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Davis KM, Eckert MC, Hutchinson A, Harmon J, Sharplin G, Shakib S, Caughey GE. Effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface: A quantitative systematic review. Int J Nurs Stud 2021; 121:103986. [PMID: 34242979 DOI: 10.1016/j.ijnurstu.2021.103986] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Globally, chronic disease is a leading cause of illness, disability and death and an important driver of health system utilization and spending. Continuity of care is a significant component of quality healthcare. However, an association between nurse-led services, interventions, patient outcomes and continuity of care at the primary and secondary interface as an outcome, has not been established for people with chronic disease. OBJECTIVE To identify the effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface. DESIGN Quantitative systematic review. DATA SOURCES Systematic searches of Medline, Cochrane, Embase, Emcare, JBI and Scopus databases were conducted of studies published between 1946 and May 2019 using the search terms "nurse", "continuity of care" and "chronic disease". REVIEW METHODS Quality of the included studies was assessed using the Cochrane risk of bias tool for randomized controlled trials and Joanna Briggs Institute quality appraisal checklists. A second reviewer screened 10% of full text articles and all articles in critical appraisal. Studies were excluded from the review if they were of poor methodological quality or the description of the effect of the nurse-led service was inadequately reported. RESULTS Fourteen studies were included in the review (n=4,090 participants). All studies incorporated recognized continuity of care interventions. The nurse-led services were associated with fewer hospitalizations, reduced by 2-8.9% and re-admissions reduced by 14.8-51% (n=886). Reporting of positive patient experiences and improvement in symptoms and lifestyle was also evident. An association of nurse-led services with improved continuity of care between primary and secondary health services as an outcome per se could not be concluded. CONCLUSION Nurse-led services for adults provide coordinated interventions that support continuity of care for people with chronic disease in both the primary and secondary healthcare settings that are associated with reduced hospitalizations or readmissions and patient satisfaction. However, the limited use of validated continuity of care outcome measurement tools precluded establishing correlations between interventions, patient outcomes and continuity of care as a specific outcome.
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Affiliation(s)
- K M Davis
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia.
| | - M C Eckert
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/@DrJoanneHarmon
| | - A Hutchinson
- UniSA, Clinical and Health Sciences, University of South Australia
| | - J Harmon
- UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/marioneckert5
| | - G Sharplin
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia
| | - S Shakib
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - G E Caughey
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
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Parajuli DR, Kourbelis C, Franzon J, Newman P, McKinnon RA, Shakib S, Whitehead D, Clark RA. 207Effectiveness of the pharmacist-involved multidisciplinary management of heart failure to improve readmission and mortality rates: systematic review and meta-analysis of randomized controlled trials. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D R Parajuli
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
| | - C Kourbelis
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
| | - J Franzon
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
| | - P Newman
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
| | - R A McKinnon
- Flinders Medical Centre and Flinders University, College of Medicine and Public Health, Adelaide, Australia
| | - S Shakib
- Royal Adelaide Hospital, Department of Clinical Pharmacology, Adelaide, Australia
| | - D Whitehead
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
| | - R A Clark
- Flinders Medical Centre and Flinders University, College of Nursing and Health Sciences, Adelaide, Australia
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Turner J, Edwards S, Stanners M, Shakib S, Bell J. BARRIERS AND FACILITATORS TO DEPRESCRIBING IN PRACTICE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J.P. Turner
- Institut universitaire de gériatrie de Montréal, University de Montreal, Montreal, Quebec, Canada,
- Monash University, Melbourne, Victoria, Australia,
| | - S. Edwards
- Drug and Therapeutics Information Service (DATIS), Adelaide, South Australia, Australia,
| | - M. Stanners
- Torrens University, Adelaide, South Australia, Australia,
| | - S. Shakib
- The University of Adelaide, Adelaide, South Australia, Australia,
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - J. Bell
- Monash University, Melbourne, Victoria, Australia,
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Caughey GE, Barratt JD, Shakib S, Kemp-Casey A, Roughead EE. Medication use and potentially high-risk prescribing in older patients hospitalized for diabetes: a missed opportunity to improve care? Diabet Med 2017; 34:432-439. [PMID: 27135418 DOI: 10.1111/dme.13148] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 12/25/2022]
Abstract
AIMS To examine the appropriateness of medicine use and potentially high-risk prescribing before and after hospitalization for diabetes. METHODS A retrospective cohort study of patients hospitalized for diabetes was conducted using administrative data from the Australian Government Department of Veterans' Affairs for the period between 1 January 2012 and 31 December 2012. The appropriateness of medicine use and potentially high-risk prescribing, including hyper-polypharmacy and associated treatment conflicts, were examined for the 120-day periods before and after hospitalization. RESULTS A total of 876 patients were hospitalized for a diabetes-related complication. Of these, 25% were not dispensed an antidiabetic medicine 4 months before hospitalization and 25% had not had their HbA1c levels measured in the preceding 6 months. The use of antidiabetic medicines increased to 85% after hospitalization, with a 25.6% relative increase (95% CI 10.9-42.1) in the proportion of those dispensed insulin. The prevalence of high-risk prescribing before hospital admission was high; 70% had > 10 medicines dispensed, a third had at least one treatment conflict and half were dispensed a potentially inappropriate medicine. The use of long-acting sulphonylureas and corticosteroids had relative decreases of 46.0% (95% CI 17.0-64.9) and 29.9% (95% CI 8.8-46.0), respectively. Few changes in other high-risk prescribing patterns were observed after discharge. CONCLUSIONS This study has identified poor medication-related care and, in particular, high-risk-prescribing in people subsequently hospitalized for diabetes. While diabetes medicine use improved after hospitalization, there was little change in potentially inappropriate medicine use, which suggests that an opportunity to improve medication use in this older vulnerable population has been missed.
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Affiliation(s)
- G E Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide
| | - J D Barratt
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide
| | - S Shakib
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide
- Discipline of Pharmacology, School of Medicine, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide
| | - A Kemp-Casey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide
- Centre for Health Services Research, School of Population Health, University of Western Australia, Perth, Australia
| | - E E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide
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Caughey GE, Vitry AI, Ramsay EN, Gilbert AL, Shakib S, Ryan P, Esterman A, McDermott RA, Roughead EE. Effect of a general practitioner management plan on health outcomes and hospitalisations in older patients with diabetes. Intern Med J 2016; 46:1430-1436. [PMID: 27718515 DOI: 10.1111/imj.13286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 09/25/2016] [Accepted: 09/25/2016] [Indexed: 01/15/2023]
Affiliation(s)
- G. E. Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - A. I. Vitry
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - E. N. Ramsay
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - A. L. Gilbert
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
| | - S. Shakib
- Clinical Pharmacology Royal Adelaide Hospital Adelaide South Australia Australia
- Discipline of Clinical Pharmacology University of Adelaide Adelaide South Australia Australia
| | - P. Ryan
- School of Public Health University of Adelaide Adelaide South Australia Australia
| | - A. Esterman
- Sansom Institute of Health Service Research and School of Nursing and Midwifery University of South Australia Adelaide South Australia Australia
- Centre for Research Excellence in Chronic Disease Prevention, The Cairns Institute James Cook University Cairns Queensland Australia
| | - R. A. McDermott
- School of Population Health University of South Australia Adelaide South Australia Australia
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences James Cook University Cairns Queensland Australia
| | - E. E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences University of South Australia Adelaide South Australia Australia
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Sundararajan K, Milne D, Edwards S, Chapman MJ, Shakib S. Anti-seizure prophylaxis in critically ill patients with traumatic brain injury in an intensive care unit. Anaesth Intensive Care 2015; 43:646-51. [PMID: 26310417 DOI: 10.1177/0310057x1504300515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objectives of this prospective observational study were to determine the proportion of patients with traumatic brain injury who received effective anti-seizure prophylaxis. The study was conducted in a tertiary level ICU of a major trauma referral centre between February 2012 and August 2013. A total of 2361 patients were admitted to the ICU in this study period, of whom125 patients (index) with traumatic head injury were included in this study. The patients had a mean age of 45 years (SD=19), a mean score on the Glasgow Coma Scale of 9 (SD=4), a mean injury severity score of 27 (SD=13) and a mean APACHE III score of 55 (SD=27). Only 13.6 % (17 of 125) of patients were given anti-seizure prophylaxis and phenytoin levels were measured in 9.6% (12 of 125). Although all 12 patients achieved an effective concentration for phenytoin therapy (>40 µmol/l) after the loading dose, no patient had their target concentration consistently maintained in the recommended therapeutic range (40 to 80 µmol/l) throughout the seven-day monitoring period. There was wide fluctuation in phenytoin levels in the patients in this study. Twenty-two (18%) of the index patients had post-traumatic seizures, indicating a high prevalence for this study. Poor compliance with guidelines could possibly explain this phenomenon. Future studies are needed to look at the dosing and monitoring of phenytoin and/or alternative anti-seizure prophylaxis in patients with traumatic brain injury.
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Affiliation(s)
- K Sundararajan
- Staff Specialist, Intensive Care Unit, Royal Adelaide Hospital and Senior Clinical Lecturer, Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia
| | - D Milne
- Senior Pharmacist, Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia
| | - S Edwards
- Statistician, Data Management and Analysis Centre (DMAC), Discipline of Public Health, University of Adelaide, Adelaide, South Australia
| | - M J Chapman
- Director of ICU Research and Senior Staff Specialist, Intensive Care Unit, Royal Adelaide Hospital and Professor, Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia
| | - S Shakib
- Director, Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia
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Vitry AI, Nguyen TA, Ramsay EN, Caughey GE, Gilbert AL, Shakib S, Ryan P, Esterman A, McDermott RA, Roughead EE. General practitioner management plans delaying time to next potentially preventable hospitalisation for patients with heart failure. Intern Med J 2015; 44:1117-23. [PMID: 24942781 DOI: 10.1111/imj.12512] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 06/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies have shown that the Australian Medicare-funded chronic disease management programme can lead to improvements in care processes. No study has examined the impact on long-term health outcomes. AIMS This retrospective cohort study assessed the association between provision of a general practitioner management plan and time to next potentially preventable hospitalisation for older patients with heart failure. METHODS We used the Australian Government Department of Veterans' Affairs (DVA) claims database and compared patients exposed to a general practitioner management plan with those who did not receive the service. Kaplan-Meier analysis and Cox proportional hazards models were used to compare time until next potentially preventable hospitalisation for heart failure between the exposed and unexposed groups. RESULTS There were 1993 patients exposed to a general practitioner management plan and 3986 unexposed patients. Adjusted results showed a 23% reduction in the rate of potentially preventable hospitalisation for heart failure at any time (adjusted hazard ratio, 0.77; 95% confidence interval, 0.64 to 0.92; P = 0.0051) among those with a general practitioner management plan compared with the unexposed patients. Within one year, 8.6% of the exposed group compared with 10.7% of the unexposed group had a potentially preventable hospitalisation for heart failure. CONCLUSIONS A general practitioner management plan is associated with delayed time to next potentially preventable hospitalisation for heart failure.
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Affiliation(s)
- A I Vitry
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, University of South Australia, Adelaide, Australia
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Kim DD, Krishnarajah J, Lillioja S, de Looze F, Marjason J, Proietto J, Shakib S, Stuckey BGA, Vath JE, Hughes TE. Efficacy and safety of beloranib for weight loss in obese adults: a randomized controlled trial. Diabetes Obes Metab 2015; 17:566-572. [PMID: 25732625 DOI: 10.1111/dom.12457] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/15/2015] [Accepted: 02/26/2015] [Indexed: 12/25/2022]
Abstract
AIM To assess the efficacy, safety and tolerability of beloranib treatment for obesity. METHODS This phase II, double-blind, randomized study investigated the effects of beloranib suspension (0.6, 1.2 and 2.4 mg) or placebo, administered subcutaneously, for 12 weeks in 147 participants (primarily white women) with obesity. No diet or exercise advice was administered. RESULTS At week 12, beloranib resulted in dose-dependent progressive weight loss of -5.5 ± 0.5, -6.9 ± 0.6 and -10.9 ± 1.1 kg for the 0.6, 1.2 and 2.4 mg beloranib doses, respectively, compared with -0.4 ± 0.4 kg with placebo (all p < 0.0001 vs placebo). Weight loss with beloranib was associated with corresponding reductions in waist circumference and body fat mass, as well as improvements in lipids, high-sensitivity C-reactive protein and blood pressure. Sleep disturbance and gastrointestinal adverse events were more common with beloranib than with placebo; these were generally mild to moderate, transient and dose-related, and led to more early study withdrawals in participants in the group with the highest dose of beloranib. CONCLUSIONS In this 12-week phase II study, beloranib produced clinically and statistically significant weight loss and corresponding improvements in cardiometabolic risk factors. Beloranib appeared safe, and the 0.6 and 1.2 mg doses were generally well tolerated. The 2.4 mg dose was associated with increased sleep latency and mild to moderate gastrointestinal adverse events over the first month of treatment. These findings represent a novel mechanism for producing clinically meaningful weight loss.
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Affiliation(s)
- D D Kim
- Zafgen, Inc., Cambridge, MA, USA
| | | | - S Lillioja
- Clinical Informatics and CRTU-IHMRI, University of Wollongong, Wollongong, NSW, Australia
| | - F de Looze
- AusTrials Pty Ltd, Sherwood, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - J Proietto
- Austin Health, Heidelberg, VIC, Australia
| | - S Shakib
- CMAX Drug Studies Unit, Adelaide, SA, Australia
| | - B G A Stuckey
- Keogh Institute for Medical Research, Nedlands, WA, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA, Australia
| | - J E Vath
- Zafgen, Inc., Cambridge, MA, USA
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Nguyen TA, Caughey G, Pratt N, Shakib S, Kemp A, Roughead E. Hospitalization for drug-induced hepatotoxicity: linking Y-codes with pharmaceutical claims data to identify implicated medicines. J Clin Pharm Ther 2015; 40:213-9. [DOI: 10.1111/jcpt.12249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/12/2015] [Indexed: 11/27/2022]
Affiliation(s)
- T. A. Nguyen
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; Sansom Institute; University of South Australia; Adelaide SA Australia
| | - G. Caughey
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; Sansom Institute; University of South Australia; Adelaide SA Australia
| | - N. Pratt
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; Sansom Institute; University of South Australia; Adelaide SA Australia
| | - S. Shakib
- Department of Clinical Pharmacology; The Royal Adelaide Hospital; Adelaide SA Australia
| | - A. Kemp
- Centre for Health Services Research; School of Population Health; The University of Western Australia; Crawley SA Australia
| | - E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre; School of Pharmacy and Medical Sciences; Sansom Institute; University of South Australia; Adelaide SA Australia
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Thomas JS, Koo M, Shakib S, Wu J, Khanal S. Impact of a compulsory final year medical student curriculum on junior doctor prescribing. Intern Med J 2015; 44:156-60. [PMID: 24528813 DOI: 10.1111/imj.12316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/09/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Attendance at face-to-face sessions and completion of online components of the National Prescribing Curriculum was made compulsory for final year medical students at the University of Adelaide in 2010. AIMS To determine the impact of a compulsory prescribing curriculum for final year medical students on their prescribing competencies at the start of clinical practice. Graduates' attitudes to their medical school training in prescribing were also surveyed. METHODS Two cohorts of medical graduates from the University of Adelaide who commenced medical practice in 2010 and 2011 were required to complete a prescribing task using the National Inpatient Medication Chart (NIMC) at orientation and after 6 months of clinical practice. The main outcome measure was a performance in a scenario-based prescribing test, as determined by test scores and overall safety of prescriptions at orientation and 6 months of clinical practice. RESULTS There was a small difference in the average total score for the prescribing task between the 2010 and 2011 cohorts at orientation (P = 0.0007). The 2011 cohort had a higher number of safer charts at commencement of practice. We found no difference between the 2010 and 2011 cohorts in attitudes towards their undergraduate pharmacology education, and new graduates feel poorly prepared. CONCLUSION Medical graduates who are required to complete a practically oriented prescribing curriculum in final year perform slightly better on a prescribing assessment at commencement of practice. More work on preparing graduates for this complex task before graduation is needed.
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Affiliation(s)
- J S Thomas
- Clinical Education, University of Adelaide, Adelaide, South Australia, Australia
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Pisaniello AD, Wong DTL, Kajani I, Robinson K, Shakib S. Anaemia in chronic heart failure: more awareness is required. Intern Med J 2013; 43:999-1004. [DOI: 10.1111/imj.12195] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 05/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A. D. Pisaniello
- Cardiology Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - D. T. L. Wong
- Cardiology Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - I. Kajani
- Cardiology Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - K. Robinson
- Department of Haematology-Oncology; The Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - S. Shakib
- Clinical Pharmacology Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
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Tayeb H, Nelson A, Psaltis P, Awwad G, Scherer D, Shakib S, Dundon B, Roberts-Thomson K, Sanders P. Automated Implantable Cardiac Defibrillator: A Competing Risks Analysis. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pisaniello A, Shakib S, Kajani I, Robinson K, Wong D. Evaluation of Anaemia in a Cohort of Chronic Heart Failure Patients. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Caughey GE, Roughead EE, Shakib S, McDermott RA, Vitry AI, Gilbert AL. Comorbidity of chronic disease and potential treatment conflicts in older people dispensed antidepressants. Age Ageing 2010; 39:488-94. [PMID: 20511245 DOI: 10.1093/ageing/afq055] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES the study aimed to examine the prevalence of comorbidity, the prescribing of potentially inappropriate medications and treatment conflicts in a large sample of older people who have been dispensed an antidepressant medicine. METHODS a cross-sectional study of administrative claims data from the Department of Veterans' Affairs, Australia, 1 April-31 July 2007, of veterans aged > or =65 years was conducted. Comorbidities determined using the pharmaceutical-based comorbidity index, Rx-Risk-V. Concomitant medicines that may be potentially inappropriate for patients with depression and areas of treatment conflicts were determined from Australian clinical guidelines or reference compendia. RESULTS a total of 39,695 subjects were included, with a median of 5 comorbid conditions (inter-quartile range 3-6). Ninety percent of medicine use was attributed to the treatment of comorbid conditions. Eighty-seven percent of the study cohort was identified as having at least one comorbid condition that may cause a potential treatment conflict when an antidepressant is used. Those conditions of most concern included cardiovascular diseases, anxiety disorders, arthritis or pain management and osteoporosis. CONCLUSION we observed a high level of potentially inappropriate prescribing and treatment conflicts that may arise when caring for older patients dispensed an antidepressant with comorbidity. These have the potential to place a large number of older people with depression at increased risk for adverse events.
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Abstract
The role of aspirin for primary prevention in healthy individuals has been the subject of clinical trials for more than a quarter of a century. Because of this evidence, or sometimes despite it, many individuals self-administer aspirin to prevent cardiovascular events. This article reviews the published work for aspirin in primary prevention of cardiovascular and malignant diseases and considers whether aspirin would be approved by regulatory authorities for this use if it were to be marketed for this indication today.
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Affiliation(s)
- S Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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Leong D, Shakib S, Gillam M, Ryan P, Salter A, Gericke C. Prediction of Outcome for Hospitalised Heart Failure Patients: A Competing Risks Analysis. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shakib S, Desanti GE, Jenkinson WE, Parnell SM, Jenkinson EJ, Anderson G. Checkpoints in the development of thymic cortical epithelial cells:
FIGURE 1. J Immunol 2009. [DOI: 10.4049/jimmunol.0990018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Broadley SA, Vanags D, Williams B, Johnson B, Feeney D, Griffiths L, Shakib S, Brown G, Coulthard A, Mullins P, Kneebone C. Results of a phase IIa clinical trial of an anti-inflammatory molecule, chaperonin 10, in multiple sclerosis. Mult Scler 2008; 15:329-36. [PMID: 19039022 DOI: 10.1177/1352458508099141] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chaperonin 10 (Cpn10) is a mitochondrial molecule involved in protein folding. The aim of this study was to determine the safety profile of Cpn10 in patients with multiple sclerosis (MS). METHODS A total of 50 patients with relapse-remitting or secondary progressive MS were intravenously administered 5 mg or 10 mg of Cpn10 weekly for 12 weeks in a double-blind, randomized, placebo controlled, phase II trial. Clinical reviews, including Expanded Disability Status Scale and magnetic resonance imaging (MRI) with Gadolinium, were undertaken every 4 weeks. Stimulation of patient peripheral blood mononuclear cells with lipopolysaccharide ex vivo was used to measure the in vivo activity of Cpn10. RESULTS No significant differences in the frequency of adverse events were seen between treatment and placebo arms. Leukocytes from both groups of Cpn10-treated patients produced significantly lower levels of critical proinflammatory cytokines. A trend toward improvement in new Gadolinium-enhancing lesions on MRI was observed, but this difference was not statistically significant. No differences in clinical outcome measures were seen. CONCLUSIONS Cpn10 is safe and well tolerated when administered to patients with MS for 3 months, however, a further extended phase II study primarily focused on efficacy is warranted.
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Affiliation(s)
- S A Broadley
- School of Medicine, Gold Coast Campus, Griffith University, and Gold Coast Hospital, Southport, Queensland, Australia.
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Shakib S, Philpott H, Clark R. What we have here is a failure to communicate! Improving communication between tertiary to primary care for chronic heart failure patients. Intern Med J 2008; 39:595-9. [DOI: 10.1111/j.1445-5994.2008.01820.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Robinson K, Kenefeck R, Pidgeon EL, Shakib S, Patel S, Polson RJ, Zaitoun AM, Atherton JC. Helicobacter pylori-induced peptic ulcer disease is associated with inadequate regulatory T cell responses. Gut 2008; 57:1375-85. [PMID: 18467372 DOI: 10.1136/gut.2007.137539] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Helicobacter pylori infection is the major cause of peptic ulceration and gastric adenocarcinoma. To address the hypothesis that the human acquired immune response to H. pylori influences pathogenesis, we characterised the gastric T helper (Th) and regulatory T cell (Treg) response of infected patients. METHODS The human gastric CD4(+) T cell response of 28 donors who were infected with H. pylori and 44 who were not infected was analysed using flow cytometry. The T cell associated mucosal cytokine response was analysed by real-time polymerase chain reaction assay of samples from 38 infected and 22 uninfected donors. Recombinant interleukin 10 (IL10) was added to co-cultures of H. pylori and AGS cells and its suppressive effects upon inflammatory responses were measured. RESULTS We found that the H. pylori-specific response consists of both T helper 1 and 2 subsets with high levels of IL10-secreting Tregs. People with peptic ulcer disease had a 2.4-fold reduced CD4(+)CD25(hi)IL10(+) Treg response (p = 0.05) but increased Th1 and Th2 responses (Th1: 3.2-fold, p = 0.038; Th2: 6.1-fold, p = 0.029) compared to those without ulcers. In vitro studies showed that IL10 inhibited IL8 expression and activation of nuclear factor kappa B induced by H. pylori in gastric epithelial cells, and enhanced H. pylori growth in a bacterial-cell co-culture model. CONCLUSIONS Together our data suggest that H. pylori induces a regulatory T cell response, possibly contributing to its peaceful coexistence with the human host, and that ulcers occur when this regulatory response is inadequate.
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Affiliation(s)
- K Robinson
- Institute of Infection, Immunity & Inflammation, University of Nottingham, Centre for Biomolecular Sciences, Nottingham, UK.
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Ponniah A, Anderson B, Shakib S, Doecke CJ, Angley M. Pharmacists' role in the post-discharge management of patients with heart failure: a literature review. J Clin Pharm Ther 2007; 32:343-52. [PMID: 17635336 DOI: 10.1111/j.1365-2710.2007.00827.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The incidence of heart failure is increasing in developed countries. In the aged population, heart failure is a common cause of hospitalization and hospital readmission, which in conjunction with post-discharge care, impose a significant cost burden. Inappropriate medication management and drug-related problems have been identified as major contributors to hospital readmissions. In order to enhance the care and clinical outcomes, and reduce treatment costs, heart failure disease management programmes (DMPs) have been developed. It is recommended that these programmes adopt a multi-disciplinary approach, and pharmacists, with their understanding and knowledge of medication management, can play a vital role in the post-discharge care of heart failure patients. The aim of this literature review was to assess the role of pharmacists in the provision of post-charge services for heart failure patients. METHOD An extensive literature search was undertaken to identify published studies and review articles evaluating the benefits of an enhanced medication management service for patients with heart failure post-discharge. RESULTS Seven studies were identified evaluating 'outpatient' or 'post-discharge' pharmacy services for patients with heart failure. In three studies, services were delivered prior to discharge with either subsequent telephone or home visit follow-up. Three studies involved the role of a pharmacist in a specialist heart failure outpatient clinic. One study focused on a home-based intervention. In six of these studies, positive outcomes, such as decreases in unplanned hospital readmissions, death rates and greater compliance and medication knowledge were demonstrated. One study did not show any difference in the number of hospitalizations between intervention and control groups. The quality of evidence of the randomized controlled trials was assessed using the Jadad scoring method. None of the studies achieved a score of more than 2, out of a maximum of 5, indicating the potential for bias. DISCUSSION The DMPs carried out by pharmacists have contributed to positive patient outcomes, which has highlighted the value of extending the traditional roles of pharmacists from the provision of professional guidance to the delivery of continuity of care through a more holistic and direct approach. CONCLUSION This review has demonstrated the effectiveness of pharmacists' interventions to reduce the morbidity and mortality associated with heart failure. However, there is an on-going need for the development and evaluation of pharmacy services for these patients.
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Affiliation(s)
- A Ponniah
- School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, SA, Australia
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Affiliation(s)
- D L Worthley
- Department of General Medicine, Royal Adelaide Hospital, North Terrace, South Australia, Australia
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Hindiyeh M, Goulding C, Morgan H, Kenyon B, Langer J, Fox L, Dean G, Woolstenhulme D, Turnbow A, Billetdeaux E, Shakib S, Gordon C, Powers A, Vardeny G, Johnson M, Skodack-Jones L, Carroll K. Evaluation of BioStar FLU OIA assay for rapid detection of influenza A and B viruses in respiratory specimens. J Clin Virol 2000; 17:119-26. [PMID: 10942092 DOI: 10.1016/s1386-6532(00)00081-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Demand for the rapid diagnosis of influenza infections has increased with the advent of the availability of neuraminidase antiviral therapy for influenza A and B. Several rapid assays that detect both influenza A and B are now available. OBJECTIVES In this study we compared the performance of the BioStar FLU OIA assay to Bartels Viral Respiratory Screening and Identification Kit (Bartels Inc., Issaquah, WA), and cell culture. STUDY DESIGN A total of 145 patient specimens for influenza virus detection submitted in either viral transport medium or in sterile containers were evaluated by the three methods. Specimen types included nasal washings, nasal swabs, sputum, throat swabs, and bronchial alveolar lavage (BAL) fluids. RESULTS Fifty six positive specimens were identified based on culture and/or DFA. Of these, 30 specimens were positive by the OIA assay for an overall sensitivity of 54%. The OIA assay detected 48% (n = 21) of the 44 culture positive specimens and 81% (n = 29) of the 36 DFA positive specimens. Eighty six of the 89 culture/DFA negative samples were negative by the OIA assay (97% specificity). Analysis of the OIA assay sensitivity from samples submitted in M4 transport medium or in sterile containers revealed that M4 transport medium does not reduce the sensitivity of the OIA assay. Fifteen of the 27 positive samples submitted in M4 transport medium were positive by the OIA assay (56% sensitivity) compared to 15 of 29 positive samples transported in sterile containers (52% sensitivity). Twelve specimens were either culture and/or DFA positive for viruses other than influenza, but negative by the OIA assay, suggesting that there was no cross reactivity of the OIA assay with the other virus types recovered in this study. CONCLUSIONS The overall excellent specificity of the BioStar FLU OIA allows for treatment of positive patients for influenza, however, a negative result should be confirmed by DFA and culture.
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Affiliation(s)
- M Hindiyeh
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, USA.
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Taverner D, Bickford L, Shakib S, Tonkin A. Evaluation of the dose-response relationship for intra-nasal oxymetazoline hydrochloride in normal adults. Eur J Clin Pharmacol 1999; 55:509-13. [PMID: 10501820 DOI: 10.1007/s002280050665] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate the dose-response relationship of increasing doses of oxymetazoline compared with placebo in normal subjects, and to determine the sensitivities of rhinomanometry, acoustic rhinometry and symptoms in discriminating between differing doses of oxymetazoline in normal subjects. METHODS The study had a randomized, double-blind, placebo-controlled, parallel group, dose-response design. One hundred and twenty-five healthy volunteers with no nasal obstruction were randomized to administration of a single intra-nasal dose of oxymetazoline (6.25 microg, 12.5 microg, 25 microg or 50 microg) or placebo to each nasal cavity. Nasal airway resistance (NAR) was measured by active posterior rhinomanometry. Total minimum cross-sectional area (tMCA) and volume (tVOL) were measured by acoustic rhinometry. Symptoms of congestion (CON) were assessed on a visual analogue scale. RESULTS The two highest doses of oxymetazoline produced a significant decrease in NAR compared with placebo (P = 0.015) but not between placebo and 12.5 microg or 6.25 microg. There was a dose-response relationship for tVOL, which increased significantly after all doses compared with placebo (P < 0. 001) and showed differences between 6.25-microg and 25-microg (P < 0. 014) and 12.5-microg and 50-microg (P < 0.05) doses. tMCA increased compared with placebo after all treatments (P = 0.028), but there were no significant differences between any of the active doses. There were no significant changes in CON after any treatments compared with placebo. CONCLUSIONS tVOL shows a clear dose-response relationship for the range of doses of oxymetazoline administered. tVOL provides a sensitive and discriminatory measure of small nasal changes after low doses of oxymetazoline. NAR is able to discriminate between doses, but is less sensitive than tVOL and tMCA, requiring a higher threshold dose before significant changes are seen in nasal patency.
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Affiliation(s)
- D Taverner
- Department of Clinical and Experimental Pharmacology, University of Adelaide, South Australia, 5005 Australia.
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Shakib S, Clark E, Buckley N, Howe L. A COMPARISON OF THE PERFORMANCE OF DIFFERENT TECHNIQUES FOR THE DETERMINATION OF A ONCE DAILY GENTAMICIN DOSE. Ther Drug Monit 1999. [DOI: 10.1097/00007691-199908000-00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
AIMS The effects of a single dose of oxymetazoline nasal spray on nasal patency have been compared with placebo using three separate measuring systems in normal subjects. METHODS The study was a placebo-controlled, randomised double-blind crossover trial. Subjects without ear, nose or throat disease and with resting nasal airways resistance >0.15 Pa s cm-3 were selected so that a fall in airways resistance could be detected. Nasal airways resistance (NAR) was measured by NR6-2 rhinomanometer. Acoustic rhinometry (SR-2000 rhinometer) provided the sum of the minimum cross-sectional areas (tMCA) and volume (tVOL) of the left and right nasal cavities. Symptoms of congestion were assessed on a visual analogue scale (CON, range 0-100). Measurements were made for 60 min before and for 120 min after bilateral administration of oxymetazoline nasal spray (0.9 mg) or placebo (0.9% saline). Crossover occurred 7-21 days later. Results for all measures were analysed as change from average baseline value by trapezoidal AUC, and statistical significance was tested by 2-way anova. RESULTS NAR, tMCA, tVOL and CON did not change after placebo, but NAR and CON fell and tMCA and tVOL increased significantly at all timepoints after oxymetazoline. NAR_AUC, tVOL_AUC, tMCA_AUC were significantly different between placebo and oxymetazoline (P<0.001) as was CON_AUC (P=0.012). The day-to-day intraindividual repeatability of baseline NAR tMCA and tVOL was <10%. CONCLUSIONS Normal subjects can be used to detect the effects of nasally vasoactive drugs with a variety of complementary systems, with the advantages of easy subject recruitment and low variability.
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Affiliation(s)
- L Bickford
- Department of Clinical and Experimental Pharmacology, University of Adelaide, South Australia, 5005, Australia
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