*The Australian Pharmaceutical Advisory Committee guidelines call for a detailed medication history to be taken at the first point of admission to hospital. Accurate medication histories are vital in optimising health outcomes and have been shown to reduce mortality rates. This study aimed to examine the accuracy of medication histories taken in the Emergency Department of the Royal Adelaide Hospital. Medication histories recorded by medical staff were compared to those elicited by a pharmacy researcher. The study, conducted over a six-week period, included 100 patients over the age of 70, who took five or more regular medications, had three or more clinical co-morbidities and/or had been discharged from hospital in three months prior to the study. Following patient interviews, the researcher contacted the patient's pharmacist and GP for confirmation and completion of the medication history. Out of the 1152 medications recorded as being used by the 100 patients, discrepancies were found for 966 medications (83.9%). There were 563 (48.9%) complete omissions of medications. The most common discrepancies were incomplete or omitted dosage and frequency information. Discrepancies were mostly medications that treated RESUMEN Las guías del Comité Consultivo FarmacéuticoAustraliano piden que se realice un historial de medicación detallado en el punto de ingreso del hospital. Para optimizar los resultados en salud son vitales los historiales de medicación fiables que han demostrado reducir las tasas de mortalidad. Este estudio trató de examinar la fiabilidad de los historiales de medicación tomados en el Servicio de Urgencias del Hospital Real de Adelaida registradas por el personal médicos y se compararon con las extraídas por un investigador de farmacia. El estudio, conducido durante seis semanas, incluyó 100 pacientes de mas de 70 años que tomaban cinco o mas medicamentos habituales, tenían tres o más comorbilidades y/o habían sido dados de alta del hospital en los tres meses anteriores al estudio. Después de las entrevistas a los pacientes, el investigador contactaba al farmacéutico y al médico del paciente para la confirmación y compleción del historial. Del as 1152 medicaciones registradas como utilizadas por los 100 pacientes, se encontraron discrepancias en 966 (83,9%). Hubo 563 (48,9%) omisiones completas de medicación. Las discrepancias más comunes fueron la omisión de dosis y frecuencia. Las discrepancias eran mayoritariamente medicaciones dermatológicas y para problemas de oído, nariz y garganta, pero alrededor del 29% eran usadas para tratar problemas cardiovasculares. Este estudio da apoyo a la presencia de un farmacéutico en un Servicio de Urgencias que pueda compilar un historial de medicación intensivo y fiable para mejorar la gestión del a Original Research
Background: Neuropsychiatric symptoms (NPS) in dementia impact profoundly on the quality of life of people living with dementia and their care givers. Evidence for the effectiveness and safety of current therapeutic options is varied. Cannabinoids have been proposed as an alternative therapy, mainly due to their activity on CB1 receptors in the central nervous system. However, little is known regarding the safety and effectiveness of cannabinoid therapy in people with dementia. A literature review was undertaken to identify, describe and critically appraise studies investigating cannabinoid use in treating NPS in dementia. Methods: We undertook a systematic review adhering to PRISMA guidelines. Twenty-seven online resources were searched, including Medline, PsycINFO and Embase. Studies assessing the safety and or effectiveness of cannabinoids in treating NPS in dementia in people aged ⩾ 65 years were included. Study quality was assessed using the Johanna Briggs Institute and Cochrane Collaboration critical appraisal tools. Results: Twelve studies met the inclusion criteria. There was considerable variability across the studies with respect to study design (50% randomized controlled trials), intervention [dronabinol (33%), nabilone (25%) or delta-9 tetrahydrocannabinol (THC; 42%)] and outcome measures. Dronabinol (three studies) and THC (one study) were associated with significant improvements in a range of neuropsychiatric scores. The most common adverse drug event (ADE) reported was sedation. A high risk of bias was found in eight studies. The highest-quality trial found no significant improvement in symptoms or difference in ADE rate between treatment arms. Included studies used low doses of oral cannabinoids and this may have contributed to the lack of demonstrated efficacy. Conclusion: While the efficacy of cannabinoids was not proven in a robust randomized control trial, observational studies showed promising results, especially for patients whose symptoms were refractory. In addition, the safety profile is favourable as most of the ADEs reported were mild. Future trials may want to consider dose escalation and formulations with improved bioavailability.
*The Australian Pharmaceutical Advisory Committee guidelines call for a detailed medication history to be taken at the first point of admission to an Emergency Department (ED). The elderly, in particular those residing in Residential Aged Care Facilities and those with a non-English speaking background, have been identified as patient groups vulnerable to medication misadventure. Objective: to analyse the incidence of discrepancies in medication histories in these demographic groups when pharmacist elicited medication histories were compared with those taken by ED physicians. It also aimed to investigate the incidence of medication related ED presentations. Methods: The study was conducted over a six week period and included 100 patients over the age of 70, who take five or more regular medications, have three or more clinical co-morbidities and/or have been discharged from hospital in three months prior to the study. Results: Twenty four participants were classified as 'language barrier'; 12 participants were from residential aged care facilities, and 64 participants were classified as 'general'. The number of * Maja AJDUKOVIC.
Objective To analyse management of chronic pain in the Australian aged care setting. Methods In the course of performing medication reviews, details of medications prescribed (including dosage) were collated and stored in a secure database along with information about medical morbidities, demographic data and the results of clinical investigations. Details of analgesic and adjuvant medication used in pain management was subjected to de‐identified analysis. Results There were 22 319 reviews analysed. Prescribing of opiate analgesics was widespread, with products containing oxycodone used in 24% of cases. Many residents were concurrently prescribed two or more analgesics. Adjuvant agents were prescribed in 3073 cases, with the most commonly used individual agent being pregabalin (n = 1411). Use of medications for management of adverse effects associated with opioids was common. Conclusion Use of analgesics and related medications is widespread in the aged care sector. These agents are associated with significant adverse effects, and older people may not tolerate doses that deliver satisfactory pain control.
To measure the glomerular filtration rate (GFR) in adults and children with cystic fibrosis (CF) using a radio-isotope technique as the gold standard and to compare this to serum creatinine based equations, serum cystatin C levels and tobramycin clearance, and to determine which method correlates most closely with measured GFR in this population.
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