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Chitre M.,Clinical Services | Shechter D.,Scientific Affairs | Grauer A.,Amgen Inc.
American Journal of Health-System Pharmacy | Year: 2011

Purpose. The pharmacologic properties, clinical efficacy, and safety profile of the injectable agent denosumab for the treatment of postmenopausal women with osteoporosis are reviewed. Summary. Denosumab, a human monoclonal antibody that targets a key protein mediator of bone resorption, was approved by the Food and Drug Administration in June 2010 for the treatment of postmenopausal women with osteoporosis who are at high risk for fracture, including "patients who have failed or are intolerant to other available osteoporosis therapy." Available in a 60-mg prefilled syringe, denosumab should be administered subcutaneously by a health care professional at six-month intervals. In Phase III clinical efficacy trials involving nearly 10,000 postmenopausal women, the use of denosumab was associated with a number of significant benefits: reduced bone resorption, increased bone mass, and reduced rates of vertebral, nonvertebral, and hip fractures. Results of two comparison studies indicated that denosumab therapy increased bone mineral density (BMD) at various skeletal sites to a significantly greater extent than alendronate therapy. In the largest clinical trial of the drug to date, adverse effects occurring significantly more often with denosumab versus placebo included eczema-related effects and cellulitis; long-term safety evaluations are ongoing. Conclusion. Denosumab has been shown to decrease bone resorption; increase BMD at all skeletal sites measured; and significantly reduce rates of vertebral, nonvertebral, and hip fractures in postmenopausal women with osteoporosis. Denosumab appears to have a favorable risk:benefit profile and provides a new treatment option for many patients in this population. Copyright © 2011, American Society of Health-System Pharmacists, Inc. All rights reserved.

Bosanac P.,Clinical Services | Hollander Y.,Acute Unit | Castle D.,University of Melbourne
Australasian Psychiatry | Year: 2013

Objective: To review the current role and comparative efficacy of short-acting intramuscular (IM) antipsychotics in the management of acute agitation, in current clinical practice. Method: The efficacy and tolerability of IM antipsychotics in the management of acute agitation in current clinical practice were reviewed in the Medline, PubMed, Cinahl Plus, Scopus-v.4 and PsycInfo databases. Results: The comparative efficacy of the rapidly-acting IM atypical antipsychotics (olanzapine, ziprasidone and aripiprazole) is similar to that of the typical antipsychotic, haloperidol. IM olanzapine and ziprasidone were associated with fewer extrapyramidal side-effects and had similar cardiac tolerability to IM haloperidol. Conclusions: Further studies are required in the ongoing development of contemporary, evidence-based clinical guidelines in acute agitation, including head-to-head comparisons of currently utilized IM atypical antipsychotics, sequential treatment or combinations of medications. © The Royal Australian and New Zealand College of Psychiatrists 2013.

Finley P.R.,University of California at San Francisco | Bluml B.M.,APhA Foundation | Bunting B.A.,Clinical Services | Kiser S.N.,Community Health Enhancement and Health Education Center
Journal of the American Pharmacists Association | Year: 2011

Objective: To assess the clinical and economic impact of a pharmacist-focused health management program for patients with depression. Design: Prospective, nonrandomized, proof-of-concept investigation. Setting: Asheville, NC, from July 2006 through December 2007. Participants: Employees or adult dependents with depressive symptoms who agreed to enroll in an employer-sponsored treatment program conducted at two ambulatory clinics where consultative services were provided. Participants were included in the analysis if they participated in the program for at least 1 year and had two or more documented visits with a pharmacist. Intervention: Outpatient-based pharmacists provided assessment, self-management services follow-up, and treatment recommendations to primary care providers within a collaborative care management model. Main outcome measures: Changes in severity of depressive symptoms and impact on overall health care costs for employers and beneficiaries. Results: Of the 151 beneficiaries referred to the program, 130 (82%) remained under pharmacist care for a minimum of 1 year and were included in the aggregate analysis. Statistically significant improvements were observed for Patient Health Questionnaire (PHQ)-9 scores from baseline to endpoint (11.5 ± 6.6 to 5.3 ± 4.7 [mean ± SD], P < 0.0001). The clinical response rate was 68% with a 56% remission rate. In economic subgroup analysis (n = 48), annual medical costs decreased from an average of $6,351 per enrollee to $5,876, which was lower than the projected value ($7,195). Total health care costs to the employer increased from $7,935 per enrollee to $8,040, which was lower than the projected value ($9,023). Conclusion: Patients in the first year of the program had significant improvement in the PHQ-9 clinical indicator of depression severity. Total health care costs per patient per year were reduced compared with projected costs without the program. Employers expressed their appreciation for this collaborative care program and continued to offer this voluntary health benefit after the study's conclusion.

Brewer M.L.,Curtin University Australia | Stewart-Wynne E.G.,Clinical Services
Journal of Interprofessional Care | Year: 2013

Royal Perth Hospital, in partnership with Curtin University, established the first interprofessional student training ward in Australia, based on best practice from Europe. Evaluation of the student and client experience was undertaken. Feedback from all stakeholders was obtained regularly as a key element of the quality improvement process. An interprofessional practice program was established with six beds within a general medical ward. This provided the setting for 2- to 3-week clinical placements for students from medicine, nursing, physiotherapy, occupational therapy, social work, pharmacy, dietetics and medical imaging. Following an initial trial, the training ward began with 79 students completing a placement. An interprofessional capability framework focused on the delivery of high quality client care and effective teamwork underpins this learning experience. Quantitative outcome data showed not only an improvement in students' attitudes towards interprofessional collaboration but also acquisition of a high level of interprofessional practice capabilities. Qualitative outcome data from students and clients was overwhelmingly positive. Suggestions for improvement were identified. This innovative learning environment facilitated the development of the students' knowledge, skills and attitudes required for interprofessional, client centred collaborative practice. Staff reported a high level of compliance with clinical safety and quality. © 2013 Informa UK Ltd.

Beckmann K.R.,University of Adelaide | Roder D.M.,University of South Australia | Hiller J.E.,Australian Catholic University | Farshid G.,Clinical Services | Lynch O.W.,University of Adelaide
Journal of Medical Screening | Year: 2013

Objectives: There is considerable interest in whether mammography screening leads to over-diagnosis of breast cancer. However self-selection into screening programmes may lead to risk differences that affect estimates of over-diagnosis. This study compares the breast cancer risk profiles of participants and non-participants of population-based mammography screening. Risk profiles are also compared between those who have and have not used private screening services. Setting: This study involved 1162 women aged 40-84 who participated in the 2012 Health Omnibus, an annual face-to-face interview-based survey of a representative sample of the population in the state of South Australia. Methods: Data were collected on participation in mammography screening, demographic characteristics and breast cancer risk factors (including reproductive, familial and lifestyle factors). Missing data were multiply imputed. Factors independently associated with ever having been screened were identified using multivariable logistic regression, for population-based and ad hoc, private mammography screening separately. Results: Compared with non-participants, participants of population-based screening were more likely to have used hormone replacement therapy (odds ratio [OR] 1/4 3.72), experienced breast biopsy or surgery (OR 1/4 2.22), and be overweight or obese (OR 1/4 1.57). They were less likely to be sufficiently active (OR 1/4 0.57) or be born in a non-English speaking country (OR 1/4 0.50) or aged under 50 (OR 1/4 0.09). Women who were screened privately were more likely to have a family history of breast cancer (OR 1/4 1.66) and have experienced breast biopsy or surgery (OR 1/4 3.17) than those who had not. Conclusions: South Australian women who participated in the population-based mammography screening have a slightly higher prevalence of breast cancer risk factors. This also applies to those who undertook private screening.

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