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Stability of extemporaneously prepared clofazimine oral suspensions 临时配制的氯法齐明口服混悬液的稳定性
IF 2.1 Q2 Health Professions Pub Date : 2024-01-17 DOI: 10.1002/jppr.1893
Ellie Ponsonby-Thomas BPharmSc, Charis Lau BPharm, Sherine Tan BPharm, Malinda Salim PhD, Ben J. Boyd PhD

Background

Clofazimine is recommended as a treatment for tuberculosis in infants. Extemporaneously prepared clofazimine oral suspensions are more appropriate dosage forms for infants than tablets, however no data exist to inform appropriate storage conditions.

Aim

To examine the physical and chemical stability of extemporaneously prepared clofazimine oral suspensions and determine appropriate storage conditions.

Method

An oral suspension of clofazimine 10 mg/mL was prepared by grinding six 100 mg clofazimine tablets to produce a fine powder. Ora-Blend SF (sugar free) was added to make a final volume of 60 mL. Six 10 mL aliquots were placed in amber plastic bottles with plastic bottle caps. Three bottles were stored at room temperature, and three bottles were refrigerated at 4°C. Following shaking, a 1 mL sample was taken from each bottle on days 0, 7, 14, 28, and 60. Samples were assayed using the high-performance liquid chromatography method. The samples were visually examined for colour change and separation at each time point. Stability was defined as the retention of at least 90% of the initial concentration. Ethics approval was not required for this research article as it was a stability study that did not involve human subjects.

Results

The clofazimine content remained >94% of the initial concentration throughout the 60-day period for samples that were kept at room temperature, and slightly <90% (87.4%) for samples that were kept refrigerated at 4°C. No separation or colour change was noted throughout the 60-day period for both preparations.

Conclusion

Extemporaneously prepared suspensions of clofazimine in Ora-Blend SF were chemically stable for at least 60 days when stored at room temperature. Clofazimine degraded slightly more rapidly at 4°C compared to room temperature.

氯唑明被推荐用于治疗婴儿结核病。研究临时制备的氯唑明口服混悬液的物理和化学稳定性,并确定适当的储存条件。将 6 片 100 毫克的氯唑明药片研磨成细粉,制备氯唑明 10 毫克/毫升的口服混悬液。加入 Ora-Blend SF(无糖),最终体积为 60 mL。将六份 10 毫升的等分样品装入带有塑料瓶盖的琥珀色塑料瓶中。三瓶室温保存,三瓶 4°C 冷藏。摇匀后,在第 0、7、14、28 和 60 天从每个瓶中各取 1 毫升样品。样品采用高效液相色谱法进行检测。目测样品在每个时间点的颜色变化和分离情况。稳定性的定义是保留至少 90% 的初始浓度。在室温下保存 60 天的样品中,氯法齐明的含量始终保持在初始浓度的 94% 以上,而在 4°C 冷藏条件下保存的样品中,氯法齐明的含量略低于 90%(87.4%)。两种制剂在 60 天内均未出现分离或颜色变化。在室温下保存至少 60 天,Ora-Blend SF 中临时制备的氯唑明悬浮液化学性质稳定。与室温相比,氯唑明在 4°C 下的降解速度稍快。
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引用次数: 0
The challenge of drug prescribing for older people 为老年人开药的挑战
IF 2.1 Q2 Health Professions Pub Date : 2024-01-10 DOI: 10.1002/jppr.1904
David Fonda
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引用次数: 0
Farewell to the Geriatric Therapeutics Review series: the end of the beginning 告别《老年治疗学评论》丛书:结束的开始
IF 2.1 Q2 Health Professions Pub Date : 2023-12-22 DOI: 10.1002/jppr.1900
R. Elliott
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引用次数: 0
Vitamin B12 deficiency in older people: a practical approach to recognition and management 老年人维生素 B12 缺乏症:识别和管理的实用方法
IF 2.1 Q2 Health Professions Pub Date : 2023-12-18 DOI: 10.1002/jppr.1897
Nadia Mouchaileh
Vitamin B12 deficiency is common in older people and is linked to anaemia, cognitive decline, and dementia. Clinical presentation is variable, ranging from no symptoms or subtle, non‐specific symptoms, through to serious, irreversible neurological symptoms if left untreated. Although common, it is often under‐recognised, with diagnosis usually occurring on incidental blood test screening. Older people are at increased risk of vitamin B12 deficiency due to insufficient dietary intake, malabsorption associated with aged‐related changes in gastrointestinal function, higher incidence of pernicious anaemia, and chronic use of interfering medications such as metformin and proton‐pump inhibitors. Early detection and treatment in symptomatic deficiency are crucial to prevent irreversible damage. Vitamin B12 intramuscular injection bypasses potential absorption issues and is traditionally the first‐line treatment in older people. However, emerging evidence suggests that high‐dose oral replacement may be as effective. Older people often require lifelong therapy due to the irreversible nature of the underlying cause of deficiency. This review provides an overview of vitamin B12 deficiency and its management in older people.
维生素 B12 缺乏症在老年人中很常见,与贫血、认知能力下降和痴呆症有关。临床表现多种多样,从无症状或细微的非特异性症状,到严重的不可逆转的神经系统症状(如不及时治疗)。这种疾病虽然常见,但往往未被充分认识,通常是在偶然的验血筛查中才被诊断出来。由于膳食摄入不足、与年龄有关的胃肠功能变化导致的吸收不良、恶性贫血发病率较高以及长期服用二甲双胍和质子泵抑制剂等干扰性药物,老年人患维生素 B12 缺乏症的风险增加。早期发现和治疗无症状的缺乏症对于防止不可逆转的损害至关重要。维生素 B12 肌肉注射可绕过潜在的吸收问题,传统上是老年人的一线治疗方法。然而,新的证据表明,大剂量口服补充剂可能同样有效。由于缺乏症的根本原因具有不可逆的性质,老年人通常需要终生接受治疗。本综述概述了老年人维生素 B12 缺乏症及其治疗。
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引用次数: 0
Multidisciplinary care of older adults in the emergency department to influence deprescribing in older adults: a cohort study 在急诊科为老年人提供多学科护理以影响老年人的去处方化:一项队列研究
IF 2.1 Q2 Health Professions Pub Date : 2023-12-18 DOI: 10.1002/jppr.1896
Christopher Reilly BPharm, Elizabeth Buikstra PhD, Edward Strivens MBBS, BSci, Elizabeth Marsden MBBS, PhD, Jarred Brose BNurs, Alison Craswell BNurs, PhD

Background

Inappropriate polypharmacy in older adults is a major health problem associated with poor clinical and health service outcomes.

Aim

We aimed to evaluate the effectiveness of a geriatric pharmacist service in the emergency department (ED) identifying potentially inappropriate prescribing (PIP).

Method

Between 1 June 2018–31 May 2019, adults ≥70 years of age presenting to ED were reviewed by the Geriatric Emergency Department Intervention (GEDI) pharmacist. The intervention consisted of pharmacist-led medication review using Screening Tool of Older Person’s Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria, patient education on recommendations, an updated medication list, and a letter sent to their general practitioner (GP) electronically. For eligible consenting older adults, telephone calls were made at least 28 days post-discharge to assess the effectiveness of the intervention. A survey with GPs after 6 months determined how recommendations were perceived. Ethics approval was granted by the Metro North Health B Human Research Ethics Committee (reference no: HREC/18QCH/69–1245) and research governance approval was granted by the study site (Cairns Hinterland Hospital and Health Service, reference no: SSA/Q12345/40673). Informed consent was obtained from all participants via a project information sheet and either the completion of a written consent form (patient participants), verbal consent before interview (GP participants), or implied consent via email responses (GP participants). Routinely collected health data obtained for this study were de-identified and data included in the follow-up study was de-identified.

Results

The GEDI pharmacist reviewed 1214 older adults with an average age of 81 years. The median number of prescribed medications was 10 and 36.8% of older adults had STOPP recommendations. When contacted (n = 35), of those enrolled in the follow-up study, 71% had stated their medications changed, 40% reported all STOPP medications had ceased, and 69% had START medications commenced, suggesting the recommendations provided were clinically appropriate and readily accepted by their GPs.

Conclusion

Integration of a geriatric pharmacist demonstrated ample opportunities to address PIP in targeted olde

老年人不当使用多种药物是一个主要的健康问题,与不良的临床和医疗服务结果有关。我们旨在评估急诊科(ED)老年药剂师服务识别潜在不当处方(PIP)的有效性。2018 年 6 月 1 日至 2019 年 5 月 31 日期间,老年急诊科干预(GEDI)药剂师对急诊科就诊的年龄≥70 岁的成年人进行了审查。干预措施包括由药剂师根据老年人处方筛查工具(STOPP)和提醒医生正确治疗筛查工具(START)标准进行药物审查,对患者进行建议教育,更新药物清单,并以电子方式致函全科医生(GP)。对于符合条件并同意接受干预的老年人,在出院后至少 28 天进行电话回访,以评估干预的效果。6 个月后对全科医生进行调查,了解他们对建议的看法。该研究获得了大都会北部卫生局人类研究伦理委员会的伦理批准(参考编号:HREC/18QCH/69-1245),并获得了研究地点(凯恩斯腹地医院和卫生服务机构,参考编号:SSA/Q12345/40673)的研究管理批准。所有参与者均通过项目信息表和填写书面同意书(患者参与者)、访谈前口头同意(全科医生参与者)或通过电子邮件回复暗示同意(全科医生参与者)获得知情同意。GEDI 药剂师对 1214 名平均年龄为 81 岁的老年人进行了审查。处方药的中位数为 10 种,36.8% 的老年人有 STOPP 建议。当与他们取得联系时(n = 35),在参加随访研究的人中,71% 的人表示他们的用药有所改变,40% 的人报告说所有 STOPP 药物都已停止使用,69% 的人开始使用 START 药物,这表明所提供的建议在临床上是适当的,并且很容易被他们的全科医生接受。这项研究表明,药剂师能够通过对患者的教育以及在出院时向全科医生传达建议来促进适当的处方。
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引用次数: 0
Fred J Boyd 2023 oration 弗雷德-博伊德 2023 年致辞
IF 2.1 Q2 Health Professions Pub Date : 2023-12-17 DOI: 10.1002/jppr.1899
M. K. Dunkley
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引用次数: 0
Estimation of kidney function for medication dosing in adult patients with chronic kidney disease: a practice update 估计成年慢性肾病患者的肾功能以确定用药剂量:实践更新
IF 2.1 Q2 Health Professions Pub Date : 2023-11-13 DOI: 10.1002/jppr.1884
Sanja Mirkov BPharm, PGDipPH, Carla Scuderi MClinPharm, BPharm, Jess Lloyd BPharm, GradDipClinPharm,, John Coutsouvelis PhD, MClinPharm, BPharm, FSHP, Shaun O'Connor BPharm, MSHP, Simon Potts BPharm, BSc (Hons), Suzanne Newman BPharm, GradDipHospPharm, Jason Roberts PhD, BPharm (Hons), BAppSc, FSHP, FISAC, FAHMS

Chronic kidney disease (CKD) is a major health concern with a growing disease burden and inequalities in access to treatments. Glomerular filtration rate (GFR) is accepted as the best overall measure of kidney function and is considered the most important measure for medications cleared by the kidneys. In clinical practice, equations that estimate GFR using validated prediction equations are routinely used. This practice update was developed by a Working Group comprising clinical pharmacists representing the Society of Hospital Pharmacists of Australia (SHPA) Specialty Practice streams of Nephrology, Oncology and haematology, Critical care and Infectious diseases. It is intended to provide practical recommendations for clinical pharmacists who use equations to estimate GFR for medication dosing decisions. The limitations of the various equations in use — such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), the Cockcroft–Gault equation and Modification of Diet in Renal Disease — are summarised and compared to direct measures of kidney function using exogenous markers. The CKD-EPI equation is recommended to be used routinely as a primary measure of kidney function. Dose adjustments should also consider medication-specific, patient-related, and disease-related characteristics. Kidney function and the response to therapy should be continuously assessed by monitoring the signs, symptoms and disease outcomes, the emergence of adverse reactions or medication-induced disorders and use therapeutic drug monitoring (if available) to adjust doses accordingly.

慢性肾脏病(CKD)是一个重大的健康问题,其疾病负担日益加重,且治疗机会不平等。肾小球滤过率(GFR)被认为是衡量肾功能的最佳综合指标,也被认为是衡量肾脏清除药物的最重要指标。在临床实践中,使用有效的预测方程估算 GFR 是常规方法。本实践更新由代表澳大利亚医院药剂师协会(SHPA)肾脏病学、肿瘤学和血液学、重症监护和传染病专业实践流的临床药剂师组成的工作组制定。该工作小组旨在为使用方程估算 GFR 以决定用药量的临床药剂师提供实用建议。文中总结了各种常用方程(如慢性肾脏病流行病学协作组 (CKD-EPI)、Cockcroft-Gault 方程和肾病饮食调整)的局限性,并将其与使用外源性标记物直接测量肾功能的方法进行了比较。建议将 CKD-EPI 方程作为肾功能的主要常规测量方法。剂量调整还应考虑药物特异性、患者相关性和疾病相关特性。应通过监测体征、症状和疾病结果、不良反应或药物引起的紊乱的出现来持续评估肾功能和对治疗的反应,并使用治疗药物监测(如有)来相应地调整剂量。
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引用次数: 0
Medication error reporting attitudes and practices in a regional Australian hospital: a qualitative study 澳大利亚一家地区医院报告用药错误的态度和做法:一项定性研究
IF 2.1 Q2 Health Professions Pub Date : 2023-11-10 DOI: 10.1002/jppr.1887
Shady Abdelmaksoud BPharm, MClinPharm, Mohammed S. Salahudeen BPharm, PharmD, PhD, FHEA, Colin M. Curtain BPharm, GradDipComp, PhD

Background

Medication errors are events that may cause or lead to inappropriate medication use or patient harm. Australians living outside metropolitan areas have poorer health outcomes than those living in urban areas. Medication error reporting (MER) practices vary due to the attitude of healthcare professionals (HCPs). MER can improve patient safety in community and hospital settings.

Aim

To explore HCPs' attitudes, practices, and recommendations towards MER in a regional hospital setting in Australia.

Method

Semistructured interviews were employed to identify the attitudes, practices, and recommendations of HCPs for the best utilisation of medication error reports. The study recruited HCPs (nurses, pharmacists, and doctors) working in all clinical areas from November 2021–February 2022. Interviews were recorded and transcribed via thematic analysis. Ethics approval was obtained from the Goulburn Valley Health (GVH) Human Research Ethics Committee (Reference no: GVH 35/21). Informed consent was obtained from participants via an information sheet and completion of a written consent form.

Results

Interviews with twelve HCPs elucidated four themes: barriers and enablers to reporting, and perceived benefits and recommendations for medication error reports. There was good understanding among regional HCPs about the benefits of MER. Attitudes and practices varied, with nurses reporting more medication errors than doctors, and pharmacists being concerned about the impact of reporting on interprofessional relations. Their recommendations involved standardising medication error definition and improving electronic system education.

Conclusion

Despite HCPs' understanding of the role of MER, their practices varied. We recommend improved protected time for learning, training with the incident reporting software, education about medication errors, and formalisation of test feedback to clinicians. The implementation of workplace cultural practice changes to improve organisational systems and enhance error reporting without fear of repercussions, and the adoption of additional solutions such as electronic prescribing are also encouraged.

背景用药错误是指可能造成或导致用药不当或对患者造成伤害的事件。与居住在城市地区的人相比,居住在大都市以外地区的澳大利亚人的健康状况较差。由于医疗保健专业人员(HCPs)的态度不同,用药错误报告(MER)的做法也不尽相同。用药错误报告可以改善社区和医院环境中的患者安全。 目的 探讨澳大利亚地区医院的医护人员对用药错误报告的态度、做法和建议。 方法 采用半结构式访谈,以确定医疗保健人员对最佳利用用药错误报告的态度、做法和建议。研究招募了 2021 年 11 月至 2022 年 2 月期间在所有临床领域工作的 HCP(护士、药剂师和医生)。研究人员对访谈进行了录音,并通过专题分析对访谈内容进行了转录。古尔本谷医疗机构(GVH)人类研究伦理委员会(参考编号:GVH 35/21)已批准了伦理研究。通过信息表和填写书面同意书获得了参与者的知情同意。 结果 对 12 名保健医生进行的访谈阐明了四个主题:报告的障碍和促进因素、感知到的好处以及对用药错误报告的建议。各地区的高级保健人员对 MER 的益处都有很好的理解。他们的态度和做法各不相同,护士比医生报告更多的用药错误,药剂师则担心报告对专业间关系的影响。他们的建议包括统一用药错误的定义和改进电子系统教育。 结论 尽管医疗保健人员对 MER 的作用有所了解,但他们的做法各不相同。我们建议改善受保护的学习时间、事故报告软件培训、用药错误教育以及对临床医生的测试反馈正规化。此外,我们还鼓励实施工作场所文化实践变革,以改进组织系统并加强错误报告,而不必担心受到影响,同时鼓励采用电子处方等其他解决方案。
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引用次数: 0
A case of extrapyramidal side effects due to possible paliperidone: voriconazole interaction 帕潘立酮:伏立康唑可能相互作用导致的锥体外系副作用病例
IF 2.1 Q2 Health Professions Pub Date : 2023-11-10 DOI: 10.1002/jppr.1892
Louise Beilby BPharm, GradCertPharmPrac, Lucy Arno BPharm (Hons), MHA

Background

It is thought that paliperidone, an active metabolite of risperidone, has limited potential for pharmacokinetic drug–drug interactions (DDIs) due to minimal metabolism by cytochrome P450 3A4 (CYP3A4) and cytochrome P450 2D6 (CYP2D6). However, DDIs have been reported and include a theoretical interaction between paliperidone and voriconazole based on interactions between risperidone and strong CYP3A4 inhibitor azoles.

Aim

To describe the first recorded DDI between paliperidone and voriconazole leading to extrapyramidal side effects (EPSEs).

Clinical details

A 34-year-old male presented with febrile neutropenia presumed due to clozapine. Clozapine was ceased and paliperidone commenced with voriconazole added to the patient's empiric piperacillin/tazobactam therapy due to a suspected fungal infection. Two days after starting voriconazole, the patient developed hypertonia and hyperreflexia in all limbs, thought most likely to be antipsychotic induced EPSEs. Paliperidone was withheld and EPSEs resolved.

Outcomes

The patient had previously tolerated long-term paliperidone at higher doses, prior to transitioning to clozapine. The development of EPSEs occurred two days post azole initiation, indicating a probable paliperidone adverse drug reaction (ADR) due to strong CYP3A4 inhibition by voriconazole. This case appears to be the first documented report of this previous theoretical DDI in practice. Further studies, including therapeutic drug monitoring, are required to confirm findings.

Conclusion

Paliperidone may be affected by pharmacokinetic drug–drug interactions and patients should be monitored for ADRs when CYP3A4 inhibitors are concomitantly administered.

背景 据认为,由于细胞色素 P450 3A4 (CYP3A4) 和细胞色素 P450 2D6 (CYP2D6) 的代谢作用极小,利培酮的活性代谢产物帕利哌酮发生药代动力学药物相互作用 (DDI) 的可能性有限。然而,DDIs 已有报道,其中包括根据利培酮与强 CYP3A4 抑制剂唑类之间的相互作用而得出的帕利哌酮与伏立康唑之间的理论相互作用。 目的 描述帕利哌酮与伏立康唑之间导致锥体外系副作用(EPSE)的首次DDI记录。 临床详情 一名34岁的男性因发热性中性粒细胞减少症就诊,推测是氯氮平所致。由于怀疑是真菌感染,患者停用了氯氮平,开始服用帕利哌酮,并在哌拉西林/他唑巴坦的经验性治疗基础上加用了伏立康唑。开始服用伏立康唑两天后,患者出现四肢肌张力亢进和反射亢进,被认为很可能是抗精神病药物诱发的EPSE。患者停用帕潘立酮后,EPSE症状消失。 结果 患者在转用氯氮平之前曾长期耐受较高剂量的帕潘立酮。EPSE发生在开始使用唑类药物两天后,这表明帕利哌酮可能是由于伏立康唑对CYP3A4的强烈抑制而引起的药物不良反应(ADR)。本病例似乎是以前理论上的 DDI 在实践中的首次有据可查的报告。需要进一步研究,包括治疗药物监测,以确认研究结果。 结论 帕潘立酮可能会受到药代动力学药物相互作用的影响,当同时服用 CYP3A4 抑制剂时,应监测患者的 ADR。
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引用次数: 0
Pharmacists in Australian general practice: Discussion of the findings of an evaluation from 2016 to 2021 澳大利亚全科医师药剂师:2016年至2021年评估结果的讨论
IF 2.1 Q2 Health Professions Pub Date : 2023-11-07 DOI: 10.1002/jppr.1878
Louise S. Deeks BSc (Hons), PGDip, PGCert, Mark Naunton BPharm (Hons), PhD, Gregory M. Peterson BPharm (Hons), MBA, PhD, Thilini Sudeshika BPharm (Hons), PGDipToxicology, MPhil, Christopher Freeman BPharm, GDipClinPharm, PhD, Ravi Sharma MPharm (Hons), MSc, PGCert, Stacy Leavens BA, MA, Sam Kosari BPharm (Hons), PhD

Pharmacists embedded in general practice can improve medicines optimisation and patient safety, but Australia has been slower to adopt and fund this model than other comparable countries. Over the last decade there have been various local programs integrating pharmacists in general practice across Australia. This article summarises the results of an evaluation in Canberra from 2016–2021. Pharmacists predominantly conducted clinical activities, including medication reviews and clinical audits. General practitioner (GP) acceptance and implementation of medication review recommendations was high (75%). General practice pharmacists were able to achieve positive clinical outcomes in asthma and smoking cessation. Surveys and interviews identified that the general practice pharmacist role was welcomed by patients, GPs, and other healthcare professionals. Patient satisfaction was very high, with patients supporting the expansion of this pharmacy service. Collaboration between the pharmacists and other healthcare professionals was high. Some pharmacists left employment in general practice after less than a year. Introducing a clear job description could be beneficial in retaining pharmacists, improving trust and working relationships, and enhancing collaboration. The majority of clinical activities conducted by the pharmacists had the potential to improve patient care and decrease healthcare costs. Apart from healthcare savings, benefit–cost ratios of income generated and costs reduced by pharmacists when compared to salaries suggested that pharmacists may be cost-beneficial in some scenarios. Absence of funding for this model of care remains a barrier to wider adoption in Australia and needs addressing. This study was approved by the University of Canberra Human Research Ethics Committee (Project number: 15–235) and funded under the Primary Health Network Program (Grant number: 25097479).

融入全科实践的药剂师可以改善药物优化和患者安全,但与其他可比国家相比,澳大利亚采用和资助这种模式的速度较慢。在过去的十年里,有各种各样的地方项目将药剂师整合到澳大利亚的一般实践中。本文总结了2016-2021年在堪培拉进行的评估结果。药剂师主要进行临床活动,包括药物审查和临床审计。全科医生(GP)接受和执行药物审查建议的比例很高(75%)。全科执业药师能够在哮喘和戒烟方面取得积极的临床结果。调查和访谈表明,普通执业药师的角色受到患者、全科医生和其他医疗保健专业人员的欢迎。患者满意度非常高,患者支持扩大药房服务。药剂师和其他医疗专业人员之间的合作程度很高。一些药剂师在不到一年的时间里就离开了全科诊所。引入明确的工作描述可能有利于留住药剂师,改善信任和工作关系,并加强合作。药剂师进行的大多数临床活动都有可能改善患者护理并降低医疗保健费用。除了节省医疗费用外,与工资相比,药剂师产生的收入和减少的费用的效益成本比表明,药剂师在某些情况下可能具有成本效益。这种护理模式缺乏资金仍然是澳大利亚广泛采用这种模式的障碍,需要加以解决。这项研究由堪培拉大学人类研究伦理委员会批准(项目编号:15-235),并由初级卫生网络计划(资助编号:25097479)资助。
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引用次数: 0
期刊
Journal of Pharmacy Practice and Research
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