ORCID Profile
0000-0002-1783-0161
Current Organisations
La Trobe University
,
University of Melbourne
,
Monash University
,
University College London
,
Victoria University
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Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.IJNURSTU.2017.03.008
Abstract: No published study has been specifically designed to compare medication administration errors between original medication packaging and multi-compartment compliance aids in care homes, using direct observation. Compare the effect of original medication packaging and multi-compartment compliance aids on medication administration accuracy. Prospective observational. Ten Greater London care homes. Nurses and carers administering medications. Between October 2014 and June 2015, a pharmacist researcher directly observed solid, orally administered medications in tablet or capsule form at ten purposively s led care homes (five only used original medication packaging and five used both multi-compartment compliance aids and original medication packaging). The medication administration error rate was calculated as the number of observed doses administered (or omitted) in error according to medication administration records, compared to the opportunities for error (total number of observed doses plus omitted doses). Over 108.4h, 41 different staff (35 nurses, 6 carers) were observed to administer medications to 823 residents during 90 medication administration rounds. A total of 2452 medication doses were observed (1385 from original medication packaging, 1067 from multi-compartment compliance aids). One hundred and seventy eight medication administration errors were identified from 2493 opportunities for error (7.1% overall medication administration error rate). A greater medication administration error rate was seen for original medication packaging than multi-compartment compliance aids (9.3% and 3.1% respectively, risk ratio (RR)=3.9, 95% confidence interval (CI) 2.4 to 6.1, p<0.001). Similar differences existed when comparing medication administration error rates between original medication packaging (from original medication packaging-only care homes) and multi-compartment compliance aids (RR=2.3, 95%CI 1.1 to 4.9, p=0.03), and between original medication packaging and multi-compartment compliance aids within care homes that used a combination of both medication administration systems (RR=4.3, 95%CI 2.7 to 6.8, p<0.001). A significant difference in error rate was not observed between use of a single or combination medication administration system (p=0.44). The significant difference in, and high overall, medication administration error rate between original medication packaging and multi-compartment compliance aids supports the use of the latter in care homes, as well as local investigation of tablet and capsule impact on medication administration errors and staff training to prevent errors occurring. As a significant difference in error rate was not observed between use of a single or combination medication administration system, common practice of using both multi-compartment compliance aids (for most medications) and original packaging (for medications with stability issues) is supported.
Publisher: Royal Society of Chemistry (RSC)
Date: 2018
DOI: 10.1039/C8NR07059H
Abstract: 2D binary colloidal alloys obtained by sequential depositions of microgel monolayers used to fabricate vertically aligned nanowires by soft nanotemplating.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.SAPHARM.2018.03.060
Abstract: Inappropriate use of pain medication has serious consequences for older populations. Experts in the field have noted an increase in opioid prescriptions, and opioid-related hospitalisations and deaths among this vulnerable population. In the pursuit of educating pharmacists, physicians, allied healthcare professionals, researchers, academics and the public facing the challenges of chronic pain medication management, 'The Inaugural Monash University School of Public Health and Preventive Medicine (SPHPM) Best Practice in Chronic Pain Medication Management Day Conference' was held in December 2016 at the Alfred Medical Research and Education Precinct (Melbourne, Australia). Fifteen experts presented on aspects of chronic pain epidemiology and current analgesic use in older Australians, and discussed current practice and associated challenges. Presenters highlighted the dramatic increase in opioid prescribing, development of tolerance and withdrawal symptoms, problems with abuse and addiction, increased risk of death from overdose or suicide, potentiation of sedative effects with concurrent use of anxiolytics/hypnotics, and medication ersion. Pharmacists are very accessible to patients and are crucial members of medication management teams. They have the necessary medication expertise to review medication regimens and provide patient education. Towards addressing chronic pain medication management of older populations, pharmacists can contribute in several ways, such as being aware of relevant guidelines and completing further training, contributing to policy and guideline development, participating in multidisciplinary panels, working groups and pain management teams, collaborating on research projects, and educating the community. With regards to opioid medication management, pharmacists are in an ideal position to: monitor prescription dispensing and potential misuse, provide education about overuse, and, if appropriate, provide access to naloxone. In order to fulfil these roles and responsibilities, allied healthcare professionals should be educated and informed, and opportunities for continuing professional education should be available and utilised. Pharmacists should have the necessary knowledge and skills to optimise chronic pain management, and to both deliver and inform policies and guidelines on pharmacological management of chronic pain in older people.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Oxford University Press (OUP)
Date: 10-2019
DOI: 10.1111/IJPP.12581
Abstract: To develop an elective workshop designed to equip pharmacy students with skills to effectively communicate with adolescents. To conduct preliminary evaluation of the workshop to assess its impact on pharmacy student perceived confidence and knowledge relating to the importance of adolescent counselling and counselling techniques. Academics from three universities in three countries collaborated on the workshop development and evaluation. The workshop structure was designed upon the foundations of communication best practices and established techniques, and it consisted of two online modules and an in-person tutorial. Pharmacy students undertaking a 4-year Bachelor, Master or Doctor of Pharmacy degree from all three participating universities evaluated the workshop via pre- and post-questionnaires. A total of 81 pharmacy students volunteered to attend and evaluate the workshop. Of these 81 students, 31 completed paired pre- and post-questionnaires, 44 students completed unpaired questionnaires and six students were lost to follow-up. Of the paired pre- and post-questionnaires, students were mostly female (67.7%) with an average age of 24.9 years (standard deviation, SD = 5.6) and were in the first (32.3%), second (16.1%) or third (51.6%) year of their pharmacy programme. Over 80% of students somewhat or strongly agreed that the workshop made them feel more comfortable speaking with young people in pharmacy settings. Mean (SD) perceived confidence (pre = 21.7 (4.0) and post = 24.9 (4.5)) and knowledge scores (pre = 5.2 (1.5) and post = 6.6 (1.6)) significantly improved after undertaking the workshop. The workshop increased pharmacy student perceived confidence and knowledge relating to the importance of adolescent counselling and counselling techniques.
Publisher: Wiley
Date: 07-2010
Publisher: Wiley
Date: 28-07-2017
DOI: 10.1111/JGH.13750
Publisher: Wiley
Date: 28-02-2023
DOI: 10.1111/JGS.18305
Abstract: Dietary supplement and complementary and alternative medication (CAM) use can contribute to drug interactions, polypharmacy, nonadherence with prescription medications, and healthcare expenses, whereas evidence supporting benefits of using these products is sparse. There is a lack of current published literature describing the patterns or predictors of their use in community‐dwelling older adults. We performed a cross‐sectional analysis of community‐dwelling adults from Australia and the US, aged 70 years and older (65 years for US minorities), enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) study. At study enrollment, eligible participants were required to be without concurrent 5‐year life‐limiting illness and free of documented evidence of cardiovascular disease, dementia, or significant physical disability. During the final study visit, a questionnaire was administered to collect information about supplement/CAM use. Data from 15,729 participants who completed this questionnaire between January 2017 and January 2018 were analyzed. Descriptive statistics were used to report the prevalence and types of products used. Factors associated with use were determined using multivariate regression. Mean age of respondents was 79.6 years 56.4% were female, 88.8% were from Australia, 56.5% reported 12 years of education or less, and 98.7% were living at home. Two‐thirds (66.2%) of participants reported use of one or more supplement/CAM in the previous month. Products most commonly used included vitamin D (33.8% of participants), fish oil (22.7%), calcium (20.6%), glucosamine (14.8%), and multivitamin (12.9%). Female sex, US residency, higher education, polypharmacy (prescription medications), and frailty (in women) were significantly associated with higher use of supplements/CAMs. Dietary supplement and CAM use is common among community‐dwelling older adults in the United States and Australia. Given the high prevalence of use, collaboration between healthcare providers and older adult patients is important to insure safe and optimal use of these products.
Publisher: Therapeutic Guidelines Limited
Date: 06-2018
Publisher: Oxford University Press (OUP)
Date: 11-2022
DOI: 10.1093/GERONI/IGAC059.2122
Abstract: Polypharmacy and frailty are two common geriatric syndromes. We examined the association between polypharmacy and frailty and if, together, they predicted disability-free survival (DFS), defined as time to the first event of dementia, persistent physical disability or death. We included 19,114 participants from the "ASPirin in Reducing Events in the Elderly" (ASPREE) clinical trial. Polypharmacy was defined as regular, concomitant use of five or more prescription medications. Frailty was assessed using a modified Fried phenotype and a deficit accumulation frailty index (FI) of 66 items. The association between polypharmacy and frailty was assessed by multinomial logistic regression. In addition, Cox regression was used to determine the association between polypharmacy-exposed frailty and DFS. In iduals with polypharmacy (vs. & 5 medications) were 55% more likely to be pre-frail (Relative Risk Ratio or RRR: 1.55 95%Confidence Interval or CI:1.44, 1.68) and three times more likely to be frail (RRR: 3.34 95%CI: 2.64, 4.22) according to Fried phenotype. Frail in iduals had a two-fold reduction in their survival free of dementia/disability (Hazard ratio or HR: 2.16 95%CI: 1.56, 2.99), whereas frail in iduals with polypharmacy had a four-fold reduction (HR: 4.24 95%CI: 3.28, 5.47). Effect sizes were more prominent when frailty was assessed using the FI than when assessed by Fried phenotype. Polypharmacy was significantly associated with pre-frailty/frailty. Polypharmacy-exposed pre-frailty/frailty increased the risk of death, dementia or physical disability among older adults. Addressing polypharmacy in older people could ameliorate the impact of frailty on in iduals’ functional status, cognition and survival.
Publisher: Springer Science and Business Media LLC
Date: 06-02-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2022
DOI: 10.1161/HYPERTENSIONAHA.122.19356
Abstract: Impaired cerebral blood flow has been associated with an increased risk of falls. Mean arterial pressure (MAP) and variability in MAP have been reported to affect cerebral blood flow but their relationships to the risk of falls have not previously been reported. Utilising data from the Aspirin in Reducing Events in the Elderly trial participants, we estimated MAP and variability in MAP, defined as within-in idual SD of MAP from baseline and first 2 annual visits. The relationship with MAP was studied in 16 703 participants amongst whom 1539 falls were recorded over 7.3 years. Variability in MAP was studied in 14 818 of these participants who experienced 974 falls over 4.1 years. Falls were confined to those involving hospital presentation. Cox regression was used to calculate hazard ratio and 95% CI for associations with falls. Long-term variability in MAP was not associated with falls except amongst frail or prefrail participants using antihypertensive medications. Within this group each 5 mm Hg increase in long-term variability in MAP increased the risk of falls by 16% (hazard ratio, 1.16 [95% CI, 1.02–1.33]). Amongst the antihypertensive drugs studied, beta-blocker monotherapy (hazard ratio, 1.93 [95% CI, 1.17–3.18]) was associated with an increased risk of falls compared with calcium channel blockers. Higher levels of long-term variability in MAP increase the risk of serious falls in older frail and prefrail in iduals taking antihypertensive medications. The observation that the relationship was limited to frail and prefrail in iduals might explain some of the variability of previous studies linking blood pressure indices and falls.
Publisher: Wiley
Date: 06-10-2016
DOI: 10.1002/JPPR.1249
Publisher: Wiley
Date: 04-09-2018
DOI: 10.1111/APT.14955
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.SAPHARM.2013.01.002
Abstract: Though staff at Australian nursing homes (NHs) commonly administer medicines that have been re-packed into dose administration aids (DAAs) that organize medicines according to dose schedule, these pharmacy-supplied devices have not been extensively evaluated in the Australian setting. To audit the accuracy and suitability of re-packing medicines into DAAs (blister packs or sachets) for NHs and identify the proportion of DAAs with inaccurate or unsuitable medicine re-packing. Between January and June 2011, pharmacist researchers visited 49 randomly and purposively selected NHs from rural, regional, and metropolitan Victoria (Australia) to audit a s le of residents' newly prepared DAAs that contained all of their regularly re-packed medicines for 1 week. Over 1 or 2 days, the pharmacy-supplied DAAs were compared with the current prescriber-prepared NH medicine chart. Any occurrences of inaccurately re-packed medicines (discrepancies, with verification as necessary) or unsuitable medicine re-packing were recorded as DAA incidents and descriptive statistics was used to analyze the data. Six hundred and eighty-four incidents occurring in 457 DAAs were detected from a total of 3959 DAAs audited for 1757 residents (incident rate of 11.5% of DAAs) from 49 participating NHs. Incidents were detected in 10.5% of blister packs and 14.5% of sachets. The top five incidents were unsuitable re-packing according to pharmaceutical guidelines (50.1%) added medicine (9.8%) incorrect quantity re-packed (5.4%) omitted medicine (5.3%) and damaged medicine (5.1%). The incident rate of inaccurate or unsuitable medicine re-packing within DAAs supplied to NHs for use in medicine administration was higher than in previous research. Recommendations include using current findings in conjunction with further research to develop a quality improvement initiative to reduce DAA incident rates and improve NH standard of care.
Publisher: Wiley
Date: 21-10-2016
DOI: 10.1111/AJAG.12236
Publisher: Wiley
Date: 21-01-2021
DOI: 10.1111/PAPR.12980
Abstract: Evaluate the Pain Impact Index, a simple, brief, easy‐to‐use, and novel tool to assess the impact of chronic pain in community‐dwelling older adults. A Rasch modelling analysis was undertaken in Stata using a partial credit model suited to the Likert‐type items that comprised the Index. The Index was evaluated for ordering of category thresholds, unidimensionality, overall fit to the Rasch model, measurement bias (Differential Item Functioning, DIF), targeting, and construct validity. The four‐item Pain Impact Index was self‐completed by 6454 community‐dwelling Australians who were aged at least 70 years and experienced pain on most days. Two items showed evidence of threshold disordering, and this was resolved by collapsing response categories (from 5 to 3) for all items. The rescored Index conformed to the unidimensionality assumption and had satisfactory fit with the Rasch model (analyses conducted on a reduced s le size to mitigate the potential for overpowering: n = 377, P 0.0125, power 77%). When considering uniform DIF, the most frequent sources of measurement bias were age, knee pain, and upper back pain. When considering nonuniform DIF, the most frequent source of measurement bias was knee pain. The Index had good ability to differentiate between respondents with different levels of pain impact and had highest measurement precision for respondents located around the average level of pain impact in the study s le. Both convergent and discriminant validity of the Index were supported. The Pain Impact Index showed evidence of unidimensionality, was able to successfully differentiate between levels of pain impact, and had good evidence of construct validity.
Publisher: SAGE Publications
Date: 30-08-2020
Abstract: This study explored public perceptions about the importance of, and how to create, ageing- and dementia-friendly pharmacists and pharmacies. In September 2016, four focus groups (45 minutes each) were conducted with 16 participants who represented organisations, groups or forums working with and/or for older people and people with dementia in Greater London. Discussions were recorded via handwritten notes and thematically analysed. Participants confirmed the importance of pharmacists and pharmacies being ageing- and dementia-friendly and described variability in whether this is currently the case. Suggested strategies for improvement included targeting communication, pharmacist leadership and shop layout.
Publisher: Oxford University Press (OUP)
Date: 08-2016
DOI: 10.2146/AJHP160261
Publisher: Wiley
Date: 09-05-2023
DOI: 10.1111/JGS.18395
Abstract: The protective effects of allopurinol on physical function in older adults are not well understood, despite its potential to improve functional gains and reduce sarcopenia. This study aims to determine the association between allopurinol, persistent physical disability, and frailty in older gout patients. This analysis used data from a randomized trial in an older cohort, ASPirin in Reducing Events in the Elderly (ASPREE). ASPREE recruited 19,114 participants aged ≥65 years without prior cardiovascular events, dementia, or independence‐limiting physical disability at trial enrolment. This analysis examined the association of baseline and time‐varying allopurinol use with persistent physical disability and new‐onset frailty in participants with gout at baseline (self‐report or use of any anti‐gout medications). Frailty was measured using the Fried frailty phenotype (score ≥3/5) and a deficit accumulation frailty index (FI) (score .21/1.0). Multivariable Cox proportional‐hazards models were used for main analyses. This analysis included 1155 gout participants, with 630 taking allopurinol at baseline and 525 not. During a median follow‐up of 5.7 years, 113 new allopurinol users were identified. Compared with nonusers, baseline allopurinol use was associated with a significant risk reduction of persistent physical disability (Adjusted HR 0.46, 95% CI 0.23–0.92, p = 0.03). The strength of the association was modestly attenuated in the time‐varying analysis (Adjusted HR 0.56, 0.29–1.08, p = 0.08). No significant associations with frailty measures were observed for either baseline allopurinol use (Fried frailty: Adjusted HR 0.83, 0.62–1.12 FI: Adjusted HR 0.96, 0.74–1.24) or time‐varying allopurinol use (Fried frailty: Adjusted HR 0.92, 0.69–1.24 FI: Adjusted HR 1.02, 0.78–1.33). Allopurinol use in older adults with gout is associated with a reduced risk of persistent physical disability but not associated with risk of frailty.
Publisher: SAGE Publications
Date: 02-10-2018
Abstract: The longitudinal pattern of medication use among family caregivers of people with dementia is not well understood, despite the potential for medication over- or under-use. To investigate caregiver medication use over a five-year follow-up using data obtained via self-report and from a national prescription register, and compare agreement between medication data obtained from the two sources. Medication data for 222 family caregivers of people with Alzheimer’s disease were obtained via self-report and from the Finnish Social Insurance Institution. Generalised estimating equations, Kappa statistics and related s les Wilcoxon signed rank test were used to analyse medication use over time. The mean number of medications used by caregivers increased from 3.4 to 4.1 (self-reported current regular medications) and 2.4 to 2.8 (reimbursed prescription medications during the past 90 days) over five years (p 0.001). Significantly, more medications were identified via self-report (mean 3.6, SD = 3.3) than the national prescription register (mean 2.6, SD = 2.4, Z= –12.300, p 0.001). Agreement between the two data sources was good for cardiovascular medications and anti-hypertensives (Kappa = 0.883–0.967, p 0.001) and medications for acid-related disorders (Kappa = 0.508–0.092, p 0.001). Agreement was moderate for analgesics (Kappa = 0.281–0.477, p 0.001) and psychotropics (Kappa = 0.281–0.562, p 0.002). The proportion of caregivers using five or more medications increased from 27.5% to 44.6% (self-report), and 16.7% to 27.7% (register) (p 0.001). Caregivers use an increasing number of medications in the first five years of caring for persons with dementia, and self-report using a higher number of medications than data from the national prescription register suggest.
Publisher: Elsevier BV
Date: 11-2012
Publisher: Elsevier BV
Date: 11-2012
Publisher: Oxford University Press (OUP)
Date: 07-2017
DOI: 10.2146/AJHP170094
Publisher: Wiley
Date: 19-08-2022
DOI: 10.1002/EHF2.14101
Abstract: Prescribed opioids are commonly used in the older community‐dwelling population for the treatment of chronic pain. Although the harmful effects of opioid abuse and overdose are well understood, little is known about the long‐term cardiovascular (CV) effects of prescribed opioids. The aim of this study was to investigate the CV effects associated with prescribed opioid use. A post hoc analysis of participants in the Aspirin in Reducing Events in the Elderly (ASPREE) trial was conducted. Participants in the ASPREE trial included community‐dwelling older adults without a prior history of CV disease (CVD). Prescribed opioid use was defined as opioid use at baseline and/or at the first annual visit (AV1). Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals (95% CI) for associations between opioid use and CVD events following AV1. Of the 17 701 participants included (mean age 75.2 years, 58.2% female), 813 took opioids either at baseline or at AV1. Over a median follow‐up period of 3.58 years (IQR 2.50–4.62), CVD events, most notably heart failure hospitalization, occurred in 7% ( n = 57) amongst opioid users and 4% ( n = 680) amongst non‐opioid users. After adjustment for multiple covariates, opiate use was associated with a 1.67‐fold (CI 1.26–2.23, P 0.001) increase in the hazard ratio for CVD events. These findings identify opioid use as a non‐traditional risk factor for CVD events in community‐dwelling older adults.
Publisher: Elsevier BV
Date: 09-2016
Publisher: Public Library of Science (PLoS)
Date: 17-02-2015
Publisher: Springer Science and Business Media LLC
Date: 04-09-2019
DOI: 10.1007/S40266-019-00704-6
Abstract: Our objective was to investigate associations between proton pump inhibitor (PPIs) use and infection-related hospitalizations among residents of long-term care facilities (LTCFs). This was a case-control study of residents aged ≥ 65 years admitted to hospital between July 2013 and June 2015. Residents admitted for infections (cases) and falls or fall-related injuries (controls) were matched for age (± 2 years), sex, and index date of admission (± 6 months). Conditional logistic regression was used to estimate crude and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between PPI use and infection-related hospitalizations. Analyses were adjusted for age, sex, polypharmacy, diabetes, heart failure, chronic obstructive pulmonary disease, myocardial infarction, cerebrovascular accident, and concomitant use of cancer and immunosuppressant medications. Subgroup analyses were performed for high- and low/moderate-intensity PPIs and for respiratory and non-respiratory infections. Logistic regression was used to compare the odds of infection-related hospitalizations among users of high- and low/moderate-intensity PPIs. Overall, 181 cases were matched to 354 controls. Preadmission PPI use was associated with infection-related hospitalizations (aOR 1.66 95% CI 1.11-2.48). In subgroup analyses, the association was apparent only for respiratory infections (aOR 2.26 95% CI 1.37-3.73) and high-intensity PPIs (aOR 1.93 95% CI 1.23-3.04). However, the risk of infection-related hospitalization was not significantly higher among users of high- versus low/moderate-intensity PPIs (aOR 1.25 95% CI 0.74-2.13). Residents who use PPIs may be at increased risk of infection-related hospitalizations, particularly respiratory infections. Study findings provide further support for initiatives to minimize unnecessary PPI use in the LTCF setting.
Publisher: Oxford University Press (OUP)
Date: 23-01-2014
DOI: 10.1111/IJPP.12091
Abstract: Dose administration aids (DAAs) organise medicines that have been repacked according to the day of the week and time of the day in which they must be taken. In Australia, DAAs are commonly prepared by pharmacy staff for residential aged care facility (RACF) medicine administration. Although the limited available literature indicates that DAA incidents of inaccurate or unsuitable medicine repacking do occur, there is a paucity of qualitative research identifying quality improvement strategies for this service. This study aims to investigate the perceived contributing factors to DAA incidents and strategies for quality improvement in RACFs and pharmacies. Health professional perceptions were drawn from three structured focus groups, including six pharmacists, five nurses, a pharmacy technician and a personal care worker. Participants were involved in the preparation, supply or use of DAAs at pharmacies or RACFs that were involved in a previous DAA audit. Transcripts were analysed using thematic analysis. Four major themes were identified as contributing to DAA incidents, with quality improvement strategies aligned to those same four themes: communication, knowledge and awareness, medicine handling and attitude. Strategies included improving interprofessional communication and addressing the limitations associated with RACF medicine records targeting medicine knowledge gaps and increasing awareness of DAA incidents encouraging greater care when preparing and checking DAAs and fostering a team mentality among members of the aged care team. Recommendations include using current findings to develop multidisciplinary quality improvement initiatives to prevent DAA incidents and to improve the quality of this pharmacy medicine supply service.
Publisher: Elsevier BV
Date: 09-2014
Publisher: Elsevier BV
Date: 03-2018
Publisher: Elsevier BV
Date: 2022
DOI: 10.2139/SSRN.4022935
Publisher: Elsevier BV
Date: 07-2023
Publisher: Elsevier BV
Date: 07-2022
Publisher: Elsevier BV
Date: 05-2017
Publisher: Oxford University Press (OUP)
Date: 19-10-2015
DOI: 10.1111/JPHS.12105
Abstract: Medicines maintain and improve care home (CH) residents' health and therefore, it is imperative that CH medicine management systems are regularly evaluated to ensure they continually provide a high standard of care. Multicompartment compliance aid (MCA) medicine management systems are often used to assist United Kingdom CH staff with managing the large volume of medicines used by residents. This study aimed to identify the factors that led to the widespread adoption of MCAs into United Kingdom CHs, limitations associated with their current use and their relevance in the future. In June and July 2014 semi-structured interviews were conducted with eight pharmacists who were purposively selected for their expertise in CH medicine management systems in the United Kingdom. A qualitative thematic approach was employed in the analysis of data. Findings indicated that MCAs were introduced into CHs to address unsafe medicine administration practices and because of pharmacy commercial interest. Identified limitations included reduced staff alertness during medicine administration, restricted ability to identify medicines, and medicine wastage. Participants predicted continued use of MCAs in the future due to their perceived benefits of improved safety and efficiency, although some pharmacists recommended that they be removed and CH staff trained to administer medicines from original packaging. These findings can contribute towards information used by health care providers when deciding on the relevance of MCAs in their current medicine management systems. Additionally, they can contribute towards information used by policy makers when revising United Kingdom CH medicine management guidelines.
Publisher: Elsevier BV
Date: 02-2021
Publisher: Elsevier BV
Date: 07-2020
Publisher: Elsevier BV
Date: 07-2015
Publisher: SAGE Publications
Date: 11-09-2020
Abstract: Objective: To describe the prevalence, location and impact of moderate to severe pain experienced on most days in community-dwelling older (≥70 years) adults who were ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial participants. Methods: Cross-sectional ASPREE Longitudinal Study of Older Persons (ALSOP) data were collected from self-reported questionnaires administered to 16,439 ASPREE participants. Results: Of 14,155 respondents, 41% of males ( n = 2651/6475) and 50% of females ( n = 3803/7680) reported experiencing pain on most days. One quarter of respondents reported experiencing pain on most days that was moderate or severe in intensity ( n = 3560/14,155), commonly located in the lower back, knees and upper back. Of those reporting moderate or severe pain, 51% reported taking analgesic medication on most days ( n = 1812/3560), almost one-third also reported regular interference with sleep (29%, n = 1024/3560), walking (35%, n = 1239/3560) and daily activities (41%, n = 1467/3560). Discussion: Lower back, knee or upper back pain is a common accompaniment of ageing.
Publisher: Springer Science and Business Media LLC
Date: 23-08-2013
DOI: 10.1007/S11096-013-9839-Z
Abstract: There is a risk that medicines can be dispensed into dose administration aids (DAAs), inaccurately or unsuitably. Quality improvement interventions (QIIs) may target this pharmacy medicine supply service and reduce the occurrence of these dispensing errors. In turn, medicine administration can improve in nursing homes (NHs) that use these devices. To develop, introduce and evaluate the potential of a QII to improve DAA medicine supply. Fourteen Victorian community pharmacies and 45 NHs. A QII was developed using findings from three focus groups with 13 participants involved with DAAs at community pharmacies and NHs. The intervention was introduced to community pharmacies and NHs via a pharmacist-facilitated education session attendees completed an evaluation questionnaire. Potential usefulness and effectiveness of the QII at improving DAA supply and reducing dispensing errors. The QII was titled: 'Be alert and work together for medicine safety, DAA incident awareness toolkit'. Four-hundred and thirty-five questionnaires were returned (85.0 % response rate). Respondents believed the intervention had the potential to improve pharmacy medicine supply or NH medicine administration involving DAAs 'very' (47.3 % of responses) or 'extremely well' (23.4 %). The intervention had the potential to reduce the occurrence of DAA dispensing errors 'very' (49.6 %) or 'extremely well' (20.5 %). A stakeholder informed QII was perceived to have the potential to improve DAA medicine supply from community pharmacies to NHs and reduce the occurrence of dispensing errors found within them. Future quantitative evaluation of the intervention is required.
Publisher: SAGE Publications
Date: 16-04-2020
Abstract: It is important for healthcare professional students to understand the experience of people with dementia, their family, and their carers. Despite person-centred educational policies, current curriculums may not adequately prepare students to meet the needs of people with dementia. This study qualitatively evaluated the impact of a virtual dementia experience on medical and pharmacy students’ self-reported knowledge and attitudes towards people with dementia. Ten focus groups were conducted with 29 medical and 24 pharmacy students in September and October 2016. All students had undertaken a multisensory virtual dementia experience designed to simulate the cognitive and perceptual difficulties faced by people with dementia. Focus groups were used to evaluate the virtual dementia experience in terms of perceived usefulness, suggestions for improvement, and ability to inform students’ understanding of dementia-friendly environments. Focus groups were audio-recorded and analysed via a thematic approach. The virtual dementia experience was described as useful and impactful, and students suggested how it could be more tailored towards their learning needs, such as via incorporating hospital, medical, and pharmacy-specific scenarios and opportunities for role play. Additionally, students explained how dementia-friendly communication techniques could be used in their future practice and provided strategies to optimise dementia-friendly characteristics of current work environments. A virtual dementia experience improved student self-reported knowledge and attitudes towards people with dementia.
Publisher: Elsevier BV
Date: 02-2015
Publisher: SAGE Publications
Date: 26-11-2021
Abstract: Falls are associated with considerable morbidity and mortality in aged care services and falls risk increasing drugs (FRIDs) are often overlooked as a contributor to falls. This study aims to investigate the association between the risk of falling and use of FRIDs from aged care services. Inverse-probability-weighted multinomial logistic regression was used to estimate the association between falls risk and regular FRIDs in 383 residents from six Australian aged care services. Overall, residents at high and low falls risk had similar prevalence of FRIDs. Prevalence of antipsychotics and sedative-hypnotics was low. Residents at high falls risk had higher adjusted odds of using ≥2 psychotropic medications (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.17-2.61) and ≥2 medications that cause/worsen orthostatic hypotension (OR = 3.59, 95% CI = 2.27-5.69). High prevalence of FRIDs was mainly attributable to medications for which residents had clinical indications. Clinicians appeared to have largely avoided FRIDs that explicit criteria deem potentially inappropriate for high falls risk.
Publisher: JMIR Publications Inc.
Date: 24-08-2022
Abstract: he demand for orthopaedic specialist consultation for patients with osteoarthritis (OA) in public hospitals is large and continues to grow. Lengthy wait times are increasingly affecting patients from low socioeconomic and culturally and linguistically erse (CALD) backgrounds who are more likely to rely on public health care. he aim of this study was to co-design a digital health intervention for patients with OA who are waiting for an orthopaedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. he stakeholders involved in the co-design process included the research team, end-users (patients), clinicians, academic experts, senior hospital staff and a research, design and development agency. The iterative co-design process comprised of several key phases, which included the collation and refinement of evidence-based information by the research team with assistance from academic experts. Structured interviews with 16 clinicians (sex: 10 female and six male) and 11 end-users (mean ± SD, age: 64.3 ± 7.2, sex: seven female and four male) of 1-hour duration were completed to understand the needs of the intervention. Weekly workshops were held with key stakeholders throughout the development. A different cohort of 15 end-users examined the feasibility of the study during a 2-week testing period (age: 61.5 ± 9.7, sex: 12 female and three male). The system usability scale (SUS) was utilized as the primary measure of the feasibility of the intervention. even content modules were developed which were refined over several iterative rounds. Key themes highlighted in the clinician and end-user interviews were the erse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio and visual) and access to patient-centered information as early as possible in the healthcare journey. All content was translated to Vietnamese, the most widely spoken language following English in the LGAs included in this study. Patients with hip and knee OA from erse CALD backgrounds tested its feasibility. A mean score of 82.7 ± 16 was recorded for the SUS placing it in the excellent category for usability. hrough the co-design process, we developed an evidence-based, holistic and patient-centered digital health intervention. The intervention has been specifically designed to be used by patients from erse backgrounds, including those with low health, digital and written literacy levels. The effectiveness of the intervention for improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial.
Publisher: Springer Science and Business Media LLC
Date: 26-03-2018
DOI: 10.1007/S40266-018-0537-3
Abstract: Residents of long-term care facilities (LTCFs) are at high risk of hospitalization. Medications are a potentially modifiable risk factor for hospitalizations. Our objective was to systematically review the association between medications or prescribing patterns and hospitalizations from LTCFs. We searched MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and International Pharmaceutical Abstracts (IPA) from inception to August 2017 for longitudinal studies reporting associations between medications or prescribing patterns and hospitalizations. Two independent investigators completed the study selection, data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Tools. Three randomized controlled trials (RCTs), 22 cohort studies, five case-control studies, one case-time-control study and one case-crossover study, investigating 13 different medication classes and two prescribing patterns were included. An RCT demonstrated that high-dose influenza vaccination reduced all-cause hospitalization compared with standard-dose vaccination (risk ratio [RR] 0.93 95% confidence interval [CI] 0.88-0.98). Another RCT found no difference in hospitalization rates between oseltamivir as influenza treatment and oseltamivir as treatment plus prophylaxis (treatment = 4.7%, treatment and prophylaxis = 3.5% p = 0.7). The third RCT found no difference between multivitamin/mineral supplementation and hospitalization (odds ratio [OR] 0.94 95% CI 0.74-1.20) or emergency department visits (OR 1.05 95% CI 0.76-1.47). Two cohort studies demonstrated influenza vaccination reduced hospitalization. Four studies suggested polypharmacy and potentially inappropriate medications (PIMs) increased all-cause hospitalization. However, associations between polypharmacy (two studies), PIMs (one study) and fall-related hospitalizations were inconsistent. Inconsistent associations were found between psychotropic medications with all-cause and cause-specific hospitalizations (11 studies). Warfarin, nonsteroidal anti-inflammatory drugs, pantoprazole and vinpocetine but not long-term acetylsalicylic acid (aspirin), statins, trimetazidine, digoxin or β-blockers were associated with all-cause or cause-specific hospitalizations in single studies of specific resident populations. Most cohort studies assessed prevalent rather than incident medication exposure, and no studies considered time-varying medication use. High-quality evidence suggests influenza vaccination reduces hospitalization. Polypharmacy and PIMs are consistently associated with increased all-cause hospitalization.
Publisher: Informa UK Limited
Date: 10-2015
DOI: 10.2147/IPRP.S91014
Publisher: Oxford University Press (OUP)
Date: 27-02-2015
DOI: 10.1111/IJPP.12183
Abstract: The purpose of this article is to identify information that is currently available to pharmacists concerning the stability of medications repackaged into multicompartment compliance aids (MCAs). This article explores the potential risks associated with repackaging medications into MCAs for pharmacists who supply and patients who use them. There is a paucity of information currently available to pharmacists concerning the stability of medications repackaged into MCAs as it is not routinely provided by pharmaceutical manufacturers. However, some studies have identified the potential for adverse effects on safety, bioavailability and stability that may have a clinical impact. There are also professional and legal implications of removing medications from their original packaging for storage in MCAs. There is a growing need for further information concerning the stability of medications repackaged into MCAs to guide pharmacists who are supplying these compliance aids to primary and secondary care. Pharmaceutical manufacturers and researchers should be advised to conduct stability testing in MCAs for orally administered medications. This information should be readily available, and pharmacists should be made aware of it via their pharmaceutical bodies. As a result, decisions regarding MCA preparation can be more informed, and pharmacist and patient risks associated with repackaging potentially unstable medications can be minimised.
Publisher: Elsevier BV
Date: 12-2018
Publisher: Wiley
Date: 14-12-2021
DOI: 10.1002/PHAR.2652
Abstract: What is the association between anticholinergic burden and specific domains of cognitive function in older adults who are initially without major cognitive impairment? Post‐hoc analysis of longitudinal observational data from the ASPirin in Reducing Events in the Elderly (ASPREE) study. 19,114 participants from Australia and the United States aged 70 years and older (65 years and older for US minorities) were recruited and followed for a median of 4.7 years. At enrollment, participants were free of known cardiovascular disease, major physical disability, or dementia. Cognitive assessments administered at baseline and biennially at follow‐up visits included the Modified Mini‐Mental State examination (3MS), Hopkins Verbal Learning Test–Revised (HVLT‐R) delayed recall, Controlled Oral Word Association Test (COWAT), and Symbol Digit Modalities Test (SDMT). Anticholinergic burden was calculated at baseline using the Anticholinergic Cognitive Burden (ACB) scale and grouped as scores of 0 (no burden), 1‐2 (low to moderate), or 3+ (high). Linear mixed effects models were used to assess the relationship between ACB score and cognition over time. After adjusting for sex, age, education, minority status, smoking status, hypertension, diabetes, depression, chronic kidney disease, country, and frailty, participants with a high ACB score had worse performance over time for 3MS (Adjusted [Adj] B=‐0.092, P=0.034), HVLT‐R delayed recall (Adj B=‐0.104, P .001), COWAT (Adj B=‐0.151, P .001), and SDMT (Adj B=‐0.129, P=0.026), than participants with an ACB score of 0. A low to moderate ACB score was also associated with worse performance over time for HVLT‐R delayed recall (Adj B=‐0.037, P=0.007) and COWAT (Adj B=‐0.065, P=0.003), compared to those with no ACB. Anticholinergic burden predicts worse cognitive function over time in initially dementia‐free older adults, particularly for executive function (COWAT) and episodic memory (HVLT‐R).
Publisher: Wiley
Date: 09-2022
DOI: 10.1002/EJP.2013
Abstract: Few studies have explored the impact of low back or lower limb pain severity on recurrent (≥2) falls in older adults. Investigate the association between the severity of low back or lower limb pain, and ≥2 falls or falls‐related injuries. Community‐dwelling Australian males and females in the ASPREE Longitudinal Study of Older Persons (ALSOP), aged ≥ 70 years. Self‐reported, cross‐sectional questionnaire data regarding number of falls and falls‐related injuries in the last 12 months and sites and severity of pain experienced on most days. Adjusted relative risks (RR) were estimated from multivariable Poisson regression models, for males and females separately. Of 14,892 ALSOP participants, 13% ( n = 1983) reported ≥2 falls (‘recurrent fallers’) in the last 12 months. Males and females who reported severe low back, or severe lower limb pain on most days were more likely to report ≥2 falls in the last 12 months compared to those with mild pain (lower back: males RR = 1.70 and females RR = 1.5, p = 0.001 lower limb: males RR = 2.0, p 0.001 and females RR = 1.4, p = 0.003). Female recurrent fallers who reported severe low back (RR = 1.3, p = 0.029) or lower limb (RR = 1.2, p = 0.024) pain on most days were more likely to report a falls‐related injury in the last 12 months compared to females with mild pain. Severe low back or lower limb pain was associated with an increased likelihood of recurrent falls (males/females) or falls‐related injuries (females only). Assessment of severe low back and lower limb pain should be considered as a priority when undertaking falls‐risk evaluation. Severe low back pain, or severe lower limb pain is associated with an increased likelihood of recurrent falls in older males and females, and an increased likelihood of falls‐related injuries in older female recurrent fallers. Assessment and management of severe low back and lower limb pain should be prioritized when undertaking falls‐risk assessment. Future longitudinal research is required to further interrogate this relationship and its underlying mechanisms.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Julia Gilmartin-Thomas.