Vaughn Eaton

Assessment of an Age-Adjusted Warfarin Initiation Protocol

OBJECTIVE: To examine the time taken to reach a stable international normalized ratio (INR), as well as the incidence of overanticoagulation of an age-adjusted warfarin initiation protocol. METHODS: Inpatients and outpatients commencing warfarin therapy at 2 teaching hospitals were dosed according to the age-adjusted protocol. Data were collected prospectively. MAIN OUTCOME MEASURES: Time to reach a stable INR of 2–3 and the number of patients experiencing an INR ≥4 during the first week of warfarin therapy. RESULTS: Seventy-three patients were assessed; at the completion of the 4-day titration protocol, 63% had achieved a stable INR. After an additional 2 days of empiric dosage adjustment by the attending physician, 86% of the subjects demonstrated a stable INR. Five patients (7%) experienced an INR ≥4. These patients had a nonsignificant trend toward a lower plasma albumin level compared with other patients (p = 0.057, Students t-test). The INR-driven dose adjustments on days 3 and 4 of this protocol coped with other variables that have been shown to affect maintenance warfarin dosing. These included weight, gender, pharmacologic factors affecting clearance, and the presence of certain predesignated risk factors. CONCLUSIONS: The age-adjusted dosing protocol rapidly achieved a stable INR with minimal overanticoagulation. Patients with low serum albumin levels (<3.0 g/dL) may be sensitive to the effects of warfarin during the loading phase.

Nicotine as an Antiepileptic Agent in ADNFLE: An N-of-One Study: NICOTINE IN ADNFLE

Summary:  Purpose: To test nicotine patch treatment for a patient with a defined mutation for autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) whose seizures were refractory to standard antiepileptic therapy.

INITIAT-E.D.: Impact of timing of INITIation of Antibiotic Therapy on mortality of patients presenting to an Emergency Department with sepsis

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.

Snapshot of Barriers to and Indicators for Antimicrobial Stewardship in Australian Hospitals

Effective antimicrobial stewardship programs are vital in an environment of emerging resistance to existing antimicrobials and the limited availability of new antimicrobials. There are institutional barriers to successful implementation of these programs. Key performance indicators (KPI) are useful for determining the success of antimicrobial stewardship programs and for benchmarking purposes.

Snapshot of Antimicrobial Stewardship in Australian Hospitals

The diminishing investment into the development of new antimicrobials is of significant global concern. This, coupled with the emergence of anti‐infective drug resistance, highlights the need to both prolong and optimise the use of existing antimicrobials. Strategies or programs to optimise antimicrobial use fall under the broad heading of antimicrobial stewardship.

Doctors’ perspectives towards a bedside aminoglycoside therapeutic drug monitoring service: a collaboration between pharmacy and clinical pharmacology

A computerised area‐under‐the‐curve aminoglycoside therapeutic drug monitoring (A‐TDM) and dosing service was implemented at Flinders Medical Centre.

Safety of continuous antibiotic infusions administered through an Australian hospital in the home service: a pilot study

Few studies have assessed the safety of antibiotic infusions in the hospital in the home (HITH) setting, or the vascular access and ambulatory infusion devices used for delivering these infusions.

Using Personal Digital Assistants for a Pharmacist Intervention Monitoring Database: Cost Analysis

Clinical pharmacists play an important role in inpatient care; however, their contribution and resultant cost savings are often difficult to define and quantify.