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Sample records for actual beta-blocker prescribing

  1. Differential associations between actual and expected GP practice prescribing rates for statins, ACE inhibitors, and beta-blockers: a cross-sectional study in England

    Ward, Paul R; Noyce, Peter R; St Leger, Antony S

    2005-01-01

    Aim To explore the relationship between actual and expected general medical practitioner (GP) practice prescribing rates for statins, angiotensin converting enzyme (ACE) inhibitors, and beta-blockers. Background There is a growing body of literature highlighting inequities in GP practice prescribing rates for many drug therapies. The equity of prescribing is of central importance in the area of therapeutics since it explores the interface between those patients who should and those who actual...

  2. Non-selective beta-blockers decrease thrombotic events in patients with heart failure

    De Peuter, Olav R.; Souverein, Patrick C.; Klungel, Olaf H.; Lip, Gregory Y.; Buller, Harry R.; De Boer, Anthonius; Kamphuisen, Pieter W.

    2010-01-01

    Background: Beta-blockers are often prescribed to patients with heart failure (HF) without distinctions between types of beta-blockers. The 2002 COMET study showed superiority of carvedilol (a non-selective beta-blocker) over metoprolol (selective beta-blocker) on mortality and cardiovascular events

  3. Beta blockers after myocardial infarction: have trials changed practice?

    Baber, N S; Julian, D.G.; Lewis, J. A.; Rose, G.

    1984-01-01

    A survey of British consultant cardiologists was carried out to elicit their current practices when prescribing long term beta blockers after myocardial infarction. Sixty (72%) of the respondents reported that they used beta blockers prophylactically even in the absence of any other indications; the details of their stated policies, however, varied considerably. The favourable evidence of clinical trials in this indication appears to have been assimilated into hospital practice.

  4. How Do Beta Blocker Drugs Affect Exercise?

    ... Stroke More How do beta blocker drugs affect exercise? Updated:Aug 5,2015 Beta blockers are a ... about them: Do they affect your ability to exercise? The answer can vary a great deal, depending ...

  5. Photochemical fate of beta-blockers in NOM enriched waters

    Beta-blockers, prescribed for the treatment of high blood pressure and for long-term use after a heart attack, have been detected in surface and ground waters. This study examines the photochemical fate of three beta-blockers, atenolol, metoprolol, and nadolol. Hydrolysis accounted for minor losses of these beta-blockers in the pH range 4–10. The rate of direct photolysis at pH 7 in a solar simulator varied from 6.1 to 8.9 h−1 at pH 7. However, the addition of a natural organic matter (NOM) isolate enhanced the photochemical loss of all three compounds. Indirect photochemical fate, generally described by reactions with hydroxyl radical (·OH) and singlet oxygen (1ΔO2), and, the direct reaction with the triplet excited state, 3NOM⁎, also varied but collectively appeared to be the major loss factor. Bimolecular reaction rate constants of the three beta-blockers with 1ΔO2 and ·OH were measured and accounted for 0.02–0.04% and 7.2–38.9% of their loss, respectively. These data suggest that the 3NOM⁎ contributed 50.6–85.4%. Experiments with various 3NOM⁎ quenchers supported the hypothesis that it was singly the most important reaction. Atenolol was chosen for more detailed investigation, with the photoproducts identified by LC–MS analysis. The results suggested that electron-transfer could be an important mechanism in photochemical fate of beta-blockers in the presence of NOM. - Highlights: ► Photochemical degradation of beta-blockers in the simulated natural waters. ► Reactive Oxygen Species play a minor role in the indirect photodegradation. ► The loss of beta-blockers results from direct reaction with 3DOM⁎.

  6. Beta-blocker therapy is not associated with symptoms of depression and anxiety in patients receiving an implantable cardioverter-defibrillator

    Hoogwegt, Madelein T; Kupper, Nina; Theuns, Dominic A M J;

    2012-01-01

    Beta-blockers are frequently prescribed to implantable cardioverter-defibrillator (ICD) patients. Beta-blocker therapy has been proposed to induce emotional distress such as depression and anxiety, but a paucity of studies has examined the relationship between beta-blockers and distress. We...... investigated the association between beta-blocker therapy, including type and dosage, and symptoms of anxiety and depression in a consecutive cohort of patients receiving an ICD....

  7. Myokardinfarkt und Beta-Blocker

    Stühlinger H-G

    2003-01-01

    Full Text Available Im Rahmen eines akuten koronaren Syndroms (akuter Herzinfarkt, Angina pectoris kommt es, aufgrund eines Ungleichgewichtes zwischen Angebot und Bedarf, zu einem akuten Mangel an Sauerstoff im Herzmuskel. Ursache ist eine reduzierte Sauerstoffzufuhr durch verengte bzw. verschlossene Gefäße. Bis zur Behebung der Ursache vergehen oft mehrere Stunden. In dieser Phase muß - durch Verminderung des Sauerstoffbedarfs im Herzmuskel - eine Verlangsamung der Nekroseentwicklung erreicht werden. Das Ausmaß der Nekrose wird reduziert, somit die für die Langzeitprognose wichtige Linksventrikelfunktion verbessert. Eine Verminderung des Sauerstoffbedarfs erreicht man durch kontrollierte Frequenzsenkung mittels intravenöser Beta-Blockade. In optimaler Weise wird diese Methode durch die Anwendung eines kardioselektiven Beta-Blockers mit kurzer Halbwertszeit durchgeführt. Beta-Blocker haben nicht nur auf die Nekroseentwicklung, sondern auch auf die Inzidenz von Rhythmusstörungen - besonders in der Akutphase - Auswirkungen. Vor allem die mit dieser therapeutischen Maßnahme verbundene Reduktion von Kammerflimmern ist von großer Bedeutung.

  8. Photochemical fate of beta-blockers in NOM enriched waters

    Wang, Ling; Xu, Haomin; Cooper, William J. [Urban Water Research Center, Department of Civil and Environmental Engineering, University of California, Irvine, Irvine, CA 92697-2175 (United States); Song, Weihua, E-mail: wsong@fudan.edu.cn [Department of Environmental Science and Engineering, Fudan University, Shanghai 200433 (China)

    2012-06-01

    Beta-blockers, prescribed for the treatment of high blood pressure and for long-term use after a heart attack, have been detected in surface and ground waters. This study examines the photochemical fate of three beta-blockers, atenolol, metoprolol, and nadolol. Hydrolysis accounted for minor losses of these beta-blockers in the pH range 4-10. The rate of direct photolysis at pH 7 in a solar simulator varied from 6.1 to 8.9 h{sup -1} at pH 7. However, the addition of a natural organic matter (NOM) isolate enhanced the photochemical loss of all three compounds. Indirect photochemical fate, generally described by reactions with hydroxyl radical ({center_dot}OH) and singlet oxygen ({sup 1}{Delta}O{sub 2}), and, the direct reaction with the triplet excited state, {sup 3}NOM{sup Low-Asterisk }, also varied but collectively appeared to be the major loss factor. Bimolecular reaction rate constants of the three beta-blockers with {sup 1}{Delta}O{sub 2} and {center_dot}OH were measured and accounted for 0.02-0.04% and 7.2-38.9% of their loss, respectively. These data suggest that the {sup 3}NOM{sup Low-Asterisk} contributed 50.6-85.4%. Experiments with various {sup 3}NOM{sup Low-Asterisk} quenchers supported the hypothesis that it was singly the most important reaction. Atenolol was chosen for more detailed investigation, with the photoproducts identified by LC-MS analysis. The results suggested that electron-transfer could be an important mechanism in photochemical fate of beta-blockers in the presence of NOM. - Highlights: Black-Right-Pointing-Pointer Photochemical degradation of beta-blockers in the simulated natural waters. Black-Right-Pointing-Pointer Reactive Oxygen Species play a minor role in the indirect photodegradation. Black-Right-Pointing-Pointer The loss of beta-blockers results from direct reaction with {sup 3}DOM{sup Low-Asterisk }.

  9. Beta blockers: A new role in chemotherapy

    Nagaraja, Archana S; Sadaoui, Nouara C.; Lutgendorf, Susan K.; Ramondetta, Lois M.; Sood, Anil K

    2013-01-01

    Beta-blockers are a class of drugs widely used to treat cardiac, respiratory and other ailments. They act by blocking beta-adrenergic receptor–mediated signalling. Studies in various cancers have shown that patients taking a beta-blocker have higher survival and lower recurrence and metastasis rates. This is supported by several preclinical and in vitro studies showing that adrenergic activation modulates apoptosis, promotes angiogenesis and other cancer hallmarks, and these effects can be ab...

  10. Detrimental effects of beta-blockers in COPD - A concern for nonselective beta-blockers

    van der Woude, HJ; Zaagsma, J; Postma, DS; Winter, TH; van Hulst, M; Aalbers, R

    2005-01-01

    Introduction: beta-Blockers are known to worsen FEV1 and airway hyperresponsiveness (AHR) in patients with asthma. Both characteristics determine the outcome of COPD, a disease with frequent cardiac comorbidity requiring beta-blocker treatment. Design: A double-blind, placebo-controlled, randomized,

  11. Topical beta-Blockers and Mortality

    Muskens, Rogier P. H. M.; Wolfs, Roger C. W.; Wittenian, Jacqueline C. M.; Hofman, Albert; de Jong, Paulus T. V. M.; Stricker, Bruno H. C.; Jansonius, Nomdo M.

    2008-01-01

    Purpose: To study the associations between long-term and short-term use of topical beta-blockers and mortality. Design: Prospective population-based cohort study. Participants: To examine long-term effects, 3842 participants aged 55 years and older were recruited. To examine short-term effects, 484

  12. Treating High Blood Pressure: Is a Beta-Blocker Drug Right for You?

    ... High Blood Pressure: Is a Beta-blocker Drug Right for You? What are beta-blockers? Beta-blockers ... talk with your doctor about which drugs are right for you. If your blood pressure is slightly ...

  13. Use of beta blockers in various clinical states

    Radović Vesna V.

    2011-01-01

    Full Text Available Introduction. According to the convincing evidence, a decline in mortality rate has been achieved with beta-blockers in patients with an acute myocardial infarction and in post-infarction follow-up. In fact, there has been a clear reduction of sudden coronary death. The necessary condition for the efficiency of beta-blockers is an early use. They are also a medication of choice for angina after an infarction. The objective of this work was to evaluate the use of beta-blockers after a myocardial infarction in various clinical states and to eliminate doubts concerning their prescription. Beta blockers Even in conditions considered contraindications for administration of beta blockers such as old age, diabetes, non-Q-wave myocardial infarction, peripheral vascular disease, arterial disease, heart insufficiency, ventricular arrhythmias, renal disease, chronic obstructive pulmonary disease, asthma and depression, patients benefit from beta blockers when they are given along with a right choice of the medication and a regular follow-up of the patient. Preference is given to cardioselective beta blockers in patients with diabetes or lung disease. Beta-blockers do not cause long-term lipid alterations. Therefore, the matter of clinically significant alterations of lipids or blood glucose levels should not need further consideration as a problem of the treatment of diabetics. Discussion and conclusion. Investigations have proved that the use of beta-blockers reduces the development of cerebrovascular accidents, heart insufficiency and hypertension. Despite strong arguments and numerous recommendations, beta-blockers have not been accepted to a sufficient extent as an integral part of treatment of acute coronary syndrome and related diseases, to the detriment of many lost lives and in spite of favourable pharmaco-economic aspect.

  14. Use of beta blockers in various clinical states

    Radović Vesna V.

    2011-01-01

    Introduction. According to the convincing evidence, a decline in mortality rate has been achieved with beta-blockers in patients with an acute myocardial infarction and in post-infarction follow-up. In fact, there has been a clear reduction of sudden coronary death. The necessary condition for the efficiency of beta-blockers is an early use. They are also a medication of choice for angina after an infarction. The objective of this work was to evaluate the use of beta-blockers after a my...

  15. Refractory anaphylactoid shock potentiated by beta-blockers.

    Javeed, N; Javeed, H; Javeed, S; Moussa, G; Wong, P; Rezai, F

    1996-12-01

    Allergic reactions, including anaphylactoid shock due to contrast material, are not uncommon. However, persistent anaphylactoid shock refractory to conventional therapy is rare. We present a case of refractory anaphylactoid shock during coronary angiography unresponsive to aggressive standard therapy in a patient on beta-blockers. Significant clinical improvement was noted upon administration of glucagon. Since beta-blockers are commonly used in patients with coronary artery disease, this potentially life-threatening complication has to be kept in mind with any procedure involving contrast media in patients on beta-blockers. Immediate access to glucagon by keeping it in the procedure room may be lifesaving in these situations. PMID:8958428

  16. Long-term compliance with beta-blockers, angiotensin-converting enzyme inhibitors, and statins after acute myocardial infarction

    Gislason, Gunnar H; Rasmussen, Jeppe Nørgaard; Abildstrøm, Steen Z;

    2006-01-01

    AIMS: To study initiation, dosages, and compliance with beta-blockers, angiotensin-converting enzyme (ACE)-inhibitors, and statins in patients after acute myocardial infarction (AMI) and to identify likely targets for improvement. METHODS AND RESULTS: Patients admitted with first AMI between 1995...... and 2002 were identified by linking nationwide administrative registers. A total of 55 315 patients survived 30 days after discharge and were included; 58.3% received beta-blockers, 29.1% ACE-inhibitors, and 33.5% statins. After 1, 3, and 5 years, 78, 64, and 58% of survivors who had started therapy were...... still receiving beta-blockers, 86, 78, and 74% were receiving ACE-inhibitors, and 85, 80, and 82% were receiving statins, respectively. Increased age and female sex were associated with improved compliance. The dosages prescribed were generally 50% or less of the dosages used in clinical trials...

  17. Beta-blockers in cirrhosis and refractory ascites

    Kimer, Nina; Feineis, Martin; Møller, Søren;

    2015-01-01

    OBJECTIVE: It is currently discussed if beta-blockers exert harmful effects and increase mortality in patients with cirrhosis and refractory ascites. In this study, we provide an overview of the available literature in this field in combination with a retrospective analysis of 61 patients with...... trials (9 trials on propranolol, 1 case-control study and 4 retrospective analyses) were identified. One trial suggested an increased mortality in patients treated with beta-blockers and refractory ascites. The results of the remaining trials were inconclusive. No increase in mortality among beta-blocker......-treated patients was found in the present retrospective analysis. CONCLUSIONS: Treatment with beta-blockers may increase mortality in patients with cirrhosis and refractory ascites. However, the current evidence is sparse and high-quality studies are warranted to clarify the matter....

  18. Fracture risk in perimenopausal women treated with beta-blockers

    Rejnmark, Lars; Vestergaard, Peter; Kassem, Moustapha;

    2004-01-01

    beta2-Adrenergic receptors have been identified on human osteoblastic and osteoclastic cells, raising the question of a sympathetic regulation of bone metabolism. We investigated effects of treatment with beta-adrenergic receptor antagonists (beta-blockers) on bone turnover, bone mineral density...... (BMD), and fracture risk. Within the Danish Osteoporosis Prevention Study (DOPS) a population based, comprehensive cohort study of 2016 perimenopausal women, associations between treatment with beta-blockers and bone turnover and BMD were assessed in a cross-sectional design at the start of study....... Moreover, in a nested case-control design, fracture risk during the subsequent 5 years was assessed in relation to treatment with beta-blockers at baseline. Multiple regression- and logistic regression-analyses were performed. Treatment with beta-blockers was associated with a threefold increased fracture...

  19. Perioperative beta blockers in patients having non-cardiac surgery

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi;

    2008-01-01

    American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidenc...

  20. Impairment of physical performance after treatment with beta blockers and alpha blockers.

    Bengtsson, C.

    1984-01-01

    An investigation was made into the effect of various types of beta blockers, an alpha blocker, a combined alpha and beta blocker, and a diuretic on physical performance in a normotensive man. Beta blockers, the alpha blocker, and the combined alpha and beta blocker significantly (p less than 0.001) reduced physical performance. Further studies are needed to confirm these findings in a larger series of subjects.

  1. Pre-stroke use of beta-blockers does not affect ischaemic stroke severity and outcome

    De Raedt, S.; Haentjens, P.; De Smedt, A.; Brouns, R.; Uyttenboogaart, Maarten; Luijckx, G. J.; De Keyser, J.

    2012-01-01

    Background and purpose: It is unclear whether pre-stroke beta-blockers use may influence stroke outcome. This study evaluates the independent effect of pre-stroke use of beta-blockers on ischaemic stroke severity and 3 months functional outcome. Methods: Pre-stroke use of beta-blockers was investiga

  2. BETA-BLOCKERS IN THE TREATMENT OF ARTERIAL HYPERTENSION: EVIDENCE BASED DATA AND REAL PRACTICE

    M. V. Leonova

    2015-01-01

    Data of the largest meta-analyzes of beta-blockers use in arterial hypertension is presented. The role of beta-blockers among other basic groups of antihypertensive drugs (thiazide diuretics, calcium channel blockers, ACE inhibitors) is evaluated. Special considerations of beta-blockers use in hypertensive patients with diabetes mellitus and chronic heart failure are discussed. Special attention is paid to bisoprolol.

  3. HEART FAILURE, DIABETES, BETA-BLOCKERS AND RISK OF HYPOGLYCEMIA

    A. A. Aleksandrov

    2008-01-01

    Full Text Available Aim. To evaluate an influence of carvedilol on risk of hypoglycemia in patients with diabetes type 2 (D2 and chronic heart failure (CHF treated with angiotensin converting enzyme (ACE inhibitors.Material and methods. 13 patients (10 men, 3 women; aged 59,8±6,7 y.o. with D2 and CHF caused by ischemic heart disease were included in the study. Before inclusion all patients were treated with ACE inhibitors and various beta-blockers (atenolol, metoprolol, bisoprolol. These beta-blockers were changed for carvedilol. Heart ultrasonography, blood pressure control, glycemia monitoring, HbA1c level determination were performed before, during and after carvedilol therapy.Results. Carvedilol reduces frequency and duration of hypoglycaemia episodes. There were not episodes of severe hypoglycaemia during carvedilol therapy.Conclusion. Carvedilol reduces risk of hypoglycemia when it is used in combination with ACE inhiditors in diabetic patients with CHF.

  4. Beta-blockers and depression in elderly hypertension patients in primary care

    Ringoir, Lianne; Pedersen, Susanne S.; Widdershoven, Jos W M G;

    2014-01-01

    BACKGROUND AND OBJECTIVES: Previous findings regarding a possible association between beta-blocker use and depression are mixed. To our knowledge there have been no studies investigating the association of beta-blockers with depression in primary care hypertension patients without previous...... myocardial infarction. The aim of this study was to determine the relation between lipophilic beta-blocker use and depression in elderly primary care patients with hypertension. METHODS: This was a cross-sectional study in primary care practices located in the South of The Netherlands. Primary care......-squared test showed that lipophilic beta-blocker users as compared to non-beta-blockers users were more likely to be in a higher depression category. Ordinal regression showed a significant relationship between use of lipophilic beta-blockers and depression (OR=1.60, 95% CI=1.08--2.36) when adjusting...

  5. Banding ligation versus beta-blockers for primary prevention in oesophageal varices in adults

    Gluud, Lise Lotte; Krag, Aleksander

    2012-01-01

    Non-selective beta-blockers are used as a first-line treatment for primary prevention in patients with medium- to high-risk oesophageal varices. The effect of non-selective beta-blockers on mortality is debated and many patients experience adverse events. Trials on banding ligation versus non......-selective beta-blockers for patients with oesophageal varices and no history of bleeding have reached equivocal results....

  6. Beta-blocker use and clinical outcomes after primary vascular surgery

    Høgh, A; Lindholt, J S; Nielsen, H;

    2013-01-01

    To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction.......To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction....

  7. Banding ligation versus beta-blockers as primary prophylaxis in esophageal varices

    Gluud, Lise L; Klingenberg, Sarah; Nikolova, Dimitrinka;

    2007-01-01

    To compare banding ligation versus beta-blockers as primary prophylaxis in patients with esophageal varices and no previous bleeding.......To compare banding ligation versus beta-blockers as primary prophylaxis in patients with esophageal varices and no previous bleeding....

  8. Discontinuation of beta-blockers and the risk of myocardial infarction in the elderly.

    Teichert, M.; Smet, P.A.G.M. de; Hofman, A.; Witteman, J.C.; Stricker, B.H.C.

    2007-01-01

    BACKGROUND: It has been shown that the abrupt cessation of treatment with beta-adrenoceptor antagonists (beta-blockers) increases the risk of myocardial infarction in patients with hypertension. As beta-blockers differ in their pharmacokinetic and pharmacodynamic properties, this risk of discontinua

  9. A review on the putative association between beta-blockers and depression

    Verbeek, D.E.; van Riezen, J.; de Boer, R.A.; van Melle, J.P.; de Jonge, P.

    2011-01-01

    Several kinds of systematic studies have been conducted verifying the putative association between beta-blockers and depressive symptoms. However, many of these studies had important limitations in their design. In most of the studies, no effect of beta-blockers on depressive symptoms was seen. Beca

  10. Beta blocker therapy is associated with reduced depressive symptoms 12 months post percutaneous coronary intervention

    Battes, Linda C; Pedersen, Susanne S.; Oemrawsingh, Rohit M;

    2012-01-01

    Beta blocker therapy may induce depressive symptoms, although current evidence is conflicting. We examined the association between beta blocker therapy and depressive symptoms in percutaneous coronary intervention (PCI) patients and the extent to which there is a dose-response relationship between...

  11. Beta-blockers in the environment: part II. Ecotoxicity study.

    Maszkowska, Joanna; Stolte, Stefan; Kumirska, Jolanta; Łukaszewicz, Paulina; Mioduszewska, Katarzyna; Puckowski, Alan; Caban, Magda; Wagil, Marta; Stepnowski, Piotr; Białk-Bielińska, Anna

    2014-09-15

    The increasing consumption of beta-blockers (BB) has caused their presence in the environment to become more noticeable. Even though BB are safe for human and veterinary usage, ecosystems may be exposed to these substances. In this study, three selected BB: propranolol, metoprolol and nadolol were subjected to ecotoxicity study. Ecotoxicity evaluation was based on a flexible ecotoxicological test battery including organisms, representing different trophic levels and complexity: marine bacteria (Vibrio fischeri), soil/sediment bacteria (Arthrobacter globiformis), green algae (Scenedesmus vacuolatus) and duckweed (Lemna minor). All the ecotoxicological studies were supported by instrumental analysis to measure deviation between nominal and real test concentrations. Based on toxicological data from the green algae test (S. vacuolatus) propranolol and metoprolol can be considered to be harmful to aquatic organisms. However, sorption explicitly inhibits the hazardous effects of BB, therefore the risks posed by these compounds for the environment are of minor importance. PMID:24975494

  12. Skin prick testing in patients using beta-blockers: a retrospective analysis

    Fung Irene N; Kim Harold L

    2010-01-01

    Abstract Rationale The use of beta-blockers is a relative contraindication in allergen skin testing yet there is a paucity of literature on adverse events in this circumstance. We examined a population of skin tested patients on beta-blockers to look for any adverse effects. Methods Charts from 2004-2008 in a single allergy clinic were reviewed for any patients taking a beta-blocker when skin tested. Data was examined for skin test reactivity, type of skin test, concomitant asthma diagnosis, ...

  13. Beta blockers and the sensitivity of the thallium treadmill test

    The effect beta blockers (BB) may have on the sensitivity of the thallium treadmill test (Th-TMT) is controversial. The purpose of this study was to test the hypothesis that BB decrease the sensitivity of the Th-TMT. Two hundred three patients over a two-year period were identified who satisfied the following criteria. All had symptom-limited upright treadmill exercise tests with stress and redistribution thallium imaging, as well as coronary angiography within two months of the Th-TMT. Of 58 patients with CAD not on BB, 52 had an abnormal Th-TMT scan (sensitivity 90 percent). In comparison, the sensitivity of the Th-TMT scan in the 88 patients with CAD receiving BB was 76 percent (p less than 0.05). We conclude that BB may significantly decrease the sensitivity of the Th-TMT. Physicians should fully appreciate the higher false negative rate (24 vs 10 percent) for patients on BB and consider cautious withdrawal prior to diagnostic studies

  14. Heart rate distribution and predictors of resting heart rate after initiation of beta-blocker treatment in patients with coronary artery disease: REsults of Sympathetic Evaluation And Research of China(RESEARCH) study

    ZHAO Ying-xin; LI Yue-ping; GAO Fei; MA Han-ying; WANG Zhi-jian; HAN Hong-ya; SHEN Hua

    2013-01-01

    Background The importance of heart rate as secondary prevention strategies for patients with coronary artery disease (CAD) is emphasized by multiple guidelines.However,limited information is available on the heart rate distribution and the change patterns of resting heart rate when initiating beta-blocker therapy among Chinese patients with CAD.Methods The REsults of Sympathetic Evaluation And Research of China (RESEARCH) study is a multi-centre,prospective,observational study involving 147 centers in 23 cities across China.All eligible beta-blocker naive patients were prescribed with metroprolol succinate.Initial dosage and target heart rate were selected at the discretion of their physicians in charge according to their usual institutional practice.The heart rate distribution and the change patterns of resting heart rate after initiation of beta-blocker therapy were observed.Results The majority of patients (63.6%) were prescribed with 47.5 mg metroprolol succinate.At baseline,there were only 17.4% of patients whose heart rate was less than 70 beats per minute,and the proportion reached 42.5% and 79.1%,one month and two months after initiation of beta-blockers,respectively.Multivariate linear regression analysis showed that baseline heart rate (B=0.900,SE=0.006,t=141.787,P<0.0001) and the dosage (B=-0.007,SE=0.002,t=-3.242,P=0.001) were independent predictors of resting heart rate 2 months after beta-blocker therapy.Conclusions Resting heart rate is not optimally controlled in a broadly representative cohort of Chinese outpatients with CAD even after initiation of β-blocker therapy,and baseline heart rate and the dosage of beta-blocker are both independent predictors of resting heart rate after β-blocker therapy.

  15. Can non-selective beta-blockers prevent hepatocellular carcinoma in patients with cirrhosis?

    Thiele, Maja; Wiest, Reiner; Gluud, Lise Lotte;

    2013-01-01

    Hepatocellular carcinoma is the main liver-related cause of death in patients with compensated cirrhosis. The early phases are asymptomatic and the prognosis is poor, which makes prevention essential. We propose that non-selective beta-blockers decrease the incidence and growth of hepatocellular...... carcinoma via a reduction of the inflammatory load from the gut to the liver and inhibition of angiogenesis. Due to their effect on the portal pressure, non-selective beta-blockers are used for prevention of esophageal variceal bleeding. Recently, non-hemodynamic effects of beta-blockers have received...... reduce hepatic inflammation. Blockage of β-adrenoceptors also decrease angiogenesis by inhibition of vascular endothelial growth factors. Because gut-derived inflammation and neo-angiogenesis are important in hepatic carcinogenesis, non-selective beta-blockers can potentially reduce the development and...

  16. Comparison of the clinical outcome of different beta-blockers in heart failure patients

    Bølling, Rasmus; Scheller, Nikolai Madrid; Køber, Lars;

    2014-01-01

    AIM: To compare survival on different beta-blockers in heart failure. METHODS AND RESULTS: We identified all Danish patients ≥35 years of age who were hospitalized with a first admission for heart failure and who initiated treatment with a beta-blocker within 60 days of discharge. The study period...... according to beta-blocker dosages, patients that received high-dose carvedilol (≥50 mg daily) had a lower all-cause mortality risk (HR 0.873, 0.789-0.966) than patients receiving high-dose (≥200 mg daily) metoprolol (reference). High-dose bisoprolol (≥10 mg daily) was associated with a greater risk of death......: Heart failure patients receiving high-dose carvedilol (≥50 mg daily) showed significantly lower all-cause mortality risk and hospitalization risk, compared with other beta-blockers....

  17. Effects of a beta-blocker on the cardiovascular response to MDMA (Ecstasy)

    Hysek, C M; Vollenweider, F X; Liechti, M. E.

    2010-01-01

    BACKGROUND: MDMA (3,4-methylenedioxymethamphetamine, 'Ecstasy') produces tachycardia and hypertension and is rarely associated with cardiovascular and cerebrovascular complications. In clinical practice, beta-blockers are often withheld in patients with stimulant intoxication because they may increase hypertension and coronary artery vasospasm due to loss of beta(2)-mediated vasodilation and unopposed alpha-receptor activation. However, it is unknown whether beta-blockers affect the cardiovas...

  18. Beta-Blockers in the Management of Hypertension and/or Chronic Kidney Disease

    Hirofumi Tomiyama; Akira Yamashina

    2014-01-01

    This minireview provides current summaries of beta-blocker use in the management of hypertension and/or chronic kidney disease. Accumulated evidence suggests that atenolol is not sufficiently effective as a primary tool to treat hypertension. The less-than-adequate effect of beta-blockers in lowering the blood pressure and on vascular protection, and the unfavorable effects of these drugs, as compared to other antihypertensive agents, on the metabolic profile have been pointed out. On the oth...

  19. Non-selective beta-blockers may reduce risk of hepatocellular carcinoma

    Thiele, Maja; Albillos, Agustín; Abazi, Rozeta;

    2015-01-01

    BACKGROUND & AIMS: Non-selective beta-blockers (NSBB) are used in patients with cirrhosis and oesophageal varices. Experimental data suggest that NSBB inhibit angiogenesis and reduce bacterial translocation, which may prevent hepatocellular carcinoma (HCC). We therefore assessed the effect of NSBB...... reduce HCC-related mortality (RD -0.011; 95% CI -0.040 to 0.017). CONCLUSIONS: Non-selective beta-blockers may prevent HCC in patients with cirrhosis....

  20. Poor tolerance of beta-blockers by elderly patients with heart failure

    Yanagisawa, Satoshi

    2010-01-01

    Satoshi Yanagisawa, Noriyuki Suzuki, Toshikazu TanakaDepartment of Cardiology, Okazaki City Hospital, Aichi, JapanAbstract: Despite the well-understood importance of beta-blocker therapy in heart failure, it is sometimes not possible to use beta-blockers in elderly patients due to poor tolerance. In this report, we describe the case of an 83-year-old patient with severe systolic heart failure complicated by aortic valve stenosis and atrial fibrillation. A simple therapeutic approach involving...

  1. Chronic Exposure to Beta-Blockers Attenuates Inflammation and Mucin Content in a Murine Asthma Model

    Nguyen, Long P.; Omoluabi, Ozozoma; Parra, Sergio; Frieske, Joanna M.; Clement, Cecilia; Ammar-Aouchiche, Zoulikha; Ho, Samuel B.; Ehre, Camille; Kesimer, Mehmet; Knoll, Brian J.; Tuvim, Michael J; Dickey, Burton F.; Bond, Richard A.

    2007-01-01

    Single-dose administration of beta-adrenoceptor agonists produces bronchodilation and inhibits airway hyperresponsiveness (AHR), and is the standard treatment for the acute relief of asthma. However, chronic repetitive administration of beta-adrenoceptor agonists may increase AHR, airway inflammation, and risk of death. Based upon the paradigm shift that occurred with the use of beta-blockers in congestive heart failure, we previously determined that chronic administration of beta-blockers de...

  2. Beta-blockers: friend or foe in asthma?

    Arboe B

    2013-07-01

    induce acute bronchoconstriction, and, not least, may have beneficial effects on airway inflammation and airway hyperresponsiveness in some patients with asthma. Further studies addressing the potential role of β-blocker therapy for asthma are clearly needed, but careful selection of the target population is warranted.Keywords: asthma, beta-blockers, lung function, airway responsiveness

  3. [Beta-blockers usage in cardio-vascular diseases co-existing with COPD].

    Walczak, Dorota; Kowal, Aneta; Jankowska, Renata

    2012-12-01

    Chronic obstructive pulmonary disease (COPD) is one of the most frequent chronic diseases. Slightly reversable and progressive decrease in airflow through the airways is characteristic for the disease. It has been brought up last years that COPD course influences not only pulmonary system status but also many co-existing diseases in the eldery, especially cardio-vascular diseases, such as: ischaemic heart disease, hypertension, heart arrythmias, heart infarction. Wide usage and established position in the treatment of cardio-vascular diseases have the antagonists of beta-adrenergic receptors (beta-blockers). The aim of this work was the combination of the studies results quoted in the literature about the usage of beta-blockers in cardiovascular diseases co-existing with COPD. Conclusions. Nowadays there are no unambiguous recommendations for the usage of beta-blocker in patients with COPD and the decision about including them into treatment depends on the individually estimated risk of complications. PMID:23437704

  4. USE OF BETA-BLOCKERS IN THE PERIOPERATIVE PERIOD: HOW STRONG ARE THE EVIDENCES?

    V. V. Samoylenko

    2015-09-01

    Full Text Available Optimization of the pharmacotherapy in preoperative period is the cornerstone of the concept of risk modification of cardiovascular complications in the perioperative period. Therefore, special attention has recently been focused on the use of beta-blockers in the postoperative period. Nowadays convincing evidence base for the use of this class of drugs in the perioperative period that was the basis for the development of clinical guidelines is accumulated. Moreover, results of large randomized trials of beta-blockers are controversial. This has resulted in significant differences in the classes of recommendations and levels of evidence.Analysis of the results of basic researches and the provisions of recommendations of the international and national professional medical societies on the use of beta-blockers in patients with cardiovascular disease to reduce the risk of cardiac complications in the perioperative period for planned extracardiac surgical procedures is presented.

  5. Beta-blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease

    Andersson, Charlotte; Shilane, David; Go, Alan S;

    2014-01-01

    BACKGROUND: The effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI). OBJECTIVES: The purpose of this study was to assess the association of beta-blockers with outcomes among...... patients with new-onset CHD. METHODS: We studied consecutive patients discharged after the first CHD event (acute coronary syndrome or coronary revascularization) between 2000 and 2008 in an integrated healthcare delivery system who did not use beta-blockers in the year before entry. We used time......-blockers among patients with new-onset CHD was associated with a lower risk of cardiac events only among patients with a recent MI....

  6. Effects of beta-blockers on heart failure with preserved ejection fraction: a meta-analysis.

    Feng Liu

    Full Text Available BACKGROUND: Effects of beta-blockers on the prognosis of the heart failure patients with preserved ejection fraction (HFpEF remain controversial. The aim of this meta-analysis was to determine the impact of beta-blockers on mortality and hospitalization in the patients with HFpEF. METHODS: A search of MEDLINE, EMBASE, and the Cochrane Library databases from 2005 to June 2013 was conducted. Clinical studies reporting outcomes of mortality and/or hospitalization for patients with HFpEF (EF ≥ 40%, being assigned to beta-blockers treatment and non-beta-blockers control group were included. RESULTS: A total of 12 clinical studies (2 randomized controlled trials and 10 observational studies involving 21,206 HFpEF patients were included for this meta-analysis. The pooled analysis demonstrated that beta-blocker exposure was associated with a 9% reduction in relative risk for all-cause mortality in patients with HFpEF (95% CI: 0.87 - 0.95; P < 0.001. Whereas, the all-cause hospitalization, HF hospitalization and composite outcomes (mortality and hospitalization were not affected by this treatment (P=0.26, P=0.97, and P=0.88 respectively. CONCLUSIONS: The beta-blockers treatment for the patients with HFpEF was associated with a lower risk of all-cause mortality, but not with a lower risk of hospitalization. These finding were mainly obtained from observational studies, and further investigations are needed to make an assertion.

  7. Pre-injury beta blocker use does not affect the hyperdynamic response in older trauma patients

    David C Evans

    2014-01-01

    Full Text Available Purpose: Trauma dogma dictates that the physiologic response to injury is blunted by beta-blockers and other cardiac medications. We sought to determine how the pre-injury cardiac medication profile influences admission physiology and post-injury outcomes. Materials and Methods: Trauma patients older than 45 evaluated at our center were retrospectively studied. Pre-injury medication profiles were evaluated for angiotensin-converting enzyme inhibitors / angiotensin receptor blockers (ACE-I/ARB, beta-blockers, calcium channel blockers, amiodarone, or a combination of the above mentioned agents. Multivariable logistic regression or linear regression analyses were used to identify relationships between pre-injury medications, vital signs on presentation, post-injury complications, length of hospital stay, and mortality. Results: Records of 645 patients were reviewed (mean age 62.9 years, Injury Severity Score >10, 23%. Our analysis demonstrated no effect on systolic and diastolic blood pressures from beta-blocker, ACE-I/ARB, calcium channel blocker, and amiodarone use. The triple therapy (combined beta-blocker, calcium channel blocker, and ACE-I/ARB patient group had significantly lower heart rate than the no cardiac medication group. No other groups were statistically different for heart rate, systolic, and diastolic blood pressure. Conclusions: Pre-injury use of cardiac medication lowered heart rate in the triple-agent group (beta-blocker, calcium channel blocker, and ACEi/ARB when compared the no cardiac medication group. While most combinations of cardiac medications do not blunt the hyperdynamic response in trauma cases, patients on combined beta-blocker, calcium channel blocker, and ACE-I/ARB therapy had higher mortality and more in-hospital complications despite only mild attenuation of the hyperdynamic response.

  8. Heart rate and use of beta-blockers in stable outpatients with coronary artery disease.

    Ph Gabriel Steg

    Full Text Available BACKGROUND: Heart rate (HR is an emerging risk factor in coronary artery disease (CAD. However, there is little contemporary data regarding HR and the use of HR-lowering medications, particularly beta-blockers, among patients with stable CAD in routine clinical practice. The goal of the present analysis was to describe HR in such patients, overall and in relation to beta-blocker use, and to describe the determinants of HR. METHODS AND FINDINGS: CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization procedure, evidence of coronary stenosis of >50%, or chest pain associated with proven myocardial ischemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. Most of the 33,177 patients included in this analysis were men (77.5%. Mean (SD age was 64.2 (10.5 years, HR by pulse was 68.3 (10.6 bpm, and by electrocardiogram was 67.2 (11.4 bpm. Overall, 44.0% had HR ≥ 70 bpm. Beta-blockers were used in 75.1% of patients and another 14.4% had intolerance or contraindications to beta-blocker therapy. Among 24,910 patients on beta-blockers, 41.1% had HR ≥ 70 bpm. HR ≥ 70 bpm was independently associated with higher prevalence and severity of angina, more frequent evidence of myocardial ischemia, and lack of use of HR-lowering agents. CONCLUSIONS: Despite a high rate of use of beta-blockers, stable CAD patients often have resting HR ≥ 70 bpm, which was associated with an overall worse health status, more frequent angina and ischemia. Further HR lowering is possible in many patients with CAD. Whether it will improve symptoms and outcomes is being tested.

  9. Treatment with beta-blockers in nurse-led heart failure clinics

    Gustafsson, Finn; Schou, Morten; Videbaek, Lars;

    2007-01-01

    BACKGROUND: Beta-blockers (BBs) are a cornerstone in the treatment of chronic heart failure (HF), but several surveys have documented that many patients are not offered treatment or are not titrated to target doses. In part to address this problem, specialized, nurse-led HF clinics have been...

  10. Chronic beta-blocker treatment in patients with advanced heart failure - Effects on neurohormones

    Teisman, ACH; van Veldhuisen, DJ; Boomsma, F; de Kam, PJ; Pinto, YM; de Zeeuw, D; van Gilst, WH

    2000-01-01

    Background: To date, the use of beta-blockers in treating patients with chronic heart failure gains support, this since several large clinical trials reported reduced mortality after chronic beta-blockade. Part of these beneficial effects may result from inhibition of deleterious neurohormone activa

  11. Beta-Blockers and the Kidney: Implications for Renal Function and Renin Release.

    Epstein, Murray; And Others

    1985-01-01

    Reviews and discusses current information on the human renal response as related to beta-blockers (antihypertension agents). Topic areas considered include cardioselectivity, renal hemodynamics, systemic hemodynamics, changes with acute and chronic administration, influence of dose, and others. Implications and an 11-item multiple-choice self-quiz…

  12. SAFETY AND EFFICACY OF BETA-BLOCKERS IN THE TREATMENT OF STABLE ANGINA-PECTORIS

    DEMUINCK, ED; LIE, KI

    1990-01-01

    In stable exercise-induced angina pectoris, beta-blockers exert their beneficial effects mainly through a reduction in heart rate, blood pressure, and contractility. Additional beneficial effects are an improvement in myocardial oxygen supply through a redistribution of coronary flow, a lengthening

  13. Comparison of beta blocker and digoxin alone and in combination for management of patients with atrial fibrillation and heart failure.

    Fauchier, Laurent; Grimard, Caroline; Pierre, Bertrand; Nonin, Emilie; Gorin, Laurent; Rauzy, Bruno; Cosnay, Pierre; Babuty, Dominique; Charbonnier, Bernard

    2009-01-15

    In patients with atrial fibrillation (AF) and heart failure (HF), beta blockers and digoxin reduce the ventricular rate, but controversy exists concerning how these drugs affect prognosis in this setting. This study compared the effects of beta blocker and digoxin on mortality in patients with both AF and HF. In a single-center institution, patients with AF and HF seen between January 2000 and January 2004 were identified and followed until September 2007. Of 1,269 consecutive patients with both AF and HF, 260 were treated with a beta blocker alone, 189 with beta blocker plus digoxin, 402 with digoxin alone, and 418 without beta blocker or digoxin (control group). During a follow-up of 881+/-859 days, 247 patients died. Compared with the control group, treatment with beta blocker was associated with a decreased mortality (relative risk=0.58, 95% confidence interval 0.40 to 0.85, p=0.005 for beta blocker alone and 0.59, 95% confidence interval 0.40 to 0.87, p=0.008 for beta blocker plus digoxin). By contrast, treatment with digoxin alone was not associated with a better survival (relative risk=0.97, 95% confidence interval 0.73 to 1.30, p=NS). Results remained significant after adjustment for potential confounders and similar when we considered, separately, HF with permanent or nonpermanent AF, presence or absence of coronary disease, and patients with decreased or preserved systolic function. In conclusion, in unselected patients with AF and HF, treatments with beta blocker alone or with beta blocker plus digoxin are associated with a similar decrease in the risk of death. Digoxin alone is associated with a worse survival chance, similar to that of patients without any rate control treatment. PMID:19121446

  14. Studies of the outcome of the treatment with beta-blockers in secondary prevention of the ischemic heart disease

    Radović Vesna V.

    2009-01-01

    Convincing evidence of the decline of mortality has been achieved with beta-blockers in patients with an acute myocardial infarction and in post-infarction follow-up. The beta-blockers are also the most efficient antianginal medications for the decrease of ischemia in outpatients. They are highly efficient as a monotherapy for angina and are also a medication of choice for angina after the coronary. The objective of this work was an estimate of the use of beta-blockers in secondary prevention...

  15. Use of statins and beta-blockers after acute myocardial infarction according to income and education

    Rasmussen, Jeppe Nørgaard; Gislason, Gunnar H; Rasmussen, Søren;

    2007-01-01

    OBJECTIVE: To study the initiation of and long-term refill persistency with statins and beta-blockers after acute myocardial infarction (AMI) according to income and education. DESIGN AND SETTING: Linkage of individuals through national registers of hospitalisations, drug dispensation, income and...... education. PARTICIPANTS: 30 078 patients aged 30-74 years surviving first hospitalisation for AMI in Denmark between 1995 and 2001. MAIN OUTCOME MEASURES: Initiation of statin or beta-blocker treatment (out-patient claim of prescriptions within 6 months of discharge) and refill persistency (first break in...... treatment lasting at least 90 days, and re-initiation of treatment after a break). RESULTS: When simultaneously estimating the effect of income and education on initiation of treatment, the effect of education attenuated and a clear income gradient remained for both drugs. Among patients aged 30-64 years...

  16. Individual patient data meta-analysis of beta-blockers in heart failure: rationale and design

    Kotecha Dipak

    2013-01-01

    Full Text Available Abstract The Beta-Blockers in Heart Failure Collaborative Group (BB-HF was formed to obtain and analyze individual patient data from the major randomized controlled trials of beta-blockers in heart failure. Even though beta-blockers are an established treatment for heart failure, uptake is still sub-optimal. Further, the balance of efficacy and safety remains uncertain for common groups including older persons, women, those with impaired renal function and diabetes. Our aim is to provide clinicians with a thorough and definitive evidence-based assessment of these agents. We have identified 11 large randomized trials of beta-blockers versus placebo in heart failure and plan to meta-analyze the data on an individual patient level. In total, these trials have enrolled 18,630 patients. Uniquely, the BB-HF group has secured access to the individual data for all of these trials, with the participation of key investigators and pharmaceutical companies. Our principal objectives include deriving an overall estimate of efficacy for all-cause mortality and cardiovascular hospitalization. Importantly, we propose a statistically-robust sub-group assessment according to age, gender, diabetes and other key factors; analyses which are only achievable using an individual patient data meta-analysis. Further, we aim to provide an assessment of economic benefit and develop a risk model for the prognosis of patients with chronic heart failure. This paper outlines inclusion criteria, search strategies, outcome measures and planned statistical analyses. Trial registration Clinical trial registration information: http://clinicaltrials.gov/ct2/show/NCT00832442

  17. ENDOTHELIAL DYSFUNCTION AND ROLE NITRATES AND BETA-BLOCKERS IN ITS CORRECTION IN ISCHEMIC HEART DISEASE

    A. N. Britov

    2016-01-01

    The role of endothelial dysfunction in the pathogenesis of ischemic heart disease and some other cardiovascular diseases is considered. The endothelial dysfunction takes place at the earliest stages of diseases. The interaction of vasodilator and vasoconstrictor factors produced by vascular endothelium is discussed. The treating effect of some medicinal products (nitrates, beta-blockers and others) is analyzed from the point of view of their correcting influence on endothelial function.

  18. Esmolol: A Unique Beta-Blocker in Maintaining Cardiovascular Stability Following Neurosurgical Procedures

    Samad EJ Golzari; Kamyar Ghabili; Mehdi Ghaffarlou; Mahmood Eydi; Hamzeh Hosseinzadeh

    2012-01-01

    Purpose: Patients with increased intracranial pressure (ICP) are prone to severe cardiac and or cerebral complications following emergence from general anesthesia and especially post-extubation phase. Administering beta blockers including esmolol is believed to be helpful in providing a stable hemodynamic at the end of the surgery and recovery stages and reducing recovery phase length. Methods: In a double-blind prospective randomized clinical trial, 60 adult patients with ASA (American Socie...

  19. Application of Beta Blockers in the Treatment of Heart Failure%β-受体阻滞剂在心力衰竭治疗中的应用

    唐荣华

    2014-01-01

    在对心力衰竭治疗过程中β受体阻滞剂为基本的药物。然而,在临床上怎样才能正确的应用β受体阻滞剂是对临床医生造成困扰的一个问题。优势在于心力衰竭指南能够依据循证医学证据为临床治疗提供大的治疗方向。劣势在于怎样根据患者的具体情况实施有针对性的治疗方案,这是一个非常棘手的问题。因而,临床医生对指南正确理解,同时以指南为依据结合患者临床实际情况,对β受体阻滞剂的使用情况进行有针对性的应用,这样能够使药物发挥更好的临床效果。%In the treatment of heart failure of beta blockers in the process of basic drugs.However,in clinical on how to correctly use of beta blockers is a problem caused problems for clinicians.Advantage of heart failure guidelines can according to evidence based medicine treatment direction for the clinical treatment of.The disadvantage is that how to according to the specific circumstances of patients implement targeted treatment programs,this is a very difficult problem.Thus,clinicians to guide correct understanding,at the same time to guide as the basis and combining with the actual situation of patients,the use of beta blockers for targeted applications,such clinical effects can make medicines work better.

  20. How Administration of the Beta-Blocker Propranolol Before Extinction can Prevent the Return of Fear.

    Kroes, Marijn C W; Tona, Klodiana-Daphne; den Ouden, Hanneke E M; Vogel, Susanne; van Wingen, Guido A; Fernández, Guillén

    2016-05-01

    Combining beta-blockers with exposure therapy has been advocated to reduce fear, yet experimental studies combining beta-blockers with memory reactivation have had contradictory results. We explored how beta-blockade might affect the course of safety learning and the subsequent return of fear in a double-blind placebo-controlled functional magnetic resonance imaging study in humans (N=46). A single dose of propranolol before extinction learning caused a loss of conditioned fear responses, and prevented the subsequent return of fear and decreased explicit memory for the fearful events in the absence of drug. Fear-related neural responses were persistently attenuated in the dorsal medial prefrontal cortex (dmPFC), increased in the hippocampus 24 h later, and correlated with individual behavioral indices of fear. Prediction error-related responses in the ventral striatum persisted during beta-blockade. We suggest that this pattern of results is most consistent with a model where beta-blockade can prevent the return of fear by (i) reducing retrieval of fear memory, via the dmPFC and (ii) increasing contextual safety learning, via the hippocampus. Our findings suggest that retrieval of fear memory and contextual safety learning form potential mnemonic target mechanisms to optimize exposure-based therapy with beta-blockers. PMID:26462618

  1. Mortality and reinfarction among patients using different beta-blockers for secondary prevention after a myocardial infarction

    Andersen, Søren Skøtt; Hansen, Morten Lock; Gislason, Gunnar H;

    2009-01-01

    OBJECTIVES: To study differences in the clinical efficacy of various brands of beta-blocker in secondary prevention after a myocardial infarction (MI). METHODS: All patients hospitalized with a first MI between 1995 and 2002 who were still alive 30 days after discharge and had had at least one...... prescription for a beta-blocker filled were identified by individual-level linkage of nationwide registries of hospitalizations and drugs dispensed from pharmacies. A total of 32,259 MI patients were included in the study. Multivariable Cox proportional hazard models were used to analyze the risks of death and...... recurrent MI related to treatment with different beta-blockers. RESULTS: The risks for death and recurrent MI were similar in patients using different beta-blockers, except that mortality from all causes among patients with a prescription for sotalol was higher. Subgroup analyses of high-risk patients with...

  2. Pre-treatment with beta blockers and the frequency of hypokalaemia in patients with acute chest pain.

    Simpson, E; Rodger, J C; Raj, S. M.; Wong, C.; Wilkie, L; Robertson, C.

    1987-01-01

    Plasma potassium concentration was measured at admission in 1234 patients who presented with acute chest pain. One hundred and ninety five patients were on beta blockers before admission. The potassium concentrations of patients admitted early (within four hours of onset of symptoms) were compared with those admitted later (4-18 hours after onset of symptoms). There was a transient fall in plasma potassium concentrations in patients not pre-treated with beta blockers. This was not seen in pat...

  3. Primary prevention of atrial fibrillation with beta-blockers in patients with end-stage renal disease undergoing dialysis

    Ting-Tse Lin; Jiun-Yang Chiang; Min-Tsun Liao; Chia-Ti Tsai; Juey Jen Hwang; Fu-Tien Chiang; Jiunn-Lee Lin; Lian-Yu Lin

    2015-01-01

    Current evidence suggests that beta-blocker lower the risk of development of atrial fibrillation (AF) and in-hospital stroke after cardiac surgery. This study was to assess whether beta-blockers could decrease incidence of new-onset AF in patients with end stage renal disease (ESRD). We identified patients from a nation-wide database called Registry for Catastrophic Illness, which encompassed almost 100% of the patients receiving dialysis therapy in Taiwan from 1995 to 2008. Propensity score ...

  4. Night-time exogenous melatonin administration may be a beneficial treatment for sleeping disorders in beta blocker patients

    Fares, Auda

    2011-01-01

    Sleep disorders are the common side effects of beta blockers. Beta blockers have been shown to reduce the production of melatonin via specific inhibition of adrenergic beta1-receptors. Exogenous melatonin, taken in the evening as a supplement, could reduce the central nervous system (CNS) side effects (sleep disorder) associated with beta-adrenergic receptor blockers as well as the potential risk associated with reduction of the melatonin synthesis.

  5. Beta-Blockers, Left and Right Ventricular Function, and In-Vivo Calcium Influx in Muscular Dystrophy Cardiomyopathy

    Alison Blain; Elizabeth Greally; Steve Laval; Andrew Blamire; Volker Straub; MacGowan, Guy A.

    2013-01-01

    Beta-blockers are used to treat acquired heart failure in adults, though their role in early muscular dystrophy cardiomyopathy is unclear. We treated 2 different dystrophic mouse models which have an associated cardiomyopathy (mdx: model for Duchenne Muscular Dystrophy, and Sgcd-/-: model for limb girdle muscular dystrophy type 2F) and wild type controls (C57 Bl10) with the beta blocker metoprolol or placebo for 8 weeks at an early stage in the development of the cardiomyopathy. Left and righ...

  6. Central origin of respiratory arrest in beta-blocker intoxication in rats

    Langemeijer, J.J.M.; de Wildt, D J; de Groot, G.; Sangster, B.

    1987-01-01

    Propranolol HCl (7.5 mg·kg−1), timolol maleate (7.0 mg·kg−1), and sotalol HCl (10 mg·kg−1) were administered intracerebroventricularly (icv) to spontaneously breathing (SB) rats. The respiratory rate declined until the rats all died from respiratory arrest. Artificial ventilation resulted in survival of the rats for a 3-hr observation period. Intravenous (iv) administration of the same doses of the three beta blockers to SB rats did not result in either respiratory depression or death. Except...

  7. Effect of short-acting beta blocker on the cardiac recovery after cardiopulmonary bypass

    Qian Yanning

    2011-08-01

    Full Text Available Abstract The objective of this study was to investigate the effect of beta blocker on cardiac recovery and rhythm during cardiac surgeries. Sixty surgical rheumatic heart disease patients were received esmolol 1 mg/kg or the same volume of saline prior to removal of the aortic clamp. The incidence of cardiac automatic re-beat, ventricular fibrillation after reperfusion, the heart rate after steady re-beat, vasoactive drug use during weaning from bypass, the posterior parallel time and total bypass time were decreased by esmolol treatment. In conclusion: Esmolol has a positive effect on the cardiac recovery in cardiopulmonary bypass surgeries.

  8. Effect of beta-blocker therapy on functional status in patients with heart failure--a meta-analysis

    Abdulla, Jawdat; Køber, Lars; Christensen, Erik;

    2005-01-01

    BACKGROUND: The results of randomised control trials (RCTs) evaluating the effect of beta-blockers on functional status in patients with chronic heart failure are conflicting. AIM: To perform a systematic review and meta-analysis of RCTs evaluating the effect of beta-blockers on New York Heart...... Association (NYHA) classification and exercise tolerance in chronic heart failure. METHODS AND RESULTS: We selected 28 RCTs evaluating beta-blocker versus placebo in addition to ACE inhibitor therapy. Combined results of 23 RCTs showed that beta-blockers improved NYHA class by at least one class with odds...... ratio (OR) 1.80 (1.33-2.43) p<0.0001. Meta-analysis of 10 RCTs showed a significant prolongation of exercise time by 44.19 (6.62-81.75) s p=0.021. Combining 8 RCTs evaluating the maximal peak oxygen uptake and 9 RCTs evaluating 6-min walk distance showed that beta-blockers had no significant effect...

  9. [Are the theoretical drawbacks of beta-blocker treatment in pregnancy being confirmed? A review of the literature].

    Tcherdakoff, P; Goupil-Colliard, M

    1983-01-01

    The use of beta-blocking drugs in the treatment of hypertension during pregnancy has been the subject of controversies on the basis of theoretical hazards due to the pharmacology and pharmacokinetic characteristics of these drugs. A review of the literature on the subject shows that: The danger of premature contractions, abortion or premature delivery does not seem to increase with the use of beta-blockers. The blood supply is not more impaired with beta-blockers than with other antihypertensive drugs according to fetal growth, birth-weight, frequency of perinatal deaths or APGAR score. Although beta-blocking drugs pass into fetal circulation, neonatal bradycardia, respiratory distress or hypoglycemia do not seem more frequent with beta-blockers. Beta-blockers pass from maternal plasma into milk but the 24 hour dose brought to the newborn by maternal feeding is so slight as to be negligible. Thus, the cumulative data and the favorable opinions of many authors, the greater efficiency of beta-blockers authorizes the use of these drugs in the treatment of hypertension in pregnancy, where it seems to improve the outcome of the pregnancy and the state of the fetus at birth. PMID:6138464

  10. Treatment with oral beta-blockers during pregnancy complicated by maternal heart disease increases the risk of fetal growth restriction

    Ersbøll, A S; Hedegaard, M; Søndergaard, L;

    2014-01-01

    OBJECTIVE: To investigate the effect on fetal growth of treatment with oral beta-blockers during pregnancy in women with congenital or acquired heart disease. DESIGN: Historical matched cohort study. SETTING: Centre for Pregnant Women with Heart Disease, Copenhagen University Hospital, Denmark....... POPULATION: A cohort of 175 women with heart disease, grouped according to beta-blocker treatment, and a cohort of 627 women from the overall population matched on seven birthweight-determining factors. METHODS: Differences between groups were tested by simple descriptive statistics and assessed using...... standard hypothesis tests. Associations were estimated by correlational analysis and multivariable regression. MAIN OUTCOME MEASURE: Proportion of infants born small for gestational age (SGA). RESULTS: More of the infants exposed to beta-blockers were SGA compared with non-exposed infants (29.4 versus 15...

  11. Impact of oral beta-blocker therapy on mortality after primary percutaneous coronary intervention for Killip class 1 myocardial infarction.

    Hioki, Hirofumi; Motoki, Hirohiko; Izawa, Atsushi; Kashima, Yuichirou; Miura, Takashi; Ebisawa, Souichirou; Tomita, Takeshi; Miyashita, Yusuke; Koyama, Jun; Ikeda, Uichi

    2016-05-01

    The use of beta-blockers therapy has been recommended to reduce mortality in patients with left ventricular dysfunction after acute myocardial infarction (AMI). Primary percutaneous coronary intervention (PCI), which has become the mainstay of treatment for AMI, is associated with a lower mortality than fibrinolysis. The benefits of beta-blockers after primary PCI in AMI patients without pump failure are unclear. We hypothesized that oral beta-blocker therapy after primary PCI might reduce the mortality in AMI patients without pump failure. The assessment of lipophilic vs. hydrophilic statin therapy in acute myocardial infarction (ALPS-AMI) study was a multi-center study that enrolled 508 AMI patients to compare the efficacy of hydrophilic and lipophilic statins in secondary prevention after myocardial infarction. We prospectively tracked cardiovascular events for 3 years in 444 ALPS-AMI patients (median age 66 years; 18.2 % women) who had Killip class 1 on admission and were discharged alive. The primary endpoint was all-cause mortality. The 3-year follow-up was completed in 413 patients (93.0 %). During this follow-up, 21 patients (4.7 %) died. In Kaplan-Meier analysis, patients on beta-blockers had a significantly lower incidence of all-cause mortality (2.7 vs. 7.3 %, log-rank p = 0.025). After adjusting for the calculated propensity score for using beta-blockers, their use remained an independent predictor of all-cause mortality (hazard ratio 0.309; 95 % confidence interval 0.116-0.824; p = 0.019). In the statin era, the use of beta-blocker therapy after primary PCI is associated with lower mortality in AMI patients with Killip class 1 on admission. PMID:25863805

  12. Non-selective vs. selective beta-blocker treatment and the risk of thrombo-embolic events in patients with heart failure

    O.R. de Peuter; P.C. Souverein; O.H. Klungel; H.R. Büller; A. de Boer; P.W. Kamphuisen

    2011-01-01

    Aims Heart failure (HF) is associated with a prothrombotic state, resulting in an increased risk for thrombo-embolic events. Studies suggest a reduced prothrombotic state when non-selective beta-blockers relative to selective beta-blockers are given. We studied the influence of non-selective beta-bl

  13. Heart rate reduction and exercise performance in recent onset heart failure with reduced ejection fraction: arguments for beta-blocker hypo-response

    Verbrugge, Frederik Hendrik; Vrijsen, Jeroen; Vercammen, Jan; Grieten, Lars; Dupont, Matthias; Mullens, Wilfried

    2015-01-01

    Objective Beta blockers reduce all-cause mortality and readmissions in heart failure with reduced ejection fraction (HFrEF), which may be explained by their effect on heart rate (HR). This study assessed the impact of HR reduction with beta blockers on exercise capacity in recent onset HFrEF. Methods and results Fifty consecutive patients with recent onset HFrEF (

  14. High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning.

    Engebretsen, Kristin M; Kaczmarek, Kathleen M; Morgan, Jenifer; Holger, Joel S

    2011-04-01

    INTRODUCTION. High-dose insulin therapy, along with glucose supplementation, has emerged as an effective treatment for severe beta-blocker and calcium channel-blocker poisoning. We review the experimental data and clinical experience that suggests high-dose insulin is superior to conventional therapies for these poisonings. PRESENTATION AND GENERAL MANAGEMENT. Hypotension, bradycardia, decreased systemic vascular resistance (SVR), and cardiogenic shock are characteristic features of beta-blocker and calcium-channel blocker poisoning. Initial treatment is primarily supportive and includes saline fluid resuscitation which is essential to correct vasodilation and low cardiac filling pressures. Conventional therapies such as atropine, glucagon and calcium often fail to improve hemodynamic status in severely poisoned patients. Catecholamines can increase blood pressure and heart rate, but they also increase SVR which may result in decreases in cardiac output and perfusion of vascular beds. The increased myocardial oxygen demand that results from catecholamines and vasopressors may be deleterious in the setting of hypotension and decreased coronary perfusion. METHODS. The Medline, Embase, Toxnet, and Google Scholar databases were searched for the years 1975-2010 using the terms: high-dose insulin, hyperinsulinemia-euglycemia, beta-blocker, calcium-channel blocker, toxicology, poisoning, antidote, toxin-induced cardiovascular shock, and overdose. In addition, a manual search of the Abstracts of the North American Congress of Clinical Toxicology and the Congress of the European Association of Poisons Centres and Clinical Toxicologists published in Clinical Toxicology for the years 1996-2010 was undertaken. These searches identified 485 articles of which 72 were considered relevant. MECHANISMS OF HIGH-DOSE INSULIN BENEFIT. There are three main mechanisms of benefit: increased inotropy, increased intracellular glucose transport, and vascular dilatation. EFFICACY OF HIGH

  15. Utility of atropine in patients under beta-blocker effect during exercise stress echocardiography

    The objective is to assess the usefulness of adding atropine 0.5 to 1.0 mg by intravenous injection during peak exercise in patients under beta-blocker effect that are subjected to exercise stress echocardiography. Population: exercise stress echocardiography was performed in 73 patients receiving beta-blocking agents with basal heart rate below 60 beats per minute (BPM). Two groups were established at random: group I (18 patients that did not receive atropine during maximal exercise) and group II (50 patients from whom 28 received 0.5 mg atropine IV 30 seconds to one minute before concluding the exercise and 22 patients who received 1.0 mg atropine IV 30 seconds to one minute before its conclusion). From a demographic point of view, there were no differences between the two groups. Mean age was 59 ± 10.8 years (57% male). Most of the patients received metoprolol (87%) and no significant statistical differences in relation with the doses were found in these two groups. At the end of the exercise, the patients had a mean heart rate of 84% from their maximal heart rate (MHR). The values post-exercise were 76% at 30 seconds, 68% at 60 sec., 62% at 90 sec., and 59% of the maximal heart rate at 120 sec. When comparing the percentage of the maximal heart rate achieved in maximal exercise and the one observed during the first 120 sec. after exercise, no statistically significant difference was observed between the two groups (p > 0.05). Conclusion: during the performance of stress exercise echocardiography, the administration of intravenous atropine was of no use for incrementing the peak heart rate post-exercise in patients with significant beta-blocker effect (basal heart rate < 60 BPM)

  16. Is heart rate reduction more important than target dose in chronic heart failure therapy with a beta-blocker?

    Yong-Fang Guo; Yi An

    2011-01-01

    1 IntroductionBeta-adrenoceptor blocking agents (beta-blockers) are now well established as cornerstone therapy in patients with systolic chronic heart failure (CHF).[1] Clinical data have overwhelmingly proven the beneficial effects of beta-blocker therapy in terms of improving patient prognosis,decreasing requirements for hospitalization,and postponing disease progression.[2-4] However,it remains unclear what the optimal efficacious and safe dose for an individual patient with CHF is,and whether this can simply be inferred from the target dose for each beta-blocking agent as used in the major clinical trials.Beta-blockers are a heterogeneous class of drugs,and due to the polymorphisms of beta-adrenoceptor gene expression,there is marked individual variation in responsiveness to specific agents.[5] If pharmacodynamic markers of responsiveness to beta-blockade (such as heart rate (HR) reduction) are more important than the achievement of a target dose,could they become another potential therapeutic target in beta-blocker therapy? We provide a discussion of the question in this article.

  17. The safety of beta-blocker use in chronic obstructive pulmonary disease patients with respiratory failure in the intensive care unit

    Kargin, Feyza; Takir, Huriye Berk; Salturk, Cuneyt; Goksenoglu, Nezihe Ciftaslan; Karabay, Can Yucel; Mocin, Ozlem Yazicioglu; Adiguzel, Nalan; Gungor, Gokay; Balci, Merih Kalamanoglu; Yalcinsoy, Murat; Kargin, Ramazan; Karakurt, Zuhal

    2014-01-01

    Background The safety of beta-blockers as a heart rate-limiting drug (HRLD) in patients with acute respiratory failure (ARF) due to chronic obstructive lung disease (COPD) has not been properly assessed in the intensive care unit (ICU) setting. This study aims to compare the use of beta-blocker drugs relative to non-beta-blocker ones in COPD patients with ARF due to heart rate-limiting with respect to length of ICU stay and mortality. Methods We performed a retrospective (January 2011-Decembe...

  18. Management of Agitation Following Aneurysmal Subarachnoid Hemorrhage: Is There a Role for Beta-Blockers?

    Fayaz Ibrahim

    2012-01-01

    Full Text Available Introduction. Stroke is a leading cause of mortality and morbidity in the United States. About 20% of the stroke is hemorrhagic and about 50% of these is due to aneurysmal subarachnoid hemorrhage. A troublesome neuropsychiatric complication of subarachnoid hemorrhage is agitation/aggression. Case Presentation. A 45-year-old man with no prior psychiatric history, sustained subarachnoid hemorrhage. After initial stabilization for 2 days, he underwent craniotomy and clipping of anterior cerebral communicating artery aneurysm. Treatment was continued with labetalol, nimodipine, and levetiracetam. Beginning postoperative day 4, patient developed episodes of confusion and agitation/aggression. Switching of Levetiracetam to valproate did not show any improvement. Psychiatry team tried to manage him with intense nursing intervention and different medications like olanzapine, valproate, lorazepam, and haloperidol. However, patient continued to be agitated and aggressive. Switching from labetalol to metoprolol resulted in dramatic improvement within 3 days. Discussion. Antipsychotics and benzodiazepines are often not sufficiently effective in the control of agitation/aggression in patients with traumatic brain injury and similar conditions. Our case report and the literature review including a cochrane review suggests that beta-blockers may be helpful in this situation.

  19. Removal of beta-blockers from aqueous media by adsorption onto graphene oxide.

    Kyzas, George Z; Koltsakidou, Anastasia; Nanaki, Stavroula G; Bikiaris, Dimitrios N; Lambropoulou, Dimitra A

    2015-12-15

    The aim of the present study is the evaluation of graphene oxide (GhO) as adsorbent material for the removal of beta-blockers (pharmaceutical compounds) in aqueous solutions. The composition and morphology of prepared materials were characterized by scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FT-IR). Atenolol (ATL) and propranolol (PRO) were used as model drug molecules and their behavior were investigated in terms of GhO dosage, contact time, temperature and pH. Adsorption mechanisms were proposed and the pH-effect curves after adsorption were discussed. The kinetic behavior of GhO-drugs system was analyzed after fitting to pseudo-first and -second order equations. The adsorption equilibrium data were fitted to Langmuir, Freundlich and Langmuir-Freundlich model calculating the maximum adsorption capacity (67 and 116 mg/g for PRO and ATL (25 °C), respectively). The temperature effect on adsorption was tested carrying out the equilibrium adsorption experiments at three different temperatures (25, 45, 65 °C). Then, the thermodynamic parameters of enthalpy, free energy and entropy were calculated. Finally, the desorption of drugs from GhO was evaluated by using both aqueous eluants (pH2-10) and organic solvents. PMID:26282775

  20. Esmolol: A Unique Beta-Blocker in Maintaining Cardiovascular Stability Following Neurosurgical Procedures

    Samad EJ Golzari

    2012-08-01

    Full Text Available Purpose: Patients with increased intracranial pressure (ICP are prone to severe cardiac and or cerebral complications following emergence from general anesthesia and especially post-extubation phase. Administering beta blockers including esmolol is believed to be helpful in providing a stable hemodynamic at the end of the surgery and recovery stages and reducing recovery phase length. Methods: In a double-blind prospective randomized clinical trial, 60 adult patients with ASA (American Society of Anesthesiologist class of I-II scheduled to undergo elective neurosurgery operations were randomly divided into two groups receiving esmolol (n=30 and placebo (n=30 as IV infusion within four minutes prior to extubation continued by an IV infusion for 10 minutes after extubation. Results: There was a significant difference between two groups regarding the changes of systolic blood pressure and heart rate at all studied stages after extubation (P≤0.05. However, no significant difference existed between esmolol and control groups regarding recovery and extubation times emphasizing the fact that esmolol is of excellent early recovery and extubation profiles. Conclusion: Esmolol is advised to be used in preventing hyperdynamic status throughout extubation phase without extending recovery phase length.

  1. Biodegradation and cometabolic modeling of selected beta blockers during ammonia oxidation.

    Sathyamoorthy, Sandeep; Chandran, Kartik; Ramsburg, C Andrew

    2013-11-19

    Accurate prediction of pharmaceutical concentrations in wastewater effluents requires that the specific biochemical processes responsible for pharmaceutical biodegradation be elucidated and integrated within any modeling framework. The fate of three selected beta blockers-atenolol, metoprolol, and sotalol-was examined during nitrification using batch experiments to develop and evaluate a new cometabolic process-based (CPB) model. CPB model parameters describe biotransformation during and after ammonia oxidation for specific biomass populations and are designed to be integrated within the Activated Sludge Models framework. Metoprolol and sotalol were not biodegraded by the nitrification enrichment culture employed herein. Biodegradation of atenolol was observed and linked to the activity of ammonia-oxidizing bacteria (AOB) and heterotrophs but not nitrite-oxidizing bacteria. Results suggest that the role of AOB in atenolol degradation may be disproportionately more significant than is otherwise suggested by their lower relative abundance in typical biological treatment processes. Atenolol was observed to competitively inhibit AOB growth in our experiments, though model simulations suggest inhibition is most relevant at atenolol concentrations greater than approximately 200 ng·L(-1). CPB model parameters were found to be relatively insensitive to biokinetic parameter selection suggesting the model approach may hold utility for describing pharmaceutical biodegradation during biological wastewater treatment. PMID:24112027

  2. Oral physiology, nutrition and quality of life in diabetic patients associated or not with hypertension and beta-blockers therapy.

    Pereira, L J; Foureaux, R C; Pereira, C V; Alves, M C; Campos, C H; Rodrigues Garcia, R C M; Andrade, E F; Gonçalves, T M S V

    2016-07-01

    The relationship between type 2 diabetes oral physiology, nutritional intake and quality of life has not been fully elucidated. We assessed the impact of type 2 diabetes - exclusive or associated with hypertension with beta-blockers treatment - on oral physiology, mastication, nutrition and quality of life. This cross-sectional study was performed with 78 complete dentate subjects (15 natural teeth and six masticatory units minimum; without removable or fixed prostheses), divided into three groups: diabetics (DM) (n = 20; 45·4 ± 9·5 years), diabetics with hypertension and receiving beta-blockers treatment (DMH) (n = 19; 41·1 ± 5·1 years) and controls (n = 39; 44·5 ± 11·7 years) matched for gender, age and socioeconomic status. Blood glucose, masticatory performance, swallowing threshold, taste, food intake, stimulated and unstimulated salivary flow, pH and buffering capacity of saliva were assessed. Glycemia was higher in DM than in controls (P physiology, nutrition or quality of life. However, when hypertension and beta-blockers treatment were associated with diabetes, the salivary flow rate, chewing cycles and number of teeth decreased. PMID:27043215

  3. Dose dependent effect of statins on postoperative atrial fibrillation after cardiac surgery among patients treated with beta blockers

    Kelly Rosemary F

    2009-11-01

    Full Text Available Abstract Background Previous studies on the effects of Statins in preventing atrial fibrillation (AF after cardiac surgery have shown conflicting results. Whether statins prevent AF in patients treated with postoperative beta blockers and whether the statin-effect is dose related are unknown. Methods We retrospectively studied 1936 consecutive patients who underwent coronary artery bypass graft (CABG (n = 1493 or valve surgery (n = 443 at the Minneapolis Veterans Affairs Medical Center. All patients were in sinus rhythm before the surgery. Postoperative beta blockers were administered routinely (92% within 24 hours postoperatively. Results Mean age was 66+10 years and 68% of the patients were taking Statins. Postoperative AF occurred in 588 (30% patients and led to longer length of stay in the intensive care unit versus those without AF (5.1+7.6 days versus 2.5+2.3 days, p 20 mg daily had a 36% reduction in the risk of postoperative AF (OR 0.64, 95% CI 0.43 to 0.6; p = 0.03 in comparison to those taking lower dosages. Conclusion Among cardiac surgery patients treated with postoperative beta blockers Statin treatment reduces the incidence of postoperative AF when used at higher dosages

  4. Association of beta-Blocker Therapy With Risks of Adverse Cardiovascular Events and Deaths in Patients With Ischemic Heart Disease Undergoing Noncardiac Surgery A Danish Nationwide Cohort Study

    Andersson, C.; Merie, C.; Jorgensen, M.;

    2014-01-01

    IMPORTANCE Clinical guidelines have been criticized for encouraging the use of beta-blockers in noncardiac surgery despite weak evidence. Relevant clinical trials have been small and have not convincingly demonstrated an effect of beta-blockers on hard end points (ie, perioperative myocardial...... infarction, ischemic stroke, cardiovascular death, and all-cause death). OBJECTIVE To assess the association of beta-blocker treatment with major cardiovascular adverse events (MACE) and all-cause mortality in patients with ischemic heart disease undergoing noncardiac surgery. DESIGN, SETTING. PARTICIPANTS...... models were used to calculate the 30-day risks of MACE (ischemic stroke, myocardial infarction, or cardiovascular death) and all-cause mortality associated with beta-blocker therapy. MAIN OUTCOMES AND MEASURES Thirty-day risk of MACE and all-cause mortality. RESULTS Of 28 263 patients with ischemic heart...

  5. Nationwide trends in the prescription of beta-blockers and angiotensin-converting enzyme inhibitors after myocardial infarction in Denmark, 1995-2002

    Gislason, Gunnar H; Abildstrom, Steen Z; Rasmussen, Jeppe Nørgaard;

    2005-01-01

    OBJECTIVES: To study the use of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors after acute myocardial infarction (AMI) in Denmark from 1995 to 2002. DESIGN: Information about patients with first AMI aged > or = 30 years and the dispensing of beta-blockers and ACE inhibitors from......-diuretics and antidiabetic drugs received beta-blockers less frequently, but patients taking loop-diuretics or antidiabetic drugs had the greatest increase. ACE inhibitor use increased from 24.5 to 35.5% (OR = 1.86, CI: 1.72-2.01). Women, patients aged or = 80 years and patients not taking loop......-diuretics received ACE inhibitors less frequently, but patients not taking loop-diuretics had the greatest increase. CONCLUSIONS: Beta-blocker use increased markedly post-AMI from 1995 to 2002, whereas ACE inhibitor use increased modestly. The results suggested undertreatment of women, elderly patients and people...

  6. Effect of beta-blocker therapy on the risk of infections and death after acute stroke--a historical cohort study.

    Ilko L Maier

    Full Text Available BACKGROUND: Infections are a frequent cause for prolonged hospitalization and increased mortality after stroke. Recent studies revealed a stroke-induced depression of the peripheral immune system associated with an increased susceptibility for infections. In a mice model for stroke, this immunosuppressive effect was reversible after beta-blocker administration. The aim of our study was to investigate the effect of beta-blocker therapy on the risk of infections and death after stroke in humans. METHODS: 625 consecutive patients with ischemic or hemorrhagic stroke, admitted to a university hospital stroke unit, were included in this historical cohort study. The effect of beta-blocker therapy on post-stroke pneumonia, urinary tract infections and death was investigated using multivariable Poisson and Cox regression models. RESULTS: 553 (88.3% patients were admitted with ischemic stroke, the remaining 72 (11.7% had a hemorrhagic stroke. Median baseline NIHSS was 8 (IQR 5-16 points. 301 (48.2% patients received beta-blocker therapy. There was no difference in the risk of post-stroke pneumonia between patients with and without beta-blocker therapy (Rate Ratio = 1.00, 95%CI 0.77-1.30, p = 0.995. Patients with beta-blocker therapy showed a decreased risk for urinary tract infections (RR = 0.65, 95%CI 0.43-0.98, p = 0.040. 7-days mortality did not differ between groups (Hazard Ratio = 1.36, 95%CI 0.65-2.77, p = 0.425, while patients with beta-blocker therapy showed a higher 30-days mortality (HR = 1.93, 95%CI 1.20-3.10, p = 0.006. CONCLUSIONS: Beta-blocker therapy did not reduce the risk for post-stroke pneumonia, but significantly reduced the risk for urinary tract infections. Different immune mechanisms underlying both diseases might explain these findings that need to be confirmed in future studies.

  7. Meta-analysis of randomized controlled trials on magnesium in addition to beta-blocker for prevention of postoperative atrial arrhythmias after coronary artery bypass grafting

    Wu Xiaosan

    2013-01-01

    Full Text Available Abstract Background Atrial arrhythmia (AA is the most common complication after coronary artery bypass grafting (CABG. Only beta-blockers and amiodarone have been convincingly shown to decrease its incidence. The effectiveness of magnesium on this complication is still controversial. This meta-analysis was performed to evaluate the effect of magnesium as a sole or adjuvant agent in addition to beta-blocker on suppressing postoperative AA after CABG. Methods We searched the PubMed, Medline, ISI Web of Knowledge, Cochrane library databases and online clinical trial database up to May 2012. We used random effects model when there was significant heterogeneity between trials and fixed effects model when heterogeneity was negligible. Results Five randomized controlled trials were identified, enrolling a total of 1251 patients. The combination of magnesium and beta-blocker did not significantly decrease the incidence of postoperative AA after CABG versus beta-blocker alone (odds ratio (OR 1.12, 95% confidence interval (CI 0.86-1.47, P = 0.40. Magnesium in addition to beta-blocker did not significantly affect LOS (weighted mean difference −0.14 days of stay, 95% CI −0.58 to 0.29, P = 0.24 or the overall mortality (OR 0.59, 95% CI 0.08-4.56, P = 0.62. However the risk of postoperative adverse events was higher in the combination of magnesium and beta-blocker group than beta-blocker alone (OR 2.80, 95% CI 1.66-4.71, P = 0.0001. Conclusions This meta-analysis offers the more definitive evidence against the prophylactic administration of intravenous magnesium for prevention of AA after CABG when beta-blockers are routinely administered, and shows an association with more adverse events in those people who received magnesium.

  8. Beta-blocker therapy in patients with left ventricular systolic dysfunction and chronic obstructive lung disease in an ambulatory care setting

    Billups SJ

    2009-12-01

    Full Text Available Objective: To evaluate beta blocker persistence six months after beta-blocker initiation or dose titration in heart failure (HF patients with COPD compared to those without COPD. Secondary objectives included comparison of beta-blocker dose achieved, changes in left ventricular ejection fraction (LVEF and incidence of hospitalizations or emergency department (ED visits during follow-up.Methods: We conducted a matched, retrospective, cohort study including 86 patients with COPD plus concomitant HF (LVEF ≤40% and 137 patients with HF alone. All patients were followed in an outpatient HF clinic. Eligible patients had a documented LVEF ≤40% and were initiated or titrated on a beta-blocker in the HF clinic. Patients were matched based on LVEF (categorized as ≤ 20% or 21-40%, gender, and age (> or ≤70 years. The primary outcome was beta blocker persistence at 6 months. Secondary outcomes were dose achieved, LVEF, and incidence of hospitalizations or ED visits. Results: There were no differences between the COPD and non-COPD groups in beta-blocker persistence at six-month follow-up (94.2% vs. 93.4% respectively, adjusted p=0.842. The proportion of patients who achieved a daily metoprolol dose equivalent of at least 100 mg was similar between the groups (adjusted p=0.188. The percent of patients with at least one ED visit or hospitalization in the six-month post-titration period was substantial but similar between the groups (53.5% and 48.2% for COPD and non-COPD patients, respectively, adjusted p=0.169. Conclusion: Our results support the use of beta-blockers in the population of heart failure patients with COPD and without reactive airway disease.

  9. Withholding or Continuing Beta-Blocker Treatment Before Dipyridamole Myocardial Perfusion Imaging for the Diagnosis of Coronary Artery Disease? a Randomized Clinical Trial

    Babak Fallahi

    2013-01-01

    Full Text Available Although it has been shown that acute beta-blocker administration may reduce the presence or severity of myocardial perfusion defects with dipyridamole stress, little information is available about the potential effect of chronic beta-blocker treatment on the sensitivity of dipyridamole myocardial perfusion imaging (DMPI.Methods As a randomized clinical trial, one hundred twenty patients (103 male and 17 female with angiographically confirmed CAD who were on long-term beta blocker therapy ([greater than or equal to]3 months enrolled in a randomized clinical trial study. The patients were allocated into two groups: Group A (n=60 in whom the beta-blocker agent was discontinued for 72h before DMPI and Group B (n=60 without discontinuation of beta-blockers prior to DMPI.ResultsNo significant difference was noted between the groups concerning age, sex, type of the injected radiotracer and number of involved coronary vessels. The mean rank of total perfusion scores for whole myocardium (irrespective of reversibility or irreversibility in group B was not significantly different from that of group A, (65.75 vs. 55.25, P=0.096. Regarding the only irreversible perfusion defects, the mean rank of perfusion score in group B was higher than that of group A for whole myocardium (72 vs. 49, P=0.0001; however, no difference was noted between two groups for only reversible perfusion defects (61.0 vs. 60.0, P=0.898. The overall sensitivity of DMPI for the diagnosis of CAD in group A (91.7% was not statistically different from group B (90%.ConclusionBeta-blocker withholding before DMPI did not generally affect the sensitivity of the test for the diagnostic purposes in our study. Thus, beta-blocker withdrawal for just the purpose of diagnostic imaging is not mandatory particularly when medication discontinuation may cause the patients to face increased risk of heart events.

  10. The influence of radiation sterilisation on some {beta}-blockers in the solid state

    Marciniec, B. [Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Gruwaldzka Str., 60-780 Poznan (Poland); Ogrodowczyk, M., E-mail: mogrodo@ump.edu.pl [Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Gruwaldzka Str., 60-780 Poznan (Poland); Czajka, B.; Hofman, M. [Department of Cooridinational Chemistry, A. Mickiewicz University, Grunwaldzka 6, 60-780 Poznan (Poland)

    2011-02-20

    Research highlights: {yields} Six {beta}-blockers (acebutolol, alprenolol, atenolol, metoprolol, pindolol, propranolol) in solid phase were exposed to the ionising radiation by e-beam in doses from 25 to 400 kGy. {yields} To establish the effects of irradiation on their physico-chemical properties, the compounds were then analysed by DSC, SEM, XRD and FT-IR. {yields} For alprenolol, propranolol and metoprolol linear relations were found between the irradiation dose and the decrease in the melting point (r = 0.9446-0.9864). {yields} No changes were observed in the FT-IR spectra and in the SEM images of the compounds studied. - Abstract: Six derivatives of aryloxyalkylaminopropanol of known {beta}-adrenolytic activity (acebutolol, alprenolol, atenolol, metoprolol, pindolol, propranolol) in solid phase were exposed to the ionising radiation generated by e-beam of high-energy electrons from an accelerator ({approx}10 MeV) in doses from 25 to 400 kGy. To establish the effects of irradiation on their physico-chemical properties, the compounds were then analysed by differential scanning calorimetry (DSC), scanning electron microscope (SEM), X-ray diffraction (XRD) and FT-IR spectrometry. The standard sterilisation dose (25 kGy) was found to cause no changes in only one derivative - acebutolol, whereas in the other derivatives the irradiation caused colour changes, differences in X-ray diffraction patterns and in the character of DSC curves, including a decrease in the melting point. For each derivative one clear peak corresponding to the process of melting was observed and its position shifted towards lower temperatures with increasing dose of irradiation. For all compounds studied the value of the shift was between 0.1 and 1.0 {sup o}C. For alprenolol, propranolol and metoprolol linear relations were found between the irradiation dose and the decrease in the melting point, described by the correlation coefficient (between 0.9446 and 0.9864). No changes were observed in

  11. Beta-blockers, left and right ventricular function, and in-vivo calcium influx in muscular dystrophy cardiomyopathy.

    Alison Blain

    Full Text Available Beta-blockers are used to treat acquired heart failure in adults, though their role in early muscular dystrophy cardiomyopathy is unclear. We treated 2 different dystrophic mouse models which have an associated cardiomyopathy (mdx: model for Duchenne Muscular Dystrophy, and Sgcd-/-: model for limb girdle muscular dystrophy type 2F and wild type controls (C57 Bl10 with the beta blocker metoprolol or placebo for 8 weeks at an early stage in the development of the cardiomyopathy. Left and right ventricular function was assessed with cardiac magnetic resonance imaging (MRI and in-vivo myocardial calcium influx with manganese enhanced MRI. In the mdx mice at baseline there was reduced stroke volume, cardiac index, and end-diastolic volume with preserved left ventricular ejection fraction. These abnormalities were no longer evident after treatment with beta-blockers. Right ventricular ejection fraction was reduced and right ventricular end-systolic volume increased in the mdx mice. With metoprolol there was an increase in right ventricular end-diastolic and end-systolic volumes. Left and right ventricular function was normal in the Sgcd-/- mice. Metroprolol had no significant effects on left and right ventricular function in these mice, though heart/body weight ratios increased after treatment. In-vivo myocardial calcium influx with MEMRI was significantly elevated in both models, though metoprolol had no significant effects on either. In conclusion, metoprolol treatment at an early stage in the development of cardiomyopathy has deleterious effects on right ventricular function in mdx mice and in both models no effect on increased in-vivo calcium influx. This suggests that clinical trials need to carefully monitor not just left ventricular function but also right ventricular function and other aspects of myocardial metabolism.

  12. Early intravenous beta-blockers in patients with acute coronary syndrome–A meta-analysis of randomized trials

    Chatterjee, Saurav; Chaudhuri, Debanik; Vedanthan, Rajesh; Fuster, Valentin; Ibanez, Borja; Bangalore, Sripal; Mukherjee, Debabrata

    2014-01-01

    Background Intravenous (IV) beta-blockade is currently a Class IIa recommendation in early management of patients with acute coronary syndromes (ACS) without obvious contraindications. Methods We searched the PubMed, EMBASE and the Cochrane Register for Controlled Clinical Trials for randomized clinical trials from 1965 through December, 2011, comparing intravenous beta-blockers administered within 12 hours of presentation of ACS with standard medical therapy and/or placebo. The primary outcome assessed was the risk of short-term (in-hospital mortality-with maximum follow up duration of 90 days) all-cause mortality in the intervention group versus the comparator group. The secondary outcomes assessed were ventricular tachyarrhythmias, myocardial reinfarction, cardiogenic shock, and stroke. Pooled treatment effects were estimated using relative risk with Mantel–Haenszel risk ratio, using a random-effects model. Results Sixteen studies enrolling 73,396 participants met the inclusion / exclusion criteria. In- hospital mortality was reduced 8% with intravenous beta-blockers, RR=0.92 (95% CI, 0.86–1.00; p=0.04) when compared with controls. Moreover, intravenous beta-blockade reduced the risk of ventricular tachyarrhythmias (RR=0.61; 95 % CI 0.47–0.79; p=0.0003) and myocardial reinfarction (RR=0.73, 95 % CI 0.59–0.91; p=0.004) without increase in the risk of cardiogenic shock, (RR=1.02; 95% CI 0.77–1.35; p=0.91) or stroke (RR=0.58; 95 % CI 0.17–1.98; p=0.38). Conclusions Intravenous beta-blockers early in the course of appropriate patients with ACS appears to be associated with significant reduction in the risk of short-term cardiovascular outcomes, including a reduction in the risk of all-cause mortality. PMID:23168009

  13. Can brown fat uptake of 18F-FDG be reduced by beta-blockers?

    With the increasing application of F-18-fluorodeoxyglucose (FDG) positron emission imaging, there has been an evolving appreciation for the range of normal variants and the realization that false- positives can lead to serious consequences. One of the most common causes of a false-positive study is the uptake of FDG in areas of brown adipose tissue. BAT is generally present in deep cervical regions, including the supraclavicular areas, the interscapular and paravertebral regions, and areas near large vessels. Areas of involvement are often spatially closely related to important lymph node groups in the neck, axilla, and upper mediastinum, making critical differentiation difficult. The uptake of 18F FDG in brown adipose tissue (BAT) limits the ability of a PET scan to detect the sites of viable disease. Many studies have been done after premedication with Diazepam (benzodiazepines) to reduce the uptake of FDG by brown fat. But they are of limited value. Thus, it would be ideal if a drug could completely reverse the brown fat uptake and thus aid in proper management of the patient. The aim of this study is to see if by giving a single dose of a beta-blocker such as 'Ciplar' (Propranolol) 40 mg, 30 minutes prior to the FDG injection will help in reduction of brown fat uptake of 18F-FDG or not. Materials and Methods: Patients who were referred for a PET scan, either for a pretreatment or a post treatment evaluation and who showed FDG uptake in brown adipose tissue (BAT) were taken up for this study. The total number of patients was 14. A repeat PET scan was done after a gap of at least 48 hrs after the first study. The patients were advised to keep themselves warm with adequate warm clothing on the day of the second study. 40 mg of 'Ciplar' (propranolol) was given orally 30 minutes prior to the 18F-FDG injection. A whole body PET scan was performed on a dedicated whole body PET scanner (ADVANCE, GE Medical Systems, Milwaukee, WI.), using attenuation correction with 68

  14. How should we manage heart failure developing in patients already treated with angiotensin-converting enzyme inhibitors and beta-blockers for hypertension, diabetes or coronary disease?

    Gustafsson, Finn; Segura, Julian; Ruilope, Luis M

    2010-01-01

    An increasing number of patients in the community are being treated with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and beta-blockers for hypertension, coronary disease or diabetic renal and vascular complications. Some of these patients will develop heart...... failure despite such treatment. Based on data from hypertension trials it can be estimated that approximately 5% of treated patients will develop heart failure over 5 years. It is unclear whether patients developing heart failure on and off ACE-inhibitors or beta-blockers, respectively, at the time of...... heart failure diagnosis have similar prognosis.Treatment options for patients developing heart failure while already treated with ACE inhibitors/ARBs and beta-blockers are very limited if current heart failure guidelines are followed. In this review possible strategies are outlined and important areas...

  15. How should we manage heart failure developing in patients already treated with angiotensin-converting enzyme inhibitors and beta-blockers for hypertension, diabetes or coronary disease?

    Gustafsson, Finn; Segura, Julian; Ruilope, Luis M

    2010-01-01

    An increasing number of patients in the community are being treated with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and beta-blockers for hypertension, coronary disease or diabetic renal and vascular complications. Some of these patients will develop heart...... failure despite such treatment. Based on data from hypertension trials it can be estimated that approximately 5% of treated patients will develop heart failure over 5 years. It is unclear whether patients developing heart failure on and off ACE-inhibitors or beta-blockers, respectively, at the time...... of heart failure diagnosis have similar prognosis.Treatment options for patients developing heart failure while already treated with ACE inhibitors/ARBs and beta-blockers are very limited if current heart failure guidelines are followed. In this review possible strategies are outlined and important areas...

  16. Fatal Case of Recurrent Takotsubo Cardiomyopathy Presenting with Cardiac Arrest and Variable Ventricular Involvement What Role Beta Agonist and Beta Blockers?

    Sharrett, Jonathan; Surabhi, Satish; Philips, Scott; Morse, Harold

    In conclusion, we believe that the demise of the patient is due to the combination of severe emotional distress, respiratory distress with fear of impending doom, and the overuse of B2 agonists likely created an opportune environment for Takotsubo cardiomyopathy. We also propose a mechanism whereby recurrences with different wall motion variants may occur during beta blocker therapy. PMID:27141704

  17. Treatment with non-selective beta-blockers is associated with reduced severity of systemic inflammation and improved survival of patients with acute-on-chronic liver failure

    Mookerjee, Rajeshwar P; Pavesi, Marco; Thomsen, Karen Louise;

    2016-01-01

    BACKGROUND AND AIMS: Non-selective beta-blockers (NSBBs) have been shown to have deleterious outcomes in patients with refractory ascites, alcoholic hepatitis and spontaneous bacterial peritonitis leading many physicians to stop the drug in these cases. Acute on chronic liver failure (ACLF) is...

  18. Reseaech progress on the application of beta blockers in cancer%β受体阻滞剂在癌症中应用的研究进展

    房晶雪; 程刚

    2015-01-01

    Beta blockers were the first-line drugs for the treatment of hypertension. In recent years,studies had shown that beta blockers was benefit for the survival of cancer patients,but there is a controversial. This article reviewed the uses of beta blockers in cancer in preclinical studies and clinical researches over the last three years, in order to study the role of beta blockers in cancer.%β受体阻滞剂是治疗高血压的一线药物. 近年研究表明,β受体阻滞剂的使用对癌症患者的生存有益,但存在一定的争议性. 本文回顾了近3年来β受体阻滞剂在癌症中应用的临床前研究和临床研究进展,为更好地研究β受体阻滞剂在癌症中的作用提供帮助.

  19. Photocatalytic degradation kinetics and mechanism of environmental pharmaceuticals in aqueous suspension of TiO{sub 2}: A case of {beta}-blockers

    Yang Hai [State Key Laboratory of Organic Geochemistry and Guangdong Key Laboratory of Environmental Resources Utilization and Protection, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Kehua Street, Tianhe District, Guangzhou 510640 (China); Graduate School of Chinese Academy of Sciences, Beijing 100049 (China); An Taicheng, E-mail: antc99@gig.ac.cn [State Key Laboratory of Organic Geochemistry and Guangdong Key Laboratory of Environmental Resources Utilization and Protection, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Kehua Street, Tianhe District, Guangzhou 510640 (China); Li Guiying [State Key Laboratory of Organic Geochemistry and Guangdong Key Laboratory of Environmental Resources Utilization and Protection, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Kehua Street, Tianhe District, Guangzhou 510640 (China); Song Weihua; Cooper, William J. [Urban Water Research Center, Department of Civil and Environmental Engineering, University of California, Irvine, CA 92697-2175 (United States); Luo Haiying [State Key Laboratory of Organic Geochemistry and Guangdong Key Laboratory of Environmental Resources Utilization and Protection, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Kehua Street, Tianhe District, Guangzhou 510640 (China); Graduate School of Chinese Academy of Sciences, Beijing 100049 (China); Guangzhou Product Quality Supervision and Testing Institute, National Centre for Quality Supervision and Testing of Processed Food (Guangzhou), Guangzhou 510110 (China); Guo Xindong [Guangzhou Product Quality Supervision and Testing Institute, National Centre for Quality Supervision and Testing of Processed Food (Guangzhou), Guangzhou 510110 (China)

    2010-07-15

    This study investigated the photocatalytic degradation of three {beta}-blockers in TiO{sub 2} suspensions. The disappearance of the compounds followed pseudo-first-order kinetics according to the Langmuir-Hinshelwood model and the rate constants were 0.075, 0.072 and 0.182 min{sup -1} for atenolol, metoprolol and propranolol, respectively. After 240 min irradiation, the reaction intermediates were completely mineralized to CO{sub 2} and the nitrogen was predominantly as NH{sub 4}{sup +}. The influence of initial pH and {beta}-blocker concentration on the kinetics was also studied. From adsorption studies it appears that the photocatalytic degradation occurred mainly on the surface of TiO{sub 2}. Further studies indicated that surface reaction with {center_dot}OH radical was principally responsible for the degradation of these three {beta}-blockers. The major degradation intermediates were identified by HPLC/MS analysis. Cleavage of the side chain and the addition of the hydroxyl group to the parent compounds were found to be the two main degradation pathways for all three {beta}-blockers.

  20. C-A4-03: Risks to the Newborn Associated With In-Utero Exposure to Beta-Blockers and Calcium-Channel Blockers

    Davis, Robert; Andrade, Susan; Rubanowice, David; McPhillips, Heather; Boudreau, Denise; Raebel, Marsha; Smith, David; Ulcickas-Yood, M; Lane, Kim; Varghese, Renny; Platt, Richard

    2010-01-01

    Background: While medication use to manage cardiovascular disease during pregnancy is widespread, data on its safety for the developing infant is scarce. We used population-based data from 5 HMOs to study risks for perinatal complications and congenital defects among infants exposed in-utero to beta -blockers and calcium-channel blockers.

  1. Sequential comparison of therapy with beta-blockers and calcium channel blockers with celiprolol therapy in patients with angina pectoris, hypertension, or both

    Cleophas, TJM; Niemeyer, MG; Bernink, PJLM; Zwinderman, KH; Wijk, AV; Wall, EEVD

    1996-01-01

    Unlike patients with either hypertension (HT) of angina pectoris (AP) alone, patients with both HT and AP usually have a reduced left ventricular compliance and may, therefore, have an impaired capability to cope with acute hemodynamic changes generated by standard beta-blockers or calcium channel b

  2. Effects of incremental beta-blocker dosing on myocardial mechanics of the human left ventricle: MRI 3D-tagging insight into pharmacodynamics supports theory of inner antagonism.

    Schmitt, Boris; Li, Tieyan; Kutty, Shelby; Khasheei, Alireza; Schmitt, Katharina R L; Anderson, Robert H; Lunkenheimer, Paul P; Berger, Felix; Kühne, Titus; Peters, Björn

    2015-07-01

    Beta-blockers contribute to treatment of heart failure. Their mechanism of action, however, is incompletely understood. Gradients in beta-blocker sensitivity of helically aligned cardiomyocytes compared with counteracting transversely intruding cardiomyocytes seem crucial. We hypothesize that selective blockade of transversely intruding cardiomyocytes by low-dose beta-blockade unloads ventricular performance. Cardiac magnetic resonance imaging (MRI) 3D tagging delivers parameters of myocardial performance. We studied 13 healthy volunteers by MRI 3D tagging during escalated intravenous administration of esmolol. The circumferential, longitudinal, and radial myocardial shortening was determined for each dose. The curves were analyzed for peak value, time-to-peak, upslope, and area-under-the-curve. At low doses, from 5 to 25 μg·kg(-1)·min(-1), peak contraction increased while time-to-peak decreased yielding a steeper upslope. Combining the values revealed a left shift of the curves at low doses compared with baseline without esmolol. At doses of 50 to 150 μg·kg(-1)·min(-1), a right shift with flattening occurred. In healthy volunteers we found more pronounced myocardial shortening at low compared with clinical dosage of beta-blockers. In patients with ventricular hypertrophy and higher prevalence of transversely intruding cardiomyocytes selective low-dose beta-blockade could be even more effective. MRI 3D tagging could help to determine optimal individual beta-blocker dosing avoiding undesirable side effects. PMID:25888512

  3. Optimal use of &beta;-blockers in high-risk hypertension: A guide to dosing equivalence

    McGill, Janet B

    2010-01-01

    Janet B McGillDepartment of Medicine, Washington University School of Medicine, St. Louis, Missouri, USAAbstract: Hypertension is the number one diagnosis made by primary care physicians, placing them in a unique position to prescribe the antihypertensive agent best suited to the individual patient. In individuals with diabetes mellitus, blood pressure (BP) levels > 130/80 mmHg confer an even higher risk for cardiovascular and renal disease, and these patients will benefit from aggress...

  4. ISOCRATIC SEPARATION OF FOUR BETA BLOCKERS WITH AMLODIPINE BY C18 RP-HPLC: APPLICATION TO AMLODIPINE DETERMINATION IN PHARMACEUTICAL DOSAGE FORMS

    Panchumarthy Ravisankar

    2013-06-01

    Full Text Available This method described for the successful separation of a beta blockers with amlodipine by RP-HPLC on a C18 column with UV detection. One of the key goals of High Performance Liquid Chromatography technique is to achieve a consistent and reproducible separation. A simple, precise, selective and sensitive HPLC method was developed and validated for determination of five anti-hypertensive agents, atenolol hydrochloride, metoprolol succinate, propranolol hydrochloride, amlodipine besylate and nebivolol hydrochloride with application to estimation of amlodipine besylate. RP-HPLC method was developed by using Welchrom C18 column (4.6 mm i.d. X 250mm, 5µm, Shimadzu LC-20AT ProminenceLiquid Chromatograph. The mobile phase composed of 10mM Phosphate buffer (pH3.0, adjusted with triethylamine: acetonitrile (50:50, v/v. The flow rate was set to 1.0ml/min with the responses measured at 235nm using Shimadzu SPD-20A Prominence UV-Visible detector. This method provides effective and reproducible separation of five anti-hypertensive agents less than 6 minutes. The retention times of atenolol hydrochloride, metoprolol succinate, propranolol hydrochloride, amlodipine besylate and nebivolol hydrochloride were found to be 2.310 min, 2.830 min, 3.473 min, 4.260 min and 4.960 min respectively. The statistical validation of the developed method was carried out according to ICH guidelines. Amlodipine besylate was found to give linear response in the concentration range of 2-10µg/ml. Recovery studies were performed to ascertain the accuracy by standard addition method and average recovery was found to be 99.83-100.40%. The LOD and LOQ were found to be 0.2251µg/ml and 0.6823µg/ml respectively. The developed method can be used for routine quality control analysis of amlodipine besylate in pharmaceutical tablet dosage form. It can also be extended for the determination of other above mentioned most commonly prescribed anti-hypertensive agents. The analysis yields a

  5. The Influence of Molecular Structure Modifications on Vibrational Properties of Some Beta Blockers: A Combined Raman and DFT Study

    A. Farcaș

    2016-01-01

    Full Text Available We report results of a systematic Raman, SERS, and DFT study on four beta blocking molecules: Atenolol, Metoprolol, Propranolol, and, for the first time reported in the literature, Bisoprolol. The choice of these molecules was motivated by the structural similarities between Atenolol, Bisoprolol, and Metoprolol on one hand and by their differences relative to Propranolol. The density functional theory (DFT approach, using the B3LYP method at the 6-311+G(d,p level of theory, has been employed for geometry optimization and vibration bands assignments. The obtained results highlight the major role played by the central aromatic ring whose vibrations dominate the Raman spectra in all compounds. While the phenyl group vibrations dominate the Raman spectrum in the case of Atenolol, Bisoprolol, and Metoprolol, the spectrum of Propranolol presents high intensity vibrations of the naphthyl group. SERS performed on gold and silver colloids, at various pH conditions, revealed a higher sensitivity for Propranolol detection. The pH dependence of the spectrum indicates that the studied beta blockers attach themselves to the metal nanoparticles in a protonated form. The molecular adsorption geometry on metal nanoparticles surface has been evaluated by using the experimental SER spectra and the quantum chemical calculations.

  6. Guideline-recommended therapy, including beta-blocker utilization, in patients with chronic heart failure: results from a Canadian community hospital heart function clinic

    Heffernan M

    2016-01-01

    Michael Heffernan Division of Cardiology, Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada Abstract: A comprehensive analysis of beta-blocker utilization and other guideline-recommended therapies for the treatment of chronic heart failure in a Canadian community hospital heart function clinic has not been undertaken and was, therefore, the focus of this study. The proportion of patients who would be potential candidates for ivabridine and sacubitril–valsartan therapy as a res...

  7. Guideline-recommended therapy, including beta-blocker utilization, in patients with chronic heart failure: results from a Canadian community hospital heart function clinic

    Heffernan, Michael

    2016-01-01

    Michael Heffernan Division of Cardiology, Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada Abstract: A comprehensive analysis of beta-blocker utilization and other guideline-recommended therapies for the treatment of chronic heart failure in a Canadian community hospital heart function clinic has not been undertaken and was, therefore, the focus of this study. The proportion of patients who would be potential candidates for ivabridine and sacubitril–valsartan therapy as a...

  8. ISOCRATIC SEPARATION OF FOUR BETA BLOCKERS WITH AMLODIPINE BY C18 RP-HPLC: APPLICATION TO AMLODIPINE DETERMINATION IN PHARMACEUTICAL DOSAGE FORMS

    Panchumarthy Ravisankar; Garikapati Devala Rao

    2013-01-01

    This method described for the successful separation of a beta blockers with amlodipine by RP-HPLC on a C18 column with UV detection. One of the key goals of High Performance Liquid Chromatography technique is to achieve a consistent and reproducible separation. A simple, precise, selective and sensitive HPLC method was developed and validated for determination of five anti-hypertensive agents, atenolol hydrochloride, metoprolol succinate, propranolol hydrochloride, amlodipine besylate and neb...

  9. The secondary prophylactic efficacy of beta-blocker after endoscopic gastric variceal obturation for first acute episode of gastric variceal bleeding

    Choi, Moon Han; Kim, Young Seok; Kim, Sang Gyune; Lee, Yun Nah; Seo, Yu Ri; Kim, Min Jin; Lee, Sae Hwan; Jeong, Soung Won; Jang, Jae Young; Kim, Hong Soo; Kim, Boo Sung

    2013-01-01

    Background/Aims The most appropriate treatment for acute gastric variceal bleeding (GVB) is currently endoscopic gastric variceal obturation (GVO) using Histoacryl®. However, the secondary prophylactic efficacy of beta-blocker (BB) after GVO for the first acute episode of GVB has not yet been established. The secondary prophylactic efficacy of BB after GVO for the first acute episode of GVB was evaluated in this study. Methods Ninety-three patients at Soonchunhyang University Hospital with ac...

  10. Rationale and design of a double-blind, multicenter, randomized, placebo-controlled clinical trial of early administration of intravenous beta-blockers in patients with ST-elevation myocardial infarction before primary percutaneous coronary intervention : EARLY beta-blocker Administration before primary PCI in patients with ST-elevation Myocardial Infarction trial

    Roolvink, Vincent; Rasoul, Saman; Ottervanger, Jan Paul; Dambrink, Jan-Henk E.; Lipsic, Erik; van der Horst, Iwan C. C.; de Smet, Bart; Kedhi, Elvin; Gosselink, A. T. Marcel; Piek, Jan J.; Sanchez-Brunete, Vicente; Ibanez, Borja; Fuster, Valentin; van't Hof, Arnoud W. J.

    2014-01-01

    Background beta-Blockers have a class 1a recommendation in the treatment of patients with ST-elevation myocardial infarctions (STEMIs), as they are associated with a reduced mortality, recurrent myocardial infarction, life-threatening arrhythmias, and with prevention of unfavorable left ventricular

  11. A self-controlled case series to assess the effectiveness of beta blockers for heart failure in reducing hospitalisations in the elderly

    Pratt Nicole L

    2011-07-01

    Full Text Available Abstract Background To determine the suitability of using the self-controlled case series design to assess improvements in health outcomes using the effectiveness of beta blockers for heart failure in reducing hospitalisations as the example. Methods The Australian Government Department of Veterans' Affairs administrative claims database was used to undertake a self-controlled case-series in elderly patients aged 65 years or over to compare the risk of a heart failure hospitalisation during periods of being exposed and unexposed to a beta blocker. Two studies, the first using a one year period and the second using a four year period were undertaken to determine if the estimates varied due to changes in severity of heart failure over time. Results In the one year period, 3,450 patients and in the four year period, 12, 682 patients had at least one hospitalisation for heart failure. The one year period showed a non-significant decrease in hospitalisations for heart failure 4-8 months after starting beta-blockers, (RR, 0.76; 95% CI (0.57-1.02 and a significant decrease in the 8-12 months post-initiation of a beta blocker for heart failure (RR, 0.62; 95% CI (0.39, 0.99. For the four year study there was an increased risk of hospitalisation less than eight months post-initiation and significant but smaller decrease in the 8-12 month window (RR, 0.90; 95% CI (0.82, 0.98. Conclusions The results of the one year observation period are similar to those observed in randomised clinical trials indicating that the self-controlled case-series method can be successfully applied to assess health outcomes. However, the result appears sensitive to the study periods used and further research to understand the appropriate applications of this method in pharmacoepidemiology is still required. The results also illustrate the benefits of extending beta blocker utilisation to the older age group of heart failure patients in which their use is common but the evidence is

  12. Beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, nitrate-hydralazine, diuretics, aldosterone antagonist, ivabradine, devices and digoxin (BANDAID(2) ): an evidence-based mnemonic for the treatment of systolic heart failure.

    Chia, N; Fulcher, J; Keech, A

    2016-06-01

    Heart failure causes significant morbidity and mortality, with recognised underutilisation rates of guideline-based therapies. Our aim was to review current evidence for heart failure treatments and derive a mnemonic summarising best practice, which might assist physicians in patient care. Treatments were identified for review from multinational society guidelines and recent randomised trials, with a primary aim of examining their effects in systolic heart failure patients on mortality, hospitalisation rates and symptoms. Secondary aims were to consider other clinical benefits. MEDLINE and EMBASE were searched using a structured keyword strategy and the retrieved articles were evaluated methodically to produce an optimised reference list for each treatment. We devised the mnemonic BANDAID (2) , standing for beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, nitrate-hydralazine (or potentially neprilysin inhibitor), diuretics, aldosterone antagonist, ivabradine, devices (automatic implantable cardioverter defibrillator, cardiac resynchronisation therapy or both) and digoxin as a representation of treatments with strong evidence for their use in systolic heart failure. Treatment with omega-3 fatty acids, statins or anti-thrombotic therapies has limited benefits in a general heart failure population. Adoption of this mnemonic for current evidence-based treatments for heart failure may help improve prescribing rates and patient outcomes in this debilitating, high mortality condition. PMID:26109136

  13. Beta-blockers

    Arboe, Bente; Ulrik, Charlotte Suppli

    2013-01-01

    Recently, β-blockers have been suggested as a potential maintenance treatment option for asthma. The aim of this review is to provide an overview of the current knowledge of the potential benefits and risks of β-blocker therapy for asthma.......Recently, β-blockers have been suggested as a potential maintenance treatment option for asthma. The aim of this review is to provide an overview of the current knowledge of the potential benefits and risks of β-blocker therapy for asthma....

  14. Usefulness of {sup 123}I-metaiodobenzylguanidine myocardial scintigraphy for predicting the effectiveness of {beta}-blockers in patients with dilated cardiomyopathy from the standpoint of long-term prognosis

    Fujimoto, Shinichiro; Inoue, Aritomo; Hisatake, Shinji; Yamashina, Shohei; Yamashina, Hisayo; Nakano, Hajime; Yamazaki, Junichi [Toho University School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Tokyo (Japan)

    2004-10-01

    The usefulness of {sup 123}I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in predicting the effectiveness of {beta}-blocker therapy in dilated cardiomyopathy (DCM) was investigated from the standpoint of long-term prognosis. The subjects were 53 DCM patients in whom {beta}-blockers had been successfully introduced and used for 6 months or longer. When symptoms were stable before the introduction of {beta}-blockers and for up to 1 year thereafter, MIBG myocardial single-photon emission computed tomography was performed and the images analysed to obtain the extent score (EXT), severity score (SEV) and washout rate (WR). At the same time, echocardiography was performed to measure left ventricular ejection fraction (LVEF). Thereafter, patients were placed under observation for an average of 1,314{+-}986 days, with the occurrence of cardiac events as the endpoint. The degree of improvement in WR after introduction of {beta}-blockers was a significant predictor of cardiac events. In fact, none of the patients whose improvement in WR was valued at 10 or higher had cardiac events. Accordingly, using improvement in WR of 10 as the cut-off value, the patients were divided into two groups, ''improved'' and ''unimproved''. There were significant differences between the groups in respect of early EXT, early SEV and WR before the introduction of {beta}-blockers. As regards predictors of WR improvement, multivariate logistic regression analysis demonstrated that early EXT, WR and LVEF were significant predictors. This study shows that, from the standpoint of long-term prognosis, DCM patients who would benefit the most from {beta}-blocker therapy are those with low early EXT and early SEV and high WR before {beta}-blocker introduction regardless of LVEF values. (orig.)

  15. Patient medication adherence and physician prescribing among congestive heart failure patients of Yemen

    K M Alakhali

    2013-01-01

    Full Text Available Congestive heart failure has been associated with high morbidity and mortality requiring hospitalisation and is further complicated by noncompliance and under prescriptions. We aim to determine medication adherence and percentage deviation among Asians population in general and Yemenis in particular. A cross-sectional, prospective observational study with purposive sampling was conducted at two cardiac outpatient centers in 70 congestive heart failure patients for a period of 3 months. An Arabic translated Morisky 4 item scale assessed the adherence of patients. Deviation in prescribing was determined by chart review. All 70 patients had mean age of 56.6΁16 years. Morisky 4 item scale predicted low adherence (n=33; 47.1% and overall nonadherencerate (n=38; 54.2% was slightly higher than adherence. Percentage nonadherence versus adherence was high with diuretics (53 vs. 46% and, digoxin (40 vs. 29%. The adherence percentage of angiotensin receptor blockers (9% and beta blockers (8% was low. Diuretics were the most prescribed drugs (n=69; 99%, followed by angiotensin converting enzyme inhibitors (n=51; 73%, cardiac glycoside (n=48; 69%, few patients were on angiotensin receptor blockers (n=8; 11% and (n=9; 13% beta blockers. The maximum prescribing rate deviation was seen with angiotensin receptor blockers (−89% and beta blockers (−87% followed by nitrates (−77%. Digoxin (−31% and angiotensin converting enzymes (−27% deviated comparatively less. Prescribing as well as utilisation rates generally were low resulting in nonachievement of therapeutic goals which could be resolved using multimodel approach.

  16. Chronic effects assessment and plasma concentrations of the {beta}-blocker propranolol in fathead minnows (Pimephales promelas)

    Giltrow, Emma [Institute for the Environment, Brunel University, Uxbridge, Middlesex UB8 3PH (United Kingdom); Eccles, Paul D. [Institute for the Environment, Brunel University, Uxbridge, Middlesex UB8 3PH (United Kingdom); Biosciences, School of Health Sciences and Social Care, Brunel University, Uxbridge, Middlesex UB8 3PH (United Kingdom); Winter, Matthew J.; McCormack, Paul J. [AstraZeneca Safety, Health and Environment, Brixham Environmental Laboratory, Freshwater Quarry, Brixham, Devon TQ5 8BA (United Kingdom); Rand-Weaver, Mariann [Biosciences, School of Health Sciences and Social Care, Brunel University, Uxbridge, Middlesex UB8 3PH (United Kingdom); Hutchinson, Thomas H. [Natural Environmental Research Council, Plymouth Marine Laboratory, Prospect Place, The Hoe, Plymouth PL1 3DH (United Kingdom); Sumpter, John P., E-mail: john.sumpter@brunel.ac.uk [Institute for the Environment, Brunel University, Uxbridge, Middlesex UB8 3PH (United Kingdom)

    2009-11-27

    The presence of many human pharmaceuticals in the aquatic environment is now a worldwide concern, yet little is known of the chronic effects that these bioactive substances may be having on aquatic organisms. Propranolol, a non-specific beta adrenoreceptor blocker ({beta}-blocker), is used to treat high blood pressure and heart disease in humans. Propranolol has been found in surface waters worldwide at concentrations ranging from 12 to 590 ng/L. To test the potential for ecologically relevant effects in fish in receiving waters, short-term (21 days) adult reproduction studies were conducted, in which fathead minnows were exposed to nominal concentrations of propranolol hydrochloride [CAS number 318-98-9] ranging from 0.001 to 10 mg/L (measured concentrations typically from 78 to 130%). Exposure of fish to 3.4 mg/L (measured) over 3 days caused 100% mortality or severe toxicity requiring euthanasia. The most sensitive endpoints from the studies were a decrease in hatchability (with regard to the number of days to hatch) and a concentration-related increase in female gonadal somatic index (GSI), giving LOEC{sup hatchability} and LOEC{sup female} {sup GSI} values of 0.1 mg/L. Concentration-related decreases in weights of male fish were also observed, with LOEC{sup m}ale wet weight value of 1.0 mg/L, and the LOEC{sup r}eproduction value was 1.0 mg/L. Collectively, these data do not suggest that propranolol was acting as a reproductive toxin. Plasma concentrations of propranolol in male fish exposed to nominal concentrations of 0.1 and 1.0 mg/L were 0.34 and 15.00 mg/L, respectively, which constitutes 436 and 1546% of measured water concentrations. These compare with predicted concentrations of 0.07 and 0.84 mg/L, and thus to a degree support the use of partition coefficient models for predicting concentrations in plasma in fish. In addition, propranolol plasma concentrations in fish exposed to water concentrations of 0.1 and 1.0 mg/L were greater than the human

  17. Assessment of response to beta-blockers by expression of βArr2 and RhoA/ROCK2 in antrum mucosa in cirrhotic patients

    Trebicka, Jonel; von Heydebrand, Matthias; Lehmann, Jennifer;

    2016-01-01

    BACKGROUND & AIMS: Non-selective beta-blockers (NSBB) are first choice for prevention of variceal bleeding. But possible deleterious effects in refractory ascites and frequent non-response are clinical drawbacks. Since levels of vasoactive proteins in antrum mucosa reflect vascular dysfunction in...... and protein expression of Ras homolog family member A (RhoA), Rho-kinase (ROCK)2, beta-arrestin2 (βArr2), endothelial nitric oxide synthase (eNOS) and the phosphorylation of downstream effectors VASP and moesin were analyzed using PCR and Western blot. Further 21 patients on NSBB were evaluated on...

  18. Do immigrants from Turkey, Pakistan and Yugoslavia receive adequate medical treatment with beta-blockers and statins after acute myocardial infarction compared with Danish-born residents? A register-based follow-up study

    Hempler, Nana Folmann; Diderichsen, Finn; Larsen, Finn Breinholt;

    2010-01-01

    We undertook a study investigating whether immigrants from Turkey, Pakistan and Yugoslavia received adequate medical treatment with beta-blockers and statins after acute myocardial infarction (AMI) when compared with Danish-born residents and explored whether associations between patient origin and...

  19. Different effects of calcium antagonist and beta-blocker therapy on left-ventricular diastolic function in ischemic heart disease. A direct comparison of the impact of mibefradil and atenolol

    Hassager, C; Thygesen, K; Grande, P;

    2001-01-01

    OBJECTIVE: To compare the effect of a calcium antagonist and a beta-blocker on left-ventricular diastolic function in patients with ischemic heart disease. METHODS: 138 patients with chronic stable angina pectoris were randomized in a multicenter, double-blind trial to treatment with either...

  20. Cost-effectiveness analysis of nebivolol and metoprolol in essential hypertension: A pharmacoeconomic comparison of antihypertensive efficacy of beta blockers

    Rachna S Patel

    2014-01-01

    Full Text Available Objective: To estimate and compare the cost-effectiveness and safety of nebivolol with sustained-release metoprolol in reducing blood pressure by 1 mm of Hg per day in hypertensive patients. Materials and Methods: This was a prospective, randomized, open label, observational analysis of cost-effectiveness, in a questionnaire-based fashion to compare the cost of nebivolol (2.5 mg, 5 mg, 10 mg and sustained released metoprolol succinate (25 mg, 50 mg, 100 mg in hypertensive patients using either of the two drugs. A total of 60 newly detected drug naïve hypertensive patients were considered for the comparison, of which 30 patients were prescribed nebivolol and the other 30 were prescribed metoprolol succinate as per the recommended dosage. Based on the data, statistical analysis was carried out using GraphPad Prism 5 and MS Excel Spreadsheet 2007. Result: The cost of reducing 1 mm of Hg blood pressure per day with nebivolol was 0.60, 0.70, and 1.06 INR, whereas that of metoprolol succinate was 0.93, 1.18, and 1.25 INR at their respective equivalent doses, hence significantly lower with the nebivolol group as compared to the metoprolol group (P < 0.05. Conclusion: This pharmacoeconomic analysis shows that nebivolol is more cost-effective as compared to metoprolol when the cost per reduction in blood pressure per day is considered. This may affect the patients economically during their long-term use of these molecules for the treatment of hypertension.

  1. The difference between actual and prescribed weight bearing of total hip patients with a trochanteric osteotomy: long-term vertical force measurements inside and outside the hospital

    H.L.P. Hurkmans (Henri); J.B.J. Bussmann (Hans); R.W. Selles (Ruud); E. Benda (Eric); H.J. Stam (Henk); J.A.N. Verhaar (Jan)

    2007-01-01

    textabstractOBJECTIVE: To determine whether patients load the operated leg at a prescribed weight-bearing target load during postoperative recovery. DESIGN: A descriptive prospective study. SETTING: Orthopedic clinic and patients' homes. PARTICIPANTS: Fifty patients who had undergone total hip arthr

  2. Analysis by liquid chromatography-electrospray ionization tandem mass spectrometry and acute toxicity evaluation for beta-blockers and lipid-regulating agents in wastewater samples.

    Hernando, M D; Petrovic, M; Fernández-Alba, A R; Barceló, D

    2004-08-13

    This paper describes a multiresidue method for the extraction and determination of two therapeutic groups of pharmaceuticals, lipid-regulating agents (clofibric acid, bezafibrate, gemfibrocil, fenofibrate) and beta-blockers (atenolol, sotalol, metoprolol, betaxolol) in waters by solid-phase extraction followed by liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI-MS-MS). Recoveries obtained from spiked HPLC water, as well as, from spiked real samples (sewage treatment plants influent and effluents, river and tap water) were all above 60%, with the exception of betaxolol with a 52% recovery. The quantitative MS analysis was performed using a multiple reaction monitoring. The LC-MS-MS method gave detection limits ranging from 0.017 to 1.25 microg/l in spiked effluent. Precision of the method, calculated as relative standard deviation, ranged from 3.7 to 18.5%. Individual and combined effects on Daphnia magna were evaluated for both therapeutic groups. Individual effects in culture medium showed these compounds as not harmful and not toxic, an exception is fenofibrate that was found to be harmful, but at high, in the environment unrealistic concentrations (EC50 of 50 mg/l). Combined effect in wastewater showed synergistic toxic effects at low concentration level (2 microg/l). PMID:15387181

  3. Use of beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and breast cancer survival: Systematic review and meta-analysis.

    Raimondi, Sara; Botteri, Edoardo; Munzone, Elisabetta; Cipolla, Carlo; Rotmensz, Nicole; DeCensi, Andrea; Gandini, Sara

    2016-07-01

    Breast cancer (BC) is the second leading cause of cancer death among women in Western Countries. Beta-blocker (BB) drugs, angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) were suggested to have a favorable role in the development and progression of BC. We have performed a meta-analysis to clarify the potential benefits of these drugs on BC survival. A total number of 46 265 BC patients from eleven papers were included, ten independent studies on BB use and seven on ACEi/ARB use. The summary hazard ratio (SHR) was estimated by pooling the study-specific estimates with random effects models and maximum likelihood estimation. We assessed the homogeneity of the effects across studies and evaluated between-study heterogeneity by meta-regression and sensitivity analyses. We found a significant improvement in BC specific survival for patients treated with BB drugs at the time of BC diagnosis (SHR: 0.44; 95%CI: 0.26-0.73 with I(2)  = 78%). We also observed a borderline significant improvement in disease free survival for subjects treated with BB (SHR: 0.71, 95%CI: 0.19-1.03). No association of ACEi/ARB use with disease free and overall survival was found. In conclusion, we report epidemiological evidence that BB improve BC-specific survival. Clinical trials addressing this hypothesis are warranted. PMID:26916107

  4. Use of iodine-123 metaiodobenzylguanidine myocardial imaging to predict the effectiveness of {beta}-blocker therapy in patients with dilated cardiomyopathy

    Fukuoka, Shuji [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Hayashida, Kohei [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Hirose, Yoshiaki [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Shimotsu, Yoriko [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Ishida, Yoshio [Department of Radiology, National Cardiovascular Center, Osaka (Japan); Kakuchi, Hiroyuki [Department of Internal Medicine, National Cardiovascular Center, Osaka (Japan); Eto, Tanenao [First Department of Internal Medicine, Miyazaki Medical College, Miyazaki (Japan)

    1997-05-01

    We studied 13 patients with dilated cardiomyopathy (DCM) and seven normal subjects. We obtained myocardial SPET images 15 min and 4 h after administration of {sup 123}I-MIBG (111 MBq). Studies were performed in the patients with DCM before and 1 and 3 months after the administration of metoprolol and in the normal subjects. We calculated the regional {sup 123}I-MIBG washout rate (r-WR) in the SPET image, and the global {sup 123}I-MIBG washout rate (g-WR) and heart-mediastinum activity ratio (H/M) using the anterior planar image. We classified patients into those showing a {>=}5% increase in LV ejection fraction (LVEF) at 3 months compared with LVEF values before the treatment (group I, n=7) and those showing a <5% increase in LVEF (group II, n=6). In normal subjects, the r-WR values in each of the anterior, lateral, septal and inferior segments were significantly lower than those in groups I and II. These values were 18%{+-}9%, 18%{+-}15%, 20%{+-}12% and 21%{+-}15%, respectively. This study demonstrated that with regional assessment {sup 123}I-MIBG SPET imaging can be used to predict the functional improvement of LVEF at 1 month of {beta}-blocker therapy in patients with DCM. (orig./VHE). With 4 figs., 1 tab.

  5. Myocardial scintigraphy using iodine-123 15-(p-Iodophenyl)-3-R, S-methylpentadecanoic acid predicts the response to beta-blocker therapy in patients with dilated cardiomyopathy but does not reflect therapeutic effect

    Yoshinaga, Keiichiro; Tahara, Minoru; Torii, Hiroyuki; Akimoto, Masaki [Kagoshima City Medical Association Hopital (Japan); Kihara, Koichi; Tei, Chuwa

    2000-05-01

    Myocardial fatty acid metabolism is disturbed in patients with idiopathic dilated cardiomyopathy. Myocardial scintigraphy using iodine-123 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP) was used to assess the response to {beta}-blocker therapy in 19 patients with dilated cardiomyopathy. BMIPP myocardial scintigraphy was performed before and 6 months after initiating {beta}-blocker therapy with metoprolol. Cardiac BMIPP uptake was assessed as the total defect score (TDS) and heart-to-mediastinum activity (H/M) ratio. Patients were classified retrospectively as responders with an improvement of at least one functional class (New York Heart Association) or an increase in ejection fraction of {>=}0.10 at 6 months, or as nonresponders meeting neither criterion. Responders had a significantly better pretreatment TDS (p<0.005) and H/M ratio (p<0.0001) than nonresponders. TDS exhibited no significant changes over 6 months in either group (responders: 13.2{+-}3.7 vs 12.5{+-}3.3; nonresponders: 20.8{+-}6.5 vs 20.5{+-}3.0). Responders showed no significant changes in H/M ratio (2.47{+-}0.28 vs 2.43{+-}0.42); paradoxically, nonresponders showed a significant increase from 1.82{+-}0.11 to 2.10{+-}0.19 (p<0.05), suggesting that {beta}-blocker therapy protected the myocardial fatty acid metabolism even in the absence of clinical improvement. BMIPP myocardial scintigraphy provides a prediction of response to {beta}-blocker treatment, but does not reflect the therapeutic effect in responders at 6 months. (author)

  6. Electronic Prescribing

    ... Do you prescribe electronically?” For more information about electronic prescribing, call 1-800-MEDICARE (1-800-633- ... to the pharmacy, and my prescription was ready. Electronic eRx Prescribing CMS Product No. 11382 Revised July ...

  7. Development of SPME-LC-MS method for screening of eight beta-blockers and bronchodilators in plasma and urine samples.

    Goryński, Krzysztof; Kiedrowicz, Alicja; Bojko, Barbara

    2016-08-01

    The current work describes the development and validation of a simple, efficient, and fast method using solid phase microextraction coupled to liquid chromatography-tandem mass spectrometry (SPME-LC-MS/MS) for the concomitant measurement of eight beta-blockers and bronchodilators in plasma and urine. The presented assay enables quantitative determination of acebutolol, atenolol, fenoterol, nadolol, pindolol, procaterol, sotalol, and timolol. In this work, samples were prepared on a high-throughput platform using the 96-well plate format of the thin film solid phase microextraction (TFME) system, and a biocompatible extraction phase made of hydrophilic-lipophilic balance particles. Analytes were separated on a pentafluorophenyl column (100mm×2.1mm, 3μm) by gradient elution using an UPLC Nexera coupled with an LCMS-8060 mass spectrometer. The mobile phase consisted of water-acetonitrile (0.1% formic acid) at a flow rate of 0.4mLmin(-1). The linearity of the method was checked within therapeutic blood-plasma concentrations, and shown to adequately reflect typically expected concentrations of future study samples. Post-extraction addition experiments showed that the matrix effect ranged in plasma from 98% for procaterol to 115% for nadolol, and in urine, from 85% for nadolol and pindolol to 119% for atenolol. The method was successfully validated using Food and Drug Administration (FDA) guidelines, and met all acceptance criteria for bioanalytical assays at five concentration levels for all selected drugs. The final protocol can be successfully applied for monitoring concentrations of the selected drugs in both plasma and urine matrices obtained from patients or athletes. PMID:26971030

  8. β受体阻滞剂治疗慢性心力衰竭30例临床分析%The efficacy of beta blocker treatment in thirty chronic heart failure patients

    胡光春

    2016-01-01

    目的:观察在常规药物治疗基础上加用β受体阻滞剂治疗慢性心力衰竭的临床疗效。方法选择30例心力衰竭患者以滴定法的治疗策略使用β受体阻滞剂,并以心脏超声检查和6 min步行距离来客观评价临床症状和心功能改善情况。结果为期2年的治疗后观察患者临床症状好转、心脏缩小和心功能改善(P<0.01)。结论针对社区或基层的慢性心力衰竭患者应尽早积极使用β受体阻滞剂,以达到改善症状和心功能的目的。%ObjectiveTo evaluate the effect of additional beta blocker on the standard therapy for chronic heart failure. MethodsBeta blocker metoprolol was titrated in thirty patients with chronic heart failure. Echocardiogram and six-minute walking distance were used for the evaluation of clinical symptoms and cardiac function.ResultsTwo-year follow up showed improved symptoms,decreased left ventricular diameter and increased left ventricular ejection fraction. ConclusionEarly use of beta blocker is essential for the clinical improvement for chronic heart failure in district hospital.

  9. β受体阻滞剂在慢性心力衰竭中的应用现状%Status in Clinical Settings of Beta-Blocker Treatment in Patients with Chronic Heart Failure

    王勤

    2011-01-01

    β受体阻滞剂在慢性心力衰竭治疗中的优势已被多项大型临床试验证实.近10年来,β受体阻滞剂被广泛应用于慢性心力衰竭的临床治疗,但是大量的流行病学资料显示:其使用率在欧洲及我国均较低,并且存在地区性差异,同时使用剂量与指南的推荐剂量存在明显差距.现就β受体阻滞剂的临床应用现状做一综述.%The advantages of beta-blockers in the treatment for chronic heart failure ( CHF) have been largely confirmed by clinical trials over the last lO years. However, a large body of epidemiological data shows that the use of beta-blockers in Europe and China was relatively low , there were regional variations in the use of beta-blocken, and the dosages were significantly different compared to the dosage recommended in European guidelines. This article reviews the use of, and the clinical status of β-blockers.

  10. Use of beta-blockers in chronic obstructive pulmonary disease%β受体阻滞剂在慢性阻塞性肺疾病患者中的应用

    曾葭; 白冲

    2010-01-01

    β肾上腺素能受体阻滞剂禁止使用于支气管哮喘和慢性阻塞性肺疾病患者.近年研究发现,使用心脏选择性β受体阻滞剂治疗慢性阻塞性肺疾病和肺源性心脏病,长期治疗可降低死亡率,提高患者生活质量.本文就β受体阻滞剂在慢性阻塞性肺疾病患者中的应用作一综述.%Beta-blockers were contraindicated in bronchial asthma and chronic obstructive pulmonary disease (COPD). Recent studies show that chronic administration of cardioselective betablockers in patients with COPD or pulmonary heart disease can improve mortality and quality of life. This paper reviewed the application of beta-blockers on patients with COPD.

  11. The Basic Mechanism of Beta-blocker in Chronic Heart Failure%β受体阻断剂在慢性心衰中作用的基础机制

    刘伟

    2011-01-01

    心力衰竭是很多心血管疾病的最终阶段,也是常见的致死原因之一.心力衰竭时起代偿作用的交感神经系统的持续兴奋是导致心力衰竭恶化的一个重要原因.近年来,众多临床试验证实β受体阻断剂类药物对心力衰竭有良好的治疗作用,β受体阻断剂能通过慢性抑制交感神经的兴奋,改善心力衰竭患者心功能,从而减少患者病死率,增加生存率.%Heart failure is the final phase for many cardiovascular diseases , one of the common fatal causes as well. One important reason of heart failure deterioration is the sustained excitement of sympathetic nervous system which is a compensatory mechanism in heart failure. In recent years,evidence has been accumulated on the beneficial actions of beta-blockers in patients with heart failure. The effect of beta-blocker in chronic inhibition of sympathetic nervous system can improve cardiac function of heart failure patients , reduce mortality and increase survival rates.

  12. Rationalising prescribing

    Wadmann, Sarah; Bang, Lia E.

    2015-01-01

    with chronic care management in Denmark. We demonstrate how attempts to rationalise prescribing by informing GPs about drug effects, adverse effects and price do not satisfy GPs' knowledge needs. We argue that, for GPs, 'rational' prescribing cannot be understood in separation from the processes that enable...

  13. PRESCRIBING PATTERN OF ANTIHYPERTENSIVES IN INDIVIDUALS WITH HYPERTENSION ALONE AND WITH COEXISTING DIABETES MELLITUS – A COMPARATIVE STUDY

    J. Keerthi Sagar*, S. Narendranath, H.S. Somashekar, S.R. Reshma, Susheela Somappa Halemani and Prabhakar Adake

    2012-06-01

    Full Text Available Objective: Analysis of prescribing pattern of antihypertensives in patients with hypertension alone and with coexisting diabetes mellitus. Materials and Methods: A cross sectional study was conducted in an outpatient and inpatient department of general medicine at JJM Medical College hospital for a period of 3 months (July 2011 to September 2011. Prescriptions of the patients were collected and relevant data was entered in the preformed proforma and analyzed.Results: A total of 210 prescriptions were analyzed using chi square test. Out of which 126 prescriptions were of patients with hypertension alone which contain calcium channel blockers (30%, beta blockers (26%, angiotensin receptor blockers (15%, angiotensin converting enzyme inhibitors (4% and fixed dose combinations of angiotensin receptor blockers with hydrochlorothiazide (11% and combination of amlodipine with hydro-chlorothiazide (2.5%.84 Prescriptions of hypertension with coexisting diabetes mellitus had calcium channel blockers (24%, angiotensin converting enzyme inhibitors (19%, angiotensin receptor blockers (13%, beta blockers (13%, and fixed dose combinations of angiotensin receptor blockers with hydrochlorothiazide (18% and combination of amlodipine with hydrochlorothiazide (6%.[χ2=17.01, p=o.oo4] Conclusion- The present study shows that angiotensin converting enzyme inhibitors because of its beneficial effects which are well known are more commonly prescribed drugs in individuals with hypertension with coexisting diabetes mellitus. Calcium channel blockers and newly introduced angiotensin receptor blockers alone or in combination with hydrochlorothiazide are preferred drugs in both the study groups. Beta blockers are less preferred in patients of hypertension with coexisting diabetes mellitus for obvious reasons.

  14. Progress in use of beta-blockers for cardiovascular diseases%β受体阻滞剂在心血管疾病中的应用进展

    冯庆芝

    2005-01-01

    β受体阻滞剂(beta-blocker)过去多作为抗心律失常药应用于临床,近年来其应用范围逐渐扩大,现已应用于抗高血压、纠正心肌缺血、改善心功能,品种及剂型也日新月异,其作用机制是多方面的,至今尚未完全清楚,不同制剂作用机制亦有差别,其核心作用是预防儿茶酚胺的心脏毒性作用。

  15. The classification , clinical usage and its progress of beta-blocker%β-受体阻滞药的分类、临床应用及其进展

    刘万车; 方立梅; 胡少红; 谷雨; 张冬梅; 刑春阳

    2009-01-01

    The application of beta-blocker is unfailing for more than forty years, furthermore its indica-tion is magnified continually, which make it play very important role in the treatment of caxdiovascular diseases. In order to master the elassfication , clinical application and the recent research better, we write this overview by summarizeing articles at home and abroad.%β-受体阻滞药的应用40多年来久用不衰,而且适应证不断拓宽,使其在心血管疾病的治疗中起着十分重要的作用,为更好地掌握其分类、临床应用及其进展,本文结合国内外文献作一综述.

  16. β-受体阻滞剂对高血压患者房颤发生的预防作用%Prevention of atrial fibrillation about beta blockers in patients with hypertension

    郜黎伟; 邱林林; 赵宏

    2014-01-01

    Objective To evaluate the role of beta blockers and significance in prevention of atrial fibrillation( AF)in patients with hy-pertension. Methods The levels of PⅠCP and procollagen typeⅢ( PCⅢ)and Transforming growth factor beta 1( TGF -β1)were meas-ured by enzyme linked immunosorbent assay( ELISA)in 128 hypertension patients in the treatment group and 128 controls,24 hours dy-namic electrocardiogram were measured also. Results There are no significant difference abort AF cases occurred in two groups( P ﹥0. 05),serum P Ⅰ CP and PC Ⅲ and TGF - beta 1 level is significantly lower in treatment group than in control group( P < 0. 05). Conclusion Beta blockers reduced AF by blocking autonomic nerve to reverse myocardial fibrosis,and impact in the prevention of AF in patients with hypertension.%目的:研究高血压患者出现心房颤动( AF)前预防使用β-受体阻滞剂的作用及意义。方法:对高血压患者治疗组128例和对照组128例进行24小时动态心电图及实验室检查,并对结果进行分析。结果:AF发生例数两组比较差异无统计学意义( P﹥0.05),治疗组血清PⅠCP、PCⅢ及TGF-β1水平明显低于对照组( P<0.05)。结论:β-受体阻滞剂通过阻断自主神经以逆转心肌纤维化减少AF发生,实现对高血压患者房颤发生的预防作用。

  17. Effect of beta blocker in treatment of paroxysmal atrial fibrillation:a meta-analysis%β受体阻滞剂治疗阵发性心房颤动疗效及安全性的Meta分析

    张淑娟; 赵庆彦; 代子玄; 王晓占; 郭宗文; 赵红宜

    2015-01-01

    Objective To assess the efficacy and safety of beta blockers in the treatment of paroxysmal atrial fibrilla-tion.Method From 2001 January to 2014 September, computer retrieval of controlled trials in the Cochrane library, PubMed database, Wanfang Data, Chinese academic periodical full-text database, VIP database ( VIP) , the clinical randomized con-trolled trials of beta blocker therapy in patients with paroxysmal atrial fibrillation ( RCT) were collected, 2 reviewers according to the inclusion and exclusion criteria, extracted the data independently, cross check and evaluate the quality of methodology, use RevMan 5 software to perform the Meta-analysis.Result 26 studies of 3368 cases were included.(1) combined with the application of beta blocker therapy in patients with paroxysmal atrial fibrillation was better than amiodarone (OR=1.97, 95%CI 1.49~2.61, P 0.05), the overall induced gastrointestinal adverse reaction rate was lower than the control group (OR=0.48, 95%CI, 0.35~0.66, P =0.05) and ACEI (OR=0.62, 95%CI 0.37~1.04, P >=0.05) showed no significant difference;the overall adverse reaction induced by arrhythmia rate the treatment group was lower than that of control group (OR=0 .60, 95%CI, 0.46~0.79, P <0.05).Conclusion Beta blockers has good clinical efficacy in the treatment of paroxysmal atrial fibrillation with low incidence rate of adverse reaction.Limited with the quality of the included studies, the evaluation of the treatment of paroxysmal atrial fibrillation efficacy and safety need more high quality randomized controlled double-blind trial.%目的:系统评价β受体阻滞剂治疗阵发性心房颤动的有效性及安全性。方法计算机检索2001年1月—2014年9月Cochrane图书馆临床对照试验数据库、Pubmed、万方数据、中国学术期刊全文数据库、维普数据库( VIP)等,收集β受体阻滞剂治疗阵发性房颤的临床随机对照试验( RCT),由2名评价者按纳入、排除标准独立选择

  18. Clinical practice of beta blockers:New ideas and disputes%β受体阻滞剂的临床实践——新视点与争议

    戴闺柱

    2011-01-01

    β受体阻滞剂在心血管疾病(cardiovascular disease,CVD)治疗中得到广泛应用,其药理基础是抑制交感神经活性,预防儿茶酚胺对心脏的毒性,发挥一系列心血管保护作用.但β受体阻滞剂的临床使用还存在诸多争议和不同观念.本文将β受体阻滞剂在高血压、心肌梗死(myocardial infarction,MI)和心力衰竭中的使用涌现的新观点和存在的争议做简要评述.%Beta blockers are wildly used in the treatment of cardiovascular disease.The pharmacology is based on the inhibition of sympathetic activity to prevent heart from the toxicity of catecholamines to protect the cardiovascular.However,there are still many disputes and different ideas about the clinical use of β-blockers.This article will review the new ideas and disputes about β-blockers in the use of hypertension,myocardial infarction and heart failure.

  19. Clinical study on ACEI combined with beta-blocker in the treatment of chronic heart failure%卡托普利联合美托洛尔治疗慢性心力衰竭的临床研究

    殷洪志

    2014-01-01

    目的 观察卡托普利联合美托洛尔对慢性心力衰竭(CHF)的治疗作用,并探讨其作用机制.方法 60例CHF患者分为常规治疗组(A组)和卡托普利+美托洛尔治疗组(B组),观察治疗后左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)、基质金属蛋白酶-9(MMP-9)和高敏C反应蛋白(hs-CRP)水平变化.酶联免疫吸附双抗体夹心法(ELISA)检测血清MMP-9表达水平;乳胶增强免疫比浊法检测血清hs-CRP表达水平.结果 B组LVEF及LVEDD[(63.21±6.09)%、(58.42±5.73) mm]的改善显著优于A组[(41.13±3.67)%、(66.24±4.24) mm](t=7.62、6.54,均P<0.01);B组MMP-9和hs-CRP[(1.31±0.24) ng/mL、(6.34±0.58) mg/L]水平显著低于A组[(2.23±0.39) ng/mL、(8.31±0.74) mg/L](t=6.82、7.03,均P<0.01).A和B组的有效率分别为36.7%和73.3%,差异有统计学意义(x2=6.90,P<0.05).结论 卡托普利与美托洛尔联合治疗对CHF患者心功能具有保护作用,抑制MMP-9和hs-CRP的表达可能是其主要的作用机制.%Objective To investigate the effects of ACEI combined with beta-blocker on cardiac function in patients with chronic heart failure (CHF)and explore its action mechanisms.Methods 60 CHF patients were enrolled in this study.The patients were randomly divided into the two groups:conventional treatment group(group A,n =30),ACEI combined with beta-blocker treatment group (group B,n =30).The LVEF,LVEDD,MMP-9,and hsCRP were recorded after treatment.The expression of MMP-9 was measured by ELISA.The level of serum hs-CRP was measured by latex enhanced immunoturbidimetric assay.Results The improvement of LVEF and LVEDD in B group [(63.21 ± 6.09) %,(58.42 ± 5.73)mm] were better than those in A group [(41.13 ± 3.67) %,(66.24 ± 4.24) mm] (t =7.62,6.54,P < 0.01).The expressions of MMP-9 and hs-CRP in group B [(1.31 ± 0.24) ng/ml,(6.34 ± 0.58) mg/L] were significantly lower than those in A group[(2.23 ±0.39) ng/mL,(8.31 ±0.74) mg/L] (t =6.82,7.03,P <0.01).The

  20. ANTIHYPERTENSIVE MEDICATION PRESCRIBING PATTERNS IN A UNIVERSITY TEACHING HOSPITAL IN SOUTH DELHI

    Fowad Khurshid et al.

    2012-07-01

    Full Text Available Study objective: To investigate the use of antihypertensive drugs in hypertensive patients and to identify whether such pattern of prescription is appropriate in accordance with international guidelines for management of hypertension. Methods: This was a prospective analysis. A prescription based survey among patients with established hypertension was conducted at the Medicine Out-Patient Department of University Teaching Hospital in South Delhi, India. Data were collected from patients’ medical records as well as patients’ interviews.Results: A total of 192 hypertensive patients fulfilled the criteria for inclusion in the study analysis. Combination therapy was used more commonly than monotherapy (54.6% vs 45.4. Among the monotherapy category, the various classes of drugs used were as follows: beta- blockers (28.8%, diuretics (24.1%, calcium channel blockers (21.8%, ACE inhibitors (18.4%, angiotensin II receptor blockers (5.7% and α 1- blocker (1.1%. With respect to overall utilization pattern, diuretics (42.2% were the most frequently prescribed class, beta- blockers (41.2% ranked second followed by calcium channel blockers (39.1%, ACE inhibitors (26.0%, angiotensin II receptor blockers (23.4% and α 1- blocker (9.4%. As for individual medicines, amlodipine (35.4% was the most commonly prescribed antihypertensive drug followed by atenolol (17.8%, ramipril (17.2 % and furosemide (13.0 %. Among the combination therapies, 2- drug treatment was preferred for 75% of the hypertensive patients with CCB and β-blocker being the most frequent drug combination (22.4%.Conclusion: The general pattern of antihypertensive utilization seems to be in accordance with the international guidelines for management of hypertension.

  1. Analysis of 1 case with intermittent left bundle branch block caused by high doses of beta blocker%大剂量β受体阻滞剂致间歇性左束支传导阻滞1例分析

    王清丽; 金向梅; 张力; 赵激扬

    2014-01-01

    We have treated 1 case with intermittent left bundle branch block caused by high doses of beta blocker.We briefly reported the treatment experience.%在临床治疗了1例大剂量β受体阻滞剂致间歇性左束支传导阻滞的患者,现将体会简要报告。

  2. Clinical Experience of Beta Blocker Therapy in Unstable Angina%β受体阻滞剂治疗不稳定型心绞痛的临床体会

    许志茹

    2015-01-01

    目的:针对β受体阻滞剂治疗不稳定型心绞痛的临床体会进行分析。方法选择我院在2013年6月~2014年6月期间,收治的80例不稳定型心绞痛患者,分为对照组和观察组。对照组常规心绞痛治疗,观察组常规治疗+β受体阻滞剂治疗。观察两组患者的临床治疗效果、不良反应、心绞痛发作情况。结果观察组与对照组患者的临床治疗总有效率分别为95.00%、65.00%,P<0.05,具有统计学意义。观察组与对照组患者的不良反应发生率分别为2.50%、15.00%,P<0.05,具有统计学意义。观察组与对照组患者的心绞痛发作次数和持续时间均有显著差异,P<0.05,具有统计学意义。结论在不稳定型心绞痛治疗中,β受体阻滞剂发挥重要作用,可以改善患者临床症状,降低不良反应,提高患者生活质量。%Objective To analysis Beta blockers in the treatment of unstable angina clinical experience. Methods Selected 80 patients with unstable angina treated in June 2013~June 2014, divided into control group and observation group. The control group conventional treatment angina pectoris, observation group conventional treatment+beta blockers. Observed the clinical therapeutic effect of two groups of patients, adverse reactions, angina pectoris attack Situation. Results Observation group and control group in patients with the clinical total effective rate respectively were 95.00%, 65.00%, P<0.05, there was statistical significance. Observation group and control group patients the incidence of adverse reactions were 2.50%, 15.00%, P<0.05, there was statistical significance. Observation group and control group in patients with angina frequency and duration were signiifcantly different, P<0.05, there was statistical signiifcance. Conclusion In the treatment of unstable angina, β-blockers play an important role, can improve the clinical symptoms and reduce adverse reactions and improve the

  3. Study on the influence of beta-blockers on endogenous CO concentration and NOS activity in rat corpus ;cavernosum%β受体阻滞剂对雄性大鼠阴茎组织中内源性一氧化碳浓度及一氧化氮合酶活性影响的研究

    李明; 丁连芹; 张万峰; 王贵平; 杨振涛; 王洪杰

    2016-01-01

    Objective To discuss the impact of beta -blockers on endogenous CO concentration and NOS activity in rat corpus cavernosum .Methods Thirty adult male rats were equally divided into three groups , the first group raised with first generation beta -blocker ( Propranolol ) , the control group raised with regular diet , the third group raised with second generation beta -blocker ( Metoprolol ) .The concentration of CO was measure by modified dual -wavelength spectrophotometry , the NOS activity was measure by improved Griess measurement .Results The concentration of CO and the NOS activity of first generation beta -blocker ( Propranolol ) group were lower than the group raised with regular diet .The concentration of CO and the NOS activity of the group raised with regular die were lower than the group raise with second generation beta -blocker (Metoprolol).The difference between groups were statistically significant (P<0.05).Conclusions The first generation beta-blockers can reduce the concentration of CO and the NOS activity in rat corpus cavernosum , the second generation beta -blockers can increase the concentration of CO and the NOS activity in rat corpus cavernosum .%目的:探讨β受体阻滞剂对雄性大鼠阴茎组织中内源性CO浓度及NOS活性的影响。方法健康雄性大鼠30只,分为三组,第一代β受体阻滞剂(普萘洛尔)饲养组,正常饲养组,第二代β受体阻滞剂(倍他乐克)饲养组,采用改良双波长分光光度法检测大鼠阴茎组织中CO浓度,改良Griess法检测大鼠阴茎组织中NOS活性。结果普萘洛尔饲养组大鼠阴茎组织中内源性CO浓度及NOS活性低于正常饲养组,正常饲养组大鼠阴茎组织中CO浓度及NOS活性低于倍他乐克饲养组,各组间差异具有统计学意义(P均<0.05)。结论第一代β受体阻滞剂可导致成年雄性大鼠阴茎海绵体内源性CO浓度及NOS活性下降,而第二代β受体阻滞剂可增加成年

  4. Educating nonmedical prescribers

    Stewart, Derek; MacLure, Katie; George, Johnson

    2012-01-01

    The last decade has seen developments in nonmedical prescribing, with the introduction of prescribing rights for healthcare professionals. In this article, we focus on the education, training and practice of nonmedical prescribers in the UK. There are around 20 000 nurse independent prescribers, 2400 pharmacist supplementary/independent prescribers, several hundred allied health professional supplementary prescribers and almost 100 optometrist supplementary/independent prescribers. Many are a...

  5. Antipsychotics, Lithium, Benzodiazepines, Beta-Blockers.

    Karper, Laurence P.; And Others

    1994-01-01

    The psychopharmacologic treatment of aggression is a critical component of the treatment of psychiatric patients. The diagnostic assessment of aggressive patients is reviewed and relevant literature is presented to help clinicians select appropriate medication. Side-effects, dosages, and methods of administration are highlighted. (JPS)

  6. Beta-blockers and heart failure.

    Cruickshank, John M

    2010-01-01

    The life-time risk of developing HF is about 20% (40% if hypertension present). With increasing longevity in the developed world the burden of HF (hospitalisation) is set to increase over the next 10-20 years. CAD and hypertension are the two main causes of HF; CAD (and obesity) in the case of systolic HF and hypertension in the case of diastolic HF (mainly in the elderly). BB have become the corner-stone (alongside ACE-inhibitors) in the treatment of systolic HF. Bisoprolol, metoprolol and carvedilol (on an ACE-inhibitor background) have reduced all-cause death by 34-5%. The presence of intrinsic sympathomemetic activity (xamoterol, bucindolol, nebivolol) diminishes efficacy in the treatment of systolic HF. First-line bisoprolol has proved "non-inferior" to first-line enalapril in reducing all-cause death and is probably superior in reducing sudden death. The main mode of action of BB in treating systolic HF is inhibition of chronic beta-1 stimulation-induced myocardial apoptosis/necrosis/inflammation. The combination of pure beta-1 blockade (low-dose bisoprolol) and pure beta-2 blockade (clenbuterol) may prove invaluable in the treatment of end-stage systolic HF (thus avoiding cardiac transplantation). The appropriate treatment of diastolic HF has yet to be determined. Beta-blockade is effective in the prevention of HF i) in the post-MI period and ii) as first-line agents in the treatment of young/middle-aged hypertension and as second-line agents (to first-line diuretics) in the treatment of elderly systolic hypertension. BB are highly effective in reversing LVH in young/middle-aged hypertensives (LVH pre-disposes to HF in young/middle-aged hypertension) and are (bisoprolol) at least as good as ACE-inhibitors. Choice of BB is important as benefit is not a class-effect. ISA (xamoterol, bucindolol, nebivolol) markedly diminishes efficacy. The choice is between bisoprolol, metoprolol succinate and carvedilol for optimal efficacy. Adverse reactions are associated, mainly, with beta-2 blockade and alpha-blockade. Thus non-selective (e.g. propranolol) or modestly beta-1 selective (e.g. metoprolol, atenolol) are associated with metabolic disturbance, bronchospasm, epinephrine/hypertensive interaction (with cigarette-smoking or insulin-induced hypoglycaemia), while the possession of alpha-blocking activity (e.g. carvedilol) is associated with dizziness and postural hypotension. The possession of beta-2 blockade, particularly if combined with alpha-blockade, is associated with an increased occurrence of sexual dysfunction. Lipophilic BB like propranolol and metoprolol appear in high concentrations in human brain tissue and are associated with side-effects such as insomnia, dreams and nightmares. PMID:21180298

  7. Using situation investigation on beta-blockers in patients with chronic heart failure combined chronic obstructive pulmonary disease%β受体阻滞剂在慢性心力衰竭合并慢性阻塞性肺疾病患者中的使用状况调查

    丁旭; 林海龙; 李雅洁; 赵洪涛

    2014-01-01

    目的:了解慢性心力衰竭(CHF)患者合并慢性阻塞性肺疾病(COPD)发生率,了解β受体阻滞剂使用情况,为未来针对这部分患者β受体阻滞剂的使用提供依据。方法根据2007年1月1日~2009年12月31日出院诊断CHF患者住院资料和用药资料,研究慢性阻塞性肺病共存检出率、分析β受体阻滞剂使用比例、类型、剂量和未应用的原因。结果共有598例CHF患者,其中合并慢性阻塞性肺病的患者74例(12.4%),β受体阻滞剂药物使用11例(14.9%),最常用的为美托洛尔(29.4±10.1) mg/d,所有使用剂量均未达到目标剂量。有β受体阻滞剂禁忌证患者26例(35.1%),没有明确的原因未应用β受体阻滞剂患者37例(50.0%)。结论 CHF患者合并COPD并不少见,β受体阻滞剂在这组患者中使用比例及用量明显不足,在未来应对相关的诊断和治疗给予足够的关注。%Objective To know about the detection rate of chronic obstructive pulmonary disease ( COPD) in hospitalized cases with chronic heart failure ( CHF) , and to explore the usage state of the beta-blockers performed in these cases. Methods General data and medication data from January 1, 2007 to December31, 2009 were collected in hospitalized cases whose diagnosis was CHF after discharge. To find out the detection rate of COPD in hospitalized cases with CHF, the usage rate, category, dosage and causes failed to perform of beta-blockers in these cases. Results 598 cases with CHF were selected, among them 74 cases who complicated with COPD were detective the detection rate was 12.4%, the usage rate of beta-blockers performed in these cases was 14.9%. Metoprolol was the most common category, and the average dosage was (29.4±10.1) mg per day. No one received the target dose that the guide line had been recommended.26 cases (35.1%) had contraindication in medication of beta-blockers, but yet 37 cases (50.0%) who had no contraindication could not receive beta-blockers owing

  8. Research progress of beta-blockers in the treatment of infantile hemangioma%β-受体阻滞剂治疗婴幼儿血管瘤的研究进展

    李忠达; 彭智

    2016-01-01

    Infantile hemangiomas (IH) are the most common tumors of infancy, with a prevalence of approxi-mately 4~10%of infants. Although the natural history of IH is to spontaneously involute, a significant minority of IH re-quire therapy with the aim to prevent disfigurement, functional impairment, or ulceration. In 2008, propranolol, a non-se-lective beta (β)-blocker, was reported to be highly effective in treating IH. Since that time there have been more than 200 articles published regarding the efficacy and potential toxicity ofβ-blockers, both systemic and topical, for the treatment of IH. Based on these findings,β-blockers appear to be highly effective in treating IH and are well tolerated, though side effects have been reported. When therapy is appropriately monitored,β-blockers have been proven to be a safer and su-perior alternative to systemic steroids. This paper mainly reviews the treatment of IH through beta-blockers in recent years involving the mechanism, side effects, usage and dosage.%婴幼儿血管瘤(IH)是一种最常见的良性肿瘤,在婴幼儿中患病率为4%~10%,虽然有部分IH存在自然消退过程,但少数IH仍需要有效治疗,以防止其对皮肤的损害,导致肢体功能障碍以及发生局部溃疡.自2008年,普萘洛尔,一种非选择性β-受体阻滞剂被报道能高效治疗婴幼儿血管瘤之后,目前有约200篇文献报道β-受体阻滞剂对IH治疗存在全身性、局部性疗效及潜在毒性.基于以上发现,β-受体阻滞剂在治疗IH中产生非常高的疗效并得到了认可.与类固醇比较,即使β-受体阻滞剂在使用过程中产生一定的副作用,如果在治疗过程中得到适当监测,其更加安全与优质.本文主要对近几年来β-受体阻滞剂治疗IH作用机制,不良反应,用法、用量做一综述.

  9. Pharmacoeconomics of antihypertensive drugs prescribed in a multispecialty hospital in South India

    P S Dhivya

    2014-01-01

    Full Text Available The main objective of this study is to evaluate the most cost-effective therapy among the different group of antihypertensive prescribed in a multispecialty hospital. According to inclusion and exclusion criteria, 104 hypertensive patients were selected. Participants were interviewed at about the demographic data. Initial clinical assessment of blood pressure (BP and pulse rate were done. They were prescribed monotherapy either with angiotensin receptor blocker (ARB (n = 7 or beta blocker (BB (n = 23 or calcium channel blocker (CCB (n = 9. Angiotensin converting enzyme with BB (n = 27, ARB with CCB (n = 17 and ARB with BB (n = 21 were prescribed in combination therapy. The cost of antihypertensive drugs was calculated using incremental cost for "per mmHg" reduction and cost for "per patient" reaching target BP. The data are analyzed using suitable statistical methods. ARB with BB shows significant reduction in BP. To maintain the targeted BP, BB is found to be cost-effective in both systolic BP (SBP and diastolic BP (DBP as well as in the reduction of "per mmHg" of DBP. In case of reduction of "per mmHg" of SBP ARB is cost-effective. Treatment of hypertension with BBs is cost-effective.

  10. Diltiazem como alternativa ao betabloqueador na angiotomografia de artérias coronárias Diltiazem as an alternative to beta-blocker in coronary artery computed tomography angiography

    Carlos Eduardo Rochitte

    2012-08-01

    Full Text Available FUNDAMENTO: A redução da frequência cardíaca (FC na angiografia por tomografia das artérias coronarianas (ATCCor é fundamental para a qualidade de imagem. A eficácia dos bloqueadores de cálcio como alternativas para pacientes com contraindicações aos betabloqueadores não foi definida. OBJETIVOS: Comparar a eficácia na redução da FC e variabilidade RR do metoprolol e diltiazem na ATCCor. MÉTODOS: Estudo prospectivo, randomizado, aberto, incluiu pacientes com indicação clínica de ATCCor, em ritmo sinusal, com FC>70bpm e sem uso de agentes que interferissem com a FC. Cinquenta pacientes foram randomizados para grupos: metoprolol IV 5-15 mg ou até FC≤60 bpm(M, e diltiazem IV 0,25-0,60mg/kg ou até FC≤60 bpm (D. Pressão arterial (PA e FC foram aferidas na condição basal, 1min, 3min e 5min após agentes, na aquisição e após ATCCor. RESULTADOS: A redução da FC em valores absolutos foi maior no grupo M que no grupo D (1, 3, 5min, aquisição e pós-exame. A redução percentual da FC foi significativamente maior no grupo M apenas no 1 min e 3 min após início dos agentes. Não houve diferença no 5 min, durante a aquisição e após exame. A variabilidade RR percentual do grupo D foi estatisticamente menor do que a do grupo M durante a aquisição (variabilidade RR/ FC média da aquisição. Um único caso de BAV, 2:1 Mobitz I, revertido espontaneamente ocorreu (grupo D. CONCLUSÃO: Concluímos que o diltiazem é uma alternativa eficaz e segura aos betabloqueadores na redução da FC na realização de angiografia por tomografia computadorizada das artérias coronarianas. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0BACKGROUND: Reducing heart rate (HR in CT angiography of the coronary arteries (CTACor is critical to image quality. The effectiveness of calcium channel blockers as alternatives for patients with contraindications to beta-blockers has not been established. OBJECTIVES: To compare the efficacy in the

  11. β受体阻滞剂应用于慢性阻塞性肺疾病治疗的Meta分析%Meta-analysis of beta-blockers for chronic obstructive pulmonary disease

    徐婷娟; 胡世莲; 沈干; 徐维平; 吴蕾; 陈尹

    2013-01-01

    ) . P > 0. 051 and FEV1% increased 0. 89% 「 95% CI( - 1. 26. 3. 04) . P > 0.05」 after treatment with beta-blockers. Conclusion Cardioselective beta — blockers do not produce obvious adverse respiratory effects.

  12. Discussion of Beta-blocker in the treatment of chronic obstructive pulmonary disease complicated with chronic heart failure%慢性阻塞性肺疾病合并慢性心力衰竭患者使用β阻滞剂的探讨

    赵华昌

    2014-01-01

    Chronic obstructive pulmonary disease(COPD) is one of the common diseases in respiratory system, and a group of systemic inflammatory diseases which are positively correlated to ages; chronic heart failure(CHF) is a syndrome characterized by impaired cardiac functions which are caused by hypertension and coronary heart disease to a certain developmental stage. The two groups of diseases usually co-exist clinically and become severe along with the ages.The CHF guides, home and abroad, both recommend cardioselective beta-blocker, but clinical physicians, considering its adverse effects, tend to refuse or avoid the use of beta-blocker on patients with COPD complicated with CHF. In recent years, increasing evidence shows that the beta-blocker in the treatment of COPD complicated with CHF does not have significant adverse effects, and its safety has been confirmed. No evidence shows that its function in reducing pulmonary ventilation equals to FEV1. In clinical practices, however, relevant studies warn that the beta-blocker may lead to condition deterioration. Through observation, the current author suggests that the strategy of"individualization"may be adopted for patients with COPD complicated with CHF when receiving cardioselective beta-blocker.%慢性阻塞性肺疾病(COPD)是呼吸系统常见病,是一组与年龄呈正相关的全身炎症性疾病;慢性心力衰竭(CHF)多系高血压、冠心病发展到一定程度后导致心功能损害为主的综合征。在临床上这两组疾病常常合并存在,且随着年龄的增加而增加。国内外的慢性心力衰竭指南均推荐使用心脏选择性β受体阻滞剂,但是临床医师遇到COPD合并CHF患者因担心β受体阻滞剂的不良反而拒绝或回避使用。近年来越来越多的证据表明,心脏选择性β受体阻滞剂在COPD合并CHF患者中没有明显的不良反应,且安全性得到证实,没有证据显示其降低肺通气功能如第1

  13. Exploring the equity of GP practice prescribing rates for selected coronary heart disease drugs: a multiple regression analysis with proxies of healthcare need

    St Leger Antony S

    2005-02-01

    Full Text Available Abstract Background There is a small, but growing body of literature highlighting inequities in GP practice prescribing rates for many drug therapies. The aim of this paper is to further explore the equity of prescribing for five major CHD drug groups and to explain the amount of variation in GP practice prescribing rates that can be explained by a range of healthcare needs indicators (HCNIs. Methods The study involved a cross-sectional secondary analysis in four primary care trusts (PCTs 1–4 in the North West of England, including 132 GP practices. Prescribing rates (average daily quantities per registered patient aged over 35 years and HCNIs were developed for all GP practices. Analysis was undertaken using multiple linear regression. Results Between 22–25% of the variation in prescribing rates for statins, beta-blockers and bendrofluazide was explained in the multiple regression models. Slightly more variation was explained for ACE inhibitors (31.6% and considerably more for aspirin (51.2%. Prescribing rates were positively associated with CHD hospital diagnoses and procedures for all drug groups other than ACE inhibitors. The proportion of patients aged 55–74 years was positively related to all prescribing rates other than aspirin, where they were positively related to the proportion of patients aged >75 years. However, prescribing rates for statins and ACE inhibitors were negatively associated with the proportion of patients aged >75 years in addition to the proportion of patients from minority ethnic groups. Prescribing rates for aspirin, bendrofluazide and all CHD drugs combined were negatively associated with deprivation. Conclusion Although around 25–50% of the variation in prescribing rates was explained by HCNIs, this varied markedly between PCTs and drug groups. Prescribing rates were generally characterised by both positive and negative associations with HCNIs, suggesting possible inequities in prescribing rates on the basis

  14. CCB+利尿剂+β受体阻滞剂联合降压治疗与动脉弹性的相关性%The Correlation of CCB Add Diuretics and Beta-blockers Joint Antihypertensive Therapy Correlation of Arterial Elasticity

    王淑霞

    2015-01-01

    Objective To study the CCB add diuretic and beta blockers combination therapy and the correlation of arterial elasticity. Methods Selected 50 cases of patients with high blood pressure in our hospital as research object, were divided into the treatment group and the control group, each group had 25 cases, the control group mainly uesed the CCB and ACEI treatment, the treatment group mainly adopts CCB added diuretic and beta blockers with antihypertensive therapy, compared the clinical effect of two groups of patients.Results The total effective was 94.43% in the treatment group and the control group total effective was 87.55%, the treatment group treatment effect was bettere than the control group, P<0.05, was difference had statistically significance.Conclusion Patients with hypertension by CCB add diuretica and beta blockers joint treatment, which could effectively improve patients wiht hypertensive in small artery elasticity, has obtained the good curative effect in clinical.%目的 探讨CCB+利尿剂+β受体阻滞剂联合降压治疗与动脉弹性的相关性.方法 选取我院收治的50例高血压患者作为研究对象,将其分为治疗组与对照组,各25例,对照组主要采用CCB+ACEI治疗,治疗组主要采用CCB+利尿剂+β受体阻滞剂联合降压治疗,对两组患者的临床效果进行比较.结果 治疗组的总有效为94.43%,对照组的总有效为87.55%,治疗组的效果优于对照组,P<0.05,差异不具有统计学意义.结论 对高血压患者采用CCB+利尿剂+β受体阻滞剂联合降压治疗,能够有效的改善高血压患者的小动脉弹性,在临床中取得了良好的治疗效果.

  15. Treating effect analysis of big dose oryzanol with beta blocker for cardiovascular neurosis disease%大剂量谷维素联合β-受体阻滞剂治疗心血管神经症的疗效分析

    王云

    2014-01-01

    目的:探究大剂量谷维素联合β-受体阻滞剂治疗心血管神经症的临床疗效。方法抽取2012年2月至2013年2月在我院就诊的80例心血管神经症患者作为研究对象,以随机的方式分为观察组与对照组,各40例;对照组使用常规治疗方法进行治疗,观察组使用大剂量谷维素联合β-受体阻滞剂进行治疗;对两组患者临床治疗效果进行观察比较。结果观察组治疗有效率(97.50%)明显高于对照组(72.50%),两组数据差异明显(P<0.05),有统计学意义。结论对于心血管神经症患者,采取大剂量谷维素联合β-受体阻滞剂进行治疗效果良好,能够提高患者临床治疗有效率,改善患者生活质量。%ObjectiveTo explore a big dose of oryzanol beta blockers clinical efifcacy in the treatment of cardiovascular neurosis.Methods from february 2012 to february 2013 in our hospital 80 cases of patients with cardiovascular neurosis as the research object, in the form of random divided into observation group and control group, 40 cases; control group treated with conventional treatment methods, the observation group used high doses of oryzanol joint treated with beta blockers; to compare clinical therapeutic effects in both groups.Results treatment efifcient (97.50%) of the observation group was obviously higher than that of control group (72.50%), two groups of data difference obvious (P < 0.05=, having statistical signiifcance. Conclusion for patients with cardiovascular neurosis, taking high doses of oryzanol in combination with beta blockers treatment effect is good, can effectively improve the clinical treatment, improve patient quality of life.

  16. 感染性休克患者心脏及微循环的功能变化与β受体阻滞剂的血流动力学效应%Functional changes of heart and microcirculation in patients with septic shock and analysis of the hemodynamic effects of beta blockers

    孙志宝; 安庆华; 郑玉明; 齐凯; 程悦

    2016-01-01

    目的:探讨β受体阻滞剂在改善心脏及微循环功能的作用以及对血流动力学参数的影响,为临床更好的使用β受体阻滞剂治疗感染性休克提供参考。方法选取2012年3月-2014年2月医院81例感染性休克患者,随机分为观察组41例和对照组40例;对照组采用常规体液复苏的治疗方法,观察组在此基础上采用β受体阻滞剂的治疗方法,比较两组患者血流动力学指标及组织氧合指数参数,数据采用SPSS 17.0软件进行统计分析。结果观察组患者治疗后心率(HR)、心脏指数(CI)显著低于对照组;每搏输出量指数(SVI)显著高于对照组,差异有统计学意义(P<0.05);两组患者各时间点中心静脉血氧饱和度(ScvO2)比较差异无统计学意义,说明β受体阻滞剂有效的降低了血乳酸值。结论β受体阻滞剂可以改善心室顺应性以及舒张功能,血流动力学参数有所变化,提高组织灌注水平,可作为临床治疗感染性休克的有效手段之一。%OBJECTIVE To investigate the effect of beta blockers in improving the function of the heart and micro‐circulation and the influence of the parameters of the blood flow so as to provide references for using beta blockers to cure septic shock in clinical practice .METHODS Totally 81 patients with septic shock in our hospital from Mar . 2012 to Feb .2014 were selected and these patients were randomly divided into observation group (41 cases) and control group (40 cases) .The control group was treated with routine fluid resuscitation ,and on the basis of this , the observation group was treated with beta blockers .The hemodynamic parameters and tissue oxygenation index were measured in two groups .All data were statistically analyzed by SPSS 17 .0 software .RESULTS The heart rate (HR) and cardiac index (CI) of the observation group were significantly lower than those in the control group ,and the stroke

  17. Changing doctor prescribing behaviour

    Gill, P.S.; Mäkelä, M.; Vermeulen, K.M.;

    1999-01-01

    The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane Collabora......The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane...... Collaboration on Effective Professional Practice. This register is kept up to date by searching the following databases for reports of relevant research: DHSS-DATA; EMBASE; MEDLINE; SIGLE; Resource Database in Continuing Medical Education (1975-1994), along with bibliographies of related topics, hand searching...

  18. Assessing prescribing competence

    Mucklow, John; Bollington, Lynne; Maxwell, Simon

    2011-01-01

    Prescribing of medicines is the key clinical activity in the working life of most doctors. In recent years, a broad consensus regarding the necessary competencies has been achieved. Each of these is a complex mix of knowledge, judgement and skills. Surveys of those on the threshold of their medical careers have revealed widespread lack of confidence in writing prescriptions. A valid and reliable assessment of prescribing competence, separate from an overall assessment of medical knowledge and...

  19. Psychotropic prescribing in HIV

    Reid, E; Orrell, C.; K Stoloff; Joska, J.

    2012-01-01

    Psychiatric disorders frequently co-occur with HIV, as preceding conditions or consequent to HIV infection. This potentially compromises HIV diagnosis and antiretroviral (ARV) treatment adherence. We provide a brief guide to the diagnosis and treatment of common mental disorders in people living with HIV/AIDS, including: prescribing psychotropics in HIV; neuropsychiatric side-effects of ARVs and other medications commonly prescribed in HIV; and the diagnosis and treatment of depression, anxie...

  20. Insight into the rational use of nonselective beta-blockers in cirrhotic patients with portal hypertension%非选择性β受体拮抗剂在肝硬化门静脉高压患者中的合理应用

    涂传涛(综述); 王吉耀(审校)

    2014-01-01

    It is well established that variceal hemorrhage is one of the most common and severe complications in patients with liver cirrhosis and portal hypertension. Despite the advances in the last three decades in its treatment, mortality from variceal bleeding is still around 15%~20%. Moreover,variceal bleeding often leads to deterioration of liver functions. Furthermore,it is a common trigger for other complications of liver cirrhosis. Therefore, primary and secondary preventions of variceal hemorrhageare important strategy for improving the survival in patients with decompensated liver cirrhosis and esophageal varices. Nonselective beta-blockers (NSBB) have been shown to reduce the hepatic venous portal pressure gradient and are recommended for the prevention of the first variceal hemorrhage and rebleeding. The advantages of NSBB therapy are good tolerance,oral administrationand lowcost.However,the indication of NSBB should be limited to patientswith a high risk of variceal bleeding because of the potential side effects of the therapy.%曲张静脉出血是肝硬化门静脉高压患者最常见和最严重的并发症之一。近三十余年来,尽管对其治疗取得了进展,但其相关病死率仍达15%~20%左右。不仅如此,曲张静脉出血常导致肝功能进一步的恶化,也是诱发肝硬化其他并发症的共同启动因素。因此,预防曲张静脉首次出血与再出血是提高失代偿期肝硬化和食管曲张静脉患者生存率的重要措施。非选择性β受体阻滞剂(nonselective beta-blockers, NSBB)因具有明确地降低肝静脉压力剃度的作用,被推荐用于预防曲张静脉首次出血和再出血。尽管该类药物具有耐受性好、口服方便和经济实惠的优点,但在使用过程中因存在副作用和潜在的不良作用,一般推荐应有选择地用于那些高危的曲张静脉患者。

  1. Psychotropic prescribing in HIV

    E Reid

    2012-11-01

    Full Text Available Psychiatric disorders frequently co-occur with HIV, as preceding conditions or consequent to HIV infection. This potentially compromises HIV diagnosis and antiretroviral (ARV treatment adherence. We provide a brief guide to the diagnosis and treatment of common mental disorders in people living with HIV/AIDS, including: prescribing psychotropics in HIV; neuropsychiatric side-effects of ARVs and other medications commonly prescribed in HIV; and the diagnosis and treatment of depression, anxiety, psychosis, agitation, sleep disturbance, pain, and mania. Psychotropic treatments recommended were drawn primarily from those available in the public sector of South Africa.

  2. Matrix with Prescribed Eigenvectors

    Ahmad, Faiz

    2011-01-01

    It is a routine matter for undergraduates to find eigenvalues and eigenvectors of a given matrix. But the converse problem of finding a matrix with prescribed eigenvalues and eigenvectors is rarely discussed in elementary texts on linear algebra. This problem is related to the "spectral" decomposition of a matrix and has important technical…

  3. The effect of early intravenous beta blockers on prognosis in patients with acute myocardial infarction:a Meta analy-sis%早期静脉应用β受体阻滞剂对急性心肌梗死患者预后影响的 Meta 分析

    王丹宁; 陈鹏飞; 黄颖; 陈侃; 王磊; 廖德宁

    2015-01-01

    目的:系统评价再灌注时心肌梗死后早期静脉应用β受体阻滞剂对患者预后的影响。方法检索Pubmed、Embase、Cochrane 图书馆、中国知网、万方数据知识服务平台、维普期刊资源整合服务平台、中国生物医学文献数据库,收集比较再灌注背景下心肌梗死后早期静脉使用β受体阻滞剂(试验组)不使用或者使用安慰剂(对照组)对患者预后影响的研究。主要观察指标为短期及长期的全因病死率及恶性心律失常、心肌再梗死、心源性休克等发生率。采用Revman5.2软件对提取的数据进行荟萃分析。结果纳入8项临床研究,共48367例患者。 Meta分析显示,试验组与对照组相比,心肌梗死患者恶性室性心律失常发生率下降(OR=0.83,95%CI 0.75~0.93, P =0.0009);心源性休克、心力衰竭发生率增加(OR=1.29,95%CI 1.18~1.41, P <0.01),2组心肌梗死患者全因病死率、再梗死、缺血等不良事件发生率差异无统计学意义(OR=0.98 ,95%CI 0.92~1.05, P =0.63;OR=0.95 ,95%CI 0.88~1.03, P =0.21)。结论在心肌梗死早期静脉给予β受体阻滞剂可以降低梗死后恶性室性心律失常发生率,但同时也有增加心源性休克、心力衰竭发生的风险,在改善病死率方面没有明显获益。%Objective To evaluate the effect of early intravenous beta blockers on prognosis in patients with acute myocardial infarction( AMI) .Methods Searched on PubMed, Embase, Cochrane library, CNKI, Wanfang Data,VIP journal resources integration service platform, the Chinese biomedical literature database, collected and compared AMI reperfusion pa-tients received early intravenous beta blockers ( test group) and does not use beta blockers or placebo ( control group) to study the impact on prognosis.Main outcome measurements included short-term and long-term all

  4. 非瓣膜性心房颤动患者内皮和血小板功能及β受体阻滞剂干预的临床意义%Endothelial function and platelet activation in patients with non-valvular atrial fibrillation and the influence of beta-blocker on them

    种甲; 杨杰孚

    2011-01-01

    目的 探讨非瓣膜性心房颤动(房颤)与内皮细胞功能及血小板功能的关系,观察β受体阻滞剂治疗对房颤患者内皮功能及血小板功能的影响.方法 非瓣膜性持续性房颤患者(房颤组)25例,窦性心律组(窦律组)35例,通过竞争性酶联免疫(ELASA)分析定量测定两组血清血管性血友病因子(von Willebrand Factor,vWF)和可溶性P选择素水平,及房颤组β受体阻滞剂治疗后上述指标的变化.结果 房颤组血清vWF水平(1945.2±111.3)g/L高于窦律组(1862.3±101.6)g/L,差异有统计学意义(P<0.05).房颤组患者服用β受体阻滞剂(阿替洛尔)后,血清vWF水平下降至(1758.3±152.4)g/L,与服药前比较差异有统计学意义(P<0.01).血清可溶性P选择素水平房颤组与窦律组[分别为(24.32±9.21)g/L与(24.68±11.70)g/L]比较,差异无统计学意义(P>0.05),服用β受体阻滞剂后血清可溶性P选择素水平下降至(21.05±8.94)g/L,但与服药前相比差异无统计学意义(P>0.05).vWF与可溶性P选择素无相关性(Pearson相关系数为-0.008,P>0.05).结论 房颤患者血清vWF水平较窦性心律者升高,提示存在心血管内皮损伤.服用阿替洛尔后,房颤患者血清vWF水平下降,提示阿替洛尔用于房颤患者除能有效控制心室率外,还可能具有内皮保护功能.%Objective To examine the serum von Willebrand factor (vWF) and soluble Pselectin levels in patients with non-valvular atrial fibrillation (NVAF), and to observe the influence of beta-blocker treatment on endothelial function and platelet activation in NVAF patients. Methods The 25 subjects, 17 males and 8 females, with persistent NVAF and left ventricular ejection fraction (LVEF)≥50%, were enrolled in NVAF group. Those with myocardial infarction, cardiomyopathy or hyperthyroidism were excluded. Another 35 subjects with sinus rhythm were as control (age,gender and LVEF matched with NVAF group, and with similar cardiovascular diseases). Serum

  5. Panic Disorder: When Fear Overwhelms

    ... treatment with medications. Another type of medication called beta-blockers can help control some of the physical symptoms ... excessive sweating, a pounding heart, or dizziness. Although beta blockers are not commonly prescribed, they may be helpful ...

  6. Treatment and Management

    ... benefits found on adults, other medications such as beta-blockers and aldosterone may also be used in children. ... of blood flow out of the heart. Instead, beta blockers and calcium channel blockers are prescribed to patients ...

  7. Treating Anxiety Disorders | NIH MedlinePlus the Magazine

    ... drugs. Commonly prescribed: Xanax, Klonopin, Valium, and Ativan. Beta blockers. These drugs block norepinephrine, the body's "fight-or- ... trembling voice, sweating, dizziness, and shaky hands. Because beta blockers don't affect the emotional symptoms of anxiety, ...

  8. Effects of angiotensin-converting enzyme inhibitors and beta blockers on clinical outcomes in patients with and without coronary artery obstructions at angiography (from a Register-Based Cohort Study on Acute Coronary Syndromes).

    Manfrini, Olivia; Morrell, Christine; Das, Rajiv; Barth, Julian H; Hall, Alistair S; Gale, Christopher P; Cenko, Edina; Bugiardini, Raffaele

    2014-05-15

    We sought to determine the effectiveness of angiotensin-converting enzyme (ACE) inhibition and β-blocker treatment as a function of the degree of coronary artery disease (CAD) obstruction at angiography. The Evaluation of Methods and Management of Acute Coronary Events registry enrolled patients who had been hospitalized for an acute coronary syndrome. There were 1,602 patients who had cardiac catheterization that were used for this analysis. The main outcome measures were evidence-based therapies prescribed at discharge and 6-month incidence of all-cause mortality. The cohort consisted of 1,252 patients with obstructive CAD (>50% luminal diameter obstructed) and 350 patients with nonobstructive CAD. Multivariate logistic regression analysis adjusted for further medications and other clinical factors was performed. Patients with nonobstructive CAD had significantly (p <0.001) higher rates of β-blocker (77.8% vs 63.3%) and lower rates of ACE-inhibitor (57.7% vs 66.4%) prescriptions. In patients with nonobstructive CAD, ACE-inhibitor therapy was clearly associated with a lower 6-month mortality (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.03 to 0.78, p = 0.004). No significant association between β-blocker use and death was found. In patients with obstructive CAD, both β blockers (OR 0.47, 95% CI 0.32 to 0.67, p <0.001) and ACE inhibitors (OR 0.47, 95% CI 0.26 to 0.87, p = 0.01) were significantly associated with a reduced risk of 6-month mortality. In conclusion, ACE-inhibitor therapy seems to be an effective first-line treatment for preventing the occurrence of mortality in patients with nonobstructive CAD. PMID:24698468

  9. The Prescribed Velocity Method

    Nielsen, Peter Vilhelm

    The- velocity level in a room ventilated by jet ventilation is strongly influenced by the supply conditions. The momentum flow in the supply jets controls the air movement in the room and, therefore, it is very important that the inlet conditions and the numerical method can generate a satisfacto...... description of this momentum flow. The Prescribed Velocity Method is a practical method for the description of an Air Terminal Device which will save grid points close to the opening and ensure the right level of the momentum flow....

  10. 非选择性β受体阻滞剂预防食管胃静脉曲张破裂出血的研究进展%Advances in Study on Preventive Efficacy of Non-selective beta-Blockers in Patients with Esophageal Gastric Variceal Bleeding

    段旭红; 诸葛宇征; 张峰

    2015-01-01

    Esophageal gastric variceal bleeding(EGVB)is a serious complication of cirrhotic portal hypertension with high mortality rate. Prevention of EGVB is an important mean to improve the survival of patients. Non-selective beta-blockers(NSBBs)is one of the first-line drugs for primary and secondary prevention of EGVB,however,only about 1 / 3 of cirrhotic patients respond to this treatment when evaluated by hepatic venous pressure gradient( HVPG). This may be related to the genetic polymorphisms of NSBBs’receptors and the metabolic enzymes. This article reviewed the progress in study on therapeutic efficacy of NSBBs and its influencing factors for preventing EGVB in cirrhotic patients.%食管胃静脉曲张破裂出血(EGVB)是肝硬化门静脉高压的常见严重并发症,死亡率高,预防 EGVB 是提高患者生存期的重要手段。非选择性β受体阻滞剂(NSBBs)是 EGVB 一级和二级预防的主要方法之一,但仅1/3患者的肝静脉压力梯度对其治疗有应答;这可能与 NSBBs 受体及其代谢酶的基因多态性有关。本文就 NSBBs 预防 EGVB 的疗效和影响因素作一综述。

  11. Bioavailability and generic prescribing.

    Mindel, J S

    1976-01-01

    Although oral drug bioinequivalence has been attributed to a number of causes (excipients, dosage form, variation in dissolution time, and aging) less is known about bioavailability problems of topical medications in ophthalmology. Factors that can alter drug absorption from solutions (pH, partition coefficient, container impurities, contact time, etc.) are noted, and cases in which bioavailability problems should be considered as causes of therapeutic failure are discussed. Various attitudes representing pharmaceutical companies, the federal government, pharmacists, consumers and physicians toward the related problems of bioinequivalence and generic prescribing are examined. Techniques for in vivo and in vitro drug testing and for establishing uniform conditions of drug manufacture and storage can contribute to identification and minimization of bioavailability problems. A rational program based on a combination of such techniques could, ultimately, lead to establishment of the terms "generic equivalency" and "therapeutic equivalency" as synonymous. PMID:13505

  12. Appropriate prescribing for older people

    Drenth - van Maanen, A.C.

    2013-01-01

    Appropriate prescribing is the result of pharmacotherapeutic decision-making to maximise the net health benefit of treatment, given the resources available. Several risk factors for inappropriate prescribing in older people have been identified, such as polypharmacy, impaired renal function, and frequent transfers between healthcare settings. The objectives of the studies described in this thesis were to describe the frequency and nature of risk factors for inappropriate prescribing in older ...

  13. [Good prescribing practice].

    Seidling, Hanna M; Haefeli, Walter E

    2014-06-01

    Drug prescription is the very first step initiating a cascade of events in the medication process. It is, hence, decisive for success or failure of any pharmacologic treatment. A good prescription must therefore consider (1) relevant patient factors and co-morbidities, (2) evidence-based knowledge on medically sound prescribing practices, and (3) the setting in which a prescription is issued. The setting will determine which partners will participate, contribute, and safeguard the ongoing medication process and how much responsibility can be shared. Partners in the medication process refer to other healthcare professionals dispensing the drug, teaching the patient, or administering the medicines. It also involves the patients or their relatives with their information needs and often variable motivation and conviction to use a drug. By issuing a prescription, the physician must provide the partners with sufficient and appropriate information, must ensure that they understand the meaning of the prescription and are able to perform their assigned tasks during the medication process. Lastly, medication prescription is also subject to formal constraints and must meet legal criteria that are relevant for reimbursement by health insurance companies. PMID:24867345

  14. Prevention of pancreatic cancer by the beta-blocker propranolol

    Al-Wadei, Hussein A.N.; Al-Wadei, Mohammed H.; Schuller, Hildegard M

    2009-01-01

    Pancreatic ductal adenocarcinoma (PDAC) is among the leading causes of cancer deaths and is unresponsive to existing therapy. Smoking and alcohol-induced pancreatitis are among the risk factors for PDAC. We have previously reported that beta-adrenergic receptors (β-ARs) stimulate the proliferation and migration of human PDAC cells in vitro via cAMP-dependent signaling and that the nicotine-derived nitrosamine NNK activates this pathway directly in vitro while additionally stimulating the rele...

  15. &beta;-blockers: a novel class of antitumor agents

    Ji, Yi

    2012-01-01

    Yi Ji,1,* Siyuan Chen,2,* Xianmin Xiao,1 Shan Zheng,1 Kai Li,1 1Division of Oncology, Department of Pediatric Surgery, 2Research Institute of Pediatrics, Children's Hospital of Fudan University, Shanghai, China*These authors contributed equally to this workAbstract: β-adrenergic signaling modulates key signaling pathways that are important for tumor-promoting processes, and numerous mechanisms of action have been elucidated. Preclinical studies have demonstrated that &bet...

  16. Beta-blockers: friend or foe in asthma?

    Arboe B; Ulrik CS

    2013-01-01

    Bente Arboe, Charlotte Suppli UlrikDepartment of Pulmonary Medicine, Hvidovre Hospital and University of Copenhagen, Hvidovre, DenmarkBackground and aim: Recently, β-blockers have been suggested as a potential maintenance treatment option for asthma. The aim of this review is to provide an overview of the current knowledge of the potential benefits and risks of β-blocker therapy for asthma.Method: Systematic literature review.Results: No significant increase in the number of...

  17. Beta-Blocker Therapy and Hemophagocytic Lymphohistiocytosis: A Case Report

    C. Müller

    2010-01-01

    as indicated by high lactate dehydrogenase and alanine aminotransferase levels. A therapeutic switch from propranolol to the 1-receptor blocker metoprolol appeared to be instrumental in hemodynamic improvement and allowed discharge from hospital. However, the infant ultimately died from secondary inflammatory reactivation and intractable pulmonary obstructive disease. The autopsy results revealed HLH. Conclusion. Our case describes HLH secondary to heart failure and Downs syndrome. In this highly activated inflammatory state the beneficial hemodynamic effects of propranolol may be accompanied by immunomodulatory effects and the risk of acute liver failure. HLH occurs with a distinct pathophysiology, and specific treatment might be mandatory to increase the chance of survival.

  18. Beta-Blocker Therapy and Hemophagocytic Lymphohistiocytosis: A Case Report

    C. Müller; L. B. Mänhardt; Willaschek, C.; Schneider, E. M.; E. A. Stuth; Buchhorn, R.

    2010-01-01

    Objective. The aim of this paper is to describe a fatal case of hemophagocytic lymphohistiocytosis (HLH) in a patient with severe heart failure, who was treated with low-dose propranolol. Patient and Interventions. We report on a 7-month-old boy with Downs syndrome who was born with an unbalanced, left dominant atrioventricular septal defect and aortic coarctation. Despite coarctation repair and pulmonary artery banding he developed intractable heart failure and fever of unknown origin. Since...

  19. The role of beta-blockers in septic patients.

    Hamzaoui, O; Teboul, J L

    2015-03-01

    β-blockers are widely used to treat cardiovascular diseases and in the peri-operative period in selected patients. The main benefit in terms of morbidity and/or mortality of their use is believed to be linked to specific effects on myocardial oxygen supply/demand balance, to anti-arrhythmic effects and anti-inflammatory effects. Use of β-blockers in severe sepsis is still under debate and if any, their appropriate indications remain unclear. In this article, we analyze the recent literature addressing the metabolic, immuno-modulatory and hemodynamic effects of non cardio-selective and of cardio-selective β-blockers in experimental and human sepsis in order to help clarifying the potential place of these drugs in patients with severe sepsis. From this analysis, it appears that β-adrenoceptor blocking agents may represent a therapeutic approach in patients with severe sepsis, in whom catecholaminergic hyperactivity including excessive tachycardia is supposed to play an aggravating role. However, many questions about effectiveness, safety and cardio-selectivity of the drugs and about the appropriate target population remain partially unanswered. Recently, esmolol, a short-time acting β1-adrenoceptor blocker titrated to decrease heart rate below 95 beats/min was shown to exert beneficial effects in a monocentric randomized clinical trial including selected septic patients. Further large multicenter randomized trials are required to confirm the potential benefit of such a therapy in patients with severe sepsis. PMID:24941896

  20. Use of prescribed and non-prescribed medication for dyspepsia.

    Krol, N.P.; Muris, J.W.M.; Schattenberg, G.T.B.M.R.; Grol, R.P.T.M.; Wensing, M.J.P.

    2004-01-01

    OBJECTIVE: To explore patient factors related to the use of prescribed and non-prescribed drugs for dyspepsia in The Netherlands. DESIGN: Patient survey study. SETTING AND SUBJECTS: Questionnaires sent to patients who had a prescription for dyspepsia medication from their general practitioner. MAIN

  1. Appropriate prescribing for older people

    Drenth - van Maanen, A.C.

    2013-01-01

    Appropriate prescribing is the result of pharmacotherapeutic decision-making to maximise the net health benefit of treatment, given the resources available. Several risk factors for inappropriate prescribing in older people have been identified, such as polypharmacy, impaired renal function, and fre

  2. Drugs prescribed for self poisoners.

    Prescott, L F; Highley, M S

    1985-01-01

    Of 230 adults admitted for self poisoning over two months, 153 (67%) had previously been taking a total of 309 prescribed drugs. Of these patients, 119 (78%) had been given psychotropic drugs (usually benzodiazepines), 81 (53%) obtained them on repeat prescription, and 47 (31%) had been prescribed multiple psychotropic drugs, often in seemingly illogical combinations. The use of these drugs increased progressively with age and most patients took the same drugs in overdosage as they had been p...

  3. Inappropriate prescribing in the elderly.

    Gallagher, P

    2012-02-03

    BACKGROUND AND OBJECTIVE: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. METHODS: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. RESULTS AND DISCUSSION: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. CONCLUSION: Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug

  4. Hospital prescribing errors : epidemiological assessment of predictors

    Fijn, R; Van den Bemt, PMLA; Chow, M; De Blaey, CJ; De Jong-Van den Berg, LTW; Brouwers, JRBJ

    2002-01-01

    Aims To demonstrate in epidemiological method to assess predictors of prescribing errors.. Methods A retrospective case-control Study. comparing prescription,, with and without errors, Results Only prescriber and drug characteristics were associated with errors, Prescriber characteristics were medic

  5. Assessment of antibiotic prescribing in Latvian general practitioners

    Dumpis Uga

    2013-01-01

    Full Text Available Abstract Background Though general antibiotic consumption data is available, information on the actual patterns of prescribing antibiotics locally is difficult to obtain. An easy to use methodology was designed to assess ambulatory management of infections by Latvian general practitioners (GPs. Methods GPs were asked to record data in a patient data collection form for every patient that received antibiotics. Study period – (7 days one week in November, 2008. Data recorded included the following details: an antibiotic, the prescribed dose, dosing interval, route of administration combined with the demographic factors of the patient and clinical diagnosis based on a pre-defined list. Results Two hundred forty eight forms out of the 600 (41% were returned by post. Antibiotics were prescribed in 6.4% (1711/26803 of outpatient consultations. In total, 1763 antibiotics were prescribed during the study period. Ninety seven percent of the patients received monotherapy and only 47 (2.7% patients were prescribed two antibiotics. The most commonly prescribed antibiotics were amoxicillin (33.9% of prescribed, amoxicillin/clavulanate (18,7% and clarithromycin (7.6%. The most commonly treated indications were pharyngitis (29.8%, acute bronchitis (25.3% and rhinosinusitis (10.2%. Pneumonia was mostly treated with amoxicillin/clavulanate (25,7%, amoxicillin (15.7% and clarithromycin (19.3%. Conclusions Methodology employed provided useful additional information on ambulatory practice of prescribing antibiotics and could be used in further assessment studies. Educational interventions should be focused on treatment of acute pharyngitis and bronchitis in children and unnecessary use of quinolones in adults for uncomplicated urinary tract infection.

  6. Independent pharmacist prescribing in Canada

    Law, Michael R.; Ma, Tracey; Fisher, Judith; Sketris, Ingrid S

    2012-01-01

    Background: While pharmacists are trained in the selection and management of prescription medicines, traditionally their role in prescribing has been limited. In the past 5 years, many provinces have expanded the pharmacy scope of practice. However, there has been no previous systematic investigation and comparison of these policies.

  7. Dichotomy in the definition of prescriptive information suggests both prescribed data and prescribed algorithms: biosemiotics applications in genomic systems

    D'Onofrio David J

    2012-03-01

    Full Text Available Abstract The fields of molecular biology and computer science have cooperated over recent years to create a synergy between the cybernetic and biosemiotic relationship found in cellular genomics to that of information and language found in computational systems. Biological information frequently manifests its "meaning" through instruction or actual production of formal bio-function. Such information is called Prescriptive Information (PI. PI programs organize and execute a prescribed set of choices. Closer examination of this term in cellular systems has led to a dichotomy in its definition suggesting both prescribed data and prescribed algorithms are constituents of PI. This paper looks at this dichotomy as expressed in both the genetic code and in the central dogma of protein synthesis. An example of a genetic algorithm is modeled after the ribosome, and an examination of the protein synthesis process is used to differentiate PI data from PI algorithms.

  8. Associação de betabloqueadores e treinamento físico na insuficiência cardíaca de camundongos Asociación de betabloqueantes y entrenamiento físico en la insuficiencia cardíaca de ratones Association of physical training with beta-blockers in heart failure in mice

    Andréa Somolanji Vanzelli

    2010-09-01

    tolerancia al esfuerzo se evaluó por prueba progresivo máxima y la fracción de acortamiento se evaluó (FE por ecocardiografía. El diámetro de los cardiomiocitos y la fracción de colágeno fueron evaluados por medio de análisis histológico. Los dados fueron comparados por ANOVA de un camino con post hoc de Duncan. El nivel de significancia se consideró como p BACKGROUND: Currently there are several types of interventions for the treatment of heart failure (HF. Among these are beta-blocker therapy (BB and physical training (PT. However, the effects of the combination of these therapies are poorly studied. OBJECTIVE: To investigate the effects of BB treatment with metoprolol (M and carvedilol (C associated with PT in mice with HF. METHODS: We used a genetic model of sympathetic hyperactivity-induced heart failure in mice. Initially, we divided the HF animals into three groups: sedentary (S; trained (T; treated with M (138 mg/kg (M; or C (65 mg/kg (C. In the second part, we divided the groups into three subgroups: sedentary (S; trained and treated with M (TM; and trained and treated with C (CT. The PT consisted of aerobic training on a treadmill for 8 weeks. Exercise tolerance was assessed by maximal graded test, and fractional shortening (FS was assessed by echocardiography. Cardiomyocyte diameter and collagen volume fraction were evaluated by histological analysis. Data were compared by one way ANOVA and post hoc Duncan test. The significance level was set at p < 0.05. RESULTS: As to FS and cardiac remodeling, we found that, in isolation, T, M, and C showed an improvement of the variables analyzed. As to therapy combination, after the intervention period, we observed an increase in exercise tolerance in MT and CT (43.0% and 33.0% respectively. There was also a reduction in cardiomyocyte diameter (10.0% and 9.0% respectively and in collagen volume fraction (52.0% and 63.0% after the intervention. However, only CT significantly improved FS. CONCLUSION: The association

  9. Prescribing patterns in premenstrual syndrome

    Jones Paul W

    2002-06-01

    Full Text Available Abstract Background Over 300 therapies have been proposed for premenstrual syndrome. To date there has been only one survey conducted in the UK of PMS treatments prescribed by GPs, a questionnaire-based study by the National Association of Premenstrual Syndrome in 1989. Since then, selective serotonin re-uptake inhibitors have been licensed for severe PMS/PMDD, and governmental recommendations to reduce the dosage of vitamin B6 (the first choice over-the-counter treatment for many women with PMS have been made. This study investigates the annual rates of diagnoses and prescribing patterns for premenstrual syndrome (1993–1998 within a computerised general practitioner database. Methods Retrospective survey of prescribing data for premenstrual syndrome between 1993–1998 using the General Practice Research Database for the West Midlands Region which contains information on 282,600 female patients Results Overall the proportion of women with a prescription-linked diagnosis of premenstrual syndrome has halved over the five years. Progestogens including progesterone were the most commonly recorded treatment for premenstrual syndrome during the whole study period accounting for over 40% of all prescriptions. Selective serotonin-reuptake inhibitors accounted for only 2% of the prescriptions in 1993 but rose to over 16% by 1998, becoming the second most commonly recorded treatment. Vitamin B6 accounted for 22% of the prescriptions in 1993 but dropped markedly between 1997 and 1998 to 11%. Conclusions This study shows a yearly decrease in the number of prescriptions linked to diagnoses for premenstrual syndrome. Progestogens including progesterone, is the most widely prescribed treatment for premenstrual syndrome despite the lack of evidence demonstrating their efficacy.

  10. Redução da prevalência de apneia central em pacientes com insuficiência cardíaca sob uso de betabloqueador Reducción de la prevalencia de apnea central en pacientes con insuficiencia cardiaca bajo uso de betabloqueante Reduction of central sleep apnea in heart failure patients with beta-blockers therapy

    Christiano Pereira Silva

    2010-02-01

    portadores de IC. MÉTODOS: 65 pacientes portadores de IC fueron sometidos a polisonografía diagnóstica. Los resultados de la polisonografía se evaluaron según el empleo o no de BB. El día del examen, los pacientes contestaron el cuestionario de Minnesota para la calidad de vida con IC. Tras 6 y 12 meses de la fecha de la polisonografía, hubo contacto telefónico con todos los pacientes, para la repetición del cuestionario de Minnesota. RESULTADOS: La prevalencia de apnea del sueño (IAH > 15/h fue de un 46,1% en la población total, además de la apnea central se identificó en solamente un 18,4% de los pacientes. El empleo de BB, en análisis multivariado, fue el único predictor de ocurrencia de menor índice de apnea e hipopnea (IAH central (p=0,002, mayor saturación (p=0,02 y menor desaturación promedio de oxígeno (p=0,03. Además de ello, el empleo de BB fue predictor de mejor calidad de vida tras 6 y 12 meses (p=0,002 y 0,001 respectivamente y de menor número de hospitalizaciones en estos períodos (p=0,001 y p=0,05 respectivamente. CONCLUSIÓN: El empleo de BB reduzco la incidencia de apnea central en la población total, si lo comparamos con los datos de la literatura. Además de esto, los BB mejoran parámetros de la calidad del sueño y de vida de portadores de IC.BACKGROUND: Sleep apneas are frequent in patients with heart failure (HF. Estimate of the pre-beta blocker age (BB point out to 45% of central apneas in these patients. OBJECTIVE: Assess the influence of BB in central apneas and their interference in the quality of sleep and life of patients with heart failure. METHODS: 65 patients with heart failure underwent diagnostic polysomnography. Polysomnography have been assessed according to the use or not of BB. On the day of examination, the patients answered the Minessota questionnaire for quality of life with HF. After 6 and 12 months from the polysomnography date, all patients were contacted by phone, in order to repeat the Minessota

  11. The quality of outpatient antimicrobial prescribing

    Malo, Sara; Bjerrum, Lars; Feja, Cristina;

    2013-01-01

    The aim of the study was to analyse and compare the quality of outpatient antimicrobial prescribing in Denmark and Aragón (in northeastern Spain), with the objective of assessing inappropriate prescribing....

  12. Prescribed Fire Plan Union Slough NWR 1994

    US Fish and Wildlife Service, Department of the Interior — This document outlines a prescribed burn schedule for Union Slough National Wildlife Refuge. The Prescribed Fire Plan provides the following information; names of...

  13. Promoting rational prescribing: an international perspective.

    Hogerzeil, H. V.

    1995-01-01

    Irrational prescribing is a global problem. Rational prescribing cannot be defined without a method of measurement and a reference standard. The former is now available but the latter needs further development. Proven effective interventions to promote rational prescribing in developed countries are treatment protocols based on wide consultation and consensus, properly introduced and with a possibility of feedback; face-to-face education focussed on a particular prescribing problem in selecte...

  14. Inappropriate prescribing: criteria, detection and prevention.

    O'Connor, Marie N

    2012-06-01

    Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.

  15. Nonmedical prescribing: where are we now?

    Cope, Louise C; Abuzour, Aseel S; Tully, Mary P

    2016-08-01

    Nonmedical prescribing has been allowed in the United Kingdom (UK) since 1992. Its development over the past 24 years has been marked by changes in legislation, enabling the progression towards independent prescribing for nurses, pharmacists and a range of allied health professionals. Although the UK has led the way regarding the introduction of nonmedical prescribing, it is now seen in a number of other Western-European and Anglophone countries although the models of application vary widely between countries. The programme of study to become a nonmedical prescriber (NMP) within the UK is rigorous, and involves a combination of taught curricula and practice-based learning. Prescribing is a complex skill that is high risk and error prone, with many influencing factors. Literature reports regarding the impact of nonmedical prescribing are sparse, with the majority of prescribing research tending to focus instead on prescribing by doctors. The impact of nonmedical prescribing however is important to evaluate, and can be carried out from several perspectives. This review takes a brief look back at the history of nonmedical prescribing, and compares this with the international situation. It also describes the processes required to qualify as a NMP in the UK, potential influences on nonmedical prescribing and the impact of nonmedical prescribing on patient opinions and outcomes and the opinions of doctors and other healthcare professionals. PMID:27493720

  16. Nurse prescribing in mental health: national survey.

    Dobel-Ober, D; Brimblecombe, N; Bradley, E

    2010-08-01

    Mental health nurses can now train to become independent prescribers as well as supplementary prescribers. Independent nurse prescribing can potentially help to reorganize mental health services, increase access to medicines and improve service user information, satisfaction and concordance. However, mental health nursing has been slow to undertake prescribing roles, and there has been little work conducted to look at where nurse prescribing is proving successful, and those areas where it is less so. This survey was designed to collect information from directors of nursing in mental health trusts about the numbers of mental health prescribers in England, gather views about prescribing in practice, and elicit intentions with regards to the development of nurse prescribing. In some Trusts, the number of mental health nurse prescribers has increased to the point where wider impacts on workforce, the configuration of teams and services are inevitable. Currently, the way that prescribing is used within different organizations, services and teams varies and it is unclear which setting is most appropriate for the different modes of prescribing. Future work should focus on the impact of mental health nurse prescribing on service delivery, as well as on service users, colleagues and nurses themselves. PMID:20633075

  17. Development of a SPE-HPLC-MS/MS method for the determination of most prescribed pharmaceuticals and related metabolites in urban sewage samples.

    Gurke, Robert; Rossmann, Julia; Schubert, Sara; Sandmann, Tobias; Rößler, Martin; Oertel, Reinhard; Fauler, Joachim

    2015-05-15

    Based on regional prescription data several pharmaceuticals with variable amounts of prescription and corresponding metabolites were selected and analyzed in influent and effluent samples of the sewage treatment plant (STP) in Dresden, Germany. Pharmaceuticals of the following most prescribed therapeutic groups were chosen: antibiotics, antifungals, anticonvulsants, antipsychotics, antidepressants, and cardiovascular active compounds like beta blockers and angiotensin-converting enzyme inhibitors. To analyze the selected compounds, a multi-target method was developed and applied to 24-h composite wastewater samples for three single days in May and June 2014. The method was based on a cleanup of a sample with a volume of 1mL using solid phase extraction followed by a high performance liquid chromatography coupled to a tandem mass spectrometer. Analytes were separated in a 15min chromatographic separation and quantified using 23 Internal Standards and a calibration curve in 40-fold diluted blank urine. The limit of quantification varied between 50 and 200ng/L and for all analytes good accuracy and precision as well as linearity for the calibration curve with the correlation coefficient R(2) higher than 0.99 was reached. A total of 41 and 40 of the selected 55 analytes were detected and quantified in the influent and effluent samples of the studied STP, respectively. Valsartan was the compound with the highest maximum concentration in influent (27.1μg/L) and effluent (15.7μg/L). Furthermore, analytes like bezafibrate, candesartan, carbamazepine, gabapentin, metoprolol, levetiracetam, pregabalin and telmisartan as well as the metabolite O-desmethyl venlafaxine were detectable in influent and effluent samples, respectively, with a concentration higher than 1μg/L. PMID:25841203

  18. Estimations of actual availability

    Adaptation of working environment (social, organizational, physical and physical) should assure higher level of workers availability and consequently higher level of workers performance. A special theoretical model for description of connections between environmental factors, human availability and performance was developed and validated. The central part of the model is evaluations of human actual availability in the real working situation or fitness for duties self-estimation. The model was tested in different working environments. On the numerous of 2000 workers standardized values and critical limits for Availability questionnaire were defined. Standardized method was used in identification of the most important impact of environmental factors. Identified problems were eliminated by investments in the organization in modification of selection and training procedures in humanization of working environment. For workers with behavioural and health problems individual consultancy was offered. Described method is a tool for identification of impacts. In combination with behavioural analyses and mathematical analyses of connections offers possibilities to keep adequate level of human availability and fitness for duty in each real working situation. Model should be a tool for achieving adequate level of nuclear safety by keeping the adequate level of workers availability and fitness for duty. For each individual worker possibility for estimation of level of actual fitness for duty is possible. Effects of prolonged work and additional tasks should be evaluated. Evaluations of health status effects and ageing are possible on the individual level. (author)

  19. Estimations of actual availability

    Adaptation of working environment (social, organizational, physical and physical) should assure higher level of workers' availability and consequently higher level of workers' performance. A special theoretical model for description of connections between environmental factors, human availability and performance was developed and validated. The central part of the model is evaluations of human actual availability in the real working situation or fitness for duties self-estimation. The model was tested in different working environments. On the numerous (2000) workers, standardized values and critical limits for an availability questionnaire were defined. Standardized method was used in identification of the most important impact of environmental factors. Identified problems were eliminated by investments in the organization in modification of selection and training procedures in humanization of working .environment. For workers with behavioural and health problems individual consultancy was offered. The described method is a tool for identification of impacts. In combination with behavioural analyses and mathematical analyses of connections, it offers possibilities to keep adequate level of human availability and fitness for duty in each real working situation. The model should be a tool for achieving adequate level of nuclear safety by keeping the adequate level of workers' availability and fitness for duty. For each individual worker possibility for estimation of level of actual fitness for duty is possible. Effects of prolonged work and additional tasks should be evaluated. Evaluations of health status effects and ageing are possible on the individual level. (author)

  20. Inappropriate prescribing in geriatric patients.

    Barry, Patrick J

    2012-02-03

    Inappropriate prescribing in older people is a common condition associated with significant morbidity, mortality, and financial costs. Medication use increases with age, and this, in conjunction with an increasing disease burden, is associated with adverse drug reactions. This review outlines why older people are more likely to develop adverse drug reactions and how common the problem is. The use of different tools to identify and measure the problem is reviewed. Common syndromes seen in older adults (eg, falling, cognitive impairment, sleep disturbance) are considered, and recent evidence in relation to medication use for these conditions is reviewed. Finally, we present a brief summary of significant developments in the recent literature for those caring for older people.

  1. β受体阻滞剂分别联合血管紧张素受体拮抗剂和钙离子拮抗剂治疗江门地区中青年高血压的临床效果观察%Curative Effect of Beta-blockers Respectively Combination of Angiotensin Receptor Blockers and Calcium Antagonists in the Treatment of Young and Middle-Aged High Blood Pressure in Jiangmen

    黄享贞; 钟洁霞

    2015-01-01

    目的:比较β受体阻滞剂分别联合血管紧张素受体拮抗剂(ARB)和钙离子拮抗剂(CCB)治疗江门地区中青年高血压的治疗效果。方法:选取2012年12月-2014年12月收治的江门地区中青年高血压患者300例,随机数字表法分为观察组和对照组各150例。观察组患者给予ARB联合β受体阻滞剂治疗,对照组给予CCB联合β受体阻滞剂治疗,观察两组治疗前后的血压、心率变化情况以及降压疗效和症状改变情况。结果:治疗8周后两组患者的血压、心率均较治疗前下降(P0.05),观察组心率下降较对照组明显,差异有统计学意义(P0.05),heart rate decline in treatment group and control group,the difference was statistically significant(P<0.05).In terms of hypertension treatment,observation group total effective rate was 94.67%,control group total effective rate was 82.00%, total effective rate of observation group was obviously higher than that of control group,the difference was statistically significant (P<0.05).In terms of symptom improvement,observation group total effective rate was 96.67%,control group total effective rate was 84.67%,total effective observation group was obviously higher than that of control group,the difference was statistically significant(P<0.05).Conclusion:The application of combined beta-blockers ARB can significantly reduce the diastolic and systolic blood pressure of patients,slow heart rate,and in terms of antihypertensive effects and symptoms improve curative effect is good,worthy of clinical promotion.

  2. The changing nature of prescribing: pharmacists as prescribers and challenges to medical dominance.

    Weiss, Marjorie C; Sutton, Jane

    2009-04-01

    This paper investigates the potential threat to medical dominance posed by the addition of pharmacists as prescribers in the UK. It explores the role of prescribing as an indicator of professional power, the legitimacy and status of new pharmacist prescribers and the forces influencing professional jurisdictional claims over the task of prescribing. It draws upon 23 interviews with pharmacist supplementary prescribers. Data suggest that the legitimacy of pharmacists as prescribers, as experienced in the workplace, has been aided by: (1) blurred definitions of prescribing; (2) the emphasis on new prescribers' competence urging pharmacist prescribers to limit their areas of clinical practice; and (3) a team approach to patient management. Competence, self-limitation on practice and the benefits of team working as part of the ideology of patient safety were thus an important influence on pharmacists' jurisdictional claim over prescribing. While pharmacists have successfully negotiated a role for themselves as prescribers, medicine has retained its high status, relative to other health professionals and with patients; it controls the knowledge base relevant for prescribing practice and has managed to develop an 'overseer' role over the process of prescribing. Prescribing, as an indicator of medicine's autonomy of control over their work and professional status, has changed. Yet the extent to which new prescribers have been able to threaten the professional dominance of medicine is debatable. PMID:19055585

  3. Measuring prescribing: the shortcomings of the item.

    Bogle, S. M.; Harris, C. M.

    1994-01-01

    OBJECTIVES--To assess the validity of the item as a measure of the volume of a drug prescribed; and to investigate the possibility that higher quantities per item are prescribed for patients who are not exempt from the prescription charge. DESIGN--Five substudies. For the first, a frequency distribution was derived of the different quantities per item of 10 commonly used drugs prescribed by 20 randomly selected practices in each of five family health service authority areas. For the second, t...

  4. A survey of optometrists' ophthalmic medication prescribing

    Gonzalez AL; Bennett N; Lakhani R

    2014-01-01

    Agustin L Gonzalez, Nikki Bennett, Rakesh Lakhani Inter American University, School of Optometry, Bayamón, Puerto Rico Abstract: Optometry is recognized as a primary care profession within the health care system. For years, much emphasis has been placed on the core function of optometrists as prescribers for refractive correction, yet little is known about their medication prescribing habits. Optometrists have had the ability to prescribe medications for the last 30 years, and still l...

  5. Reflujo vesicoureteral: conceptos actuales

    Sandalio Durán Álvarez

    2000-06-01

    to disappear spontaneously. No antibiotics should be prescribed in children with asymptomatic bacteriuria since they are potentially dangerous. The presence or not of vesico-ureteral reflux should be determined by urethocystography in every patient under 5 years of age suffering from febrile acute urinary infections and specially in children under 3 years, regardless of sex and the result of ultrasound study, and also in children of any age if ultrasound test detects scars, pelvic dilation, wrong corticomedullary delimitation or dysplasia signs; it should also be studied in prenatal hydronephrosis confirmed after birth and in children with unilateral renal agenesis or multicystic renal dysplasia. Siblings and children of patients with vesico-ureteral reflux need to be specially assessed. It has not been proved so far that antimicrobial prophylaxis can prevent renal damage in patients with vesico-ureteral reflux. Controlled studies are required to be able to accurately define the usefulness or ineffectiveness of antibiotics. It is recommended not to use it in children over 3 years of age.

  6. Aspirin Often Wrongly Prescribed for Atrial Fibrillation

    ... page: https://medlineplus.gov/news/fullstory_159459.html Aspirin Often Wrongly Prescribed for Atrial Fibrillation Blood thinners -- not aspirin -- dramatically cut the risk of stroke, researchers say ...

  7. Modelling marine emissions and atmospheric distributions of halocarbons and dimethyl sulfide: the influence of prescribed water concentration vs. prescribed emissions

    Lennartz, S. T.; Krysztofiak, G.; Marandino, C. A.; Sinnhuber, B.-M.; Tegtmeier, S.; Ziska, F.; Hossaini, R.; Krüger, K.; Montzka, S. A.; Atlas, E.; Oram, D. E.; Keber, T.; Bönisch, H.; Quack, B.

    2015-10-01

    Marine-produced short-lived trace gases such as dibromomethane (CH2Br2), bromoform (CHBr3), methyliodide (CH3I) and dimethyl sulfide (DMS) significantly impact tropospheric and stratospheric chemistry. Describing their marine emissions in atmospheric chemistry models as accurately as possible is necessary to quantify their impact on ozone depletion and Earth's radiative budget. So far, marine emissions of trace gases have mainly been prescribed from emission climatologies, thus lacking the interaction between the actual state of the atmosphere and the ocean. Here we present simulations with the chemistry climate model EMAC (ECHAM5/MESSy Atmospheric Chemistry) with online calculation of emissions based on surface water concentrations, in contrast to directly prescribed emissions. Considering the actual state of the model atmosphere results in a concentration gradient consistent with model real-time conditions at the ocean surface and in the atmosphere, which determine the direction and magnitude of the computed flux. This method has a number of conceptual and practical benefits, as the modelled emission can respond consistently to changes in sea surface temperature, surface wind speed, sea ice cover and especially atmospheric mixing ratio. This online calculation could enhance, dampen or even invert the fluxes (i.e. deposition instead of emissions) of very short-lived substances (VSLS). We show that differences between prescribing emissions and prescribing concentrations (-28 % for CH2Br2 to +11 % for CHBr3) result mainly from consideration of the actual, time-varying state of the atmosphere. The absolute magnitude of the differences depends mainly on the surface ocean saturation of each particular gas. Comparison to observations from aircraft, ships and ground stations reveals that computing the air-sea flux interactively leads in most of the cases to more accurate atmospheric mixing ratios in the model compared to the computation from prescribed emissions

  8. Modelling marine emissions and atmospheric distributions of halocarbons and DMS: the influence of prescribed water concentration vs. prescribed emissions

    S. T. Lennartz

    2015-06-01

    Full Text Available Marine produced short-lived trace gases such as dibromomethane (CH2Br2, bromoform (CHBr3, methyliodide (CH3I and dimethylsulfide (DMS significantly impact tropospheric and stratospheric chemistry. Describing their marine emissions in atmospheric chemistry models as accurately as possible is necessary to quantify their impact on ozone depletion and the Earth's radiative budget. So far, marine emissions of trace gases have mainly been prescribed from emission climatologies, thus lacking the interaction between the actual state of the atmosphere and the ocean. Here we present simulations with the chemistry climate model EMAC with online calculation of emissions based on surface water concentrations, in contrast to directly prescribed emissions. Considering the actual state of the model atmosphere results in a concentration gradient consistent with model real-time conditions at ocean surface and atmosphere, which determine the direction and magnitude of the computed flux. This method has a number of conceptual and practical benefits, as the modelled emission can respond consistently to changes in sea surface temperature, surface wind speed, sea ice cover and especially atmospheric mixing ratio. This online calculation could enhance, dampen or even invert the fluxes (i.e. deposition instead of emissions of VSLS. We show that differences between prescribing emissions and prescribing concentrations (−28 % for CH2Br2 to +11 % for CHBr3 result mainly from consideration of the actual, time-varying state of the atmosphere. The absolute magnitude of the differences depends mainly on the surface ocean saturation of each particular gas. Comparison to observations from aircraft, ships and ground stations reveals that computing the air–sea flux interactively leads in most of the cases to more accurate atmospheric mixing ratios in the model compared to the computation from prescribed emissions. Calculating emissions online also enables effective testing of

  9. Influences on Non-Medical Prescribing: Nurse and Pharmacist Prescribers in Primary and Community Care

    Maddox, Clare

    2011-01-01

    Since 1994 there have been considerable additions to the range of health care professionals (HCPs) that can prescribe in the United Kingdom (UK). These HCPs include nurses, pharmacists, radiographers, physiotherapists, podiatrists, chiropodists and optometrists. After a period of specific prescribing training these HCPs are often referred to as non-medical prescribers (NMPs). There has been a limited amount of research that has investigated the influences on the prescribing behaviour of NMPs....

  10. Nurse practitioner prescribing: an international perspective

    Fong J

    2015-10-01

    Full Text Available Jacqueline Fong,1,2 Thomas Buckley,2 Andrew Cashin3 1St George Hospital, Kogarah, 2Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia; 3School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia Background: Internationally, the delivery of care provided by nurses and midwives has undergone a significant change due to a variety of interrelated factors, including economic circumstances, a diminishing number of medical providers, the unavailability of adequate health care services in underserved and rural areas, and growing specialization among the professions. One solution to the challenges of care delivery has been the introduction of nurse practitioners (NPs and the authorization of NPs to prescribe medicines. Aim: The aim of this paper was to review the current international literature related to NP prescribing and compare the findings to the Australian context. The review focuses on literature from the United States, Canada, Europe, Australia, and New Zealand. Methods: Databases were searched from January 2000 to January 2015. The following keywords: “nurse practitioner”, “advanced nurse”, “advanced practice nurse”, “prescri*”, “Australia”, “United States America”, “UK”, “New Zealand”, “Canada”, “Europe”, “drug prescri*”, “prescri* authority”, and “prescri* legislation” were used. Findings: NPs tend to prescribe in differing contexts of practice to provide care in underserved populations and require good systems literacy to practice across complex systems. The key themes identified internationally related to NP prescribing relate to barriers to prescribing, confidence in prescribing, and the unique role of NPs in prescribing medicines, eg, the high prevalence of prescribing pain medicines in several countries, including Australia. Conclusion: Across all countries reviewed, there appears a need for further research into the organizational and

  11. [Specificities of prescribing medicines for children].

    Mercier, Jean-Christophe; Droz, Nina; Bourgade, Clara; Vizeneux, Audrey; Cotillon, Marie; de Groc, Thibault

    2016-01-01

    The vast majority of medicines have been developed for adults. Consequently, the prescribing of medicines for children must take into account their pharmacodynamic characteristics and must be calculated individually according to the degree of prematurity, the age, the weight or body area and the clinical condition. Medication errors are the most common type of medical errors, notably in children, due to dosage errors or prescribtion of inappropriate medicines. The best way to avoid them lies in the use of prescribing software, the involvement of pharmacists in care units, and proper communication between prescribing doctors, caregivers, pharmacists and families. PMID:27177480

  12. Design of materials with prescribed nonlinear properties

    Wang, Fengwen; Sigmund, Ole; Jensen, Jakob Søndergaard

    2014-01-01

    We systematically design materials using topology optimization to achieve prescribed nonlinear properties under finite deformation. Instead of a formal homogenization procedure, a numerical experiment is proposed to evaluate the material performance in longitudinal and transverse tensile tests...

  13. A survey of optometrists' ophthalmic medication prescribing

    Gonzalez AL

    2014-03-01

    Full Text Available Agustin L Gonzalez, Nikki Bennett, Rakesh Lakhani Inter American University, School of Optometry, Bayamón, Puerto Rico Abstract: Optometry is recognized as a primary care profession within the health care system. For years, much emphasis has been placed on the core function of optometrists as prescribers for refractive correction, yet little is known about their medication prescribing habits. Optometrists have had the ability to prescribe medications for the last 30 years, and still little information is available about optometric pharmaceutical trends. This study consists of a survey aimed at obtaining self-reported data to depict optometrists' likelihood of prescribing ophthalmic medications during a regular clinic day. We conclude that optometrists are indeed using medications in their clinics, and the trends are very similar to the epidemiological distribution of eye disorders in the general population. Keywords: optometry, prescription drug audit, pharmacoepidemiology

  14. The Web site your doctor prescribes

    ... Navigation Bar Home Current Issue Past Issues The Web site your doctor prescribes Past Issues / Summer 2008 ... gov® is a free, comprehensive, up-to-date Web site with health information from the world's largest ...

  15. Medication errors: prescribing faults and prescription errors

    Velo, Giampaolo P; Minuz, Pietro

    2009-01-01

    Medication errors are common in general practice and in hospitals. Both errors in the act of writing (prescription errors) and prescribing faults due to erroneous medical decisions can result in harm to patients.Any step in the prescribing process can generate errors. Slips, lapses, or mistakes are sources of errors, as in unintended omissions in the transcription of drugs. Faults in dose selection, omitted transcription, and poor handwriting are common.Inadequate knowledge or competence and ...

  16. Spirometry use in patients prescribed albuterol

    Ornelas CS; Robbins RA; Park K

    2012-01-01

    Background: Previous studies have shown that spirometry is obtained in only about a third of patients with chronic obstructive pulmonary disease (COPD) in primary care practice. This study evaluated spirometry use in persons prescribed an albuterol inhaler in the primary care clinics at a Veterans Administration (VA) hospital.Methods: One hundred ninety-seven patients prescribed albuterol were reviewed for age, education level of the primary care practioners, other respiratory medications an...

  17. e-Learning initiatives to support prescribing

    Maxwell, Simon; Mucklow, John

    2012-01-01

    Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is curr...

  18. PRESCRIBED FIRE: LIABILITY, REGULATION, AND ENDOGENOUS RISK

    Jonathan K. Yoder

    2002-01-01

    This paper compares the incentive effects of strict liability and negligence rules when timing of activity affects environmental risk. The model is developed in the context of prescribed fire as a land management input, with an extension to the related problem of wildfire risk mitigation through vegetation management. The use of prescribed fire for land management and wildfire risk control is increasing in parts of the United States, and related liability and regulatory law is changing with it.

  19. Nurse prescribing ethics and medical marketing.

    Adams, J

    This article suggests that nurse prescribers require an awareness of key concepts in ethics, such as deontology and utilitarianism to reflect on current debates and contribute to them. The principles of biomedical ethics have also been influential in the development of professional codes of conduct. Attention is drawn to the importance of the Association of the British Pharmaceutical Industry's code of practice for the pharmaceutical industry in regulating marketing aimed at prescribers. PMID:21500692

  20. Antidepressant prescribing in five European countries

    Abbing-Karahagopian, V; Huerta, C; Souverein, P C;

    2014-01-01

    PURPOSE: Drug utilization studies have applied different methods to various data types to describe medication use, which hampers comparisons across populations. The aim of this study was to describe the time trends in antidepressant prescribing in the last decade and the variation in the prevalen......-69% for depression respectively). CONCLUSION: Despite applying uniform methods, variations in the prevalence of antidepressant prescribing were obvious in the different populations. Database characteristics and clinical factors may both explain these variations....

  1. Oral Ascorbic Acid in Combination with Beta-Blockers Is More Effective than Beta-Blockers Alone in the Prevention of Atrial Fibrillation after Coronary Artery Bypass Grafting

    Eslami, Masoud; Badkoubeh, Roya Sattarzadeh; Mousavi, Mehdi; Radmehr, Hassan; Salehi, Mehrdad; Tavakoli, Nafiseh; Avadi, Mohamad Reza

    2007-01-01

    Because adrenergic beta antagonists are not sufficient to prevent atrial fibrillation after coronary artery bypass grafting, this prospective, randomized trial was designed to evaluate the effects of ascorbic acid as an adjunct to β-blockers.

  2. Pharmaceutical marketing research and the prescribing physician.

    Greene, Jeremy A

    2007-05-15

    Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue. PMID:17502635

  3. Angiotensin AT1-receptor blockers and cerebrovascular protection: do they actually have a cutting edge over angiotensin-converting enzyme inhibitors?

    Oprisiu-Fournier, Roxana; Faure, Sébastien; Mazouz, Hakim;

    2009-01-01

    is presented to support the hypothesis that antihypertensive drugs that increase angiotensin II formation, such as diuretics, AT1-receptor blockers and dihydropyridines, may have greater brain anti-ischemic effects than antihypertensive drugs that decrease angiotensin II formation, such as beta-blockers...

  4. e-Learning initiatives to support prescribing.

    Maxwell, Simon; Mucklow, John

    2012-10-01

    Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. PMID:22509885

  5. Prescribed Fire is Cool on Florida Highway

    Caster, Jeff; McBurney, Willson; Farley, Patricia; Rodriguez, Rose; Green, Lane; McGorty, Kevin

    2007-01-01

    Though unprecedented in the sunshine state, plans for a prescribed fire on US319/SR61, Kate Ireland Parkway in north Florida sparked enthusiasm and excitement among roadside managers. The recently expanded high speed corridor passes for ten miles through the Red Hills Region (www.ttrs.org/rhcp); a rural landscape that is host to America’s largest remnant of the great longleaf pine forest (www.longleafalliance.org). Prescribed fire is a necessary and popular landscape management tool used by g...

  6. STANDARDIZATION AND ITS ROLE IN PRESCRIBING QUALITY

    Radu Catalin Criveanu; Natalita Maria Sperdea

    2014-01-01

    Standardization activity which by its applications, has an important impact on the economy and society, is the main tool for regulating the quality of products. Products' standardization must pursue simultaneously the requirements of producers, traders and consumers. The paper presents some aspects of standardization issues lead us to understand its importance in prescribing quality.

  7. How to prescribe physical exercise in rheumatology

    S. Maddali Bongi; Del Rosso, A

    2011-01-01

    Physical exercise, aiming to improve range of movement, muscle strength and physical well being, lately substituted the immobilization previously prescribed in rheumatic diseases. International guidelines, recommendations of Scientific Societies, and structured reviews regard physical exercise as of pivotal importance in treating rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, fibromyalgia syndrome, osteoporosis, and to be considered in connective tissue diseases. Therapeutic ex...

  8. Constructing euclidean simplex with prescribed dihedral angles

    Given 1/2n (n + 1) dihedral angles, what is the condition under which there exists an n-dimensional simplex with the prescribed dihedral angles? A complete solution for this problem is given with application demonstrated. (author). 3 refs

  9. Potentiality, Actuality, and Quantum Mechanics

    Boris Koznjak

    2007-12-01

    Full Text Available In this paper a possible interpretative value of Aristotle’s fundamental ontological doctrine of potentiality (δύναµις and actuality (ἐνέργεια is considered in the context of operationally undoubtedly the most successful but interpretatively still controversial theory of modern physics – quantum mechanics – especially regarding understanding the nature of the world, the phenomena of which it describes and predicts so successfully. In particular, beings of the atomic world are interpreted as real potential beings (δυνάµει ὄντα actualized by the measurement process in appropriate experimental arrangement, and the problem of actual beings (ἐνεργείᾳ ὄντα of the atomic world (better known as the measurement problem in quantum mechanics is considered in the context of Aristotle’s threefold requirement for the priority of actuality over potentiality – in time (χρόνος, definition or knowledge (λόγος, and substantiality (οὐσία.

  10. E-Prescribing: Clinical Implications for Patients with Diabetes

    Smith, Marie; Dang, Devra; Lee, Jennifer

    2009-01-01

    With the recent Center for Medicare and Medicaid Services and stimulus package incentives for health information technology, many clinicians are expected to adopt or enhance their use of e-prescribing systems. E-prescribing has nearly eradicated medication errors resulting from prescriber handwriting interpretations, yet several other patient-care and workflow benefits still remain a promise. As prescribers select or update their e-prescribing systems (whether stand-alone or integrated with e...

  11. Inappropriate prescribing and prescribing omissions among drug-related problems using STOPP-START criteria

    Verdoorn, M.A.; Kwint, H.-F.; Faber, A.; L. Bouvy, M.

    2013-01-01

    Background and objectives: Medication review has been suggested as a way to prevent drug related problems (DRPs). Screening tools have been formulated to identify potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) respectively called Screening Tool of Older Person'

  12. Assessing attitudes toward electronic prescribing adoption in primary care: a survey of prescribers and staff

    Emily Devine

    2010-09-01

    Conclusions Domain scores improved. Prescribers' self-assessment of computer use at home and computer knowledge predicted attitudes toward adoption. This instrument may be useful in tailoring strategies for successful adoption.

  13. Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of consultations

    Latter, Sue; Smith, Alesha; Blenkinsopp, Alison; Nicholls, Peter G.; Little, Paul; Chapman, Stephen

    2012-01-01

    OBJECTIVES: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals. METHODS: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was pr...

  14. More than a prescriber: gerontological nurse practitioners' perspectives on prescribing and pharmaceutical marketing.

    Mahoney, Diane Feeney; Ladd, Elissa

    2010-01-01

    The purpose of this study was to gain understanding about nurse practitioners' (NPs') prescriptive decision making for geriatric patients with attention to pharmaceutical marketing influences. Prior research has focused on physician prescribers and identified suboptimal practices. Because the majority of medications are prescribed to older adults, NPs in geriatric practice were targeted as an information-rich group to interview about prescribing issues. Given the exploratory nature of this research, qualitative focus group methods were employed using content analysis. Fifteen NPs were recruited at an annual national geriatric NP conference. They worked in all regions of the United States, had an average of 9 years prescribing experience, and participated in 1 of the 2 focus groups. The key theme that emerged was that they were more than a prescriber. Findings revealed overwhelming consistency among the NP participants that their nursing background instilled a holistic approach that encompassed both nondrug and therapeutic drug options and skepticism about drug marketing, as well as offered a positive difference by tailoring to their patients' biophysical, psychological, and economic needs with an involvement in the interplay of geriatric care issues not typically addressed by physicians. The participants' reported approaches were in alignment with geriatric prescribing recommendations. PMID:20159350

  15. Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections.

    McKay, Rachel; Mah, Allison; Law, Michael R; McGrail, Kimberlyn; Patrick, David M

    2016-07-01

    Antibiotic use is a modifiable driver of antibiotic resistance. In many circumstances, antibiotic use is overly broad or unnecessary. We systematically assessed factors associated with antibiotic prescribing for respiratory tract infections (RTI). Studies were included if they used actual (not self-reported or intended) prescribing data, assessed factors associated with antibiotic prescribing for RTIs, and performed multivariable analysis of associations. We searched Medline, Embase, and International Pharmaceutical Abstracts using keyword and MeSH (medical subject headings) search terms. Two authors reviewed each abstract and independently appraised all included texts. Data on factors affecting antibiotic prescribing were extracted. Our searches retrieved a total of 2,848 abstracts, with 97 included in full-text review and 28 meeting full inclusion criteria. Compared to other factors, diagnosis of acute bronchitis was associated with increased antibiotic prescribing (range of adjusted odds ratios [aOR], 1.56 to 15.9). Features on physical exam, such as fever, purulent sputum, abnormal respiratory exam, and tonsillar exudate, were also associated with higher odds of antibiotic prescribing. Patient desire for an antibiotic was not associated or was modestly associated with prescription (range of aORs, 0.61 to 9.87), in contrast to physician perception of patient desire for antibiotics, which showed a stronger association (range of aORs, 2.11 to 23.3). Physician's perception of patient desire for antibiotics was strongly associated with antibiotic prescribing. Antimicrobial stewardship programs should continue to expand in the outpatient setting and should emphasize clear and direct communication between patients and physicians, as well as signs and symptoms that do and do not predict bacterial etiology of upper respiratory tract infections. PMID:27139474

  16. Actualities in logistics and transport

    Simona Dordea; Liliana Nicodim

    2008-01-01

    The increasing flow of commodities represents a fundamental component of the actual changes within the economic systems at global, regional and local frameworks. It must be pointed that these changes have not a quantity substance only, but at the same time, a structural and an operational one. The structural changes refer in the essence to the production systems and the operational ones to the transport systems and, compulsory, to the distribution. So, being given this situation, the essentia...

  17. Juventud actual y sociedad futura

    Llano, A

    1985-01-01

    La juventud postmoderna tiene el reto de crear innovación cultural insertándose, al mismo tiempo, en la dinámica actual de la tradición. La revolución que los tiempo exigen pide recorrer, en primer extremo, el camino de la paz; también, superar la cultrua de la muerte e integrar el afán de servicio como superación de las utopías frustrantes.

  18. Best available control measures for prescribed burning

    Section 190 of the Clean Air Act (CAA) as amended in 1990 requires the US Environmental Protection Agency (EPA) to issue guidance on Best Available Control Measures (BACM) of PM10 (particulate matter with a nominal aerodynamic diameter less than or equal to 10 micrometers) from urban fugitive dust, residential wood combustion, and prescribed silvicultural and agricultural burning (prescribed burning). The purpose of this guidance is to assist states (especially, but not exclusively, those with PM10 nonattainment areas which have been classified as serious) in developing a control measure for these three source categories. This guidance is to be issued no later than May 15, 1992 as required under the CAA. The guidance will be issued in the form of a policy guidance generic to all three BACM and in the form of Technical Information Documents (TIDs) for each of the three source categories. The policy guidance will provide the analytical approach for determining BACM and the TID will provide the technical information. The purpose of this paper is to present some insight from the forthcoming TID on what BACM might entail for prescribed burning in a serious PM10 nonattainment area

  19. Prescriber and staff perceptions of an electronic prescribing system in primary care: a qualitative assessment

    Sittig Dean F

    2010-11-01

    Full Text Available Abstract Background The United States (US Health Information Technology for Economic and Clinical Health Act of 2009 has spurred adoption of electronic health records. The corresponding meaningful use criteria proposed by the Centers for Medicare and Medicaid Services mandates use of computerized provider order entry (CPOE systems. Yet, adoption in the US and other Western countries is low and descriptions of successful implementations are primarily from the inpatient setting; less frequently the ambulatory setting. We describe prescriber and staff perceptions of implementation of a CPOE system for medications (electronic- or e-prescribing system in the ambulatory setting. Methods Using a cross-sectional study design, we conducted eight focus groups at three primary care sites in an independent medical group. Each site represented a unique stage of e-prescribing implementation - pre/transition/post. We used a theoretically based, semi-structured questionnaire to elicit physician (n = 17 and staff (n = 53 perceptions of implementation of the e-prescribing system. We conducted a thematic analysis of focus group discussions using formal qualitative analytic techniques (i.e. deductive framework and grounded theory. Two coders independently coded to theoretical saturation and resolved discrepancies through discussions. Results Ten themes emerged that describe perceptions of e-prescribing implementation: 1 improved availability of clinical information resulted in prescribing efficiencies and more coordinated care; 2 improved documentation resulted in safer care; 3 efficiencies were gained by using fewer paper charts; 4 organizational support facilitated adoption; 5 transition required time; resulted in workload shift to staff; 6 hardware configurations and network stability were important in facilitating workflow; 7 e-prescribing was time-neutral or time-saving; 8 changes in patient interactions enhanced patient care but required education; 9 pharmacy

  20. [INTERACTION OF BETA-BLOCKER PROPRANOLOL WITH RENIN-ANGIOTENSIN SYSTEM INHIBITORS IN RAT KIDNEY].

    Kuzmin, O B; Buchneva, N V; Landar, L N

    2016-01-01

    Propranolol injection (0.5 mg/kg, s.c.) in anesthetized rats increases diuresis 1.60 times (p ACE inhibitor enalapril (1 mg/kg, orally, 7 days) increases the sensitivity of rat kidney to drug, increasing its diuretic effect 2.33 times, natriuresis 2.49 times, and urine potassium excretion 1.80 times (p inhibitor aliskiren (4 mg/kg, orally, 7 days) is accompanied by 2.30-fold increase in the diuretic effect of propranolol, 2.56-fold increase in natriuresis, and 2.27-fold increase in urine potassium excretion (p < 0.05). It is concluded that the renal tissue RAS is involved in the mechanism of propranolol action in the kidney, acting as modulator preventing excessive loss of water and electrolytes with urine. PMID:27455575

  1. Interaction of selected vasodilating beta-blockers with adrenergic receptors in human cardiovascular tissues

    beta- And alpha 1-adrenoceptor antagonist properties of bufuralol, carvedilol, celiprolol, dilevalol, labetalol, and pindolol were investigated in human myocardium and mammary artery using binding techniques and functional studies. In myocardial membranes, beta-adrenoceptor antagonists showed monophasic competition isotherms for [125I]pindolol binding with high affinity (Ki from 1-100 nM), except for celiprolol which displayed a biphasic competition isotherm (pKi = 6.4 +/- 0.06 for beta 1- and 4.8 +/- 0.07 for beta 2-adrenoceptors). Drug interactions with alpha 1-adrenoceptors were evaluated in human mammary artery by [3H]prazosin binding and by measuring contractile responses to norepinephrine (NE). Labetalol and carvedilol showed a moderate affinity for alpha 1-adrenoceptors (pKi = 6.2 +/- 0.01 and 6.1 +/- 0.06, respectively), and inhibited NE-induced contractions (pA2 = 6.93 +/- 0.23 and 8.64 +/- 0.24, respectively). Dilevalol, bufuralol, and pindolol displayed weak effect both in binding (Ki in micromolar range) and functional experiments (pA2 = 5.98, 5.54, and 6.23, respectively). Celiprolol did not show antagonist properties up to 100 microM in functional studies, but displayed a slight affinity for alpha 1-adrenoceptors in binding studies. The data indicate that the vasodilating activity of these beta-adrenoceptor antagonists is caused in some instances by an alpha 1-adrenoceptor antagonism (labetalol, carvedilol), whereas for the others alternative mechanisms should be considered

  2. THE ROLE OF BETA-BLOCKERS IN THE TREATMENT OF CARDIOVASCULAR DISEASES IN PREGNANT WOMEN

    R. I. Striuk

    2015-12-01

    Full Text Available Highly selective β-adrenoblockers (β-AB are used in pregnant women with cardiovascular diseases (arterial hypertension, arrhythmia, Marfan syndrome, hypertrophic cardiomyopathy. β-AB fall into the category C according to safety classification of Food and Drug Administration (US FDA. Their prescription in different clinical situations meets the principle of "risk–benefit". Fetus and newborn status should be monitored because β-AB can cause bradycardia, hypoglycemia, apnea and metabolic disorders. The risk of these side effects is extremely low, while β-AB clinical efficacy is high.

  3. Management of anesthesia in unspecified extra-adrenal pheochromocytoma patient who used beta-blocker

    Ayse Belin Ozer

    2014-01-01

    Full Text Available An operation was planned for a female patient aged 59 for intra-abdominal mass. The patient was using nebivolol for hypertension. Blood pressure (BP of the patient was raised to 200/130 mmHg during anesthesia induction. BP was gradually reduced by remifentanil infusion. Following the manipulation of the mass, BP began to increase (225/160 mmHg, thus nitroglycerin and followed nitroprusside infusion was started. Propofol (200 + 200 mg and furosemide (20 mg were administered intravenously. BP suddenly dropped (90/60 mmHg following the removal of the mass, nitroglycerine, and nitroprusside infusions were stopped; remifentanil dose was decreased and fluid was quickly infused. The patient was uneventually recovered. Vanilmandelic acid level was higher in the patient and pheochromocytoma was considered.

  4. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies.

    Graudins, Andis; Lee, Hwee Min; Druda, Dino

    2016-03-01

    Management of cardiovascular instability resulting from calcium channel antagonist (CCB) or beta-adrenergic receptor antagonist (BB) poisoning follows similar principles. Significant myocardial depression, bradycardia and hypotension result in both cases. CCBs can also produce vasodilatory shock. Additionally, CCBs, such as verapamil and diltiazem, are commonly ingested in sustained-release formulations. This can also be the case for some BBs. Peak toxicity can be delayed by several hours. Provision of early gastrointestinal decontamination with activated charcoal and whole-bowel irrigation might mitigate this. Treatment of shock requires a multimodal approach to inotropic therapy that can be guided by echocardiographic or invasive haemodynamic assessment of myocardial function. High-dose insulin euglycaemia is commonly recommended as a first-line treatment in these poisonings, to improve myocardial contractility, and should be instituted early when myocardial dysfunction is suspected. Catecholamine infusions are complementary to this therapy for both inotropic and chronotropic support. Catecholamine vasopressors and vasopressin are used in the treatment of vasodilatory shock. Optimizing serum calcium concentration can confer some benefit to improving myocardial function and vascular tone after CCB poisoning. High-dose glucagon infusions have provided moderate chronotropic and inotropic benefits in BB poisoning. Phosphodiesterase inhibitors and levosimendan have positive inotropic effects but also produce peripheral vasodilation, which can limit blood pressure improvement. In cases of severe cardiogenic shock and/or cardiac arrest post-poisoning, extracorporeal cardiac assist devices have resulted in successful recovery. Other treatments used in refractory hypotension include intravenous lipid emulsion for lipophilic CCB and BB poisoning and methylene blue for refractory vasodilatory shock. PMID:26344579

  5. Birth defects following maternal exposure to ergotamine, beta blockers, and caffeine.

    Hughes, H E; Goldstein, D A

    1988-01-01

    Ergotamine exposure during pregnancy has been suggested to cause birth defects which have a vascular disruptive aetiology. The present case provides additional support for the possible adverse fetal effects of exposure to ergotamine, caffeine, and propranolol during the first four months of pregnancy. At birth the infant showed evidence of early arrested cerebral maturation and paraplegia. The nature of these defects suggests a primary vascular disruptive aetiology. We hypothesise that ergota...

  6. Atrial fibrillation pharmacotherapy after hospital discharge between 1995 and 2004: a shift towards beta-blockers

    Hansen, Morten Lock; Gadsbøll, Niels; Gislason, Gunnar H;

    2008-01-01

    AIMS: To study evolvement in pharmacotherapy of atrial fibrillation from 1995 to 2004. METHODS AND RESULTS: All Danish patients were discharged following first-time atrial fibrillation and their pharmacotherapy was identified by individual-level-linkage of nationwide registers of hospitalization...

  7. Transport of beta-blockers and calcium antagonists by diffusion in cat myocardium

    Haunsø, Stig; Sejrsen, Per; Svendsen, Jesper Hastrup

    1991-01-01

    . In anesthetized cats the hearts were excised. Apparent diffusion coefficients in cat myocardium at 37 degrees C (D'37) for 14C-verapamil (protein bound), 3H-metoprolol (lipophilic), 3H-atenolol (hydrophilic), and 3H-propranolol (lipophilic and protein bound) were determined by means of a "true transient diffusion...

  8. Tendencias Actuales del Constitucionalismo Latinoamericano

    Jorge Carpizo

    2009-01-01

    El artículo analiza los cambios constitucionales que ha habido en América Latina y que han tenido incidencia directa en el progreso de la democracia en la región; de esta manera, hace una amplia comparación de la creación de instituciones que persiguen este fin en los diferentes estados. Desde una definición amplia y actual de democracia, se revelan sus principales focos de peligro como la ilegitimidad del Estado de derecho o la percepción de corrupción predominante en la población. El escrit...

  9. Enfoque actual del aborto recurrente

    José Pacheco; María Isabel de Michelena; Patricia Orihuela

    2009-01-01

    El tema de aborto recurrente ha tenido diversos planteamientos, de acuerdo a los progresos en la genética y biología molecular y conforme se avanzó en mejores métodos clínicos de diagnóstico. En la presente revisión, hacemos un alcance sobre los actuales conocimientos sobre la etiología, diagnóstico y manejo del aborto recurrente, así como su repercusión en la pareja que sufre de subfertilidad por esta causa.

  10. How People Actually Use Thermostats

    Meier, Alan; Aragon, Cecilia; Hurwitz, Becky; Mujumdar, Dhawal; Peffer, Therese; Perry, Daniel; Pritoni, Marco

    2010-08-15

    Residential thermostats have been a key element in controlling heating and cooling systems for over sixty years. However, today's modern programmable thermostats (PTs) are complicated and difficult for users to understand, leading to errors in operation and wasted energy. Four separate tests of usability were conducted in preparation for a larger study. These tests included personal interviews, an on-line survey, photographing actual thermostat settings, and measurements of ability to accomplish four tasks related to effective use of a PT. The interviews revealed that many occupants used the PT as an on-off switch and most demonstrated little knowledge of how to operate it. The on-line survey found that 89% of the respondents rarely or never used the PT to set a weekday or weekend program. The photographic survey (in low income homes) found that only 30% of the PTs were actually programmed. In the usability test, we found that we could quantify the difference in usability of two PTs as measured in time to accomplish tasks. Users accomplished the tasks in consistently shorter times with the touchscreen unit than with buttons. None of these studies are representative of the entire population of users but, together, they illustrate the importance of improving user interfaces in PTs.

  11. The pitfalls of prescribing for family and friends

    Bird, Sara

    2015-01-01

    In most of Australia there is no legislation prohibiting medical practitioners from prescribing for family and friends. In South Australia it is prohibited to prescribe Schedule 8 drugs for family members unless it is a verifiable emergency.

  12. Pharmaceutical policies : effects of financial incentives for prescribers

    Sturm, H.; Austvoll-Dahlgren, A.; Aaserud, M.; Oxman, A. D.; Ramsay, C.; Vernby, A.; Koesters, J. P.

    2007-01-01

    Background Pharmaceuticals, while central to medical therapy, pose a significant burden to health care budgets. Therefore regulations to control prescribing costs and improve quality of care are implemented increasingly. These include the use of financial incentives for prescribers, namely increased

  13. Prescribing tests must have curriculum support

    Lemon TI

    2013-05-01

    Full Text Available Rupali D Shah, Thomas I LemonSchool of Medicine, Cardiff University, University Hospital of Wales, Cardiff, WalesGordon, Catchpole and Baker1 have discussed and investigated a very interesting, currently relevant, subject in medical education; particularly with the introduction of the prescribing test for undergraduates trialled in the UK this year and set to become a fully-fledged part of the curriculum and assessment criteria for 2014 graduates.2 It would of course be of great interest to compare the themes discussed in this paper and see they how would compare to recent graduates in late 2014.View original paper by Gordon and colleagues.

  14. Leveraging hospital formularies for improved prescribing.

    Karas, Albert; Kuehl, Bonnie

    2014-01-01

    Hospital formularies, guided by the Pharmacy and Therapeutics Committee, exist to optimize medication use by identifying and designating drugs of choice to guide rational prescribing, ultimately reducing patient risk and costs and improving patient outcomes. Guidelines and a framework exist to guide critical evaluations of medications for formulary listing; however, there may be opportunities to improve and standardize how a formulary change could be instituted in Canadian hospitals. A formulary change at an Ontario hospital revealed that there are some key challenges to the formulary change process including the importance of a robust project plan, appropriate resources, healthcare staff education, and acceptance. PMID:25046967

  15. [Prescribed drugs - a new crime field?].

    Schwarzenbrunner, Thomas

    2014-12-01

    The first chapter of the following article discusses measures in terms of substitution treatment of a program of the Austrian Minister of the Interior. The relevance of psychosocial measures and aims of substitution treatment for opioid-dependent patients is illuminated. The abstinence as the only goal definition is modified and by the results of the study PREMOS a target differentiation at addiction work is illustrated. The second chapter addresses the misuse of prescribed drugs. Thereby police report data will be analyzed and the market situation of opioids will be outlined. PMID:25377373

  16. Analyzing transaction workflows in an ePrescribing system.

    Virk, Pushwaz; Bates, David W; Halamka, John; Fournier, Gail A; Rothschild, Jeffrey M

    2006-01-01

    Electronic Prescribing (ePrescribing) is the process of prescribing medications using an outpatient computerized physician order entry (CPOE) system that electronically exchanges prescriptions directly with the pharmacy and/or pharmacy benefits manager (PBM). Our project aims to evaluate proposed ePrescription transmission standards and a community utility for ePrescribing called the eRx Gateway for safety, quality and efficiency. PMID:17238748

  17. An expanded prescribing role for pharmacists - an Australian perspective

    Kreshnik Hoti; Jeffery Hughes; Bruce Sunderland

    2011-01-01

    Expanded pharmacist prescribing is a new professional practice area for pharmacists. Currently, Australian pharmacists’ prescribing role is limited to over-the-counter medications. This review aims to identify Australian studies involving the area of expanded pharmacist prescribing. Australian studies exploring the issues of pharmacist prescribing were identified and considered in the context of its implementation internationally. Australian studies have mainly focused on the attitudes of com...

  18. Electronic Point-of-Care Prescribing: Writing the `Script'

    Gordon Schiff; Bates, David W

    2000-01-01

    Moving from a paper-based prescribing system to a system in which physicians prescribe directly into computers represents an important but challenging transition. This article addresses 5 issues related to computerised prescribing. The first issue is that paper-based prescribing systems do not work. Rates of errors and inappropriate prescriptions are unacceptably high. Using computers to structure and check prescriptions holds great promise for ameliorating this situation. The second issue is...

  19. Pharmacy Student Perceptions of Pharmacist Prescribing: A Comparison Study

    Charrois, Theresa L; Meagen Rosenthal; Kreshnik Hoti; Christine Hughes

    2013-01-01

    Several jurisdictions throughout the world, such as the UK and Canada, now have independent prescribing by pharmacists. In some areas of Canada, initial access prescribing can be done by pharmacists. In contrast, Australian pharmacists have no ability to prescribe either in a supplementary or independent model. Considerable research has been completed regarding attitudes towards pharmacist prescribing from the perspective of health care professionals, however currently no literature exists re...

  20. "Academic detailing" improving prescribing practices in North Vancouver, conference told

    Silversides, A.

    1997-01-01

    Physician prescribing practices were the focus of a recent 1-day conference in Toronto. A BC hospital pharmacist outlined a successful initiative that provides physicians with impartial prescribing advice, saying it has resulted in considerable savings and improved prescribing practices in North Vancouver. Drugs of Choice author Dr. Joel Lexchin says such initiatives, called academic detailing, along with peer feedback, are cost-effective ways to improve prescribing habits.

  1. Undergraduate Medical Students' Reasoning with Regard to the Prescribing Process

    Harries, C. S.; Botha, J.

    2007-01-01

    When final year medical students reporting poor prescribing confidence were tested, key prescribing weaknesses emerged. This study aimed to characterize student variability in both the experience of and cognitive levels displayed during prescribing. Blooms Taxonomy cognitive categories were assigned to each question of a student test measuring…

  2. Glaucoma Therapy: Prescribing Pattern and Cost Analysis

    Rashmi Sharma, Ruchi Khajuria, Pushpinder Sharma, P. Sadhotra, B. Kapoor, K. Kohli, C.L. Sharma

    2004-04-01

    Full Text Available In the present study out of total 200 prescriptions of POAG (primary open angle glaucoma studied66% were found to be of monotherapy including timolol, brimonidine, pilocarpine, betaxolol, levobunolol,latanoprost and apraclonidine in 30%, 15 %, 6%, 8% , 4%, 1% and 2% of the prescriptions respectivelyand 34% were found to be of polypharmacy with timolol+pilocarpine, timolol+acetazolamide, timolol+brimonidine and betaxolol+brimonidine in 13%, 4%, 8% and 9% of the prescriptions respectively.10% drugs were prescribed by generic name. Written instruction to the patients regarding dose anddosing interval was mentioned in 100% prescriptions, but the proper method of instillation wasmentioned only in 15% of the prescriptions. Results of the present study clearly indicated urgentneed for prescribers to improve their communication skills, to give proper instructions to the patientregarding instillation of drug, as little bit of caution like instillation from the side of the eye in thesupine position followed by rolling of the eyeball can decrease the wastage, decrease cost andimprove compliance. However, in the present scenario cost of the traditional medications like betablockers,pilocarpine etc. is found to be much less than newer medications (prostaglandin analogues,brimonidine. Moreover, in presence of wide cost variation among various brands of the same drugour study could help the opthalmologist to use all possible measures of pharmacoeconomics whileprescribing an antiglaucoma drug.

  3. Early Diagnosis, Timely Treatment

    Full Text Available ... have a very good chance of receiving proper treatment and care to the point where vision loss ... eye examinations. Announcer: Today's most frequently prescribed glaucoma treatment contains a beta blocker to reduce the pressure. ...

  4. A study of drug prescribing pattern using WHO prescribing indicators in the state of Goa, India

    Ulhas K. Chandelkar

    2014-12-01

    Conclusions: Baseline data gathered by this study can be used by researchers and policymakers. Further the problem-based basic training in pharmacotherapy; targeted continuing education can prove useful to medical profession to improve prescribing practice and public health administrators for promoting effective rational drug use. [Int J Basic Clin Pharmacol 2014; 3(6.000: 1057-1061

  5. E-prescribing: clinical implications for patients with diabetes.

    Smith, Marie; Dang, Devra; Lee, Jennifer

    2009-09-01

    With the recent Center for Medicare and Medicaid Services and stimulus package incentives for health information technology, many clinicians are expected to adopt or enhance their use of e-prescribing systems. E-prescribing has nearly eradicated medication errors resulting from prescriber handwriting interpretations, yet several other patient-care and workflow benefits still remain a promise. As prescribers select or update their e-prescribing systems (whether stand-alone or integrated with electronic health records), close attention is needed to the e-prescribing application features and level of clinical decision support to avoid clinical blind spots, including incomplete or inaccurate patient medication lists, poor drop-down menu or screen design, and lack of clinically relevant and actionable drug interaction and drug allergy alerts. This article presents three case studies that highlight common e-prescribing problems involving diabetes patients. PMID:20144439

  6. Should dermatologists prescribe hormonal contraceptives for acne?

    Harper, Julie C

    2009-01-01

    ABSTRACT One of the primary factors contributing to the development of acne vulgaris is excess sebum. Sebaceous glands and sebum excretion are regulated, at least in part, by androgen hormones. Acne treatments that block this androgen effect include spironolactone and combination oral contraceptives (COC). Three COC are now FDA approved to treat moderate acne. Dermatologists must become experts at prescribing these hormonal contraceptives. Likewise, it is vital to be aware of contraindications to hormonal contraceptive therapy. Proper patient selection relies on an appropriate medical history and an assessment of blood pressure. A pelvic exam and/or Papanicolaou smear are not required prior to initiating therapy with a COC. It is important to counsel patients about potential adverse effects of COC pills and to establish appropriate expectations concerning acne improvement. PMID:19845722

  7. Proton Pump Inhibitors and the Prescribing Cascade.

    Rababa, Mohammad; Al-Ghassani, Amal Ali; Kovach, Christine R; Dyer, Elaine M

    2016-04-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE Instructions 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Proton Pump Inhibitors and the Prescribing Cascade" found on pages 23-31, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until March 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe the prescribing cascade of proton pump inhibitors (PPI) in nursing home residents. 2. Identify the statistically

  8. Codeine in paediatrics: pharmacology, prescribing and controversies.

    Andrzejowski, Paul; Carroll, Will

    2016-06-01

    Codeine is a drug that until recently was widely used in children. It was endorsed by the WHO as the second step on the analgesic ladder for cancer pain and has been used routinely for postoperative and breakthrough pain. Recently, its safety and efficacy have been called into question, following deaths after adenotonsillectomy was associated with its use. This has led to regulation by the US Food and Drug Administration, European Medicines Agency and the UK Medicines and Healthcare products Regulatory Agency to place significant restrictions on its use, and some centres have stopped using it altogether.In this article, we discuss the developmental pharmacology underpinning its action, reviewing what is known about the pharmacokinetics, pharmacodynamics and pharmacogenetics in children, how this relates to prescribing, as well as the practical issues and the recent regulatory framework surrounding its use. PMID:26984558

  9. Lorentzian Einstein metrics with prescribed conformal infinity

    Enciso, Alberto

    2014-01-01

    We prove that there are asymptotically anti-de Sitter Einstein metrics with prescribed conformal infinity. More precisely we show that, given any suitably small perturbation $\\hat g$ of the conformal metric of the $(n+1)$-dimensional anti-de Sitter space at timelike infinity, which is given by the canonical Lorentzian metric on the $n$-dimensional cylinder, there is a Lorentzian Einstein metric on $(-T,T)\\times \\mathbb{B}^n$ whose conformal geometry is given by $\\hat g$. This is a Lorentzian counterpart of the Graham-Lee theorem in Riemannian geometry and is motivated by the holographic prescription problem in the context of the AdS/CFT correspondence in string theory.

  10. Tendencias Actuales del Constitucionalismo Latinoamericano

    Jorge Carpizo

    2009-12-01

    Full Text Available El artículo analiza los cambios constitucionales que ha habido en América Latina y que han tenido incidencia directa en el progreso de la democracia en la región; de esta manera, hace una amplia comparación de la creación de instituciones que persiguen este fin en los diferentes estados. Desde una definición amplia y actual de democracia, se revelan sus principales focos de peligro como la ilegitimidad del Estado de derecho o la percepción de corrupción predominante en la población. El escrito hace un estudio de los atributos más importantes que pueden encontrarse actualmente en esta parte del continente, y no todos ellos parecen ser siempre optimistas; tal es el caso, por ejemplo, de los referendos cuando no son conducidos conforme a la ley o los no siempre exitosos gobiernos divididos y de coalición. Es claro que el avance en materia de democracia ha sido significativo en los últimos treinta años, pero aún existen factores de riesgo que no deben perderse de vista puesto que resulta imperativo seguir el camino sin retroceder.

  11. Tendencias actuales del constitucionalismo latinoamericano

    Jorge Carpizo

    2009-12-01

    Full Text Available El artículo analiza los cambios constitucionales que ha habido en América Latina y que han tenido incidencia directa en el progreso de la democracia en la región; de esta manera, hace una amplia comparación de la creación de instituciones que persiguen este fin en los diferentes estados. Desde una definición amplia y actual de democracia, se revelan sus principales focos de peligro como la ilegitimidad del Estado de derecho o la percepción de corrupción predominante en la población. El escrito hace un estudio de los atributos más importantes que pueden encontrarse actualmente en esta parte del continente, y no todos ellos parecen ser siempre optimistas; tal es el caso, por ejemplo, de los referendos cuando no son conducidos conforme a la ley o los no siempre exitosos gobiernos divididos y de coalición. Es claro que el avance en materia de democracia ha sido significativo en los últimos treinta años, pero aún existen factores de riesgo que no deben perderse de vista puesto que resulta imperativo seguir el camino sin retroceder.

  12. Risk and liabilities of prescribing compounded medications.

    Randell, Michael D; Duffy, Phillip J

    2014-07-01

    Complications resulting from the use of compounded medications have become a troubling trend nationwide. There is a significant potential for patients to suffer serious harm from the use of substandard medications prepared by compounding pharmacies, and the reality of this problem has been demonstrated in several well-publicized incidences of serious medical complications, including patient deaths, that directly resulted from the use of medications prepared at compounding pharmacies. Unlike US Food and Drug Administration (FDA)-approved drugs, compounded products are not required to meet evidentiary standards for establishing safety and efficacy. Moreover, these products are not held to Good Manufacturing Practices, which require regular inspections, quality control testing, and rejection of material not meeting specifications. Physicians, as well as other prescribers, need to be aware that when a patient suffers harm from using a compounded medication, those injured patients may bring negligence and malpractice claims, not only against the pharmacy and the pharmacist responsible for preparing the medication, but also against the prescribing physician and the physician’s practice. Consequently, the best way for physicians to manage professional risk and avoid both litigation and potential negative patient outcomes related to compounded pharmaceuticals is to not use these products if there is an FDA-approved product available. However, if the use of a compounded medication is medically necessary, then physicians should adhere to the FDA guidance concerning traditional compounding. Moreover, it would be prudent for any physician who intends to either resell or participate in the distribution of compounded products beyond the direct treatment of their patients to consider obtaining the appropriate insurance coverage for this activity. PMID:25276868

  13. The actual goals of geoethics

    Nemec, Vaclav

    2014-05-01

    The most actual goals of geoethics have been formulated as results of the International Conference on Geoethics (October 2013) held at the geoethics birth-place Pribram (Czech Republic): In the sphere of education and public enlightenment an appropriate needed minimum know how of Earth sciences should be intensively promoted together with cultivating ethical way of thinking and acting for the sustainable well-being of the society. The actual activities of the Intergovernmental Panel of Climate Changes are not sustainable with the existing knowledge of the Earth sciences (as presented in the results of the 33rd and 34th International Geological Congresses). This knowledge should be incorporated into any further work of the IPCC. In the sphere of legislation in a large international co-operation following steps are needed: - to re-formulate the term of a "false alarm" and its legal consequences, - to demand very consequently the needed evaluation of existing risks, - to solve problems of rights of individuals and minorities in cases of the optimum use of mineral resources and of the optimum protection of the local population against emergency dangers and disasters; common good (well-being) must be considered as the priority when solving ethical dilemmas. The precaution principle should be applied in any decision making process. Earth scientists presenting their expert opinions are not exempted from civil, administrative or even criminal liabilities. Details must be established by national law and jurisprudence. The well known case of the L'Aquila earthquake (2009) should serve as a serious warning because of the proven misuse of geoethics for protecting top Italian seismologists responsible and sentenced for their inadequate superficial behaviour causing lot of human victims. Another recent scandal with the Himalayan fossil fraud will be also documented. A support is needed for any effort to analyze and to disclose the problems of the deformation of the contemporary

  14. Doctors' attitudes about prescribing and knowledge of the costs of common medications.

    McGuire, C

    2012-02-01

    INTRODUCTION: Compliance with medical therapy may be compromised because of the affordability of medications. Inadequate physician knowledge of drug costs may unwittingly contribute to this problem. METHODS: We measured attitudes about prescribing and knowledge of medication costs by written survey of medical and surgical non consultant hospital doctors and consultants in two University teaching hospitals (n = 102). Sixty-eight percent felt the cost of medicines was an important consideration in the prescribing decision, however, 88% often felt unaware of the actual costs. Only 33% had easy access to drug cost data, and only 3% had been formally educated about drug costs. Doctors\\' estimates of the cost of a supply of ten commonly used medications were accurate in only 12% of cases, too low for 50%, and too high for 38%. CONCLUSIONS: Interventions are needed to educate doctors about drug costs and provide them with reliable, easily accessible cost information in real-world practice.

  15. Methods to reduce prescribing errors in elderly patients with multimorbidity.

    Lavan, Amanda H; Gallagher, Paul F; O'Mahony, Denis

    2016-01-01

    The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers' lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people's prescriptions/screening tool to alert to right treatment) criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another challenge is to design, build, validate, and test by clinical trials suitably versatile and efficient software engines that can reliably and swiftly perform complex medication reviews in

  16. A study of drug prescribing pattern using WHO prescribing indicators in the state of Goa, India

    Ulhas K. Chandelkar; Rataboli, Padmanabh V

    2014-01-01

    Background: The quality of life in developing countries can be improved by enhancing the standards of medical treatment at all levels of the health care delivery system. Teaching hospitals have a special responsibility toward society to promote rational prescribing by their staff and, through them, the future generations of doctors. Methods: A sample of 1000 patient prescriptions was assessed retrospectively to assess the drug prescription patterns in the state of Goa. Results: Of 1842 ...

  17. Investigation of actual use of laxatives and application to the active drug information offer in drug control guidance

    Odanaka, Minori; Asahi, Mariko; Yokogawa, Koichi; Miyamoto, Kenichi

    2002-01-01

    On the therapy of constipation, there are few reports that surveyed the actual circumstance of patients taking laxatives and the effectiveness of the drug. In this study, we investigated the contents in prescription, the actual conditions of administration of laxatives, and the subjective symptoms of inpatients in all wards of Kanazawa University hospital (2000. 12.1-2000. 12. 10). As a result of the investigation, the percentage of patients prescribed some laxatives was found to be about 31....

  18. Methods to reduce prescribing errors in elderly patients with multimorbidity

    Lavan, Amanda H; Gallagher, Paul F; O’Mahony, Denis

    2016-01-01

    The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers’ lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people’s prescriptions/screening tool to alert to right treatment) criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another challenge is to design, build, validate, and test by clinical trials suitably versatile and efficient software engines that can reliably and swiftly perform complex medication reviews

  19. Using Computer-Generated Feedback to Improve Physician Prescribing

    Wilkinson, William E.; Gehlbach, Stephen H; Hammond, William E.; Clapp, Nancy E.

    1982-01-01

    A model utilizing computerized feedback to improve physician prescribing was studied in a family medicine residency practice. The frequency of generic prescribing was monitored for two sets of commonly used drugs: 21 “feedback” drugs and 13 “silent” drugs. After a four-month baseline period, the residents and faculty physicians were randomized into two groups. The experimental group received nine monthly printouts identifying “feedback” drugs they had prescribed by brand name with estimates o...

  20. Improving benzodiazepine prescribing in family practice through review and education.

    Rosser, W.W.; Simms, J. G.; Patten, D W; J. Forster

    1981-01-01

    Indications for and dosages of four commonly prescribed benzodiazepines were recorded at a family medicine centre with the aid of a computerized data collection system. Four guidelines were then developed for appropriate prescribing of these drugs: (a) benzodiazepines should be used less frequently with increasing age; (b) short-acting drugs are preferable to long-acting drugs; (c) patients 65 years of age and over should receive half the daily dose prescribed for younger patients; and (d) us...

  1. The case of pharmacist prescribing policy in Israel

    Yariv, Hila

    2015-01-01

    Pharmacy prescribing policy in Israel has been negotiated and changed in recent years in order to improve patient treatment and access to medicines, and reduce national health insurance costs by allowing pharmacists to prescribe medications. Various stakeholders and institutions were involved in the formulation process, affecting the process while representing different motives. The complexity of pharmacy prescribing policy formulation is universal - any policy project needs, for strategic an...

  2. Prescribed Travel Schedules for Fatigue Management

    Whitmire, Alexandra; Johnston, Smith; Lockley, Steven

    2011-01-01

    The NASA Fatigue Management Team is developing recommendations for managing fatigue during travel and for shift work operations, as Clinical Practice Guidelines for the Management of Circadian Desynchrony in ISS Operations. The Guidelines provide the International Space Station (ISS ) flight surgeons and other operational clinicians with evidence-based recommendations for mitigating fatigue and other factors related to sleep loss and circadian desynchronization. As much international travel is involved both before and after flight, the guidelines provide recommendations for: pre-flight training, in-flight operations, and post-flight rehabilitation. The objective of is to standardize the process by which care is provided to crewmembers, ground controllers, and other support personnel such as trainers, when overseas travel or schedule shifting is required. Proper scheduling of countermeasures - light, darkness, melatonin, diet, exercise, and medications - is the cornerstone for facilitating circadian adaptation, improving sleep, enhancing alertness, and optimizing performance. The Guidelines provide, among other things, prescribed travel schedules that outline the specific implementation of these mitigation strategies. Each travel schedule offers evidence based protocols for properly using the NASA identified countermeasures for fatigue. This presentation will describe the travel implementation schedules and how these can be used to alleviate the effects of jet lag and/or schedule shifts.

  3. Improving Prescribing Practices in Primary Care

    Atle Fretheim; Oxman, Andrew D.; Kari Håvelsrud; Shaun Treweek; Kristoffersen, Doris T; Arild Bjørndal

    2006-01-01

    Editors' Summary Background. An important issue in health care is “getting research into practice,” in other words, making sure that, when evidence from research has established the best way to treat a disease, doctors actually use that approach with their patients. In reality, there is often a gap between evidence and practice.   An example concerns the treatment of people who have high blood pressure (hypertension) and/or high cholesterol. These are common conditions, and both increase the ...

  4. Pharmacy Student Perceptions of Pharmacist Prescribing: A Comparison Study

    Theresa L. Charrois

    2013-11-01

    Full Text Available Several jurisdictions throughout the world, such as the UK and Canada, now have independent prescribing by pharmacists. In some areas of Canada, initial access prescribing can be done by pharmacists. In contrast, Australian pharmacists have no ability to prescribe either in a supplementary or independent model. Considerable research has been completed regarding attitudes towards pharmacist prescribing from the perspective of health care professionals, however currently no literature exists regarding pharmacy student views on prescribing. The primary objective of this study is to examine pharmacy student’s opinions and attitudes towards pharmacist prescribing in two different settings. Focus groups were conducted with selected students from two universities (one in Canada and one in Australia. Content analysis was conducted. Four main themes were identified: benefits, fears, needs and pharmacist roles. Students from the Australian University were more accepting of the role of supplementary prescribing. In contrast, the Canadian students felt that independent prescribing was moving the profession in the right direction. There were a number of similarities with the two groups with regards to benefits and fears. Although the two cohorts differed in terms of their beliefs on many aspects of prescribing, there were similarities in terms of fears of physician backlash and blurring of professional roles.

  5. A RCT evaluating the effectiveness and cost-effectiveness of academic detailing versus postal prescribing feedback in changing GP antibiotic prescribing.

    Naughton, Corina

    2009-10-01

    The aim of this study is to evaluate the effectiveness of academic detailing (AD) plus postal prescribing feedback versus postal prescribing feedback alone in reducing: (i) the overall rate of antibiotic; and (ii) proportion of second-line antibiotic prescribing. In addition, the cost-effectiveness of an outreach prescriber adviser service versus a postal prescribing feedback service was evaluated.

  6. Specific therapeutic group age-sex related prescribing units (STAR-PUs): weightings for analysing general practices' prescribing in England.

    Lloyd, D C; Harris, C. M.; Roberts, D J

    1995-01-01

    OBJECTIVES--To derive cost comparators for prescribing by English general practitioners in eight specific therapeutic groups, based on age-sex related weightings, and to confirm, from a new dataset, earlier age-sex weightings for overall prescribing (ASTRO-PUs). DESIGN--Calculations based on one year's prescribing data from selected practices using AAH Meditel software, held on MediPlus by Intercontinental Medical Statistics (IMS, UK and Ireland), and research practices using VAMP software, h...

  7. The percentage of error of different weight estimation methods toward actual weight in children admitted to 17 shahrivar hospital

    Hamidreza Badeli

    2015-01-01

    Conclusions: Results indicated a significant difference between the estimated weight and the actual one based on visual expert′s estimation and APLS method. As, these methods were easy, rapid and accurate for body weight estimation in emergencies and may be more accurate than parent′s estimation, it seems that it could be helpful for prescribing medication dosage and equipment sizes.

  8. Drugs Prescribed by Dentists in Fars Province, Iran

    Fani; Ghaeminia; Farjood

    2013-01-01

    Background Medication is one of the supplementary steps in dental treatment. Dentists prescribe medicine in order to avoid post-surgery complications. To the best knowledge of the researchers, no thorough study has been carried out to review the prescribed drugs in Fars province, Iran. Objectives The current study aimed to determine the current status of the issue and compare it with global standards. ...

  9. Proton pump inhibitors: potential cost reductions by applying prescribing guidelines.

    Cahir, Caitriona

    2012-01-01

    There are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care. This study aims to establish potential cost savings in a community drug scheme for a one year period according to published clinical and cost-effective guidelines for PPI prescribing.

  10. Determinants of physicians' prescribing behaviour of methylphenidate for cognitive enhancement.

    Ponnet, Koen; Wouters, Edwin; Van Hal, Guido; Heirman, Wannes; Walrave, Michel

    2014-01-01

    The non-medical use of methylphenidate for cognitive enhancement becomes a more and more common practice among college and university students. Although physicians are a source of access, little is known about the underlying mechanisms that might lead to physicians' intention and behaviour of prescribing methylphenidate to improve students' academic performance. Applying Ajzen's theory of planned behaviour (TPB), we tested whether attitudes, subjective norms (controllability and self-efficacy) and perceived behavioural control predicted the intention and the prescribing behaviour of physicians. Participants were 130 physicians (62.3% males). Structural equation modelling was used to test the ability of TPB to predict physicians' behaviour. Overall, the present study provides support for the TPB in predicting physicians' prescribing behaviour of methylphenidate for cognitive enhancement. Subjective norms, followed by attitudes, are the strongest predictors of physicians' intention to prescribe methylphenidate. To a lesser extent, controllability predicts the intention of physicians, and self-efficacy predicts the self-reported behaviour. Compared to their male colleagues, female physicians seem to have more negative attitudes towards prescribing methylphenidate for cognitive enhancement, feel less social pressure and perceive more control over their behaviour. Intervention programmes that want to decrease physicians' intention to prescribe methylphenidate for improving academic performance should primarily focus on alleviating the perceived social pressure to prescribe methylphenidate and on converting physician neutral or positive attitudes towards prescribing methylphenidate into negative attitudes. PMID:23713799

  11. An expanded prescribing role for pharmacists – an Australian perspective

    Kreshnik Hoti

    2011-04-01

    Full Text Available Expanded pharmacist prescribing is a new professionalpractice area for pharmacists. Currently, Australianpharmacists’ prescribing role is limited to over-the-countermedications. This review aims to identify Australian studiesinvolving the area of expanded pharmacist prescribing.Australian studies exploring the issues of pharmacistprescribing were identified and considered in the context ofits implementation internationally. Australian studies havemainly focused on the attitudes of community and hospitalpharmacists towards such an expansion. Studies evaluatingthe views of Australian consumers and pharmacy clients werealso considered. The available Australian literature indicatedsupport from pharmacists and pharmacy clients for anexpanded pharmacist prescribing role, with preference fordoctors retaining a primary role in diagnosis. Australianpharmacists and pharmacy client’s views were also inagreement in terms of other key issues surrounding expandedpharmacist prescribing. These included the nature of anexpanded prescribing model, the need for additional trainingfor pharmacists and the potential for pharmacy clients gainingimproved medication access, which could be achieved withinan expanded role that pharmacists could provide. Currentevidence from studies conducted in Australia providesvaluable insight to relevant policymakers on the issue ofpharmacist prescribing in order to move the agenda ofpharmacist prescribing forwards.

  12. Legal and actual central bank independence

    Artha, I.K.D.S.; J. de Haan

    2010-01-01

    Indicators of central bank independence (CBI) based on the interpretation central bank laws in place may not capture the actual independence of the central bank. This paper develops an indicator of actual independence of the Bank Indonesia (BI), the central bank of Indonesia, for the period 1953-2008 and compares it with a new legal CBI indicator based on Cukierman (1992). The indicator of actual independence captures institutional and economic factors that affect CBI. We find that before 199...

  13. A Drug Utilization Study of Psychotropic Drugs Prescribed in the Psychiatry Outpatient Department of a Tertiary Care Hospital

    Thakkar, Karan B.; Jain, Mangal M.; Billa, Gauri; Joshi, Abhijit; Khobragade, Akash A.

    2013-01-01

    Background: Psychiatric disorders are one of the major causes of morbidity. Development of newer drugs like SSRIs and atypical antipsychotics has altered the treatment paradigms. Various factors like cost of drugs, local paradigms, etc. play a role in the selection of drug therapy and hence, affect the outcome. Keeping this in mind, we conducted a study to delineate the various drugs used in psychiatric disorders, to find discrepancies, if any, between the actual and the ideal prescribing pat...

  14. Factor analysis improves the selection of prescribing indicators

    Rasmussen, Hanne Marie Skyggedal; Søndergaard, Jens; Sokolowski, Ineta;

    2006-01-01

    indicators directly quantifying choice of coxibs, indicators measuring expenditure per Defined Daily Dose, and indicators taking risk aspects into account, (2) "Frequent NSAID prescribing", comprising indicators quantifying prevalence or amount of NSAID prescribing, and (3) "Diverse NSAID choice", comprising...... indicators focusing on the width of GPs' formularies. The number of indicators for measuring the important aspects of quality in prescribing of NSAIDs could be reduced substantially by selecting the indicator in each dimension with the highest factor loading. A high preference for coxibs indicated both...... appropriate and inappropriate prescribing, as revealed by the correlation of the indicators in the first factor. CONCLUSION: Correlation and factor analysis is a feasible method that assists the selection of indicators and gives better insight into prescribing patterns....

  15. Actual Causation in CP-logic

    Vennekens, Joost

    2011-01-01

    Given a causal model of some domain and a particular story that has taken place in this domain, the problem of actual causation is deciding which of the possible causes for some effect actually caused it. One of the most influential approaches to this problem has been developed by Halpern and Pearl in the context of structural models. In this paper, I argue that this is actually not the best setting for studying this problem. As an alternative, I offer the probabilistic logic programming language of CP-logic. Unlike structural models, CP-logic incorporates the deviant/default distinction that is generally considered an important aspect of actual causation, and it has an explicitly dynamic semantics, which helps to formalize the stories that serve as input to an actual causation problem.

  16. Pharmacist independent prescribing in secondary care: opportunities and challenges.

    Bourne, Richard S; Baqir, Wasim; Onatade, Raliat

    2016-02-01

    In recent years a number of countries have extended prescribing rights to pharmacists in a variety of formats. The latter includes independent prescribing, which is a developing area of practice for pharmacists in secondary care. Potential opportunities presented by wide scale implementation of pharmacist prescribing in secondary care include improved prescribing safety, more efficient pharmacist medication reviews, increased scope of practice with greater pharmacist integration into acute patient care pathways and enhanced professional or job satisfaction. However, notable challenges remain and these need to be acknowledged and addressed if a pharmacist prescribing is to develop sufficiently within developing healthcare systems. These barriers can be broadly categorised as lack of support (financial and time resources), medical staff acceptance and the pharmacy profession itself (adoption, implementation strategy, research resources, second pharmacist clinical check). Larger multicentre studies that investigate the contribution of hospital-based pharmacist prescribers to medicines optimisation and patient-related outcomes are still needed. Furthermore, a strategic approach from the pharmacy profession and leadership is required to ensure that pharmacist prescribers are fully integrated into future healthcare service and workforce strategies. PMID:26613738

  17. Vasodilatory mechanisms of beta receptor blockade.

    Rath, Géraldine; Balligand, Jean-Luc; Dessy, Chantal

    2012-01-01

    Beta-blockers are widely prescribed for the treatment of a variety of cardiovascular pathologies. Compared to traditional beta-adrenergic antagonists, beta-blockers of the new generation exhibit ancillary properties such as vasodilation through different mechanisms. This translates into a more favorable hemodynamic profile. The relative affinities of beta-adrenoreceptor antagonists towards the three beta-adrenoreceptor isotypes matter for predicting their functional impact on vasomotor contro...

  18. Subjective biological self and self-actualization.

    Sumerlin, J R; Berretta, S A; Privette, G; Bundrick, C M

    1994-12-01

    Ginsburg, Rogers, and Maslow, humanistic theorists, have maintained that the self is an emergent characteristic of one's biological makeup. The relationship between physical self-efficacy as an appraisal of subjective biology and self-actualization was examined in a sample of 160 black and white participants. An r of .46 supports the association of subjective biology and self-actualization. Whereas there were no gender or racial differences in scores on self-actualization, men scored higher on physical self-efficacy and subscales of perceived physical ability and perceived self-presentation confidence. PMID:7899017

  19. Prime Hook National Wildlife Refuge Prescribed Fire Plan March 2014

    US Fish and Wildlife Service, Department of the Interior — The plan describes how the refuge will use prescribed fire to treat hazardous fuels, enhance wildlife habitats, biological diversity and integrity, and delineates...

  20. Considerations in prescribing fire on national wildlife refuges

    US Fish and Wildlife Service, Department of the Interior — Prescribed burning has been used on the southern National Wildlife Refuges in coastal areas since the 1940s. An intensive forest wildlife program was initiated in...

  1. Antibiotic prescribing by pediatricians for respiratory tract infection in children.

    Arnold, S R; Allen, U D; Al-Zahrani, M; Tan, D H; Wang, E E

    1999-08-01

    To examine antimicrobial prescribing rates for viral respiratory tract infections by primary care pediatricians in the greater Toronto area, charts were reviewed for the week of 17-21 February 1997 at 61 pediatricians' offices. Antibiotics were considered appropriate if the diagnosis was compatible with bacterial infection. A total of 3,585 patient visits were reviewed. The common cold was the most common respiratory tract syndrome leading to an office visit (1,317 visits). The overall rate of appropriate antibiotic prescribing was 89.5%. There was no significant difference in prescribing when physicians were compared by year of graduation from medical school, sex, or location of training. Diagnostic codes (ICD-9 [International Classification of Diseases, 9th edition] codes) did not match the chart diagnosis in 41% of cases. Toronto primary care pediatricians appear to have a lower rate of inappropriate antibiotic prescribing than do primary care physicians in other regions of Canada and the United States. PMID:10476734

  2. Crab Orchard National Wildlife Refuge : Prescribed Fire Plan : 1995

    US Fish and Wildlife Service, Department of the Interior — The Crab Orchard National Wildlife Refuge Prescribed Fire Plan has been developed to meet the station objectives set forth in the Master Plan, by aiding the forest...

  3. Prescribed Burning Plan for 1985 : Parker River National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — This is the 1985 prescribed burning plan for Parker River National Wildlife Refuge. Treatment Area #3 is the area consisting of the fresh water marsh inside the...

  4. Medicare Part D Prescriber Look-up Tool

    U.S. Department of Health & Human Services — This look-up tool is a searchable database that allows you to look up a Medicare Part D prescriber by National Provider Identifier (NPI), or by name and location....

  5. On a class of graphs with prescribed mean curvature

    We study a class of quasilinear elliptic equations on the unit ball of Rn and apply these results to get the existence of graphs with prescribed mean curvature on n-hyperbolic spaces. (author). 18 refs

  6. 1980 Prescribed Burning Progam: Union Slough National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — This document outlines a prescribed burning program for Union Slough National Wildlife Refuge. The following information is provided; names of burn units,...

  7. Annual Prescribed Burn Plan: [Rice Lake National Wildlife Refuge 1994

    US Fish and Wildlife Service, Department of the Interior — This document contains prescribed fire proposals for Rice Lake NWR during 1994. Details on the physical features, primary resource objective, vegetation cover...

  8. Prescribed Fire Proposal Fiscal Year 1994: Trempealeau National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — This Prescribed Burning Proposal for Trempealeau NWR summarizes the physical features, vegetative cover type, primary resource objectives, site preparation, safety...

  9. 1994 Prescribed Burning Plan: Shiawassee National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — This Prescribed Burn Plan provides a description of each burn unit on the Refuge and summarizes the safety concerns, monitoring, and burn operations for these units.

  10. Impact of prescribed burning on blanket peat hydrology

    Holden, J; Palmer, SM; Johnston, K; Wearing, C.; Irvine, B; Brown, LE

    2015-01-01

    Fire is known to impact soil properties and hydrological flowpaths. However, the impact of prescribed vegetation burning on blanket peatland hydrology is poorly understood. We studied ten blanket peat headwater catchments. Five were subject to prescribed burning, while five were unburnt controls. Within the burnt catchments we studied plots where the last burn occurred ∼2 (B2), 4 (B4), 7 (B7) or greater than 10 years (B10+) prior to the start of measurements. These were compared with plots at...

  11. Pharmacist-led feedback workshops increase appropriate prescribing of antimicrobials.

    McLellan, Lucy; Dornan, Tim; Newton, Pippa; Williams, Steven D; Lewis, Penny; Steinke, Douglas; Tully, Mary P

    2016-01-01

    OBJECTIVES: To investigate whether and how structured feedback sessions can increase rates of appropriate antimicrobial prescribing by junior doctors. METHODS: This was a mixed-methods study, with a conceptual orientation towards complexity and systems thinking. Fourteen junior doctors, in their first year of training, were randomized to intervention (feedback) and 21 to control (routine practice) groups in a single UK teaching hospital. Feedback on their antimicrobial prescribing was given, ...

  12. Perspectives on prescribing in nursing homes in Helsinki

    Hosia-Randell, Helka

    2010-01-01

    Prescribing for older patients is challenging. The prevalence of diseases increases with advancing age and causes extensive drug use. Impairments in cognitive, sensory, social and physical functioning, multimorbidity and comorbidities, as well as age-related changes in pharmacokinetics and pharmacodynamics all add to the complexity of prescribing. This study is a cross-sectional assessment of all long-term residents aged ≥ 65 years in all nursing homes in Helsinki, Finland. The residen...

  13. Prescribing the behavior of early terminating GMRES and Arnoldi iterations

    Duintjer Tebbens, Jurjen; Meurant, G.

    2014-01-01

    Roč. 65, č. 1 (2014), s. 69-90. ISSN 1017-1398 R&D Projects: GA AV ČR IAA100300802 Grant ostatní: GA AV ČR(CZ) M100301201 Institutional research plan: CEZ:AV0Z10300504 Keywords : Arnoldi process * early termination * GMRES method * prescribed GMRES convergence * Arnoldi method * prescribed Ritz values Subject RIV: BA - General Math ematics Impact factor: 1.417, year: 2014

  14. The need for reassessment of digoxin prescribing for the elderly.

    Nolan, L; Kenny, R; O'Malley, K

    1989-01-01

    1. The prevalence and circumstance of digoxin prescribing was assessed in five private nursing homes. 2. Forty-one patients (21% residents) were taking digoxin. 3. Seventeen patients were in atrial fibrillation and the remainder in sinus rhythm. The ventricular rate exceeded 100 beats min-1 in eight of the 17 patients in atrial fibrillation. 4. Thirty-seven patients were prescribed 0.0625 mg digoxin daily and serum digoxin concentrations were subtherapeutic in 20 of 32 patients in whom concen...

  15. Prescribed burning in Italy: issues, advances and challenges

    Ascoli D; Bovio G

    2013-01-01

    Prescribed burning has been carried out since the late 1970s in several southern European countries. Italy hosted some pioneer experiences in the early ’80s, but these did not follow up into practical implementation, and few studies and applications were carried out in subsequent years. In the last decade, a new interest arose and several experiences were carried out. We aim to illustrate the limitations, advances and challenges of prescribed burning in Italy by reviewing the national literat...

  16. Fluorine prescribing practice of paediatricians in Berlin, Germany

    Mittelsdorf, Arlette

    2010-01-01

    The subject of this study was to find out about paediatricians' approach towards fluoride within the municipal area of Berlin, Germany. For this purpose, an anonymous questionnaire consisting of 14 questions had been mailed; it was answered by a total number of 33 paediatricians. Basically, the survey indicates that they all prescribe fluorine in tablet form, but they differ about initiation and duration. About 30% prescribe fluorine between the age of 30 days and 6 years. All of ...

  17. Potential prescribing omissions vs polypharmacy among elderly patients

    Blanco-Reina, Encarnación; Ariza-Zafra, Gabriel; Ocaña-Riola, Ricardo; León-Ortíz, Matilde

    2013-01-01

    Objective: Screening tools have been formulated to identify potentially inappropriate prescribing (PIP) in older people. Screening Tool of Older Person’s Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) have been developed to identify PIP and potential prescribing omissions (PPOs). Although there are many publications on PIP, very few studies have analyzed the omissions. The aim was to measure the prevalence rates of potential PPOs using START. Methods: ...

  18. Potentially inappropriate prescribing among older people in the United Kingdom

    Bradley, Marie C; Motterlini, Nicola; Padmanabhan, Shivani; Cahir, Caitriona; Williams, Tim; Fahey, Tom; Hughes, Carmel M

    2014-01-01

    Background: Potentially inappropriate prescribing (PIP) in older people is associated with increases in morbidity, hospitalisation and mortality. The objective of this study was to estimate the prevalence of and factors associated with PIP, among those aged ≥70 years, in the United Kingdom, using a comprehensive set of prescribing indicators and comparing these to estimates obtained from a truncated set of the same indicators.Methods: A retrospective cross-sectional study was carried out in t...

  19. Conterminous U.S. actual evapotranspiration data

    U.S. Geological Survey, Department of the Interior — Actual ET (ETa) is produced using the operational Simplified Surface Energy Balance (SSEBop) model (Senay and others, 2013) for the period 2000 to present. The...

  20. Teaching safe prescribing to medical students: perspectives in the UK

    Nazar H

    2015-04-01

    Full Text Available Hamde Nazar,1 Mahdi Nazar,2 Charlotte Rothwell,1 Jane Portlock,3 Andrew Chaytor,1 Andrew Husband1 1School of Medicine, Pharmacy and Health, Durham University, UK; 2Cumberland Infirmary, North Cumbria University Hospitals NHS Trust, UK; 3School of Pharmacy and Biomedical Sciences, University of Portsmouth, UK Abstract: Prescribing is a characteristic role of a medical practitioner. On graduating from medical school, students are presumed to have acquired the necessary pharmacology knowledge underpinning the therapeutics and developed their personal skills and behaviors in order to write a safe and effective prescription (The Four Ps. However, there are reports of errors in medical prescribing and dissatisfied feedback from recent graduates, which evidence potential flaws in the current training in the practice of prescribing. We examine the Four Ps from a systems approach and offer scope for educators and curriculum designers to review and reflect on their current undergraduate teaching, learning, and assessment strategies in a similar manner. We also adopt a national framework of common competencies required of all prescribers to remain effective and safe in their area of practice as a more objective layer to the broader learning outcomes of the General Medical Council Tomorrow's Doctors 2009. This exercise demonstrates where standard, recognized competencies for safe prescribing can be accommodated pedagogically within existing medical curricula.Keywords: prescribing, medical curriculum, clinical pharmacology teaching, therapeutics, education

  1. Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing

    Van Royen Paul

    2002-09-01

    Full Text Available Abstract Background Antibiotics are being overprescribed in ambulant care, especially for respiratory tract infections (RTIs. Gaining insight into the actual reasons for prescribing remains important for the design of effective strategies to optimise antibiotic prescribing. We aimed to determine items of importance for the antibiotic prescribing decision and to make them operational for an intervention trial. Methods A postal questionnaire based upon focus group findings was sent to 316 Flemish general practitioners (GPs. On a verbal rating scale the GPs scored to what extent they consider the questionnaire items in decision making in case of suspected RTI in a coughing patient and how strongly the items support or counter antibiotic treatment. Factor analysis was used to condense the data. The relative importance of the yielded operational factors was assessed using Wilcoxon Matched Pairs test. Results 59.5% completed the study. Response group characteristics (mean age: 42.8 years; 65.9% men approximated that of all Flemish GPs. Participants considered all the items included in the questionnaire: always the operational factor 'lung auscultation', often 'whether or not there is something unusual happening' – both medical reasons – and to a lesser extent 'non-medical reasons' (P Conclusion This study quantified, condensed and confirmed the findings of previous focus group research. Practice guidelines and interventions to optimise antibiotic prescribing have to take non-medical reasons into account.

  2. Teaching safe prescribing to medical students: perspectives in the UK.

    Nazar, Hamde; Nazar, Mahdi; Rothwell, Charlotte; Portlock, Jane; Chaytor, Andrew; Husband, Andrew

    2015-01-01

    Prescribing is a characteristic role of a medical practitioner. On graduating from medical school, students are presumed to have acquired the necessary pharmacology knowledge underpinning the therapeutics and developed their personal skills and behaviors in order to write a safe and effective prescription (The Four Ps). However, there are reports of errors in medical prescribing and dissatisfied feedback from recent graduates, which evidence potential flaws in the current training in the practice of prescribing. We examine the Four Ps from a systems approach and offer scope for educators and curriculum designers to review and reflect on their current undergraduate teaching, learning, and assessment strategies in a similar manner. We also adopt a national framework of common competencies required of all prescribers to remain effective and safe in their area of practice as a more objective layer to the broader learning outcomes of the General Medical Council Tomorrow's Doctors 2009. This exercise demonstrates where standard, recognized competencies for safe prescribing can be accommodated pedagogically within existing medical curricula. PMID:25945072

  3. Factors influencing the choice of antidepressants: A study of antidepressant prescribing practice at University psychiatric clinic in Belgrade

    Marić Nađa P.

    2012-01-01

    Full Text Available Background/Aim. Antidepressants are a widely used class of drugs. The aim of this study was to investigate different aspects of antidepressant prescribing practice at University Psychiatric Clinic in Belgrade. Methods. This cross-sectional study was carried out by retrospective analysis of the patient's medical charts. The study included all patients with antidepressant prescribed at discharge during 2009 (n = 296. The evaluation was focused on patient- related factors (socio-demographic and illness related, psychiatrist-related factors (sex and duration of working experience and drug related factors (type of antidepressant, dose, polypharmacy and reimbursement by national health insurance. Results. Antidepressants were prescribed for unipolar depression (F32-34, ICD X either without comorbidity (46.2% or with comorbidity (24.7%, mostly as a monotherapy (91% had one antidepressant, to the patients who were 65% female, aged 50.1 ± 8.9, most of them with 12 years of education (52.6%, married (69.3% and employed (55.9%. The majority of patients had a history of two hospitalizations (Med 2; 25th-75th perc. 1-4 during nine years (Med 9; 25th-75th perc. 2-15 after the first episode of depression. Among them, 19% were found to be suicidal in a lifetime. The single most prescribed antidepressant was sertraline (20.4%, followed by fluoxetine (13.3% and maprotiline (11.7%. Utilization of antidepressants was positively correlated with the rate of reimbursement (p < 0.01. The most prescribed antidepressant group was selective serotonin reuptake inhibitors (SSRI (47.8%, followed by tricyclic antidepresants (TCA (25.3% and new antidepressants - venlafaxine, tianeptine, mirtazapine, bupropion, trazodone (15.1%. Most of the drugs were prescribed in doses which are at the lower end of the recommended dose-range. Regarding severity of the actual depressive episode, TCA were prescribed for severe depression with psychotic features, while SSRI were choice for

  4. The actual universe of valuation standards

    Ion Anghel

    2013-08-01

    Full Text Available In the actual context (with issues like as viability of the global markets, cross-border transactions, transparency in financial reporting etc. it is a common interest for professional valuers, investors, universities, researchers etc. to consider a convergent set of global professional valuation standards. It is also in their best interest to work towards enhancement and refinement of valuation methodologies and applications to be prepared to address valuation issues that are bound to arise in the future. The paper is a view of actual universe of valuation standards and options for national valuation standard enforcements starting from the operating system named International Valuation Standards (IVS.

  5. Factors influencing prescribing behaviour of physicians in Greece and Cyprus: results from a questionnaire based survey

    Fragoulakis Vasilis

    2009-08-01

    Full Text Available Abstract Background Over the past few decades, drug and overall healthcare expenditure have risen rapidly in most countries. The present study investigates the attitudes and the factors which influence physician prescribing decisions and practice in Greece and Cyprus. Methods A postal questionnaire was developed by researchers at the Department of Health Economics at the National School of Public Health in Greece, specifically for the purposes of the study. This was then administered to a sample of 1,463 physicians in Greece and 240 physicians in Cyprus, stratified by sex, specialty and geographic region. Results The response rate was 82.3% in Greece and 80.4% in Cyprus. There were similarities but also many differences between the countries. Clinical effectiveness is the most important factor considered in drug prescription choice in both countries. Greek physicians were significantly more likely to take additional criteria under consideration, such as the drug form and recommended daily dose and the individual patient preferences. The list of main sources of information for physicians includes: peer-reviewed medical journals, medical textbooks, proceedings of conferences and pharmaceutical sales representatives. Only half of prescribers considered the cost carried by their patients. The majority of doctors in both countries agreed that the effectiveness, safety and efficacy of generic drugs may not be excellent but it is acceptable. However, only Cypriot physicians actually prescribe them. Physicians believe that new drugs are not always better and their higher prices are not necessarily justified. Finally, doctors get information regarding adverse drug reactions primarily from the National Organisation for Medicines. However, it is notable that the majority of them do not inform the authorities on such reactions. Conclusion The present study highlights the attitudes and the factors influencing physician behaviour in the two countries and may

  6. Inappropriate prescribing in the older population: need for new criteria.

    O'Mahony, Denis

    2012-02-03

    Inappropriate prescribing (IP) is a common and serious global healthcare problem in elderly people, leading to increased risk of adverse drug reactions (ADRs), polypharmacy being the main risk factor for both IP and ADRs. IP in older people is highly prevalent but preventable; hence screening tools for IP have been devised, principally Beers\\' Criteria and the Inappropriate Prescribing in the Elderly Tool (IPET). Although Beers\\' Criteria have become the most widely cited IP criteria in the literature, nevertheless, they have serious deficiencies, including several drugs that are rarely prescribed nowadays, a lack of structure in the presentation of the criteria and omission of several important and common IP instances. New, more up-to-date, systems-based and easily applicable criteria are needed that can be applied in the routine clinical setting.

  7. How often are spectacle lenses not dispensed as prescribed?

    Kanwar Mohan

    2012-01-01

    Full Text Available Spectacles are routinely prescribed by the ophthalmologist and dispensed by the opticians. We investigated how frequently the spectacles are not dispensed as prescribed and whether the frequency of inaccurate spectacles would decrease if the patients, at the time of collecting spectacles, ask the optician to verify that the spectacles have been dispensed accurately. We found inaccurate spectacles in about one-third of our patients and incorrect spherocylinders more frequently with an error in the spherical element and cylinder axis. These inaccuracies decreased significantly when patients while collecting spectacles, asked the optician to verify the accuracy of the spectacles dispensed. It is suggested that while prescribing spectacles, the patients should be made aware of the possibility of dispensing errors. To decrease the frequency of incorrect spectacles, the patients while collecting spectacles, should ask the optician to check whether the spectacles have been dispensed accurately.

  8. An audit of generic prescribing in a general surgical department.

    Gleeson, M

    2013-01-17

    BACKGROUND: The Health Service Executive introduced a generic prescription policy to reduce costs. Despite this, generic prescription rates remain low. AIM: To audit in-patient prescription practice in a single surgical department and identify potential savings which could be realised by adherence to the generic prescribing policy. METHODS: Surgical in-patient charts were obtained at the point of discharge and their drug prescription information was recorded. RESULTS: 51 % of prescriptions involved a trade-name prescription where an appropriate generic equivalent existed. The cost implications for hospital and community patients were found to be greatly affected by substitution policies that exist at hospital pharmacy level. CONCLUSION: There is a need to promote greater adherence to generic prescribing amongst hospital doctors in line with international best practice. It can have a positive impact in terms of safe prescribing and can have cost implications at both hospital and community level.

  9. Prescribed burning in Italy: issues, advances and challenges

    Ascoli D

    2013-02-01

    Full Text Available Prescribed burning has been carried out since the late 1970s in several southern European countries. Italy hosted some pioneer experiences in the early ’80s, but these did not follow up into practical implementation, and few studies and applications were carried out in subsequent years. In the last decade, a new interest arose and several experiences were carried out. We aim to illustrate the limitations, advances and challenges of prescribed burning in Italy by reviewing the national literature of the last 40 years on this subject. Unfavorable land characteristics, conflicting management goals, a hostile socio-cultural environment, and an inadequate regulatory framework have supposedly limited the application of prescribed burning in Italy. Nevertheless, in the last 20 years the legislation at the regional level has been updated to consider the use of fire, and new procedures to authorize prescribed fires allowed for experiments and application, even within National Parks. From 2005 to 2012, prescribed burning programs for fire hazard reduction, forest and range management, biodiversity conservation and firefighter training were implemented throughout Italy. Several vegetation and fuel types were involved (e.g., broadleaved and coniferous forests, Mediterranean and continental shrubland, grassland, slash. Studies on fire behavior and effects helped to set prescriptions for specific objectives and environments. Results were transferred to professionals through training sessions. Some of the challenges ahead are improving the legislative framework, e.g., by introducing a certification for the use of fire, and addressing issues of pastoral fire through conflict resolution programs. Prescribed burning in Italy could be developed by committing to carry out ecological studies on its implications to silviculture, range management and habitat conservation.

  10. Primary non-adherence to prescribed medication in general practice

    Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún;

    2013-01-01

    Primary non-adherence refers to the patient not redeeming a prescribed medication at some point during drug therapy. Research has mainly focused on secondary non-adherence. Prior to this study, the overall rate of primary non-adherence in general practice in Iceland was not known.......Primary non-adherence refers to the patient not redeeming a prescribed medication at some point during drug therapy. Research has mainly focused on secondary non-adherence. Prior to this study, the overall rate of primary non-adherence in general practice in Iceland was not known....

  11. Electronic prescribing - how does it affect the ward pharmacist?

    Franklin, B D; O'Grady, K.; Donyai, P.; Jacklin, A.; Barber, N

    2005-01-01

    It is likely that electronic prescribing will be a common feature in tomorrow’s hospitals. However, we do not yet know how its introduction will affect the practice of hospital pharmacists. We are evaluating a closed-loop electronic prescribing, automated dispensing, bar-coded administration system (ServeRx) on one surgical ward. As part of this evaluation, we wanted to explore its impact on the ward pharmacist. Our objectives were to assess the impact of ServeRx on the time spent providing a...

  12. Actual global problems of radiation protection

    Personal views on some actual problems in radiation protection are given in this paper. Among these problems are: evolution methodology used in radiation protection regulations; radiation protection, nuclear energy and safety, and new approaches to the process of the hazardous substances management. An interesting fact relating to the X-ray, radiation protection and Nikola Tesla are given also. (author)

  13. Teacher Self-Actualization and Student Progress

    Coble, Charles R.; Hounshell, Paul B.

    1972-01-01

    There were no differences in biology achievement or critical thinking scores of students of teachers with different degrees of self actualization. However, when grouped according to their success in increasing students' critical thinking ability, effective teachers could be distinguished from ineffective by their scores on the existentiality''…

  14. Culture Studies and Self-Actualization Theory.

    Farmer, Rod

    1983-01-01

    True citizenship education is impossible unless students develop the habit of intelligently evaluating cultures. Abraham Maslow's theory of self-actualization, a theory of innate human needs and of human motivation, is a nonethnocentric tool which can be used by teachers and students to help them understand other cultures. (SR)

  15. Humanistic Education and Self-Actualization Theory.

    Farmer, Rod

    1984-01-01

    Stresses the need for theoretical justification for the development of humanistic education programs in today's schools. Explores Abraham Maslow's hierarchy of needs and theory of self-actualization. Argues that Maslow's theory may be the best available for educators concerned with educating the whole child. (JHZ)

  16. Developing Human Resources through Actualizing Human Potential

    Clarken, Rodney H.

    2012-01-01

    The key to human resource development is in actualizing individual and collective thinking, feeling and choosing potentials related to our minds, hearts and wills respectively. These capacities and faculties must be balanced and regulated according to the standards of truth, love and justice for individual, community and institutional development,…

  17. Whiteheadian Actual Entitities and String Theory

    Bracken, Joseph A.

    2012-06-01

    In the philosophy of Alfred North Whitehead, the ultimate units of reality are actual entities, momentary self-constituting subjects of experience which are too small to be sensibly perceived. Their combination into "societies" with a "common element of form" produces the organisms and inanimate things of ordinary sense experience. According to the proponents of string theory, tiny vibrating strings are the ultimate constituents of physical reality which in harmonious combination yield perceptible entities at the macroscopic level of physical reality. Given that the number of Whiteheadian actual entities and of individual strings within string theory are beyond reckoning at any given moment, could they be two ways to describe the same non-verifiable foundational reality? For example, if one could establish that the "superject" or objective pattern of self- constitution of an actual entity vibrates at a specific frequency, its affinity with the individual strings of string theory would be striking. Likewise, if one were to claim that the size and complexity of Whiteheadian 'societies" require different space-time parameters for the dynamic interrelationship of constituent actual entities, would that at least partially account for the assumption of 10 or even 26 instead of just 3 dimensions within string theory? The overall conclusion of this article is that, if a suitably revised understanding of Whiteheadian metaphysics were seen as compatible with the philosophical implications of string theory, their combination into a single world view would strengthen the plausibility of both schemes taken separately. Key words: actual entities, subject/superjects, vibrating strings, structured fields of activity, multi-dimensional physical reality.

  18. Actual imaging time in fetal MRI

    Objective: Safety issues in magnetic resonance imaging (MRI) are important, especially in fetal MRI. However, since basic data with respect of the effective exposure time in fetal MRI are not available, this study aimed to determine the actual imaging time during a fetal MRI study. Methods: 100 fetal MRI studies of singleton pregnancies performed on a 1.5 T system were analysed with respect to study duration (from starting the survey scan until the end of study), the number of sequences acquired, and the actual imaging time, which was calculated by adding up scan time of each sequence. Furthermore, each sequence type was analysed regarding the number of acquisitions, specific absorption rates (SAR), and duration. Results: Mean study duration was 34.6 min (range: 14–58 min; standard deviation (SD): 9.7 min), the average number of sequences acquired was 26.6 (range: 11–44, SD: 6.6). Actual scan time averaged 11.4 min (range: 4–19 min, SD: 4.0 min). Ultrafast T2-weighted and steady-state free-precession sequences accounted for 62.3% of actual scan time, and were distributed over the whole duration of the study. Conclusion: Actual imaging time only accounts for 33% of total study time and is not continuous. The remaining time is consumed by the preparation phases of the scanner, and is spent with planning sequences and the eventual repositioning of the coil and/or pregnant woman. These data may help to more accurately estimate the exposure to radiofrequency deposition and noise during fetal MRI studies.

  19. Prescribed burning plan : Stillwater NWR : de Braga Burn Unit 67

    US Fish and Wildlife Service, Department of the Interior — This 1991 Annual Prescribed Burning Plan for Stillwater NWR calls for all 67 acres of the de Braga burn unit to be burned. The objective of this burn is to remove...

  20. A Nurse Prescribing Programme Incorporating e-Learning

    Burgess, Joan

    2007-01-01

    In order to become a UK Nurse Prescriber, a First Level Registered Nurse must undergo an approved University based educational programme, which consists of theory, and a period of practice supervised by doctors. The Nursing and Midwifery Council (NMC) requires nurses undertaking this programme to have some formal university attendance and to be…

  1. GPs motivations of prescribing antidepressants and their practical relevance.

    Volkers, A.; Jong, A. de; Braspenning, J.C.C.; Bakker, D. de; Dijk, L. van

    2004-01-01

    Background: Insight in the motivations of prescribing antidepressants may contribute to advance the efficiency of the current, large antidepressant prescription rate. Less is known about why general practitioners (GPs) treat patients with antidepressants or not and choose modern SSRIs instead of the

  2. Practices in prescribing protein substitutes for PKU in Europe

    Aguiar, A; Ahring, K; Almeida, M F;

    2015-01-01

    BACKGROUND: There appears little consensus concerning protein requirements in phenylketonuria (PKU). METHODS: A questionnaire completed by 63 European and Turkish IMD centres from 18 countries collected data on prescribed total protein intake (natural/intact protein and phenylalanine-free protein...

  3. Initiatives to improve appropriate antibiotic prescribing in primary care.

    Harris, Diane J

    2013-11-01

    Influencing clinicians' prescribing behaviour is important because inappropriate use and overuse of antibiotics are major drivers of antibiotic resistance. A systematic review of interventions for promoting prudent prescribing of antibiotics by general practitioners suggests that multifaceted interventions will maximize acceptability. This article reports how this type of approach has been used successfully in Derbyshire, UK over the last 4 years. The range of interventions that have been used includes educational meetings (both open group events and others targeted at higher prescribers in the surgery) using a supportive and guiding ethos; the provision of support materials aimed at empowering avoidance or delayed antibiotic prescribing, where appropriate, and improving patients' knowledge and confidence in self-management; and the production of different treatment guidelines incorporating key messages with evidence, indicating where antibiotics are unlikely to be of benefit. Education on antibiotics in schools was a novel approach, which was developed in North Derbyshire to increase public awareness of the appropriate treatment for common illnesses without using antibiotics. PMID:24030546

  4. 20 CFR 220.115 - Need to follow prescribed treatment.

    2010-04-01

    ... of the claimant's religion. (2) The prescribed treatment would be cataract surgery for one eye, when there is an impairment of the other eye resulting in a severe loss of vision and is not subject to....g., open heart surgery), unusual nature (e.g., organ transplant), or other reason is very risky...

  5. 20 CFR 416.930 - Need to follow prescribed treatment.

    2010-04-01

    ... religion. (2) The prescribed treatment would be cataract surgery for one eye when there is an impairment of the other eye resulting in a severe loss of vision and is not subject to improvement through treatment...), unusual nature (e.g., organ transplant), or other reason is very risky for you; or (5) The...

  6. New drugs in general practice: prescribing patterns and external influences

    Florentinus, S.R.

    2006-01-01

    In this thesis several studies are presented with the objective to detect and elucidate the patterns by which new drugs are prescribed by general practitioners (GPs). Furthermore, we studied the influences of medical specialists and community pharmacists as important factors on the GP's decision to

  7. Urinary Tract Infection: Analysis of Prescribing Pattern of Antibiotics

    MAHADEVAMMA L

    2012-03-01

    Full Text Available Antibiotics are one of most common drugs prescribed in hospital today. It has been estimated that up to onethird of all patients receive at least one antibiotics during hospitalization`. The cost involved is therefore correspondingly high and up to 40% of a hospital’s drug expenditure may be devoted to the purchase of antibiotics1. The objective of this study was to analyze the prescribing pattern of antibiotics in Urinary Tract Infection (UTI. A prospective cross sectional and observational study was conducted on patients diagnosed with UTI. The study was carried out in the OBG and Urology departments of both in-patients and out-patients, for a period of 5 months (Aug 2011 to Dec 2011. Patients diagnosed with UTI and who were above age group of 15-years were included in the study. A suitable data collection form was prepared to collect the required data. Among 162 patents, 54 were in-patients and 108 were out-patients. Most of the in-patients were prescribed with Ciprofloxacin 13(22.8%, and Ceftriaxone 19(33.3%. In out-patients, Ciprofloxacin 25(23.8%, Norfloxacin 15(14.3% and Ceftriaxone 14(13.3% were prescribed frequently. The study found that gram negative organisms like E. coli and Klebsills was the most predominant organisms associated with infection. It was also found that Cephalosporin's were most commonly used and Quinolones were the second most commonly used drugs for the treatment of UTI.

  8. Prescribed fire as an alternative measure in European grassland conservation

    Valkó, Orsolya; Deák, Balázs; Török, Péter; Tóthmérész, Béla

    2015-04-01

    There are contrasting opinions on the perspectives of prescribed burning management in European grasslands. One hand, prescribed burning can be effectively used with relatively low implementation costs for the management of open landscapes, the reduction of accumulated litter or for decreasing the chance of wildfires. On the other hand burning can also have serious detrimental impacts on grassland ecosystems by promoting the dominance of some problem species (e.g. some competitors or invasive species) and by threatening endangered plant and animal species, especially invertebrates, thus, inappropriate burning can result in a loss of biodiversity in the long run. Our goal was to review the publications on the application of prescribed burning in European grasslands considering general (e.g. timing, frequency and duration) and specific (e.g. types of grasslands, effects on endangered species) circumstances. Even prescribed burning forms an integral part of the North-American grassland management practice, it is rarely applied in Europe, despite the fact that uncontrolled burning occurs frequently in some regions. According to the North-American experiences prescribed burning can be a viable solution for biodiversity conservation and can be a feasible solution for several nature conservation problems. We reviewed prescribed burning studies from Europe and North-America to identify findings which might be adapted to the European grassland conservation strategy. We found that not only the application of fire management is scarce in Europe but there is also a lack of published studies on this topic. European studies - contrary to the North-American practice - usually used yearly dormant-season burning, and concluded that this burning type solely is not feasible to preserve and maintain species-rich grasslands. In North-American grasslands, application of burning has a stronger historical, practical and scientific background; it is fine-tuned in terms of timing, frequency

  9. Oral morphine prescribing practices in severe cancer pain

    B Barathi

    2009-01-01

    Full Text Available Background: Nearly one million cancer patients in India need oral morphine for pain relief. Despite doctors prescribing oral morphine in our center, many cancer patients with severe pain found to be not facilitated with adequate pain relief. Aim: This audit was conducted to look at the "oral morphine prescribing practices for severe cancer pain" at a tertiary care hospital. Materials and Methods: Twenty case files of patients, who were admitted with severe cancer pain, and receiving oral morphine were analyzed in pre- and posteducational session. Local standards were set to assess the adequacy of pain relief. Deficiency in achieving analgesia was found in preinterventional audit. A clinical audit was conducted before and after the educational session on oral morphine prescribing. The education for doctors and nurses focused on starting patients on morphine, titration, and administering rescue dose. Then local guidelines on oral morphine prescribing were circulated. And analysis of following factors were done following pre- and posteducational session: Pain intensity at the beginning of treatment, starting dose of morphine, increments in morphine dose, number of rescue doses given, and fall in pain intensity at the end of 1 week. The outcomes were compared with the standards. Results: Preintervention audit showed that only 50% of patients achieved adequate pain relief. Rescue dose was administered in only 20% of patients. While reaudit following the educational session showed that 80% of patients achieved adequate pain relief and 100% received rescue doses. Conclusion: Educational sessions have significant impact on improving oral morphine prescribing practice among doctors and nurses. It was found failing to administer regular as well as rescue doses resulted in inadequate pain relief in patients receiving oral morphine.

  10. Impact of prescribed burning on blanket peat hydrology

    Holden, Joseph; Palmer, Sheila M.; Johnston, Kerrylyn; Wearing, Catherine; Irvine, Brian; Brown, Lee E.

    2015-08-01

    Fire is known to impact soil properties and hydrological flow paths. However, the impact of prescribed vegetation burning on blanket peatland hydrology is poorly understood. We studied 10 blanket peat headwater catchments. Five were subject to prescribed burning, while five were unburnt controls. Within the burnt catchments, we studied plots where the last burn occurred ˜2 (B2), 4 (B4), 7 (B7), or greater than 10 years (B10+) prior to the start of measurements. These were compared with plots at similar topographic wetness index locations in the control catchments. Plots subject to prescribed vegetation burning had significantly deeper water tables (difference in means = 5.3 cm) and greater water table variability than unburnt plots. Water table depths were significantly different between burn age classes (B2 > B4 > B7 > B10+) while B10+ water tables were not significantly different to the unburnt controls. Overland flow was less common on burnt peat than on unburnt peat, recorded in 9% and 17% of all runoff trap visits, respectively. Storm lag times and hydrograph recession limb periods were significantly greater (by ˜1 and 13 h on average, respectively) in the burnt catchments overall, but for the largest 20% of storms sampled, there was no significant difference in storm lag times between burnt and unburnt catchments. For the largest 20% of storms, the hydrograph intensity of burnt catchments was significantly greater than those of unburnt catchments (means of 4.2 × 10-5 and 3.4 × 10-5 s-1, respectively), thereby indicating a nonlinear streamflow response to prescribed burning. Together, these results from plots to whole river catchments indicate that prescribed vegetation burning has important effects on blanket peatland hydrology at a range of spatial scales.

  11. Inappropriate prescribing and adverse drug events in older people.

    Hamilton, Hilary J

    2009-01-01

    Inappropriate prescribing (IP) in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs), morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  12. Inappropriate prescribing and adverse drug events in older people

    Gallagher Paul F

    2009-01-01

    Full Text Available Abstract Inappropriate prescribing (IP in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs, morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  13. What galvanic vestibular stimulation actually activates

    IanSCurthoys

    2012-01-01

    In a recent paper in Frontiers Cohen et al. (2012) asked “What does galvanic vestibular stimulation actually activate?” and concluded that galvanic vestibular stimulation (GVS) causes predominantly otolithic behavioural responses. In this Perspective paper we show that such a conclusion does not follow from the evidence. The evidence from neurophysiology is very clear: galvanic stimulation activates primary otolithic neurons as well as primary semicircular canal neurons (Kim and Curthoys,...

  14. ACTUALIZATION OF SELF EDUCATION OF SENIOR PUPILS

    Bykov Viktor Stepanovich; Rychkova Lydya Sergeevna

    2012-01-01

    The issue of necessity of self-education of pupils is timely in modern conditions. One can’t find a sphere of human activity without a connection with moral and material values of whole society and separate individual. In connection with this the purpose of the study is examination of necessity of construction of pedagogical system actualizing self-education of a pupil. This system is specified by tendencies of humanization, differentiation, ecological compatibility of social processes, raise...

  15. The remote experiment position in actual taxonomy

    Samoila, Cornel; Ursutiu, Doru; Cotfas, Petru; Zamfira, Sorin

    2007-01-01

    Taxonomy is a classification effort for establishment of learning/teaching operational objectives. There are some famous taxonomies, Bloom's being the most quoted. In spite of the fact that some researchers have tried to explain the position of elearning in already known taxonomies, this subject was not too much in the general attention. In the paper the authors intend to go deeply and to analyze the position of the new methodology-remote experiment-in the actual taxonomies. In addition they ...

  16. Can professionals actually enable occupational justice?

    Elizabeth Townsend; Rebecca Marval

    2013-01-01

    : Where everyday injustice – occupational injustice – persists, health and social professionals have an ethical, moral and professional obligation to reduce injustice with and for destitute as well as privileged members of society. But can professionals actually enable occupational justice? This reflective paper takes readers on a journey toward optimistically responding maybe. The analytic approach is summarized in preparation for tracing when and how the awakening to occupational injustice ...

  17. Actual trends in International marketing (selected problems)

    Hana Machková

    2005-01-01

    Changes in international business environment in the beginning of 90ties had infl uenced marketing strategies of many companies. The main objective of the article is to analyze actual trends and their infl uence on international business activities. The analysis of the main types of international business strategies is made in the introductory part. The process of the segmentation, targeting and positioning is following. International brand management, the third part of the article, focus on ...

  18. Stress-Mediated Increases in Systemic and Local Epinephrine Impair Skin Wound Healing: Potential New Indication for Beta Blockers

    Sivamani, Raja K; Pullar, Christine E.; Manabat-Hidalgo, Catherine G; Rocke, David M.; Richard C Carlsen; Greenhalgh, David G.; R Rivkah Isseroff

    2009-01-01

    Editors' Summary Background. Skin—the largest organ in the human body—protects the rest of the body against infection by forming an impervious layer over the whole external body surface. Consequently, if this layer is damaged by rubbing, cutting, or burning, it must be quickly and efficiently repaired. Wound repair (healing) involves several different processes. First, the clotting cascade stops bleeding at the wound site and immune system cells attracted into the site remove any bacteria or ...

  19. 201 thallium scintiscanning during exercise in patients with coronary diseases following administration of the cardioselective beta-blocker atenolol

    Changes of regional myocardial perfusion before and after administration of Atenolol (AT) (5 mg i.v.) were investigated by 201-Tl stress-imaging in 14 patients (PAT) with >= 70% coronary obstructions. Scintigrams were performed in 4 projections; scintigraphic defects (SD) in one of the six LV segments had to be identified in at least 2 projections and to show a decrease of activity >= 25%. All PAT had at least one reversible SD. Results: After AT, stress-induced SDs were unchanged in 11 of the 14 PAT at identical work loads (131 Watt). The total number of reversible defects was 33 before and 28 after AT (n.s.). However, not only the 3 PAT with improved stress scintigrams, but also 6 of the 11 PAT with unchanged abnormal stress scintigrams were clinically improved (ECG normalized, no angina). Thus in almost half of the patients (6/14), the stress ECG was normalized without normalisation of perfusion pattern of thallium scintigrams. We conclude that in these patients subendocardial perfusion was enough improved to meet the reduced metabolic needs but not enough to normalise stress images. (orig./MG)

  20. TIMING OF PRE-OPERATIVE BETA-BLOCKER TREATMENT IN VASCULAR SURGERY PATIENTS: INFLUENCE ON POST-OPERATIVE OUTCOME

    W.-J. Flu

    2016-01-01

    Full Text Available Введение. В соответствии с мнением экспертов, рекомендуется начинать терапию β-блокаторами в сроки от нескольких дней до нескольких недель до операции. Цель. Оценить влияние срока начала терапии β-блокаторами перед операцией на частоту сердечных сокращений (ЧСС и уровень высокочувствительного С-реактивного белка (вч-СРБ 1 в предоперационном периоде и 2 на послеоперационный исход. Материал и методы. У 940 больных, которым проведены операции на сосудах, учитывалось время начала терапии β-блокаторами (0-1 нед, от >1 до 4 нед и >4 нед перед операцией и определялись ЧСС и уровень вч-СРБ перед операцией. До и после операции проводилось рутинное измерение уровня Т-тропонина и регистрировались электрокардиограммы. Конечными точками исследования были сердечные события в течение 30 дней (объединенная частота инфаркта миокарда и летальности от сердечных причин и отдаленная летальность. Взаимосвязь между сроком начала лечения β-блокаторами и исходом оценивалась с помощью многофакторного регрессионного анализа с учетом факторов сердечного риска. Результаты. Лечение β-блокатором за 0-1 нед до операции начинали у 158 (17% больных, от 1 до 4 нед — у 393 (42% больных и от 4 нед — у 389 (41% больных. Медиана ЧСС в день операции у больных этих подгрупп составляла, соответственно, 74 (±17, 70 (±16 и 66 (±15 уд/мин (р<0,001 при сравнении групп больных с продолжительностью лечения более и менее 1 нед до операции. Уровень вч-СРБ, соответственно, был 4,9 (±7,5, 4,1 (±6,0 и 4,5 (±6,3 мг/л (р=0,782. Лечение, начатое за >1 до 4 нед и >4 нед до операции ассоциировалось с меньшей частотой сердечных событий в течение 30 дней после операции [отношение шансов (ОШ 0,46; 95% доверительный интервал [ДИ]: 0,27-0,76; ОШ 0,48; 95% ДИ 0,29-0,79] и более низкой летальностью при отдаленном наблюдении [относительный риск (ОР 0,52, 95% ДИ 0,21-0,67 и ОР 0,50, 95% ДИ 0,25-0,71], чем лечение, начатое в срок <1 нед перед операцией. Заключение. Результаты исследования указывают, что лечение β-блокаторами, начатое в срок >1 нед перед операцией, связано с более низкой предоперационной ЧСС и улучшением исходов по сравнению с лечением, начатым в срок <1 нед перед операцией. Однако снижение медианы концентрации вч-СРБ у больных, получавших лечение β-блокатором >1 нед, в сравнении с больными, у которых лечение было начато в срок от 0 до 1 нед до операции, не наблюдалось.

  1. Beta-blockers and health-related quality of life in patients with peripheral arterial disease and COPD

    Yvette RBM van Gestel; Sanne E Hoeks; Don D Sin; Henk Stam; Frans W Mertens; Bax, Jeroen J.; van Domburg, Ron T.; Don Poldermans

    2009-01-01

    Yvette RBM van Gestel1, Sanne E Hoeks1, Don D Sin2, Henk Stam3, Frans W Mertens3, Jeroen J Bax4, Ron T van Domburg5, Don Poldermans61Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands; 2Department of Medicine, University of British Columbia and The James Hogg iCAPTURe Center, St. Paul’s Hospital, Vancouver, Canada; 3Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands; 4Department of Cardiology, Leiden University Medica...

  2. EFFECTS OF BETA-BLOCKER METOPROLOL ON QUALITY OF LIFE IN ELDERLY PATIENTS WITH CHRONIC HEART FAILURE

    I. V. Vologdina

    2007-01-01

    Full Text Available Aim. To study effect of cardioselective β-adrenoblocker metoprolol tartrate (in retarded formulation on quality of life in elderly patients with chronic heart failure (CHF of ischemic etiology.Material and methods. 78 patients with CHF class III (NYHA were involved in the study. Patients were 81,6±0,25 y.o. in average. All patients had clinical signs of mild-to-moderate depressive disorders. Patients were split on 2 groups comparable in sex and age. Patients of the 1st group (n=43 received metoprolol tartrate (Egilok Retard, 50-100 mg/d additionally to standard therapy. Patients of the 2nd group (n=35 received only standard therapy. The somatic status was assessed before and after 1 and 3 months of therapy by clinical condition evaluated scale (CCES, 6-minute walking test, left ventricular ejection fraction (Echocardiography as well as mental status by special tests (SMSP, BDI, Hamilton scale, C.D.Spilberger-Y.L.Hanin scale and qualities of life (MLHFQ, SF-36.Results. Reduction of CHF class from III to II was observed in 31 (76,7% patients of the 1st group and in 23 (65,7% patients of the 2nd group. Tolerability of Egilok Retard was good and there were not cessations because of side effects. In 3 months of therapy severity of the somatic status according to CCES reduced more significantly in the 1st group in comparison with the 2nd group (29,5 % vs 11,5 %, p <0,001. The exercise tolerance increased higher in the 1st group comparing with the 2nd one (34 % vs 17 %, respectively, p<0,001. The severity of depression reduced (according to SMSP, Hamilton scale more significantly in the 1st group in comparison with this in the 2nd one. Quality of life also improved more significantly in the 1st group according to MLHFQ and SF-36 (physical functions, role physical functions, social function scales at the end of therapy.Conclusion. Metoprolol tartrate (in retarded formulation improves somatic and mental status as well as quality of life in elderly patients with CHF.

  3. A new frontier for an old drug? A word of caution for beta-blockers in sepsis!

    Maybauer, Marc O; Maybauer, Dirk M

    2015-01-01

    Recent promising findings indicate a possible benefit of β-blockade in septic patients. Ongoing trials on esmolol in septic shock are investigating its hemodynamic effects, focusing on heart rate control and echocardiographic changes, as well as potential anti-inflammatory effects. However, given the complex physiology of sepsis and pharmacological effects on β-blockade, large multi-center trials are essential before such a therapy may be applied safely. PMID:26296157

  4. Adrenalectomy abolishes antagonism of alpha-adrenoceptor-mediated hypotension by a beta-blocker in conscious rats.

    Tabrizchi, R.; Pang, C. C.

    1990-01-01

    1. The effects of a single bolus injection of propranolol, atenolol or ICI 118,551, non-selective beta-, selective beta 1- and selective beta 2-adrenoceptor antagonists, respectively, on mean arterial pressure (MAP) and plasma catecholamine concentrations were examined in seven groups of conscious and unrestrained adrenalectomized rats receiving a continuous infusion of the alpha-adrenoceptor antagonist phentolamine. In all rats adrenaline was undetectable in the plasma four days after adrena...

  5. Stress-mediated increases in systemic and local epinephrine impair skin wound healing: potential new indication for beta blockers.

    Raja K Sivamani

    2009-01-01

    Full Text Available BACKGROUND: Stress, both acute and chronic, can impair cutaneous wound repair, which has previously been mechanistically ascribed to stress-induced elevations of cortisol. Here we aimed to examine an alternate explanation that the stress-induced hormone epinephrine directly impairs keratinocyte motility and wound re-epithelialization. Burn wounds are examined as a prototype of a high-stress, high-epinephrine, wound environment. Because keratinocytes express the beta2-adrenergic receptor (beta2AR, another study objective was to determine whether beta2AR antagonists could block epinephrine effects on healing and improve wound repair. METHODS AND FINDINGS: Migratory rates of normal human keratinocytes exposed to physiologically relevant levels of epinephrine were measured. To determine the role of the receptor, keratinocytes derived from animals in which the beta2AR had been genetically deleted were similarly examined. The rate of healing of burn wounds generated in excised human skin in high and low epinephrine environments was measured. We utilized an in vivo burn wound model in animals with implanted pumps to deliver beta2AR active drugs to study how these alter healing in vivo. Immunocytochemistry and immunoblotting were used to examine the up-regulation of catecholamine synthetic enzymes in burned tissue, and immunoassay for epinephrine determined the levels of this catecholamine in affected tissue and in the circulation. When epinephrine levels in the culture medium are elevated to the range found in burn-stressed animals, the migratory rate of both cultured human and murine keratinocytes is impaired (reduced by 76%, 95% confidence interval [CI] 56%-95% in humans, p < 0.001, and by 36%, 95% CI 24%-49% in mice, p = 0.001, and wound re-epithelialization in explanted burned human skin is delayed (by 23%, 95% CI 10%-36%, p = 0.001, as compared to cells or tissues incubated in medium without added epinephrine. This impairment is reversed by beta2AR antagonists, is absent in murine keratinocytes that are genetically depleted of the beta2AR, and is reproduced by incubation of keratinocytes with other beta2AR-specific agonists. Activation of the beta2AR in cultured keratinocytes signals the down-regulation of the AKT pathway, accompanied by a stabilization of the actin cytoskeleton and an increase in focal adhesion formation, resulting in a nonmigratory phenotype. Burn wound injury in excised human skin also rapidly up-regulates the intra-epithelial expression of the epinephrine synthesizing enzyme phenylethanolamine-N-methyltransferase, and tissue levels of epinephrine rise dramatically (15-fold in the burn wounded tissue (values of epinephrine expressed as pg/ug protein +/- standard error of the mean: unburned control, 0.6 +/- 0.36; immediately postburn, 9.6 +/- 1.58; 2 h postburn, 3.1 +/- 1.08; 24 h post-burn, 6.7 +/- 0.94. Finally, using an animal burn wound model (20% body surface in mice, we found that systemic treatment with betaAR antagonists results in a significant increase (44%, 95% CI 27%-61%, p < 0.00000001 in the rate of burn wound re-epithelialization. CONCLUSIONS: This work demonstrates an alternate pathway by which stress can impair healing: by stress-induced elevation of epinephrine levels resulting in activation of the keratinocyte beta2AR and the impairment of cell motility and wound re-epithelialization. Furthermore, since the burn wound locally generates epinephrine in response to wounding, epinephrine levels are locally, as well as systemically, elevated, and wound healing is impacted by these dual mechanisms. Treatment with beta adrenergic antagonists significantly improves the rate of burn wound re-epithelialization. This work suggests that specific beta2AR antagonists may be apt, near-term translational therapeutic targets for enhancing burn wound healing, and may provide a novel, low-cost, safe approach to improving skin wound repair in the stressed individual.

  6. Factors affecting the development of adverse drug reactions to &beta;-blockers in hospitalized cardiac patient population

    Todorović,Zoran; Mugosa,Snezana; Djordjevic, Natasa; Djukanovic, Nina; Protic,Dragana; Bukumiric, Zoran; Radosavljevic,Ivan; Boskovic,Aneta

    2016-01-01

    Snežana Mugoša,1,2 Nataša Djordjević,3 Nina Djukanović,4 Dragana Protić,5 Zoran Bukumirić,6 Ivan Radosavljević,7 Aneta Bošković,8 Zoran Todorović5,9 1Department of Pharmacotherapy, Faculty of Pharmacy, University of Montenegro, 2Clinical Trial Department, Agency for Medicines and Medical Devices of Montenegro, Podgorica, Montenegro; 3Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, 4High Med...

  7. ETHICAL PRACTICES IN DRUG PRESCRIBING. A COMPARATIVE STUDY BETWEEN DOCTORS’ AND PHARMACISTS’ OPINION ABOUT DRUG PRESCRIBING IN ROMANIA

    LASZLO-ZOLTAN SZTANKOVSZKY

    2015-11-01

    Full Text Available The prescription of drugs is influenced by a number of factors with a great impact upon the health of the main beneficiaries of health services. The purpose of the study is to identify the perception of doctors and pharmacists on drug prescription practices adopted by doctors. Material and Methods: a number of 349 subjects (149 pharmacists and 200 doctors answered a survey about the perception of drug dispensing in Romania. Variables like age, work environment (urban, rural, length of employment were taken into account. Results: When prescribing a treatment, 93% of doctors follow the standard treatment protocol for the given diagnosis and 93,5% of them are declaring that personal resources are the main source for training while the percent appreciated by pharmacists is evaluated to 65,78%. A total of 50% of doctors are considering other criteria than the treatment when prescribing a drug (financial contribution for the patient or National Health Insurance House. A total of 59% of doctors are recommending overthe-counter products while pharmacists consider that is happening in more than 70% of the cases. Conclusions: There are differences of opinion between doctors and pharmacists regarding doctor’s practices of prescribing drugs to their patients, like: kinds of sponsorship for the continuing education, the relationship with the pharmaceutical representative or the frequency of prescribing over-the-counter products or supplements when they are recommending a certain treatment.

  8. Alternatives to potentially inappropriate medications for use in e-prescribing software: triggers and treatment algorithms

    Hume, Anne L.; Quilliam, Brian J; Goldman, Roberta; Eaton, Charles; Lapane, Kate L

    2011-01-01

    Objective To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults. Design Literature review, expert panel and focus group. Setting Primary care with access to e-prescribing systems. Participants Primary care physicians using e-prescribing systems receiving medication history. Interventions Standardised treatment algorithms for clinicians attempting to prescribe PIMs...

  9. Announcing the CDC guideline for prescribing opioids for chronic pain.

    Houry, Debra; Baldwin, Grant

    2016-06-01

    This guideline provides recommendations for primary care providers who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses: (a) when to initiate or continue opioids for chronic pain; (b) opioid selection, dosage, duration, follow-up, and discontinuation; and (c) assessing risk and addressing harms of opioid use. This guideline is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including abuse, dependence, overdose, and death (Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016;65:1-49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1.). PMID:27178083

  10. A model for solving the prescribed burn planning problem

    Rachmawati, Ramya; Ozlen, Melih; Karin J. Reinke; Hearne, John W.

    2015-01-01

    The increasing frequency of destructive wildfires, with a consequent loss of life and property, has led to fire and land management agencies initiating extensive fuel management programs. This involves long-term planning of fuel reduction activities such as prescribed burning or mechanical clearing. In this paper, we propose a mixed integer programming (MIP) model that determines when and where fuel reduction activities should take place. The model takes into account multiple vegetation types...

  11. Information and interaction : influencing drug prescribing in Swedish primary care

    Stålsby Lundborg, Cecilia

    1999-01-01

    Aim The studies concern drug information and continuing education on drug treatment, focusing on doctors' prescribing in primary care in Sweden. The long-term aim has been to develop educational models accepted by the doctors, and to develop and apply means of evaluating the education. Methods Data have been collected from the study populations mainly through questionnaires and dispensed prescriptions, i.e., quantitative data. In addition, qualitative interview data w...

  12. Special Needs to Prescribe Exercise Intensity for Scientific Studies

    Peter Hofmann; Gerhard Tschakert

    2011-01-01

    There is clear evidence regarding the health benefits of physical activity. These benefits follow a dose-response relationship with a particular respect to exercise intensity. Guidelines for exercise testing and prescription have been established to provide optimal standards for exercise training. A wide range of intensities is used to prescribe exercise, but this approach is limited. Usually percentages of maximal oxygen uptake (VO2) or heart rate (HR) are applied to set exercise training in...

  13. Antibiotic-prescribing patterns for Iraqi patients during Ramadan

    Mikhael EM

    2014-11-01

    Full Text Available Ehab Mudher Mikhael, Ali Lateef Jasim Clinical Pharmacy Department, College of Pharmacy, Baghdad University, Baghdad, Iraq Background: During Ramadan, Muslims fast throughout daylight hours. There is a direct link between fasting and increasing incidence of infections. Antibiotic usage for treatment of infections should be based on accurate diagnosis, with the correct dose and dosing regimen for the shortest period to avoid bacterial resistance. This study aimed to evaluate the practices of physicians in prescribing suitable antibiotics for fasting patients and the compliance of the patients in using such antibiotics at regular intervals.Materials and methods: An observational study was carried out during the middle 10 days of Ramadan 2014 in two pharmacies at Baghdad. A total of 34 prescriptions (Rx for adults who suffered from infections were examined. For each included Rx, the researchers documented the age and sex of the patient, the diagnosis of the case, and the name of the given antibiotic(s with dose and frequency of usage. A direct interview with the patient was also done, at which each patient was asked about fasting and if he/she would like to continue fasting during the remaining period of Ramadan. The patient was also asked if the physician asked him/her about fasting before writing the Rx.Results: More than two-thirds of participating patients were fasting during Ramadan. Antibiotics were prescribed at a higher percentage by dentists and surgeons, for which a single antibiotic with a twice-daily regimen was the most commonly prescribed by physicians for patients during the Ramadan month.Conclusion: Physicians fail to take patient fasting status into consideration when prescribing antibiotics for their fasting patients. Antibiotics with a twice-daily regimen are not suitable and best to be avoided for fasting patients in Iraq during Ramadan – especially if it occurs during summer months – to avoid treatment failure and provoking

  14. Pharmacoeconomic Consequences of Variable Patient Compliance With Prescribed Drug Regimens

    John Urquhart

    1999-01-01

    Variable compliance with prescribed drug regimens is a leading source of variability in drug response. Specifics differ by drug and disease. The role of variable compliance was clearly defined in 2 trials of lipid-lowering agents, cholestyramine and gemfibrozil, in which exceptionally careful measurements of compliance were made, which has not been done in later trials. Economic consequences of variable compliance are estimated by converting dose-dependent changes in absolute risk of incident...

  15. A study on prescribing patterns of antihypertensives in geriatric patients

    Arshad H Mohd

    2012-01-01

    Full Text Available Objective: Hypertension is a leading contributor to the global burden of cardiovascular morbidity and mortality. The main objective of the present study was to assess the prescribing patterns for antihypertensives in geriatric patients. Materials and Methods: A Prospective observational study was carried out for the period of six months in an out-patient department. Elderly patients who have been diagnosed with hypertension as per JNC-7 guidelines and patients receiving or prescribed with antihypertensive drugs were included. Results: A total of 100 prescriptions were analyzed during the six-month study period. 72% of the patients were in the age group of 65-67 years and this was found to be higher in men 69%. During the study period 80% of the patients were Pre-Hypertensive systolic (80-89 mmHg and Diastolic (120-139 mmHg followed by Stage-I Hypertension and Stage-II Hypertension. The most common drug classes involved in the study was Calcium Channel Blockers 37% followed by Angiotensin II receptor antagonists 21% and the most commonly prescribed drugs in the study population were Amlodipine 37%, Losartan 11% and Telmisartan 10%. The most common anti-hypertensive fixed dose combination therapy involved in the study was Telmisartan + Hydrochlorothiazide 15% and most common two drug combination therapy involved in the study was Amlodipine + Atenolol 7% followed by Metoprolol + Amlodipine 1%. Conclusion: Our study shows that the most commonly prescribed drug classes involved were Calcium Channel Blockers followed by Angiotensin II receptor antagonists and the anti-hypertensive drug combinations among hypertensive patients were considerable and this practice positively impacted on the overall blood pressure control.

  16. Analysis for commonly prescribed non-sedating antihistamines

    Michael E. El-Kommos

    2015-03-01

    Full Text Available A comprehensive review with 185 references for the analysis of commonly prescribed members of an important class of drugs, non-sedating antihistamines (NSAs, is presented. The review covers most of the methods described for the analysis of cetirizine (CTZ, ebastine (EBS, fexofenadine (FXD, ketotifen (KET and loratadine (LOR in pure forms, in different pharmaceutical dosage forms and in biological fluids. The review covers the period from 1991 till now.

  17. Teaching safe prescribing to medical students: perspectives in the UK

    Nazar H; Nazar M; Rothwell C; Portlock J; Chaytor A; Husb; De, A.

    2015-01-01

    Hamde Nazar,1 Mahdi Nazar,2 Charlotte Rothwell,1 Jane Portlock,3 Andrew Chaytor,1 Andrew Husband1 1School of Medicine, Pharmacy and Health, Durham University, UK; 2Cumberland Infirmary, North Cumbria University Hospitals NHS Trust, UK; 3School of Pharmacy and Biomedical Sciences, University of Portsmouth, UK Abstract: Prescribing is a characteristic role of a medical practitioner. On graduating from medical school, students are presumed to have acquired the necessary pharmacology knowledge un...

  18. [Treatment of senile diseases should prescribe Chinese patent medicine scientifically].

    Zhao, Xin-Xiang

    2014-04-01

    Treatment of senile diseases by Chinese patent medicine should prescribe according to physiological and pathological specialty of the aged. It's necessary for treatment according to syndrome differentiation associating with the disease,reasonable combination of drugs avoiding adverse reactions,gentle medicine character but not fierce,small medicine quantity but not great, the use of Chinese patent medicine mild and tonic used properly but not excessively. PMID:24812911

  19. Comparison of CRBRP standards to DOE prescribed standards

    The tables list standards committed to by CRBRP in its design documents, its Environmental Report, and its Preliminary Safety Analysis Report. The compilation of these standards has been placed in column form beside the column of prescribed standards listed under the various headings of Chapter 1 of DOE's Order 5480.1A, Environmental Protection, Safety, and Health Protection Program for DOE Operations. (The DOE standards listed, however, include all those in the other applicable chapters of 5480.1A as mandated in Chapter 1.) There are some CRBRP systems which are impacted very little, if any, by the safety requirements of 5480.1A's prescribed standards. The standards committed to in those systems are, consequently, not included in this comparison. The comparison is made in detail, however, for standards committed to in those systems of CRBRP having areas of safety corresponding to DOE's jurisdiction/requirements as opposed to areas covered only by the USNRC's jurisdiction/regulations. Included in this document are: (1) a table listing titles of the standards not already listed in the comparison table, and (2) a list of acronyms. It seems apparent by the comparison that CRBRP meets the DOE requirement that the Project standards be equal or better (more conservative) than DOE's own prescribed standards

  20. Antimicrobial stewardship: Improving antibiotic prescribing practice in a respiratory ward

    Yeo, Jing Ming

    2016-01-01

    International efforts have mandated guidelines on antibiotic use and prescribing, therefore the focus is now on encouraging positive behavioral changes in antibiotic prescribing practice. Documentation of indication and intended duration of antibiotic use in drug charts is an evidence-based method of reducing inappropriate antibiotic prescribing. It is also a standard detailed in our local antimicrobial guidelines. We collected baseline data on compliance with documentation of indication and duration in drug charts in a respiratory ward which revealed compliance rates of 24% and 39% respectively. We introduced interventions to improve accessibility to the guideline and to increase awareness by distributing antibiotic guardian pocket cards with a three-point checklist and strategically-placed mini-posters. We also aim to increase team motivation by obtaining their feedback in multidisciplinary team meetings and by introducing certificates for their involvement in the quality improvement process. The results of the second cycle post-intervention showed an increase in compliance rates for documentation of indication and duration of 97% and 69% respectively. After a further awareness and discussion session at the multidisciplinary team meeting with the local antimicrobial management team audit nurses, a third cycle showed compliance rates of 94% and 71% for indication and duration respectively. This project has highlighted the importance of improving accessibility and of encouraging interventions that would bring about a change in personal value and subsequently in behavior and individual practice. PMID:26893898

  1. Prosecution of physicians for prescribing opioids to patients.

    Reidenberg, M M; Willis, O

    2007-06-01

    Many patients in pain receive inadequate doses of opioids. Fear of government action against prescribing doctors is one cause of this inadequate treatment. The purpose of the study was to assess criminal prosecutions by reviewing press reports of indictments or trials of doctors for opioid offenses during 2 years. Forty-seven cases were reported involving 53 doctors. Fifteen cases were for offenses unrelated to medical practice. In 32 cases, the charge was based on determining the prescriptions for opioids were outside the bounds of proper medical practice. Only two of these cases were evaluated by a state medical board before indictment. Five doctors were indicted for murder related to drug overdose deaths. None were found guilty of murder. Prosecutorial excesses and hyperbole were common. The state medical board's review of appropriateness of prescribing opioids when a doctor-patient relationship is presumed to exist could decrease inappropriate criminal indictments and reduce this component of fear of prescribing adequate opioid therapy for patients in pain. PMID:17329989

  2. Prescribing pattern of antidiabetic drugs in Indore city hospital

    Vengurlekar Sudha

    2008-01-01

    Full Text Available Diabetes mellitus is a metabolic disorder characterized by hyperglycemia, glycosuria, and sometimes ketonemia. The present study was carried out to assess prescribing practice and general trend of diabetes among patients at the Bombay Hospital, Indore. Prescriptions and complete records of diabetic patients were monitored and data was filed as per WHO prescription proforma. The study revealed that prescription of metformin (27% and glimepiride (22.60% were found to be maximum among various available antidiabetic drugs. Category wise the maximum prescribed drugs are glimepride (22.60%, sulfonylurea category, metformin (27%, biguanide category and pioglitazones (13.90%, glitazone category. Insulin prescription was found to be very less (4.5%. Combination of metformin and glimepiride (20.86% was prescribed most commonly. Most common disease associated with diabetes mellitus was found to be hypertension (35%. Highest prevalence of disease was found to be in the age group of 51 to 60 followed by age group of 41 to 50. Men patients (66.36% were found to be predominated over women patients (33.64%.

  3. Antimicrobial stewardship: Improving antibiotic prescribing practice in a respiratory ward.

    Yeo, Jing Ming

    2016-01-01

    International efforts have mandated guidelines on antibiotic use and prescribing, therefore the focus is now on encouraging positive behavioral changes in antibiotic prescribing practice. Documentation of indication and intended duration of antibiotic use in drug charts is an evidence-based method of reducing inappropriate antibiotic prescribing. It is also a standard detailed in our local antimicrobial guidelines. We collected baseline data on compliance with documentation of indication and duration in drug charts in a respiratory ward which revealed compliance rates of 24% and 39% respectively. We introduced interventions to improve accessibility to the guideline and to increase awareness by distributing antibiotic guardian pocket cards with a three-point checklist and strategically-placed mini-posters. We also aim to increase team motivation by obtaining their feedback in multidisciplinary team meetings and by introducing certificates for their involvement in the quality improvement process. The results of the second cycle post-intervention showed an increase in compliance rates for documentation of indication and duration of 97% and 69% respectively. After a further awareness and discussion session at the multidisciplinary team meeting with the local antimicrobial management team audit nurses, a third cycle showed compliance rates of 94% and 71% for indication and duration respectively. This project has highlighted the importance of improving accessibility and of encouraging interventions that would bring about a change in personal value and subsequently in behavior and individual practice. PMID:26893898

  4. La filosofía alemana actual

    Sobrevilla, David

    2011-01-01

    En su libro La filosofía actual, publicado en segunda edición en1969, señalaba el profesor español José Ferrater Mora que antes de esa fecha habían existido tres imperios filosóficos: el continental, el angloamericano y el ruso, que eran en cierto modo aglutinados por la fenomenología --existencial o no--, la filosofía analítica -formal o lingüística-- y el marxismo -ortodoxo o heterodoxo--. Pero que en ese momento, la situación había cambiado; pues había una interrelaciónfecunda entre las tr...

  5. What galvanic vestibular stimulation actually activates

    Ian S Curthoys

    2012-07-01

    Full Text Available In a recent paper in Frontiers Cohen et al. (2012 asked What does galvanic vestibular stimulation actually activate? and concluded that galvanic vestibular stimulation (GVS causes predominantly otolithic behavioural responses. In this Perspective paper we show that such a conclusion does not follow from the evidence. The evidence from neurophysiology is very clear: galvanic stimulation activates primary otolithic neurons as well as primary semicircular canal neurons (Kim and Curthoys, 2004. Irregular neurons are activated at lower currents. The answer to what behaviour is activated depends on what is measured and how it is measured, including not just technical details, such as the frame rate of video, but the exact experimental context in which the measurement took place (visual fixation vs total darkness. Both canal and otolith dependent responses are activated by GVS.

  6. ¿Es sustentable la agricultura actual?

    Sarandón, Santiago J.

    2008-01-01

    Mi charla, encarada desde mi formación de Ing Agrónomo, va a ser más técnica, con la idea de contestar la pregunta: ¿Es sustentable la agricultura actual? ¿Es posible pensar que este modelo de agricultura puede perdurar otros 50 o 100 años? En primer lugar, quiero discutir la (in)sustentabilidad del modelo de agricultura moderno. Analizar después, cuáles son sus causas; luego plantear el desafío de la sustentabilidad y discutir un poco por qué razón, un concepto (la sustentabilidad), que ya l...

  7. Compliance to the prescribed dose and overall treatment time in five randomized clinical trials of altered fractionation in radiotherapy for head-and-neck carcinomas

    Purpose: To investigate compliance to the prescribed dose-fractionation schedule in five randomized controlled trials of altered fractionation in radiotherapy for head-and-neck carcinoma. Methods and Materials: Individual patient data from 2566 patients participating in the European Organization for Research and Treatment of Cancer (EORTC) 22791, EORTC 22811, EORTC 22851, Princess Margaret Hospital (PMH), and continuous hyperfractionated accelerated radiotherapy (CHART) head-and-neck trials were merged in the fractionation IMPACT (Intergroup Merger of Patient data from Altered or Conventional Treatment schedules) study database. The ideal treatment time was defined as the minimum time required to deliver a prescribed schedule. Compliance to the prescribed overall treatment time was quantified as the difference between the actual and the ideal overall time. An overall measure of compliance in an individual patient, the total dose lost (TDL), was calculated as the dose lost due to prolongation of therapy (assuming a Dprolif of 0.64 Gy/day) plus the difference between the prescribed and the actual dose given. Results: The time in excess of the ideal ranged up to 97 days (average 3.9 days), and 25% of the patients had delays of 6 days or more. World Health Organization (WHO) performance status and nodal stage had a significant effect on TDL. TDL was significantly higher in the conventional than in the altered arm of the EORTC 22851 and CHART trials. In the PMH trial, TDL was significantly higher in the hyperfractionation than in the conventional arm. Centers participating in the three EORTC trials varied significantly in their compliance. There was a significant improvement in compliance in patients treated more recently. Conclusions: Even in randomized controlled trials, compliance to the prescribed radiation therapy schedule may be relatively poor, especially after conventional fractionation. This affects the interpretation of the outcome of these trials

  8. Carbonaceous aerosols from prescribed burning of a boreal forest ecosystem

    Mazurek, M.A. (Brookhaven National Lab., Upton, NY (United States)); Cofer, W.R. III; Levine, J.S. (National Aeronautics and Space Administration, Hampton, VA (United States). Langley Research Center)

    1990-10-01

    The identity and ambient mass concentrations of radiatively important carbonaceous aerosols were measured for a boreal forest prescribed burn conducted in northern Ontario, CAN in August 1989. Nonsize-segregated airborne particles were collected for smoldering-fire and full-fire conditions using a helicopter sampling platform. Total carbon (TC), organic carbon (OC) and elemental carbon (EC) were measured. Smoke plume mass concentrations of the OC and EC particles were greatest for full-fire conditions and had ranges of 1.560 to 2.160 mg/m{sup {minus}1} (OC) and 0.120 to 0.160 mg/m{sup {minus}3} (EC) with OC:EC ratios of 10 to 18, respectively. Smoldering fire conditions showed smoke plume OC and EC levels of 0.570--1.030 mg/m{sup {minus}3} (OC) and 0.006--0.050 mg/m{sup {minus}3} (EC) and much higher ratios of OC:EC (21 to 95). These aerosol data indicate the formation of EC particles is greatest during full-fire combustion of boreal forest material relative to smoldering combustion. However, EC particles comprise a minor fraction of the particulate carbon smoke aerosols for both full-fire and smoldering conditions; the major component of carbonaceous smoke aerosols emitted during the prescribed burn is OC. Overall, the OC and EC in-plume smoke aerosol data show nonuniform production of these particles during various stages of the prescribed burn, and major differences in the type of carbonaceous aerosol that is generated (OC versus EC).

  9. Carbonaceous aerosols from prescribed burning of a boreal forest ecosystem

    The identity and ambient mass concentrations of radiatively important carbonaceous aerosols were measured for a boreal forest prescribed burn conducted in northern Ontario, CAN in August 1989. Nonsize-segregated airborne particles were collected for smoldering-fire and full-fire conditions using a helicopter sampling platform. Total carbon (TC), organic carbon (OC) and elemental carbon (EC) were measured. Smoke plume mass concentrations of the OC and EC particles were greatest for full-fire conditions and had ranges of 1.560 to 2.160 mg/m-1 (OC) and 0.120 to 0.160 mg/m-3 (EC) with OC:EC ratios of 10 to 18, respectively. Smoldering fire conditions showed smoke plume OC and EC levels of 0.570--1.030 mg/m-3 (OC) and 0.006--0.050 mg/m-3 (EC) and much higher ratios of OC:EC (21 to 95). These aerosol data indicate the formation of EC particles is greatest during full-fire combustion of boreal forest material relative to smoldering combustion. However, EC particles comprise a minor fraction of the particulate carbon smoke aerosols for both full-fire and smoldering conditions; the major component of carbonaceous smoke aerosols emitted during the prescribed burn is OC. Overall, the OC and EC in-plume smoke aerosol data show nonuniform production of these particles during various stages of the prescribed burn, and major differences in the type of carbonaceous aerosol that is generated (OC versus EC)

  10. Primary-care prescribing of anti-osteoporotic-type medications following hospitalisation for fractures.

    McGowan, Bernie M

    2011-03-01

    We examined the prescribing of antiosteoporotic medications pre- and post hospital admission in patients with fragility fractures as well as factors associated with prescribing of these treatments following admission.

  11. Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care

    Bregnhøj, L; Thirstrup, S; Kristensen, M B;

    2009-01-01

    To evaluate the effect of a combined or a single educational intervention on the prescribing behaviour of general practitioners (GPs). The primary endpoint was effect on inappropriate prescribing according to the Medication Appropriateness Index (MAI)....

  12. Legal limitations for nurse prescribers in Primary Health Care

    N. Geyer

    1998-01-01

    The nurse plays an important role in the delivery of primary health care services in South Africa. The primary purpose is to provide the public with access to safe competent basic health care and to achieve this, the nurse should be empowered to practice within legal and ethical boundaries. This paper explores and describes the limitations imposed by legislation on the nurse’s ability to prescribe treatment in the primary health care field. The focus is mainly on the Nursing Act, the Pharmacy...

  13. Controlled Substances Add New Layer to E-Prescribing.

    Kaldy, Joanne

    2016-01-01

    The Electronic Prescriptions for Controlled Substances (EPCS) program was established by the Drug Enforcement Administration to allow health facilities to use electronic transmission and other modern technology for prescribing controlled substances and replacing old technology such as fax. Its goal is to eliminate fraud, abuse, and diversion of controlled medications while streamlining the processes of making them more easily available to patients in need. While rules regarding EPCS have the potential to improve care and give practitioners more data for quality improvement, they also may create new challenges for practitioners, facilities, and vendors alike. All stakeholders need to work together to ensure effective, efficient EPCS systems. PMID:27056356

  14. Study of Prescribing Pattern for Rational Drug Therpay

    Pushpender Sharma, B.Kapoor

    2003-07-01

    Full Text Available The present study of prescribing pattern for evaluation of rational drug therapy was carried out inJammu city for a period of six months. Two hundred prescriptions written by qualified medicalgraduate and postgraduate doctors were collected and studied for their correctness and rationality.The doctor's identity, patient's name, age and address, superscription, route of administration anddmation oftherapy were mentioned in 27%,100%, 27%, 5%,63%,20% and 66% of prescriptionsrespectively. Drug use has been found to be inappropriate in 33 % ofthe drugs and large l1lunber ofprescriptions do not conform to the ideal pattern .

  15. Design objectives with non-zero prescribed support displacements

    Pedersen, Pauli; Pedersen, Niels Leergaard

    2011-01-01

    When non-zero prescribed support displacements are involved in addition to design independent loads for a continuum/structure, then the objectives of minimum compliance (total elastic energy) and of maximum strength lead to different designs. This is verified by the presented sensitivities. Designs...... minimization as well as that of direct strength maximization; we choose the objective of obtaining uniform energy density and show by examples that the obtained solutions are close to fulfilling also strength maximization, with the price of increased compliance. Optimal design examples are presented and...

  16. Radiation safety actuality in Republic of Moldova

    Radioecological monitoring issues and radiation safety are actual in the Republic of Moldova. Japan events show us the possibility of natural disasters. Republic of Moldova is surrounded by 8 NPPs, the closest being at the distance of 160 km. Moldovas territory is in seismic zone where underground earthquake shocks reaches 7 points or more. Thatis why radiation safety and radioecological monitoring is actual in our republic. Traces of Chernobyl were left in Moldovas soils. The fallouts of radio nuclides formed on the soil surfaces in the Republic of Moldova following the Chernobyl Nuclear Power Station Accident have been continuously affected by attacks of both natural and technicaly generated agents since the time of fallout. During the past decade a shift in emphasis has taken place regarding the need for more complete and accurate information on reservoir sedimentation. Classical sedimentation surveys involve repeated field measurement and, therefore, this is probably the most costly and time consuming method. The application of radio nuclides, particularly Cs 137, for water erosion and sedimentation studies in Republic of Moldova has not been attempted so far. This paper presents the results obtained on reservoir sedimentation rates in an area subjected to wide range in land degradation dy sheet-rill erosion. The profil characteristics support the assumption that in most undisturbed sites there is a sharp decline in Cs 137 activity with increasing dept. Such an asymmetrical distribution of the Cs 137 would suggest a standard pattern in the form of a cantilever. If the validity of this assamption is accepted it is possible to define two major types of Cs 137 cantilever distribution: shallow and deep buried cantilever. The main criterion in classifying these pattents lies generally in the shape of Cs 137 depth profile and particularly in burial magnitude of Cs 137 peak derived from Chernobyl. Hills area has been impacted by greatest sendimentation. This regional

  17. La estructura resistente en la arquitectura actual

    Manterola Armisén, J.

    1998-10-01

    Full Text Available A significant portion in nowadays architecture uses the resistant structures as a fundamental element conveying expression to a building. Resistant structures usually designed, calculated and built by engineers are in some occasions -those that draw our attention now- designed by architects who stress the plastic dimension. Sometimes architects have just tried to soften the elementality of the resistance per se. To abandon the quantitative element to get centered in the qualitative and expressive is a leitmotiv in the architectural proceedings that has been brilliantly fruitful in many an occasion -notice Frei Otto's work among others- but that, in other cases, damages the understanding of the resistant aspect by excessively priorizing the structure appearance upon the structure itself. This article makes a critical account of a series of structures in recent buildings, classified by resistance typologies, flat or spatial trusses, frames, domes, hanging and distensible roofs, tensigrity structures, etc., preceded by a retrospect on how resistance has been traditionally understood.

    Una parte de la arquitectura actual se caracteriza por utilizar la estructura resistente como el elemento expresivo fundamental del edificio. Las estructuras resistentes, diseñadas, calculadas y construidas hasta ahora por ingenieros, han pasado, en algunas ocasiones -las que aquí nos interesan-, a ser diseñadas por arquitectos que acentúan su dimensión plástica. En otras ocasiones los arquitectos se han reducido a dulcificar la elementalidad de lo resistente en cuanto tal. El abandono de lo cuantitativo, para centrarse en lo cualitativo y expresivo, es el "leit motiv" de ese proceder arquitectónico que ha dado frutos muy brillantes en bastantes ocasiones, no hay sino que ver el trabajo de Frei Otto y otros, pero que, en otros casos, perjudican el entendimiento de lo resistente al primar, excesivamente, la apariencia de estructura sobre lo que es la

  18. Evaluation of prescribing pattern of the private practitioners by the undergraduate medical students

    Zaida Rahman; Rumana Nazneen; Mahmuda Begum

    2009-01-01

    To sensitize the fourth year undergraduate medical students about rational prescribing, 600 prescriptions of private practitioners were collected by them and analyzed using WHO/INRUD indicators. There were average 3.81 drugs per prescriptions. Drugs were prescribed in generic name only in 5 prescriptions. About 50% drugs were prescribed from the Essential Drug List; only 17.5% of prescriptions were complete in respect to patient medical information. Antibiotics were prescribed in 72.5% of the...

  19. Prescribing pattern of non-steroidal anti-inflammatory drugs at outpatient departments of teaching hospitals

    Md. Shamsur Rahman, Zinnat Ara Begum; and Md. Khoshroz Samad

    2007-01-01

    The prescribing pattern of non-steroidal anti-inflammatory drugs (NSAIDs) in prescriptions prescribed by the qualified medical personnel in the outpatient departments of three selected teaching hospitals in Dhaka city were studied. A total of 600 prescriptions containing NSAIDs were collected. The clinical conditions for which NSAIDs prescribed were identical in all the three hospitals, although there were wide variations in the prescribing pattern with respect to pharmacological sub-classes ...

  20. Pharmacist prescribing in the United Kingdom and the implication for the Nigerian context

    Auta, A; Strickland-Hodge, B; Maz, J; Alldred, DP

    2015-01-01

    Background: Non-medical professionals including pharmacists have been granted the right to prescribe medicines in the United Kingdom. In Nigeria, only medical doctors, dentists and some nurses in primary care facilities have the legal right to prescribe medicines and patients' access to prescriptions can be seriously affected by a shortage of prescribers and long waiting times in hospitals. Objective: This article presents a review of pharmacist prescribing in the UK including its model, impa...

  1. Doctors and Drugs : How Swedish Emergency and Family Physicians Understand Drug Prescribing

    Bastholm Rahmner, Pia

    2009-01-01

    Background: Drug prescribing is increasing, making prescribing one of the most common interventions in healthcare. The beneficial effects of drugs are manifold, but drug use also involves risks of drug-drug interaction (DDI), side effects and other drug-related problems. Despite research, a gap remains in our knowledge about the variation in physicians understanding of drug prescribing. Knowledge of how physicians think about and understand drug prescribing might make it po...

  2. Benzodiazepine prescribing behaviour and attitudes: a survey among general practitioners practicing in northern Thailand

    Critchley Julia; Garner Paul; Srisurapanont Manit; Wongpakaran Nahathai

    2005-01-01

    Abstract Background Over-prescribing of benzodiazepines appears common in many countries, a better understanding of prescribing practices and attitudes may help develop strategies to reduce prescribing. This study aimed to evaluate benzodiazepine prescribing behaviour and attitudes in general practitioners practising in Chiang Mai and Lampoon, Thailand. Methods Questionnaire survey of general practitioners in community hospitals, to estimate: i) use of benzodiazepines for anxiety/insomnia, pa...

  3. Prescribing pattern of antimicrobials in various clinical departments of a tertiary care hospital

    Rohith V.

    2016-04-01

    Conclusions: It was found that penicillins were the most commonly prescribed group of antimicrobials, significantly less number of antimicrobials were prescribed by generic name, 80.18% of antimicrobials were prescribed from NLEM and tablets/ capsules were the most common dosage forms. [Int J Basic Clin Pharmacol 2016; 5(2.000: 402-405

  4. Evaluation of prescribing indicators in prescriptions of private practitioners in Kolkata, India

    Pragnadyuti Mandal

    2015-10-01

    Conclusion: Poly-pharmacy, lack of generic prescribing, low rate of prescriptions from EDL is the present prescribing scenario of private set-up based practitioners of Kolkata. Regulation and intervention is required to improve the irrational prescribing practices. [Int J Basic Clin Pharmacol 2015; 4(5.000: 919-923

  5. Statin prescribing according to gender, age and indication: what about the benefit-risk balance?

    Kildemoes, Helle Wallach; Stovring, Henrik; Hansen, Ebba Holme;

    2016-01-01

    RATIONALES, AIMS AND OBJECTIVES: The increasing dispensing of statins has raised concern about the appropriateness of prescribing to various population groups. We aimed to (1) investigate incident and prevalent statin prescribing according to indication, gender and age and (2) relate prescribing ...

  6. Repeat prescribing: scale, problems and quality management in ambulatory care patients.

    Smet, P.A.G.M. de; Dautzenberg, M.

    2004-01-01

    The reported scale of repeat prescriptions ranges from 29% to 75% of all items prescribed, depending on the definition of repeat prescribing and other variables. It is likely that a substantial part of repeat prescribing by general practitioners (GPs) occurs without direct doctor-patient contact. Wh

  7. The Great Boundary Crossing: Perceptions on Training Pharmacists as Supplementary Prescribers in the UK

    Tann, Jennifer; Blenkinsopp, Alison; Grime, Janet; Evans, Amanda

    2010-01-01

    Objective: To explore the perceptions of General Medical Practitioners and pharmacist supplementary prescribers of the training provided for qualification as a pharmacist supplementary prescriber, and the experience of pharmacist supplementary prescribers of subsequent continuing professional development in practice. Design: A qualitative study of…

  8. Prescribing trends for dabigatran etexilate in primary care.

    McCullagh, L

    2012-05-01

    At the time of the analysis, dabigatran etexilate was licensed, in Ireland, for thromboprophylaxis in adults after elective total hip- and total knee-replacement only. A retrospective review (January 2010 to June 2011) of the National General Medical Services Prescription Database showed that 1929 patients had received prescriptions for dabigatran etexilate. Of these, 42% had received it for longer than the licensed maximum duration (at that time) of 35 days. The Eastern Health board dabigatran etexilate cohort (n = 510) was analysed further. Here 64.5% had received the drug for longer than 35 days. Seventy-six (32.5%) of the 234 patients who had received more than 90 days of dabigatran etexilate had concurrently received rate\\/rhythm control therapy. Likewise, 47 (31%) of the 152 patients who had received more than 180 days of dabigatran etexilate had been co-prescribed rate\\/rhythm control therapy. It is possible that dabigatran etexilate had been prescribed for stroke prevention in atrial fibrillation.

  9. The involvement of prescribed drugs in road trauma.

    Drummer, Olaf H; Yap, Suwan

    2016-08-01

    Coroners files and toxicological records of fatally-injured drivers in Victoria from 2000 to 2006 and from 2007 to 2013 were reviewed in separate studies to establish the role of prescribed drugs on crash risk. 2638 driver fatalities were included in the study, which represented over 97% of all driver fatalities in this period. The detection limits of the drugs were at the low end of those seen with common illicit drugs or prescribed drugs. Drugs of any type were found in 34.4% of the study group, medicinal drugs 21.2%, and alcohol (≥0.05 gram/100mL) was found in 24.8%. The prevalence of the most common drugs detected that are legally available by prescription were anti-depressants (7.9%), benzodiazepines (7.0%), opiates/opioids (6.6%), and sedating anti-histamines (1.1%). Each driver was assessed for responsibility using a previously published and validated method. The crash risk of drivers taking opioids, benzodiazepines, or anti-depressants (primarily the serotonin reuptake inhibitors), were not significantly over-represented compared to the drug-free control group, although there was a suggestion of increased crash risk for benzodiazepines. Crash risk was elevated for drivers using cannabis (by presence of THC in blood at>2ng/mL) and amphetamines. These data show that drivers using medicinal drugs alone are unlikely to show significant crash risk even if drugs are potentially impairing. PMID:26826848

  10. Specifically Prescribed Dynamic Thermodynamic Paths and Resolidification Experiments

    Nguyen, J; Orlikowski, D; Streitz, F; Holmes, N; Moriarty, J

    2003-11-19

    We describe here a series of dynamic compression experiments using impactors with specifically prescribed density profiles. Building upon previous impactor designs, we compose our functionally graded density impactors of materials whose densities vary from about 0.1 g/cc to more than 15 g/cc. These impactors, whose density profiles are not restricted to be monotonic, can be used to generate prescribed thermodynamic paths in the targets. These paths include quasi-isentropes as well as combinations of shock, rarefraction, and quasi-isentropic compression waves. The time-scale of these experiments ranges from nanoseconds to several microseconds. Strain-rates in the quasi-isentropic compression experiments vary from approximately 10{sup 4}s{sup -1} to 10{sup 6}s{sup -1}. We applied this quasi-isentropic compression technique to resolidify water where ice is at a higher temperature than the initial water sample. The particle velocity of quasi-isentropically compressed water exhibits a two-wave structure and sample thickness scales consistently with water-ice phase transition time. Experiments on resolidification of molten bismuth are also promising.

  11. Potentially inappropriate prescribing in an Irish elderly population in primary care.

    Ryan, Cristín

    2009-12-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers\\' criteria, Screening Tool of Older Persons\\' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.

  12. An overiew of non medical prescribing across one strategic health authority: a questionnaire survey

    Courtenay Molly

    2012-06-01

    Full Text Available Abstract Background Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP has been implemented within organisations across a strategic health authority (SHA. The aim of the study was to provide an overview of NMP across one SHA. Methods NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7% participants responded. Data was collected between November 2010 and February 2011. Results The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6% compared to community practitioner prescribers (198 or 22.4%, pharmacist independent supplementary prescribers (35 or 4%, and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%. Nearly all (over 90% of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p  Conclusion NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and

  13. Airborne characterization of smoke marker ratios from prescribed burning

    A. P. Sullivan

    2014-05-01

    Full Text Available A Particle-into-Liquid Sampler – Total Organic Carbon and fraction collector system was flown aboard aTwin Otter aircraft sampling prescribed burning emissions in South Carolina in November2011 to obtain smoke marker measurements. The fraction collector provided 2 min time-integrated off-line samples for carbohydrate (i.e., smoke markers levoglucosan, mannosan, galactosan analysis by high-performance anion-exchange chromatography with pulsed amperometric detection. Each fire location appeared to have aunique Δ levoglucosan / Δ water-soluble organic carbon (WSOC ratio (RF01/RF02/RF03/RF05 = 0.163 ± 0.007 μg C μg C−1, RF08 = 0.115 ± 0.011 μg C μg C−1, RF09A = 0.072 ± 0.028 μg C μg C−1, RF09B = 0.042 ± 0.008 μg C μg C−1. These ratios were comparable to those obtained from controlled laboratory burns and suggested that the emissions sampled during RF01/RF02/RF03/RF05 were dominated by the burning of grasses, RF08 by leaves, RF09A by needles, and RF09B by marsh grasses. These findings were further supported by the Δ galactosan / Δ levoglucosan ratios (RF01/RF02/RF03/RF05 = 0.067 ± 0.004 μg μg−1, RF08 = 0.085 ± 0.009 μg μg−1, RF09A = 0.101 ± 0.029 μg μg−1 obtained as well as by the ground-based fuel and filter sample analyses during RF01/RF02/RF03/RF05. Differences between Δ potassium / Δ levoglucosan ratios obtained for these prescribed fires vs. laboratory-scale measurements suggest that some laboratory burns may not accurately represent potassium emissions from prescribed burns. The Δ levoglucosan / Δ WSOC ratio had no clear dependence on smoke age or fire dynamics suggesting that this ratio is more dependent on the type of fuel being burned. Levoglucosan was stable over a timescale of at least 1.5 h and could be useful to help estimate the air quality impacts of biomass burning.

  14. Potentially inappropriate prescribing in older primary care patients.

    Sandra Vezmar Kovačević

    Full Text Available OBJECTIVES: The aim of the study was to determine the rate of Potentially Inappropriate Medicines (PIM and Potential Prescription Omissions (PPO according to Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START criteria. STUDY DESIGN: A cross-sectional survey in community pharmacy. METHOD: A prospective cross-sectional study was performed, during March-May 2012, in five community pharmacies. Patients aged ≥65 years, who collected one or more prescribed medications, were asked to participate in the study, and an interview was scheduled. Patients were asked to provide their complete medical and biochemical record from their general practitioner. RESULTS: 509 patients, mean age 74.8±6.5 years, 57.4% female, participated in the study. 164 PIM were identified in 139 patients (27.3%. The most common were: long-term use of long-acting benzodiazepines (20.7%, use of non-steroidal antiinflammatory drugs (NSAID in patients with moderate-severe hypertension (20.1%, use of theophylline as monotherapy for chronic obstructive pulmonary disease (COPD, 15.9% and use of aspirin without appropriate indication (15.2%. Patients with more than four prescpritions had a higher risk for PIM (OR 2.85, 95% CI 1.97-4.14, p<0.001. There were 439 PPO, identified in 257, (50.5% patients. Predictors for PPO were older age, presence of diabetes, myocardial infarction, osteoporosis, stroke, COPD and/or angina pectoris. CONCLUSION: STOPP/START criteria may be useful in identifying inappropriate prescribing and improving the current prescribing practices. Pharmacists should focus more on patients with more than four medications and/or patients with gout or pain accompanied with arterial hypertension because those patient may be at higher risk of PIM. Additionlly, patients older than 74 years with diabetes, osteoporosis, myocardial infarction, stroke, angina pectoris and/or COPD may have an

  15. An evaluation of the appropriateness and safety of nurse and midwife prescribing in Ireland.

    Naughton, Corina

    2012-09-19

    AIM: To evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice. BACKGROUND: The number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain. DESIGN: A multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients\\' records and 208 medications prescribed by 25 Registered Nurse Prescribers. METHODS: Data were extracted from patient and prescription records between March-May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen\\'s kappa statistic (inter-rater reliability). RESULTS: Nurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95-96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug-drugs or disease-condition interaction, and duplication of therapy were judged appropriate in 87-92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)-80% (reviewer 1) of prescribing decisions met all eight criteria. CONCLUSION: The majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing.

  16. Evaluation of trends of drug-prescribing patterns based on WHO prescribing indicators at outpatient departments of four hospitals in southern Ethiopia

    Summoro TS

    2015-08-01

    Full Text Available Temesgen Sidamo Summoro,1 Kassa Daka Gidebo,2 Zewde Zemma Kanche,1 Eskinder Wolka Woticha2 1School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Background: Rational prescribing is a primary step to ensure rational drug use. Often, half of the medicines are prescribed irrationally and half of these are even used incorrectly as the patients fail to take their medicines appropriately. The aim of this research was to evaluate drug-prescribing patterns of four hospitals in southern Ethiopia.Methods: A retrospective cross-sectional study was conducted between May 15 and June 25, 2014, to evaluate the drug-prescribing patterns based on the World health Organization (WHO prescribing indicators. The prescription papers, kept for the last 1 year in the outpatient departments of the four hospitals, were analyzed according to WHO guidelines. Also, prescriptions in the hospitals were analyzed to determine the most frequently prescribed drugs. All the statistical calculations were performed using SPSS® version 20.0 software.Results and discussion: The average number of drugs per prescription ranges from 1.82±0.90 to 2.28±0.90, whereas the percentage of use of antibiotics and injections ranged from 46.7 to 85 and 15 to 61.7, respectively. The average percentages of drugs prescribed by generic name and from the essential drugs list were 95.8 and 94.1, respectively. Anti-infective and analgesic drugs are found to be the most frequently prescribed medicines. In terms of polypharmacy, there was a slight deviation in prescribing patterns from what is acceptable according to the WHO criteria. Prescribing by generic name and from essential drug list was almost optimal. There was a significant deviation in the use of injectables in two of the four hospitals (50%, whereas their use in the other

  17. Impact of Early Electronic Prescribing on Pharmacists’ Clarification Calls in Four Community Pharmacies Located in St John’s, Newfoundland

    Phillips, Jennifer L.; Shea, Jennifer M; Leung, Valerie; MacDonald, Don

    2015-01-01

    Background Electronic prescribing (e-prescribing) can potentially help prevent medication errors. As the use of e-prescribing increases across Canada, understanding the benefits and gaps of early e-prescribing can help inform deployment of future e-prescribing systems. Objective The purpose of this exploratory study was to determine the prevalence of, reasons for, and average time taken for pharmacist clarification calls to prescribers for electronic medical record (EMR)-generated and handwri...

  18. Particulate emissions from a mid-latitude prescribed chaparral fire

    Cofer, Wesley R., III; Levine, Joel S.; Sebacher, Daniel I.; Winstead, Edward L.; Riggin, Philip J.; Brass, James A.; Ambrosia, Vincent G.

    1988-01-01

    Particulate emission from a 400-acre prescribed chaparral fire in the San Dimas Experimental Forest was investigated by collecting smoke aerosol on Teflon and glass-fiber filters from a helicopter, and using SEM and EDAX to study the features of the particles. Aerosol particles ranged in size from about 0.1 to 100 microns, with carbon, oxygen, magnesium, aluminum, silicon, calcium, and iron as the primary elements. The results of ion chromatographic analysis of aerosol-particle extracts (in water-methanol) revealed the presence of significant levels of NO2(-), NO3(-), SO4(2-), Cl(-), PO4(3-), C2O4(2-), Na(+), NH4(+), and K(+). The soluble ionic portion of the aerosol was estimated to be about 2 percent by weight.

  19. Design of Ultraspherical Window Functions with Prescribed Spectral Characteristics

    Stuart W. A. Bergen

    2004-10-01

    Full Text Available A method for the design of ultraspherical window functions that achieves prescribed spectral characteristics is proposed. The method comprises a collection of techniques that can be used to determine the three independent parameters of the ultraspherical window such that a specified ripple ratio and main-lobe width or null-to-null width along with a user-defined side-lobe pattern can be achieved. Other known two-parameter windows can achieve a specified ripple ratio and main-lobe width; however, their side-lobe pattern cannot be controlled as in the proposed method. A comparison with other windows has shown that a difference in performance exists between the ultraspherical and Kaiser windows, which depends critically on the required specifications. The paper also highlights some applications of the proposed method in the areas of digital beamforming and image processing.

  20. Intensity in phonological intervention: is there a prescribed amount?

    Williams, A Lynn

    2012-10-01

    Despite a number of studies that have demonstrated positive outcomes for inducing clinical change in children with speech sound disorders (SSD), there is a need to address the question of whether resources are being applied in an optimal manner. As a consequence, there has been a call to look within interventions to examine parameters that may contribute to intervention outcomes; specifically the intensity of intervention (dose, frequency, duration, and cumulative intervention intensity). In this paper, empirical evidence from three intervention studies using multiple oppositions primarily, and a second contrastive approach, minimal pairs, is reported with regard to the parameters of intervention intensity. The findings indicated that greater intensity yields greater treatment outcomes. Further, quantitative and qualitative changes in intensity occur as intervention progresses, and there were differences in intensity based on severity of the SSD. Based on these data, suggestions were made toward establishing some prescribed amounts of intensity to affect treatment outcomes for children with SSD. PMID:22686582

  1. Risk evaluation and mitigation strategies (REMS): educating the prescriber.

    Nicholson, Susan C; Peterson, Janet; Yektashenas, Behin

    2012-02-01

    The US FDA Amendments Act of 2007 was signed into law on 27 September 2007. A provision of this law granted the FDA new powers to enhance drug safety by requiring the pharmaceutical industry to develop Risk Evaluation and Mitigation Strategies (REMS). REMS are deemed necessary when a question exists as to whether the benefits of a drug outweigh its risks. REMS constitute a safety plan with several potential components, including a medication guide, a communication plan, elements to ensure safe use and an implementation system to help guide the prescribers, pharmacists and patients. This applies to existing drugs on the market, new drug applications (NDAs), abbreviated NDAs (generics) and biologics licence applications. REMS represent an 'upgrade' from previously required risk minimization action plans, based on the strengthening of FDA powers of authority and enforceability to incur monetary penalties against individuals representing the pharmaceutical industry who fail to comply. For illustrative purposes, we chose the drug romiplostim (Nplate®) to present an REMS, as all components were utilized to help assuage risks associated with the drug. Romiplostim is an FDA-approved drug used to treat thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura that has a significant adverse safety profile based on the risk of changes in bone marrow reticulin formation and bone marrow fibroses, and other associated risks. This review of current REMS policy is intended to provide the prescriber with a better understanding of current modalities in FDA-mandated drug safety programmes, which will impact day-to-day healthcare provider practices. PMID:22171604

  2. Congruence between international guidelines and mite specific immunotherapy prescribing practices.

    Antonicelli, L; Braschi, M C; Bilò, M B; Angino, A; Pala, A P; Baldacci, S; Maio, S; Bonifazi, F

    2011-10-01

    Both rhinitis (ARIA) and asthma (GINA) guidelines recommend allergen-specific immunotherapy (SIT) tailored to the specific levels of severity of each disease. Real world studies evaluating congruence between these recommendations and prescribing practice in the single patient with comorbidity are lacking. An observational polycentric study was carried out in 518 patients recruited from 34 allergy centers throughout Italy. A questionnaire was administered to each consecutive patient over a span of four months. Taking into account guideline recommendations for both diseases, concomitant in the same patient, three subsets resulted: patients not eligible for SIT (11%); patients eligible for SIT for one disease only (60%); patients eligible for SIT for both diseases (29%). SIT was prescribed in 257 (49.6%) subjects. The level of SIT prescription was about 50% in all three groups. Consistent with the ARIA guidelines, a correlation between the prescription of SIT and the severity of rhinitis was documented (r=0.87; p=0.001). An association with asthma severity was found (p=0.02), but the trend was inconsistent with the GINA recommendations. Young age was the most important factor for SIT prescription both in the eligible for one disease and in the eligible for both diseases subset. The tendency towards worsening of symptoms was a factor for SIT in the eligible for one disease subset. In mite allergic patients with rhinitis and asthma comorbidity, the severity of rhinitis and the young age are the most important factors driving the SIT prescription. The congruence of SIT prescription was better for the ARIA than GINA guidelines. PMID:21628094

  3. The Actual Prayer in the Holy Qur'an

    ERTUĞRUL, Resul

    2015-01-01

    Prayer is one of the fundamental concepts in the Qur'an that Allah's appeal to people. The concept of actual prayer, which means the effort spent by people before and during prayer, is not used in the Qur'an. However, in a number of verses about prayer, the need of actual prayer is emphasized and actual prayers of various prophets take place.The aim of this study is presenting the fact of actual prayer and demonstrating the importance given to the actual prayer in the Qur’an. In the introduct...

  4. Protocol for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study: a cluster randomised controlled trial using ePrescribing data

    Guthrie, Bruce; Treweek, Shaun; Petrie, Dennis; Barnett, Karen; Ritchie, Lewis D; Robertson, Chris; Bennie, Marion

    2012-01-01

    Introduction High-risk prescribing in primary care is common and causes considerable harm. Feedback interventions to improve care are attractive because they are relatively cheap to widely implement. There is good evidence that feedback has small to moderate effects, but the most recent Cochrane review called for more high-quality, large trials that explicitly test different forms of feedback. Methods and analysis The study is a three-arm cluster-randomised trial with general practices being randomised and outcomes measured at patient level. 262 practices in three Scottish Health Board areas have been randomised (94% of all possible practices). The two active arms receive different forms of prescribing safety data feedback, with rates of high-risk prescribing compared with a ‘usual care’ arm. Sample size estimation used baseline data from participating practices. With 85 practices randomised to each arm, then there is 93% power to detect a 25% difference in the percentage of high-risk prescribing (from 6.1% to 4.5%) between the usual care arm and each intervention arm. The primary outcome is a composite of six high-risk prescribing measures (antipsychotic prescribing to people aged ≥75 years; non-steroidal anti-inflammatory drug (NSAID) prescribing to people aged ≥75 without gastroprotection; NSAID prescribing to people prescribed aspirin/clopidogrel without gastroprotection; NSAID prescribing to people prescribed an ACE inhibitor/angiotensin receptor blocker and a diuretic; NSAID prescription to people prescribed an oral anticoagulant without gastroprotection; aspirin/clopidogrel prescription to people prescribed an oral anticoagulant without gastroprotection). The primary analysis will use multilevel modelling to account for repeated measurement of outcomes in patients clustered within practices. Ethics and dissemination The study was reviewed and approved by the NHS Tayside Committee on Medical Research Ethics B (11/ES/0001). The study will be

  5. Quality Improvement Initiative to Decrease Variability of Emergency Physician Opioid Analgesic Prescribing

    John H. Burton

    2016-05-01

    Full Text Available Introduction: Addressing pain is a crucial aspect of emergency medicine. Prescription opioids are commonly prescribed for moderate to severe pain in the emergency department (ED; unfortunately, prescribing practices are variable. High variability of opioid prescribing decisions suggests a lack of consensus and an opportunity to improve care. This quality improvement (QI initiative aimed to reduce variability in ED opioid analgesic prescribing. Methods: We evaluated the impact of a three-part QI initiative on ED opioid prescribing by physicians at seven sites. Stage 1: Retrospective baseline period (nine months. Stage 2: Physicians were informed that opioid prescribing information would be prospectively collected and feedback on their prescribing and that of the group would be shared at the end of the stage (three months. Stage 3: After physicians received their individual opioid prescribing data with blinded comparison to the group means (from Stage 2 they were informed that individual prescribing data would be unblinded and shared with the group after three months. The primary outcome was variability of the standard error of the mean and standard deviation of the opioid prescribing rate (defined as number of patients discharged with an opioid divided by total number of discharges for each provider. Secondary observations included mean quantity of pills per opioid prescription, and overall frequency of opioid prescribing. Results: The study group included 47 physicians with 149,884 ED patient encounters. The variability in prescribing decreased through each stage of the initiative as represented by the distributions for the opioid prescribing rate: Stage 1 mean 20%; Stage 2 mean 13% (46% reduction, p<0.01, and Stage 3 mean 8% (60% reduction, p<0.01. The mean quantity of pills prescribed per prescription was 16 pills in Stage 1, 14 pills in Stage 2 (18% reduction, p<0.01, and 13 pills in Stage 3 (18% reduction, p<0.01. The group mean

  6. Challenges in health visitor prescribing in a London primary care trust.

    Thurtle, Val

    2007-11-01

    In this primary care trust there was limited health visitor prescribing. A case study approach sought to identify reasons for this, to lead to recommendations and changes to develop health visitor prescribing. The situation was examined using qualitative methods to consider the opportunities and challenges in health visitor prescribing. Semi-structured interviews with eighteen health visitors and managers explored their views of health visitor prescribing and its position within the PCT. The findings demonstrated only three health visitors prescribed; yet the majority were positive about prescribing, both for clients and health visitor development. Practitioners recognised their difficult working context and felt that organisational systems were not supportive of prescribing. A culture of prescribing was not felt to be in evidence, but was seen as a realistic possibility. Recommendations for change focused on the organisation and practitioners, with improved communication and structures supportive of prescribing. There was a need for practitioners to be active in learning so that they could share knowledge, experience and commitment to prescribing in locally based groups. PMID:18064850

  7. Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists.

    Lockwood, Emily B

    2008-10-01

    AIM: Nurses and midwives are expanding the scope of their professional practice, assuming additional responsibilities including the management and prescribing of medications. The aim of the study was to discover the attitudes of clinical nurse specialists (CNSs) in Ireland to nurse prescribing and to examine perceived barriers to engaging in this aspect of future role expansion. BACKGROUND: The expansion of the nursing role in relation to nurse prescribing is an ongoing process and is subject to incremental iterations of legislation and professional policy. Nurse prescribing as an expanded role function has become a reality in many countries. Ireland has addressed the matter in a formal and systematic way through legislation. METHOD: A questionnaire was administered to a sample of 283 CNSs practising in a variety of care settings in Ireland. Attitudes were measured using Likert-type attitudinal scales, designed specifically for the study. RESULTS AND CONCLUSIONS: Findings indicate that the majority of clinical nurse specialists were positively disposed toward nurse prescribing as a future role expansion. The fear of litigation was identified as the most significant barrier to nurse prescribing. The majority of respondents equated nurse prescribing with increased autonomy and holistic care. The findings indicate that there is a need for further examination of the educational requirements of the CNS in relation to nurse prescribing. The legislative implications for nurse prescribing and fear of legal consequences need to be considered prior to any implementation of nurse prescribing. IMPLICATIONS FOR NURSING MANAGEMENT: While senior clinicians are willing to embrace future role expansion in the area of nurse prescribing, their Nurse Managers should recognize that facilitation of nurse prescribing needs to address the legal and educational requirements for such activity. Failure to address these requirements can represent a barrier to role expansion. This paper offers

  8. Comparisons of anti-diabetic prescriptions of private practitioners and hospital prescribers: A survey

    Ananya Mandal

    2013-01-01

    Full Text Available Monotherapy as well as effective and safe combination therapy for diabetes is practiced widely by both private and government hospital prescribers. This study attempted to compare the prescriptions of government and private practitioners to obtain a fair idea of the trends of diabetes management in either group. Prescriptions for diabetic patients from both private practitioners and government medical college prescribers were collected. These were analyzed for parameters such as number and type of drugs, cost, and generic prescription. Private prescribers were not significantly different from hospital prescribers in terms of number of drugs per prescription, cost of therapy, and treatment regimens. However, there was a dearth of generic prescriptions from private consultants (33% vs. 9%. Metformin and Glimepiride were the most prescribed drugs in both groups. However, private practitioners preferred Gliclazide, Glipizide, and Glibenclamide more than hospital prescribers.

  9. Appropriate prescribing in the elderly: an investigation of two screening tools, Beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland.

    Ryan, C

    2009-08-01

    Elderly patients are particularly vulnerable to inappropriate prescribing, with increased risk of adverse drug reactions and consequently higher rates of morbidity and mortality. A large proportion of inappropriate prescribing is preventable by adherence to prescribing guidelines, suitable monitoring and regular medication review. As a result, screening tools have been developed to help clinicians improve their prescribing.

  10. The prescribing physician's influence on consumer choice between medically equivalent pharmaceuticals

    Granlund, David; Rudholm, Niklas

    2012-01-01

    This paper reports on a study of the prescribing physician's influence on consumers' choice between medically equivalent pharmaceuticals. The study was performed using a dataset of 666,000 observations in which consumers were asked whether they were prepared to pay the price difference in order to obtain the prescribed pharmaceutical instead of the cheapest available substitute. The main results support the hypothesis that prescribing physicians have an impact on consumers' choice between med...

  11. Prescribing vitamins at primary health care level: Exploration of facts, factors and solution

    Adhir Kumar Das, Md. Sayedur Rahman

    2010-01-01

    The impact of educational intervention on prescribing trend of vitamins at primary health care level was investigated by analyzing 2000 prescriptions containing vitamins. Prevalence of vitamin prescribing was 30.16%, 38.69% and 45.35% and contribution of vitamins in the cost of drugs prescribed in vitamin containing prescription was 27.58%, 30.40% and 41.85% at Upazilla Health Complexes (UHC), non-government organizations (NGO) and private practices (PP) respectively. Both parameters signific...

  12. Stakeholders' views on granting prescribing authority to pharmacists in Nigeria: a qualitative study.

    Auta, Asa; Strickland-Hodge, Barry; Maz, Julia

    2016-08-01

    Background In Nigeria, only medical doctors, dentists and some nurses in primary care facilities have the legal right to prescribe medicines to patients. Patients' access to prescription medicines can be seriously affected by the shortage of prescribers leading to longer waiting times in hospitals. Objective This research was carried out to investigate stakeholders' views on granting prescribing authority to pharmacists in Nigeria. Setting The study was conducted in Nigeria. Methods Qualitative, semi-structured interviews were conducted with 43 Nigerian stakeholders including policymakers, pharmacists, doctors and patient group representatives. Transcribed interviews were entered into the QSR NVivo 10 software and analysed using a thematic approach. Main outcome measure Stakeholders' perception on the granting of prescribing authority to pharmacists in Nigeria. Results Three major themes emerged from the interviews: (1) prescribing as a logical role for pharmacists, (2) pharmacist prescribing- an opportunity or a threat and (3) the potential barriers to pharmacist prescribing. Many non-medical stakeholders including pharmacists and patient group representatives supported an extended role for pharmacists in prescribing while the majority of medical doctors including those in policy making were reluctant to do so. Generally, all stakeholders perceived that pharmacist prescribing represents an opportunity to increase patients' access to medicines, reduce doctors' workload and promote the utilisation of pharmacists' skills. However, many stakeholders including pharmacists and doctors commonly identified pharmacists' inadequate skills in diagnosis, medical resistance and shortage of pharmacists as potential barriers to the introduction of pharmacist prescribing in Nigeria. Conclusion The present study showed a split of opinion between participants who were medical doctors and those who were non-doctors in their support for pharmacist prescribing. However, all

  13. Drug information for patients: bringing together the messages from prescriber, pharmacist and manufacturer *

    Herxheimer, Andrew; Davies, Charles

    1982-01-01

    Patients may receive information about their medicine from the prescriber, the pharmacist and the manufacturer (in a package insert). If it is to be used effectively, all this information must be integrated: the different sources should complement, and not seem to contradict one another. Prescribers and pharmacists should therefore have at hand the text of any package inserts that patients will receive with prescribed medicines. In addition, doctors might be helped by an aide-mémoire, remindi...

  14. Clinical Comparative Effectiveness of Independent Non-Medical Prescribers for Type 2 Diabetes

    Abutaleb, Mohammed

    2015-01-01

    Independent and supplementary prescribing are the two main forms of non-medical prescribing (NMP) that have been practised in the UK since 2006. Most available studies have qualitatively investigated the impact of NMP, especially in primary care. This may be due to the fact that prescriptions are issued mainly by general practitioners in primary care. This PhD thesis aimed at investigating the clinical effectiveness of independent pharmacist and diabetes specialist nurse (DSN) prescribers in ...

  15. Patients' valuation of the prescribing nurse in primary care: a discrete choice experiment

    Gerard, Karen; Tinelli, Michela; Latter, Sue; Smith, Alesha; Blenkinsopp, Alison

    2015-01-01

    Background: recently, primary care in the United Kingdom has undergone substantial changes in skill mix. Non-medical prescribing was introduced to improve patient access to medicines, make better use of different health practitioners' skills and increase patient choice. There is little evidence about value-based patient preferences for ‘prescribing nurse’ in a general practice setting. Objective: to quantify value-based patient preferences for the profession of prescriber and other factor...

  16. First Approximations of Prescribed Fire Risks Relative to Other Management Techniques Used on Private Lands

    Twidwell, Dirac; Wonkka, Carissa L.; Sindelar, Michael T.; Weir, John R

    2015-01-01

    Fire is widely recognized as a critical ecological and evolutionary driver that needs to be at the forefront of land management actions if conservation targets are to be met. However, the prevailing view is that prescribed fire is riskier than other land management techniques. Perceived risks associated with the application of fire limits its use and reduces agency support for prescribed burning in the private sector. As a result, considerably less cost-share support is given for prescribed f...

  17. Antibiotics prescribing practices in oral implantology among jordanian dentists. A cross sectional, observational study

    Hamdan Ahmad AS; Ahmad Waleed KH; Habarneh Hanan M; Khatib Adel A; Khdairi Nadiajda O; Afifeh Khaldoon; AbuKaraky Ashraf E; Sawair Faleh A

    2011-01-01

    Abstract Background In oral implantology, there is no consensus on the most appropriate regimen for antibiotics prescribing, the decision to prescribe antibiotic is usually based on procedure, patient and clinician related factors. The aim of this study was to investigate the rationale of antibiotic prescribing among Jordanian clinicians who practice oral implantology. Findings The target sample for the study was the 250 Jordan Dental Implant Group members. A five page questionnaire contained...

  18. Potentially inappropriate prescribing and cost outcomes for older people: a national population study.

    Cahir, Caitriona

    2010-05-01

    Optimization of drug prescribing in older populations is a priority due to the significant clinical and economic costs of drug-related illness. This study aimed to: (i) estimate the prevalence of potentially inappropriate prescribing (PIP) in a national Irish older population using European specific explicit prescribing criteria; (ii) investigate the association between PIP, number of drug classes, gender and age and; (iii) establish the total cost of PIP.

  19. Specialist pediatric palliative care prescribing practices: A large 5-year retrospective audit

    Anuja Damani

    2016-01-01

    Full Text Available Introduction: There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging specialty. Prescribing pain and symptom control drugs in children with cancer requires knowledge of palliative care formulary, dosing schedules, and prescription guidelines. This study is a retrospective audit of prescribing practices of a specialist palliative care service situated in a tertiary cancer center. Methods: A total of 1135 medication records of children receiving specialist pediatric palliative care services were audited for 5 years (2010-2014 to evaluate prescribing practices in children with advanced cancer. Results: A total of 51 types of drugs were prescribed with an average of 4.2 drugs per prescription. 66.9% of the prescriptions had paracetamol, and 33.9% of the prescriptions had morphine. Most common nonsteroidal anti-inflammatory drugs prescribed was ibuprofen (23.9%, and more than 50% of the prescriptions had aperients. The most commonly prescribed aperient was a combination of liquid paraffin and sodium-picosulfate. Dexamethasone was prescribed in 51.9% of patients and in most cases this was part of oral chemotherapy regimen. Generic names in prescription were used only in 33% of cases, and adverse effects of the drugs were documented in only 9% of cases. In 25% of cases, noncompliance to the WHO prescription guidelines was seen, and patient compliance to prescription was seen in 40% of cases. Conclusions: Audit of the prescribing practices in specialist pediatric palliative care service shows that knowledge of pediatric palliative care formulary, rational drug use, dosing, and prescribing guidelines is essential for symptom control in children with advanced life-limiting illness. Noncompliance to WHO prescribing guidelines in one fourth of cases and using nongeneric names in two-thirds of prescription indicates poor prescribing practices and warrants prescriber education. Prescription

  20. Appropriateness of antibiotic prescribing for upper respiratory tract infections in general practice

    Sigurðardóttir, Nanna Rún; Nielsen, Anni Brit Sternhagen; Munck, Anders;

    2015-01-01

    Objective: To compare the appropriateness of antibiotic prescribing for upper respiratory tract infections (URTIs) in two countries with different prevalence of antimicrobial resistance: Denmark and Iceland. Design: A cross-sectional study. Settings and subjects. General practitioners (GPs...... and Iceland could not fully be explained by different symptoms and signs among patients. Conclusion: Icelandic GPs have a higher antibiotic prescribing rate compared with Danish GPs, but the percentage of inappropriate antibiotic prescribing is highest in Denmark for sinusitis, and in Iceland...

  1. Repeat prescribing: a role for community pharmacists in controlling and monitoring repeat prescriptions.

    Bond, C.; Matheson, C.; Williams, S; Williams, P.; Donnan, P

    2000-01-01

    BACKGROUND: Traditional systems of managing repeat prescribing have been criticised for their lack of clinical and administrative controls. AIM: To compare a community pharmacist-managed repeat prescribing system with established methods of managing repeat prescribing. METHOD: A randomised controlled intervention study (19 general medical practices, 3074 patients, 62 community pharmacists). Patients on repeat medication were given sufficient three-monthly scripts, endorsed for monthly dispens...

  2. River ecosystem response to prescribed vegetation burning on Blanket Peatland.

    Lee E Brown

    Full Text Available Catchment-scale land-use change is recognised as a major threat to aquatic biodiversity and ecosystem functioning globally. In the UK uplands rotational vegetation burning is practised widely to boost production of recreational game birds, and while some recent studies have suggested burning can alter river water quality there has been minimal attention paid to effects on aquatic biota. We studied ten rivers across the north of England between March 2010 and October 2011, five of which drained burned catchments and five from unburned catchments. There were significant effects of burning, season and their interaction on river macroinvertebrate communities, with rivers draining burned catchments having significantly lower taxonomic richness and Simpson's diversity. ANOSIM revealed a significant effect of burning on macroinvertebrate community composition, with typically reduced Ephemeroptera abundance and diversity and greater abundance of Chironomidae and Nemouridae. Grazer and collector-gatherer feeding groups were also significantly less abundant in rivers draining burned catchments. These biotic changes were associated with lower pH and higher Si, Mn, Fe and Al in burned systems. Vegetation burning on peatland therefore has effects beyond the terrestrial part of the system where the management intervention is being practiced. Similar responses of river macroinvertebrate communities have been observed in peatlands disturbed by forestry activity across northern Europe. Finally we found river ecosystem changes similar to those observed in studies of wild and prescribed forest fires across North America and South Africa, illustrating some potentially generic effects of fire on aquatic ecosystems.

  3. Pharmacoeconomic consequences of variable patient compliance with prescribed drug regimens.

    Urquhart, J

    1999-03-01

    Variable compliance with prescribed drug regimens is a leading source of variability in drug response. Specifics differ by drug and disease. The role of variable compliance was clearly defined in 2 trials of lipid-lowering agents, cholestyramine and gemfibrozil, in which exceptionally careful measurements of compliance were made, which has not been done in later trials. Economic consequences of variable compliance are estimated by converting dose-dependent changes in absolute risk of incident coronary disease into the unicohort format, which designates how many patients must be treated to prevent, in a given time, a defined 'coronary event'. Two strong influences on the costs of treatment are: (i) the shape of the relation between drug intake and risk reduction; and (ii) the strength of the linkage between intake and prescription refills. The intake-effect relation for cholestyramine is linear, making compliance-neutral the cost to prevent 1 coronary event, provided that refills match intake. If refills exceed intake, treatment costs rise. The intake-effect relation for gemfibrozil is more typically nonlinear, so poorer compliers purchase and take the drug in amounts that have little benefit, increasing the cost to prevent 1 coronary event. If refills run at a higher rate than intake, costs increase still further. A key question for future study is: do policies that encourage timely refills increase compliance enough to offset their potential to waste money in the purchasing of an untaken drug? PMID:10537430

  4. Inhaled Drug Delivery: A Practical Guide to Prescribing Inhaler Devices

    Pierre Ernst

    1998-01-01

    Full Text Available Direct delivery of medication to the target organ results in a high ratio of local to systemic bioavailability and has made aerosol delivery of respiratory medication the route of choice for the treatment of obstructive lung diseases. The most commonly prescribed device is the pressurized metered dose inhaler (pMDI; its major drawback is the requirement that inspiration and actuation of the device be well coordinated. Other requirements for effective drug delivery include an optimal inspiratory flow, a full inspiration from functional residual capacity and a breath hold of at least 6 s. Available pMDIs are to be gradually phased out due to their use of atmospheric ozone-depleting chlorofluorocarbons (CFCs as propellants. Newer pMDI devices using non-CFC propellants are available; preliminary experience suggests these devices greatly increase systemic bioavailability of inhaled corticosteroids. The newer multidose dry powder inhalation devices (DPIs are breath actuated, thus facilitating coordination with inspiration, and contain fewer ingredients. Furthermore, drug delivery is adequate even at low inspired flows, making their use appropriate in almost all situations. Equivalence of dosing among different devices for inhaled corticosteroids will remain imprecise, requiring the physician to adjust the dose of medication to the lowest dose that provides adequate control of asthma. Asthma education will be needed to instruct patients on the effective use of the numerous inhalation devices available.

  5. River ecosystem response to prescribed vegetation burning on Blanket Peatland.

    Brown, Lee E; Johnston, Kerrylyn; Palmer, Sheila M; Aspray, Katie L; Holden, Joseph

    2013-01-01

    Catchment-scale land-use change is recognised as a major threat to aquatic biodiversity and ecosystem functioning globally. In the UK uplands rotational vegetation burning is practised widely to boost production of recreational game birds, and while some recent studies have suggested burning can alter river water quality there has been minimal attention paid to effects on aquatic biota. We studied ten rivers across the north of England between March 2010 and October 2011, five of which drained burned catchments and five from unburned catchments. There were significant effects of burning, season and their interaction on river macroinvertebrate communities, with rivers draining burned catchments having significantly lower taxonomic richness and Simpson's diversity. ANOSIM revealed a significant effect of burning on macroinvertebrate community composition, with typically reduced Ephemeroptera abundance and diversity and greater abundance of Chironomidae and Nemouridae. Grazer and collector-gatherer feeding groups were also significantly less abundant in rivers draining burned catchments. These biotic changes were associated with lower pH and higher Si, Mn, Fe and Al in burned systems. Vegetation burning on peatland therefore has effects beyond the terrestrial part of the system where the management intervention is being practiced. Similar responses of river macroinvertebrate communities have been observed in peatlands disturbed by forestry activity across northern Europe. Finally we found river ecosystem changes similar to those observed in studies of wild and prescribed forest fires across North America and South Africa, illustrating some potentially generic effects of fire on aquatic ecosystems. PMID:24278367

  6. Practical Approaches to Prescribing Physical Activity and Monitoring Exercise Intensity.

    Reed, Jennifer L; Pipe, Andrew L

    2016-04-01

    Regular physical activity helps to prevent heart disease, and reduces the risk of first or subsequent cardiovascular events. It is recommended that Canadian adults accumulate at least 150 minutes of moderate- to vigorous-intensity aerobic exercise per week, in bouts of 10 minutes or more, and perform muscle- and bone-strengthening activities at least 2 days per week. Individual exercise prescriptions can be developed using the frequency, intensity, time, and type principles. Increasing evidence suggests that high-intensity interval training is efficacious for a broad spectrum of heart health outcomes. Several practical approaches to prescribing and monitoring exercise intensity exist including: heart rate monitoring, the Borg rating of perceived exertion scale, the Talk Test, and, motion sensors. The Borg rating of perceived exertion scale matches a numerical value to an individual's perception of effort, and can also be used to estimate heart rate. The Talk Test, the level at which simple conversation is possible, can be used to monitor desired levels of moderate- to vigorous-intensity exercise. Motion sensors can provide users with practical and useful exercise training information to aid in meeting current exercise recommendations. These approaches can be used by the public, exercise scientists, and clinicians to easily and effectively guide physical activity in a variety of settings. PMID:26897182

  7. Prescribed fire effects on biological control of leafy spurge

    Fellows, D.P.; Newton, W.E.

    1999-01-01

    The flea beetle, Aphthona nigriscutis Foudras, is a potentially useful agent for biological control of leafy spurge (Euphorbia esula L.) in grasslands devoted to wildlife conservation. However, effects of other grassland management practices on the persistence and dynamics of flea beetle populations are not well understood. We conducted small plot tests to evaluate 1) the effect of prerelease burning on establishment of A. nigriscutis colonies, and 2) the ability of established A. nigriscutis colonies to survive prescribed fire. More colonies established on plots that were burned prior to beetle release (83% establishment) than on unburned plots (37% establishment), possibly due to litter reduction and baring of the soil surface. However, most colonies established with the aid of fire did not survive past the first generation unless the habitat was otherwise suitable for the species, and we conclude that the primary benefit of prerelease burning is increased recruitment of A. nigriscutis during the first few generations. Established colonies were not harmed by burns in October and May. Both spring and fall burns resulted in an increase in leafy spurge stem density during the first growing season, but stem density declined to the preburn level by the second growing season.

  8. Who will prescribe? A proposal for specialized opioid management clinics.

    Loder, Elizabeth

    2003-09-01

    There is currently no uniform system of providing care for patients with chronic nonmalignant pain who require ongoing opioid maintenance therapy. Some patients receive care in a general practice setting, while others are managed in pain clinics where opioid management is only one of many services provided. Current events involving increased abuse and diversion of opioid medications suggest the need for improved case management and coordination when opioids are used for chronic nonmalignant pain. Based on the model of anticoagulation clinics, the author proposes the development of specialized opioid management clinics. These clinics would: 1) evaluate patient-specific risks and benefits of therapy; 2) supervise the mechanics of opioid prescribing; 3) provide systematic and secure monitoring of patient adherence to therapy; 4) assess goals of therapy and progress towards them; 5) coordinate opioid treatment with other pain-related treatment; 6) supply education to patients, family members and caregivers about the appropriate use of opioids; 7) maintain communication with other caregivers and pharmacists; and 8) provide regular psychological assistance and support for patients. PMID:17147670

  9. Transfer Pricing Based on Actual versus Standard Costs

    Lengsfeld, Stephan; Schiller, Ulf

    2003-01-01

    The use of information plays an important role in the choice of transfer prices (TP). We discuss the information provision of two centralized mechanisms, namely, actual-cost and standard-cost based TP. Actual cost based TP use all available cost information whereas standard cost based TP only reflect expected cost. We analyze the impact of either regime on the incentives of two divisions that make upfront investments and - later - trade an intermediate good. Actual cost based TP allow for a f...

  10. The antecedents of herbal product actual purchase in Malaysia

    Sarina Ismail; Sany Sanuri Mohd Mokhtar

    2015-01-01

    This study is meant to examine the relationships of several antecedents of actual purchase of herbal product in Malaysia. Actual purchase is considered to have a vital link to a business success. The study identified eight antecedents of consumer actual purchase such as intention, attitude, social influence, product safety and culture belief. A total of 473 respondents (about 82%) completed and returned the questionnaire. A seven point Likert scale was used to measure responses. The data were...

  11. Influence of population and general practice characteristics on prescribing of minor tranquilisers in primary care

    Wagner AC

    2010-09-01

    Full Text Available Prevalence of generalised anxiety disorders is widespread in Great Britain. Previous small-scale research has shown variations in minor tranquiliser prescribing, identifying several potential predictors of prescribing volume. Objective: This study aimed to investigate the relationship between general practice minor tranquiliser prescribing rates and practice population and general practice characteristics for all general practices in England.Methods: Multiple regression analysis of minor tranquiliser prescribing volumes during 2004/2005 for 8,291 English general practices with general practice and population variables obtained from the General Medical Services (GMS statistics, Quality and Outcomes Framework (QOF, 2001 Census and 2004 Index of Multiple Deprivation (IMD. Results: The highest rates of minor tranquiliser prescribing were in areas with the greatest local deprivation while general practices situated in areas with larger proportions of residents of black ethnic origin had lower rates of prescribing. Other predictors of increased prescribing were general practices with older general practitioners and general practices with older registered practice populations.Conclusion: Our findings show that there is wide variation of minor tranquilisers prescribing across England which has implications regarding access to treatment and inequity of service provision. Future research should determine the barriers to equitable prescribing amongst general practices serving larger populations of black ethnic origin.

  12. Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients: a before and after study.

    Westbrook, Johanna I.; Margaret Reckmann; Ling Li; Runciman, William B.; Rosemary Burke; Connie Lo; Baysari, Melissa T; Jeffrey Braithwaite; Day, Richard O

    2012-01-01

    Editors' Summary Background Medication errors—for example, prescribing the wrong drug or giving a drug by the wrong route—frequently occur in health care settings and are responsible for thousands of deaths every year. Until recently, medicines were prescribed and dispensed using systems based on hand-written scripts. In hospitals, for example, physicians wrote orders for medications directly onto a medication chart, which was then used by the nursing staff to give drugs to their patients. Ho...

  13. Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study

    Westbrook, Johanna I.; Reckmann, Margaret; Li, Ling; Runciman, William B.; Burke, Rosemary; Lo, Connie; Baysari, Melissa T.; Braithwaite, Jeffrey; Day, Richard O.

    2012-01-01

    Editors' Summary Background Medication errors—for example, prescribing the wrong drug or giving a drug by the wrong route—frequently occur in health care settings and are responsible for thousands of deaths every year. Until recently, medicines were prescribed and dispensed using systems based on hand-written scripts. In hospitals, for example, physicians wrote orders for medications directly onto a medication chart, which was then used by the nursing staff to give drugs to their patients. Ho...

  14. ‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people.

    Clyne, Barbara; Cooper, Janine A; Hughes, Carmel M.; Fahey, Tom; Smith, Susan M; OPTI-SCRIPT study team

    2016-01-01

    Background: Potentially inappropriate prescribing (PIP) is common in older people in primary care, as evidenced by a significant body of quantitative research. However, relatively few qualitative studies have investigated the phenomenon of PIP and its underlying processes from the perspective of general practitioners (GPs). The aim of this paper is to explore qualitatively, GP perspectives regarding prescribing and PIP in older primary care patients. Method: Semi-structured qualitative int...

  15. ‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people

    Clyne, Barbara; Cooper, Janine A; Hughes, Carmel M.; Fahey, Tom; Smith, Susan M

    2016-01-01

    Background: Potentially inappropriate prescribing (PIP) is common in older people in primary care, as evidenced by a significant body of quantitative research. However, relatively few qualitative studies have investigated the phenomenon of PIP and its underlying processes from the perspective of general practitioners (GPs). The aim of this paper is to explore qualitatively, GP perspectives regarding prescribing and PIP in older primary care patients.Method: Semi-structured qualitative intervi...

  16. Trends in the Association Between Prescribed and Non-Prescribed Use of Tranquillisers or Sedatives Among Adolescents in 22 European Countries

    Fotiou Anastasios

    2014-10-01

    Full Text Available AIMS – Tranquillisers and sedatives are valuable medicines with high misuse potential, increasingly used by adolescents without a doctor’s prescription. We examined the changing association between lifetime non-prescribed use of tranquillisers or sedatives and their prescribed use in European adolescents in 2003–2011. DESIGN – Cross-sectional data from 199,231 16-year-old students were collected through anonymous questionnaires administered in schools in 22 European countries participating in the European School Survey Project on Alcohol and Other Drugs (ESPAD in 2003, 2007 and 2011. RESULTS – Logistic regression analyses showed a modest increase in lifetime non-prescribed use of tranquillisers or sedatives (adjusted OR [AOR] = 1.08, 95% CI: 1.06–1.11, p < 0.001 and a decrease in prescribed use (AOR = 0.89, 95% CI: 0.87–0.91, p < 0.001 between 2003 and 2011. Adjusting for gender and survey year, any versus no prescribed use increased the odds tenfold for non-prescribed use (AOR = 10.15, 99% CI: 9.60–10.74, p < 0.001. Adjusting also for changes in cannabis use did not affect the strength of the association. Interactions of factors with survey year showed that between 2003 and 2011, there was an increase of 38% in the odds that tranquilliser or sedative misusers had not used these drugs also with a doctor’s prescription (AOR = 1.38, 99% CI: 1.28–1.50, p < 0.001. CONCLUSION – The waning strength of the association between prescribed and non-prescribed use of tranquillisers or sedatives among adolescents may suggest changes both in the patterns of use and the channels of diversion and access to this class of medication in Europe.

  17. The effects of pharmacist intervention on emergency department visits in patients 80 years and older : subgroup analyses by number of prescribed drugs and appropriate prescribing

    Anna Alassaad; Maria Bertilsson; Ulrika Gillespie; Johan Sundström; Margareta Hammarlund-Udenaes; Håkan Melhus

    2014-01-01

    Background: Clinical pharmacist interventions have been shown to have positive effect on occurrence of drug-related issues as well as on clinical outcomes. However, evidence about which patients benefiting most from the interventions is limited. We aimed to explore whether pharmacist intervention is equally effective in preventing emergency department (ED) visits in patients with few or many prescribed drugs and in those with different levels of inappropriate prescribing. Methods: Patient and...

  18. An Analysis of Personal Factors that Determine Carrie’s Self -Actual-ization in Sister Carrie

    YU Shuang-shuang

    2014-01-01

    In Dreiser’s novel Sister Carrie, the heroine Carrie’s self-actualizing natures are reflected in her self-actualization ef-fort. Those natures include the acceptance of reality and potential to be actress, etc., which play the crucial role of her star jour-ney and self-actualizing effort. Therefore, every woman should have the spiritual spirit;and, at the same time, pursue nobler spiri-tual life.

  19. Legal barriers to effective ecosystem management: exploring linkages between liability, regulations, and prescribed fire.

    Wonkka, Carissa L; Rogers, William E; Kreuter, Urs P

    2015-12-01

    Resistance to the use of prescribed fire is strong among many private land managers despite the advantages it offers for maintaining fire-adapted ecosystems. Even managers who are aware of the benefits of using prescribed fire as a management tool avoid using it, citing potential liability as a major reason for their aversion. Recognizing the importance of prescribed fire for ecosystem management and the constraints current statutory schemes impose on its use, several states in the United States have undertaken prescribed burn statutory reform. The stated purpose of these statutory reforms, often called "right to burn" or "prescribed burning" acts, is to encourage prescribed burning for resource protection, public safety, and land management. Our research assessed the consequences of prescribed burn statutory reform by identifying legal incentives and impediments to prescribed fire application for ecosystem restoration and management, as well as fuel reduction. Specifically, we explored the relationship between prescribed burning laws and decisions made by land managers by exploiting a geographic-based natural experiment to compare landowner-prescribed fire use in contiguous counties with different regulations and legal liability standards. Controlling for potentially confounding variables, we found that private landowners in counties with gross negligence liability standards burn significantly more hectares than those in counties with simple negligence standards (F6,72 = 4.16, P = 0.046). There was no difference in hectares burned on private land between counties with additional statutorily mandated regulatory requirements and those requiring only a permit to complete a prescribed burn (F6,72 = 1.42, P = 0.24) or between counties with burn ban exemptions for certified prescribed burn managers and those with no exemptions during burn bans (F6,72 = 1.39, P = 0.24). Lawmakers attempting to develop prescribed burning statutes to promote the safe use of prescribed fire

  20. Polypharmacy patterns: unravelling systematic associations between prescribed medications.

    Amaia Calderón-Larrañaga

    Full Text Available OBJECTIVES: The aim of this study was to demonstrate the existence of systematic associations in drug prescription that lead to the establishment of patterns of polypharmacy, and the clinical interpretation of the associations found in each pattern. METHODS: A cross-sectional study was conducted based on information obtained from electronic medical records and the primary care pharmacy database in 2008. An exploratory factor analysis of drug dispensing information regarding 79,089 adult patients was performed to identify the patterns of polypharmacy. The analysis was stratified by age and sex. RESULTS: Seven patterns of polypharmacy were identified, which may be classified depending on the type of disease they are intended to treat: cardiovascular, depression-anxiety, acute respiratory infection (ARI, chronic obstructive pulmonary disease (COPD, rhinitis-asthma, pain, and menopause. Some of these patterns revealed a clear clinical consistency and included drugs that are prescribed together for the same clinical indication (i.e., ARI and COPD patterns. Other patterns were more complex but also clinically consistent: in the cardiovascular pattern, drugs for the treatment of known risk factors-such as hypertension or dyslipidemia-were combined with other medications for the treatment of diabetes or established cardiovascular pathology (e.g., antiplatelet agents. Almost all of the patterns included drugs for preventing or treating potential side effects of other drugs in the same pattern. CONCLUSIONS: The present study demonstrated the existence of non-random associations in drug prescription, resulting in patterns of polypharmacy that are sound from the pharmacological and clinical viewpoints and that exist in a significant proportion of the population. This finding necessitates future longitudinal studies to confirm some of the proposed causal associations. The information discovered would further the development and/or adaptation of clinical

  1. Dispensing physicians and prescribing pharmacists: economic considerations for the UK.

    Ryan, M; Bond, C

    1994-01-01

    Recent years have seen an increase in the number of dispensing physicians in the UK. There have also been suggestions that legislation restricting certain drugs to prescription-only availability should be relaxed and that pharmacists should take a more active role in the provision of drugs. General medical practitioners and pharmacists have common ancestry in the medieval spicers, who dispensed medicines and offered medical advice. Rural practitioners have been allowed to dispense drugs since 1911. Physician dispensing can benefit patients via savings in time and the monetary cost of visiting a pharmacist, but it restricts drug choice, can compromise safety, and encourages overprescribing except for physicians with drugs budgets. The effects of physician dispensing on government costs are not yet clear. Over-the-counter (OTC) purchase can save patients the cost of a physician visit and reduce drug costs to some patients, but it can also provide an incentive to pharmacists to profit twice from a drug, at government expense. Switching drugs from prescription-only to OTC reduces the government drug bill, but provides an incentive to pharmacists to overprescribe, and may not be as safe for patients. Liberalising prescribing by doctors would discourage community pharmacies which provide an advisory service to patients. Liberalising OTC switches would reduce opportunistic assessment of patients by doctors and could compromise patient safety. Separation of physician and pharmacist functions is probably safer for patients. It is concluded that the current situation in the UK, whereby most dispensing is done by pharmacists, is the preferred option other than for those patients who do not live within easy access of a pharmacy. A reassessment of the legal status of drugs and subsequent OTC switch of drugs used to treat minor self-limiting illnesses is also favoured. PMID:10146862

  2. Prescribing for unlabeled conditions: patient benefit or therapeutic roulette?

    Serradell, J; Rucker, T D

    1990-01-01

    There is ample evidence that prescribed medications are employed for uses far broader than the approved label indications in the U.S. An enormous research agenda thus exists that should be addressed in the not-too-distant future. In fact, it seems essential that operation of the Medicare Catastrophic Drug Benefit program be designed with the best available knowledge in this area. Perhaps it might be appropriate for several universities, the U.S. Pharmacopeial Convention, and/or the FDA to establish a center to study this question. This model has been applied with clinical/surgical registries, with adverse reaction reporting, and with device failures. We need a rational, science-compatible, and uniform policy free of political and emotional arguments to address the issue of handling, monitoring, and regulating the use of drugs for unlabeled conditions. Comprehensive data should be provided for policy makers, regulators, payers, and clinicians in their evaluating the use of different drug products. Even a brief glance at any page from the National Disease and Therapeutic Index shows intended use that would cause most experts to react in disbelief. Further, there seem to be relatively few instances in which the use of a given pharmaceutical for an unlabeled indication would qualify as a drug of choice in the first place. The therapeutic and economic consequences of the use of legend drugs for unlabeled indications are difficult to document. We do know that a significant proportion of hospital admissions and days can be traced to the inappropriate use of pharmaceutical products but the net impact of our subject on institution cost has not been established.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10106657

  3. Long-term oxygen therapy: Are we prescribing appropriately?

    Mª Rosa Güell Rous

    2008-06-01

    Full Text Available Mª Rosa Güell RousDepartament de Pneumologia, Hospital de la Santa Creu I de Sant Pau, Barcelona, SpainAbstract: Long-term oxygen therapy (LTOT is the treatment proven to improve survival in chronic obstructive pulmonary disease (COPD patients with chronic respiratory failure. It also appears to reduce the number of hospitalizations, increase effort capacity, and improve health-related quality of life. Standard LTOT criteria are related to COPD patients who have PaO2 <60 mmHg, are in a clinical stable situation, and are receiving optimal pharmacological treatment. According to LTOT guidelines, oxygen should be prescribed for at least 18 hours per day although some authors consider 24 hours would be more beneficial. The benefits of LTOT depend on correction of hypoxemia. Arterial blood gases should be measured at rest. During exercise, an effort test should be done to assure adequate SaO2. During sleep, continuous monitoring of SaO2 and PaCO2 should be performed to confirm correction of SaO2 overnight. An arterial blood gas sample should be taken at awakening to assess PaCO2 in order to prevent hypoventilation from the oxygen therapy. Several issues that need to be addressed are the use of LTOT in COPD patients with moderate hypoxemia, the efficacy of LTOT in patients who desaturate during exercise or during sleep, the optimal dosage of oxygen supplementation, LTOT compliance, and the LTOT prescription in diseases other than COPD.Keywords: long-term oxygen therapy, COPD, oxygen supplementation, chronic respiratory failure, hypoxemia

  4. Acute oxygen therapy: a review of prescribing and delivery practices

    Cousins JL

    2016-05-01

    Full Text Available Joyce L Cousins,1–3 Peter AB Wark,3–5 Vanessa M McDonald2–5 1Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, Sydney, 2School of Nursing and Midwifery, 3Priority Research Centre for Healthy Lungs, 4School of Medicine and Public Health, The University of Newcastle, 5Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia Abstract: Oxygen is a commonly used drug in the clinical setting and like other drugs its use must be considered carefully. This is particularly true for those patients who are at risk of type II respiratory failure in whom the risk of hypercapnia is well established. In recent times, several international bodies have advocated for the prescription of oxygen therapy in an attempt to reduce this risk in vulnerable patient groups. Despite this guidance, published data have demonstrated that there has been poor uptake of these recommendations. Multiple interventions have been tested to improve concordance, and while some of these interventions show promise, the sustainability of these interventions are less convincing. In this review, we summarize data that have been published on the prevalence of oxygen prescription and the accurate and appropriate administration of this drug therapy. We also identify strategies that have shown promise in facilitating changes to oxygen prescription and delivery practice. There is a clear need to investigate the barriers, facilitators, and attitudes of clinicians in relation to the prescription of oxygen therapy in acute care. Interventions based on these findings then need to be designed and tested to facilitate the application of evidence-based guidelines to support sustained changes in practice, and ultimately improve patient care. Keywords: chronic obstructive pulmonary disease, COPD, type II respiratory failure, oxygen therapy, prescribing, hypoxia, hypercapnia

  5. Notification prescribing the quantities of radioisotopes and others

    The notification is wholly revised under the order and the regulations for enforcing the law concerning prevention from radiation hazards due to radioisotopes. The concentration of isotopes emitting radiation shall be 0.002 micro-curie per gram. When not tightly sealed, the quantity of such isotopes shall be 0.1 micro-curie for strontium 90 and isotopes emitting alpha rays, 1 micro-curie for isotopes emitting radiation with half-life of more than 30 days, 10 micro-curie for isotopes emitting radiation with half-life of less than 30 days and 100 micro-curie for Hydrogen 3, Beryllium 7, Carbon 14, Fluorine 18, etc. The quantity of isotopes shall be more than 10 curie for those with automatic indicators and more than 3,000 curie for those interlocked. In the controlled area the permissible dose of exterior radiation is 30 mili-rem for a week. The maximum permissible exposure dose for the workers engaged in radiation business is 3 rem for 3 months. The maximum permissible accumulative dose for such workers is a figure (unit rem) calculated by a formula D = 5(N-18), when D means the permissible accumulative dose and N number of the age. The permissible exposure dose is 12 rem for the urgent work and 1.5 rem for a year for the persons who enter into the controlled area on business. The maximum permissible density in the air, under water and on the surface, etc. are in detail prescribed with tables attached. (Okada, K.)

  6. Facebook as a Library Tool: Perceived vs. Actual Use

    Jacobson, Terra B.

    2011-01-01

    As Facebook has come to dominate the social networking site arena, more libraries have created their own library pages on Facebook to create library awareness and to function as a marketing tool. This paper examines reported versus actual use of Facebook in libraries to identify discrepancies between intended goals and actual use. The results of a…

  7. The Self-Actualization of Polk Community College Students.

    Pearsall, Howard E.; Thompson, Paul V., Jr.

    This article investigates the concept of self-actualization introduced by Abraham Maslow (1954). A summary of Maslow's Needs Hierarchy, along with a description of the characteristics of the self-actualized person, is presented. An analysis of humanistic education reveals it has much to offer as a means of promoting the principles of…

  8. Self-actualization: Its Use and Misuse in Teacher Education.

    Ivie, Stanley D.

    1982-01-01

    The writings of Abraham Maslow are analyzed to determine the meaning of the psychological term "self-actualization." After pointing out that self-actualization is a rare quality and that it has little to do with formal education, the author concludes that the concept has little practical relevance for teacher education. (PP)

  9. School Guidance Counselors' Perceptions of Actual and Preferred Job Duties

    Edwards, John Dexter

    2010-01-01

    The purpose of this study was to provide process data for school counselors, administrators, and the public, regarding school counselors' actual roles within the guidance counselor preferred job duties and actual job duties. In addition, factors including National Certification or no National Certification, years of counseling experience, and…

  10. 12 CFR 1806.203 - Selection Process, actual award amounts.

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Selection Process, actual award amounts. 1806... OF THE TREASURY BANK ENTERPRISE AWARD PROGRAM Awards § 1806.203 Selection Process, actual award... round: (1) To select Applicants not previously selected, using the calculation and selection...

  11. 25 CFR 900.54 - Should the property management system prescribe internal controls?

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Should the property management system prescribe internal... System Standards § 900.54 Should the property management system prescribe internal controls? Yes. Effective internal controls should include procedures: (a) For the conduct of periodic inventories; (b)...

  12. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices.

    Kennelly, S

    2011-10-01

    Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later.

  13. Trends in co-prescribing of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in Ireland.

    Wan Md Adnan, Wan A H

    2011-03-01

    (i) To examine the trends in co-prescribing of angiotensin converting enzyme inhibitor (ACEI) and angiotensin-II receptor blocker (ARB) therapy and (ii) to examine the influence of major clinical trials (CALM, COOPERATE, VALIANT and ONTARGET) on co-prescribing.

  14. Salient beliefs and intentions to prescribe antibiotics for patients with a sore throat.

    Walker, A. E.; Grimshaw, J. M.; Armstrong, E. M.

    2001-11-01

    OBJECTIVES: General practitioners (GPs) in the UK continue to prescribe antibiotics for patients with sore throats despite evidence that they are ineffective and can contribute to the growth of antibiotic resistance in the population. This study uses the theory of planned behaviour (TPB) to investigate the strength of intention to prescribe antibiotics, and to identify the salient beliefs associated with this intention. DESIGN: Cross-sectional study testing hypotheses derived from the TPB. METHOD: A 66-item postal questionnaire was distributed to a random sample of GPs in one NHS region (N = 185). The questionnaire included measures of intention to prescribe antibiotics, attitude, behavioural beliefs and evaluations, normative beliefs and evaluations, perceived behavioural control, control beliefs, and past prescribing. RESULTS: Two-thirds of the GPs returned complete questionnaires (N = 126, 68%). The majority intended to prescribe antibiotics for less than half of their patients with sore throats (N = 69, 55%). The variables specified in TPB predicted 48% of the variance in intention, with past behaviour adding a further 15%. Seven salient beliefs distinguished between doctors who intend to prescribe antibiotics and those who do not. CONCLUSIONS: Attitudes towards antibiotics and control beliefs are important predictors of intention to prescribe, as predicted by TPB. Interventions could target salient beliefs associated with motivation to prescribe. PMID:12614509

  15. Volume-constrained minimizers for the prescribed curvature problem in periodic media

    Goldman, Michael

    2011-01-01

    We establish existence of compact minimizers of the prescribed mean curvature problem with volume constraint in periodic media. As a consequence, we construct compact approximate solutions to the prescribed mean curvature equation. We also show convergence after rescaling of the volume-constrained minimizers towards a suitable Wulff Shape, when the volume tends to infinity.

  16. 7 CFR 1767.13 - Departures from the prescribed RUS Uniform System of Accounts.

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false Departures from the prescribed RUS Uniform System of...) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) ACCOUNTING REQUIREMENTS FOR RUS ELECTRIC BORROWERS Uniform System of Accounts § 1767.13 Departures from the prescribed RUS Uniform System of...

  17. Is self-medication with antibiotics in Europe driven by prescribed use?

    Grigoryan, Larissa; Burgerhof, Johannes G. M.; Haaijer-Ruskamp, Flora M.; Degener, John E.; Deschepper, Reginald; Monnet, Dominique L.; Di Matteo, Antonella; Scicluna, Elizabeth A.; Bara, Ana-Claudia; Lundborg, Cecilia Stalsby; Birkin, Joan

    2007-01-01

    Background: Self-medication with antibiotics may increase the risk of inappropriate use and the selection of resistant bacteria. One of the triggers for using self-medication may be past experience with antibiotics prescribed by health professionals. We examined the association between prescribed us

  18. Prescribing pattern in orthopedics outpatient department of a medical college in India

    Indranil Banerjee

    2015-12-01

    Conclusion: The current piece of work pointed out certain lacunae in the prescribing practices of the orthopedicians of the institute as evidenced by low generic prescribing, inadequate information about the duration of therapy and frequency of administration in many prescriptions. [Int J Basic Clin Pharmacol 2015; 4(6.000: 1175-1177

  19. Pharmaceutical care and its relationship to prescribing behaviour of general practitioners.

    Muijrers, P.E.; Grol, R.P.T.M.; Sijbrandij, J.; Janknegt, R.; Knottnerus, J.A.

    2006-01-01

    OBJECTIVE: To study the correlation between pharmaceutical care and prescribing routines of general practitioners (GPs). METHODS: Cross-sectional study; 201 pharmacies, 408 general practices, The Netherlands, 2000/2001. The variation in prescribing behaviour was characterised using 20 validated pres

  20. Antibiotic Prescribing Review as a Component of an Infectious Disease Course.

    Speedie, Marilyn K.; And Others

    1979-01-01

    The review of physician-prescribing is recognized as an important function for pharmacists. It is suggested that a course aimed at antibiotic drug prescribing review (DPR) would provide the opportunity to reinforce and apply the principles of DPR and to demonstrate how theoretical knowledge of antibiotics could be applied directly to practice.…

  1. Encouraging good antimicrobial prescribing practice: A review of antibiotic prescribing policies used in the South East Region of England

    Mayon White Richard T

    2001-05-01

    Full Text Available Abstract Background Good prescribing practice has an important part to play in the fight against antimicrobial resistance. Whilst it was perceived that most hospitals and Health Authorities possessed an antibiotic policy, a review of antibiotic policies was conducted to gain an understanding of the extent, quality and usefulness of these policies. Methods Letters were sent to pharmacists in hospitals and health authorities in across the South East region of the National Health Service Executive (NHSE requesting antibiotic policies. data were extracted from the policies to assess four areas; antibiotic specific, condition specific, patient specific issues and underpinning evidence. Results Of a possible 41 hospital trusts and 14 health authorities, 33 trusts and 9 health authorities (HAs provided policies. Both trust and HA policies had a median publication date of 1998 (trust range 1993-99, HA 1994-99. Eleven policies were undated. The majority of policies had no supporting references for the statements made. All policies provided some details on specific antibiotics. Gentamicin and ciprofloxacin were the preferred aminoglycoside and quinolone respectively with cephalosporins being represented by cefuroxime or cefotaxime in trusts and cephradine or cephalexin in HAs. 26 trusts provided advice on surgical prophylaxis, 17 had meningococcal prophylaxis policies and 11 covered methicillin resistant Staphylococcus aureus (MRSA. There was little information for certain groups such as neonates or children, the pregnant or the elderly. Conclusion There was considerable variation in content and quality across policies, a clear lack of an evidence base and a need to revise policies in line with current recommendations.

  2. An audit of prescribing practices for benzodiazepines and Z-drugs.

    Cadogan, C

    2015-03-01

    Concerns persist over the use of benzodiazepines and Z-drugs in Ireland. A prospective prescription audit was conducted in 81 community pharmacies across Ireland over a four week period. The study sought to assess the level of prescription compliance with key components of benzodiazepine and Z-drug prescribing guidelines. 28% of audit booklets issued were returned, yielding data on 4,418 prescriptions. The findings suggest that little progress has been made in improving the prescribing of benzodiazepines and Z-drugs in Ireland in the decade since publication of the Benzodiazepine Committee\\'s report. Fewer than one fifth of prescriptions (18.8%) were fully compliant with the assessment criteria and the majority (53.7%) had multiple discrepancies. This study highlights the importance of monitoring and auditing benzodiazepine and Z-drug prescribing practices. Interventions involving patients, prescribers and pharmacists are required to improve the prescribing and use of these medications in Ireland.

  3. Factors Influencing Successful Prescribing by Intern Doctors: A Qualitative Systematic Review

    Christina R. Hansen

    2016-08-01

    Full Text Available As the majority of prescribing in hospital is undertaken by intern doctors, the aims of this systematic review were to compile the evidence of the qualitative literature on the views and experiences of intern doctors and to examine the role of the pharmacist in assisting in prescribing by interns. A systematic review of the qualitative literature was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement. The findings were synthesized using thematic analysis. Seven publications were included. Factors influencing prescribing behaviour were related to the environment; collaboration in medical teams; hierarchical structures; and patient and individual factors. This review confirmed that interns’ prescribing behaviour is influenced by multiple factors, and further highlighted the need for an educational intervention that supports the intern completing the prescribing task in a complex environment, and not just addresses the presumed knowledge gap(s.

  4. Rapidly increasing prescribing of proton pump inhibitors in primary care despite interventions

    Haastrup, Peter; Paulsen, Maja Skov; Zwisler, Jon Eik;

    2014-01-01

    and 2011 and association with age and gender of users along with the impact of interventions on the prescribing of drug subgroups are analysed. Results: 96.8% of all antisecretory drugs sold are proton pump inhibitors (PPIs) and 94.4% of the PPIs are prescribed in primary care. Prescribing of PPIs has...... increased substantially during the past decade. Both number of users and the average individual use have increased. The prescribing of ulcerogenic drugs to the elderly has stagnated in the same time range. Reimbursement modifications and scientific guidelines do not seem to have had a substantial influence...... on the steadily increasing prescribing of PPIs. Conclusion: Use of PPIs has increased substantially during the past decade, without a change in indications for use of PPIs in the same time range. Interventions to enhance adherence to guidelines and promote rational use of PPIs do not seem to have had...

  5. Dispensing of non-prescribed antibiotics in Jordan

    Almaaytah A

    2015-09-01

    without prescription in Jordan in violation with national regulations regarding this practice. The findings of this study could provide a layout for governmental health authorities to implement strict enfrorcment of national regulations regarding antibiotic dispensing in order to avoid the serious complications that could arise in the future as a result of such practices. Keywords: pharmacy, pharmacy practice, non-prescribed antibiotics, microbial resistance, Jordan

  6. Biological denitrification of high sodium nitrate bearing actual reprocessing waste

    High nitrate bearing alkaline waste solution of reprocessing plant origin was decontaminated by adopting an ion exchange followed by a chemical treatment based process. The resulting effluent was then subjected to nitrate removal by biodenitrification. A flow through bioreactor provided with stainless steel modules as support for biomass growth was setup and the biomass in reactor was acclimatized to a NaNO3 solution of concentration level comparable to actual effluents. The bioreactor was used for denitrification of the actual effluent in continuous mode and complete denitrification of the actual reprocessing waste solution containing 17,500 ppm of nitrate has been successfully demonstrated. (author)

  7. A STUDY ON SELF-ACTUALIZATION OF HIGHER SECONDARY STUDENTS

    Mahendran. T

    2015-10-01

    Full Text Available The aim of the present study is to find out the level of self-actualization of higher secondary students. Selfactualization has been variously thought of a need, a cognitive style, trait of a life process etc. It may either cover one or more such components. Normative survey method has been used and by using simple random sampling technique 652 students were selected from Cuddalore district educational district, Tamilnadu, India. Gathered data was analyzed by using the statistical techniques. The results show that the level of self-actualization is average and there is significant difference in the self-actualization scores based on locality of school and parental income.

  8. Actual competition, potential competition, and bank profitability in rural markets

    Gary Whalen

    1988-01-01

    An empirical study of the relationship between market concentration and bank performance in rural markets, examining both actual and potential competition and controlling for risk, market share, and simultaneity.

  9. The antecedents of herbal product actual purchase in Malaysia

    Sarina Ismail

    2015-08-01

    Full Text Available This study is meant to examine the relationships of several antecedents of actual purchase of herbal product in Malaysia. Actual purchase is considered to have a vital link to a business success. The study identified eight antecedents of consumer actual purchase such as intention, attitude, social influence, product safety and culture belief. A total of 473 respondents (about 82% completed and returned the questionnaire. A seven point Likert scale was used to measure responses. The data were analyzed using Partial Least Squares (PLS path modeling. The path coefficient results supported the direct influence of intention, attitude, social influence and product safety on actual buying. Moreover, the findings reveal that attitude, social influence, product safety, and culture belief also influenced buying intention.

  10. BAP Position Statement: Off-label prescribing of psychotropic medication to children and adolescents.

    Sharma, Aditya N; Arango, Celso; Coghill, David; Gringras, Paul; Nutt, David J; Pratt, Peter; Young, Allan H; Hollis, Chris

    2016-05-01

    The off-label use of medicines for children and adolescents remains a common and important issue for prescribing practice across child and adolescent psychiatry, paediatrics and primary care. This editorial focusses on psychotropic drug treatment, which plays an essential part in the comprehensive management of a range of child and adolescent psychiatric disorders. Despite a growing evidence base for drug treatment in child and adolescent psychiatric disorders, much psychotropic medication continues to be prescribed off-label (i.e. outside the limits of the marketing authorisation or product license). The reasons for and implications of off-label prescribing, including the potential clinical benefits/risks and medico-legal implications, are often poorly understood by both patients and prescribers. An important unintended consequence of the uncertainties and confusion surrounding the status of off-label prescribing for children and adolescents may be that effective drug treatments are being withheld or underused. This BAP Position Statement aims to clarify these issues, challenge some of the myths surrounding off-label prescribing for children and adolescents and offer practical guidance for prescribers. PMID:27098018

  11. Antibiotics prescribing practices in oral implantology among jordanian dentists. A cross sectional, observational study

    Hamdan Ahmad AS

    2011-07-01

    Full Text Available Abstract Background In oral implantology, there is no consensus on the most appropriate regimen for antibiotics prescribing, the decision to prescribe antibiotic is usually based on procedure, patient and clinician related factors. The aim of this study was to investigate the rationale of antibiotic prescribing among Jordanian clinicians who practice oral implantology. Findings The target sample for the study was the 250 Jordan Dental Implant Group members. A five page questionnaire contained 41 questions, both closed and open questions were used to collect data. Statistical analysis was performed using SPSS Windows 16.0 (SPSS Inc., Chicago, IL, USA. Descriptive statistics were generated. The response rate was (70.4% 176/250. Mean age was 37.2 yrs, 49.4% always prescribe antibiotics mainly oral amoxicillin and amoxicillin with clavulinic acid. Antibiotics prescribing increased with flap raising, multiple implants and sinus or bone augmentation. Patient medical condition, periodontitis and oral hygiene were the most important clinical factors in antibiotic prescribing, non-clinical factors were; reading scientific materials, courses and lectures, knowledge gained during training, and the effectiveness and previous experience with the drug. Conclusions Wide variations in antibiotics types, routes, dose and duration of administration were found. Recommendations on antibiotic prescribing are needed to prevent antibiotic overprescribing and misuse.

  12. Antibiotic prescribing in DR Congo: a knowledge, attitude and practice survey among medical doctors and students.

    Kamala Thriemer

    Full Text Available OBJECTIVES: Antibiotic resistance (ABR particularly hits resource poor countries, and is fuelled by irrational antibiotic (AB prescribing. We surveyed knowledge, attitudes and practices of AB prescribing among medical students and doctors in Kisangani, DR Congo. METHODS: Self-administered questionnaires. RESULTS: A total of 184 questionnaires were completed (response rate 94.4%. Knowledge about AB was low (mean score 4.9/8 points, as was the estimation of local resistance rates of S. Typhi and Klebsiella spp.(correct by 42.5% and 6.9% of respondents respectively. ABR was recognized as a problem though less in their own practice (67.4% than nation- or worldwide (92.9% and 85.5%, p<.0001. Confidence in AB prescribing was high (88.6% and students consulted more frequently colleagues than medical doctors when prescribing (25.4% versus 11.6%, p= 0.19. Sources of AB prescribing included pharmaceutical companies (73.9%, antibiotic guidelines (66.3%, university courses (63.6%, internet-sites (45.7% and WHO guidelines (26.6%. Only 30.4% and 16.3% respondents perceived AB procured through the central procurement and local pharmacies as of good quality. Local AB guidelines and courses about AB prescribing are welcomed (73.4% and 98.8% respectively. CONCLUSIONS: This data shows the need for interventions that support rational AB prescribing.

  13. Preparing to prescribe: How do clerkship students learn in the midst of complexity?

    McLellan, Lucy; Yardley, Sarah; Norris, Ben; de Bruin, Anique; Tully, Mary P; Dornan, Tim

    2015-12-01

    Prescribing tasks, which involve pharmacological knowledge, clinical decision-making and practical skill, take place within unpredictable social environments and involve interactions within and between endlessly changing health care teams. Despite this, curriculum designers commonly assume them to be simple to learn and perform. This research used mixed methods to explore how undergraduate medical students learn to prescribe in the 'real world'. It was informed by cognitive psychology, sociocultural theory, and systems thinking. We found that learning to prescribe occurs as a dynamic series of socially negotiated interactions within and between individuals, communities and environments. As well as a thematic analysis, we developed a framework of three conceptual spaces in which learning opportunities for prescribing occur. This illustrates a complex systems view of prescribing education and defines three major system components: the "social space", where the environmental conditions influence or bring about a learning experience; the "process space", describing what happens during the learning experience; and the intra-personal "cognitive space", where the learner may develop aspects of prescribing expertise. This conceptualisation broadens the scope of inquiry of prescribing education research by highlighting the complex interplay between individual and social dimensions of learning. This perspective is also likely to be relevant to students' learning of other clinical competencies. PMID:25980553

  14. Causes and consequences of e-prescribing errors in community pharmacies

    Abramson EL

    2015-05-01

    Full Text Available Erika L Abramson Departments of Pediatrics and Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Abstract: Major national policy forces are promoting the adoption and use of health information technology (health IT to improve the quality, safety, and efficiency of health care delivery. One such health IT is electronic prescribing (e-prescribing, which is the direct transmission of prescription information from a provider to a pharmacy. Given research showing that handwritten prescriptions are unsafe and associated errors can lead to tremendous inefficiency for patients and pharmacists, e-prescribing has many potential benefits. However, as with the introduction of any new technology, unintended, adverse consequences may result. The purpose of this review is to explore the causes and consequences of e-prescribing errors in community pharmacies, which are pharmacies not affiliated with a hospital or clinic. Many new types of errors – including provider order entry errors, transcription errors, and dispensing errors – appear to result from e-prescribing. These lead to important consequences for pharmacies, including safety threats to patients, reduced efficiency for pharmacists, processing delays, and increased pharmacy cost. Increased attention to system design and pharmacist training, as well as additional research in this area, will be critical to realize the full benefits of e-prescribing. Keywords: electronic prescribing, medication errors, community pharmacies 

  15. Effect of actual vapor pressure on estimating evapotranspiration at Serbia

    Trajković Slaviša; Živković Svetlana

    2009-01-01

    Actual vapor pressure (VP) is an important parameter that is used in many evapotranspiration equations. However, vapor pressure is difficult to measure accurately. In the humid climate, the actual vapor pressure can be derived from minimum air temperature. The objectives of this study were: first, to estimate errors that can arise if VP data are not available and have to be estimated; second, to compare the Priestley-Taylor ET0 values computed under various levels of VP data availability; and...

  16. Actual Versus Perceived Risk of Victimization and Handgun Ownership

    Elpi, Clara Maria

    2011-01-01

    This study tested the hypotheses that perceived risk of victimization had a stronger effect than actual exposure to victimization risk on handgun ownership and that this relationship was stronger for women than men. Perceived and actual risks of victimization have been discussed with respect to handgun ownership, but a general consensus in the literature was lacking and recent empirical research was scarce. Crime rates and respondentsâ social characteristics were used as proxy measures for ...

  17. Psychosocial predictors of actual turnover among Belgian health care workers

    Derycke, Hanne; Vlerick, Peter; Clays, Els; D'hoore, William; Braeckman, Lutgart

    2010-01-01

    Background: Turnover of nursing staff is a major challenge for healthcare settings and for healthcare in general, urging the need to improve retention. Aim: The aim was to explore the prospective relations between personal and psychosocial work-related factors and actual turnover among Belgian healthcare workers. Methods: Predictors of actual turnover were assessed using the longitudinal Belgian data from the Nurses Early Exit Study (NEXT). Two self-administered questionnaires with a time...

  18. Physician Payments from Industry Are Associated with Greater Medicare Part D Prescribing Costs

    Perlis, Roy H.; Perlis, Clifford S.

    2016-01-01

    Background The U.S. Physician Payments Sunshine Act mandates the reporting of payments or items of value received by physicians from drug, medical device, and biological agent manufacturers. The impact of these payments on physician prescribing has not been examined at large scale. Methods We linked public Medicare Part D prescribing data and Sunshine Act data for 2013. Physician payments were examined descriptively within specialties, and then for association with prescribing costs and patterns using regression models. Models were adjusted for potential physician-level confounding features, including sex, geographic region, and practice size. Results Among 725,169 individuals with Medicare prescribing data, 341,644 had documented payments in the OPP data (47.1%). Among all physicians receiving funds, mean payment was $1750 (SD $28336); median was $138 (IQR $48-$394). Across the 12 specialties examined, a dose-response relationship was observed in which greater payments were associated with greater prescribing costs per patient. In adjusted regression models, being in the top quintile of payment receipt was associated with incremental prescribing cost per patient ranging from $27 (general surgery) to $2931 (neurology). Similar associations were observed with proportion of branded prescriptions written. Conclusions While distribution and amount of payments differed widely across medical specialties, for each of the 12 specialties examined the receipt of payments was associated with greater prescribing costs per patient, and greater proportion of branded medication prescribing. We cannot infer a causal relationship, but interventions aimed at those physicians receiving the most payments may present an opportunity to address prescribing costs in the US. PMID:27183221

  19. Prescribing Pattern in Outpatient Departments of Two Tertiary Care Teaching Hospitals in Dhaka

    Halima Begum

    2015-09-01

    Full Text Available Background: Medically inappropriate, ineffective and economically inefficient use of drugs is very common in our country. About 40% or more drugs expenditure may be wasted through irrational prescribing and dispensing. The need for promoting rational use of drugs is not only because of economic considerations; also it is an essential element for achieving quality of the health and medical care for patients and the community. For this purpose a cross sectional study was carried out among the individuals attending the outpatient departments (OPD of Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Orthopedics, Dermatology & Venereology, Ophthalmology and Otolaryngology of two tertiary care teaching hospitals of Dhaka, Bangladesh. Objective: To observe the prescribing pattern in outpatient departments of two tertiary care teaching hospitals (Dhaka by using World Health Organization (WHO core prescribing indicators. Materials and Methods: Six hundred prescriptions of patients attending the OPD of Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Orthopedics, Dermatology & Venereology, Ophthalmology and Otolaryngology of Enam Medical College Hospital (private hospital and Sir Salimullah Medical College Hospital (public hospital were collected randomly on working days from April to September 2014. Then the prescriptions were analyzed by following the “Prescribing indicators form” as recommended by the International Organization of Rational Use of Drugs (INRUD/WHO. Results: Average number of drugs per prescription was significantly high (3.07 in public hospital and 3.00 in private hospital. Generic prescribing was significantly lower in private hospital (4.00% than that in public hospital (21.00%. Antibiotic prescription was higher in private hospital (42.35%. Injection prescribed in public hospital was 5.74% whereas 5.66% in private hospital. Drugs prescribed from Essential Drug List of Bangladesh were less in both the hospitals (42

  20. What are the perceived learning needs of Australian general practice registrars for quality prescribing?

    Aslani Parisa

    2010-12-01

    Full Text Available Abstract Background Little is known about the perceived learning needs of Australian general practice (GP registrars in relation to the quality use of medicines (QUM or the difficulties experienced when learning to prescribe. This study aimed to address this gap. Methods GP registrars' perceived learning needs were investigated through an online national survey, interviews and focus groups. Medical educators' perceptions were canvassed in semi-structured interviews in order to gain a broader perspective of the registrars' needs. Qualitative data analysis was informed by a systematic framework method involving a number of stages. Survey data were analysed descriptively. Results The two most commonly attended QUM educational activities took place in the workplace and through regional training providers. Outside of these structured educational activities, registrars learned to prescribe mainly through social and situated means. Difficulties encountered by GP registrars included the transition from hospital prescribing to prescribing in the GP context, judging how well they were prescribing and identifying appropriate and efficient sources of information at the point of care. Conclusions GP registrars learn to prescribe primarily and opportunistically in the workplace. Despite many resources being expended on the provision of guidelines, decision-support systems and training, GP registrars expressed difficulties related to QUM. Ways of easing the transition into GP and of managing the information 'overload' related to medicines (and prescribing in an evidence-guided, efficient and timely manner are needed. GP registrars should be provided with explicit feedback about the process and outcomes of prescribing decisions, including the use of audits, in order to improve their ability to judge their own prescribing.