ORCID Profile
0000-0003-0801-3802
Current Organisations
INRAE
,
Pharmacy Board of Australia
,
Flinders Medical Centre
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Publisher: SAGE Publications
Date: 09-08-2018
Abstract: Dyspnoea, a common and multifactorial symptom in patients with acute coronary syndrome, has been associated with lower quality of life and hospital readmission. Prescriber preference for antiplatelet therapy, the standard of care in this patient group, is shifting to ticagrelor due to mortality benefits demonstrated in trials compared with clopidogrel. In these trials, dyspnoea was more commonly reported in patients prescribed ticagrelor but the aetiology is still debated. An observational cohort study was conducted to quantify the rates and severity of dyspnoea reported in patients with acute coronary syndrome and newly prescribed ticagrelor compared with those prescribed clopidogrel. Dyspnoea was more commonly reported in patients prescribed ticagrelor at each follow up post-discharge ( p = 0.016). Rates were higher than previously reported in clinical trials. In some patients, dyspnoea necessitated drug therapy change and was associated with readmission to hospital ( p = 0.046). As ticagrelor is widely prescribed as a first-line antiplatelet agent for a range of patients with acute coronary syndrome, the incidence of dyspnoea in a generalized patient cohort may result in higher rates of drug discontinuation. This in turn could lead to higher rates of rehospitalisation and potential treatment failure than that reported from the controlled setting of a clinical trial.
Publisher: Wiley
Date: 03-2015
DOI: 10.1002/JPPR.1058
Publisher: Wiley
Date: 06-2015
DOI: 10.1002/JPPR.1079
Abstract: A computerised area‐under‐the‐curve aminoglycoside therapeutic drug monitoring (A‐TDM) and dosing service was implemented at Flinders Medical Centre. To assess attitudes and perceptions of junior medical officers and A‐ TDM service providers towards the use and impact of A‐ TDM . An electronic survey was sent to junior medical officers containing questions on: A‐ TDM awareness, impact on dosing, duration of therapy, minimisation of toxicity and the effect of provision of the service on knowledge of TDM principles. To determine whether respondents also had generally negative or positive attitudes, we used K ‐means cluster analysis. A‐ TDM service providers were also surveyed. From 145 junior medical officers contacted, 49 (33%) responded: 34 interns and 15 residents. The majority of officers provided generally positive responses, with 38 stating that they were aware of A‐TDM , 17 that it often assisted in their patient management, 34 that it improved optimal dosing, 22 that it improved duration, 32 that it improved toxicity minimisation and 33 that it improved their understanding of TDM principles. Cluster analysis produced a positive attitudes group ( n = 35) and a negative attitudes group ( n = 14) with significantly different responses for each of the six questions (p 0.01 for each), indicating consistently different attitudes towards the service. Twelve of thirteen A‐ TDM service providers responded: eight pharmacy and four medical, reporting positive attitudes towards A‐ TDM on treatment efficacy ( n = 11), dose optimisation ( n = 11) and patient safety ( n = 12). A significant proportion of respondents were aware of A‐ TDM principles and demonstrated favourable attitudes towards its use for dose optimisation and for minimising toxicity.
Publisher: Wiley
Date: 03-2011
Publisher: The Society of Hospital Pharmacists of Australia
Date: 06-07-2017
DOI: 10.24080/GRIT.1035
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.JHIN.2018.05.001
Abstract: All courses of fidaxomicin use in the study hospital were reviewed. It was used for first recurrence (six times), second recurrence (eight times) and one case of third recurrence. One patients received fidaxomicin as first-line treatment. Eight patients initially responded to therapy of these, three patients were asymptomatic at 90 days, three patients remained asymptomatic at 30 days, and two patients had recurrences five and nine days after stopping therapy. Four patients failed to respond of these, two patients required faecal transplantation and one patient required a colectomy. Two patients deteriorated and two patients died. Fidaxomicin was well tolerated. These findings suggest that the utility of fidaxomicin at this stage of infection is unclear.
Publisher: Informa UK Limited
Date: 10-2015
DOI: 10.2147/IPRP.S92850
Publisher: Informa UK Limited
Date: 12-2021
DOI: 10.2147/IDR.S319780
Publisher: Springer Science and Business Media LLC
Date: 27-10-2017
Publisher: CSIRO Publishing
Date: 26-06-2023
DOI: 10.1071/AH23072
Abstract: Objectives To explore general practitioners’ perspectives on the discharge summaries they receive about their patients who have been discharged from hospital. Methods A survey of general practitioners in the catchment of a major metropolitan South Australian health service consisting of three teaching hospitals was undertaken. Surveys were disseminated electronically and via hardcopy mailout to general practitioners. The 36-question survey focused on five constructs of discharge summaries: accessibility, length and clarity, format, transparency, and medicines content. Results A total of 150 general practitioners responded (response rate, 27.6%). Respondents were vocationally registered (96%), predominately from metropolitan practices (90.2%), and 65.8% were female. Overwhelmingly, 86.7% of general practitioners stated that the optimal time for receipt of discharge summaries was h post-discharge, and 96.6% considered that late arrival of discharge summaries adversely impacts patient care. The ideal length of discharge summaries was reported as pages by 64% of respondents. A large proportion of respondents (84.6%) would like to be notified when their patients are admitted and discharged from hospital, and 82.7% were supportive of patients receiving their own copy of the discharge summary. A total of 76.7% general practitioners reported that they had detected omissions or discrepancies in the discharge summaries. Provision of rationale for medication changes was viewed as important by 86.7%, however, only 29.3% reported that it is always or often communicated. Conclusions General practitioners supported timely receipt, concise length of discharge summary and format refinement to improve the utility and communication of this important clinical handover from hospital to community care.
Publisher: The Society of Hospital Pharmacists of Australia
Date: 08-11-2017
DOI: 10.24080/GRIT.1043
Publisher: SAGE Publications
Date: 12-02-2014
Publisher: Wiley
Date: 06-04-2015
Abstract: To analyse the association between time from triage to administration of initial antibiotics and mortality in all patients presenting with sepsis to a tertiary hospital ED. A retrospective review of patients presenting to the ED with sepsis from January to December 2012 was conducted at Flinders Medical Centre, South Australia. Outcome measures were: time elapsed from triage to administration of initial antibiotic therapy and in-hospital mortality. A total of 220 patients presented with sepsis, comprising 102 cases of uncomplicated sepsis and 118 severe sepsis. The median time to antibiotic administration was 3.5 h (interquartile range [IQR] 1.7-6.6) and in-hospital mortality was 28.6% (95% CI 22.6-34.6%). There was no association observed between delays to antibiotics and mortality in the total patient population. When stratified by presenting severity, patients with severe sepsis demonstrated a trend towards increased mortality when delays to antibiotics exceeded 6 h from triage (HR = 2.25, 95% CI 0.91-5.59, P = 0.08) in comparison with <1 h. Significant delays to antibiotic administration occurred when initial agents were charted as a 'regular medicine' (9.4 h, IQR 5.1-16.6) in comparison with a 'once only order' (3.4 h, IQR 1.7-6.7), P < 0.001. Early administration of antibiotics specifically in patients with severe sepsis might be beneficial. Further studies within the ED are warranted to establish the effect of delayed antibiotics in a generalised sepsis cohort.
Publisher: Korea Health Personnel Licensing Examination Institute
Date: 07-06-2017
Abstract: Purpose: We aimed to assess the preparedness of junior doctors to use vancomycin, and to determine whether attending an educational session and being provided pocket guidelines were associated with self-reported confidence and objective knowledge. Methods: This was a 2-component cross-sectional study. A 60-minute educational session was implemented and pocket guidelines were provided. Preparedness was evaluated by a self-reported confidence survey in the early and late stages of each training year, and by continuing medical education (CME) knowledge scores. Results: Self-confidence was higher among those later in the training year (n=75) than in those earlier (n=120) in the year for all questions. In the late group, vancomycin education was associated with higher self-confidence regarding the frequency of therapeutic drug monitoring (P=0.02) and dose amendment (P=0.05) however, the confidence for initial monitoring was lower (P .05). Those with pocket guidelines were more confident treating patients with vancomycin (P .001), choosing initial (P=0.01) and maintenance doses (P .001), and knowing the monitoring frequency (P=0.03). The 85 respondents who completed the knowledge assessment scored a mean±standard deviation of 8.55±1.55 on 10 questions, and the interventions had no significant effect. Conclusion: Attending an educational session and possessing pocket guidelines were associated with preparedness, as measured by higher self-reported confidence using vancomycin. High knowledge scores were attained following CME however attending an educational session or possessing pocket guidelines did not significantly increase the knowledge scores. Our findings support providing educational sessions and pocket guidelines to increase self-confidence in prescribing vancomycin, yet also highlight the importance of evaluating content, format, and delivery when seeking to improve preparedness to use vancomycin through education.
Publisher: BMJ
Date: 02-2019
DOI: 10.1136/BMJOPEN-2018-026624
Abstract: To investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context. Data were collected at two English hospital NHS trusts over two time-periods: June 2016 and February 2017. Cohort study. Trust 1 data were sourced from prospective point prevalence surveys. Trust 2 data were extracted retrospectively from an electronic report. Inpatients treated for urinary tract infection (UTI), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and skin and soft tissue infection (SSTI). Data on allergy were collected, and antibiotic selection assessed for adherence to trust guidelines with differences between groups presented as adjusted ORs. A total of 1497 patients were included, with 2645 antibiotics orders. Patients were treated for CAP (n=495 33.1%), UTI (407 27.2%), HAP (330 22%) and SSTI (265 17.7%). There were 240 (16%) patients with penicillin allergy. Penicillin allergy was recorded as allergy (n=52 21.7%), side effect (27 11.3%) and no documentation (161 67.1%). Overall, 2184 (82.6%) antibiotic orders were guideline-adherent. Adherence was greatest for those labelled penicillin allergy (453 of 517 87.6%) versus no allergy (1731 of 2128 81.3%) (OR 0.52 (95% CI 0.37 to 0.73) p .001). Guideline-adherence for CAP was higher if penicillin allergy (151 of 163 92.6%) versus no allergy (582 of 810 71.9%) (OR 0.20 (95% CI 0.10 to 0.37) p .001). There was no difference in adherence between those with and without penicillin allergy for UTI, HAP or SSTI treatment. A relatively high proportion of patients had a penicillin allergy and two thirds of these had no description of their allergy, which has important implications for patient safety. Patients with penicillin allergy treated for CAP, received more guideline adherent antibiotics than those without allergy. Future studies investigating the clinical impact of penicillin allergy should include data on adherence to antibiotic guidelines.
Publisher: Informa UK Limited
Date: 10-2018
DOI: 10.2147/IDR.S176519
Publisher: Wiley
Date: 03-2014
Publisher: American Chemical Society (ACS)
Date: 09-2022
Abstract: The recent discovery of comammox (complete ammonia oxidation)
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.JIAC.2017.09.010
Abstract: Despite vancomycin being in use for over half-a-century, it is still not dosed or monitored appropriately in many centers around the world. The objective of this study was to determine the effectiveness of a multifaceted intervention to implement a vancomycin dosing and monitoring guideline across multiple medical and surgical units over time. This was an observational before-and-after interventional cohort study. The pre-intervention period was August to December 2010-2011 and the post-intervention period was September to November 2012-2014. The implementation strategy comprised: face-to-face education, online continuing medical education, dissemination of pocket guideline and email reminder. Outcome measures included: appropriate prescribing of loading and maintenance doses, therapeutic drug monitoring, time to attain target range and nephrotoxicity. Post-implementation prescribing of loading doses increased (10.4%-43.6%, P=<0.001), guideline adherent first maintenance dose (44%-68.4% P = 0.04), correct dose adjustment from (53.1%-72.2%, P = 0.009). Beneficial effects pre and post-implementation were observed for adherent timing of initial concentration (43.2%-51.9%, P = 0.01), concentrations in target range (32.6%-44.1%, P = 0.001), time to target range (median 6-4 days, P=<0.001), potentially nephrotoxic concentrations (30.7%-20.9%, P=<0.001) and nephrotoxicity (10.4%-6.8%, P=<0.001). A multifaceted intervention to implement a vancomycin dosing and monitoring guideline significantly improved prescribing, monitoring, pharmacokinetic and safety outcomes for patients treated with vancomycin over an extended period. However, increased guideline adoption by clinicians is required to maximize and prolong the utility of this important agent.
Publisher: Oxford University Press (OUP)
Date: 23-09-2005
Abstract: Aquaporins facilitate the uptake of soil water and mediate the regulation of root hydraulic conductivity (Lpr) in response to a large variety of environmental stresses. Here, we use Arabidopsis (Arabidopsis thaliana) plants to dissect the effects of salt on both Lpr and aquaporin expression and investigate possible molecular and cellular mechanisms of aquaporin regulation in plant roots under stress. Treatment of plants by 100 mm NaCl was perceived as an osmotic stimulus and induced a rapid (half-time, 45 min) and significant (70%) decrease in Lpr, which was maintained for at least 24 h. Macroarray experiments with gene-specific tags were performed to investigate the expression of all 35 genes of the Arabidopsis aquaporin family. Transcripts from 20 in idual aquaporin genes, most of which encoded members of the plasma membrane intrinsic protein (PIP) and tonoplast intrinsic protein (TIP) subfamilies, were detected in nontreated roots. All PIP and TIP aquaporin transcripts with a strong expression signal showed a 60% to 75% decrease in their abundance between 2 and 4 h following exposure to salt. The use of antipeptide antibodies that cross-reacted with isoforms of specific aquaporin subclasses revealed that the abundance of PIP1s decreased by 40% as early as 30 min after salt exposure, whereas PIP2 and TIP1 homologs showed a 20% to 40% decrease in abundance after 6 h of treatment. Expression in transgenic plants of aquaporins fused to the green fluorescent protein revealed that the subcellular localization of TIP2 and PIP1 and PIP2 homologs was unchanged after 45 min of exposure to salt, whereas a TIP1 -green fluorescent protein fusion was relocalized into intracellular spherical structures tentatively identified as intravacuolar invaginations. The appearance of intracellular structures containing PIP1 and PIP2 homologs was occasionally observed after 2 h of salt treatment. In conclusion, this work shows that exposure of roots to salt induces changes in aquaporin expression at multiple levels. These changes include a coordinated transcriptional down-regulation and subcellular relocalization of both PIPs and TIPs. These mechanisms may act in concert to regulate root water transport, mostly in the long term (≥6 h).
Publisher: Springer Science and Business Media LLC
Date: 15-03-2016
Publisher: Informa UK Limited
Date: 03-2015
DOI: 10.2147/JMDH.S78458
Publisher: Elsevier BV
Date: 12-2021
Publisher: Wiley
Date: 22-10-2020
DOI: 10.1111/CEO.13645
Publisher: Elsevier BV
Date: 04-2013
Publisher: Informa UK Limited
Date: 09-2016
DOI: 10.2147/IDR.S114942
Publisher: Informa UK Limited
Date: 05-2016
DOI: 10.2147/IDR.S107961
Start Date: 2012
End Date: 2013
Funder: National Health and Medical Research Council
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