Gabrielle Cooper

Limited human resources are a major impediment to achieving the UN health-related Millennium Development Goals in a number of Pacific Island Countries (PICs). Lack of education capacity to support competency development in medicine supply management is one of the main issues affecting workforce development in this region, which is characterised by disparate service delivery due to the range of environments in which supply occurs (ie urban, rural and remote), geographical challenges and cultural practices associated with teaching and learning. The supply of medicines, and an adequate pharmacy workforce with appropriate competencies is crucial to ensuring a well-functioning pharmaceutical system. In this region approximately 80% of patients access healthcare in rural areas without a pharmacist, thus local health personnel must be competent in pharmaceutical management relevant to the local context and culture. A new approach involves a partnership between the UN Population Fund Suva S...

ABSTRACT A study was carried out to examine the dosing of gentamicin and to investigate some of the determinants of serum gentamicin concentrations in neonates at the Royal Hobart hospital, Tasmania, Australia, and to examine the appropriateness of the current dosing protocol (that of the Royal Children's hospital, Melbourne). Clinical and demographic data were retrospectively collected from the records of 39 neonates who had received therapy with gentamicin for suspected or proven septicaemia during the period May to September, 1993. Peak and trough serum concentrations of gentamicin were measured, at least 36 hours after starting therapy. The mean gestational age (± SD) of the sample was 32.3 ± 4.9 weeks, and 30 patients were male. The mean dosage of gentamicin was 4.0 ± 1.3mg/kg/day and the median duration of therapy was 4 days (range 2 to 22 days). Trough serum concentrations of gentamicin ranged from 0.6 to 6.0mg/L (mean 1.9 ± 1.0mg/L), with 35.9 per cent being 2.0mg/L or higher. Peak serum concentrations ranged from 4.3 to 12.9 mg/L (mean 6.1 ± 1.5 mg/L), with 89.7 per cent being between 5.0 and 8.0mg/L. The peak and trough serum concentrations were significantly related, while the total daily dosage of gentamicin and the resulting peak and trough serum concentrations were not significantly related. The trough serum concentration of gentamicin was significantly related to the serum creatinine concentration. Patients who had been dosed correctly according to the protocol were less likely to have a potentially toxic trough serum concentration of gentamicin. Those administered gentamicin every 12 hours tended to have higher serum trough concentrations of the drug than those who received it either 18- or 24-hourly. This study has confirmed that excessive serum concentrations of gentamicin occur frequently in neonates, a situation which may be improved by greater usage of an 18-hourly dosing regimen and prompt adjustment of dosage according to renal function.

To date, the uptake of chlamydia screening in community pharmacies has been limited. The objective of this cross-sectional study was to determine if a cash reward, offered to both the provider and the consumer of chlamydia screening, increased the uptake of screening in community pharmacies. During 4 weeks in 2011, chlamydia screening and education were offered in four city and two suburban pharmacies to people aged 16-30 years. Those who provided a urine sample for testing, contact details, and completed a brief questionnaire were rewarded with $A10. Positive participants, and their nominated contacts, were offered treatment. Over a period of 751.5 h, 979 testing kits were requested, and 900 (93%) urine samples returned. Using probabilistic linkage methods, we determined that 671/900 (75%) urine samples were from unique individuals. 0.9 unique samples were obtained/hour of screening, 63% of which were provided by men. 19/671 (2.8%; 95% CI 1.7% to 4.4%) people tested positive, 5.2% (95% CI 2.8% to 8.8%) of women, and 1.4% (1.4 0.5 to 3.1) of men. 11/19 (58%) people were contacted and treated-two for suspected pelvic inflammatory disease. Providing a cash reward to encourage chlamydia screening in community pharmacies resulted in greater participation rates than previously reported pharmacy-based studies, particularly among men. Easily implemented mechanisms to reduce inappropriate repeat screening, incorrect contact details and effects on pharmacy work flow may enhance the efficiency of this approach.

This study was conducted to determine the prevalence of drug-related hospital admissions in southern Tasmania, Australia. The causes of consecutive admissions to medical wards of the Royal Hobart Hospital were reviewed. Comprehensive data were collected over a 10-week period on 691 admissions (median age: 67 years and range: 11-97 years; 50.8% males). Sixty-eight (9.8%) of the admissions were classified as being either probably or definitely drug-related. Most of these admissions were attributable to intentional overdose (38.2%) or an adverse drug reaction (30.9%). The overdoses often involved benzodiazepines or antipsychotics. Gastrointestinal bleeding related to the use of nonsteroidal anti-inflammatory drugs was the most common adverse drug reaction (38.1% of all reactions). Other drug-related admission categories were poor compliance (14.7%), dosage decrease or therapy cessation by a doctor producing an exacerbation of symptoms (7.4%), substance abuse (4.4%) and drug interaction (4.4%). Patients with a drug-related admission were, on average, younger than the other medical admissions, with no significant difference in gender. Patients admitted due to an overdose or substance abuse were younger than other drug-related admissions and non-drug related admissions. In conclusion, this study has determined that almost 10% of medical admissions to the hospital are drug-related and it is estimated that 40 to 50 elderly people are admitted each year suffering from gastrointestinal bleeding related to nonsteroidal anti-inflammatory drugs.