ORCID Profile
0000-0002-9276-6446
Current Organisation
Fiona Stanley Hospital
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Publisher: CSIRO Publishing
Date: 12-05-2022
DOI: 10.1071/AH22002
Abstract: The funding of medication supply in Australian public hospitals is ided between the federal government’s Pharmaceutical Benefits Scheme (PBS) and thestate or territory government who pay for the remaining medications not covered under the PBS. For some high-cost medications, such as the monoclonal antibody blinatumomab, the current criteria for PBS funding in public hospitals are challenging. The strict requirement for inpatient admission, due to the risk of potentially serious adverse effects, alongside a lack of PBS reimbursement, while a hospital inpatient, may result in the state bearing the cost. A retrospective review of five patients receiving blinatumomab at our hospital found that, on average, patients remained inpatients for longer than that stipulated to meet PBS funding criteria, predominantly due to adverse effects associated with the medication. This resulted in the state government paying for the medication in full. The upcoming National Medicines Policy review should address the increasing complexity of new medications and their access and funding.
Publisher: Wiley
Date: 09-2013
DOI: 10.1002/J.2055-2335.2013.TB00253.X
Abstract: To determine volume loss when Schedule 8 (S8) liquid medicines are measured during routine dispensing and checking processes. A literature review and policy review of local, state and territory practices pertaining to S8 liquid medicines discrepancies was conducted, including measuring techniques, monitoring and reporting requirements. Hospital staff and manufacturers were surveyed to identify commonly used measuring techniques relevant to S8 liquid medicines. Subsequently, an experiment was conducted with 3 measuring techniques (bung, needle, cannula) to identify if measuring technique, S8 liquid viscosity, frequency of dispensing and duration of storage influence volume loss. Policy review did not uncover substantial guidelines to inform practice. Survey findings demonstrated a lack of uniformity with the 3 commonly used measuring techniques. These 3 techniques were investigated. A bung with an oral syringe resulted in the least amount of loss independent of the frequency of dispensing or viscosity of the liquid measured less than 1% of the liquid remained in the syringe after a dose was removed. Average discrepancy associated with this technique was 3.4% when the volume recorded in the S8 register was compared to the actual volume measured at each dispensing. Under laboratory conditions, volume loss through routine measurement and dosing of S8 liquid medicines was on average 3.4%. We recommend that a 4% discrepancy for S8 liquid medicines be included in institutional policies when utilising the bung and oral syringe technique.
Publisher: Wiley
Date: 05-09-2022
DOI: 10.1002/JPPR.1830
Publisher: Wiley
Date: 29-09-2021
DOI: 10.1002/JPPR.1764
Publisher: Informa UK Limited
Date: 10-11-2017
DOI: 10.1080/03007995.2016.1254605
Abstract: Psoriasis vulgaris is a chronic skin condition affecting patients' quality of life. Long-term use of conventional therapy increases risk of unwanted side effects. Compound glycyrrhizin in conjunction with conventional therapy has been used in clinical practice, but the evidence for such practice has not been evaluated systematically. This review aims to evaluate the efficacy and safety of compound glycyrrhizin in combination with conventional therapy for psoriasis vulgaris. PubMed, Excerpta Medica dataBASE (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database (AMED), CiNii, Chinese Biomedical Literature, China National Knowledge Infrastructure, Chinese Scientific Journals Full Text Database and Wanfang Data were searched from their respective inceptions to July 2015. Randomized controlled trials comparing compound glycyrrhizin plus conventional therapy to conventional therapy alone for psoriasis vulgaris were included. Data analysis was performed using Review Manager 5.3. Eleven randomized controlled trials were included in this review. Meta-analysis of the 11 randomized controlled trials indicated that the addition of compound glycyrrhizin increased the number of patients achieving Psoriasis Area and Severity Index (PASI) 60 (RR: 1.30 [1.21, 1.40], I Compound glycyrrhizin in conjunction with conventional therapy enhances clinical response, and compound glycyrrhizin as add-on therapy does not appear to pose any additional risk in the treatment of psoriasis vulgaris. However, the findings should be interpreted with caution of methodological flaws in the included studies. PROSPERO registration number: CRD42015027763.
Publisher: Wiley
Date: 05-04-2023
DOI: 10.1002/JPPR.1861
Abstract: Liquid opioids (controlled drugs) in multidose bottles (MDBs) are associated with measurement losses, overfill variance, gradual contamination, and potential theft. Western Australian state poisons regulations and policies require rigorous accountability and previous reports have highlighted shortcomings in historical arrangements. To describe the process and outcomes of a transition to unit dose pod (UDP) formulations for oral liquid opioids at our institution. A UDP of oral oxycodone liquid was developed in partnership with a third‐party compounder and piloted on a paediatric ward. Additional UDP opioid formulations were developed and gradually replaced MDBs across our institution. Reportable discrepancies and staff satisfaction were compared between MDBs and UDPs. This project was registered as a quality improvement project (GEKO 27758) and considered exempt from human research and ethics approval by the South Metropolitan Health Service Human Research Ethics Committee. Between May 2017 and May 2018, 3062 UDPs were distributed with nil discrepancies, and 133 MDBs were distributed with 16 discrepancies (0% vs 12%). Most staff (92%) reported more efficient inventory counts and improved confidence in product integrity for UDPs. Staff administrative overhead required to manage reportable discrepancies from volume errors was essentially eliminated. Five UDP opioid formulations were implemented in 27 inpatient wards including methadone‐maintenance UDPs for inpatient use. By late 2020, UDPs were in use across 19 hospitals in Western Australia (WA), with annual use exceeding 33 000 units. The UDP simplifies the management of controlled drug liquids by eliminating discrepancies associated with MDBs inventory management and increasing staff confidence in product quality, leading to significant uptake across WA.
Publisher: SAGE Publications
Date: 08-2018
DOI: 10.1136/ACUPMED-2017-011484
Abstract: An ideal placebo design in clinical research should resemble the intervention under investigation to facilitate blinding, yet remain clinically inert. With regard to physical interventions such as acupuncture, a true placebo device has not been developed and validated. Since 1998, researchers have designed several placebo acupuncture devices (PADs). The three most widely used PADs are the Streitberger, the Park and the Takakura device. This review focuses on evaluating studies of these devices, in the context of credibility of blinding (COB), assessment of penetrating pain or sensation, and de qi sensation. Electronic database searches were conducted in four English and two Chinese databases from their inception until November 2016. All studies included in the review were conducted on healthy participants and compared verum manual acupuncture with any of the aforementioned PADs with respect to one or more of the above three outcomes related to blinding effect. The synthesised analyses of the 15 included studies showed that the Streitberger and Park placebo devices may not blind participants successfully when tested at a sensitive acupuncture point (LI4). In terms of penetrating sensation, there were significant differences between these two placebo devices and verum acupuncture when applied at this point. The Takakura device was the only PAD that had the potential to blind the acupuncturist. However, the blinding analyses of all outcome measures were inconsistent. Overall, there were insufficient data to confirm the blinding effects of these skin-contact PADs as each device was associated with limitations that warrant further design improvements.
Publisher: CSIRO Publishing
Date: 29-06-2021
DOI: 10.1071/AH20331
Abstract: Objective In Australian hospitals, a central distribution system is often utilised to supply medication to clinical areas. This study investigated the impact of automated dispensing cabinets (ADCs) and inventory robots in medication distribution within an Australian hospital. Methods A prospective observational study of pharmacy technician medication supply to clinical areas was conducted over a 2-week period pre- and post-implementation of ADCs and inventory robots. Information was collected on the time taken to perform all tasks required to provide a weekly medication supply service for medication other than drugs of addiction. Results There was no significant reduction of total duration for medication supply, pre-implementation mean 73.08 min versus post-implementation 68.59 min (P = 0.567). An instance of automation downtime occurred during the post-implementation period for which manual downtime procedures were implemented. Without downtime, a significant reduction in overall time taken was observed, 74.25 min versus 63.18 min (P = 0.019). Pre-restocking medication selection errors were reduced non-significantly after implementation of inventory robots, 11 (0.43%) versus 4 (0.21%) errors (P = 0.090). Conclusions Implementation of ADCs and robots did not significantly reduce the total time to provide a weekly medication supply service when downtime occurred, although a significant reduction was observed when downtime did not occur. Pharmacy medication selection errors were non-significantly lower. What is known about the topic? Australian hospitals are increasingly implementing automated technology such as ADCs and inventory robotics in an attempt to improve efficiency and accuracy of medication supply however, limited literature is available in an Australian setting. What does this paper add? This paper describes the impact of implementing ADCs in clinical areas (e.g. inpatient wards) and inventory robots in a main store pharmacy on the medication supply process. This paper highlights the benefit of improved efficiency and accuracy in selecting medication in pharmacy for distribution and identifies time to restock the ADCs is significantly increased. What are the implications for practitioners? Implementing ADCs and inventory robotics in Australian hospitals can provide benefits in efficiency and accuracy however, robust downtime procedures are essential.
Publisher: Informa UK Limited
Date: 07-2017
DOI: 10.1080/09546634.2016.1178377
Abstract: Psoriasis is a chronic inflammatory skin disorder and the efficacy and safety of Chinese herbal medicine (CHM) treatments is unclear. This review evaluates oral CHM for psoriasis vulgaris clinical trial evidence. The Cochrane Library, PubMed, EMBASE, CINAHL, AMED, CBM, CNKI, CQVIP and Wanfang databases were searched from inception to June 2015. Randomised controlled trials (RCTs) of oral CHM compared to placebo data were included and analysed using Review Manager 5.2. Seven studies were included, no study utilised identical CHM intervention. Four studies data were subgrouped (decoction or capsule ill) and pooled in meta-analysis to evaluate treatment effective rate for PASI60 or above (RR: 2.74 [0.92, 8.21] I While CHMs appear to be safe and may have benefit for psoriasis, variation between CHM interventions, outcome measures and the quality of included studies limit the conclusions of this review. Further rigorous RCTs utilising reliable, validated symptom and QoL outcome measures are recommended.
Publisher: Springer Science and Business Media LLC
Date: 2009
DOI: 10.2165/00044011-200929050-00004
Abstract: Enterally administered low-dose ketamine is being used increasingly to treat pain states. However, suitable oral or sublingual formulations are not available. The objective of the study was to develop a lozenge formulation of ketamine for use in patients with neuropathic pain, and to investigate its storage stability and bioavailability after oral or sublingual administration. A lozenge containing 25 mg of ketamine was formulated and manufactured in a hospital pharmacy setting. Stability was assessed by high-performance liquid chromatography (HPLC) during storage at 25 degrees C or 2-8 degrees C for up to 14 weeks. Bioavailability after both oral and sublingual administration was evaluated in six patients with chronic neuropathic pain. Ketamine and its metabolite norketamine in plasma were measured by HPLC. The lozenge formulation was chemically stable for at least 14 weeks. Oral and sublingual bioavailabilities [median (interquartile range)] were 24% (17-27%) and 24% (19-49%), respectively. There was substantial metabolism to norketamine for both routes. The mean norketamine/ketamine area under the plasma concentration-time curve from baseline to 8 hours ratios were 5 and 2.1 after oral or sublingual administration, respectively. The ketamine lozenge showed acceptable storage stability. Bioavailability was sufficiently high and reproducible to support its use in routine pain management. There was extensive first-pass conversion to norketamine. Efficacy studies are warranted to evaluate sublingual and oral administration of our new lozenge formulation of ketamine in patients with chronic pain states. Investigation of the role of the metabolite norketamine, which is also an NMDA receptor antagonist, is particularly important because this may contribute significantly to clinical efficacy.
Publisher: BMJ
Date: 02-2018
DOI: 10.1136/BMJOPEN-2017-017912
Abstract: Spasticity is a common complication of stroke. Current therapies for poststroke spasticity (PSS) have been reported to be associated with high costs, lack of long-term benefit and unwanted adverse events (AEs). Electroacupuncture (EA) has been used for PSS, however, its efficacy and safety is yet to be confirmed by high-quality clinical studies. This study is designed to evaluate the add-on effects and safety profile of EA when used in combination with usual care (UC). This study is a parallel group randomised controlled trial. A total of 136 participants will be included and randomly assigned to either the treatment group (EA plus UC) or the control group (UC alone). Prior to the main trial, a pilot study involving 30 participants will be conducted to assess the feasibility of the trial protocol. EA will be administered by registered acupuncturists for 20min to 30 min, three times per week for 4 weeks. The primary outcome measure (Modified Ashworth Scale) and secondary outcome measures (Fugl-Meyer Assessment and Barthel Index) will be evaluated at baseline, the end of treatment (week 4) and the end of follow-up (week 8). AEs will be monitored, recorded and reported, and their causality will be explored. Ethics approval was obtained from the ethics committees of Guangdong Provincial Hospital of Chinese Medicine and RMIT University in December 2016. The results will be disseminated in a peer-reviewed journal, and PhD theses and might be presented at international conferences. ChiCTR-IOR-16010283 Pre-results.
Publisher: Wiley
Date: 03-2013
Publisher: Springer Science and Business Media LLC
Date: 06-11-2017
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.APMR.2017.03.023
Abstract: To evaluate the effects and safety of electroacupuncture (EA) for stroke patients with spasticity. Five English databases (PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database) and 4 Chinese databases (Chinese Biomedical Database, Chinese National Knowledge Infrastructure, Chongqing VIP Database, Wanfang Database) were searched from their inception to September 2016. Randomized controlled trials were included if they measured spasticity with the Modified Ashworth Scale (MAS) in stroke patients and investigated the add-on effects of electroacupuncture to routine pharmacotherapy and rehabilitation therapies. Information on patients, study design, treatment details and outcomes assessing spasticity severity, motor function, and activities of daily living was extracted. In total, 22 trials involving 1425 participants met the search criteria and were included. The estimated add-on effects of EA to reduce spasticity in the upper limbs as measured by the MAS (standardized mean difference [SMD]=-.57 95% confidence interval [CI], -.84 to -.29), and to improve overall motor function as measured by the Fugl-Meyer Assessment of Sensorimotor Recovery (mean difference [MD]=10.60 95% CI, 8.67-12.53) were significant. Significant add-on effects of EA were also shown for spasticity in the lower limbs, lower-limb motor function, and activities of daily living ([SMD=-.88 95% CI, -1.42 to -.35 ], [MD=4.42 95% CI, .06-8.78], and [MD=6.85 95% CI, 3.64-10.05], respectively), although with high heterogeneity. For upper-limb motor function, no significant add-on effects of EA were found. EA combined with conventional routine care has the potential of reducing spasticity in the upper and lower limbs and improving overall and lower extremity motor function and activities of daily living for patients with spasticity, within 180 days poststroke. Further studies of high methodological and reporting quality are needed to confirm the effects and safety of EA, and to explore the adequate and optimal protocol of EA for poststroke spasticity, incorporating a group of comprehensive outcome measures in different populations.
Publisher: SAGE Publications
Date: 12-2018
DOI: 10.1136/ACUPMED-2017-011542
Abstract: Electroacupuncture (EA) is a modern form of acupuncture therapy where stainless steel acupuncture needles are used as percutaneous electrodes to apply electrical stimulation. The concern about electrolytic corrosion of needles during EA has not been conclusively addressed. To examine whether corrosion of stainless steel acupuncture needles occurs after EA to establish the safety profile of this therapy. The study comprised four EA sessions on healthy participants mimicking a common clinical practice, with needle surface examinations conducted immediately after each session. Used acupuncture needles that did not undergo electrical stimulation and unused needles taken from the original package were also examined as control comparisons. Two commonly used types of single-use, silicone-coated, stainless steel needles were selected for the experiment. The ES-160 digital acupunctoscope (a charge-balanced electric stimulator) was used to deliver electrical stimulation, and an oscilloscope was used to record the waveforms and electric currents. All needles were sterilised before examination by a scanning electron microscope (SEM), where images of needle tips and shafts were taken for further analysis. 32 needles were examined under the SEM. As the main findings, the SEM images showed the surface finish, burr attachments and surface characteristics of needle s les. No evidence of electrolytic corrosion was detected on any needle that underwent electrical stimulation for 30 min delivered by a charge-balanced acupunctoscope in healthy participants. The choice of a charge-balanced acupunctoscope is recommended to avoid any potential corrosion of needles in EA clinical practice.
Publisher: Hindawi Limited
Date: 12-2005
DOI: 10.1111/J.1365-2710.2005.00690.X
Abstract: An audit of opioid prescribing in a large teaching hospital across all specialties was conducted to identify areas for improvement. Opioid medications prescribed for the entire patient admission were recorded and assessed using quality statements. Of 334 patients reviewed 209 (62.6%) were prescribed an opioid. Poly-prescribing of 'when required' (p.r.n.) opioids was frequent with 107 (51.2%) patients having more than one 'p.r.n.' opioid. Dosing intervals were too long for 146 (69.8%) patients leaving them at risk of breakthrough pain. The intramuscular route was prescribed for 100 (47.8%) patients, and 49 (23.4%) of prescriptions had an inappropriate variety of administration routes. Although the criteria for assessing opioid prescribing were stringent the prescribing was sub-optimal. This survey will form the basis for future quality initiatives.
No related grants have been discovered for Barry Jenkins.