News & Updates
Congratulations to our newly accredited Pharmacists
News & Updates
The Department of Health is monitoring a respiratory illness outbreak caused by a novel (new) coronavirus that was first reported in Wuhan, China.
This alert is updated every day with the latest medical advice and official reports.
Additional information of interest can be found on the RACGP website HERE.
Information and interim guidelines for pharmacists and the pharmacy workforce are also available in these FIP Guidelines HERE
News & Updates
What is a mandatory notification?
Notifying AHPRA about a concern that a health practitioner may be putting public safety at risk is called a ‘notification’.
Anyone can make a voluntary notification about a health practitioner, but by law, registered health practitioners, employers and education providers must make a mandatory notification in some limited circumstances. Mandatory notifications help to protect the public by ensuring that Ahpra and the National Boards are alerted to any potential risks to the public.
In early March 2020, the requirements to make a mandatory notification are changing. The changes aim to support health practitioners to seek help about their health without fearing a mandatory notification.
To help practitioners understand the changes, Ahpra have updated their mandatory notifications guidelines and released them in advance of the amendments coming into effect.
Helpful resources for health practitioners
Understanding when to make a mandatory notification and when not to is an important way that health practitioners can help to protect the public and support their colleagues.
Click HERE to access the Ahpra resources to assist in the understanding of mandatory notifications. Ahpra plans to publish more resources over the coming months.
News & Updates
The Medicine Status Website (MSW) enables consumers to search for and monitor the status of medicines as they progress through the Pharmaceutical Benefits Scheme (PBS) listing process. It also enables consumers to better understand how they can contribute to PBAC decision making and the steps that must be completed to list a medicine on the PBS.
The MSW includes information on submissions considered by the PBAC from July 2019 onwards. The MSW does not include information on listing processes for vaccines or generic medicines. Please email the Department of Health (firstname.lastname@example.org) or call 1800 020 613 for information on medicines considered before July 2019.
The information on the MSW is updated periodically and is not real-time. Publishing timelines are outlined in the MSW Factsheet. The ‘Page last updated’ field at the top of each web page shows the date of the last update.
Click HERE to read further.
News & Updates
Some pharmacists feel that they can make generic substitutions where it is unauthorised and that they will act without consequence. This is not the case as PDL has assisted numerous pharmacists in the past who have been reprimanded for acting this way.
Complaints to pharmacy regulators usually happen in one of two ways; Consumers who specifically direct that no substitution take place will often file a complaint if a pharmacy generically substitutes without their permission. Alternatively, a prescriber who ‘ticks the box’ may report a pharmacist for unauthorised substitution if they become aware that this has occurred. Consumers who have their directions on no substitution ignored will often choose to change pharmacies which is an economic hit to the business.
There are often good reasons why substitution of brands should not take place. Commonly with elderly patients or those with poor health literacy, swapping away from a familiar brand may lead to confusion and medical misadventure.
The provision of a sign in the pharmacy stating that it is the policy of the pharmacy to use generics is not a license to substitute. The consumer must verbally agree that generic substitution is acceptable to them.
Generic substitution also relates to brand substitution where items are not ‘flagged’ on the Pharmaceutical Benefits list. Some drugs including warfarin should never have their brands interchanged for clinical reasons of differing bioavailability. Another class of drugs which should have brand consistency are the anti-epileptics.
A pharmacist swapped a script for Coumadin 1mg to Marevan 1mg. The pharmacist was subsequently contacted by a hospital pharmacist asserting that the brand change may have altered the patient’s INR resulting in hemorrhage. Although the assertion was not proven, the risk of swapping brands is real.
Another ill-considered change of warfarin brands led to an AHPRA investigation. A patient who was managed on the Coumadin brand of warfarin was notified to take warfarin 3 mg as a result of a change in INR. A pharmacist dispensed Marevan 3 mg stating that Coumadin did not come in a 3mg tablet. Again, a patient was hospitalized with problems relating to the INR.
Changing prescribers’ instructions
Some pharmacists believe it is okay to change instructions issued by a prescriber without seeking permission. The following scenario demonstrates this issue.
Amoxil 500mg x 20 at a dose of 1 tds is ordered.
Amoxil 500mg is unobtainable so a pharmacist decides to provide Amoxil 250mg and 40 capsules with instructions of 2 tds without consulting the prescriber.
The overall results are identical, but this change should not take place without seeking permission from the prescriber.
News & Updates
The quality and safety commission has begun implementing an evidence-based training and support program to reduce the inappropriate use of sedatives in aged care homes in remote and very remote areas.
The Aged Care Quality and Safety Commission and Dr Juanita Breen from University of Tasmania have trained a group of experienced pharmacists to deliver the successful Reducing Use of Sedatives (RedUSe) program to around 50 facilities around the country.
RedUSE involves a multi-strategy interdisciplinary approach including pharmacist-run training in facilities about the correct use of medications and alternative approaches, and bringing nurses, pharmacists and doctors together to reduce the prescribing of antipsychotics and benzodiazepines.
The program was developed by Dr Breen and UTAS’ Wicking Dementia Research and Education Centre and achieved a “significant reduction” in antipsychotic and benzodiazepine use during national trials.
Aged Care Quality and Safety Commission Chief Clinical Advisor Dr Melanie Wroth said the educational initiative was part of the commission and Department of Health’s ongoing work to reduce inappropriate chemical restraint and psychotropic use.
It deliberately targets places that frequently miss out on helpful initiatives because of logistics, she said.
“We are approaching all of the facilities that are classified as remote or very remote. It is around 50 facilities,” Dr Wroth told Australian Ageing Agenda.
The initiative aims to assist facilities broadly in relation to pharmaceutical-related issues and get a picture of what is going on, she said.
“We are keen to get hold of things that people are doing well, which may well help other people in trying to solve some of their problems a bit more creatively, and also try to have a very clear picture of what are the real barriers and challenges to providing good care to people in these areas,” she said.
The commission has appointed 10 trained pharmacists to visit the facilities to provide medication-related education and support that responds to individual facility needs.
“The [pharmacists] are now RedUSe trainers and that is one of the key things they are offering to facilities,” Dr Wroth said.
That includes training nurse champions who work at the facility and reaching out to local pharmacists to train them as champions.
“The pharmacists after they leave the facility will be keeping in touch with the champion nurses and the champion pharmacists and providing ongoing support via telephone to continue to reduce the use of the sedatives in the residents’ concerned,” Dr Wroth said.
Dr Wroth and project members recently visited the first facility, in South Australia, where the pharmacist trained three nurse champions.
The nurse champions were “super engaged and super keen,” she said.
“It was fantastic to be able see firsthand some of the really good things they are doing, and hearing about the challenges,” she said.
Not a regulatory initiative
Dr Wroth said she wanted to stress that the program aimed to be educational and supportive and should not be seen as threatening.
“We are making it quite clear that this is not a regulatory thing. Unless there is something overtly outrageous that we see, we are here to problem solve, support and assist,” she said.
The overuse of sedatives in aged care, the success of the RedUSe program in combatting it and calls for immediate action featured strongly in the royal commission’s interim report.
While this new initiative aligns with the concerns in the interim report, it has been in the works since before its release, Dr Wroth said.
“The RedUSe project has been a blessing for this particular thing because it is such a tangible and well-validated program to be dealing out to places that are under-resourced or under knowledged,” she said.
News & Updates
The Pharmaceutical Society of Australia (PSA) welcomes changes to the Workforce Incentive Program (WIP) which come into effect tomorrow and are designed to increase consumer access to an expanded primary care team of experts committed to improving every patient’s health.
“For the first time, pharmacists will be included as one of the allied health professionals’ general practices can engage through the Workforce Incentive Program,” PSA National President, Associate Professor Chris Freeman said.
“Research shows integrating a pharmacist into the primary care team can improve health outcomes for patients with chronic diseases such as diabetes, osteoporosis and cardiovascular disease; and reduce medicine-related problems, total number of medicines and inappropriately prescribed medicines.”
The Royal Australian College of General Practitioners has also welcomed the changes, with RACGP President Dr Harry Nespolon noting “This is a positive development. The RACGP values team-based models of care in which a range of healthcare professionals can contribute towards patient health outcomes, maximising use of their skills within their scope of practice.”
Read the full press release HERE.
News & Updates
Scholarships of up to $5,000 for current and aspiring female leaders
Scholarships of $2,000 to $5,000 are currently available to women working in the health and health and pharmaceuticals sector to help support their participation in a range of career building leadership development programs.
The initiative is providing junior through to executive managers with scholarships to support their growth and development. The scholarships assist with participation in one of three flagship development programs. The programs provide highly collaborative learning environments uniquely tailored to the needs of female leaders.
Expressions of Interest
Find out more and register your interest by completing the Expression of Interest form here prior to Friday, March 20: https://www.wla.edu.au/health.html
News & Updates
Nominations are now open
News & Updates
This list is a summary of only some of the changes that have occurred over the last month.
Before prescribing, always refer to the full product information.
News & Updates
Sofitel Gold Coast Broadbeach QLD - Wednesday 18 March 2020
Meeting the Challenges of Appropriate Medicines Management in the Older Adult.
The program is structured to provide accredited pharmacists, those undergoing accreditation and other interested pharmacists with relevant high-quality education covering therapeutics, practice pointers and clinical controversies. The program will, in addition, appeal to those pharmacists who are providing services to Aged Care Facilities.
Wednesday 6 May - All day
QT Hotel, Canberra City ACT
Just how prepared are our new practitioners for the realities of the profession and how can we support everyone involved in the process?
Experiential placements and internships will be the focus of Colloquium 2020 where delegates will explore “From Virtual to Reality: The journey to work-readiness”.
The event will be underpinned by an interprofessional pillar where delegates will examine interprofessional experiential placements and learning, simulation, learning styles and professional development.
For further information and to register, click HERE.
Monash University has an online course Food as Medicine. This course has been certified by the Association for Nutrition and may be of interest to pharmacists who are looking to have more evidence-based information on this topic.
This free course runs over three weeks, with four hours of weekly study. Topics range from food and its role in prevention and treatment, macronutrients, micronutrients, phytochemicals and antioxidants, nutrition complexities and controversies, and the importance of evidence.
Gain in-depth knowledge and skills in nicotine addiction and smoking cessation to work in primary and allied healthcare as a tobacco treatment and smoking cessation specialist.
The training courses are hosted by A/Prof Renee Bittoun (Founding Editor-in-Chief of The Journal of Smoking Cessation) along with other experts in the field of smoking cessation. A/Prof Bittoun has been teaching this course for over 15 years, regularly updating the content and has many years of experience in clinical practice and professional training regarding smoking cessation.
Topics: Causes, consequences, treatment and research of smoking cessation, nicotine addiction and appropriate evidence-based smoking cessation techniques in practical application.
The aim is to improve the implementation and evaluation of programs in smoking cessation.
This three-day course includes a USB stick with course materials and a certificate of attendance is awarded on completion.
Date: 24-26 March 2020
Further dates: 22-24 June 2020, 22-24 September 2020
Location: 431 Glebe Point Road, Glebe NSW 2037
For more information and to register click HERE.
Saturday 22 February 2020 9.00am to 4.30pm
Brisbane Riverview Hotel, Cnr. Kingsford Smith Drive & Hunt Street, HAMILTON QLD 4007
This is a call to action to any pharmacist committed to developing their skills as a core member of the health care team. It’s time for pharmacists to be embedded in aged care. It’s time for all Australian general practices to include pharmacists as a part of their interdisciplinary team.
This foundation training workshop will guide pharmacists with an approach that ensures compassion, interdisciplinary collaboration and rational clinical decision-making.
Learn how to proactively assess and prioritise a patient’s healthcare journey in collaboration with other healthcare providers.
This one-day workshop covers topics such as medicine reconciliation and review, consultation and communication skills, and working as part of a multidisciplinary team.
Cost PSA members: $560 Non-members: $840
See the PSA website for further details
Saturday 18 and Sunday 19 July 2020
Brisbane Airport Conference Centre
News & Updates
Dhineli Perera interviews Andrew McLachlan about critical issues that need to be addressed when updating the National Medicines Policy, and why. Read the full article in Australian Prescriber.
Click HERE to listen to the podcast.
News & Updates
Drug interactions can lead to significant toxicity or loss of clinical effect. The risks increase with the number of drugs the patient takes.
General and specialised drug interaction resources are available. Access to up-to-date electronic resources is encouraged.
There are gaps in the information on interactions for new drugs, those with complicated metabolism and drugs with limited use. It may be necessary to use multiple resources to find the information.
When assessing information about interactions, clinicians should evaluate the relevance for each patient. In high-risk situations, expert advice can be valuable. Clinicians should report new or unusual drug interactions to the Therapeutic Goods Administration.
News & Updates
Heart failure with preserved ejection fraction is a highly heterogenous disease. There is emerging evidence that treatment should be tailored to the individual’s associated comorbidities.
No current algorithms exist for the management of heart failure with preserved ejection fraction. Conventional therapies used in heart failure with reduced ejection fraction are yet to show a mortality benefit.
Key treatment objectives include control of hypertension and fluid balance.
Common comorbidities include coronary artery disease, atrial fibrillation, obesity, diabetes, renal impairment and pulmonary hypertension. These comorbidities should be considered in all patients and treatment optimised.
News & Updates
Approximately 20% of patients with obstructive lung disease have features of both asthma and chronic obstructive pulmonary disease.
These patients have a higher burden of disease and increased exacerbations compared to those with asthma or chronic obstructive pulmonary disease alone.
Management should address dominant clinical features in each individual patient, and comorbidities should be considered.
There are several interventions that are useful in the management of both asthma and chronic obstructive pulmonary disease.
As inhaled corticosteroids are key to the management of asthma, they are recommended in patients with overlapping chronic obstructive pulmonary disease.
News & Updates
There is a need to refresh Australia’s National Medicines Policy, according to an article in the latest edition of Australian Prescriber. Professors Andrew McLachlan and Parisa Aslani from the Sydney Pharmacy School at the University of Sydney comment on the directions a new policy could take.
The National Medicines Policy was launched 20 years ago with the aim to improve health outcomes for Australians. Since then, there have been significant changes in treatments, healthcare systems, medicine subsidies, digital technologies, and the pharmaceutical industry.
“There are some critical issues that need to be comprehensively addressed when planning National Medicines Policy 2.0,” says Prof McLachlan.
“Medication safety, cost and access to medicines are key considerations. Vulnerable people need to be part of a refreshed patient-centred focus in a new National Medicines Policy, including older frail people, indigenous Australians, migrants and refugees and those living with mental illness, disability or chronic ill health.
“Digital health initiatives, such as electronic medication management and real-time prescription monitoring, offer new opportunities to improve the effectiveness and safety of healthcare delivery as well as to inform health policy and health-related decisions,” Prof McLachlan says.
Read the full Australian Prescriber article.
News & Updates
Rising to the medication safety challenge
A unique cross-disciplinary event, NMS 2020 will bring together influential organisations, individuals and decision makers in the health sector to discuss and debate key issues around quality use of medicines and health technologies. The program will encourage a collaborative approach with a focus on the needs of the consumer.
Medicine safety has been named a National Health Priority Area and the 3rd WHO Global Patient Safety Challenge: Medication Without Harm. Attendees at NMS 2020 will hear from experts who can provide the latest on the medicines and health environment in this context.
Attracting people from all sectors of the health industry, this event is a rare opportunity to network, share expertise, ideas and innovations.
NMS 2020 is currently calling for abstract submissions for the following streams:
Abstract submissions close on Wednesday 26 February 2020.
Further information is available HERE.
Choosing Wisely Australia National Meeting: Empowering consumers to choose wisely
The 2020 Choosing Wisely Australia National Meeting will be held on Wednesday 20 May.
This year’s National Meeting offers a platform for Choosing Wisely members and supporters, policy makers, consumer advocates, health services and other healthcare influencers to engage in discussions, presentations and workshops.
The focus will be on empowering consumers and supporting health professionals to be champions for changing the conversations in our health system so that people only receive care that is evidence-based and truly necessary.
A networking event for all delegates will be held on the evening of 20 May.
Presenting at NMS 2020 or the Choosing Wisely National Meeting is an opportunity to spark discussion and showcase your work with an audience of experts from across Australia.
Abstract submissions are invited for each event for lightning talks and poster displays.
More information about the Choosing Wisely Australia National Meeting is available HERE.
News & Updates
Many older Australians are missing out on the chance to get vaccinated against shingles, according to the latest edition of Australian Prescriber. Only about a third of 70-year-olds have had the free vaccination against this relatively common disease.
Professor Kristine Macartney, Director of the National Centre for Immunisation Research and Surveillance says people aged 85 and above have a 50% chance of developing shingles. The vaccine is free for people between 70 and 79 years. It reduces the risk of shingles by over 50% and makes any cases that do occur less severe.
“Most older Australians have had chickenpox at some point in their life, and shingles, also known as herpes zoster, is caused by a reactivation of the chickenpox virus in the body, usually many years later,” explains Macartney.
“Someone with shingles experiences a rash, often with pain which can develop into long-lasting, difficult to treat nerve pain,” she says. “The vaccine reduces the risk of this long-term pain.”
The vaccine has a good safety record in Australia, but it should not be used by people with a lowered immune system.
A new non-live shingles vaccine, not part of the free National Immunisation Program, may potentially be used for people with a lowered immune system. This vaccine is, however, currently unavailable in Australia due to a limited global supply.
A systematic review and meta-analysis
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are a class of drugs used to treat high blood sugar in diabetes. They work by blocking the reuptake of filtered glucose by the kidney and therefore increase the loss of sugar in the urine, which also leads to increased water loss.
SLGT2is have been shown to have beneficial effects on diabetes control and heart and long-term kidney function.
However, there is a concern that these drugs can cause acute kidney injury, meaning a significant decline in kidney function happening over a short period of time that may or may not be reversible.
The authors of this study conducted a database search to identify studies reporting on adverse effects from SLGT2i use. They found 112 randomized trials. Forty-one of these reported on acute kidney injury in a total of 68,159 patients. Patients on SGLT2is had 25% lower odds for this adverse effect. In 5 observational (nonrandomized) cohorts reporting on 83,934 patients, the odds of acute kidney injury were 60% less in patients taking SGLT2is.
Ninety-two randomized studies with 81,763 patients reported on hypovolemia (fluid depletion); this was found to be more likely in patients not taking SGLT2is, with 20% higher odds.
As a result of their findings, the authors stated that they could not detect an increased risk of acute kidney injury in patients taking SGLT2is. Patients taking SGLT2is had lower odds of suffering an acute kidney injury than those who did not, despite the fact that these drugs increase fluid loss by the body.
Their findings indicate that fear of causing acute kidney injury should not stop practitioners prescribing SGLT2is.
However, the analysis had some drawbacks, such as inconsistent definitions being used in some of the studies, different patient characteristics in the included studies, studies being carried out for different lengths of time, and missing details about the severity of acute kidney injury.
Read the full study published in PLOS One HERE.
Chance of MI is greatest in the first days after bereavement but medication cuts risk factors
Giving bereaved patients a low dose of beta blocker and aspirin could reduce their raised risk of an MI in the months following the death of a loved one, Sydney researchers say.
Those experiencing grief face a raised chance of having an MI and dying, especially those who have lost a spouse or a child.
This heightened risk of mortality is greatest in the six months after a loss, with CVD accounting for up to half of the excess deaths, say the researchers from the University of Sydney, Royal North Shore Hospital in Sydney and the Kolling Institute.
Their new findings suggest that giving low-dose daily metoprolol (25mg in the morning) and aspirin (100mg) for six weeks may mitigate these risks and even lower measures of depression and anxiety.
In their study, 85 spouses or parents, whose family member had died in one of five hospitals in northern Sydney, were enrolled within two weeks of their loss.
Half (42) of the bereaved, who had an average age of 66, received the medication for six weeks, while 43 were given placebos.
Blood pressure, average 24-hour heart rate and platelet responsiveness were lower among those on medication.
After six months, blood pressure remained lower among those on medication, who also recorded lower anxiety scores.
The findings provided encouragement for doctors to consider the treatment as a preventive measure during bereavement, the researchers said.
“The increased risk of heart attack can last up to six months. It is highest in the first days following bereavement and remains at four times the risk between seven days to one month after the loss,” said lead author Professor Geoffrey Tofler, a cardiologist at Royal North Shore Hospital.
Theirs was the first randomised, controlled, clinical trial to show it is possible to reduce several cardiac risk factors during this time, without adversely affecting the grieving process.
Although the findings show the effect of the medications are similar to those in the general population, “it was important to determine efficacy and tolerability in bereaved subjects with their fluctuating symptoms of depression, anxiety and anger”.
“While clinicians need to be wary of appearing to medicalise an almost universal stressful experience, reducing heart attacks among bereaved people is a worthy goal,” the researchers wrote in the American Heart Journal.
“At a time when the deceased is the focus of attention, our finding reminds clinicians to consider the wellbeing of bereaved individuals more broadly, including encouraging adequate diet and sleep, ensuring medication adherence and reminding the bereaved to seek help for symptoms that may be cardiac.”
Biological medicines are an important advancement in the pharmaceutical treatment of patients with inflammatory and immunological diseases and cancer. Changes are occurring rapidly in this field of treatment as biosimilars become increasingly common in clinical practice. These medicines are comparable in all essential aspects to the innovator biological medicines they are based on, including safety, efficacy and mode of action, but cost significantly less.
Read this overview on the use of biosimilars from The Best Practice Advocacy Centre New Zealand HERE.
Older patients who have difficulties with memory may have Alzheimer disease, or they may have another condition with similar symptoms.
Dementia is a term used to describe a decline in mental abilities, including memory, language, and logical thinking, that is severe enough to affect daily living. When older people start to have these types of symptoms, they often worry about Alzheimer disease. Alzheimer disease is a neurodegenerative dementia, which means that the dementia causes loss of brain tissue and is not reversible. Vascular dementia is another type, caused by poor blood flow to the brain, and it is also not reversible. Dementia due to Alzheimer disease and vascular dementia can occur together.
What Conditions Act Like Neurodegenerative Dementia?
Many conditions other than Alzheimer disease or vascular dementia can affect a person’s memory, language, and logical thinking. Some of these conditions can be temporary and others are permanent. When a person is evaluated for memory problems or problems related to not thinking clearly, a number of conditions should be considered as the possible cause. Delirium is one cause, and it can be related to medication side effects, recreational drug use, toxins, endocrine disorders such as hypothyroidism, or metabolic problems like hyponatremia. Other possible causes include depression; sleep disturbances; medication side effects; hearing and vision loss; deficiencies in nutrients such as vitamin B12, folic acid, and thiamine; long-term alcohol misuse; normal pressure hydrocephalus; chronic infections such as neurosyphilis or HIV/AIDS; brain masses; subdural hematoma; autoimmune encephalitis; and cerebral vasculitis.
Click HERE to view this patient page from the Journal of the American Medical Association (JAMA).
A Case-Based Series on Practical Pathology for GPs
Liver Function Tests
Liver function tests (LFTs) are a frequently ordered panel in both primary and secondary care, however their interpretation may be challenging especially when there is mild derangement or an unexpected abnormality. Abnormal LFTs in an asymptomatic patient is particularly problematic as many LFT analytes are non-specific. While consideration of the patient’s history, potential physiological causes and medication side effects is a useful starting point, additional wisely chosen pathology tests can be a helpful next step in reaching a diagnosis.
The cases illustrate some common LFT patterns and the investigative process that may be applied.
Click HERE to access.
Ophthalmologist Dr Shanel Sharma explains why it’s vital to be vigilant for those with diabetes and why the eye is vulnerable to damage from the complications of diabetes.
Diabetes is the most common cause of blindness for people between 20 and 65 and diabetic eye diseases can affect anyone with diabetes whether type 1 or type 2. Chronically high blood glucose levels over time damage blood vessels throughout the body. Our small blood vessels are the most vulnerable and are affected first. These include the small blood vessels supplying our eyes, kidneys and our peripheral limbs (toes). People with chronically elevated blood glucose levels have substantially more, and more severe, retinopathy than those with lower blood glucose levels.
What happens in the eye is that the blood vessels become damaged and develop micro-aneurysms, start to bleed causing haemorrhages and stop carrying blood, resulting in retinal ischaemia. Ischaemic retina causes the release of a protein (VEGF – vascular endothelial growth factor), resulting in the development of sick and abnormal blood vessels, which can bleed or cause tractional retinal detachment and loss of vision. The other major way people lose sight is from diabetic macular oedema, from leaking of blood product into the macular. The macular is the part of the eye that allows one to read, look at people’s faces, or do any fine detailed work.
As there is usually a 10–15-year delay in chronically high BGLs and appearance of diabetic eye diseases, it is important to control BGLs well from the start. Although the damage to the eye is irreversible, early detection and treatment can reduce the risk of blindness by up to approximately 95%.
If you are diagnosed with diabetic retinopathy, don’t despair. Good blood glucose control can reduce its progression. People with diabetes who follow healthy eating principles can reduce their HbA1c levels by 1 to 2 percentage points. On a low GI diet, they can reduce can HbA1c levels by another 0.5 percentage points. While this may not sound significant, a decrease of just 1 percentage point in HbA1c levels will decrease the common complications of diabetes by 19% to 43%. Talk to your doctor or diabetes educator.
Reducing blood pressure helps too. The UK Prospective Diabetes Study showed a reduction of 10mmHg systolic and 5mmHg diastolic reduces the rate of retinopathy by 30%.
As diabetic eye diseases most commonly have no symptoms, it is essential to ensure that you are being screened regularly by your GP, optometrist or your ophthalmologist. Symptoms that are associated with diabetic eye diseases can include intermittent blurred vision, difficulty with focusing, loss of contrast, double vision or distortion to your vision. Additionally, diabetes is an independent risk factor for developing other eye diseases such as cataracts and glaucoma.
Protecting your eyesight is one of the most important things you can do to ensure quality and enjoyment of life.
Read the full narrative review from The Medical Journal of Australia HERE.
Serious bowel complications can lead to hospitalisation or even death if constipation (CN) not diagnosed and treated quickly. Risk further increased at higher doses of clozapine and with concomitant use with anticholinergics and other medicines that cause CN, including opioids.
Health care professionals should evaluate bowel function before starting a patient on clozapine and avoid co-prescribing clozapine with other anticholinergic medicines that can cause gastrointestinal hypomotility. Advise patients frequently of the significant risk of constipation and life-threatening bowel issues and the need to stay hydrated to prevent constipation.
Question patients about the frequency and quality of their bowel movements throughout treatment. Advise patients to contact a health care professional right away if they have difficulty having a bowel movement or passing stools, do not have a bowel movement at least three times a week or less than their normal frequency, or are unable to pass gas. Monitor patients for symptoms of potential complications associated with gastrointestinal hypomotility such as nausea, abdominal distension or pain, and vomiting. Consider prophylactic laxative treatment when starting clozapine in patients with a history of constipation or bowel obstruction.
Ageing has a degenerative effect on the skin, leaving it more vulnerable to damage. Hygiene and emollient interventions may help maintain skin integrity in older people in hospital and residential care settings; however, at present, most care is based on "tried and tested" practice, rather than on evidence.
Current evidence about the effects of hygiene and emollients in maintaining skin integrity in older people in residential and hospital settings is inadequate.
The authors of this Cochrane Review could not draw conclusions regarding frequency of skin damage or side effects due to very low‐quality evidence.
Low‐quality evidence suggests that in residential care settings for older people, certain types of hygiene and emollient interventions (two different standardised skin care regimens; moisturising soap bar; combinations of water soak, oil soak, and lotion) may be more effective in terms of clinical score of dryness when compared with no intervention or standard care.
Studies were small and generally lacked methodological rigour, and information on effect sizes and precision was absent. More clinical trials are needed to guide practice; future studies should use a standard approach to measuring treatment effects and should include patient‐reported outcomes, such as comfort and acceptability.