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Article ; Online: Unplanned rehospitalisation due to medication harm following an Acute Myocardial Infarction.

Paradissis, Chariclia / Cottrell, Neil / Coombes, Ian D / Wang, William Y S / Barras, Michael A

2024

Abstract: Introduction The contribution of medication harm to rehospitalisation and adverse patient outcomes after an acute myocardial infarction (AMI) needs exploration. Rehospitalisation is costly to both patients and the healthcare facility. Following an AMI, ... ...

Abstract	Introduction The contribution of medication harm to rehospitalisation and adverse patient outcomes after an acute myocardial infarction (AMI) needs exploration. Rehospitalisation is costly to both patients and the healthcare facility. Following an AMI, patients are at risk of medication harm as they are often older, have multiple comorbidities and polypharmacy. This study aimed to quantify and evaluate medication harm causing unplanned rehospitalisation after an AMI. Methods This was a retrospective cohort study of patients discharged from a quaternary hospital post-AMI. All rehospitalisations within 18 months were identified using medical record review and coding data. The primary outcome measure was medication harm rehospitalisation. Preventability, causality and severity assessments of medication harm were conducted. Results A total of 1564 patients experienced an AMI and 415 (26.5%) were rehospitalised. Eighty-nine patients (5.7% of total population; 6.0% of those discharged) experienced a total of 101 medication harm events. Those with medication harm were older (p=0.007) and had higher rates of heart failure (p=0.005), chronic kidney disease (CKD) (p=0.046), chronic obstructive pulmonary disease (COPD) (p=0.037) and a prior history of ischaemic heart disease (p=0.005). Gastrointestinal (GI) bleeding, acute kidney injury (AKI) and hypotension were the most common medication harm events. Forty percent of events were avoidable and 84% were classed as 'serious'. Furosemide, antiplatelets and angiotensin-converting enzyme inhibitors (ACEi) were the most commonly implicated medications. The median time to medication harm rehospitalisation was 79 days (interquartile range [IQR]: 16-200 days). Conclusion Medication harm causes unplanned rehospitalisation in 5.7% of all AMI patients (1 in 17 patients; 6.0% of those discharged). The majority of harm was serious and occurred within the first 200 days of discharge. This study highlights that measures to attenuate the risk of medication harm rehospitalisation are essential, including post-discharge medication management.
Language	English
Publishing date	2024-04-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	80092-2
ISSN	1421-9751 ; 0008-6312
ISSN (online)	1421-9751
ISSN	0008-6312
DOI	10.1159/000538773
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Article ; Online: Impact of a clinical pharmacist on optimising the quality use of medicines according to the acute coronary syndrome (ACS) secondary prevention guidelines and medication adherence following discharge in patients with ACS in Sri Lanka: a prospective non-randomised controlled trial study protocol.

Bagyawantha, Nanayakkara Muhandiramalaya Yasakalum / Coombes, Ian D / Gawarammana, Indika / Fahim, Mohamed

BMJ open

2023 Volume 13, Issue 2, Page(s) e059413

Abstract: Objectives: Ensuring quality use of medicines (QUM) through clinical pharmacy services can improve therapeutic outcomes of patients diagnosed with acute coronary syndrome (ACS). The major objective of this study is to demonstrate the added value of a ... ...

Abstract	Objectives: Ensuring quality use of medicines (QUM) through clinical pharmacy services can improve therapeutic outcomes of patients diagnosed with acute coronary syndrome (ACS). The major objective of this study is to demonstrate the added value of a clinical pharmacist to the medical and nursing team providing care to patients with ACS on the continuation of quality use of the patients' medicine after discharge. Study design: This protocol outlines a prospective, non-blinded, non-randomised, controlled interventional study. Study setting: The study will be conducted at the professorial medical wards of a tertiary care teaching hospital in Sri Lanka. Participants: Sample size will be 746 patients in both control and intervention arms. Patients diagnosed with ACS who are 18 years old or above and expected to visit the hospital for their routine clinic follow-ups after discharge will be recruited and randomised 1:1 to either the intervention group or the control group. Patients who are diagnosed and suffering from psychological disorders will be excluded from this study. Interventions: The planned interventions that will be delivered at discharge include review and optimisation of medications, assessing patient adherence and providing discharge medication counselling. Data will be collected at recruitment, 1 month, 3 months and 6 months' time intervals in both groups. Improvement of patients' medication adherence, reduction of hospital readmissions, reduction of drug-related problems, the attitude of doctors and nurses towards clinical pharmacy services and the cost-effectiveness of the clinical pharmacy services will be the major outcomes of this study. Ethics and dissemination: Ethical approval for this study has been obtained from the ethics review committee, Faculty of Medicine, University of Peradeniya (2019/EC/26) and the trial is registered at the Sri Lanka Clinical Trials Registry. The results of this study will be disseminated via conference proceedings, journal publications and thesis presentations. Trial registration number: SLCTR/2019/039.
MeSH term(s)	Humans ; Adolescent ; Patient Discharge ; Secondary Prevention/methods ; Acute Coronary Syndrome/drug therapy ; Pharmacists ; Prospective Studies ; Sri Lanka ; Medication Adherence
Language	English
Publishing date	2023-02-09
Publishing country	England
Document type	Clinical Trial ; Controlled Clinical Trial ; Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-059413
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Multifaceted pharmacist-led interventions in secondary care settings between countries of various income levels: a scoping review protocol.

Tharmalinga Sharma, Jegath Janani / McMillan, Sara S / Samaranayake, Nithushi R / Waas, Dulshika A / Coombes, Ian D / Wheeler, Amanda J

BMJ open

2024 Volume 14, Issue 4, Page(s) e083726

Abstract: Introduction: Clinical pharmacy services often involve multifaceted pharmacist-led interventions. However, current pharmacy practice models vary across different countries. Despite the documented benefits of clinical pharmacy services, the ... ...

Abstract	Introduction: Clinical pharmacy services often involve multifaceted pharmacist-led interventions. However, current pharmacy practice models vary across different countries. Despite the documented benefits of clinical pharmacy services, the characteristics of pharmacist-led interventions in different countries have not yet been adequately explored and described. Therefore, this protocol outlines the methodology for a proposed scoping review aiming to investigate various types of multifaceted pharmacist-led interventions and the outcomes used to evaluate their effectiveness within secondary care settings. Additionally, the scoping review will map the current evidence surrounding the characteristics of interventions and outcomes reported across various countries of socioeconomic status. Methods and analysis: The scoping review will be conducted according to the JBI Methodology for Scoping Reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews. We will systematically search the following electronic databases: MEDLINE (Ovid), CINAHL (EbscoHost), Embase (embase.com), Scopus (scopus.com), Cochrane Library (cochranelibrary.com) and APA PsycInfo (Ovid). Additionally, the reference lists of identified reviews and included full texts will be searched for relevant papers. Grey literature sources, such as International Pharmaceutical Abstracts and the International Pharmaceutical Federation (FIP) website, will be searched. We will include primary studies published in the English language from January 2013 to December 2023, involving secondary care multifaceted pharmacist-led interventions. Two independent reviewers will screen studies against eligibility criteria and use a piloted data extraction form to extract relevant information. We will extract relevant data, complete a tabular summary from each included publication and analyse it. Ethics and dissemination: Ethical approval is not required as we will be using data from publicly available literature sources. Findings will be disseminated in publications and presentations with relevant stakeholders. We aim to map available evidence across the breadth of studies that have reported multifaceted pharmacist-led interventions and their outcomes.
MeSH term(s)	Humans ; Pharmacists ; Secondary Care ; Pharmacy ; Pharmacy Service, Hospital ; Pharmaceutical Preparations ; Research Design ; Systematic Reviews as Topic ; Review Literature as Topic
Chemical Substances	Pharmaceutical Preparations
Language	English
Publishing date	2024-04-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-083726
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Oral antivirals for mild-moderate COVID-19: a panacea or a logistical and clinical conundrum?

Coombes, Ian D / Legg, Amy / Patterson, Tina / Kelly, Tanya / Henderson, Andrew / Roberts, Jason A

Australian prescriber

2022 Volume 45, Issue 2, Page(s) 67–68

Language	English
Publishing date	2022-03-24
Publishing country	Australia
Document type	Editorial
ZDB-ID	1075442-8
ISSN	0312-8008
ISSN	0312-8008
DOI	10.18773/austprescr.2022.021
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Zs.A 3233: Show issues

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Article ; Online: Impact of a clinical pharmacist on optimising the quality use of medicines according to the acute coronary syndrome (ACS) secondary prevention guidelines and medication adherence following discharge in patients with ACS in Sri Lanka

Indika Gawarammana / Ian D Coombes / Nanayakkara Muhandiramalaya Yasakalum Bagyawantha / Mohamed Fahim

BMJ Open, Vol 13, Iss

a prospective non-randomised controlled trial study protocol

2023 Volume 2

Abstract: Objectives Ensuring quality use of medicines (QUM) through clinical pharmacy services can improve therapeutic outcomes of patients diagnosed with acute coronary syndrome (ACS). The major objective of this study is to demonstrate the added value of a ... ...

Abstract	Objectives Ensuring quality use of medicines (QUM) through clinical pharmacy services can improve therapeutic outcomes of patients diagnosed with acute coronary syndrome (ACS). The major objective of this study is to demonstrate the added value of a clinical pharmacist to the medical and nursing team providing care to patients with ACS on the continuation of quality use of the patients’ medicine after discharge.Study design This protocol outlines a prospective, non-blinded, non-randomised, controlled interventional study.Study setting The study will be conducted at the professorial medical wards of a tertiary care teaching hospital in Sri Lanka.Participants Sample size will be 746 patients in both control and intervention arms. Patients diagnosed with ACS who are 18 years old or above and expected to visit the hospital for their routine clinic follow-ups after discharge will be recruited and randomised 1:1 to either the intervention group or the control group. Patients who are diagnosed and suffering from psychological disorders will be excluded from this study.Interventions The planned interventions that will be delivered at discharge include review and optimisation of medications, assessing patient adherence and providing discharge medication counselling. Data will be collected at recruitment, 1 month, 3 months and 6 months’ time intervals in both groups. Improvement of patients’ medication adherence, reduction of hospital readmissions, reduction of drug-related problems, the attitude of doctors and nurses towards clinical pharmacy services and the cost-effectiveness of the clinical pharmacy services will be the major outcomes of this study.Ethics and dissemination Ethical approval for this study has been obtained from the ethics review committee, Faculty of Medicine, University of Peradeniya (2019/EC/26) and the trial is registered at the Sri Lanka Clinical Trials Registry. The results of this study will be disseminated via conference proceedings, journal publications and thesis presentations.Trial ...
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A preliminary study of the association of increased anterior cingulate gamma-aminobutyric acid with remission of depression after ketamine administration.

Singh, Balwinder / Port, John D / Voort, Jennifer L Vande / Coombes, Brandon J / Geske, Jennifer R / Lanza, Ian R / Morgan, Robert J / Frye, Mark A

Psychiatry research

2021 Volume 301, Page(s) 113953

Abstract: Gamma-aminobutyric acid (GABA) and glutamate neurotransmission have been implicated in the pathophysiology of depression and mechanistically linked to ketamine's antidepressant response. Seven patients with treatment-resistant depression enrolled in an ... ...

Abstract	Gamma-aminobutyric acid (GABA) and glutamate neurotransmission have been implicated in the pathophysiology of depression and mechanistically linked to ketamine's antidepressant response. Seven patients with treatment-resistant depression enrolled in an open-label, feasibility trial of a single IV 40-min ketamine infusion during a functional MR spectroscopy (fMRS) scan utilizing a novel frequency adjusting MEGA-PRESS sequence. Next-day treatment remission and reduction in the MADRS scores correlated with anterior cingulate cortex peak GABA levels. These novel findings provide further insights into the underlying neurobiological mechanisms of ketamine and, if confirmed in larger studies, would be encouraging for further development of GABAergic biomarker associated with ketamine response.
MeSH term(s)	Depression ; Depressive Disorder, Treatment-Resistant/drug therapy ; Glutamic Acid ; Gyrus Cinguli ; Humans ; Ketamine ; gamma-Aminobutyric Acid
Chemical Substances	Glutamic Acid (3KX376GY7L) ; gamma-Aminobutyric Acid (56-12-2) ; Ketamine (690G0D6V8H)
Language	English
Publishing date	2021-04-20
Publishing country	Ireland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	445361-x
ISSN	1872-7123 ; 1872-7506 ; 0925-4927 ; 0165-1781
ISSN (online)	1872-7123 ; 1872-7506
ISSN	0925-4927 ; 0165-1781
DOI	10.1016/j.psychres.2021.113953
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 1541: Show issues

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Article ; Online: Correction: Performance of a novel spectroscopy-based tool for adjuvant therapy decision-making in hormone receptor-positive breast cancer: a validation study.

Coombes, R Charles / Angelou, Christina / Al-Khalili, Zamzam / Hart, William / Francescatti, Darius / Wright, Nicholas / Ellis, Ian / Green, Andrew / Rakha, Emad / Shousha, Sami / Amrania, Hemmel / Phillips, Chris C / Palmieri, Carlo

Breast cancer research and treatment

2024

Language	English
Publishing date	2024-05-05
Publishing country	Netherlands
Document type	Published Erratum
ZDB-ID	604563-7
ISSN	1573-7217 ; 0167-6806
ISSN (online)	1573-7217
ISSN	0167-6806
DOI	10.1007/s10549-024-07276-z
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Zs.A 1655: Show issues

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Article ; Online: Performance of a novel spectroscopy-based tool for adjuvant therapy decision-making in hormone receptor-positive breast cancer: a validation study.

Breast cancer research and treatment

2024

Abstract: Purpose: Digistain Index (DI), measured using an inexpensive mid-infrared spectrometer, reflects the level of aneuploidy in unstained tissue sections and correlates with tumor grade. We investigated whether incorporating DI with other ... ...

Abstract	Purpose: Digistain Index (DI), measured using an inexpensive mid-infrared spectrometer, reflects the level of aneuploidy in unstained tissue sections and correlates with tumor grade. We investigated whether incorporating DI with other clinicopathological variables could predict outcomes in patients with early breast cancer. Methods: DI was calculated in 801 patients with hormone receptor-positive, HER2-negative primary breast cancer and ≤ 3 positive lymph nodes. All patients were treated with systemic endocrine therapy and no chemotherapy. Multivariable proportional hazards modeling was used to incorporate DI with clinicopathological variables to generate the Digistain Prognostic Score (DPS). DPS was assessed for prediction of 5- and 10-year outcomes (recurrence, recurrence-free survival [RFS] and overall survival [OS]) using receiver operating characteristics and Cox proportional hazards regression models. Kaplan-Meier analysis evaluated the ability of DPS to stratify risk. Results: DPS was consistently highly accurate and had negative predictive values for all three outcomes, ranging from 0.96 to 0.99 at 5 years and 0.84 to 0.95 at 10 years. DPS demonstrated statistically significant prognostic ability with significant hazard ratios (95% CI) for low- versus high-risk classification for RFS, recurrence and OS (1.80 [CI 1.31-2.48], 1.83 [1.32-2.52] and 1.77 [1.28-2.43], respectively; all P < 0.001). Conclusion: DPS showed high accuracy and predictive performance, was able to stratify patients into low or high-risk, and considering its cost and rapidity, has the potential to offer clinical utility.
Language	English
Publishing date	2024-01-20
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	604563-7
ISSN	1573-7217 ; 0167-6806
ISSN (online)	1573-7217
ISSN	0167-6806
DOI	10.1007/s10549-023-07229-y
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Article: Physician drug prescribing preferences and availability for ventilation of patients with COVID-19.

Coombes, Ian D / Dooley, Michael J / Townsend, Shane / Carmichael, Sinead / Poole, Susan G / Karamujic, Nermin / Richards, Brent / Ziegenfuss, Marc / Ankravs, Melissa J / Uren, Hailie / Roberts, Jason A / Holley, Anthony

Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine

2020 Volume 22, Issue 3, Page(s) 271–274

MeSH term(s)	Australia ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Drug Prescriptions/statistics & numerical data ; Humans ; Intensive Care Units ; Pandemics ; Physicians/psychology ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Practice Patterns, Physicians'/statistics & numerical data ; Respiration ; Respiration, Artificial ; SARS-CoV-2 ; Ventilators, Mechanical/statistics & numerical data ; Ventilators, Mechanical/supply & distribution
Language	English
Publishing date	2020-10-24
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2401976-8
ISSN	1441-2772
ISSN	1441-2772
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Zs.A 6672: Show issues

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Article ; Online: Reducing Medical Admissions into Hospital through Optimising Medicines (REMAIN HOME) Study: protocol for a stepped-wedge, cluster-randomised trial.

Foot, Holly / Freeman, Christopher / Hemming, Karla / Scott, Ian / Coombes, Ian D / Williams, Ian D / Connelly, Luke / Whitty, Jennifer A / Sturman, Nancy / Kirsa, Sue / Nicholson, Caroline / Russell, Grant / Kirkpatrick, Carl / Cottrell, Neil

BMJ open

2017 Volume 7, Issue 4, Page(s) e015301

Abstract: Introduction: A model of general practitioner (GP) and pharmacist collaboration in primary care may be an effective strategy to reduce medication-related problems and provide better support to patients after discharge. The aim of this study is to ... ...

Abstract	Introduction: A model of general practitioner (GP) and pharmacist collaboration in primary care may be an effective strategy to reduce medication-related problems and provide better support to patients after discharge. The aim of this study is to investigate whether a model of structured pharmacist and GP care reduces hospital readmissions in high-risk patients. Methods and analysis: This protocol details a stepped-wedge, cluster-randomised trial that will recruit participants over 9 months with a 12-month follow-up. There will be 14 clusters each representing a different general practice medical centre. A total of 2240 participants will be recruited from hospital who attend an enrolled medical centre, take five or more long-term medicines or whose reason for admission was related to heart failure or chronic obstructive pulmonary disease.The intervention is a multifaceted service, involving a pharmacist integrated into a medical centre to assist patients after hospitalisation. Participants will meet with the practice pharmacist and their GP after discharge to review and reconcile their medicines and discuss changes made in hospital. The pharmacist will follow-up with the participant and liaise with other health professionals involved in the participant's care. The control will be usual care, which usually involves a patient self-organising a visit to their GP after hospital discharge.The primary outcome is the rate of unplanned, all-cause hospital readmissions over 12 months, which will be analysed using a mixed effects Poisson regression model with a random effect for cluster and a fixed effect to account for any temporal trend. A cost analysis will be undertaken to compare the healthcare costs associated with the intervention to those of usual care. Ethics and dissemination: The study has received ethical approval (HREC/16/QRBW/410). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders. Trial registration number: ACTRN12616001627448.
MeSH term(s)	General Practitioners ; Health Care Costs ; Heart Failure/epidemiology ; Humans ; Medication Reconciliation ; Patient Readmission ; Pharmacists ; Primary Health Care/standards ; Professional Corporations/organization & administration ; Pulmonary Disease, Chronic Obstructive/epidemiology ; Quality of Life ; Research Design
Language	English
Publishing date	2017-04-13
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2747269-3
ISSN	2044-6055 ; 2044-6055 ; 2053-3624
ISSN (online)	2044-6055
ISSN	2044-6055 ; 2053-3624
DOI	10.1136/bmjopen-2016-015301
Database	MEDical Literature Analysis and Retrieval System OnLINE

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