26 research outputs found
Consumers' views of pharmacogenetics: A qualitative study
No full textBACKGROUND: Adverse drug reactions are recognized as a significant public health issue. Pharmacogenetics (PGx) provides a potential means of preventing some adverse drug reactions by predicting the optimal medication dose for an individual; however, PGx is rarely used in clinical practice. Thus far, there have been few studies investigating consumers’ perceptions of the barriers to the implementation of PGx in clinical practice. OBJECTIVES: This study explored the views of the general public regarding their current use of medications, and their experiences of side effects and opinions on PGx. METHODS: Members of the general public who suffered a chronic medical condition and/or had an immediate family member with a chronic medical condition were recruited to form 5 separate focus groups (n ¼ 35). Three separate age ranges were used in the focus groups. A questioning route was developed and used in focus groups to determine participants’ experiences with medication use and opinions on PGx (referred to as ‘‘Personalized Medicine’’). Focus group discussions were transcribed by 2 separate investigators, and qualitative analysis, based on the framework approach, was applied to the data. Data were independently coded to identify key themes then compared both within and between focus groups. RESULTS: A common theme was a desire to have a holistic approach to disease diagnosis and medication selection. A wide range of views were expressed by the focus group participants. Concerns were raised regarding the current level of side effects experienced with medications. Storage and privacy of genetic information, and the costs involved, were also seen as potential barriers to implementation of PGx. CONCLUSIONS: PGx testing was seen as a potential positive contribution, but only if other factors were considered during the prescribing process. As participants desired a high level of information and effective communication from their health-care professionals, PGx education of clinicians and pharmacists will be essential to satisfy consumers’ requirements.Catherine A. Haddy, Helena M. Ward, Manya T. Angley, Ross A. McKinno
Monitoring physical health and adverse effects in children and adolescents prescribed antipsychotics
No full textBackground: The adverse effects and long-term health risks associated with antipsychotic use means that monitoring children and adolescents prescribed these medications is important. Aim: To implement an evidence-based chart and guideline to monitor physical health and adverse effects in children and adolescents prescribed antipsychotics in a range of practice settings; and to identify the barriers and benefits of implementation. Method: Using an action research approach a pilot trial was undertaken to implement a chart and guideline in a range of practice settings. Patient and health professional resource kits and an information compact disc were produced to facilitate implementation. Barriers identified during implementation were doctor/health professional, patient-related and environmental. Carer and doctor satisfaction questionnaires were administered to assess the implementation process and evaluate the quality and usefulness of the monitoring chart and guideline. Results: 10 doctors were recruited to participate in the implementation trial and 21 patients prescribed antipsychotics were enrolled. Monitoring data collected retrospectively from patients' case notes, such as weight/height measurements and haematological monitoring were congruent with the guideline in 41% and 29% of patients respectively. Carer and doctor satisfaction questionnaires indicated that the monitoring package was well received and raised awareness of potential adverse effects and the importance of monitoring. Conclusion: The monitoring package can bridge the evidence to practice gap regarding monitoring physical health and adverse effects in children and adolescents prescribed antipsychotics.Luke E Grzeskowiak, David P Ellis, Adam J Phillips, Manya T Angle
Integration of a consultant pharmacist into a general practice: development of a collaborative care model
No full textClinical outcomes of a collaborative, home-based postdischarge warfarin management service
No full textBACKGROUND: Warfarin remains a high-risk drug for adverse events, especially following discharge from the hospital. New approaches are needed to minimize the potential for adverse outcomes during this period. OBJECTIVE: To evaluate the clinical outcomes of a collaborative, home-based postdischarge warfarin management service adapted from the Australian Home Medicines Review (HMR) program. METHODS: In a prospective, nonrandomized controlled cohort study, patients discharged from the hospital and newly initiated on or continuing warfarin therapy received either usual care (UC) or a postdischarge service (PDS) of 2 or 3 home visits by a trained, HMR-accredited pharmacist in their first 8 to 10 days postdischarge. The PDS involved point-of-care international normalized ratio (INR) monitoring, warfarin education, and an HMR, in collaboration with the patient's general practitioner and community pharmacist. The primary outcome measure was the combined incidence of major and minor hemorrhagic events in the 90 days postdischarge. Secondary outcome measures included the incidences of thrombotic events, combined hemorrhagic and thombotic events, unplanned and warfarin-related hospital readmissions, death, INR control, and persistence with therapy at 8 and 90 days postdischarge. RESULTS: The PDS (n = 129) was associated with statistically significantly decreased rates of combined major and minor hemorrhagic events to day 90 (5.3% vs 14.7%; p = 0.03) and day 8 (0.9% vs 7.2%; p = 0.01) compared with UC (n = 139). The rate of combined hemorrhagic and thrombotic events to day 90 also decreased (6.4% vs 19.0%; p = 0.008) and persistence with warfarin therapy improved (95.4% vs 83.6%; p = 0.004). No significant differences in readmission and death rates or INR control were demonstrated. CONCLUSIONS: This study demonstrated the ability of appropriately trained accredited pharmacists working within the Australian HMR framework to reduce adverse events and improve persistence in patients taking warfarin following hospital discharge. Widespread implementation of such a service has the potential to enhance medication safety along the continuum of care.Leanne Stafford, Gregory M. Peterson, Luke R. E. Bereznicki, Shane L. Jackson, Ella C. van Tienen, Manya T. Angley, Beata V. Bajorek, Andrew J. McLachlan, Judy R. Mullan, Gary M. H. Misan, Luigi Gaetan
Graduate qualities: Exploring problem solving in the applied pharmacotherapeutics curriculum at the University of South Australia
No full textEmbedding graduate qualities or attributes, such as problem solving capacity, into program curricula requires explicit identification to students of opportunities for development and assessment of these qualities. In the University of South Australia Pharmacy program a multistage project was undertaken which firstly sought to identify student issues around problem solving ability. Secondly, in response to identified shortcomings, problem based learning was incorporated into applied pharmacotherapeutics courses. The third is the assessment of potential disadvantages to student subgroups such as non-English speaking and international students. Finally, assessment of whether students identified problem solving as an explicit process embedded in teaching methodology were undertaken. This paper reports on the successful incorporation of a problem based learning tutorial teaching modality into applied pharmacotherapeutics courses. No student subgroups were identified as being disadvantaged by the introduction of this approach
15+ MILLION TOP 1% MOST CITED SCIENTIST 12.2% AUTHORS AND EDITORS FROM TOP 500 UNIVERSITIES Chapter from the book Autism Spectrum Disorders -From Genes to Environment Downloaded from: http://www.intechopen.com/books/autism-spectrum-disorders- from-genes-t
No full textClassification of findings in the home medicine reviews of post-discharge patients at risk of medication misadventure
No full textBackground: The risk of medication misadventure for patients is greatest during times of change, particularly on discharge from hospital. Patients at high risk of medication misadventure post- discharge should be identified and provided with interventions to ensure the quality use of medicines and positive health outcomes. Home medicines reviews (HMRs) can be used to improve patient health outcomes and reduce the risk of medication misadventure. Aim: To describe the impact of issues raised in post-discharge HMRs, organised via a hospital medication liaison service. Method: HMR reports of participants were evaluated. Issues identified by the accredited pharmacist in each HMR report were classified as either a 'pharmacist intervention' delivered during the HMR or `information given' that was previously unknown to the medical team. A potential clinical impact of these issues was assigned and the overall clinical significance of all the issues identified in each HMR report was ranked. Results: In 21 HMR reports, 98 issues were identified, with the mean per HMR report of 4.7 +/- 2.2. Of the 98 issues, 25 were classified as 'pharmacist intervention' and 73 were classified as 'information given'. On 2 occasions, a potential clinical impact of 4 (potentially life-saving) was allocated to an issue identified in the HMR report. 90% of issues identified in the HMR reports were ranked as clinically significant. Conclusion: This pilot demonstrated that a liaison pharmacist was able to implement a hospital medication liaison model for patients at risk of medication misadventure. Evidence suggests that an HMR conducted post-discharge can identify clinically significant medication-related issues.Andrew Nguyen, Kevin Yu, Sepehr Shakib, Christopher J Doecke, Merelyn Boyce, Geoff March, Barbara AAnderson, Andrew L Gilbert, Manya T Angle
Hospital admissions caused by adverse drug events: an Australian prospective study
No full textObjective: To assess the frequency of adverse drug event (ADE)-related admissions (ADE-RAs) during a prospective medical record review of patients admitted to a metropolitan tertiary referral hospital. Methods: Potential ADE-RA cases were identified by examination of case records of randomly selected patients. Cases were assessed by an expert panel to measure study outcomes, which were the frequency (ADEs and ADE-RAs) as well as type, likelihood of causality, severity, avoidability and detection of ADEs. Results: Of the 370 subjects, 59 (16.0%) had a confirmed ADE-RA, with 15 (4.1%) of these serious and preventable. The 59 ADE-RAs were a result of 72 discreet ADEs. Adverse drug reactions were the most common type of ADE, followed by non-compliance. Of the 72 discreet ADEs, 31.9% were classified as 'probable' or 'highly probable'. Most ADEs (54.2%) were classified as 'definitely avoidable', 34.7% were classified as 'severe' and 21.8% were classified as both 'definitely avoidable' and 'severe'. Half the ADEs were detected after the patient had been admitted and most were detected by medical practitioners. Antineoplastics followed by antidiabetic agents were most frequently implicated. Conclusions: Implementing a systems approach that involves multiple strategies, such as improving tertiary-to-primary care information transfer and promoting medication adherence through education programs, is necessary to tackle the problem of avoidable ADE-RAs and the associated cost burden. What is Known About the Topic? It is estimated that 2-3% of Australian hospital admissions are due to adverse drug events (ADEs), but recent data are lacking. According to the Australian Statistics on Medicines, over 250 million prescriptions were dispensed in 2007, compared with just under 180 million in 1997. This 40% increase in drug utilisation over the 10 years surpasses the Australian population growth of 14% in the same period. An increase in drug use per person indicates that the rate of ADEs and possible ADE-related admissions (ADE-RAs) is likely to have increased. What Does This Paper Add? This prospective study was conducted at a large Australian metropolitan teaching hospital and we report that 59 of 370 participants (16.0%) presenting to the Emergency Department had a confirmed ADE-RA, with 15 (4.1%) presenting with a serious and preventable ADE-RA. What Are The Implications For Practitioners? The findings of this study support implementing a systems approach involving multiple strategies to tackle the problem of avoidable ADE-RAs and the associated cost burden. This study reveals that half the ADEs were not detected until after the admission process, which reinforces the importance of focusing efforts towards preventing ADE-RAs and detecting ADE-RAs through measures such as those recommended in the Australian Pharmaceutical Advisory Council guiding principles.Alexandra L. Phillips, Olimpia Nigro, Karen A. Macolino, Kirsty C. Scarborough, Christopher J. Doecke, Manya T. Angley, Sepehr Shaki
Optimal Level of Liaison Pharmacist Intervention to Facilitate a Post‐Discharge Home Medicines Review
No full textThe Effects of Cyclophosphamide on the Pharmacokinetics of Triiodothyronine in the Male Rat
No full textAbstract
In the present study, the possibility that cyclophosphamide or a cyclophosphamide metabolite may be accelerating the clearance of triiodothyronine has been examined.
Following administration of exogenous triiodothyronine to saline-and cyclophosphamide-treated rats, the area under the plasma-concentration time curve (AUC), apparent clearance (CLapp) and half-life of triiodothyronine were measured. AUC (34.43 ± 12.34 compared with 33.32 ± 9.92 nmol hL−1), CLapp (36.30 ± 12.89 compared with 37.51 ± 11.16 mLh−1) and half-life (7.50 ± 1.39 compared with 6.40 ± 0.96 h) were not significantly different in the control rats compared with the cyclophosphamide-treated rats.
As cyclophosphamide does not appear to alter the elimination of triiodothyronine, it is likely that cyclophosphamide or a cyclophosphamide metabolite is acting at the hypothalamo-pituitary axis, reducing the synthesis or release of thyroid stimulating hormone and consequently decreasing the levels of triiodothyronine and thyroxine.</jats:p
