News & Updates
In recognition of the challenges of the COVID-19 pandemic and the need to postpone the AACP’s annual clinical pharmacy seminar ConPharm 2020, the AACP is pleased to announce that the event is now online.
ConPharm 2020 online presents the same high-quality education, with presentations dedicated to providing up to date evidence-based education on the management of the medication needs of older adults, regardless of practice setting.
For those who have attended ConPharm in the past, this is an opportunity to enjoy the same relevant, high quality education that you have come to expect from this event.
For those of you who have not experienced ConPharm before, now is the time to take advantage of this offer to experience ‘the best clinical pharmacy event of the year’ in your own time.
For this year only the AACP is offering this online CPD event at a greatly reduced price of $95.00 for AACP associates and $150.00 for non-AACP associates (including GST).
With successful completion of the related multiple-choice question assessment, a total of 26.5 accredited group two CPD credits are available.
To learn more and to register, click HERE.
News & Updates
Congratulations to our newly accredited Pharmacists
News & Updates
In this episode, NPS MedicineWise CEO Steve Morris speaks with the head of the Therapeutic Goods Administration (TGA) John Skerritt about how the TGA is supporting clinicians and consumers during the COVID-19 pandemic.
They discuss some of the unique challenges the TGA has faced and the way it has adapted to these, along with innovations that should be continued beyond the pandemic period.
The Therapeutic Goods Administration: www.TGA.gov.au
The refreshed NPS MedicineWise COVID-19 information hub: www.nps.org.au/coronavirus
Click HERE to listen
News & Updates
In this episode, Steve Morris speaks with Chris Freeman, National President of the Pharmaceutical Society of Australia (PSA) about how pharmacists have responded and adapted to the COVID-19 pandemic, navigated medicines access challenges and enabled continuity of care, and the importance of taking care of their own health and wellbeing.
Click HERE to listen
News & Updates
Using real-life case scenarios, the panel, consisting of a geriatrician, GP and nurse, will discuss the challenges of optimising transitions of care for people living with dementia.
This webinar has been developed in partnership with Dementia Training Australia.
Wednesday, 26 August 2020
7:00 – 8:00 pm AEST
Click HERE for more information and to register
News & Updates
This is a free open access series of podcasts for all healthcare professionals working with older adults. Hear the the evidence base, recent advances and established best practice / wisdom in healthcare for older adults. Each episode will review an aspect of caring for older adults from the perspective of our MDT faculty.
The MDTea project was set up by Dr Iain Wilkinson and Dr Jo Preston and is funded by Health Education England (KSS). They are supported by a truly multi-professional faculty – drawn from within Kent, Surrey and Sussex.
They are passionate about looking after older adults and believe it is important for all healthcare professionals to have the skills to look after older adults wherever they may present to the healthcare system.
Click HERE to access the podcasts and more information
Glaucoma is the leading cause of irreversible blindness worldwide. In Taiwan, the prevalence and the incidence of open angle glaucoma (OAG) and angle closure glaucoma (ACG) are the highest among people of advanced age. There are various commercially available glaucoma medications that can be prescribed by a clinician. In the past three decades, topical beta-blockers have served as first-line drugs for glaucoma treatment. According to the policy of the National Health Insurance (NHI) of Taiwan, topical beta-blockers constitute first-line treatment for patients with glaucoma without contraindication to beta-blockers. Patients with glaucoma in Taiwan are highly comorbid with cardiovascular disease of either the OAG or ACG type. Several studies have reported on the cardiovascular and respiratory safety of the long-term use of topical beta-blockers. However, their findings have been conflicting. For example, both the Barbados Eye Study and Blue Mountains Eye Study have observed an association between mortality and beta-blockers. Similarly, a retrospective cohort analysis also observed a relationship between adverse outcomes and the use of topical beta-blockers for glaucoma therapy. Conversely, the Rotterdam Study and EPIC-Norfolk Cohort Study have reported that topical beta-blockers do not appear to be associated with excess cardiovascular mortality.
To clarify this important issue, researchers conducted a nationwide population-based cohort study by analysing data from Taiwan’s NHI Research Database (NHIRD) to determine the relationship between topical beta-blocker use and risks of cardiovascular and respiratory diseases in patients with glaucoma in the population of Taiwan. To the best of their knowledge, this is the first study to use a large claims database from an Asian country to examine the long-term potential complications of cardiovascular and respiratory diseases among patients with glaucoma using topical beta-blockers.
The British Geriatric Society has released a 'frailty hub' web page, a repository of published articles, national guidelines and education resources relevant to frailty.
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the subsequent announcement by the World Health Organization of a global pandemic, has altered health care across the public and private sectors. Clearly, coronavirus disease 2019 (COVID‐19) is having a huge impact on general practitioners, emergency physicians, respiratory physicians, intensivists and related staff, and is also impacting the day‐to‐day delivery of chronic health care.
Click HERE to read this article from The Medical Journal of Australia.
Click HERE to read the artricle form The Medical Journal of Australia
An update to the global guidance to support the pharmacy profession through the COVID-19 pandemic was released by the FIP on 14 July 2020.
The purpose of this document is to provide relevant information and guidelines on the COVID-19 pandemic for pharmacists and the pharmacy workforce, both in a primary care context (i.e., community pharmacies and primary healthcare facilities) and in hospital settings.
This document aims to assist pharmacists and the pharmacy workforce in preventing the spread of the disease and contributing to its efficient management in the healthcare system.
Guidelines recommend stepping down asthma treatment to the minimum effective dose to achieve symptom control, prevent adverse side effects, and reduce costs. Limited data exist on asthma prescription patterns in a real-world setting.
The authors of this study published in PLoS Medicine aimed to evaluate the appropriateness of doses prescribed to a UK general asthma population and assess whether stepping down medication increased exacerbations or reliever use, as well as its impact on costs.
In this UK study, they observed that asthma patients were increasingly prescribed higher levels of treatment, often without clear clinical indication for such high doses. Stepping down medication did not adversely affect outcomes and was associated with substantial cost savings.
Diabetes is a national health priority. The Australian National Diabetes Strategy 2016–2020 was released by the Australian Government in November 2015. The number of people with type 2 diabetes is growing, most likely the result of rising overweight and obesity rates, lifestyle and dietary changes, and an ageing population. Within 20 years, the number of people in Australia with type 2 diabetes may increase from an estimated 870,000 in 2014, to more than 2.5 million. The most socially disadvantaged Australians are twice as likely to develop diabetes.
The early identification and optimal management of people with type 2 diabetes can significantly reduce the risk of coronary artery disease, stroke, kidney failure, limb amputations and vision loss that is associated with type 2 diabetes. General practice has the central healthcare provider role in managing type 2 diabetes, from identifying those at risk right through to caring for patients at the end of life. These guidelines give up-to-date, evidence-based information tailored for general practice to support general practitioners (GPs) and their teams in providing high-quality management.
A new section of special interest is that on the management of type 2 diabetes in older people and residential aged care facilities.
In developing the 2020 edition of Management of type 2 diabetes: A handbook for general practice, The Royal Australian College of General Practitioners (RACGP) has focused on factors relevant to current Australian clinical practice. The RACGP has used the skills and knowledge of your general practice peers who have an interest in diabetes management and are members of the RACGP Specific Interests Diabetes Network.
This publication has been produced in accordance with the rules and processes outlined in the RACGP’s Conflict of Interest Policy.
This edition represents 21 years of a successful relationship between the RACGP and Diabetes Australia. We acknowledge the support of the RACGP Expert Committee – Quality Care, the Australian Diabetes Society, Australian Diabetes Educators Association, and RACGP staff in the development of these guidelines.
The goal of this implementation guide is to improve resident-centered health and well-being by reducing use of unnecessary medications, simplifying medication management, and reducing opportunities for transmission of COVID-19 between residents and staff. By streamlining medication administration, these changes may also increase the time that staff have available for other direct care activities.
The authors suggest first reviewing “How to Use this Implementation Guide.” Specific recommendations are provided in the “Recommendations” section, with an accompanying checklist for easy reference. Review the other sections as well; they are critical for safe and effective implementation of these recommendations. Recommendations should be implemented using a resident-centered approach and in a manner that aligns with facility, staff, and pharmacy workflow.
Note that this guide is focused on medication-related issues and should complement rather than replace other efforts to improve care quality and safety and infection control.
Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population.
AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921.
Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months.
Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke.
The trial was funded by the National Health and Medical Research Council of Australia.
When type 2 diabetes is no longer controlled by diet, exercise and metformin there are many options for additional treatment. These options include the glucagon-like peptide-1 (GLP-1) analogues such as dulaglutide and exenatide. When there is hyperglycaemia, these agonists act on GLP-1 receptors in the pancreas to increase insulin secretion.
Semaglutide is another genetically engineered GLP-1 receptor agonist. As a peptide, it has to be given by subcutaneous injection. The half-life of semaglutide is approximately one week, so it only needs to be injected once a week. A steady state is reached after 4–5 weeks of weekly injections. It is cleared like other peptides, so excretion should not be affected by renal or hepatic impairment.
Semaglutide has been studied in a series of trials titled the Semaglutide Unabated Sustainability in Treatment of type 2 diabetes (SUSTAIN). These phase III trials assessed the effect of weekly injections on concentrations of glycated haemoglobin (HbA1c).
Click HERE to read the full article from Australian Prescriber.
Update - extension of Serious Shortage Substitution Notice
27 July 2020
The Therapeutic Goods Administration (TGA) has extended the Serious Shortage Substitution Notice for metformin modified-release 500 mg tablets until 31 December 2020.
Some brands of metformin may be available during this period, but supply may not be sufficient to meet demand in Australia.
The TGA has also granted section 19A approvals for overseas alternatives. Further information is available on our section 19A database.
If it becomes evident that supply has returned to a level that will meet expected demand, the TGA may lapse this Serious Shortage Substitution Notice prior to 31 December 2020.
Hyponatremia, defined as serum sodium concentration < 135 mEq/l, is the most common electrolyte balance disorder in clinical practice. Many causes are listed, but syndrome of inappropriate antidiuretic hormone secretion (SIADH) is certainly the most relevant, mainly in oncological and hospitalized patients. In this review, the pathophysiological and clinical aspects are described in detail. Patients’ extensive medical history and structured physical and biochemical tests are considered the milestones marking the way of the SIADH management as to provide early detection and proper correction. We focused our attention on the poor prognostic role and negative effect on patient’s quality of life of SIADH-induced hyponatremia in both malignant and non-malignant settings, stressing how optimal management of this electrolyte imbalance can result in improved outcomes and lower health costs.