people with cancer received national endorsement. It will guide the delivery of consistent, safe, high-quality, culturally appropriate and evidence-based care. What was learned: Key elements of optimal care include: addressing the cultural appropriateness of the healthcare environment; improving cross-cultural communication; relationship building with local community; optimizing health literacy; recognition of men's and women's business; and the need to use culturally appropriate resources. The national priority in the framework informed and unified high-level direction, which was integral to effective OCP development and endorsement. The evidence-based, step-wise development approach contributed to its relevance, utility and quality.
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Affiliation(s)
| | | | | | | | | | - K. Whitfield
- Department of Health and Human Services Victoria, Melbourne, Australia
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16
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Affiliation(s)
- Miranda Niethe
- School of Pharmacy; The University of Queensland; Woolloongabba Australia
| | - Karen Whitfield
- School of Pharmacy; The University of Queensland; Woolloongabba Australia
- Royal Brisbane and Women's Hospital; Brisbane Australia
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17
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18
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Thomas C, Whitfield K, Thorpe R. PSYCHOPHYSIOLOGICAL WELL-BEING AMONG AGING AFRICAN AMERICANS: A LATENT CLASS ANALYSIS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C.S. Thomas
- University of California, Los Angeles, Los Angeles, California,
| | | | - R.J. Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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19
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Alderson S, Dacombe P, Dias M, Duncan T, Foley T, Gauher S, Hill-Cawthorne G, Wong WK, Mehta S, Mukhtar S, Patel K, Panchal S, Rodrigues I, Ryland H, Taylor F, Wang SJ, Whitfield K, Wittenberg M, Wynn-Jones W. The junior doctor dispute was about more than just the contract. Assoc Med J 2016. [DOI: 10.1136/bmj.i5437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Gomes FP, Shaw PN, Whitfield K, Koorts P, McConachy H, Hewavitharana AK. Effect of pasteurisation on the concentrations of vitamin D compounds in donor breastmilk. Int J Food Sci Nutr 2016; 67:16-9. [PMID: 26796072 DOI: 10.3109/09637486.2015.1126566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Premature infants are the main recipients of pasteurised donor human milk (PDHM), when their mothers are unable to provide their own. In this study, we evaluated the effect of pasteurisation on the concentrations of vitamin D compounds in donor breastmilk. Milk samples were obtained pre- and post-Holder pasteurisation. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to analyse the samples for vitamins D2 and D3 (D2 and D3) and 25-hydroxyvitamins D2 and D3 (25(OH)D2 and 25(OH)D3). The significance of differences in vitamin D concentrations between the two groups of milk samples was assessed using the Wilcoxon matched-pairs signed rank test, in which p < 0.05 was considered significant. Pasteurisation resulted in a significant reduction (p < 0.05) in the content of D2, D3, 25(OH)D2 and 25(OH)D3. The losses ranged from 10% to 20% following pasteurisation.
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Affiliation(s)
- Fabio P Gomes
- a School of Pharmacy , the University of Queensland , Brisbane , Queensland , Australia
| | - P Nicholas Shaw
- a School of Pharmacy , the University of Queensland , Brisbane , Queensland , Australia
| | - Karen Whitfield
- a School of Pharmacy , the University of Queensland , Brisbane , Queensland , Australia ;,b Royal Brisbane and Women's Hospital , Metro North Health Services District , Herston , Queensland , Australia
| | - Pieter Koorts
- b Royal Brisbane and Women's Hospital , Metro North Health Services District , Herston , Queensland , Australia ;,c Department of Paediatrics & Child Health , the University of Queensland , Brisbane , Queensland , Australia
| | - Helen McConachy
- b Royal Brisbane and Women's Hospital , Metro North Health Services District , Herston , Queensland , Australia
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21
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Abstract
AIM To eliminate the prescribing of codeine and codeine combination products postpartum to improve safety in breast fed infants.Concerns have been raised over the use of codeine and codeine combination products during breast feeding after the death of a neonate whose mother had been prescribed codeine postpartum. High concentrations of morphine were found in the infant's blood and this was attributed to the mother being a CYP2D6 ultrafast metaboliser.1 METHODS: The evidence surrounding the safety of codeine and codeine combination products in children, during the postpartum period and specifically for breast fed infants was collated. The evidence was presented to key stakeholders including obstetricians, midwives, safety and quality representatives, nurse unit managers and acute pain team representatives. Postpartum analgesia was discussed and an agreed protocol developed. Training and education sessions were undertaken to obstetric medical and nursing staff. RESULTS The evidence that was presented to key stakeholders included:▸ Reports over the safety concerns surrounding the use of codeine and codeine combination products during breast feeding▸ Guidelines and contraindications about the use of codeine in children that had been issued by international regulatory bodies (US Food and Drug Administration and European Medicines Agency).▸ Recommendations from the Australian Medicines Handbook to avoid in breast feeding2 ▸ Recommendations from Hale's Medications and Mothers Milk that reported limited data and had made a recent re-classification from L3 (limited data-probably compatible) to L4 (limited data-possibly hazardous).3 Before presenting the evidence to key stakeholders and undertaking training to nursing and medical staff, more than 90% of postpartum women were prescribed a codeine containing product as part of their 'as required' analgesic regimen.Since the intervention, codeine combination products have now been almost completely eliminated on medication charts for postpartum women (less than 5%). Those that are prescribed are ceased once highlighted to medical staff. The obstetric pharmacist now presents a session on postpartum analgesia at every new resident medical officer orientation outlining suitable medications to prescribe. In addition all new pharmacists to the women's and new born's team receive training about postpartum analgesia. CONCLUSION This study highlights the impact that can be achieved when health care professionals work together to change the culture and prescribing habits in a hospital setting, to enhance patient safety. Evaluating the evidence and presenting to stakeholders as well as providing ongoing training and education to medical, nursing and pharmacy staff are all essential to a successful outcome.
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Affiliation(s)
| | - Karen Whitfield
- Royal Brisbane and Women's Hospital, Australia School of Pharmacy, The University of Queensland
| | - Angela North
- School of Pharmacy, The University of Queensland
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Taufek NM, Cartwright D, Hewavitharana A, Koorts P, McConachy H, Shaw N, Whitfield K, Davies M. TO INVESTIGATE THE EFFECT OF THE PASTEURISATION PROCESS ON TRACE ELEMENTS IN DONOR BREAST MILK. Arch Dis Child 2016; 101:e2. [PMID: 27540206 DOI: 10.1136/archdischild-2016-311535.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To investigate the effect of the pasteurisation process on trace elements in donor breast milk. METHOD Premature infants often receive donor breast milk when the mother is unable to produce sufficient breast milk. It is widely accepted that donor milk has considerable advantages over formula milk.1 The Royal Brisbane and Women's Hospital (RBWH) has a milk bank that receives milk donated by women which undergoes a pasteurisation process.2 This study investigated the effect of pasteurisation on a range of trace elements in donor milk.A total of 14 participants who donated to the milk bank were recruited in this study. A 2 ml sample was collected pre- and post- pasteurisation, and frozen at -80 °C. Post-natal age of the milk was documented. Inductively-coupled plasma mass-spectrometry was used to analyse the following trace elements - zinc (Zn), copper (Cu), selenium (Se), manganese (Mn), iodine (I), iron (Fe), molybdenum (Mo) and bromine (Br). The study received ethical approval from RBWH and The University of Queensland Ethics Committee. RESULTS No significant difference was found between the levels of any of the trace elements tested pre- and post-pasteurisation. The following p-values were calculated - Zn (0.82), Cu (0.80), Se (0.97), Mn (0.63), I (0.99), Fe (0.05), Mo (0.41), Br (0.59). The following ranges in mcg/L of trace elements were calculated - Zn (365.4-5460.0), Cu (157.6-820.5), Se (10.6-23.7), Mn (0.55-3.24), I (66.4-215.3), Fe (101.5-473.1), Mo (0.20-5.45), Br (704.9-3379.0). Spearman's rank correlation analysis showed significant correlations between post-natal age of milk and trace elements - Zn (ρ=-0.578), Se (ρ=-0.627). Fe (ρ=-0.704), and Mo (ρ=-0.534). No significant correlation was found for Cu, Mn, I, and Br. CONCLUSION This study found that the pasteurisation process had minimal effect on trace element levels in donor breast milk. However, it was noted that there was a correlation between post-natal age of donor milk and Zn, Se, Fe and Mo. Further work is needed to establish factors that may influence levels of trace elements in donor milk such as post-natal age.
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Affiliation(s)
- Nor Mohd Taufek
- The University of Queensland The Royal Brisbane & Women's Hospital
| | - David Cartwright
- The Royal Brisbane & Women's Hospital Department of Paediatrics & Child Health, The University of Queensland
| | | | - Pieter Koorts
- The Royal Brisbane & Women's Hospital Department of Paediatrics & Child Health, The University of Queensland
| | | | | | - Karen Whitfield
- The University of Queensland The Royal Brisbane & Women's Hospital
| | - Mark Davies
- The Royal Brisbane & Women's Hospital Department of Paediatrics & Child Health, The University of Queensland
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Abstract
AIM To present a case of an extremely premature infant and the role that the specialist neonatal pharmacist has on the quality of care of these patients. METHOD Interventions and recommendations made by the pharmacists over the admission of a triplet born at 23 weeks and 5 days gestation were recorded. The type of interventions were categorised and classified for risk using a consequence/probability matrix.1 RESULTS: The patient required admission to the intensive care unit and subsequently the special care unit for a period of 163 days before discharge home. Over the period of admission the patient had a history of a large patent ductus arteriosus, pulmonary hypertension, bilateral grade two intraventricular haemorrhages, neonatal jaundice, hyponatraemia, hyperglycaemia, anaemia of prematurity, retinopathy of prematurity and chronic neonatal lung disease. A pleural effusion developed at day 10 requiring high frequency ventilation. At the age of 3 weeks a pseudomonas sepsis developed together with feed intolerance and abdominal distention. Milk curd syndrome was diagnosed requiring the removal of 30 cm of bowel and placement of a temporary stoma. Long term Parenteral Nutrition was prescribedSixteen interventions were recorded - low risk (3), moderate risk (9) and high risk (4).Clinical advice was provided regarding appropriate dose, therapeutic drug monitoring and administration of antibiotics including gentamicin, meropenem and flucloxacillin to enhance safety and improve efficacy. Owing to the complexity of the medication regimen at times, drug compatibility queries were common. Close liaison with the neonatal consultant, dietician and gastroenterologists was undertaken during long term Parenteral Nutrition and included discussions relating to, administration of additional electrolytes, trace elements and liver function tests. Advice was sought on the dose and administration of loperamide for short gut syndrome and control of diarrhoea. Pharmaceutical advice was provided to ensure medications were optimised for issues associated with drug administration via transpyloric tube to avoid blockage. Calculation of total daily phosphate was undertaken whilst the patient was receiving fortified feeds, to ensure adequate supplementation, to assist normal bone development. Prior to discharge palivizumab prophylaxis was recommended for respiratory syncytial virus Infection. The pharmacist provided advice on administration to the nursing staff and ensured required documentation was completed. CONCLUSION The care of the extremely premature neonate involves numerous medication related challenges. This case not only demonstrates the specialist knowledge, skills and attitudes required by a pharmacist working in this complex field but the impact that can be achieved working closely with the neonatal team.
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Abstract
AIM Breastmilk is considered the most important nutrient and source of supplementation for both term and preterm infants.1 It is composed of many important nutrients, including vitamin D.2 The content of this vitamin in breast milk is usually low, even for lactating mothers with adequate vitamin D status.2 3 Preterm infants are at the great risk of vitamin D deficiency due to decreased transplacental transfer.4 Premature infants are the main recipients of pasteurised donor human milk (PDHM), when their mothers are unable to provide their own.This study aims to evaluate the effect of pasteurisation on the concentrations of vitamin D compounds in donor breast milk. METHOD A total of 16 participants, who donated breast milk to the RBWH milk bank, were recruited in this study. Milk samples were obtained pre- and post-Holder pasteurisation. Liquid chromatography tandem mass spectrometry (LC-MS/MS) was used to analyse the samples for vitamins D2 and D3 and 25-hydroxyvitamins D2 and D3 (25(OH)D2 and 25(OH)D3). The significance of differences in vitamin D concentrations between the two groups of milk samples was assessed using the Wilcoxon matched-pairs signed rank test, in which P<0.05 was considered significant. RESULTS Pasteurisation resulted in a significant reduction (P<0.05) in the content of D2, D3, 25(OH)D2 and 25(OH)D3, with P values of 0.0001 for all targeted analytes. The concentrations of the vitamin D analogues in non-pasteurised milk ranged from 3.6 to 5.0 pM (D2), 1.0 to 9.8 pM (D3), 1.4 to 2.1 pM (25(OH)D2) and 1.2 to 9.3 pM (25(OH)D3). The concentrations of the vitamin D analogues in post-pasteurised milk ranged from 3.0 to 4.0 pM (D2), 0.6 to 9.5 pM (D3), 1.2 to 1.7 pM (25(OH)D2) and 1.1 to 9.1 pM (25(OH)D3). Losses of vitamin D compounds resulting from the pasteurisation process ranged from 10% to 20%. CONCLUSION Pasteurisation significantly affected the concentration of vitamin D compounds in pasteurised donor breast milk.
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Affiliation(s)
- Fabio Gomes
- School of Pharmacy, The University of Queensland Royal Brisbane and Women's Hospital
| | - Nick Shaw
- School of Pharmacy, The University of Queensland
| | - Karen Whitfield
- School of Pharmacy, The University of Queensland Royal Brisbane and Women's Hospital
| | - Pieter Koorts
- Royal Brisbane and Women's Hospital Department of Paediatrics & Child Health, The University of Queensland
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25
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Alexander M, Beattie-Manning R, Blum R, Byrne J, Hornby C, Kearny C, Love N, McGlashan J, McKiernan S, Milar JL, Murray D, Opat S, Parente P, Thomas J, Tweddle N, Underhill C, Whitfield K, Kirsa S, Rischin D. Guidelines for timely initiation of chemotherapy: a proposed framework for access to medical oncology and haematology cancer clinics and chemotherapy services. Intern Med J 2016; 46:964-9. [DOI: 10.1111/imj.13157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 06/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- M. Alexander
- Department of Pharmacy; Peter MacCallum Cancer Centre; Melbourne South Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne South Australia
| | - R. Beattie-Manning
- Emergency Medicine and Cancer Services; Western Health; Melbourne South Australia
| | - R. Blum
- Department of Medical Oncology; Bendigo Health; Bendigo South Australia
| | - J. Byrne
- Western and Central Integrated Cancer Service; Melbourne South Australia
| | - C. Hornby
- Cancer Strategy and Development Unit, Victorian Department of Health and Human Services; Alfred Health; Melbourne South Australia
| | - C. Kearny
- Department of Specialists Clinics; Peter MacCallum Cancer Centre; Melbourne South Australia
| | - N. Love
- Department of Nursing; Peter MacCallum Cancer Centre; Melbourne South Australia
| | - J. McGlashan
- Western and Central Integrated Cancer Service (Consumer); Alfred Health; Melbourne South Australia
| | - S. McKiernan
- Cancer Nurses Society of Australia; Adelaide South Australia
| | - J. L. Milar
- Department of Radiation Oncology; Alfred Health; Melbourne South Australia
| | - D. Murray
- Department of Building Better Care; Peter MacCallum Cancer Centre; Melbourne South Australia
| | - S. Opat
- Clinical Haematology; Monash Health; Melbourne South Australia
| | - P. Parente
- Department of Medical Oncology; Eastern Health; Melbourne South Australia
| | - J. Thomas
- Department of Nursing; Peninsula Health; Mornington Victoria South Australia
| | - N. Tweddle
- Service Development; Victorian Comprehensive Cancer Centre; Melbourne South Australia
| | - C. Underhill
- Cancer Services; Greater Southern Area Health Service and East Hume/Border Clinical Network; Albury Wodonga New South Wales/Victoria Australia
| | - K. Whitfield
- Cancer Strategy and Development Unit, Victorian Department of Health and Human Services; Alfred Health; Melbourne South Australia
| | - S. Kirsa
- Department of Pharmacy; Peter MacCallum Cancer Centre; Melbourne South Australia
| | - D. Rischin
- Department of Medical Oncology; Peter MacCallum Cancer Centre; Melbourne South Australia
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Mohd-Taufek N, Cartwright D, Davies M, Hewavitharana AK, Koorts P, Shaw PN, Sumner R, Lee E, Whitfield K. The Simultaneous Analysis of Eight Essential Trace Elements in Human Milk by ICP-MS. FOOD ANAL METHOD 2016. [DOI: 10.1007/s12161-015-0396-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Coombes I, Avent M, Cardiff L, Bettenay K, Coombes J, Whitfield K, Stokes J, Davies G, Bates I. Improvement in Pharmacist's Performance Facilitated by an Adapted Competency-Based General Level Framework. Journal of Pharmacy Practice and Research 2015. [DOI: 10.1002/j.2055-2335.2010.tb00517.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Karen Bettenay
- Medication Practitioner Development, Medication Services Queensland
| | - Judith Coombes
- School of Pharmacy; University of Queensland, and Princess Alexandra Hospital
| | | | | | - Graham Davies
- Pharmaceutical Science Division; King's College London
| | - Ian Bates
- The School of Pharmacy; University of London; London United Kingdom
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Stacey S, Coombes I, Wainwright C, Klee B, Miller H, Whitfield K. Characteristics of adverse medication events in a children's hospital. J Paediatr Child Health 2014; 50:966-71. [PMID: 25049060 DOI: 10.1111/jpc.12684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2014] [Indexed: 11/29/2022]
Abstract
AIM To compare adverse medication events (AMEs) reported in children, via the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) coding with events reported via other data sources. METHOD AME reports were retrieved using codes Y40-Y59 and X40-X44 over 6 months. Patients' charts were manually reviewed to identify events associated with error and/or harm with medicines during a hospital admission. Medication name, group, error, harm and alert documentation were recorded. Clinical incidents and pharmacist interventions were reviewed for the same period. RESULTS Two hundred sixty-three events from January to June 2011 were recorded by ICD-10 coding in 180 patients. After duplicated, missing or unrelated events were excluded and 146 AMEs remained. In the same period, 117 AMEs were reported as incidents and 190 as pharmacist interventions. In total, 276 children with 447 events were reported via all sources. Little duplication between data sources was evident. In total, 158 events involved harm, with 135 of these from ICD-10 coding, 16 from incident reports and 2 pharmacist interventions (including 6 events from multiple sources). Error was involved in 3% of ICD10 reports, 97% of incidents and 100% of interventions. Only 14% of harm-related events from ICD-10 were documented on the medical record clinical alert. Chemotherapy accounted for 31% of harm-related events, antimicrobials 18%, corticosteroids 14% and narcotics 12%. CONCLUSION Of the harm-related events, 85% were documented via ICD-10 coding with few documented in other databases. Review of ICD-10-coded AMEs can provide valuable information to improve patient safety and quality.
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Affiliation(s)
- Sonya Stacey
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia; School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia; Royal Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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29
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Whitfield K. Innovation - An Essential Leadership Skill, Limited Only By One's Own Imagination. J Pharm Pract Res 2014. [DOI: 10.1002/jppr.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Karen Whitfield
- The University of Queensland, School of Pharmacy; Brisbane Queensland Australia
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Stacey SR, Coombes I, Wainwright C, Cardiff L, Whitfield K. What does advanced practice mean to Australian paediatric pharmacists? A focus group study. International Journal of Pharmacy Practice 2014; 23:141-9. [DOI: 10.1111/ijpp.12113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 03/02/2014] [Indexed: 11/26/2022]
Abstract
Abstract
Objectives
The aim of this study was to explore perceptions and attitudes of Australian paediatric pharmacists about advanced pharmacy practice and to identify suitable methods of assessment for this level of practice.
Methods
Four focus groups (with 31 participants) were held in 2012 with Australian hospital pharmacists who work with children. Written notes and audio recordings were used to produce verbatim transcriptions and extract themes.
Key findings
There was consensus across groups that formal recognition of advanced pharmacy practice was valuable to the profession and to individuals. Elements should include a strong grounding in clinical practice, commitment to education, research and service improvement outside the department and institution. A framework for career development should be used to describe the levels of practice leading to advanced practice. Assessment should involve multiple separate criteria, and incorporate direct observation, peer review and a professional portfolio. Postgraduate qualifications are desirable but not considered essential. Different knowledge and skills are required in paediatrics; however, the definition of advanced practice remains the same.
Conclusions
Recognition of advanced practice is valuable for the profession and for individuals. Multiple methods of assessment should be used. Specialty areas such as paediatrics can be defined and assessed similar to other specialties, with acknowledgement of the specific paediatric knowledge and skills required.
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Affiliation(s)
- Sonya R Stacey
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Qld, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
- Royal Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Qld, Australia
| | - Ian Coombes
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Qld, Australia
| | - Claire Wainwright
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Qld, Australia
- Royal Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Qld, Australia
| | - Lynda Cardiff
- Pharmacist Practitioner Development Unit, Medication Services Queensland, Brisbane, Qld, Australia
| | - Karen Whitfield
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
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Niyomnaitham S, Page A, La Caze A, Whitfield K, Smith AJ. Utilisation trends of rosiglitazone and pioglitazone in Australia before and after safety warnings. BMC Health Serv Res 2014; 14:151. [PMID: 24708579 PMCID: PMC3994196 DOI: 10.1186/1472-6963-14-151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/27/2014] [Indexed: 11/10/2022] Open
Abstract
Background A see on cardiovascular diseases and bladder cancer. The changes to the patterns of rosiglitazone and pioglitazone utilisation in Australia following the timing of these various health authority warnings such as the Australian Therapeutic Good Administration (TGA), European Medicines Agency (EMA) press releases or U.S. Food and Drug Administration (FDA) is unknown. This study investigated the utilisation patterns of rosiglitazone and pioglitazone in Australia before and after warnings of major drug authorities. Methods We evaluated rosiglitazone and pioglitazone dispensing using the Pharmaceutical Benefit Scheme (PBS) subsidised drug dispensing data for the Australian population from February 2004 to July 2012. The World Health Organisation Anatomic Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) system was used to compare the drug utilisation patterns following the announcements of EMA, FDA, and TGA safety warnings, which first occurred in May 2007. The DDD/1000population/day were examined in a series of time-series regression analysis with the drug safety warnings specified as interventions. Results Rosiglitazone utilisation increased steadily from 2004 until reaching a peak at 1.96/1000population/day in January 2007. Then rosiglitazone use decreased significantly after the initial EMA press release and FDA warning on cardiovascular risk in May 2007 (with a 15.04% average monthly decline, p-value <0.001), however use did not significantly decrease after the TGA warning or subsequent EMA and FDA warnings. Pioglitazone utilisation proceeded rosiglitazone in September 2008 and remained above 1.5/1000/day during 2009–2010. However, pioglitazone utilisation has slightly declined after the FDA, EMA, and TGA warnings related to bladder cancer. Conclusions Drug safety warnings were associated with a decrease in rosiglitazone and pioglitazone utilisation in Australia. Rosiglitazone began to decline prior to TGA warnings in December 2007, which suggests that Australian prescribers may have acted in response to scientific evidence or international safety warnings (EMA, FDA), prior to the response of the TGA. Minor effects were observed after bladder cancer warnings on pioglitazone utilisation.
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Affiliation(s)
- Suvimol Niyomnaitham
- School of Pharmacy, University of Queensland, 20 Cornwall Street, Woolloongabba, Australia.
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Hale AR, Coombes ID, Stokes J, McDougall D, Whitfield K, Maycock E, Nissen L. Perioperative medication management: expanding the role of the preadmission clinic pharmacist in a single centre, randomised controlled trial of collaborative prescribing. BMJ Open 2013; 3:bmjopen-2013-003027. [PMID: 23847268 PMCID: PMC3710977 DOI: 10.1136/bmjopen-2013-003027] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Current evidence to support non-medical prescribing is predominantly qualitative, with little evaluation of accuracy, safety and appropriateness. Our aim was to evaluate a new model of service for the Australia healthcare system, of inpatient medication prescribing by a pharmacist in an elective surgery preadmission clinic (PAC) against usual care, using an endorsed performance framework. DESIGN Single centre, randomised controlled, two-arm trial. SETTING Elective surgery PAC in a Brisbane-based tertiary hospital. PARTICIPANTS 400 adults scheduled for elective surgery were randomised to intervention or control. INTERVENTION A pharmacist generated the inpatient medication chart to reflect the patient's regular medication, made a plan for medication perioperatively and prescribed venous thromboembolism (VTE) prophylaxis. In the control arm, the medication chart was generated by the Resident Medical Officers. OUTCOME MEASURES Primary outcome was frequency of omissions and prescribing errors when compared against the medication history. The clinical significance of omissions was also analysed. Secondary outcome was appropriateness of VTE prophylaxis prescribing. RESULTS There were significantly less unintended omissions of medications: 11 of 887 (1.2%) intervention orders compared with 383 of 1217 (31.5%) control (p<0.001). There were significantly less prescribing errors involving selection of drug, dose or frequency: 2 in 857 (0.2%) intervention orders compared with 51 in 807 (6.3%) control (p<0.001). Orders with at least one component of the prescription missing, incorrect or unclear occurred in 208 of 904 (23%) intervention orders and 445 of 1034 (43%) controls (p<0.001). VTE prophylaxis on admission to the ward was appropriate in 93% of intervention patients and 90% controls (p=0.29). CONCLUSIONS Medication charts in the intervention arm contained fewer clinically significant omissions, and prescribing errors, when compared with controls. There was no difference in appropriateness of VTE prophylaxis on admission between the two groups. TRIAL REGISTRATION Registered with ANZCTR-ACTR Number ACTRN12609000426280.
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Affiliation(s)
- A R Hale
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - I D Coombes
- Department of Pharmacy, Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia
| | - J Stokes
- Medicines Regulation and Quality, Queensland Health, Brisbane, Queensland, Australia
| | - D McDougall
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - K Whitfield
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Brisbane, Queensland, Australia
| | - E Maycock
- Department of Anaesthetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - L Nissen
- School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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Brok J, Huusom LD, Secher NJ, Pryds O, Whitfield K, Gluud C. Antenatal magnesium sulphate to prevent cerebral palsy in very preterm infants. BJOG 2011. [DOI: 10.1111/j.1471-0528.2011.02973.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brok J, Huusom LD, Secher NJ, Pryds O, Whitfield K, Gluud C. The information gap between the required and the actual accrued information size in the meta-analysis of antenatal magnesium sulphate to prevent cerebral palsy in preterm infants. BJOG 2011. [DOI: 10.1111/j.1471-0528.2011.02972.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Malik M, Hassali MAA, Shafie AA, Hussain A, Sandhu G, Dionysopoulos D, Phillips CJ, Tomlin AC, Doherty P, Whitfield K, Polasek TM, Lin FPY, Doogue MP, Amir M, Ellis DP, Hassali MAA, Shafie AA, Palaian S. Letters to the Editor. Journal of Pharmacy Practice and Research 2011. [DOI: 10.1002/j.2055-2335.2011.tb00071.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Madeeha Malik
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia
| | - Mohamed AA Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia
| | - Asrul A Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia
| | - Azhar Hussain
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversity Sains Malaysia Penang Malaysia
- Hamdard Institute of Pharmaceutical SciencesHamdard University Islamabad Pakistan
| | - Geeta Sandhu
- Specialist Pharmacist – Cancer Services Ambulatory Care, Princess Alexandra Hospital, The School of PharmacyUniversity of Queensland Woolloongabba Qld 4102
| | | | | | - Angela C Tomlin
- Surgical Preadmission ClinicFlinders Medical Centre Bedford Park Adelaide SA 5042
| | - Paula Doherty
- Drug Usage Evaluation, Medication Safety Project PharmacistJohn Hunter Hospital, Hunter New England Local Health Network New Lambton NSW 2305
| | - Karen Whitfield
- Quality Use of Medicines, School of PharmacyUniversity of Queensland Woolloongabba Qld 4102
| | - Thomas M Polasek
- Department of Clinical PharmacologyFlinders University and Flinders Medical Centre Adelaide SA 5042
| | - Frank PY Lin
- Centre of Health InformaticsUniversity of New South Wales Sydney NSW 2052
| | - Mathew P Doogue
- Clinical Pharmacologist and Endocrinologist, Department of Clinical PharmacologyFlinders University and Flinders Medical Centre Adelaide SA 5042
| | - Muhammad Amir
- Ziauddin College of PharmacyZiauddin University Clifton, Karachi 75600 Pakistan
| | - David P Ellis
- Women's and Children's HospitalChildren, Youth and Women's Health Service North Adelaide SA 5006
| | - Mohamed Azmi Ahmad Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversiti Sains Malaysia Penang Malaysia
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversiti Sains Malaysia Penang Malaysia
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Huusom LD, Secher NJ, Pryds O, Whitfield K, Gluud C, Brok J. Antenatal magnesium sulphate may prevent cerebral palsy in preterm infants-but are we convinced? Evaluation of an apparently conclusive meta-analysis with trial sequential analysis. BJOG 2010; 118:1-5. [DOI: 10.1111/j.1471-0528.2010.02782.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
A data matrix system used to record and summarize individual behavioral data is described. The major characteristics of the system are: (1) it provides a place to record and summarize all patient token exchanges, whether for standard contingencies or for idiosyncratic behavior; (2) it serves as a record and summary for time samples observed during a 24-hr period and as a record of reliability data on time sample measures; (3) it provides a place where the new token balance for each patient can be calculated and recorded for use the next day; (4) it provides for calculation of an individual patient's token balance at any given moment; and (5) it is a permanent record of each patient's daily participation in the program and documents progress in terms of his economic status as well as in changes in critical target behaviors.
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Abstract
BACKGROUND Impaired lung function is independently associated with higher rates of disability; however, few studies have examined the extent to which this relationship varies by sex. Because men are less likely to have disability, it is expected that the relationship between lung function and disability will be greater among women. METHODS Logistic regression models were specified to examine the relationship between lung function and disability in 689 African-American men and women participating in the Carolina African American Twin Study of Aging. Disability was defined as difficulty in performing at least one of seven basic activities of daily living. Impaired lung function was defined as per cent of predicted peak expiratory flow (PEF) <80. RESULTS Accounting for demographic and health-related characteristics, women who had impaired lung function had a higher odds (OR 1.77; 95% CI 1.02 to 3.06) of being disabled than those with normal lung function. Impaired lung function was unrelated to disability in men. CONCLUSION Lung function appears to vary by sex in this sample of African-Americans. Furthermore, among women, lung function should be considered as an important indicator of health. Every effort should be made to improve lung function in African-Americans, but interventions and health promoting strategies may need to be sex specific.
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Affiliation(s)
- R J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, USA.
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Abstract
OBJECTIVE Surveillance of patients presenting with acute flaccid paralysis (AFP) is the World Health Organization (WHO) recommended method for the detection of incident cases of poliovirus infection. Australia was certified free of circulating poliovirus in 2000 but is required to continue AFP surveillance until global certification. Although Australia reached the WHO nominated surveillance target in 2000 and 2001, it was not reached in 2002. Notification rates between states have been variable. We aim to investigate the difference in notification rates by state to determine whether different rates reflect different patterns of disease or different approaches to reporting. METHODS Notification rates were reviewed by state for the years 1997-2002. The completeness of case ascertainment was reviewed from published studies. Key informants described differences in AFP reporting in states with consistent differences in notification rates. RESULTS Australia achieved 75% of the WHO surveillance target for AFP cases between 1997 and 1999 and 98% between 2000 and 2002. After 2000, Queensland achieved 150% of its target while Victoria achieved less than 50%. New South Wales reached its target over the entire 6 years but other states and territories were not as consistent. Although the formal process for AFP reporting is uniform throughout Australia, many differences in approach were identified between Victoria and Queensland. CONCLUSION Maintaining AFP surveillance at the required WHO standard will be more likely in Australia if the populous states are able to notify cases at the same rate as Queensland (since 2000) and New South Wales (in general).
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Affiliation(s)
- K Whitfield
- School of Public Health, Latrobe University, Melbourne, Victoria, Australia
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Johansson B, Whitfield K, Pedersen NL, Hofer SM, Ahern F, McClearn GE. Origins of individual differences in episodic memory in the oldest-old: a population-based study of identical and same-sex fraternal twins aged 80 and older. J Gerontol B Psychol Sci Soc Sci 1999; 54:P173-9. [PMID: 10363039 DOI: 10.1093/geronb/54b.3.p173] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The relative importance of genetic and environmental influences on episodic memory in very late life was studied using a quantitative genetic approach. Identical (n = 125) and same-sex fraternal (n = 157) twin pairs, aged 80 and older (mean age = 83.3; SD = 3.1) and without a diagnosis of dementia were tested with seven memory measures: (1-2) Digit Span Forward and Backwards, (3) Prose Recall, (4) Thurstone's picture memory test, and the Memory in Reality (MIR) test, including the subtasks of (5) free recall, (6) recognition, and (7) relocation. Heritabilities, estimated by structural equation modeling, ranged from .04 to .49. The digit span backward test showed the highest heritability (h2 = .49), while heritabilities were typically lower for the long-term memory measures. The results demonstrate genetic influences on memory in the oldest-old, but suggest that the magnitude of these effects differs across memory measures.
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Affiliation(s)
- B Johansson
- Institute of Gerontology, University College of Health Sciences, Jönköping, Sweden.
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Abstract
Twin analyses were conducted to determine the relative influence of genetic and environmental factors on functional aging. As part of the ongoing Minnesota Twin Study of Adult Development and Aging (MTSADA), measures of 30 demographic, cognitive, physiological, personality, and behavioral variables were available from 140 monozygotic twin pairs and 97 dizygotic twin pairs ranging in age from 27 to 88 years. Functional age was based on a general linear regression model with chronological age as the dependent variable. Stepwise regression determined the subset of variables by MTSADA providing the best prediction of chronological age. Factor analysis of these 12 variables resulted in three factors: physiological measures, cognitive abilities, and processing speed. When entered into, a regression equation, the three factors accounted for 66% of the variance in chronological age. Analysis of twin similarity for components of functional age suggested the relative influence of genetic and environmental factors varies greatly for different components of functional aging. In addition, the genetic and shared environmental influences on the three components were common to all three, while the nonshared environmental influences were specific to each component.
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Affiliation(s)
- D Finkel
- Division of Social Sciences, Indiana University Southeast, USA
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Abstract
This article provides results of a comparison between the Halstead-Reitan tapper and a 1988 computerized tapping program by Loong. Care should be taken in using the computerized tapper in diagnosis or assessment.
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