Drug-Related Problems and Recommendations Made during Home Medicines Reviews for Sick Day Medication Management in Australia.

Backgrounds and Objectives: Using certain medications during an intercurrent illness can increase the risk of drug related problems (DRP) occurring such as acute kidney injury (AKI). Medications that increase this risk include sulfonylureas, angiotensin converting enzyme inhibitors, diuretics, metformin, angiotensin receptor blockers, non-steroidal anti-inflammatories drugs, and sodium glucose co-transporter 2 inhibitors (SADMANS). Sick day medication guidance (SDMG) recommends withholding SADMANS medications during an intercurrent illness where adequate fluid intake cannot be maintained. But uptake of these recommendations is poor, and it is not known whether Australian pharmacists currently provide these recommendations during home medicine reviews (HMR) as per SDMG. We aimed to gain an understanding of the characteristics of DRP identified by pharmacists during HMR, especially those relating to SADMANS medications. Materials and Methods: We conducted a retrospective audit of 201 randomly selected HMR reports, conducted by accredited pharmacists from 2020 to 2022, that were analysed in 2023. All DRP and recommendations were categorised using a modified DOCUMENT system. Results: Overall, over 98% of participants experienced a DRP and a total of 710 DRP were found, where participants experienced an average of 4.0 ± 2.0 DRP each. Non-SADMANS medications accounted for 83.1% of all DRPs, with nervous system medications contributing the most. Common problems seen in non-SADMANS medications were related to toxicity, over/underdosing and undertreating. Diuretics contributed most to DRP in SADMANS medications. Problems with SADMANS were mainly related to toxicity and contraindications. No pharmacists provided SDMG despite 71.1% of participants using at least one SADMANS medication. Conclusions: We conclude that DRP remain prevalent in community pharmacy settings. Sick day recommendations were not provided in the HMRs included in our study, possibly due to lack of pharmacist knowledge and awareness. To ensure best practice, more research should be conducted to determine pharmacists' knowledge of and barriers to provision of sick day recommendations.

General practitioners' attitudes towards and frequency of collaboration with pharmacists in China: a cross-sectional study.

BACKGROUND: Building interprofessional working relationships between general practitioners (GPs) and pharmacists is essential to ensure high-quality patient care. However, there is limited Chinese literature on GP-pharmacist collaboration, and few studies have explored GPs' experiences with pharmacist integration into general practices. This study aimed to investigate GPs' attitudes towards and frequency of collaboration with pharmacists in China. METHODS: This cross-sectional study used an online self-administered questionnaire integrating two scales, ATCI-GP and FICI-GP, which had been translated and validated to investigate 3,248 GPs from February 15 to March 15, 2023 across Zhejiang Province, China. Descriptive analyses were used, and the factors associated with GPs' frequency of collaboration with pharmacists were explored using logistic regression analysis. RESULTS: A total of 2,487 GPs (76.6%) responded and consented to participate in the survey; 52.3% were male and the mean age was 35.4 years. Most GPs agreed that they shared common goals and objectives with pharmacists when caring for patients (90.0%), and pharmacists were open to working with them on patients' medication management (80.8%). However, half of the GPs did not change or seldom changed the patient's medication on the pharmacist's advice (51.4%). Logistic regression analysis showed that GPs who were older and had more years of practice were more likely to agree that pharmacists were willing to collaborate, had common goals for treatment and that they would change the patient's medication on the advice of the pharmacist. GPs who had regular communication protocols (adjusted odds ratio1 [aOR1] = 1.88, 95% CI 1.45-2.45; aOR2 = 3.33, 95% CI 2.76-4.02), participated in joint continuing education (aOR1 = 1.87, 95% CI 1.44-2.43; aOR2 = 2.27, 95% CI 1.91-2.70), provided recommendations for medication review (aOR1 = 3.01, 95% CI 2.07-4.38; aOR2 = 3.50, 95% CI 2.51-4.86), and communicated with pharmacists during resident training (aOR1 = 2.15, 95% CI 1.78-2.60; aOR2 = 1.38, 95% CI 1.18-1.62) were associated with a more positive attitude towards and higher frequency of cooperation. CONCLUSIONS: GPs in China displayed a positive attitude towards cooperating with pharmacists, but they did not demonstrate a similar level of practice. As environmental determinants impact interdisciplinary collaboration, healthcare managers and policy-makers need to implement measures that foster a supportive environment conducive to interdisciplinary collaboration.

Why hospital-based healthcare professionals do not report adverse drug reactions: a mixed methods study using the Theoretical Domains Framework.

PURPOSE: Adverse drug reaction (ADR) underreporting is highly prevalent across the world. This study aimed to identify factors associated with ADR reporting and map these to a behavioural change framework to help inform future interventions designed to improve ADR underreporting. METHODS: A mixed methods survey was distributed to healthcare professionals at a tertiary hospital in Sydney, Australia. Quantitative data was analysed using logistic regression to identify factors that predict ADR reporting. Qualitative data was evaluated using content analysis. These were then integrated and mapped to the 14 domains within the Theoretical Domains Framework (TDF) to identify target areas relevant for improving ADR reporting. RESULTS: One hundred thirty-three healthcare professionals completed the survey. Knowing how to report ADRs (OR 4.56, 95%CI 1.95-10.7), having been trained on ADR reporting (OR 2.72, 95%CI 1.29-5.77), and encountering ADRs as part of clinical practice (OR 10.3, 95%CI 3.59-29.4) were significant predictors of reporting an ADR. Content analysis identified three categories: modifying the ADR reporting process, enabling clinicians to report ADRs, and creating a positive ADR reporting culture. After data integration, the three target TDF domains were knowledge, environmental context/resources, and beliefs about consequences. CONCLUSION: Future interventions designed to improve ADR reporting should address these target domains to instigate behaviour change in healthcare professionals' reporting of ADRs.

Hospital-Acquired Acute Kidney Injury in Noncritical Care Setting: Clinical Characteristics and Outcomes.

Background: There is limited Australian data on the incidence and outcomes of hospital-acquired acute kidney injury (HA-AKI) in noncritically ill patients. Aims: This study aimed to characterise HA-AKI and assess the impact of nephrology consultations on outcomes. Methods: A retrospective cohort of all noncritically ill patients with HA-AKI admitted to a large tertiary hospital in 2018 were followed up from hospital admission to discharge. HA-AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The primary outcome of this study was the clinical characteristics of patients who developed HA-AKI and the difference in these characteristics by nephrology consultation. Results: A total of 222 noncritically ill patients were included in the study. The mean age of included patients was 74.8 ± 15.8 years and 57.2% were females. While most patients (92%)were characterised to have KDIGO stage 1, 14% received a nephrology consultation, and 80% had complete or partial recovery of kidney function at discharge. Lower recovery rates (65% versus 83%, P = 0.022), longer hospitalisations (10 versus 5 days, P = 0.001), and higher serum creatinine values on discharge (152 versus 101 µmol/L, P < 0.001) were associated with receipt of nephrology consultation. There was no difference in mortality rates (13% versus 11%, P = 0.754) between those with and without nephrology consultation. Conclusions: Our findings indicate that signficant proportion of noncritically ill patients experience mild form of AKI and have good recovery of kidney function during hospitalisation. Although severity of AKI and length of hospitalisation were associated with nephrology interventions, large scale study is required to understand the impact of such interventions on clinical outcomes, such as hospital readmission and mortality.

Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study.

BACKGROUND: Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care. AIM: To identify facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation. METHODS: 1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis. 2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains. 3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria. RESULTS: One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators (TDF domains) were: understanding evidence-informed patient care and understanding risk factors (Knowledge); patient assessment skills and blunt chest injury management skills (Physical skills); identification with professional role (Professional role and identity); belief of consequences of care bundle (Belief about consequences); provision of training and protocol design (Environmental context and resources); and social supports (Social influences). Barriers were: not understanding the term 'care bundle' (Knowledge); lacking regional analgesia skills (Physical skills); not remembering to follow protocol (Memory, attention, and decision processes); negative emotions relating to new protocols (Emotions); equipment and protocol access (Environmental context and resources). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions. CONCLUSIONS: Multiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implementation strategies developed through this process have been included in a plan for implementation in the emergency departments of two hospitals. Evaluation of the implementation is underway.

Implementation evaluation and refinement of an intervention to improve blunt chest injury management-A mixed-methods study.

AIMS AND OBJECTIVES: To investigate uptake of a Chest Injury Protocol (ChIP), examine factors influencing its implementation and identify interventions for promoting its use. BACKGROUND: Failure to treat blunt chest injuries in a timely manner with sufficient analgesia, physiotherapy and respiratory support, can lead to complications such as pneumonia and respiratory failure and/or death. DESIGN: This is a mixed-methods implementation evaluation study. METHODS: Two methods were used: (i) identification and review of the characteristics of all patients eligible for the ChIP protocol, and (ii) survey of hospital staff opinions mapped to the Theoretical Domains Framework (TDF) to identify barriers and facilitators to implementation. The characteristics and treatment received between the groups were compared using the chi-square test or Fischer's exact test for proportions, and the Mann-Whitney U-test for continuous data. Quantitative survey data were analysed using descriptive statistics. Qualitative data were coded in NVivo 10 using a coding guide based on the TDF and Behaviour Change Wheel (BCW). Identification of interventions to change target behaviours was sourced from the Behaviour Change Technique Taxonomy Version 1 in consultation with stakeholders. RESULTS: Only 68.4% of eligible patients received ChIP. Fifteen facilitators and 10 barriers were identified to influence the implementation of ChIP in the clinical setting. These themes were mapped to 10 of the 14 TDF domains and corresponded with all nine intervention functions in the BCW. Seven of these intervention functions were selected to address the target behaviours and a multi-faceted relaunch of the revised protocol developed. Following re-launch, uptake increased to 91%. CONCLUSIONS: This study demonstrated how the BCW may be used to revise and improve a clinical protocol in the ED context. RELEVANCE TO CLINICAL PRACTICE: Newly implemented clinical protocols should incorporate clinician behaviour change assessment, strategy and interventions. Enhancing the self-efficacy of emergency nurses when performing assessments has the potential to improve patient outcomes and should be included in implementation strategy.

The experiences, unmet needs and outcomes of parents of severely injured children: a longitudinal mixed methods study protocol.

BACKGROUND: Being the parent of a severely injured child involves many stressors throughout the trauma journey. Internationally, little is known about the experiences or levels of emotional distress, parenting stress, quality of life, and resilience for parents of injured children. The aim of this study is to investigate the experiences, unmet needs and outcomes of parents of physically injured children 0-12 years over the 2 year period following injury. METHODS/DESIGN: This is a prospective longitudinal study using an embedded mixed methods design. This design has a primary qualitative strand which incorporates supplementary quantitative data on child quality of life, and parental quality of life, parenting stress, emotional distress, and resilience at four time points; the acute hospitalisation phase, and at 6, 12 and 24 months following injury. The primary sample are parents of injured children 0-12 years hospitalised in the Australian states of New South Wales, Queensland, Victoria and South Australia. Primary data sources are child and parent demographic data; survey data; and semi-structured interview data across a 24 month period. DISCUSSION: This study aims to address the existing gap in knowledge on the experiences and unmet support needs of parents in the 2 years following child injury to provide guidance for care provision for these families. There is a lack of evidence-based recommendations for supporting parents and families of injured children and strengthening their capacity to address the challenges they face.

How is care provided for patients with paediatric trauma and their families in Australia? A mixed-method study.

AIM: This study describes clinical staff opinions on the availability and suitability of resources to provide trauma care to children and their families and any perceived strengths, gaps and potential interventions to strengthen care. METHODS: A mixed-method study was conducted in five Australian paediatric trauma centres. The trauma coordinator at each site participated in a structured interview to determine models of care and trauma activity at their site. This informed the development of an electronic survey, which sought staff opinion on child and family access to services and perceived gaps in care. RESULTS: Five trauma coordinators were interviewed, and 214 clinicians (medical, nursing, allied health) from New South Wales, Victoria, South Australia and Queensland completed the survey. Each site had a trauma director and coordinator, and there was variance in resource availability. Almost all survey participants (92.5%) considered their hospital met the physical needs of injured children, 68.2% thought that the psychosocial needs of children were met and 82.1% thought that the needs of families were met. The least accessible services reported were clinical psychology/family counselling, mental health and behaviour management services. No routine follow-up support services post-discharge for the child or their families were identified. CONCLUSION: Staff providing care for injured children report that physical needs are better met than psychosocial needs. There is variability in resource levels across paediatric trauma centres. A coordinated model of care that provides psychosocial care both during hospitalisation and post-discharge could reduce this gap in care for injured children and their families.

Models of Care Delivery for Families of Critically Ill Children: An Integrative Review of International Literature.

UNLABELLED: Critical illness in children is a life changing event for the child, their parents, caregivers and wider family. There is a need to design and evaluate models of care that aim to implement family-centred care to support more positive outcomes for critically ill children and their families. Due to a gap in knowledge on the impact of such models, the present review was conducted. ELIGIBILITY CRITERIA: Primary research articles written in English that focused on children hospitalised for an acute, unexpected, sudden critical illness, such as that requiring an intensive care admission; and addressed the implementation of a model of care in a paediatric acute care hospital setting. SAMPLE: Thirteen studies met the inclusion criteria. RESULTS: The models of care implemented were associated with positive changes such as reduced parental anxiety and improved communication between parents/caregivers and health professionals. However, no model provided intervention throughout each phase of care to (or post) hospital discharge. CONCLUSIONS: Models of care applying family-centred care principles targeting critically ill children and their families can create positive changes in care delivery for the family. However a model which provides continuity across the span of care is required. IMPLICATIONS: There is need to describe how best to design, implement and sustain models of care for critically ill children and their families. The success of any intervention implementation will be dependent on the comprehensiveness of the strategy for implementation, the relevance to the context and setting, and engagement with key stakeholders.

Investigating general practitioner engagement with pharmacists in Home Medicines Review.

The Home Medicines Review (HMR) involves a home visit from an accredited HMR pharmacist to review a patient's medicines, and a report to the patient's general practitioner (GP) with recommendations for improving medicine management. Notwithstanding evidence supporting the benefits of medicines review, broad uptake by GPs in Australia remains low. We developed the 10-item Home Medicines Review Inventory (HMRI) to assess GP attitudes and behaviours regarding the HMR and modelled factors associated with the frequency of GP engagement with HMRs. Four items assessing frequency of behaviours and six items assessing attitudes related to HMR were answered by 180 GPs in a national GP survey. The HMRI's psychometric properties were examined with exploratory factor analysis (EFA), Rasch analysis, and correlations with related instruments. Structural equation modelling was used to evaluate factors associated with HMR-related behaviours. EFA and Rasch analysis generally supported the current format of the instrument. Attitudes to HMR, gender, previous positive experiences with pharmacists, a system for working together, and participation in joint education activities predicted frequency of HMR-related behaviours. Although GPs' attitudes to HMR were generally positive, HMR-related behaviours tended to occur with low frequency. This instrument may be used to investigate why HMR uptake has thus far been low and also help identify opportunities for building interprofessional communication and trust between GPs and pharmacists.

Drug-Related Problems and Sick Day Management Considerations for Medications that Contribute to the Risk of Acute Kidney Injury.

BACKGROUND: Medication use during acute illness increases the risk of experiencing drug related problems (DRPs), including acute kidney injuries. It is recommended that potentially nephrotoxic medications are withheld during acute illness, including sulfonylureas, angiotensin converting enzyme inhibitors, diuretics, metformin, angiotensin receptor blockers, non-steroidal anti-inflammatories and sodium glucose co-transporter 2 inhibitors (SADMANS). It is unknown if Australian pharmacists currently provide sick day medication management advice regarding SADMANS medications. Hence, we aimed to identify current DRPs and the recommendations made during residential medication management reviews (RMMRs), especially with SADMANS medications. METHODS: A retrospective review of 408 RMMRs was conducted. DRPs and pharmacist recommendations were classified according to a modified DOCUMENT system. General practitioners' (GP) recommendations were also categorised. RESULTS: Over 97% of residents experienced at least one DRP. Common problems for non-SADMANS medications were "toxicity or adverse drug reaction", "drug selection" and "over/underdosing" and those for SADMANS medications included "toxicity or adverse drug reaction", "monitoring" and "drug selection". GPs agreed with pharmacist recommendations approximately 40% of the time. No pharmacists provided sick day medication management advice for SADMANS medications. CONCLUSION: DRPs remain highly prevalent in aged care facilities. Medication reviews effectively identify and resolve DRPs approximately 40% of the time, but do not currently minimise the risk associated with using SADMANS medications during sick days, which is a potential area of improvement.

Hospitalisation Due to Community-Acquired Acute Kidney Injury and the Role of Medications: A Retrospective Audit.

The aim of this study is to assess the use of high-risk medications in patients with community-acquired acute kidney injury (CA-AKI) and the differences in the characteristics and outcomes of CA-AKI based on the use of these medications. This is a retrospective audit of adults (≥35 years) with CA-AKI admitted to a large tertiary care hospital over a two-year period. We investigated the prevalence of SADMANS (sulfonylureas; angiotensin converting enzyme inhibitors; diuretics; metformin; angiotensin receptor blockers; nonsteroidal anti-inflammatory drugs; and sodium glucose co-transporter 2 inhibitors) medications use in people with CA-AKI prior to hospitalisation. Outcomes including CA-AKI severity, kidney function recovery and in-hospital mortality were examined and stratified by use of SADMANS medications. The study included 329 patients, with a mean (SD) age of 75 (12) years and a 52% proportion of females, who were hospitalised with CA-AKI. Most patients (77.5%) were taking at least one regular SADMANS medication upon admission. Overall, 40% of patients (n = 132) and 41% of those on SADMANS (n = 104) had hypovolaemia or associated symptoms such as vomiting and diarrhoea during admission. Over two-thirds (68.1%) had mild AKI on admission and patients who were taking SADMANS medications were more likely to have mild AKI. Patients on SADMANS had more comorbidities and a higher medication burden, but there were no differences in AKI severity on admission or outcomes such as length of hospitalisation, ICU admission, need for dialysis, recovery rates and mortality between the two groups. However, the high prevalence of SADMANS medications use among patients with CA-AKI indicates a potential for preventability of CA-AKI-led hospitalisations. Future studies are needed to gain better insights into the role of withholding this group of medications, especially during an acute illness.

Clinical characteristics and outcomes of community acquired-acute kidney injury.

PURPOSE: Published works have reported the impact of a nephrologist intervention on outcomes for patients with hospital-acquired acute kidney injury (HA-AKI), however little is known about the clinical characteristics of patients with community-acquired acute kidney injury (CA-AKI) and the impact of nephrology interventions on outcomes in these patients. METHODS: A retrospective study on all adult patients admitted to a large tertiary care hospital in 2019 who were identified to have CA-AKI were followed from hospital admission to discharge. Clinical characteristics and outcomes of these patients were analysed by receipt of nephrology consultation. Statistical analysis included descriptive, simple Chi-squared/Fischer Exact test, independent samples t-test/Mann-Whitney U test and logistic regression. RESULTS: 182 patients fulfilled the study inclusion criteria. Mean age was 75 ± 14 years, 41% were female, 64% had stage 1 AKI on admission, 35% received nephrology input and 52% had achieved recovery of kidney function by discharge. Higher admission and discharge serum creatinine (SCr) (290.5 vs 159 and 173 vs 109 µmol/L respectively, p = < 0.001), and younger age (68 vs 79, p = < 0.001) were associated with nephrology consultations, whilst length of hospitalisation, mortality and rehospitalisation rates were not significantly different between the two groups. At least 65% were recorded to be on at least one nephrotoxic medication. CONCLUSION: Our findings provide a snapshot of current practice where close to two-thirds of hospitalised patients with CA-AKI had a mild form of AKI that was associated with good clinical outcomes. While higher SCr on admission and younger age were predictors of receiving a nephrology consultation, nephrology consultations did not have any impact on outcomes.

Sick day management in people with chronic kidney disease: a scoping review.

BACKGROUND: Use of certain medications during an acute illness may put patients at an increased risk of acute kidney injury (AKI). Patients with chronic kidney disease (CKD) are at higher risk of developing superimposed AKI. The aim of this scoping review is to collate and characterise existing evidence on sick day management considerations and practices during acute illness in people with CKD. METHODS: We searched Embase, CINAHL, MEDLINE, International Pharmaceutical Abstract, Scopus, Google Scholar and grey literature sources. We followed the methodological framework for scoping reviews, while information was extracted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Findings are presented thematically. RESULTS: Ten studies and seven guidelines met the inclusion criteria. Studies were targeted at patients, general practitioners, pharmacists, and nurses. The major themes identified included development and feasibility testing of a sick day management protocol, current practice of temporary medication discontinuation, and outcomes. Most guidelines provided recommendations for sick day management largely based on expert consensus. A digital intervention was deemed highly acceptable and easy to use, whereas patient handouts were more effective when provided along with dialogue with a health professional. While there is little evidence on the impact of sick day protocols on outcomes, a single randomised trial reported no significant association between sick day protocols and change in kidney function, AKI incidents or risk of hospitalisation. CONCLUSION: The nascent literature on sick day management in patients with CKD revealed the limited available evidence to provide guidance on implementation and on outcomes. Future research needs to clarify sick day recommendations and assess their impact on clinical outcomes including prevention of superimposed AKI or hospitalisations, as well as to address barriers to implementation.

Culture-directed antibiotics in peritoneal dialysis solutions: a systematic review focused on stability and compatibility.

BACKGROUND: This systematic review summarises the stability of less commonly prescribed antibiotics in different peritoneal dialysis solutions that could be used for culture-directed therapy of peritonitis, which would be especially useful in regions with a high prevalence of multidrug antibiotic-resistant strains. METHODS: A literature search of Medline, Scopus, Embase and Google Scholar for articles published from inception to 25 January, 2023 was conducted. Only antibiotic stability studies conducted in vitro and not recently reviewed by So et al. were included. The main outcomes were chemical, physical, antimicrobial and microbial stability. This protocol was registered in PROSPERO (registration number CRD42023393366). RESULTS: We screened 1254 abstracts, and 28 articles were included in the study. In addition to those discussed in a recent systematic review (So et al., Clin Kidney J 15(6):1071-1078, 2022), we identified 18 antimicrobial agents. Of these, 9 have intraperitoneal dosing recommendations in the recent International Society for Peritoneal Dialysis (ISPD) peritonitis guidelines, and 7 of the 9 had stability data applicable to clinical practice. They were cefotaxime, ceftriaxone, daptomycin, ofloxacin, and teicoplanin in glucose-based solutions, tobramycin in Extraneal solution only and fosfomycin in Extraneal, Nutrineal, Physioneal 1.36% and 2.27% glucose solutions. CONCLUSIONS: Physicochemical stability has not been demonstrated for all antibiotics with intraperitoneal dosing recommendations in the ISPD peritonitis guidelines. Further studies are required to determine the stability of antibiotics, especially in icodextrin-based and low-glucose degradation products, pH-neutral solutions.

Treatment and outcomes of peritonitis due to Rothia species in patients on peritoneal dialysis: A systematic review and multicentre registry analysis.

Peritoneal dialysis (PD)-associated peritonitis remains a severe complication of PD. Although peritonitis due to Rothia spp. is rare, the treatment recommendations and outcomes are uncertain. Our study aims to review (1) published literature on peritonitis caused by Rothia spp. and (2) reported cases of peritonitis due to Rothia spp. in patients on PD in Australia and New Zealand. A literature search of PubMed, Scopus, Embase and Google Scholar for articles published between January 1949 and February 2022 was conducted. To be eligible, articles had to describe antibiotic therapy and treatment outcomes in all PD patients for peritonitis caused by Rothia or Stomatococcus spp. Data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry of PD patients who developed peritonitis due to Rothia spp. between July 2011 and May 2020 were also reviewed. A total of 12 articles and 28 episodes were identified from the literature search and ANZDATA registry analysis, respectively. Over 60% of the peritonitis cases due to Rothia spp. were from the Rothia mucilaginosa species (8/12 and 17/28, respectively), while Rothia dentocariosa was the second most commonly identified species in both the literature search and the ANZDATA registry analysis (4/12 and 5/28, respectively). A majority 8 (66.7%) of the articles in the literature search employed a combination antibiotic regimen, while the remaining 4 (33.3%) used a single antibiotic regimen. In contrast, most of the episodes, 22 (78.6%) described in the ANZDATA registry analysis, employed a single antibiotic regimen, and only 6 (21.4%) episodes were treated with a combination antibiotic regimen. The duration of antibiotic therapy ranged from 2 to 3 weeks in the literature search, and 1 to 3 weeks in the ANZDATA registry. While no deaths within 30 days of developing peritonitis were reported, catheter removal was reported in three (25%) and two (7.1%) episodes in both the literature search and the ANZDATA registry analysis, respectively, of which the majority occurred in patients treated for ≤2 weeks. PD-associated peritonitis due to Rothia spp. is uncommon and associated with relatively good outcomes. Antibiotic treatment for 3 weeks is associated with better outcomes.

Characteristics and outcomes of hospital-acquired and community-acquired peritonitis in patients on peritoneal dialysis: a retrospective cohort study.

BACKGROUND: Peritonitis remains a significant complication of peritoneal dialysis. However, there is limited information on the clinical characteristics and outcomes of hospital-acquired peritonitis compared to community-acquired peritonitis in patients undergoing peritoneal dialysis. Furthermore, the microbiology and outcomes of community-acquired peritonitis may vary from hospital-acquired peritonitis. Therefore, the aim was to gather and analyse data to address this gap. METHODS: Retrospective review of the medical records of all adult patients on peritoneal dialysis within the peritoneal dialysis units in four university teaching hospitals in Sydney, Australia, who developed peritonitis between January 2010 and November 2020. We compared the clinical characteristics, microbiology and outcomes of community-acquired peritonitis and hospital-acquired peritonitis. Community acquired peritonitis was defined as the development of peritonitis in the outpatient setting. Hospital-acquired peritonitis was defined as: (1) developed peritonitis anytime during hospitalisation for any medical condition other than peritonitis, (2) diagnosed with peritonitis within 7 days of hospital discharge and developed symptoms of peritonitis within 3 days of the hospital discharge. RESULTS: Overall, 904 episodes of peritoneal dialysis-associated peritonitis were identified in 472 patients, of which 84 (9.3%) episodes were hospital-acquired. Patients with hospital-acquired peritonitis had lower mean serum albumin levels compared to those with community-acquired peritonitis(22.95 g/L vs. 25.76 g/L, p = 0.002). At the time of diagnosis, lower median peritoneal effluent leucocyte and polymorph counts were observed with hospital-acquired peritonitis compared to community-acquired peritonitis (1236.00/mm3 vs. 3183.50/mm3, p < 0.01 and 1037.00/mm3 vs. 2800.00/mm3, p < 0.01, respectively). Higher proportions of peritonitis due to Pseudomonas spp. (9.5% vs. 3.7%, p = 0.020) and vancomycin-resistant Enterococcus (2.4% vs. 0.0%, p = 0.009), lower rates of complete cure (39.3% vs. 61.7%, p < 0.001), higher rates of refractory peritonitis (39.3% vs. 16.4%, p < 0.001) and higher all-cause mortality within 30 days of peritonitis diagnosis (28.6% vs. 3.3%, p < 0.001) were observed in the hospital-acquired peritonitis group compared to the community-acquired peritonitis group, respectively. CONCLUSIONS: Despite having lower peritoneal dialysis effluent leucocyte counts at the time of diagnosis, patients with hospital-acquired peritonitis had poorer outcomes, including lower rates of complete cure, higher rates of refractory peritonitis and higher rates of all-cause mortality within 30 days of diagnosis, compared to those with community-acquired peritonitis.

Impact of a pharmacy-led screening and intervention in people at risk of or living with chronic kidney disease in a primary care setting: a cluster randomised trial protocol.

INTRODUCTION: Chronic kidney disease (CKD) is increasingly recognised as a growing global public health problem. Early detection and management can significantly reduce the loss of kidney function. The proposed trial aims to evaluate the impact of a community pharmacy-led intervention combining CKD screening and medication review on CKD detection and quality use of medicines (QUM) for patients with CKD. We hypothesise that the proposed intervention will enhance detection of newly diagnosed CKD cases and reduce potentially inappropriate medications use by people at risk of or living with CKD. METHODS AND ANALYSIS: This study is a multicentre, pragmatic, two-level cluster randomised controlled trial which will be conducted across different regions in Australia. Clusters of community pharmacies from geographical groups of co-located postcodes will be randomised. The project will be conducted in 122 community pharmacies distributed across metropolitan and rural areas. The trial consists of two arms: (1) Control Group: a risk assessment using the QKidney CKD risk assessment tool, and (2) Intervention Group: a risk assessment using the QKidney CKD plus Point-of-Care Testing for kidney function markers (serum creatinine and estimated glomerular filtration rate), followed by a QUM service. The primary outcomes of the study are the proportion of patients newly diagnosed with CKD at the end of the study period (12 months); and rates of changes in the number of medications considered problematic in kidney disease (number of medications prescribed at inappropriate doses based on kidney function and/or number of nephrotoxic medications) over the same period. Secondary outcomes include proportion of people on potentially inappropriate medications, types of recommendations provided by the pharmacist (and acceptance rate by general practitioners), proportion of people who were screened, referred, and took up the referral to visit their general practitioners, and economic and other patient-centred outcomes. ETHICS AND DISSEMINATION: The trial protocol has been approved by the Human Research Ethics Committee at the University of Sydney (2022/044) and the findings of the study will be presented at scientific conferences and published in peer-reviewed journal(s). TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12622000329763).

Community pharmacist attitudes towards collaboration with general practitioners: development and validation of a measure and a model.

BACKGROUND: Community Pharmacists and General Practitioners (GPs) are increasingly being encouraged to adopt more collaborative approaches to health care delivery as collaboration in primary care has been shown to be effective in improving patient outcomes. However, little is known about pharmacist attitudes towards collaborating with their GP counterparts and variables that influence this interprofessional collaboration. This study aims to develop and validate 1) an instrument to measure pharmacist attitudes towards collaboration with GPs and 2) a model that illustrates how pharmacist attitudes (and other variables) influence collaborative behaviour with GPs. METHODS: A questionnaire containing the newly developed "Attitudes Towards Collaboration Instrument for Pharmacists" (ATCI-P) and a previously validated behavioural measure "Frequency of Interprofessional Collaboration Instrument for Pharmacists" (FICI-P) was administered to a sample of 1215 Australian pharmacists. The ATCI-P was developed based on existing literature and qualitative interviews with GPs and community pharmacists. Principal Component Analysis was used to assess the structure of the ATCI-P and the Cronbach's alpha coefficient was used to assess the internal consistency of the instrument. Structural equation modelling was used to determine how pharmacist attitudes (as measured by the ATCI-P) and other variables, influence collaborative behaviour (as measured by the FICI-P). RESULTS: Four hundred and ninety-two surveys were completed and returned for a response rate of 40%. Principal Component Analysis revealed the ATCI-P consisted of two factors: 'interactional determinants' and 'practitioner determinants', both with good internal consistency (Cronbach's alpha = .90 and .93 respectively). The model demonstrated adequate fit (χ2/df = 1.89, CFI = .955, RMSEA = .062, 90% CI [.049-.074]) and illustrated that 'interactional determinants' was the strongest predictor of collaboration and was in turn influenced by 'practitioner determinants'. The extent of the pharmacist's contact with physicians during their pre-registration training was also found to be a significant predictor of collaboration (B = .23, SE = .43, p <.001). CONCLUSIONS: The results of the study provide evidence for the validity of the ATCI-P in measuring pharmacist attitudes towards collaboration with GPs and support a model of collaboration, from the pharmacist's perspective, in which collaborative behaviour is influenced directly by 'interactional' and 'environmental determinants', and indirectly by 'practitioner determinants'.

Development and validation of the GP frequency of interprofessional collaboration instrument (FICI-GP) in primary care.

Existing validated measures of pharmacist-physician collaboration focus on measuring attitudes toward collaboration and do not measure frequency of interactions that comprise actual collaborative behavior. Therefore, the aim of this study was to develop and validate an instrument to measure the frequency of collaboration between general practitioners (GPs) and pharmacists from the GP's perspective. An 11-item Frequency of Interprofessional Collaboration Instrument for GPs (FICI-GP) was developed and administered to 1118 GPs in eight divisions of general practice in New South Wales, Australia. Two hundred and fifty-eight (23%) GP surveys were completed and returned. Principal component analysis suggested removal of one item for a final one-factor solution. The refined 10-item FICI-GP had a Cronbach's alpha of 0.87. After collapsing the original five-point response scale to a three-point response scale, the refined FICI-GP demonstrated fit to the Rasch model. Criterion validity of the FICI-GP was supported by the correlation of FICI-GP scores with scores on a previously validated physician-pharmacist collaboration instrument as well as by predicted differences in FICI-GP scores between subgroups of respondents stratified on age, co-location with pharmacists and interactions during residency. The refined 10-item FICI-GP was shown to have good internal consistency, criterion validity and fit to the Rasch model.