Limb-shaking TIA: a case of cerebral hypoperfusion in severe cerebrovascular disease in a young adult.

BACKGROUND: Limb-shaking transient ischaemic attacks (TIAs) are an under recognised presentation of severe cerebrovascular disease resulting from cerebral hypoperfusion. Patients present with jerking, transitory limb movements precipitated by change in position or exercise that are often confused with seizure. Cerebral perfusion imaging studies are an important tool available to aid diagnosis. CASE PRESENTATION: We present the case of a young female who developed limb-shaking TIA in the context of progressive severe intracranial atherosclerotic disease (ICAD). Previous cortical infarction raised suspicion for seizure as a cause of her symptoms. However, single photon emission CT (SPECT) with CT acetazolamide challenge identified severe left hemisphere cerebral hypoperfusion and a diagnosis of limb-shaking TIA was made. Symptoms improved with maximal medical management. CONCLUSIONS: This case highlights the importance of cerebral perfusion imaging for diagnostic confirmation as well as therapeutic options available to alleviate symptoms and reduce stroke risk in patients with limb-shaking TIA.

What young Australians think about a tax on sugar-sweetened beverages.

OBJECTIVE: To determine support for a tax on sugar-sweetened beverages (SSBs) among young Australian adults and the potential impact on SSB consumption if a tax is introduced. METHODS: Cross-sectional convenience survey of Australians aged 18-30 years sampled in the City of Greater Geelong, Australia, in November-December 2017. RESULTS: A total of 1,793 responses were recorded. Overall, 48% supported a tax on SSBs, which increased to 74% and 72% if tax revenue was allocated to subsidising fruit and vegetables or funding community exercise facilities, respectively. If a tax of $0.40/100g of sugar were introduced, 53% of participants would reduce their SSB consumption and most of this group (63%) reported that they would consume more water instead. Participants who consumed SSBs more frequently were less likely to support a tax or reduce their consumption. Gender, obesity and SES were not associated with support for a tax. CONCLUSIONS: Most young adults supported the idea of a tax on SSBs if tax revenue would be used to support healthy eating or physical activity. If a tax was introduced, most indicated that they would reduce their SSB consumption and substitute water for SSBs. Implications for public health: Policymakers can expect support from young people should an SSB tax be introduced in Australia.

Drug-related problems and the clinical role of pharmacists in inpatient mental health: an insight into practice in Australia.

BACKGROUND: Drug-related problems (DRPs) cause significant morbidity and mortality in healthcare. Clinical pharmacists have shown to reduce DRPs in the inpatient setting. In mental health the effects of clinical pharmacists on DRPs is relatively unknown. OBJECTIVE: To explore the clinical role of inpatient mental health pharmacists and the factors affecting their role. SETTING: Australian hospitals. METHOD: Mixed methods. As the profile of the hospital mental health pharmacy workforce is unknown, surveys were distributed to all Australian hospitals with a pharmacy department. DRPs and recommendations were classified using an adaptation of the DOCUMENT system. In-depth semi-structured interviews were undertaken with members of the Society of Hospital Pharmacists Australia's Mental Health Committee of Specialty Practice. MAIN OUTCOME MEASURES: Types of DRPs identified by mental health pharmacists, the recommendations made to address them and the rate at which these recommendations were implemented. As well as mental health pharmacists' views on the factors which affect their clinical role. RESULTS: 277 clinical interventions were reported by 47 mental health pharmacists, with 332 DRPs identified and 355 recommendations made. Drug interactions were the most commonly identified DRP (13.9 %). DRPs ranged in severity and likelihood of occurring. Changes to therapy accounted for the vast majority of recommendations (60.8 %), with the most common being change of drug (29.9 %). In total 91.8 % of recommendations were implemented. On average pharmacists estimated 56.1 % of their clinical interventions focused on psychotropic medication issues. Sixteen pharmacists were interviewed. Their relationship with the medical officers, time constraints and a gap in the evidence base to guide practice were identified as the major factors affecting their role. CONCLUSION: Pharmacists play an important role in ensuring the quality use of medicines in inpatient mental health. However, significant factors need to be addressed to further expand clinical pharmacy services in inpatient mental healthcare in Australia.

A comprehensive review of the impact of clinical pharmacy services on patient outcomes in mental health.

BACKGROUND: The importance of pharmacists in mental healthcare is starting to be recognised around the world. However few studies have focused on the evidence supporting pharmacist involvement in the inpatient mental healthcare setting. AIM: Evaluate types of outcomes achieved and level of evidence supporting clinical pharmacy services in inpatient mental health settings. METHODS: Medline, PyscINFO and International Pharmaceutical Abstracts databases were searched from January 1990 to March 31 2013. Studies were included if in an inpatient setting, published in English, and reported an intervention provided by a pharmacist or involving a pharmacist with a pivotal role in an intervention team. Data were extracted according to sample population and size, study design and outline, country, role of the pharmacist in the study, and the main results of the study. The level of evidence for each study was assessed using Australia's National Health and Medical Research Council's hierarchy of clinical evidence and results were categorised as having economic, clinical and/or humanistic outcomes. RESULTS: Eighteen articles met the inclusion criteria. A range of pharmaceutical services provided by pharmacists in inpatient mental healthcare were identified. These services highlight the role of pharmacists as reviewers of medication charts, laboratory results and medication prescribing and as educators of patients and other health care professionals. Six studies included a control or comparison group and had pre and post intervention measures. These comprised of three randomised control trials, one historical control study and two case series post and pre-post tests, corresponding to evidence levels of II, III-3 and IV respectively. Seven studies reported clinical outcomes, two economical and one humanistic outcomes. One study reported both clinical and economical outcomes. Seven studies focused on impact evaluation measures. CONCLUSIONS: Pharmacists provide a variety of services and play a significant role in inpatient mental healthcare. However, the level of evidence supporting these services is limited and the type of outcomes achieved is narrow.