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This article discusses a case of multifocal cutaneous Mycobacterium ulcerans infection in a heart transplant recipient. Mycobacterium ulcerans is endemic in southern Australia and commonly presents as a cutaneous lesion with progressive ulceration. The patient in this case developed significant ulceration throughout his right lower limb, along with swelling, nodules, and pain. Despite multiple courses of antimicrobials, the lesions continued to worsen. A biopsy confirmed the diagnosis of multi-focal cutaneous infection with M. ulcerans. This is the first reported case of M. ulcerans infection in a solid organ transplant recipient. The article also provides information on the natural history, transmission, diagnosis, and treatment of M. ulcerans infection. [Extracted from the article]

Background: The frequency and significance of cytomegalovirus (CMV) infection in seropositive (R+) heart transplant recipients (HTR) is unclear, with preventative recommendations mostly extrapolated from other groups. We evaluated the incidence and severity of CMV infection in R+ HTR, to identify risk factors and describe outcomes. Methods: R+ HTR from 2010 to 2019 were included. Antiviral prophylaxis was not routinely used, with clinically guided monitoring the local standard of care. The primary outcome was CMV infection within one‐year post‐transplant; secondary outcomes included other herpesvirus infections and mortality. Results: CMV infection occurred in 27/155 (17%) R+ HTR. Patients with CMV had a longer hospitalization (27 vs. 20 days, unadjusted HR 1.02, 95% CI 1.00–1.02, p =.01), higher rate of intensive care readmission (26% vs. 9%, unadjusted HR 3.46, 1.46–8.20, p =.005), and increased mortality (33% vs. 8%, unadjusted HR 10.60, 4.52–24.88, p <.001). The association between CMV and death persisted after adjusting for multiple confounders (HR 24.19, 95% CI 7.47–78.30, p <.001). Valganciclovir prophylaxis was used in 35/155 (23%) and was protective against CMV (infection rate 4% vs. 27%, adjusted HR.07,.01–.72, p =.025), even though those receiving it were more likely to have received thymoglobulin (adjusted OR 10.5, 95% CI 2.01–55.0, p =.005). Conclusions: CMV infection is common in R+ HTR and is associated with a high burden of disease and increased mortality. Patients who received valganciclovir prophylaxis were less likely to develop CMV infection, despite being at higher risk. These findings support the routine use of antiviral prophylaxis following heart transplantation in all CMV R+ patients. [ABSTRACT FROM AUTHOR]

There are few studies evaluating the workforce and the time allocated to tasks performed by clinical specialty pharmacists in Australia. The aim of this study was to quantify the time that clinical specialty pharmacists spend on various activities. A Work Observation Method by Activity Timing (WOMBAT) time and motion study was conducted at a tertiary‐referral metropolitan health service with comprehensive unit‐based clinical pharmacy services. Direct observations of clinical pharmacists were conducted by researchers during weekdays. Tasks and times observed were categorised into domains of 'What, Who, How, and Where', accounting for interruptions and multitasking. Eighteen clinical cardiology, respiratory, and geriatric pharmacists were observed over 171.2 h. The majority of time involved direct patient care activities (76.1% [95% confidence interval 72.6–79.6%]), including admission‐related (7.6%), discharge‐related (16.2%), and inpatient clinical tasks (52.5%). Activities were undertaken independently (55.9%) with doctors (26.2%), with nurses (10.5%), or with patients (9.6)%; 19.1% of the pharmacist's day involved multitasking. The tasks most frequently performed together were inpatient clinical activities, including rounding and daily medicine review. This study quantified the typical task allocation of clinical pharmacists in cardiology, respiratory, and geriatric units. It demonstrated that in a hospital setting supported by comprehensive operational pharmacy services, clinical pharmacists working in acute and subacute clinical specialities, predominately undertake direct patient care tasks that have been shown to improve patient safety. [ABSTRACT FROM AUTHOR]

Heart failure contributes substantially to morbidity and mortality in older people. It is a chronic and progressive disease, with prevalence set to increase with the ageing population as incidence is strongly associated with age. There are many pharmacotherapies available for the treatment of heart failure which reduce morbidity and mortality. These include angiotensin converting enzyme inhibitors, beta‐blockers, mineralocorticoid receptor antagonists and more recently angiotensin receptor‐neprilysin inhibitor and sodium glucose co‐transporter type 2 inhibitors. Older people are under‐represented in large randomised clinical trials and therefore data supporting efficacy and safety of heart failure treatments for older people is not as strong as it is for younger people. Additionally, older people with heart failure have higher rates of polypharmacy, comorbidity, cognitive impairment and frailty. This article summarises the principles of heart failure therapy based on evidence‐based guidelines as well as the challenges of appropriate management in older people. [ABSTRACT FROM AUTHOR]

Introduction: Significant evidence-to-practice gaps in osteoporosis management have led to national guidelines, the impact of which is unknown. We evaluated osteoporosis assessment and management after hospital admission to a major metropolitan centre with minimal trauma fracture (MTF) in the context of Australian osteoporosis guidelines. Method: This retrospective analysis included patients over 50 years of age who were admitted to hospital for over 48 h with MTF from 1st January to 31st December 2015. All emergency department (ED) presentations for fracture were identified by diagnosis coding, and 60% were randomly selected for hand-screening to exclude traumatic, pathological, facial and digit fractures. Data were collected from medical records, and inpatient and discharge osteoporosis management was compared to Australian guideline recommendations. Results: Of 1355 patients presenting to the ED with fracture in 2015, 805 were screened, with 272 eligible for inclusion. Median age was 83 years (IQR 73-88); 69% were female, 161 participants (59%) presented with a hip or vertebral fracture and 80 (29%) participants had a documented pre-existing osteoporosis diagnosis. Anti-resorptive medications were indicated for 189 participants according to guidelines, though were only prescribed for one-third of these patients (n = 65/189, 34%). Bone mineral density testing was warranted in a further 83 patients, and undertaken in nine (11%). Only 110 participants (40%) had the words "osteoporosis" or "osteopenia" documented in their discharge summary. Discussion: Health professionals involved in the care of hospitalised patients with MTF are still missing opportunities to prevent future harms by commencing appropriate management to reduce subsequent fracture risk. [ABSTRACT FROM AUTHOR]

The article discusses research on the patterns of antiplatelet prescription in Australia based on the data from the Pharmaceutical Benefits Scheme (PBS) between 1999 and 2018. Topics mentioned include the contributing factor to the increase in ticagrelor and prasugrel dispensation, the reason behind the decline in antiplatelet dispensing rate in 2012, and the continuous decrease in PBS costs for antiplatelet drugs since 2010.

Pressure ulcers are known to have a profound negative effect on people's quality of life as well as being a huge financial cost to the NHS. While many acute hospitals are effectively reducing the number of hospital-acquired pressure ulcers, Chesterfield Royal Hospital wanted to ensure that in addition to achieving this target, patients admitted with existing pressure ulceration were discharged with their pressure damage improving and progressing towards healing. Wound dimensions and tissue type were monitored for category 3 and above pressure ulcers. A total of 78% of these ulcers improved during a 2-week period, with 17% of ulcers remaining static. The implementation of hybrid mattresses, along with regular repositioning, good skin care and nutrition, all contributed to improvement in the condition of pressure ulcers. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated retention and understanding of pressure ulcer prevention information by patients. Topics explored include the significance of patient education in the prevention of pressure ulcers, the administration of Wound Healing Unit (WHU)-designed questionnaires to patients that participated in the study, and the percentage of patients that recognized information relating to bedsores, skin soreness and poor mobility.