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Biomedical subjects

Julia Kennedy

Publications and source records attributed to Julia Kennedy.

6 recordsLinked to original sources
PubMed2006

The influence of PHARMAC's National Hospital Pharmaceutical Strategy on Quality Use of Medicines activities in New Zealand hospitals.

AIM: To determine the influence of PHARMAC's National Hospital Pharmaceutical Strategy (NHPS) on Quality Use of Medicine (QUM) activities in New Zealand hospitals. METHOD: In July 2002 and July 2004, a questionnaire-based cross-sectional survey on QUM activities was administered to chief pharmacists at all 30 New Zealand public hospitals employing a pharmacist (29 in July 2004), to examine pre and post-NHPS activity. RESULTS: Both surveys achieved a 97% response rate. A range of QUM activities were undertaken in hospitals. Overall, Drug Utilisation Reviews (DURs) significantly decreased (67 vs 42) (p<0.05), although antimicrobial guidelines and intranet formularies significantly increased (p<0.05). PHARMAC's QUM initiatives, still evolving, did not appear to positively influence QUM activity in 2002-4. In 2004, PHARMAC put their original plans to coordinate QUM activity on hold and chose to participate in the processes of the Safe and Quality use of Medicines Group (SQM). Formed in 2003 by the District Health Boards of New Zealand, SQM focused attention on anticoagulants and high-risk medicines. CONCLUSION: QUM activities, similar in both periods, were not positively influenced by PHARMAC's Strategy.

Cross-Sectional Studies↗
PubMed2006

Impact of Her-2 Neu overexpression on outcome of elderly women treated with wide local excision and breast irradiation for early stage breast cancer: an exploratory analysis.

OBJECTIVE: The purpose of this study was to investigate the prognostic significance of Her-2 neu status in elderly patients managed with breast conservation strategy for stage I-II breast cancer. METHODS: We conducted an IRB approved retrospective review of 153 women age 70 and older with stage I-II breast cancer, managed with wide local excision and breast radiation between January 1997 and December 2002. The subset of 106 patients had a known Her-2 neu status and was analyzed for primary patient and tumor characteristics. These characteristics were correlated with cause specific survival (CSS), overall survival (OS), and combined nodal and distant failure (NDF). Her-2 neu positivity was confirmed with FISH HercepTestTM. Statistical tests included Cox regression, contingency table and Kaplan-Meier analysis. RESULTS: Median follow-up was 55 months and patient's median age was 76. Twenty two percent of patients were Her-2 neu positive and 78% were Her-2 neu negative. Her-2 neu positivity was significantly associated with high histologic grade (P = 0.008), T2 stage (P = 0.001) and positive axillary lymph nodes (P = 0.02) among 73 patients who had surgical assessment of axilla. Overall, only 15 patients (14%) received chemotherapy. There were no recurrences in the breast. Her-2 neu positivity predicted for NDF and CSS on multivariate analysis. Projected 5-year freedom from NDF was 70% for Her-2 neu positive and 97% for Her-2 neu negative patients (P < 0.01, log-rank). CSS was 86% for Her-2 neu positive and 98% for Her-2 neu negative patients (P < 0.01, log-rank). OS was no different between Her-2 neu positive and Her-2 neu negative patients (80% versus 85%, P = 0.25). CONCLUSIONS: Her-2 neu amplification predicts development of NDF and negatively influences CSS, but not local control or OS in elderly patients treated with breast conservation. Similar to the trend in younger patients, Her-2 neu positivity may be used in the future to consider more aggressive treatment strategies in elderly patients.

Age Factors↗
PubMed2005

Quality Use of Medicines activities in New Zealand hospitals from 2000 to 2002.

AIMS: To review current activities promoting Quality Use of Medicines (QUM) in New Zealand hospitals in 2000-2002, and to identify attitudes to possible centralisation of activities. METHOD: Questionnaire-based cross-sectional survey of 30 New Zealand public hospitals. Respondents were chief pharmacists in all hospitals employing at least one pharmacist. RESULTS: Twenty-nine hospitals (96.7%) responded; 3 were linked to a tertiary hospital for QUM activities. From the 26 independent hospitals, 64 Drug Utilisation Reviews (DURs) and 63 hospital-wide campaigns were reported, and 103 medicines information bulletins produced. Nineteen (63.3%) hospitals had their own hospital formulary. Twenty-four percent of respondents reported they would use centrally-developed guidelines only if in total agreement with their own. All hospitals reported disseminating drug expenditure information; feedback comments were predominantly from financial and nursing managers. All hospitals reported providing some form of drug information service (DI) and two-thirds a drug utilisation service (DU); 70% of total dedicated staff-time to these services was in tertiary hospitals. An increase in staff-time (fulltime-equivalent staff/100 beds) for clinical pharmacists, and DU+DI pharmacists, was associated with an increase in the number of DURs undertaken (p<0.05). CONCLUSION: A range of activities to promote QUM were undertaken in New Zealand hospitals, with greater activity in tertiary and secondary hospitals. Respondents reported some resistance to centrally-developed guidelines. Promotion of QUM may be assisted by an increase in clinical pharmacy resources.

Cross-Sectional Studies↗
PubMed2004

Epstein-Barr virus in pediatric multiple sclerosis.

CONTEXT: Infection with common viruses, particularly Epstein-Barr virus (EBV), has been postulated to contribute to the pathobiology of multiple sclerosis (MS). Detailed virological studies in pediatric MS have not been previously reported. OBJECTIVE: To evaluate whether children with MS are more likely to be seropositive for EBV or other common viruses than their healthy age-matched peers. DESIGN, SETTING, AND PATIENTS: Case-control study of viral samples collected from March 1994 to February 2003 from 30 pediatric MS patients, 90 emergency department controls matched 3:1 with the MS patients by year of birth, and 53 healthy control children. MAIN OUTCOME MEASURES: Archived serum samples were analyzed for the presence of IgG antibodies directed against EBV viral capsid antigens, nuclear antigens, and early antigens, cytomegalovirus, parvovirus B19, herpes simplex virus, and varicella zoster. RESULTS: Serological evidence for remote EBV infection was present in 83% of pediatric MS patients compared with 42% of emergency department and healthy controls (P<.001). Five pediatric MS patients were negative for all 3 EBV antigens. Pediatric MS patients were less likely than controls to have been exposed to herpes simplex virus (P =.003), while seropositivity for cytomegalovirus, parvovirus B19, and varicella zoster did not differ between MS patients and controls. CONCLUSION: These results suggest an association between EBV infection and pediatric MS.

Adolescent↗
PubMed2004

Trends in accessibility to medicines for children in New Zealand: 1998-2002.

BACKGROUND: Reported rates of unlicensed and off-label use of medicines in children raise concerns regarding overall access of children to medicines OBJECTIVE: To assess changes in availability of proprietary formulations suitable for infants and young children; licensing of medicines; and subsidization of medicines for children in New Zealand. METHODS: Review of the New Ethicals Catalogue, New Ethicals Compendium, product data sheets and the New Zealand Pharmaceutical Schedule covering the years 1998-2002 inclusive. RESULTS: There was a decrease in the total number of medicines licensed in New Zealand from 2014 to 1840; but there was an increase in the number and percentage of suitable formulations that were licensed for paediatric use from 616[31%] to 642[35%]. The number of suitable paediatric formulations that were subsidized decreased from 281[13.9%] to 260[14.1%]. The number of orally available chemical entities with suitable formulations, licensed and subsidized for paediatric use declined from 101[5.0%] to 94[5.1%], but all of these chemical entities that were withdrawn had therapeutic alternatives that were licensed and subsidized. Only 36% of new medicines that had licensing for children were licensed for the 0-23 month age group. CONCLUSION: There have been modest improvements in licensing of medicines for children in New Zealand from 1998 to 2002.

Adolescent↗