Improving medication safety for home nursing clients: A prospective observational study of a novel clinical pharmacy service-The Visiting Pharmacist (ViP) study.

WHAT IS KNOWN AND OBJECTIVE: Polypharmacy, medication errors and adverse events are common in older people receiving home nursing medication management support. Access to clinical pharmacists is limited. In Australia, few home nursing clients receive a general practitioner (GP)-initiated pharmacist-led Home Medicines Review, despite their eligibility and community nurses' (CN) efforts to facilitate this. An integrated home nursing clinical pharmacy service, in which CNs directly referred clients to a pharmacist, was therefore developed and piloted. The aim was to explore the number and type of medication-related problems (MRPs) and medication treatment authorization (medication order) discrepancies identified and addressed by clinical pharmacists. METHODS: Two part-time clinical pharmacists were employed. They reviewed and reconciled clients' medications, educated clients/carers about their medicines, provided advice and support to CNs and worked with clients' GPs and other prescribers to optimize medication regimens and revise/update nurses' medication treatment authorizations. Evaluation involved review of clients' medicines data, including treatment authorizations and pharmacist medication review reports. RESULTS AND DISCUSSION: Eighty-four clients (median 86 years, 6 health conditions, 13 medications) were reviewed. The pharmacists identified 334 MRPs (median 4 per client) and 307 medication discrepancies in treatment authorizations (median 2 per client). The pharmacists made 282 recommendations to prescribers to address MRPs; 148 (52.5%) recommendations were acted on, resulting in 190 medication changes for 60 (71.4%) clients (median 2 per client). The pharmacists prepared, or assisted GPs to update, treatment authorizations for 68 (81%) clients. WHAT IS NEW AND CONCLUSION: Integrating pharmacists into a home nursing service identified and addressed MRPs and medication treatment authorization discrepancies, hence contributing to enhanced medication safety.

The management of lower extremity wounds using topical negative pressure.

The delivery of topical pressures at subatmospheric levels to heal acute and chronic wounds has been widely reported. This article reviews the role of this therapeutic modality to treat wounds of the lower extremity. Recent literature is re-viewed, and mechanisms of action of this process are also discussed.

Lead posisoning in a rural community in Jamaica

OBJECTIVE: A proliferation of "backyard battery repair shops" in Frazer's Content (Red Pond), St Catherine led to a number of cases of lead poisoning in that community. A lead decontamination project was instituted by Blue Cross of Jamaica Environmental Health Foundation in 1994 to address this problem. The aim of the present study was to evaluate the impact of that intervention. METHODS: Questionnaire were developed and filled in during interviews with 214 volunteers in Frazer's Content. Volunteers awareness of the environmental effects of lead and the success of the socioeconomic programmes were assessed. The medical records from five nearby hospitals were also checked for new cases of lead poisoning. In addition, soil and water samples were collected and analyzed by atomic absortion spectrophotometry for levels of lead. RESULTS: The results indicated that knowledge of lead poisoning had increased significantly since 1994. However, there was a marked decrease in entrepeneurial activities. Two new cases of lead posioning were noted. Seven of the soil samples had elevated lead levels (123-317 ppm) but none of the water samples had lead concentration above the critical level (10 hg/l). CONCLUSION: Based on these findings, it would appear that the decontamination and education projects done in 1994 were mostly successful in achieving their objectives. Entrepreneurial initiatives were not sustained.(Au)

The effect of electro-ejaculation on aversive behaviour and plasma cortisol concentration in rams.

Electro-ejaculation is used in rams to collect semen for fertility and bacteriological evaluation. Concern has been expressed about animal welfare implications of EE. Two experiments were carried out to compare the aversiveness of electro-ejaculation, part shearing and free movement, and to determine the changes in plasma cortisol concentration produced by electro-ejaculation, shearing and lateral restraint. In the aversion test, transit time was greater (p<0.003) for rams subjected to part shearing than free movement. There were no major differences in the transit time between the rams subjected to electro-ejaculation and those subjected to part shearing or free movement. In addition, there was no significant difference in the effort required to move rams from the three treatment groups into or through the experimental route. These results suggest that electro-ejaculation is no more aversive than part shearing. There were no significant differences in the cortisol response of the rams subjected to electro-ejaculation, shearing or lateral restraint, indicating that there were no significant differences in the distress caused by the three procedures.

Cortisol responses of calves to two methods of tail docking used with or without local anaesthetic.

Tail docking of dairy cows to facilitate milking is carried out on calves or on heifers before calving. By monitoring changes in plasma cortisol concentrations, this study evaluated the distress in calves when docked by a rubber ring or docking iron (cautery) with or without local anaesthetic. The cortisol responses indicated that in most calves docking using a rubber ring or docking iron was no more distressing than control handling and simulated docking. A small proportion of calves in control and tail docked groups exhibited larger cortisol responses, the magnitudes of which suggested that they experienced some mild distress. There was no detectable benefit with either method of docking when local anaesthetic was used. The rubber ring is the preferable method, as there was some haemorrhage after docking with the docking iron.

Cortisol responses of calves to two methods of disbudding used with or without local anaesthetic.

Cattle are disbudded or dehorned using a variety of methods. In this study, plasma cortisol concentrations were used to monitor distress in 6-week-old Friesian calves during the 9 hours following disbudding. Disbudding was carried out with a cautery iron or a dehorning scoop, with or without local anaesthetic. Cautery caused a transient rise in cortisol concentrations which returned to control values within 3 hours. The cortisol response to the scoop was more prolonged, as the plasma cortisol concentrations did not return to control levels until 7.5 hours after disbudding. The administration of a local anaesthetic reduced the cortisol response during the first 2 hours after scoop dehorning. This reduced response was followed by a delayed rise in cortisol concentrations between 2 and 7.5 hours. Cautery caused less distress than the scoop. The administration of local anaesthetic had little effect in alleviating distress in calves disbudded using the cautery iron.