A new option for diabetes

Mr Sweets is a recently retired 67-year-old gentleman (95 kg, 170 cm) living with type 2 diabetes mellitus (T2DM} for a number of years. His blood pressure and cholesterol were high, but are being managed by perindopril and atorvastatin prescribed by his doctor.

Tyrosine kinase inhibitors (nibs)

Traditional chemotherapy involves cytotoxic agents that indiscriminately target all rapidly-dividing cells. This can lead to significant side effects as healthy cells are also targeted.

One device, two doses

Ms Breathless is a 59-year-old lady living with chronic obstructive pulmonary disease (COPD) for several years now, and quit smoking over 20 years ago. She sometimes experiences symptoms of breathlessness, and an unrelenting productive cough, particularly when she comes in contact with dusty places, second-hand smoke, or when her allergies and hay fever play up. Apart from these triggers, her symptoms are well maintained with her inhalers glycopyrronium bromide (Seebri) and indacaterol (Onbrez), and she has been using them for about nine months. Ms Breathless is otherwise healthy, and not taking any other medicines.

Native and exotic pests of Eucalyptus: A worldwide perspective.

Eucalyptus species, native to Australia, Indonesia, the Philippines, and New Guinea, are the most widely planted hardwood timber species in the world. The trees, moved around the globe as seeds, escaped the diverse community of herbivores found in their native range. However, a number of herbivore species from the native range of eucalypts have invaded many Eucalyptus-growing regions in North America, Europe, Africa, Asia, and South America in the last 30 years. In addition, there have been shifts of native species, particularly in Africa, Asia, and South America, onto Eucalyptus. There are risks that these species as well as generalist herbivores from other parts of the world will invade Australia and threaten the trees in their native range. The risk to Eucalyptus plantations in Australia is further compounded by planting commercially important species outside their endemic range and shifting of local herbivore populations onto new host trees. Understanding the mechanisms underlying host specificity of Australian insects can provide insight into patterns of host range expansion of both native and exotic insects.

Look-alike, sound-alike medication errors: A novel case concerning a Slow-Na, Slow-K prescribing error

A 59-year-old man was mistakenly prescribed Slow-Na instead of Slow-K due to incorrect selection from a drop-down list in the prescribing software. This error was identified by a pharmacist during a home medicine review (HMR) before the patient began taking the supplement. The reported error emphasizes the need for vigilance due to the emergence of novel look-alike, sound-alike (LASA) drug pairings. This case highlights the important role of pharmacists in medication safety.

Nutritional intake of opioid replacement therapy patients in community pharmacies: A pilot study

Aim: Opioid replacement therapy (ORT) is an established therapy for a patient group that has been associated with nutrition-related comorbidities. This paper aims to assess the nutritional intake and supplementation in ORT patients, determine the extent of nutritional/dietary advice supplied to ORT patients and to briefly examine patients' perception of pharmacists' provision of nutritional advice. Methods: The nutritional intake of ORT patients receiving treatment in community pharmacies within the Australian Capital Territory was assessed via a 24-hour recall survey. Food intake data were analysed via nutrient analysis software and compared with Australian Nutrition Reference Values and the nutrient intakes of the Australian population. Patients were surveyed to determine supplement use and perceptions of nutritional advice gained by pharmacists. Results: Potential insufficient intake of various macronutrients and micronutrients was observed in both sexes. Less than 25 of patients recorded supplement use. Fifteen percent of males and 21 of females stated that they had approached a pharmacist with a nutrition-related query. All patients who received nutritional advice followed the advice. Conclusions: ORT patients dosing at community pharmacies appear to have poor nutritional intake. ORT patients appear to be receptive to pharmacist's advice. Community pharmacists can potentially increase the beneficial health outcomes in this population through the proactive supply of accurate nutritional advice.

An Advanced Pharmacy Practice Framework for Australia

The need to develop An Advanced Pharmacy Practice Framework for Australia (the “APPF”) was identified during the 2010 review of the competency standards for Australian pharmacists. The Advanced Pharmacy Practice Framework Steering Committee, a collaborative profession-wide committee comprised of representatives of ten pharmacy organisations, examined and adapted existing advanced practice frameworks, all of which were found to have been based on the Competency Development and Evaluation Group (CoDEG) Advanced and Consultant Level Framework (the “CoDEG Framework”) from the United Kingdom. Its competency standards were also found to align well with the Domains of the National Competency Standards Framework for Pharmacists in Australia (the “National Framework”). Adaptation of the CoDEG Framework created an APPF that is complementary to the National Framework, sufficiently flexible to customise for recognising advanced practice in any area of professional practice and has been approved by the boards/councils of all participating organisations. The primary purpose of the APPF is to assist the development of the profession to meet the changing health care needs of the community. However, it is also a valuable tool for assuring members of the public of the competence of an advanced practice pharmacist and the quality and safety of the services they deliver.

Australian pharmacists' self-perceptions in relation to the 'Advanced Pharmacy Practice Framework'

Background The Australian Pharmacy Practice Framework was developed by the Advanced Pharmacy Practice Steering Committee and endorsed by the Pharmacy Board of Australia in October 2012. The Steering Committee conducted a study that found practice portfolios to be the preferred method to assess and credential Advanced Pharmacy Practitioner, which is currently being piloted by the Australian Pharmacy Council. Credentialing is predicted to open to all pharmacists practising in Australia by November 2015. Objective To explore how Australian pharmacists self-perceived being advanced in practice and how they related their level of practice to the Australian Advanced Pharmacy Practice Framework. Method This was an explorative, cross-sectional study with mixed methods analysis. Advanced Pharmacy Practice Framework, a review of the recent explorative study on Advanced Practice conducted by the Advanced Pharmacy Practice Framework Steering Committee and semi-structured interviews (n = 10) were utilized to create, refine and pilot the questionnaire. The questionnaire was advertised across pharmacy-organizational websites via a purposive sampling method. The target population were pharmacists currently registered in Australia. Results Seventy-two participants responded to the questionnaire. The participants were mostly female (56.9%) and in the 30–40 age group (26.4%). The pharmacists self-perceived their levels of practice as either entry, transition, consolidation or advanced, with the majority selecting the consolidation level (38.9%). Although nearly half (43.1%) of the participants had not seen the Framework beforehand, they defined Advanced Pharmacy Practice similarly to the definition outlined in the Framework, but also added specialization as a requirement. Pharmacists explained why they were practising at their level of practice, stating that not having more years of practice, lacking experience, or postgraduate/post-registration qualifications, and more involvement and recognition in practice were the main reasons for not considering themselves as an Advanced Pharmacy Practitioner. To be considered advanced by the Framework, pharmacists would need to fulfill at least 70% of the Advanced Practice competency standards at an advanced level. More than half of the pharmacists (64.7%) that self-perceived as being advanced managed to fulfill 70% or more of these Advanced Practice competency standards at the advanced level. However, none of the self-perceived entry level pharmacists managed to match at least 70% of the competencies at the entry level. Conclusion Participants' self-perception of the term Advanced Practice was similar to the definition in the Advanced Pharmacy Practice Framework. Pharmacists working at an advanced level were largely able to demonstrate and justify their reasons for being advanced practitioners. However, pharmacists practising at the other levels of practice (entry, transition, consolidation) require further guidance regarding their advancement in practice.

Australia’s first Pharmacists Immunisation Pilot – about the service

Background: The first phase of the Queensland Pharmacist Immunisation Pilot (QPIP) ran between April and August 2014, to pilot pharmacists administering influenza vaccinations for the flu season for the first time in Australia. Aim: An aim was to investigate factors facilitating implementation of a pharmacist vaccination service in the community pharmacy setting. Method: The QPIP pharmacies were divided into two arms; the South East Queensland arm consisting of 51 Terry White Chemists (TWCs), and 29 pharmacies in the North Queensland (NQ) arm. The TWCs featured pharmacies which previously provided a vaccination service and that were experienced with using an online booking system, providing an opportunity to capture booking data. Results: The TWCs delivered 9902 (90%) of the influenza vaccinations in QPIP. Of these, 48.5% of the vaccines were delivered via appointments made using the online booking system, while 13.3% were in-store bookings. Over one-third (38.2%) of the vaccinations delivered in were “walk-ins” where the vaccination was delivered ‘on the spot’ as spontaneous or opportunistic vaccinations. The absence of a booking system meant all vaccinations delivered in the NQ arm were “walk-ins”. The online-booking data showed 10:00 am and Tuesday being the most popular time and day for vaccinations. Patients preferred having their vaccinations in private consultation rooms, over areas which used a screen to partition off a private area. Discussion: The presence of an online booking system appeared to increase the efficiency and penetration of the of vaccine service delivery. Also, as the level of privacy afforded to patients increased, the number of patients vaccinated also increased. Conclusions: As pharmacist-delivered vaccination services start to progressively roll out across Australia; these findings pave the way for more efficient and effective implementation of the service.

Metformin for the pain in your backside?

Pain is a sensation that most people feel at some time-be it when we accidently stub our toe, or burn our hand when reaching into the oven to pull out that souffle left baking for too long.

Raloxifene for improving attention and memory in schizophrenia?

Schizophrenia can affect people's thoughts, feelings, and behaviour, and it can be as if your brain was playing tricks on you.

Rituximab for chronic fatigue syndrome?

Most people complain about being tired and wish they could sleep in for a few more hours instead of going to work. However, 'being tired' has a whole different meaning for people living with chronic fatigue syndrome, which is also known as myalgic encephalomyelitis.

Improved understanding of the damage, ecology, and management of mirids and stinkbugs in Bollgard II

In recent years mirids and stinkbugs have emerged as important sucking pests in cotton. While stinkbugs are causing damage to bolls, mirids are causing damage to seedlings, squares and bolls. With the increasing adoption of Bollgard II and IPM approaches the use of broad-spectrum chemicals to kill Helicoverpa has been reduced and as a result mirids and stinkbugs are building to levels causing damage to bolls later in crop growth stages. Studies on stinkbugs by Dr Moazzem Khan revealed that green vegetable bug (GVB) caused significant boll damage and yield loss. A preliminary study by Dr Khan on mirids revealed that high mirid numbers at later growth stages also caused significant boll damage and that damage caused by mirids and GVB were similar. Mirids and stinkbugs therefore demand greater attention in order to minimise losses caused by these pests and to develop IPM strategies against these pests to enhance gains in IPM that have been made with Bt-transgenic cotton. Progress in this area of research will maintain sustainability and profitability of the Australian cotton industry. Mirid damage at early growth stages of cotton (up to squaring stage) has been studied in detail by Dr Khan. He found that all ages of mirids cause damage to young plants and damage by mirid nymphs is cumulative. Maximum damage occurs when the insect reaches the 4th and 5th nymphal stages. He also found that mirid feeding causes shedding of small and medium squares, and damaged large squares develop as ‘parrot beak’ bolls. Detailed studies at the boll stage, such as which stage of mirids is most damaging or which age boll is most vulnerable to feeding, is lacking. This information is a prerequisite to developing an IPM strategy for the pest in later crop growth stages. Understanding population change of the pest over time in relation to crop development is an important aspect for developing management strategies for the pest which is lacking for mirids in BollgardII. Predators and parasitoids are integral components of any IPM system and play an important part in regulating pest populations. Some generalist predators such as ants, spiders, damsel bugs and assassin bugs are known to predate on mirids. Nothing is known about parasitoids of mirids. Since green mirid (GM), Creontiades dilutus, is indigenous to Australia it is likely that we have one or more parasitoids of this mirid in Australia, but that possibility has not been investigated yet. The impact of the GVB adult parasitoid, Trichopoda giacomelli, has been studied by Dr Khan who found that the fly is established in the released areas and continues to spread. However, to get wider and greater impact, the fly should be released in new locations across the valleys. The insecticides registered for mirids and stinkbugs are mostly non-selective and are extremely disruptive to a wide range of beneficial insects. Use of these insecticides at stage I and II will minimise the impact of existing IPM programs. Therefore less disruptive control tactics including soft chemicals for mirids and stinkbugs are necessary. As with soft chemicals, salt mixtures, biopesticides based on fungal pathogens and attractants based on plant volatiles may be useful tools in managing mirids and stinkbugs with less or no disruption. Dr Khan has investigated salt mixture against mirids and GVB. While salt mixtures are quite effective and less disruptive, they are quite chemical specific. Not all chemicals mixed with salt will give the desired benefit. Therefore further investigation is needed to identify those chemicals that are effective with salt mixture against mirids and 3 of 37 GVB. Dr Caroline Hauxwell of DPI&F is working on fungal pathogen-based biopesticides against mirids and GVB and Drs Peter Gregg and Alice Del Socorro of Australian Cotton CRC are working on plant volatile-based attractants against mirids. Depending on their findings, inclusion of fungal-based biopestcides and plant volatile-based attractants in developing a management system against mirids and stinkbugs in cotton could be an important component of an IPM approach.

The diet of the dingo (Canis lupus dingo and hybrids) in north-eastern Australia: a supplement to the paper of Brook and Kutt (2011)

Dingoes and other wild dogs (Canis lupus dingo and hybrids) are generalist predators that consume a wide variety of different prey species within their range. Little is known, however, of the diets of dingoes in north-eastern Australia where the potential for impacts by dingoes exists. Recently new information has been provided on the diets of dingoes from several sites in Queensland, Australia, significantly adding to the body of published knowledge on ecosystems within this region. Further information on the diet of dingoes in north-eastern Australia is added from 1460 scats collected from five sites, representing tropical savannahs, tropical offshore islands (and a matched mainland area), dry sclerophyll forests and peri-urban areas on the fringe of Townsville. Macropods, possums and bandicoots were found to be common prey for dingoes in these areas. Evidence suggested that the frequency of prey remains in scats can be an unreliable indicator of predation risk to potential prey and it was found that novel and unexpected prey species appear in dingo diets as preferred prey become unavailable. The results support the generalisation that dingoes prefer medium- to large-sized native prey species when available but also highlight the capacity for dingoes to exploit populations of both large and small prey species that might not initially be considered at risk from predation based solely on data on scats.