Michelle Trevenen

Opportunities to develop the professional role of community pharmacists in the care of patients with asthma: A cross-sectional study

There are many indications in Australia and globally that asthma management is suboptimal. Ideally, patients need to proactively self-manage the condition with the support of health professionals. Community pharmacists are a highly accessible resource for patients but currently provide inconsistent services. General practitioners also face many barriers to the provision of chronic disease management for asthma patients. The aim of this research was to characterise patients with asthma who present to community pharmacy. The objective was to identify opportunities to develop the role of pharmacists in the context of the primary healthcare setting and in view of the needs of the patients they routinely encounter. The results of a comprehensive survey of 248 patients recruited from community pharmacies indicated there was discordance between patient perceptions of asthma control and actual asthma control. Almost half the patients surveyed had poorly controlled asthma, whereas almost three quarters perceived their asthma to be well or completely controlled. Fewer than 20% of patients were utilising written asthma action plans, and issues around quality use of medicines were identified. The significance of the incongruent perceptions regarding asthma control is that patients are unlikely to proactively seek intervention and support from healthcare professionals. Community pharmacists provide a significant opportunity to address these issues by direct intervention. There is scope to investigate pharmacists preparing written asthma action plans for patients, using software to monitor medication adherence and prescribe on-going medication. To maximise the potential of pharmacists, barriers to practice need to be identified and addressed.

FOXP3+ T regulatory lymphocytes in primary melanoma are associated with BRAF mutation but not with response to BRAF inhibitor

Summary Tumour infiltrating lymphocytes in primary melanoma have been found to correlate with patient outcomes. A subpopulation of tumour infiltrating lymphocytes expresses the transcription factor forkhead box protein 3 (FOXP3). These are known as FOXP3+ T-regulatory cells (Tregs) and are thought to play an immune suppressive role in tumourigenesis. In most tumours, including melanoma, a high density of intratumoural FOXP3+ Tregs has been associated with poor prognosis. It is not known whether these cells also influence the response to BRAF inhibition therapy in metastatic melanoma. In the present study we retrospectively investigated the density of FOXP3+ Tregs in primary melanomas, with known subsequent metastasis, in relation to various clinicopathological parameters including BRAF and NRAS mutation status, and response to BRAF inhibitor therapy. The intratumoural density of FOXP3+ Tregs was two-fold higher in melanomas with mutant BRAF compared to those with wild type BRAF status (p = 0.03). In patients treated with BRAF kinase inhibitors FOXP3+ Treg density in the primary tumour was not predictive of treatment response (p = 0.38).

Prevalence of obesity in an intensive care unit patient population

BACKGROUND The Australian health survey (2011-2012) reported that 63.4% of Australian adults were overweight or obese. Critical care medicine is expensive, with intensive care unit (ICU) services accounting for a substantial proportion of total hospital costs. These costs may be multiplied in the overweight cohort. OBJECTIVES The primary aim was to compare the body mass index (BMI) of a critically ill ICU patient cohort to Australian population norms in order to see if overweight people were over-represented. The secondary aim was to identify if any medical specialty was associated with overweight patients. METHODS A retrospective observational case note audit of 230 ICU patients between November 2012 and August 2013, with BMI as the primary outcome measure. RESULTS Approximately 75% of the cohort were overweight or obese (median BMI 28.7; IQR 25.0-32.7) representing a rate 12% higher than Australian normative data. Based on population, this equates to an estimated additional 5279 unanticipated overweight or obese ICU patients at our facility during 2013. CONCLUSIONS This study has shown that Australian ICU patients may have higher BMI than those of the general Australian population, and therefore there may be unanticipated costs associated with their care. No medical specialty was associated with higher BMI than another.

A pilot study of the utility of choline PET-CT in prostate cancer biochemical relapse following radical prostatectomy.

To evaluate the detection rate of positive choline PET–CT and its clinical role in assisting with management decisions and the correlation between positive choline PET–CT and clinical/pathological parameters in prostate cancer patients with biochemical relapse following radical prostatectomy.

Implementing endobronchial ultrasound-guided (EBUS) for staging and diagnosis of lung cancer: a cost analysis

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and guide sheath (EBUS-GS) are gaining popularity for diagnosis and staging of lung cancer compared to CT-guided transthoracic needle aspiration (CT-TTNA), blind fiber-optic bronchoscopy, and mediastinoscopy. This paper aimed to examine predictors of higher costs for diagnosing and staging lung cancer, and to assess the effect of EBUS techniques on hospital cost. Material/Methods Hospital costs for diagnosis and staging of new primary lung cancer patients presenting in 2007–2008 and 2010–2011 were reviewed retrospectively. Multiple linear regression was used to determine relationships with hospital cost. Results We reviewed 560 lung cancer patient records; 100 EBUS procedures were performed on 90 patients. Higher hospital costs were associated with: EBUS-TBNA performed (p<0.0001); increasing inpatient length of stay (p<0.0001); increasing number of other surgical/diagnostic procedures (p<0.0001); whether the date of management decision fell within an inpatient visit (p<0.0001); and if the patient did not have a CT-TTNA, then costs increased as the number of imaging events increased (interaction p<0.0001). Cohort was not significantly related to cost. Location of the procedure (outside vs. inside theater) was a predictor of lower one-day EBUS costs (p<0.0001). Cost modelling revealed potential cost saving of

Evaluation of the Accuracy of Two Marking Methods and the Novel toriCAM Application for Toric Intraocular Lens Alignment

1506 per EBUS patient if all EBUS procedures were performed outside rather than in the theater (

Implementation of asthma guidelines to West Australian community pharmacies: an exploratory, quasi-experimental study

66,259 per annum). Conclusions EBUS-TBNA only was an independent predictor of higher cost for diagnosis and staging of lung cancer. Performing EBUS outside compared to in the theater may lower costs for one-day procedures; potential future savings are considerable if more EBUS procedures could be performed outside the operating theater.

Antibiotic Allergy Labels in Children Are Associated with Adverse Clinical Outcomes

PURPOSE To compare the accuracy of two common reference marking methods for toric intraocular lens alignment before and after using the novel toriCAM application. METHODS In this prospective, randomized study, 22 participants were randomly allocated to two groups, either freehand or slit-lamp-assisted marking. Corneal markings at 0° and 180° were made using either method. The toriCAM application on a smartphone was then used to assess the rotational alignment of these markings and compared to the actual alignment as measured by the Zaldivar calipers on the iTrace Topographer (Tracey Technologies, Houston, TX) as a reference. The errors in marking with and without using the application were analyzed for all patients in each cohort and determined for each marking method. RESULTS Twenty eyes of 11 patients were marked using the freehand method and 20 eyes of the other 11 patients were marked using the slit-lamp method. The mean absolute error of all markings before toriCAM adjustment was 3.18° ± 2.22°. This was significantly reduced to 1.28° ± 1.34° after using the application (P < .001). This improvement was also noted separately in the freehand and slit-lamp groups. Comparison of the freehand and slit-lamp methods did not show any statistically significant difference in accuracy at both time points. CONCLUSIONS The novel toriCAM application is able to significantly improve the accuracy of reference marking for both freehand and slit-lamp methods. [J Refract Surg. 2018;34(3):150-155.].

A simulation model for exploring the effects of plant-soil feedbacks on the resilience of plant communities

Objectives Pharmacy assistants are often the first point of contact for patients presenting in community pharmacies. The current role of pharmacy assistants in the supply of asthma-reliever medications (short-acting β-agonists) was identified as a barrier to appropriate guideline-based care. The aim of this research was to devise and evaluate a team-based intervention to formalise the role of pharmacy assistants and to improve asthma guideline-based care in community pharmacy. Design A controlled pre-post intervention study was conducted in 336 metropolitan pharmacies located in Perth, Western Australia. Pharmacies were stratified into 2 groups (187 intervention and 149 control) based on known confounders for asthma control. The intervention was designed using a common-sense approach and resources developed included a checklist, videos and web page. Delivery was via workshops (25 pharmacies) or academic detailing (162 pharmacies). Pharmacy practice was assessed preintervention and postintervention via covert simulated patient methodology. Primary outcome measures included patient medical referral, device use demonstration and counselling, internal referral and/or direct involvement of a pharmacist in consultations. Results There was a significant increase in patient medical referral in intervention pharmacies from 32% to 47% (p=0.0007) from preintervention to postintervention, while control pharmacies showed a non-significant decrease from 50% to 44% (p=0.22). Device counselling was not routinely carried out at any stage or in any cohort of this research and no significant changes in internal referral were observed. Conclusions Increases in medical referral indicate that asthma guideline compliance can be improved in community pharmacy if implementation employs a team-based approach and involves pharmacy assistants. However, results were variable and the intervention did not improve practice related to device counselling or internal referral/pharmacist involvement. Undertaking more workshops may have improved results. Guideline implementation in community pharmacy should consider the role of pharmacy assistants and how to overcome logistical barriers to pharmacy participation in implementation activities.