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Hypermutable Pseudomonas aeruginosa isolates (hypermutators) have been identified in patients with cystic fibrosis (CF) and are associated with reduced lung function. Hypermutators display a greatly increased mutation rate and an enhanced ability to become resistant to antibiotics during treatment. Their prevalence has been established among patients with CF, but it has not been determined for patients with CF in Australia. This study aimed to determine the prevalence of hypermutable P. aeruginosa isolates from adult patients with CF from a health care institution in Australia and to characterize the genetic diversity and antibiotic susceptibility of these isolates. A total of 59  P. aeruginosa clinical isolates from patients with CF were characterized. For all isolates, rifampin (RIF) mutation frequencies and susceptibility to a range of antibiotics were determined. Of the 59 isolates, 13 (22%) were hypermutable. Whole-genome sequences were determined for all hypermutable isolates. Core genome polymorphisms were used to assess genetic relatedness of the isolates, both to each other and to a sample of previously characterized P. aeruginosa strains. Phylogenetic analyses showed that the hypermutators were from divergent lineages and that hypermutator phenotype was mostly the result of mutations in mutL or, less commonly, in mutS Hypermutable isolates also contained a range of mutations that are likely associated with adaptation of P. aeruginosa to the CF lung environment. Multidrug resistance was more prevalent in hypermutable than nonhypermutable isolates (38% versus 22%). This study revealed that hypermutable P. aeruginosa strains are common among isolates from patients with CF in Australia and are implicated in the emergence of antibiotic resistance., (Copyright © 2019 American Society for Microbiology.)

Carbapenem resistance in Klebsiella pneumoniae is most notably due to the K. pneumoniae carbapenemase (KPC) β-lactamase. In this report, we describe the occurrence of a newly described mechanism of carbapenem resistance, the NDM-1 β-lactamase, in a patient who received medical attention (but was not hospitalized) in India.

Objective: To implement and evaluate a flexible palliative care education program for Australian community pharmacists., Design: After identifying pharmacists' education needs, the program content and format were developed. This included identifying expert writers to create modules, assigning education and palliative care specialists to review content, and designing Web hosting of materials. The program was comprised of 11 modules and 79 activities., Assessment: An average of 28 responses was posted for each of the 20 noticeboard activities. Of the 60 pharmacists who began the program, 15 contributed to the discussion group, with an average of 3 posts each. Participants' responses to an online questionnaire indicated the program addressed their education needs and improved their knowledge and confidence in providing palliative cancer care., Conclusion: A program that pharmacists could access at a time and place convenient to them via the Internet was developed. Pharmacists indicated the program positively impacted their practice.

Accredited pharmacy programs in Australia provide a high standard of pharmacy education, attracting quality students. The principal pharmacy degree remains the 4-year bachelor of pharmacy degree; however, some universities offer graduate-entry master of pharmacy degrees taught in 6 semesters over a 2-year period. Curricula include enabling and applied pharmaceutical science, pharmacy practice, and clinical and experiential teaching, guided by competency standards and an indicative curriculum (a list of topics that are required to be included in a pharmacy degree curriculum before the program must be accredited by the Australian Pharmacy Council). Graduate numbers have increased approximately 250% with a dramatic increase from 6 pharmacy degree programs in 1997 to 21 such programs in 2008. Graduates must complete approximately 12 months of internship in a practice setting after graduation and prior to the competency-based registration examinations. An overview of pharmacy education in Australia is provided in the context of the healthcare system, a national system for subsidizing the cost of prescription medicines, the Australian National Medicines Policy and the practice of pharmacy. Furthermore, the innovations in practice and technology that will influence education in the future are discussed.

Aims: The objective of this study was to determine the educational needs of community pharmacists in Australia related to palliative cancer care, to guide the development of an online educational program for pharmacists., Methods: Questionnaires were posted to a random sample of community pharmacies in Australia. The questionnaire sought information pertaining to pharmacists': demographics; educational needs by rating the importance of learning more about 18 palliative cancer care topics and self-perceived level of knowledge of them; preference for format(s) for the program; willingness to participate in the program; and perception regarding their practice of palliative cancer care. Results were analysed using Statistical Package for the Social Sciences (SPSS) version 11.5 software., Main Results: A questionnaire return rate of 10.3% was achieved. The characteristics of respondents were reflective of community pharmacy practice in Australia when compared with the latest available labour force figures by the Australian Institute of Health and Welfare. Pharmacists rated all 18 topics as "important/essential", and their level of knowledge of them as "poor/good". Pharmacists preferred information provided in these formats: text (89.8%), case studies (80.6%) and multi-choice questions (69.4%). Most pharmacists (85.2%) indicated that they would participate in the program. The majority of pharmacists (71.3%) reported that they deliver palliative cancer care services; usually less-than-monthly (24.1%) or weekly (21.3%)., Conclusions: Educational needs of community pharmacists in palliative cancer care were identified. The information gathered will assist in guiding the development of an online educational program for pharmacists to improve their knowledge and skills in palliative cancer care.