Evaluation of the first pharmacist-administered vaccinations in Western Australia: a mixed-methods study.

OBJECTIVES: This study evaluated the uptake of Western Australian (WA) pharmacist vaccination services, the profiles of consumers being vaccinated and the facilitators and challenges experienced by pharmacy staff in the preparation, implementation and delivery of services. DESIGN: Mixed-methods methodology with both quantitative and qualitative data through surveys, pharmacy computer records and immuniser pharmacist interviews. SETTING: Community pharmacies in WA that provided pharmacist vaccination services between March and October 2015. PARTICIPANTS: Immuniser pharmacists from 86 pharmacies completed baseline surveys and 78 completed exit surveys; computer records from 57 pharmacies; 25 immuniser pharmacists were interviewed. MAIN OUTCOME MEASURES: Pharmacy and immuniser pharmacist profiles; pharmacist vaccination services provided and consumer profiles who accessed services. RESULTS: 15 621 influenza vaccinations were administered by immuniser pharmacists at 76 WA community pharmacies between March and October 2015. There were no major adverse events, and <1% of consumers experienced minor events which were appropriately managed. Between 12% and 17% of consumers were eligible to receive free influenza vaccinations under the National Immunisation Program but chose to have it at a pharmacy. A high percentage of vaccinations was delivered in rural and regional areas indicating that provision of pharmacist vaccination services facilitated access for rural and remote consumers. Immuniser pharmacists reported feeling confident in providing vaccination services and were of the opinion that services should be expanded to other vaccinations. Pharmacists also reported significant professional satisfaction in providing the service. All participating pharmacies intended to continue providing influenza vaccinations in 2016. CONCLUSIONS: This initial evaluation of WA pharmacist vaccination services showed that vaccine delivery was safe. Convenience and accessibility were important aspects in usage of services. There is scope to expand pharmacist vaccination services to other vaccines and younger children; however, government funding to pharmacists needs to be considered.

[Efficacy and safety of renal biopsy in children performed with an automatic biopsy device under control of ultrasonographic imaging]. / Skutecznosc i bezpieczenstwo biopsji nerki u dzieci wykonanej aparatem automatycznym pod kontrola obrazu ultrasonograficznego.

UNLABELLED: The efficacy and safety of kidney biopsy in children performed with an automatic Biopty Gun device under real time ultrasound was analysed. The procedure was performed under sedation during short hospitalisation with ultrasound assessment of complications performed after 24 hours. 98% of 131 biopsies yielded representative material with an average 16 glomeruli obtained per biopsy. Symptomatic perirenal haematomas were observed in 80%, subcapsular haematomas in 3.8% and arteriovenous fistulas in 4.6% of children on post biopsy ultrasound. They resolved spontaneously in all patients. CONCLUSIONS: Real time ultrasound guidance with the use of automatic biopsy devices should become the standard practice for kidney biopsy in children due to its efficacy and safety. The procedure should be performed during short hospitalization to enable ultrasound monitoring of early complications.

[Bilateral hydrothorax in a 13-year old girl treated with continuous ambulatory peritoneal dialysis renal replacement therapy]. / Obustronny przezprzeponowy przeciek plynu dializacyjnego do jam oplucnowych u 13-letniej dziewczynki leczonej nerkozastepczo metoda ciaglej cyklicznej dializy otrzewnowej.

Bilateral hydrothorax is a very rare complication of ambulatory peritoneal dialysis in children. We present a case of a 13-year-old girl who developed bilateral acute hydrothorax during after seven months of CCPD. Peritoneal dialysis was temporarily discontinued and the child was transferred to haemodialysis. Six weeks later the patient was successfully resumed CCPD.

[Changing clinical course of hemolytic uremic syndrome in children]. / Zmieniajacy sie obraz zespolu hemolityczno-mocznicowego u dzieci.

An incidence of hemolytic-uraemic syndrome as a cause of the acute renal failure in childhood, its early survival rate and long-term sequela quences were compared in the 1970s, 1980s, and 1990s in the same geographical area. 196 children with HUS were treated between 1972-1999. 94% had a typical D+ HUS. The majority were of patients severely ill with 87% requiring peritoneal dialysis of an average 14 days duration. The children were grouped into three 9-year periods for comparison (1972-1980, 1981-1989, 1990-1999). 105 patients were followed for 2-27 years (mean 1 years). An incidence of HUS as a cause of ARF in childhood ranged from 58% and 50% in the 1970s and 1980s to 30% in the past decade. With time survival rate has improved dramatically over the years from 80% and 75% to 97% in the 1990s. Deo spite better short term outcome the late consequences of HUS are serious. The longer the follow-up, the greater percentage of patients with severe outcome. At last follow-up only 32% children showed full recovery. 33% are on renal replacement therapy or have impaired renal function. The severity of the initial lesions to the kidney measured by the duration of anuria is a marker of poor late prognosis. With improving early outcome the clinical significance of HUS is focusing on its severe long-term consequences.

[Bilateral renal obstruction caused by cystine stones in a child with Henoch-Schönlein syndrome]. / Przypadek dziewczynki z zespolem Schönleina-Henocha i ostra zanerkowa niewydolnoscia nerek z powodu kamicy cystynowej.

Haematuria is a typical symptom of glomerular involvement in Henoch-Schoenlein syndrome in children. The authors present an unusual case of haematuria and deterioration of renal function caused by cystine stones in a child with anaphylactic purpura. This 6 year old girl was hospitalized because of severe gastrointestinal symptoms in the course of a typical Henoch-Schoenlein syndrome. After 4 weeks of illness--the child demonstrated haematuria and oliguria with severe loin pain and a rise in serum creatinine to 5.8 mg%. Urine findings of mainly non-glomerular erythrocytes and slight proteinuria were suggestive of a non-glomerular cause of renal failure. Ultrasound examination revealed the unexpected finding of bilateral kidney obstruction caused by multiple renal stones. Cystine crystals observed under microscopic examination of the urinary sediment and a positive cyanide-nitroprusside test suggested cystinuria as the cause of nephrolithiasis. High water intake and alkalization of urine and captopril for cystine excretion reduction resulted in fast improvement of renal function and and with time complete dissolution of calculi. The symptoms of Henoch-Schoenlein syndrome resolved over several weeks, and the child did not develop any signs of glomerular involvement.

[Ultrasound of exit-site and tunnel infections in children on peritoneal dialysis]. / Ocena ultrasonograficzna zapalenia ujscia i kanalu cewnika Tenckhoffa u dzieci dializowanych otrzewnowo.

Ultrasound diagnosis of catheter related infections in patients on peritoneal dialysis is easy to perform diagnostic procedure which enables more precise diagnosis and better follow-up of therapy. The authors present three cases of exit site and tunnel infections in children, illustrating the value of ultrasound evaluation in their diagnosis and in decisions on conservative treatment or catheter removal.

[The clinical course of fungal urinary tract infection in neonates]. / Grzybica ukladu moczowego noworodków--obserwacje wlasne.

The authors present the clinical course of 8 cases of fungal infection of the urinary tract in newborns. Three of the investigated children were premature or with intrauterine hypotrophy, a congenital defect of the urinary tract was detected in one child. In 5 cases the fungal infection followed bacterial septicaemia. Two of the 8 children required peritoneal dialysis, another two required insertion of intravenous catheters for parenteral feeding, and four required bladder catheterisation. The diagnosis of fungal urinary tract infection was established on the basis of urine culture, the presence of specific serum anti-candida antibodies and results of ultrasonographic examination (vs). In 7 of 8 cases the possibility of fungal infection was suggested by US examination. Seven children were treated with fluconazole combined with 5-fluorocytosine, one was treated with fluconazole. Pyelostomy was performed, in two of the patients all of them received supportive treatment. Our clinical observations point to the necessity of prophylaxis in case of predisposing factors to fungal infection and the use of abdominal ultrasonography for detection of early stages of fungal urinary tract infection.

[Clinical course and risk of fungal infections development in children with treated with chemo- and radiotherapy for solid tumors]. / Obraz kliniczny i ryzyko rozwoju zakazen grzybiczych u dzieci poddawanych chemio- i radioterapii z powodu zlosliwych guzów litych.

The authors estimated the incidence of mycotic infections among children patients with histological diagnosis of solid tumors during the period of neutropenia. Superficial mycoses including mucoses were observed in 35.3% of analysed patients, while a disseminated mycotic infections of a severe clinical course were seen in 2.9% neutropenic patients. Prophylactic administration of Diflucan (1-2 mg/kg/24h)(fluconazole) in neutropenic patients proved efficient in great majority of children, preventing the occurrence of severe mycotic complications.

New method for testing the absorbency of surgical dressings.

Absorbent cellulose dressings have been tested by immersion in a standard aqueous solution of picric acid followed by standard draining, elution of the picric acid, and measurement of the absorbance of the yellow colour at 355 nm. Six samples of gauze were graded by this procedure, and two considered unsatisfactory, despite all sinking in less than 10s. Filmated gauzes and unwoven dressings required greater dilution for the absorbance readings, reflecting their different structures.