ORCID Profile
0000-0002-5647-4673
Current Organisations
University of South Australia
,
Royal Adelaide Hospital
,
University of Adelaide
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2023
DOI: 10.1097/FTD.0000000000001047
Abstract: Different software applications have been developed to support health care professionals in in idualized drug dosing. However, their translation into clinical practice is limited, partly because of poor usability and integration into workflow, which can be attributed to the limited involvement of health care professionals in the development and implementation of drug dosing software. This study applied codesign principles to inform the design of a drug dosing software to address barriers in therapeutic drug monitoring using vancomycin as an ex le. Three workshops (face-to-face and online) were conducted by design researchers with pharmacists and prescribers. User journey storyboards, user personas, and prototyping tools were used to explore existing barriers to practice and opportunities for innovation through drug dosing software design. A prototype of the software interface was developed for further evaluation. Health care professionals (11 hospital pharmacists and 6 prescribers) with ≥2 years of clinical experience were recruited. Confidence and software usability emerged as the main themes. Participants identified a lack of confidence in vancomycin dosing and pharmacokinetic understanding and difficulty in accessing practice guidelines as key barriers that could be addressed through software implementation. Accessibility to information (eg, guidelines and pharmacokinetic resources) and information presentation (eg, graphical) within the dosing software were dependent on the needs and experience of the user. A software prototype with a speedometer-dial visual to convey optimal doses was well received by participants. The perspectives of health care professionals highlight the need for drug dosing software to be user centered and adaptable to the needs and workflow of end users. Continuous engagement with stakeholders on tool usability, training, and education is needed to promote the implementation in practice.
Publisher: Elsevier BV
Date: 02-2023
Publisher: Wiley
Date: 09-2010
DOI: 10.1002/J.2055-2335.2010.TB00535.X
Abstract: Violent behaviour displayed by hospital patients that are a physical and personal threat to patients, visitors and staff is an emergency situation. To evaluate medications used to manage violent behavioural disturbances to explore patients' antecedent characteristics and to assess concordance with hospital guidelines. Retrospective analysis (March 2008 to August 2009) of a convenience s le of hospital patients who displayed violent behaviour requiring an emergency response. Patient data were extracted from case notes and the Australian Incident Monitoring System, and included baseline demographics, medication used during admission, details of the behavioural disturbance and outcomes of the emergency response. Of the 28 patients analysed, 23 (82%) were male. Mean age was 81.5 years and 50% were aged 80 to 89 years. 17 (61%) patients were admitted for cognitive decline and 24 (86%) had a history of neuropsychiatric disorders. Clonazepam was the most frequently used drug and the intramuscular route was the most popular mode. Patients with poorly controlled pain were more likely to display violent behaviour (p 0.01). Initiating antipsychotics or dose increases during admission was significantly associated with multiple violent episodes (p 0.001). Opioids were most likely to be charted before a violent episode (n = 10 36%) and ceased after an episode (n = 5 18%). Concordance with hospital guidelines was observed in 18 (64%) cases. Non‐concordance with hospital guidelines was not predictive of multiple violent episodes. Better assessment of at‐risk patients and early intervention are required. Concordance with hospital guidelines was low. Effective implementation, monitoring and adjustment of protocols used in emergency responses require interdisciplinary collaboration.
Publisher: Springer Science and Business Media LLC
Date: 30-01-2021
Publisher: MDPI AG
Date: 28-06-2021
DOI: 10.3390/JCM10132856
Abstract: Background. Lynch syndrome is the most common genetic predisposition for hereditary cancer. Carriers of pathogenic changes in mismatch repair (MMR) genes have an increased risk of developing colorectal (CRC), endometrial, ovarian, urinary tract, prostate, and other cancers, depending on which gene is malfunctioning. In Lynch syndrome, differences in cancer incidence (penetrance) according to the gene involved have led to the stratification of cancer surveillance. By contrast, any differences in penetrance determined by the type of pathogenic variant remain unknown. Objective. To determine cumulative incidences of cancer in carriers of truncating and missense or aberrant splicing pathogenic variants of the MLH1 and MSH2 genes. Methods. Carriers of pathogenic variants of MLH1 (path_MLH1) and MSH2 (path_MSH2) genes filed in the Prospective Lynch Syndrome Database (PLSD) were categorized as truncating or missense/aberrant splicing according to the InSiGHT criteria for pathogenicity. Results. Among 5199 carriers, 1045 had missense or aberrant splicing variants, and 3930 had truncating variants. Prospective observation years for the two groups were 8205 and 34,141 years, respectively, after which there were no significant differences in incidences for cancer overall or for colorectal cancer or endometrial cancers separately. Conclusion. Truncating and missense or aberrant splicing pathogenic variants were associated with similar average cumulative incidences of cancer in carriers of path MLH1 and path_MSH2.
Publisher: Oxford University Press (OUP)
Date: 02-2019
DOI: 10.1093/AJHP/ZXY035
Abstract: This article reviews the literature concerning ceftazidime stability and potential for toxicity from pyridine (a degradation product) in the light of decades of apparent safe use of this antibiotic when given by continuous i.v. infusion but recent changes in regulatory body/manufacturer advise a need to change infusion devices more frequently. In the outpatient setting, ceftazidime is ideally administered by continuous i.v. infusion because of its short half-life and lack of post-antibiotic effect. While continuous i.v. infusion provides the optimal pharmacokinetic harmacodynamic profile, the frequency with which infusion devices need to be changed is critical to the practicality in the outpatient setting, especially where trained staff are required to visit the patient in their home to change the device. The rate of ceftazidime degradation (and pyridine formation) is temperature, concentration, and solvent dependent. By using the lowest effective dose (guided by pathogen minimum inhibitory concentration [MIC] so as to achieve a blood concentration ≥ 4 × MIC over the whole dosage interval), keeping ceftazidime concentration ≤ 3%, using 0.9% sodium chloride injection as diluent and maintaining temperature between 15-25°C when connected to the patient, the amount of pyridine formed over a 24-hour period can be minimized and toxicity prevented. When pathogen MIC dictates that > 6 g ceftazidime/day is required, alternative antibiotics should be considered and/or greater attention paid to temperature and concentration of the infusion solution. Ceftazidime can be used safely and effectively via continuous i.v. infusion in the outpatient setting with once-daily changes of infusion device provided the concentration and temperature of the infusion solution is controlled. In this way, more frequent changes of infusion device (that increase the risk of blood-borne infection and reduce the practicality of continuous i.v. infusion in the home) can be avoided.
Publisher: Elsevier BV
Date: 02-2023
Publisher: Wiley
Date: 15-11-2022
DOI: 10.1111/TID.13988
Abstract: Limited consensus exists on the optimal use of antifungal agents to prevent invasive fungal infection in the early post allogeneic hematopoietic stem cell transplant (alloHCT) period, particularly when patients cannot tolerate oral medication administration. We undertook a retrospective observational cohort study to assess the tolerability, efficacy, and cost of a new antifungal prophylaxis pathway at a major tertiary alloHCT centre. Patients aged ≥16 years who underwent alloHCT between February 2018 and October 2019 (cohort 1) or between April 2020 and November 2021 (cohort 2) were included. In both cohorts, first line prophylactic therapy was oral posaconazole. The second line drugs where oral therapy was unable to be administered were intravenous voriconazole (cohort 1) versus intravenous posaconazole (cohort 2). There were 142 patients enrolled in the study, 71 in each cohort. The proportion of patients remaining on first‐line prophylaxis or progressing to second‐, third‐, and fourth‐line options was 22.5%, 39.4%, 29.6%, and 8.5% in cohort 1 and 39.4%, 59.2%, 1.4%, and 0% in cohort 2, respectively. The frequency of neuropsychiatric adverse events was significantly higher in cohort 1 compared to cohort 2 (49.3% vs. 19.8%, p = .0004). Occurrence of proven and probable fungal infections was not significantly different between cohorts. Antifungal drug expenditure was $359 935 (AUD) more in cohort 1 ($830 486 AUD) compared to cohort 2 ($477 149 AUD). The antifungal prophylaxis pathway used in cohort 2 resulted in reduced antifungal‐associated adverse effects, less patients requiring progression to 3rd and 4th line prophylaxis and reduced antifungal drug costs. image
Publisher: American Society for Microbiology
Date: 23-02-2023
DOI: 10.1128/AAC.01550-22
Abstract: Treatment of cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell transplantation (alloHCT) patients with ganciclovir is complicated by toxicity and resistance. This study aimed to develop an intravenous ganciclovir population pharmacokinetic model for post-alloHCT patients and to determine dosing regimens likely to achieve suggested therapeutic exposure targets.
Publisher: American Society of Hematology
Date: 15-11-2022
Publisher: Elsevier BV
Date: 10-2017
Publisher: Elsevier BV
Date: 02-2023
Location: Australia
No related grants have been discovered for Philip Selby.