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Sample records for actual beta-blocker prescribing

  1. Self-reported and actual beta-blocker prescribing for heart failure patients: physician predictors.

    Directory of Open Access Journals (Sweden)

    Sanjai Sinha

    Full Text Available BACKGROUND: Beta-blockers reduce mortality among patients with systolic heart failure (HF, yet primary care provider prescription rates remain low. OBJECTIVE: To examine the association between primary care physician characteristics and both self-reported and actual prescription of beta-blockers among patients with systolic HF. DESIGN: Cross-sectional survey with supplementary retrospective chart review. PARTICIPANTS: Primary care providers at three New York City Veterans Affairs medical centers. MEASUREMENTS: MAIN OUTCOMES WERE: 1 self-reported prescribing of beta-blockers, and 2 actual prescribing of beta-blockers among HF patients. Physician HF practice patterns and confidence levels, as well as socio-demographic and clinical characteristics, were also assessed. RESULTS: Sixty-nine of 101 physicians (68% completed the survey examining self-reported prescribing of beta-blockers. Physicians who served as inpatient ward attendings self-reported significantly higher rates of beta-blocker prescribing among their HF patients when compared with physicians who did not attend (78% vs. 58%; p = 0.002, as did physicians who were very confident in managing HF patients when compared with physicians who were not (82% vs. 68%; p = 0.009. Fifty-one of these 69 surveyed physicians (74% were successfully matched to 287 HF patients for whom beta-blocker prescribing data was available. Physicians with greater self-reported rates of prescribing beta-blockers were significantly more likely to actually prescribe beta-blockers (p = 0.02; however, no other physician characteristics were significantly associated with actual prescribing of beta-blockers among HF patients. CONCLUSIONS: Physician teaching responsibilities and confidence levels were associated with self-reported beta-blocker prescribing among their HF patients. Educational efforts focused on improving confidence levels in HF care and increasing exposure to teaching may improve beta-blocker presciption in

  2. PRACTICE OF PRESCRIBING BETA-BLOCKERS AND ITS COMPLIANCE WITH CLINICAL GUIDELINES ACCORDING TO TWO REGISTERS OF CARDIOVASCULAR DISEASES

    Directory of Open Access Journals (Sweden)

    S. Yu. Martsevich

    2016-01-01

    Full Text Available  Aim. To assess real clinical practice of prescribing beta-blockers (BB and its compliance with updated guidelines, using data from outpatient registers that are carried out in medical institutions of different levels. Material and methods. We analyzed data from two outpatient registries - RECVASA and PROFILE. RECVASA register included patients aged ≥18 years with arterial hypertension (HT, ischemic heart disease (IHD, chronic heart failure (CHF and atrial fibrillation (AF that consulted in 3 outpatient clinics of Ryazan city in 2012-2013 (n=3690. PROFILE register included patients aged ≥18 years with HT, IHD, CHF, AF that consulted in specialized cardiac unit of the State Research Center for Preventive Medicine in 2011-2015 (n=1531. Results. There were differences in the basic characteristics of the registers: in the RECVASA register average age of patients was higher, HT, IHD and CHF were more frequent; PROFILE register included more patients with the history of myocardial infarction. In the RECVASA register 41.5% (n=1533 of patients received BB, and in the PROFILE register – 47.7% (n=731. The most frequently prescribed BB was bisoprolol in all cardiovascular diseases. Conclusion. In a specialized medical institution BB used more often under the conditions where they are necessary. The choice of a specific BB inside the pharmacological group, even in a specialized medical institution does not always correspond to clinical guidelines and evidence-based medicine.

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

    NARCIS (Netherlands)

    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

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

    OpenAIRE

    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.

  5. How Do Beta Blocker Drugs Affect Exercise?

    Science.gov (United States)

    ... 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 ...

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

    DEFF Research Database (Denmark)

    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

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    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

    Energy Technology Data Exchange (ETDEWEB)

    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

    OpenAIRE

    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

    NARCIS (Netherlands)

    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

    NARCIS (Netherlands)

    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. Use of beta blockers in various clinical states

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    ... 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 ...

  14. Use of beta blockers in various clinical states

    OpenAIRE

    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.

    Science.gov (United States)

    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. Beta-blockers in cirrhosis and refractory ascites

    DEFF Research Database (Denmark)

    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....

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

    DEFF Research Database (Denmark)

    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...

  18. Review of topical beta blockers as treatment for infantile hemangiomas.

    Science.gov (United States)

    Painter, Sally L; Hildebrand, Göran Darius

    2016-01-01

    The treatment of infantile hemangiomas changed from the use of oral corticosteroids to oral propranolol on the serendipitous discovery of propanolol's clinical effectiveness in 2008. Since then, clinicians have begun to use topical beta blockers--in particular, timolol maleate 0.5% gel forming solution--with good effect. Topical beta blockers are now used for lesions with both deep and superficial components and those that are amblyogenic. When initiated in the proliferative phase of the lesion, the effectiveness of the treatment can be seen within days. There is no consensus on dosing, treatment bioavailability, or clinical assessment of lesions, but these are topics for future research.

  19. Beta-blocker therapy: identification and management of side effects.

    Science.gov (United States)

    Dennis, K E; Froman, D; Morrison, A S; Holmes, K D; Howes, D G

    1991-09-01

    The purpose of this study was to develop and test a new beta-Blocker Visual Analog Scale designed to identify and quantify the impact that the side effects of beta-blocker therapy have on people's lives, and the self-management practices people use to mediate their influence. Instruments included the 20-item beta-Blocker Visual Analog Scale and the Profile of Mood States. Subjects had hypertension; 51 men were involved in a larger study involving antihypertensive medications and exercise, and 19 men and women were receiving beta-blocker therapy as first-line drug of choice. Estimates of internal consistency reliability, content validity, and concurrent and discriminant validity were moderately strong. The most problematic side effects were related to lack of sleep, vivid or active dreams, lack of energy and pep, diminished interest in sexual activity, and changes in vision. Among self-management practices used to mediate side effects were planning rest and activity periods, thinking carefully before reacting, and seeking out others for support. PMID:1680114

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

    DEFF Research Database (Denmark)

    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...

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

    OpenAIRE

    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.

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

    NARCIS (Netherlands)

    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

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

    OpenAIRE

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. "Oral ascorbic acid in combination with beta blockers in prevention of atrial fibrillation after Coronary Artery Bypass Graft "

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    Mousavi M

    2007-04-01

    Full Text Available Background: Adrenergic beta antagonists are not sufficient to prevent atrial fibrillation after coronary artery bypass graft (CABG. This study was designed to evaluate the effect of ascorbic acid as an adjunct to beta-blockers in prevention of post-CABG atrial fibrillation Methods: Patients who were more than 50 years old and scheduled to undergo CABG were included if they were treated with beta-blockers at least 1 week before surgery. Patients with previous history of atrial fibrillation, AV block, heart rate <50 /min, end-stage renal disease, severe pulmonary or liver disease and those who were taking digoxin or class I and III anti-arrhythmics or had pacemakers were not included. Ascorbic acid group were prescribed 2 gm of ascorbic acid, the night before the surgery, and 1 gm twice daily for 5 days after surgery. Beta blockers continued in both group after surgery. Telemetry monitoring was performed in ICU and Holter monitoring was performed for 4 days. Results: Fifty patients completed the study as ascorbic acid and 50 as control group. The population was 60.19 ± 7.14 years old and 67% were male. The incidence of postoperative atrial fibrillation was 4% in the ascorbic acid group and 26% in control group (odds ratio=0.119, 95% confidence interval: 0.025 to 0.558, P=0.002 Conclusion: Ascorbic acid is well-tolerated, relatively safe and seems effective. Therefore it can be prescribed as an adjunct to beta-blockers for prophylaxis of post-CABG atrial fibrillation.

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

    DEFF Research Database (Denmark)

    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....

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

    NARCIS (Netherlands)

    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

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

    NARCIS (Netherlands)

    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

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

    DEFF Research Database (Denmark)

    Høgh, A.; Lindholt, J.S.; Nielsen, Henrik;

    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....

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

    DEFF Research Database (Denmark)

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

    DEFF Research Database (Denmark)

    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....

  12. Impact of Beta-Blockers on Nonhead Injured Trauma Patients.

    Science.gov (United States)

    Hendrick, Leah E; Schroeppel, Thomas J; Sharpe, John P; Alsbrook, Diana; Magnotti, Louis J; Weinberg, Jordan A; Johnson, Benjamin P; Lewis, Richard H; Clement, L Paige; Croce, Martin A; Fabian, Timothy C

    2016-07-01

    Catecholamine surge after traumatic injury may lead to dysautonomia with increased morbidity. Small retrospective studies have shown potential benefit of beta-blockers (BB) in trauma patients with and without traumatic brain injury (TBI). This study evaluates a large multiply injured cohort without TBI that received BB. Patients were identified from the trauma registry from January 1, 2003 to December 31, 2011. Patients who received >1 dose of BB were compared to controls. Patients with TBI, length of stay (LOS) ratio (OR) 0.952; confidence interval (CI) 0.620-1.461]. In conclusion, in this largest study to date, patients receiving BB were older, more severely injured, and had a higher mortality. Unlike TBI patients, multivariable regression showed no benefit from BB in this population.

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

    Science.gov (United States)

    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

  14. Not All Beta-Blockers Are Equal in the Management of Long QT Syndrome Types 1 and 2

    NARCIS (Netherlands)

    Chockalingam, Priya; Crotti, Lia; Girardengo, Giulia; Johnson, Jonathan N.; Harris, Katy M.; van der Heijden, Jeroen F.; Hauer, Richard N. W.; Beckmann, Britt M.; Spazzolini, Carla; Rordorf, Roberto; Rydberg, Annika; Clur, Sally-Ann B.; Fischer, Markus; van den Heuvel, Freek; Kaeaeb, Stefan; Blom, Nico A.; Ackerman, Michael J.; Schwartz, Peter J.; Wilde, Arthur A. M.

    2012-01-01

    Objectives The purpose of this study was to compare the efficacy of beta-blockers in congenital long QT syndrome (LQTS). Background Beta-blockers are the mainstay in managing LQTS. Studies comparing the efficacy of commonly used beta-blockers are lacking, and clinicians generally assume they are equ

  15. Predictors of switching from beta-blockers to other anti-hypertensive drugs: a review of records of 19,177 Chinese patients seen in public primary care clinics in the New Territory East, Hong Kong

    Directory of Open Access Journals (Sweden)

    Wong Martin CS

    2011-07-01

    Full Text Available Abstract Background Beta-blocker drugs are commonly used in family practice and studies showed that they were the most popularly prescribed medications among all antihypertensive agents. This study aimed to identify the factors associated with medication switching from a beta-blocker to another antihypertensive drug among Chinese patients. Methods We used a validated database which consisted of the demographic and clinical information of all Chinese patients prescribed a beta-blocker from any public, family practice clinics between 01 Jan 2004 to 30 June 2007 in one large Territory of Hong Kong. The proportion of patients switched from beta-blockers to another antihypertensive agent 180 days within their first prescription was studied, and the factors associated with medication switching were evaluated by using multivariate regression analyses. Results From 19,177 eligible subjects with a mean age of 59.1 years, 763 (4.0% were switched from their beta-blockers within 180 days of commencing therapy. A binary logistic regression model used medication switching as the outcome variable and controlled for age, gender, socioeconomic status, clinic setting (general out-patient clinics, family medicine specialist clinic or staff clinics, district of residence, visit type (new vs. follow-up attendance, the number of concomitant co-morbidities, and the calendar year of prescription. It was found that older patients (age 50-59 years: adjusted odds ratio [AOR] 1.38, 95% C.I. 1.12-1.70; p = 0.002; age 60-69 years: AOR 1.63 95% C.I. 1.30-2.04, p Conclusions Closer monitoring of the medication taking behavior among the older patients and the new clinic visitors prescribed a beta-blocker is warranted. Future studies should evaluate the reasons of drug switching.

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

    OpenAIRE

    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, ...

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

    DEFF Research Database (Denmark)

    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...

  18. 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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    DEFF Research Database (Denmark)

    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....

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

  4. Effect of different beta blockers on penile vascular velocities in hypertensive males

    OpenAIRE

    Samer Malak Botros; Ahmed Mohamed Hussein; Ahmed Shawky Elserafy

    2015-01-01

    Background: Beta blockers are very commonly used as antihypertensive medications in young active individuals. This class has been accused of erectile dysfunction in patients taking them. Problems with erectile function can raise a concern in the treatment of hypertension and may influence the choice of treatment regimens and decisions to discontinue drugs. Aim: The aim was to assess the effect of different beta blockers: nebivolol, atenolol, bisoprolol, and carvedilol on the penile arteria...

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    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......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...... hypertension patients without previous myocardial infarction or heart failure (n=573), aged between 60 and 85 years (mean age=70±6.6), were included. All patients underwent a structured interview that included a self-report questionnaire to assess depression (PHQ-9), which was divided in four groups (PHQ-9...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    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......-up. Observational studies carry a high risk of bias. The meta-analytic approach may be used if the incidence and mortality of hepatocellular carcinoma can be extracted from trials on variceal bleeding and if the combined sample size and follow up is sufficient....

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

    NARCIS (Netherlands)

    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

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

    Science.gov (United States)

    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…

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

    NARCIS (Netherlands)

    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

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

    DEFF Research Database (Denmark)

    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...

  17. Playing with Performance: The Use and Abuse of Beta-Blockers in the Performing Arts

    Science.gov (United States)

    Patston, Tim; Loughlan, Terence

    2014-01-01

    This article discusses the use of beta-blockers by performing artists, the reasons why they are taken, and the potential associated risks. We argue that there are high levels of usage within sectors of the professional performing arts community and that there may be high levels of risk in using these medications, particularly without medical…

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

    DEFF Research Database (Denmark)

    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...

  19. Actual and prescribed energy and protein intakes for very low birth weight infants: An observational study

    Science.gov (United States)

    Allevato, Anthony J.

    Objectives: To determine (1) whether prescribed and delivered energy and protein intakes during the first two weeks of life met Ziegler's estimated requirements for Very Low Birth Weight (VLBW) infants, (2) if actual energy during the first week of life correlated with time to regain birth weight and reach full enteral nutrition (EN) defined as 100 kcal/kg/day, (3) if growth velocity from time to reach full EN to 36 weeks' postmenstrual age (PMA) met Ziegler's estimated fetal growth velocity (16 g/kg/day), and (4) growth outcomes at 36 weeks' PMA. Study design: Observational study of feeding, early nutrition and early growth of 40 VLBW infants protein (89% [3.1 g/kg/day]) were significantly less than theoretical estimated requirements. Delivered intakes were 15% less than prescribed because of numerous interruptions in delivery and medical complications. During the second week, the delivered intakes of energy (90% [86 kcal/kg/day]) and protein (102% [3.5 g/kg/day]) improved although the differences between prescribed and delivered were consistently 15%. Energy but not protein intake during the first week was significantly related to time to reach full EN. Neither energy nor protein intake significantly correlated with days to return to birth weight. The average growth velocity from the age that full EN was attained to 36 weeks' PMA (15 g/kg/day) was significantly less than the theoretical estimated fetal growth velocity (16 g/kg/day) (pintakes were consistently less than 15% of the prescribed intakes. Growth velocity between the age when full EN was achieved and 36 weeks' PMA was 6.7% lower than Ziegler's estimate. One-third to one-half of the infants have EUGR at 36 weeks' PMA.

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

    OpenAIRE

    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...

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

    Directory of Open Access Journals (Sweden)

    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

  2. Occurrence and removal of estrogens and beta blockers by various processes in wastewater treatment plants.

    Science.gov (United States)

    Gabet-Giraud, V; Miège, C; Choubert, J M; Ruel, S Martin; Coquery, M

    2010-09-01

    This study aims at evaluating occurrence and treatment efficiency of five estrogenic hormones and ten beta blockers in wastewater treatment plants (WWTP). The use of consistent sampling procedures, analytical techniques and data processing enabled to achieve an accurate comparison of the performances of the different treatment processes. First, the occurrence of molecules was evaluated in fourteen rural and urban WWTP located in France. Free and total estrogens were analyzed showing that more than 84% of estrogens in the dissolved phase of influent samples are in the free form. In effluent samples, comparable mean values but higher variation are underlined (RSD from 13 to 54% depending on the estrogen, compared to 11-21% for influents). Most of the target molecules are quantified in 30 influent and 31 effluent samples. Similar occurrence frequencies are obtained for influents from rural (6 WWTP) and urban areas (8 WWTP), except for betaxolol which is only quantified in urban wastewaters. Removal efficiencies of 8 biological treatments were studied: suspended growth biomass (activated sludge) and attached growth systems (biofilter, rotating biological contactor, reed-bed filter, trickling filter). Biological treatments are efficient to remove estrogens from the dissolved phase, with removal rate around 90%. For beta blockers, acebutolol and nadolol are efficiently removed (mean removal rate of 80%), whereas sotalol and propranolol are hardly impacted by biological treatments (removal rate below 20%). Finally, 9 tertiary treatment processes were evaluated. Ozonation, reverse osmosis and activated carbon filtration prove a high removal efficiency for beta blockers (above 80%). On the contrary, high speed chemical settler, sand filtration, silex filtration, microfiltration and UV present generally removal rates below 30% for all beta blockers. The polishing pond studied presents variable removal performances depending on the molecules (up to 75% for propranolol). The

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

    OpenAIRE

    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...

  4. 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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    DEFF Research Database (Denmark)

    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...

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

    OpenAIRE

    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...

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

    OpenAIRE

    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 ...

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

    OpenAIRE

    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.

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

    OpenAIRE

    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...

  10. Leukocyte redistribution: effects of beta blockers in patients with chronic heart failure.

    Directory of Open Access Journals (Sweden)

    Stephan von Haehling

    Full Text Available BACKGROUND: Overproduction of pro-inflammatory cytokines is a well established factor in the progression of chronic heart failure (CHF. Changes in cellular immunity have not been widely studied, and the impact of standard medication is uncertain. Here we investigate whether a leukocyte redistribution occurs in CHF and whether this effect is influenced by beta-blocker therapy. METHODOLOGY: We prospectively studied 75 patients with systolic CHF (age: 68+/-11 years, left ventricular ejection fraction 32+/-11%, New York Heart Association class 2.5+/-0.7 and 20 age-matched healthy control subjects (age: 63+/-10 years. We measured the response of cells to endotoxin exposure in vitro, analysed subsets of lymphocytes using flow cytometry, and assessed plasma levels of the pro-inflammatory markers interleukin 1, 6, tumor necrosis factor-alpha, and soluble tumor necrosis factor receptors 1 and 2. PRINCIPAL FINDINGS: While no differences in the number of leukocytes were noted between patients with CHF and healthy controls, we detected relative lymphopenia in patients with CHF (p<0.001 vs. control, mostly driven by reductions in T helper cells and B cells (both p<0.05. The number of neutrophils was increased (p<0.01. These effects were pronounced in patients who were beta-blocker naïve (32% of all patients with CHF. Increased plasma levels of soluble tumor necrosis receptor-1 correlated with the relative number of lymphocyte subsets. CONCLUSIONS: In patients with CHF, we detected a redistribution of leukocyte subsets, i.e. an increase in neutrophils with relative lymphopenia. These effects were pronounced in patients who were beta-blocker naïve. The underlying mechanism remains to be elucidated.

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

    OpenAIRE

    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...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

    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.......3%; P index (BMI) were the only factors independently associated with SGA (the relative difference in expected birthweight was -8.6%; 95% CI -13.3 to -3.9%; P = 0.0004). After adjustment for BMI......, beta-blocker treatment was associated with an increased risk of SGA (OR 2.65; 95% CI 1.15-6.10; P = 0.02). In a subgroup with isolated tachyarrhythmias, SGA infants were more frequent in the beta-blocker exposed group compared with the non-exposed group (31 versus 10%; P

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

    DEFF Research Database (Denmark)

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

    2005-01-01

    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) poxygen uptake and 9 RCTs evaluating 6-min walk distance showed that beta-blockers had no significant effect...... compared with placebo, p=0.484, and p=0.730, respectively. Combined results of the 23 RCTs showed significant reducing effect on all cause mortality with OR=0.69 (0.59-0.82) ptherapy improves dyspnoea and prolongs exercise...

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

    NARCIS (Netherlands)

    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

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

    DEFF Research Database (Denmark)

    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...... initiated in many countries. However, little information is available to describe if such programs are successful in initiating and up-titrating BBs in daily clinical practice. AIMS: To assess the proportion of patients with HF due to left ventricular systolic dysfunction on BB treatment three months after...... months (Ptitration continues to be a challenge even in specialized clinics dedicated to this task. Elderly patients appear to be less likely to receive treatment....

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

    Science.gov (United States)

    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

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

    International Nuclear Information System (INIS)

    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)

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    OpenAIRE

    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...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

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

    1991-01-01

    of the concentration profile of 3H-metoprolol and 3H-atenolol into the tissue during 20 min was calculated to be 0.36 and 0.31 mm, respectively. The protein binding of 14C-verapamil and 3H-propranolol caused a significant fall in the progression to 0.24 mm for both drugs. These results indicate that, by diffusion......Beta-blockers and calcium antagonists have been claimed to possess cardioprotective properties. This study addresses the question of whether a significant amount of these drugs will reach the cardiac myocytes during no-flow ischemia, where solute transport depends solely on diffusion....... 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...

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

    Science.gov (United States)

    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.

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

    DEFF Research Database (Denmark)

    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...... shortly after AMI. A focused effort in the immediate post-infarction period would appear to provide long-term benefit. Udgivelsesdato: 2006-May...

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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

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

    DEFF Research Database (Denmark)

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

    2005-01-01

    pharmacies within 30 d from discharge was obtained from the National Patient Registry and the Danish Registry of Medicinal Product Statistics. RESULTS: Beta-blocker use increased from 38.1% of patients in 1995 to 67.9% in 2002 (OR = 3.85, CI: 3.58-4.13). Women, elderly patients and patients taking loop......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 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...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Predicting energy expenditure from photo-plethysmographic measurements of heart rate under beta blocker therapy: Data driven personalization strategies based on mixed models.

    Science.gov (United States)

    Bonomi, Alberto G; Goldenberg, Sharon; Papini, Gabriele; Kraal, Jos; Stut, Wim; Sartor, Francesco; Kemps, Hareld

    2015-08-01

    Energy expenditure have been often estimated using computational models based on heart rate (HR) and appropriate personalization strategies to account for users cardio-respiratory characteristics. However, medications like beta blockers which are prescribed to treat several cardiac conditions have a direct influence on the cardiovascular system and may impact the relationship between HR and energy expenditure during physical activity (AEE). This study proposes to estimate AEE from HR using mixed models (MIX-REG) by introducing a novel method to personalize the prediction equation. We selected as features to represent the individual random effect in the MIX-REG model those subject characteristics which minimized both estimation error (RMSE) and between-subjects error bias variability. Data from 17 patients post-myocardial infarction were collected during a laboratory protocol. AEE was measured using indirect calorimetry and HR using an innovative wrist worn activity monitor equipped with the Philips Cardio and Motion Monitoring Module (CM3-Generation-1), which is an integrated module including a photo-plethysmographic and accelerometer sensor. The presented method showed large AEE estimation accuracy (RMSE = 1.35 kcal/min) which was comparable to that of models personalized using data from laboratory calibration protocols (HR-FLEX) and was superior to multi-linear regression and MIX-REG models trained using a stepwise features selection procedure. PMID:26738062

  12. A Review of the External Validity of Clinical Trials with Beta-Blockers in Heart Failure

    Science.gov (United States)

    Iyngkaran, Pupalan; Toukhsati, Samia R.; Thomas, Merlin C.; Jelinek, Michael V.; Hare, David L.; Horowitz, John D.

    2016-01-01

    BACKGROUND Beta-blockers (BBs) are the mainstay prognostic medication for all stages of chronic heart failure (CHF). There are many classes of BBs, each of which has varying levels of evidence to support its efficacy in CHF. However, most CHF patients have one or more comorbid conditions such as diabetes, renal impairment, and/or atrial fibrillation. Patient enrollment to randomized controlled trials (RCTs) often excludes those with certain comorbidities, particularly if the symptoms are severe. Consequently, the extent to which evidence drawn from RCTs is generalizable to CHF patients has not been well described. Clinical guidelines also underrepresent this point by providing generic advice for all patients. The aim of this review is to examine the evidence to support the use of BBs in CHF patients with common comorbid conditions. METHODS We searched MEDLINE, PubMed, and the reference lists of reviews for RCTs, post hoc analyses, systematic reviews, and meta-analyses that report on use of BBs in CHF along with patient demographics and comorbidities. RESULTS In total, 38 studies from 28 RCTs were identified, which provided data on six BBs against placebo or head to head with another BB agent in ischemic and nonischemic cardiomyopathies. Several studies explored BBs in older patients. Female patients and non-Caucasian race were underrepresented in trials. End points were cardiovascular hospitalization and mortality. Comorbid diabetes, renal impairment, or atrial fibrillation was detailed; however, no reference to disease spectrum or management goals as a focus could be seen in any of the studies. In this sense, enrollment may have limited more severe grades of these comorbidities. CONCLUSIONS RCTs provide authoritative information for a spectrum of CHF presentations that support guidelines. RCTs may provide inadequate information for more heterogeneous CHF patient cohorts. Greater Phase IV research may be needed to fill this gap and inform guidelines for a more

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  16. 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?

    DEFF Research Database (Denmark)

    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...

  17. 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?

    DEFF Research Database (Denmark)

    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 hear...

  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

    Institute of Scientific and Technical Information of China (English)

    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

    Energy Technology Data Exchange (ETDEWEB)

    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

    OpenAIRE

    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

    NARCIS (Netherlands)

    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.

    Science.gov (United States)

    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. beta-blocker Therapy is Not Associated with Reductions in Angina or Cardiovascular Events After Coronary Artery Bypass Graft Surgery : Insights from the IMAGINE Trial

    NARCIS (Netherlands)

    Booij, Harmen G.; Damman, Kevin; Warnica, J. Wayne; Rouleau, Jean L.; van Gilst, Wiek H.; Westenbrink, B. Daan

    2015-01-01

    To evaluate whether beta-blockers were associated with a reduction in cardiovascular events or angina after Coronary Artery Bypass Graft (CABG) surgery, in otherwise stable low-risk patients during a mid-term follow-up. We performed a post-hoc analysis of the IMAGINE (Ischemia Management with Accupr

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

    OpenAIRE

    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...

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

  11. 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

    NARCIS (Netherlands)

    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

  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.

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  14. Beta-blockers

    DEFF Research Database (Denmark)

    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....

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

    Directory of Open Access Journals (Sweden)

    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. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  18. Statin, Calcium Channel Blocker and Beta Blocker Therapy May Decrease the Incidence of Tuberculosis Infection in Elderly Taiwanese Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Mei-Yueh Lee

    2015-05-01

    Full Text Available Background: It is well known that diabetes mellitus impairs immunity and therefore is an independent risk factor for tuberculosis. However, the influence of associated metabolic factors, such as hypertension, dyslipidemia and gout has yet to be confirmed. This study aimed to investigate whether the strong association between tuberculosis and diabetes mellitus is independent from the influence of hypertension and dyslipidemia, and its treatment in elderly Taiwanese patients. Methods: A total of 27,958 patients aged more than 65 years were identified from the National Health Insurance Research Database (NIHRD in 1997 and were followed from 1998 to 2009. The demographic characteristics between the patients with and without diabetes were analyzed using the χ2 test. A total of 13,981 patients with type 2 diabetes were included in this study. Cox proportional hazard regression models were used to determine the independent effects of diabetes on the risk of tuberculosis. Results: After adjusting for age, sex, other co-morbidities and medications, calcium channel blocker, beta blocker and statin users had a lower independent association, with risk ratios of 0.76 (95% CI, 0.58–0.98, 0.72 (95% CI, 0.58–0.91 and 0.76 (95% CI, 0.60–0.97, respectively. Conclusion: Calcium channel blocker, beta blocker and statin therapy may decrease the incidence of tuberculosis infection in elderly Taiwanese patients with type 2 diabetes.

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

    DEFF Research Database (Denmark)

    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...... on their follow up for events of variceal bleeding defined as non-response. RESULTS: Ten patients showed HVPG ... compared to corpus and duodenum. The transcriptional levels of vasoactive proteins were higher in patients with HVPG >10mmHg and HVPG >16mmHg. Interestingly, mRNA levels of RhoA and ROCK2 were lower in patients with large varices at endoscopy. Moreover, RhoA and ROCK2 transcription correlated...

  20. 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

    DEFF Research Database (Denmark)

    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 characterized by systemic inflammation and high mortality. As NSBBs may have beneficial effects on gut motility and permeability and, systemic inflammation, the aims of this prospective, observational study were to determine whether on-going use of NSBBs reduced 28-day mortality in ACLF patients. METHODS......: The study was performed in 349 patients with ACLF included in the CANONIC study, which is a prospective observational investigation in hospitalized cirrhotic patients with acute deterioration. The data about the use of NSBBs, its type and dosage was specifically recorded. Patient characteristics...

  1. 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

    DEFF Research Database (Denmark)

    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...

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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

    NARCIS (Netherlands)

    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

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

    Science.gov (United States)

    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

  5. Ion-transfer voltammetric determination of the beta-blocker propranolol in a physiological matrix at silicon membrane-based liquid|liquid microinterface arrays.

    Science.gov (United States)

    Collins, Courtney J; Arrigan, Damien W M

    2009-03-15

    In this work, the ion-transfer voltammetric detection of the protonated beta-blocker propranolol in artificial saliva is presented. Cyclic voltammetry, differential pulse voltammetry, and differential pulse stripping voltammetry (DPSV) were employed in the detection of the cationic drug based on ion-transfer voltammetry across arrays of microinterfaces between artificial saliva and an organogel phase. It was found that the artificial saliva matrix decreased the available potential window for ion-transfer voltammetry at this liquid|liquid interface but transfer of protonated propranolol was still achieved. The DPSV method employed a preconditioning step as well as a preconcentration step followed by analytical signal generation based on the back-transfer of the drug across the array of microinterfaces. The DPSV peak current response was linear with drug concentration in the artificial saliva matrix over the concentration range of 0.05-1 microM (i(p) = -8.13 (nA microM(-1))(concentration) + 0.07 (nA), R = 0.9929, n = 7), and the calculated detection limit (3s(b)) was 0.02 microM. These results demonstrate that DPSV at arrays of liquid|liquid microinterfaces is a viable analytical approach for pharmaceutical determinations in biomimetic matrixes.

  6. Electronic Prescribing

    Science.gov (United States)

    ... 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. Degradation of the beta-blocker propranolol by electrochemical advanced oxidation processes based on Fenton's reaction chemistry using a boron-doped diamond anode

    Energy Technology Data Exchange (ETDEWEB)

    Isarain-Chavez, Eloy; Rodriguez, Rosa Maria; Garrido, Jose Antonio; Arias, Conchita; Centellas, Francesc; Cabot, Pere Lluis [Laboratori d' Electroquimica dels Materials i del Medi Ambient, Departament de Quimica Fisica, Facultat de Quimica, Universitat de Barcelona, Marti i Franques 1-11, 08028 Barcelona (Spain); Brillas, Enric, E-mail: brillas@ub.ed [Laboratori d' Electroquimica dels Materials i del Medi Ambient, Departament de Quimica Fisica, Facultat de Quimica, Universitat de Barcelona, Marti i Franques 1-11, 08028 Barcelona (Spain)

    2010-12-15

    The electro-Fenton (EF) and photoelectro-Fenton (PEF) degradation of solutions of the beta-blocker propranolol hydrochloride with 0.5 mmol dm{sup -3} Fe{sup 2+} at pH 3.0 has been studied using a single cell with a boron-doped diamond (BDD) anode and an air diffusion cathode (ADE) for H{sub 2}O{sub 2} electrogeneration and a combined cell containing the above BDD/ADE pair coupled in parallel to a Pt/carbon felt (CF) cell. This naphthalene derivative can be mineralized by both methods with a BDD anode. Almost overall mineralization is attained for the PEF treatments, more rapidly with the combined system due to the generation of higher amounts of hydroxyl radical from Fenton's reaction by the continuous Fe{sup 2+} regeneration at the CF cathode, accelerating the oxidation of organics to Fe(III)-carboxylate complexes that are more quickly photolyzed by UVA light. The homologous EF processes are less potent giving partial mineralization. The effect of current density, pH and Fe{sup 2+} and drug concentrations on the oxidation power of PEF process in combined cell is examined. Propranolol decay follows a pseudo first-order reaction in most cases. Aromatic intermediates such as 1-naphthol and phthalic acid and generated carboxylic acids such as maleic, formic, oxalic and oxamic are detected and quantified by high-performance liquid chromatography. The chloride ions present in the starting solution are slowly oxidized at the BDD anode. In PEF treatments, all initial N of propranolol is completely transformed into inorganic ions, with predominance of NH{sub 4}{sup +} over NO{sub 3}{sup -} ion.

  8. Electro-Fenton and photoelectro-Fenton degradations of the drug beta-blocker propranolol using a Pt anode: Identification and evolution of oxidation products

    Energy Technology Data Exchange (ETDEWEB)

    Isarain-Chavez, Eloy; Cabot, Pere Lluis; Centellas, Francesc; Rodriguez, Rosa Maria; Arias, Conchita; Garrido, Jose Antonio [Laboratori d' Electroquimica dels Materials i del Medi Ambient, Departament de Quimica Fisica, Facultat de Quimica, Universitat de Barcelona, Marti i Franques 1-11, 08028 Barcelona (Spain); Brillas, Enric, E-mail: brillas@ub.edu [Laboratori d' Electroquimica dels Materials i del Medi Ambient, Departament de Quimica Fisica, Facultat de Quimica, Universitat de Barcelona, Marti i Franques 1-11, 08028 Barcelona (Spain)

    2011-01-30

    The beta-blocker propranolol hydrochloride has been degraded by electrochemical advanced oxidation processes like electro-Fenton (EF) and photoelectro-Fenton (PEF) using a single cell with a Pt anode and an air diffusion cathode (ADE) for H{sub 2}O{sub 2} electrogeneration and a combined system containing the above Pt/ADE pair coupled in parallel to a Pt/carbon-felt (CF) cell. Organics are mainly oxidized with hydroxyl radical ({center_dot}OH) formed from Fenton's reaction between added Fe{sup 2+} and electrogenerated H{sub 2}O{sub 2}. The PEF treatment in Pt/ADE-Pt/CF system yields almost total mineralization because {center_dot}OH production is enhanced by Fe{sup 2+} regeneration from Fe{sup 3+} reduction at the CF cathode and Fe(III) complexes with generated carboxylic acids are rapidly photodecarboxylated under UVA irradiation. Lower mineralization degree is found for PEF in Pt/ADE cell due to the little influence of UVA light on Fe{sup 2+} regeneration. The homologous EF processes are much less potent as a result of the persistence of Fe(III)-carboxylate complexes. Aromatic intermediates such as 1-naphthol, 1,4-naphthoquinone and phthalic acid and generated carboxylic acids such as pyruvic, glycolic, malonic, maleic, oxamic, oxalic and formic are identified. While chloride ion remains stable, NH{sub 4}{sup +} and NO{sub 3}{sup -} ions are released to the medium. A reaction sequence for propranolol hydrochloride mineralization is proposed.

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

    Science.gov (United States)

    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

  10. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  11. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  12. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  13. 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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Rationalising prescribing

    DEFF Research Database (Denmark)

    Wadmann, Sarah; Bang, Lia Evi

    2015-01-01

    Initiatives in the name of 'rational pharmacotherapy' have been launched to alter what is seen as 'inappropriate' prescribing practices of physicians. Based on observations and interviews with 20 general practitioners (GPs) in 2009-2011, we explored how attempts to rationalise prescribing interact...... 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...... patients to use medication. Therefore, GPs do much more to obtain knowledge about medications than seek advice on 'rational pharmacotherapy'. For instance, GPs also seek opportunities to acquaint themselves with the material objects of medication and medical devices. We conceptualise the knowledge needs...

  16. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  17. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  18. 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

    DEFF Research Database (Denmark)

    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...... mibefradil or atenolol for 6 weeks (50 mg once daily for 2 weeks followed by 100 mg once daily for 4 weeks). The ratio between early (E) and late (A) diastolic mitral flow velocities (E/A), the E wave deceleration time (DT) and the left ventricular isovolumetric relaxation time (IRT) were measured by Doppler...... echocardiography as parameters of left-ventricular diastolic function initially, after 4 and after 6 weeks of treatment. RESULTS: Mibefradil did not change the E/A ratio significantly (+4%, NS), while atenolol treatment resulted in a significant increase in the E/A ratio (+20%, p treatment...

  19. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  20. Structural basis for enantiomer binding and separation of a common beta-blocker: crystal structure of cellobiohydrolase Cel7A with bound (S)-propranolol at 1.9 A resolution.

    Science.gov (United States)

    Ståhlberg, J; Henriksson, H; Divne, C; Isaksson, R; Pettersson, G; Johansson, G; Jones, T A

    2001-01-01

    Cellobiohydrolase Cel7A (previously called CBH 1), the major cellulase produced by the mould fungus Trichoderma reesei, has been successfully exploited as a chiral selector for separation of stereo-isomers of some important pharmaceutical compounds, e.g. adrenergic beta-blockers. Previous investigations, including experiments with catalytically deficient mutants of Cel7A, point unanimously to the active site as being responsible for discrimination of enantiomers. In this work the structural basis for enantioselectivity of basic drugs by Cel7A has been studied by X-ray crystallography. The catalytic domain of Cel7A was co-crystallised with the (S)-enantiomer of a common beta-blocker, propranolol, at pH 7, and the structure of the complex was determined and refined at 1. 9 A resolution. Indeed, (S)-propranolol binds at the active site, in glucosyl-binding subsites -1/+1. The catalytic residues Glu212 and Glu217 make tight salt links with the secondary amino group of (S)-propranolol. The oxygen atom attached to the chiral centre of (S)-propranolol forms hydrogen bonds to the nucleophile Glu212 O(epsilon1) and to Gln175 N(epsilon2), whereas the aromatic naphthyl moiety stacks with the indole ring of Trp376 in site +1. The bidentate charge interaction with the catalytic glutamate residues is apparently crucial, since no enantioselectivity has been obtained with the catalytically deficient mutants E212Q and E217Q. Activity inhibition experiments with wild-type Cel7A were performed in conditions close to those used for crystallisation. Competitive inhibition constants for (R)- and (S)-propranolol were determined at 220 microM and 44 microM, respectively, corresponding to binding free energies of 20 kJ/mol and 24 kJ/mol, respectively. The K(i) value for (R)-propranolol was 57-fold lower than the highest concentration, 12.5 mM, used in co-crystallisation experiments. Still several attempts to obtain a complex with the (R)-enantiomer have failed. By using cellobiose as a

  1. 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

    Institute of Scientific and Technical Information of China (English)

    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

  2. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  3. 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

    Institute of Scientific and Technical Information of China (English)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  5. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  6. 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

    Institute of Scientific and Technical Information of China (English)

    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

  7. 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

    Institute of Scientific and Technical Information of China (English)

    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

  8. Educating nonmedical prescribers

    OpenAIRE

    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...

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

    Science.gov (United States)

    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)

  10. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  11. 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

    Institute of Scientific and Technical Information of China (English)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  13. 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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  15. 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

    Institute of Scientific and Technical Information of China (English)

    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

  16. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  17. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  18. Changing doctor prescribing behaviour

    DEFF Research Database (Denmark)

    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...

  19. 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

    Institute of Scientific and Technical Information of China (English)

    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

  20. Changing physician prescribing behaviour.

    Science.gov (United States)

    Gray, J

    2006-01-01

    Didactic approaches to educating physicians and/or other health professionals do not produce changes in learner behaviour. Similarly, printed materials and practice guidelines have not been shown to change prescribing behaviour. Evidence-based educational approaches that do have an impact on provider behaviour include: teaching aimed at identified learning needs; interactive educational activities; sequenced and multifaceted interventions; enabling tools such as patient education programs, flow charts, and reminders; educational outreach or academic detailing; and audit and feedback to prescribers. Dr. Jean Gray reflects over the past 25 years on how there has been a transformation in the types of activities employed to improve prescribing practices in Nova Scotia. The evolution of Continuing Medical Education (CME) has resulted in the creation of the Drug Evaluation Alliance of Nova Scotia (DEANS) program, which is one exemplar of an evidence-based educational approach to improving physician prescribing in that province. Key words: Evidence-based, education, prescribing.

  1. Assessing prescribing competence

    OpenAIRE

    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...

  2. Psychotropic prescribing in HIV

    OpenAIRE

    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...

  3. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  4. Psychotropic prescribing in HIV

    Directory of Open Access Journals (Sweden)

    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.

  5. Matrix with Prescribed Eigenvectors

    Science.gov (United States)

    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…

  6. Design of materials with prescribed nonlinear properties

    DEFF Research Database (Denmark)

    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...... under finite deformation, i.e. stress-strain relations and Poisson's ratio. By minimizing errors between actual and prescribed properties, materials are tailored to achieve the target. Both two dimensional (2D) truss-based and continuum materials are designed with various prescribed nonlinear properties....... The numerical examples illustrate optimized materials with rubber-like behavior and also optimized materials with extreme strain-independent Poisson's ratio for axial strain intervals of εi ∈ [0.00,0.30]. © 2014 Elsevier Ltd. All rights reserved....

  7. 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

    Institute of Scientific and Technical Information of China (English)

    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

  8. 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

    Institute of Scientific and Technical Information of China (English)

    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

  9. Panic Disorder: When Fear Overwhelms

    Science.gov (United States)

    ... 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 ...

  10. Treatment and Management

    Science.gov (United States)

    ... 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 ...

  11. The Prescribed Velocity Method

    DEFF Research Database (Denmark)

    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 satisfactory...... 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....

  12. Beta-blockers decreases Th17/Treg cytokine ratios by down regulation of GRK2 synthesis in lymphocytes of patients with ACS%β受体阻滞剂对急性冠脉综合征Th17/Treg的作用研究

    Institute of Scientific and Technical Information of China (English)

    田秀青; 王清; 葛庆玲

    2016-01-01

    Objective To observe the effects of g protein-coupled receptor kinase-2 (GRK2) in peripheral lymphocytes on Th17/Treg cytokine ratios and investigate the potential impact and mechanism of beta-blockers on immune function in patients with acute coronary syndrome (ACS). Methods One hundred-four patients with ACS and forty-five normal coronary angiography (NCA) hospitalized patients as control group were enrolled in the study. ACS group was randomly divided into metoprolol group(n=52) and carvedilol group(n=52).The levels of lymphocyte GRK2 were detected by means of a sensitive sandwich enzyme-linked immunosorbent assay (ELISA) and IL-17 and FoxP3 in lymphocytes using flow cytometry at baseline and 6 months after the treatment. Results The levels of lymphocyte GRK2 and Th17/Treg in ACS patients were significantly higher than those of the UCA controls (both P0.05). Conclusion These results suggest that the increase of GRK2 may affect GRK2 in peripheral lymphocytes of ACS. Beta-blockers appear to have a beneficial effect on the Th17/Treg balance of immune system through decreasing activities of GRK2.%目的:探讨β受体阻滞剂对急性冠脉综合征(ACS)患者淋巴细胞G蛋白偶联受体激酶2(GRK2)和Th17/Treg的作用及意义。方法选择2013年2月至2015年12月千佛山医院心内科收治的CHD患者104例以及非CHD住院患者35例(NCA组)作为研究对象。ACS患者随机分为美托洛尔和卡维地洛治疗组。流式细胞仪测定淋巴细胞IL-17和Foxp3水平,酶联免疫吸附法测定GRK2水平。随访6个月。结果 ACS患者GRK2及IL-17/Foxp3比值均较非冠心病组明显升高(P0.05)。GRK2与IL-17/FoxP3比值呈显著正相关(P<0.01)。结论 ACS患者Th17/Treg失调与GRK2升高有关。β受体阻滞剂可降低GRK2水平,改善Th17/Treg平衡,具有免疫调节作用。

  13. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  14. Bioavailability and generic prescribing.

    Science.gov (United States)

    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

  15. Appropriate prescribing for older people

    OpenAIRE

    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 ...

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

    NARCIS (Netherlands)

    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

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

  20. NEW ADVANCES IN BETA-BLOCKER THERAPY IN HEART FAILURE

    Directory of Open Access Journals (Sweden)

    Vincenzo eBarrese

    2013-11-01

    Full Text Available The use of -blockers (BB in heart failure (HF has been considered a contradiction for many years. Considering HF simply as a state of inadequate systolic function, BB were contraindicated because of their negative effects on myocardial contractility. Nevertheless, evidence collected in the past years have suggested that additional mechanisms, such as compensatory neuro-humoral hyperactivation or inflammation, could participate in the pathogenesis of this complex disease. Indeed, chronic activation of the sympathetic nervous system, although initially compensating the reduced cardiac output from the failing heart, increases myocardial oxygen demand, ischemia and oxidative stress; moreover, high catecholamine levels induce peripheral vasoconstriction and increase both cardiac pre- and after-load, thus determining additional stress to the cardiac muscle (1. As a consequence of such a different view of the pathogenic mechanisms of HF, the efficacy of BB in the treatment of HF has been investigated in numerous clinical trials. Results from these trials highlighted BB as valid therapeutic tools in HF, providing rational basis for their inclusion in many HF treatment guidelines. However, controversy still exists about their use, in particular with regards to the selection of specific molecules, since BB differ in terms of adrenergic -receptors selectivity, adjunctive effects on -receptors, and effects on reactive oxygen species and inflammatory cytokines production. Further concerns about the heterogeneity in the response to , as well as the use in specific patients, are matter of debate among clinicians. In this review, we will recapitulate the pharmacological properties and the classification of BB, and the alteration of the adrenergic system occurring during HF that provide a rationale for their use; we will also focus on the possible molecular mechanisms, such as genetic polymorphisms, underlying the different efficacy of molecules belonging to this class.

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

    Science.gov (United States)

    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

  2. Appropriate prescribing for older people

    NARCIS (Netherlands)

    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

  3. Spacebody actual virtual

    DEFF Research Database (Denmark)

    Kjøbek, Jytte; Sørensen, Gert

    2005-01-01

    DVD som indeholder filmen 'spacebody actual virtual' . Videoen er værkdelen af forskningsprojektet Arkitektur og skikkelse, spacebody actual virtual. Foruden DVD'en indeholder projektet et reflekterende materiale på hjemmesiden www.spacebody.dk Fysisk medie: DVD......DVD som indeholder filmen 'spacebody actual virtual' . Videoen er værkdelen af forskningsprojektet Arkitektur og skikkelse, spacebody actual virtual. Foruden DVD'en indeholder projektet et reflekterende materiale på hjemmesiden www.spacebody.dk Fysisk medie: DVD...

  4. Hospital prescribing errors : epidemiological assessment of predictors

    NARCIS (Netherlands)

    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. Inappropriate prescribing in the elderly.

    LENUS (Irish Health Repository)

    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

  6. Assessment of antibiotic prescribing in Latvian general practitioners

    Directory of Open Access Journals (Sweden)

    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.

  7. Nurse prescribing: radicalism or tokenism?

    Science.gov (United States)

    McCartney, W; Tyrer, S; Brazier, M; Prayle, D

    1999-02-01

    The creation of The Medical Products (Prescription by Nurses, etc.) Act 1992 has been generally welcomed by the nursing profession. This article seeks to introduce a note of scepticism about the assumed motivations for its introduction through an analysis of various legal, ethical, economic and political dimensions. In reviewing the position of nursing vis-à-vis medicine it is argued that one of the ways that nursing has sought to improve its professional position is to take on work previously done by doctors, and nurse prescribing can be seen in the context of the concurrent de-regulation of medicines, allowing greater access to medicines and therefore greater consumer choice. This de-regulation stems from the liberation ideology of the previous Conservative government. Viewed in this way nurse prescribing, particularly with reference to the limited nature of the nursing formulary, can be seen to be anomalous. In the light of this analysis, the reasons generally put forward (notably in the Crown Report 1989) for the introduction of nurse prescribing could be seen to be peripheral to its real purpose. It is argued that the most convincing reasons for its introduction relate to the medical profession as a social institution. It is proposed that the three primary aims behind the introduction of nurse prescribing are: the saving of money; the transfer of routine medical work to nursing; and a challenge to the professional monolith of medicine.

  8. Analgesic prescribing in palliative care.

    Science.gov (United States)

    Lowe, Emma; Hanchanale, Sarika; Hurlow, Adam

    2014-12-01

    Pain management requires a multimodal approach involving pharmacological and non-pharmacological strategies. It is important to take a detailed history and examine the patient before prescribing any analgesia. This article focuses on assessment and management of pain in palliative care patients.

  9. Independent pharmacist prescribing in Canada

    OpenAIRE

    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.

  10. The influence of user fees and patient demand on prescribers in rural Nepal.

    Science.gov (United States)

    Holloway, Kathleen A; Gautam, Bharat R; Harpham, Trudy; Taket, Ann

    2002-03-01

    Irrational prescribing and over-prescription is a world-wide problem. Prescribers often cite patient demand as one of the main reasons why they over-prescribe, but the degree to which this is so is unknown. This article describes a study to test the hypothesis that patient demand causes over-prescription. The study occurred within the context of different kinds of nominal user fee for drugs in Nepal, where it was assumed that charging per drug item would deter patient demand, and hence over-prescription, as compared to charging per prescription. Focus group discussions with patients attending rural health facilities explored patient attitudes towards drugs. Patients and health workers were interviewed to gather quantitative data on (1) patient demand, and (2) health worker views of patient demand and their own prescribing habits, and comparing these with the drugs actually prescribed and dispensed to patients. Patients felt they needed more drugs than they were prescribed or dispensed, but stated that they would be happy to accept advice from prescribers for fewer drugs. In all areas of whatever fee type, there was no association between the number of drug items patients felt they needed pre-consultation and the number of drug items that they actually received as observed postconsultation. However, there was a significant association between the average number of drug items per patient that prescribers stated they usually prescribed and the actual number that were prescribed. It was concluded that patient demand was not affected by different kinds of user fee and did not directly influence prescribing behaviour.

  11. Prescribing patterns in premenstrual syndrome

    Directory of Open Access Journals (Sweden)

    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.

  12. New drug prescribing by hospital doctors: the nature and meaning of knowledge.

    Science.gov (United States)

    Prosser, Helen; Walley, Tom

    2006-04-01

    In the UK the high cost of new drugs is partly accountable for the growth in spending on prescription drugs. Most prescribing takes place in general practice and the influence of secondary care prescribing on primary care prescribing is well recognized; yet the factors that influence hospital prescribing have been little researched. Drawing on accounts of actual prescribing events from hospital doctors from a range of specialties, we investigated the processes by which new drugs come into practice, from hospital doctors' awareness of new drugs to the assimilation and interpretation of evidential sources. The determinants of new drug prescribing were interconnected within four forms of knowledge: scientific knowledge, social knowledge, patient knowledge and experiential knowledge. Furthermore, the nature of knowledge could only be understood within its situated context. The revelation of multiple and contingent forms of knowledge highlights the problematic nature of knowledge construction within the approaches of evidence-based medicine.

  13. 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

    Directory of Open Access Journals (Sweden)

    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

  14. Safe disposal of prescribed medicines.

    Science.gov (United States)

    Bergen, Phillip J; Hussainy, Safeera Y; George, Johnson; Kong, David Cm; Kirkpatrick, Carl Mj

    2015-06-01

    The National Return and Disposal of Unwanted Medicines Program provides a free and safe method for the disposal of unwanted and expired medicines. This stops drugs being dumped in landfill and waterways. An audit showed that over 600 tonnes of medicines are returned through the program. A substantial proportion of these medicines were still within their expiry dates. Salbutamol, insulin and frusemide are the most commonly discarded medicines. More than $2 million of public money is wasted each year. Hoarding and non-adherence to treatment contribute to waste. Health professionals may be able to help minimise waste by informing patients about the importance of completing prescribed courses of treatment, and discouraging them from hoarding medicines after reaching the safety net threshold on the Pharmaceutical Benefits Scheme. Prescribe no more than the required quantity of medicines. When starting a new therapy, prescribe a minimal quantity in case the drug is unsuitable for the patient. Advise patients to return all unwanted medicines to a pharmacy for disposal. PMID:26648628

  15. Prescribed Fire Plan Union Slough NWR 1994

    Data.gov (United States)

    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...

  16. Evaluation of prescribing patterns in a German network of CAM physicians for the treatment of patients with hypertension: a prospective observational study

    Directory of Open Access Journals (Sweden)

    Witt Claudia M

    2009-12-01

    Full Text Available Abstract Background The management of hypertension is a key challenge in modern health systems. This study aimed to investigate hypertension treatment strategies among physicians specialized in complementary and alternative medicine (CAM in Germany by analysing prescribing patterns and comparing these to the current treatment guidelines issued by the German Hypertension Society. Methods In this prospective, multicentre observational study, which included 25 primary care physicians specialized in CAM treatment, prescriptions and diagnoses were analysed for each consecutive hypertensive patient using routine electronic data. Data analysis was performed using univariate statistical tests (Chi square test, Cochran-Armitage trend test. Multiple logistic regression was used to determine factors associated with antihypertensive medication. Results In the year 2005, 1320 patients with 3278 prescriptions were included (mean age = 64.2 years (SD = 14.5, 63.5% women. Most patients were treated with conventional antihypertensive monotherapies (n = 838, 63.5%. Beta-blockers were the most commonly prescribed monotherapy (30.7%, followed by ACE inhibitors (24.0%. Combination treatment usually consisted of two antihypertensive drugs administered either as separate agents or as a coformulation. The most common combination was a diuretic plus an ACE inhibitor (31.2% of dual therapies. Patient gender, age, and comorbidities significantly influenced which treatment was prescribed. 187 patients (14.2% received one or more CAM remedies, most of which were administered in addition to classic monotherapies (n = 104. Men (OR = 0.66; 95% CI: 0.54-0.80 and patients with diabetes (OR = 0.55; 95% CI: 0.42-0.0.73, hypercholesterolaemia (OR = 0.59; 95% CI: 0.47-0.75, obesity (OR = 0.74; 95% CI: 0.57-0.97, stroke (OR = 0.54; 95% CI: 0.40-0.74, or prior myocardial infarction (OR = 0.37; 95% CI: 0.17-0.81 were less likely to receive CAM treatment. Conclusions The large majority

  17. Promoting rational prescribing: an international perspective.

    OpenAIRE

    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...

  18. Nurse prescribing in mental health: national survey.

    Science.gov (United States)

    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

  19. Nonmedical prescribing: where are we now?

    Science.gov (United States)

    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

  20. Inappropriate prescribing: criteria, detection and prevention.

    LENUS (Irish Health Repository)

    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.

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

    Science.gov (United States)

    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

  2. Estimations of actual availability

    International Nuclear Information System (INIS)

    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)

  3. Estimations of actual availability

    International Nuclear Information System (INIS)

    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)

  4. Inappropriate prescribing in geriatric patients.

    LENUS (Irish Health Repository)

    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.

  5. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  6. Measuring prescribing: the shortcomings of the item.

    OpenAIRE

    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...

  7. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

    Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, Mogens Brandt;

    2007-01-01

    OBJECTIVE: To describe the prevalence of inappropriate prescribing in primary care in Copenhagen County, according to the Medication Appropriateness Index (MAI) and to identify the therapeutic areas most commonly involved. SETTING: A cross-sectional study was conducted among 212 elderly ( >65 years...... most commonly involved in inappropriate prescribing were medications for treatment of peptic ulcer, cardiovascular medications, anti-inflammatory medications, antidepressants, hypnotics and anti-asthmatics. CONCLUSION: The overall prescribing quality in primary care in Copenhagen County, Denmark...

  8. Aspirin Often Wrongly Prescribed for Atrial Fibrillation

    Science.gov (United States)

    ... 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 ...

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

    Directory of Open Access Journals (Sweden)

    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

  10. Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment

    Science.gov (United States)

    Gong, Cynthia L; Hay, Joel W; Meeker, Daniella; Doctor, Jason N

    2016-01-01

    Objective To elicit prescribers' preferences for behavioural economics interventions designed to reduce inappropriate antibiotic prescribing, and compare these to actual behaviour. Design Discrete choice experiment (DCE). Setting 47 primary care centres in Boston and Los Angeles. Participants 234 primary care providers, with an average 20 years of practice. Main outcomes and measures Results of a behavioural economic intervention trial were compared to prescribers' stated preferences for the same interventions relative to monetary and time rewards for improved prescribing outcomes. In the randomised controlled trial (RCT) component, the 3 computerised prescription order entry-triggered interventions studied included: Suggested Alternatives (SA), an alert that populated non-antibiotic treatment options if an inappropriate antibiotic was prescribed; Accountable Justifications (JA), which prompted the prescriber to enter a justification for an inappropriately prescribed antibiotic that would then be documented in the patient's chart; and Peer Comparison (PC), an email periodically sent to each prescriber comparing his/her antibiotic prescribing rate with those who had the lowest rates of inappropriate antibiotic prescribing. A DCE study component was administered to determine whether prescribers felt SA, JA, PC, pay-for-performance or additional clinic time would most effectively reduce their inappropriate antibiotic prescribing. Willingness-to-pay (WTP) was calculated for each intervention. Results In the RCT, PC and JA were found to be the most effective interventions to reduce inappropriate antibiotic prescribing, whereas SA was not significantly different from controls. In the DCE however, regardless of treatment intervention received during the RCT, prescribers overwhelmingly preferred SA, followed by PC, then JA. WTP estimates indicated that each intervention would be significantly cheaper to implement than pay-for-performance incentives of $200/month

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

    OpenAIRE

    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....

  12. Antibiotic prescribing practices by dentists: a review

    Directory of Open Access Journals (Sweden)

    Najla Saeed Dar-Odeh

    2010-06-01

    Full Text Available Najla Saeed Dar-Odeh1, Osama Abdalla Abu-Hammad1, Mahmoud Khaled Al-Omiri1, Ameen Sameh Khraisat1, Asem Ata Shehabi21Faculty of Dentistry, University of Jordan, Amman, Jordan; 2Faculty of Medicine, University of Jordan, Amman, JordanAbstract: Antibiotics are prescribed by dentists for treatment as well as prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited, since most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. However, the literature provides evidence of inadequate prescribing practices by dentists, due to a number of factors ranging from inadequate knowledge to social factors. Here we review studies that investigated the pattern of antibiotic use by dentists worldwide. The main defects in the knowledge of antibiotic prescribing are outlined. The main conclusion is that, unfortunately, the prescribing practices of dentists are inadequate and this is manifested by over-prescribing. Recommendations to improve antibiotic prescribing practices are presented in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse.Keywords: over-prescribing, antimicrobial resistance, recommended practice, penicillin

  13. Effect of opioid prescribing guidelines in primary care.

    Science.gov (United States)

    Chen, Jonathan H; Hom, Jason; Richman, Ilana; Asch, Steven M; Podchiyska, Tanya; Johansen, Nawal Atwan

    2016-08-01

    Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting.A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education.We extracted electronic medical records for patients with noncancer pain receiving opioid prescriptions (Rxs) in seasonally matched preintervention (11/1/2012-6/1/2013) and postintervention (11/1/2013-6/1/2014) periods. For patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of drug screening, specialty referrals, clinic visits, emergency room visits, and quantity of opioids prescribed.After disseminating guidelines, the percentage of noncancer clinic patients receiving any opioid Rxs dropped from 3.9% to 3.4% (P = 0.02). The percentage of noncancer patients receiving chronic opioid Rxs decreased from 2.0% to 1.6% (P = 0.03). The rate of urine drug screening increased from 9.2% to 17.3% (P = 0.005) amongst noncancer chronic opioid patients. No significant differences were detected for other metrics or demographics assessed.An educational intervention for primary care opioid prescribing is feasible and was temporally associated with a modest reduction in overall opioid Rx rates. Provider use of routine drug screening increased, but overall rates of screening and specialty referral remained low despite the intervention. Despite national pressures to introduce opioid prescribing guidelines for chronic pain, doing so alone does not necessarily yield substantial changes in clinical practice.

  14. [Specificities of prescribing medicines for children].

    Science.gov (United States)

    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

  15. Nurse practitioner prescribing: an international perspective

    Directory of Open Access Journals (Sweden)

    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

  16. [Appropriate medication prescribing in older people].

    Science.gov (United States)

    Blain, H; Rambourg, P; Le Quellec, A; Ayach, L; Biboulet, P; Bismuth, M; Blain, A; Boulenger, J-P; Celton, B; Combe, B; Dauvilliers, Y; Davy, J-M; Geny, C; Hemmi, P; Hillaire-Buys, D; Jalabert, A; Jung, B; Leclercq, F; Léglise, M-S; Morel, J; Mourad, G; Ponrouch, M-P; Puisieux, F; Quantin, X; Quéré, I; Renard, E; Ribstein, J; Roch-Torreilles, I; Rolland, Y; Rosant, D; Terminet, A; Thuret, R; Villiet, M; Deshormières, N; Bourret, R; Bousquet, J; Jonquet, O; Millat, B

    2015-10-01

    Drug-induced adverse effects are one of the main avoidable causes of hospitalization in older people. Numerous lists of potentially inappropriate medications for older people have been published, as national and international guidelines for appropriate prescribing in numerous diseases and for different age categories. The present review describes the general rules for an appropriate prescribing in older people and summarizes, for the main conditions encountered in older people, medications that are too often under-prescribed, the precautions of use of the main drugs that induce adverse effects, and drugs for which the benefit to risk ratio is unfavourable in older people. All these data are assembled in educational tables designed to be printed in a practical pocket format and used in daily practice by prescribers, whether physicians, surgeons or pharmacists.

  17. The Web site your doctor prescribes

    Science.gov (United States)

    ... 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 ...

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

    OpenAIRE

    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.

    Science.gov (United States)

    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. Spirometry use in patients prescribed albuterol

    OpenAIRE

    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...

  1. Medication errors: prescribing faults and prescription errors

    OpenAIRE

    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 ...

  2. Chemotherapy e-prescribing: opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Elsaid KA

    2015-05-01

    Full Text Available Khaled A Elsaid,1,2 Steven Garguilo,1 Christine M Collins2 1Department of Pharmaceutical Sciences, School of Pharmacy, MCPHS University, Boston, MA, 2Pharmacy Services, Rhode Island Hospital, Providence, RI, USA Abstract: Chemotherapy drugs are characterized by low therapeutic indices and significant toxicities at clinically prescribed doses, raising serious issues of drug safety. The safety of the chemotherapy medication use process is further challenged by regimen complexity and need to tailor treatment to patient status. Errors that occur during chemotherapy prescribing are associated with serious and life-threatening outcomes. Computerized provider order entry (CPOE systems were shown to reduce overall medication errors in ambulatory and inpatient settings. The adoption of chemotherapy CPOE is lagging due to financial cost and cultural and technological challenges. Institutions that adopted infusional or oral chemotherapy electronic prescribing modified existing CPOE systems to allow chemotherapy prescribing, implemented chemotherapy-specific CPOE systems, or developed home-grown chemotherapy electronic prescribing programs. Implementation of chemotherapy electronic prescribing was associated with a significant reduction in the risk of prescribing errors, most significantly dose calculation and adjustment errors. In certain cases, implementation of chemotherapy CPOE was shown to improve the chemotherapy use process. The implementation of chemotherapy CPOE may increase the risk of new types of errors, especially if processes are not redesigned and adapted to CPOE. Organizations aiming to implement chemotherapy CPOE should pursue a multidisciplinary approach engaging all stakeholders to guide system selection and implementation. Following implementation, organizations should develop and use a risk assessment process to identify and evaluate unanticipated consequences and CPOE-generated errors. The results of these analyses should serve to

  3. 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

    OpenAIRE

    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.

  4. Pharmaceutical marketing research and the prescribing physician.

    Science.gov (United States)

    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

  5. Errors associated with outpatient computerized prescribing systems

    Science.gov (United States)

    Rothschild, Jeffrey M; Salzberg, Claudia; Keohane, Carol A; Zigmont, Katherine; Devita, Jim; Gandhi, Tejal K; Dalal, Anuj K; Bates, David W; Poon, Eric G

    2011-01-01

    Objective To report the frequency, types, and causes of errors associated with outpatient computer-generated prescriptions, and to develop a framework to classify these errors to determine which strategies have greatest potential for preventing them. Materials and methods This is a retrospective cohort study of 3850 computer-generated prescriptions received by a commercial outpatient pharmacy chain across three states over 4 weeks in 2008. A clinician panel reviewed the prescriptions using a previously described method to identify and classify medication errors. Primary outcomes were the incidence of medication errors; potential adverse drug events, defined as errors with potential for harm; and rate of prescribing errors by error type and by prescribing system. Results Of 3850 prescriptions, 452 (11.7%) contained 466 total errors, of which 163 (35.0%) were considered potential adverse drug events. Error rates varied by computerized prescribing system, from 5.1% to 37.5%. The most common error was omitted information (60.7% of all errors). Discussion About one in 10 computer-generated prescriptions included at least one error, of which a third had potential for harm. This is consistent with the literature on manual handwritten prescription error rates. The number, type, and severity of errors varied by computerized prescribing system, suggesting that some systems may be better at preventing errors than others. Conclusions Implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful system use does not decrease medication errors. The authors offer targeted recommendations on improving computerized prescribing systems to prevent errors. PMID:21715428

  6. e-Learning initiatives to support prescribing.

    Science.gov (United States)

    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

  7. Prescribing restrictions – a necessary strategy among some European countries to enhance future prescribing efficiency?

    Directory of Open Access Journals (Sweden)

    Brian Godman

    2012-01-01

    Full Text Available The unsustainable growth in pharmaceutical expenditure has resulted in multiple initiatives across Europe to lower prices of generics and enhance their utilisation. These include prescribing restrictions. However, there have been concerns with their impact on subsequent quality of care as well as their influence in reality. OBJECTIVES: (a Review the influence of prescribing restrictions and whether there are any differences depending on their nature and drug classes; (b Ascertain whether prescribing restrictions can be added to existing demand-side measures to further enhance prescribing efficiency; (c Whether they compromise subsequent quality of care. RESULTS: Prescribing restrictions have a variable impact on subsequent utilisation of patented protected products versus generics in a class, with their influence depending on the nature and follow-up of the restrictions rather than the class of drug. This is seen among the proton pump inhibitors, statins, and renin-angiotensin drugs. Prescribing restrictions can be successfully added to existing measures to further enhance prescribing efficiency, and do not appear to compromise subsequent quality of care. CONCLUSIONS: Prescribing restrictions can be a successful strategy as countries strive to maintain the European ideals for healthcare. However, care is needed when planning these programmes: else health authorities could be disappointed with their outcome.

  8. Auditing GPs' prescribing habits : Cardiovascular prescribing frequently continues medication initiated by specialists

    NARCIS (Netherlands)

    deVries, CS; vanDiepen, NM; Tromp, TFJ; deJongvandenBerg, LTW

    1996-01-01

    Objective: To determine to what extent general practitioners' (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists. Method: During a 4-week period, pharmacists identified GPs' prescriptions for a large group of cardiovascular drugs. Next

  9. A Helping Hand: Individually Prescribed Instruction (IPI

    Directory of Open Access Journals (Sweden)

    Bernard W. Andrews

    2014-10-01

    Full Text Available Individually Prescribed Instruction (IPI is an approach to teaching that emphasizes the diagnosis of learning problems and the provision of prescriptive assignments to assist individual students overcome their difficulties.  When this strategy is employed effectively, the teaching environment is highly adaptive.  The teacher matches the students' abilities to alternate ways of learning, and also provides remedial assistance and positive reinforcement.  Individually Prescribed Instruction has been shown to be effective across the school curriculum.  This writer reviews the success of this strategy for assisting students overcome learning problems, and proposes a model for its implementation in music instruction.

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

    DEFF Research Database (Denmark)

    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...

  11. BIFURCATION IN PRESCRIBED MEAN CURVATURE PROBLEM

    Institute of Scientific and Technical Information of China (English)

    马力

    2002-01-01

    This paper discusses the existence problem in the study of some partial differential equations. The author gets some bifurcation on the prescribed mean curvature problem on the unit ball, the scalar curvature problem on the n-sphere, and some field equations. The author gives some natural conditions such that the standard bifurcation or Thom-Mather theory can be used.

  12. Antidepressant prescribing in five European countries

    DEFF Research Database (Denmark)

    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...

  13. STANDARDIZATION AND ITS ROLE IN PRESCRIBING QUALITY

    OpenAIRE

    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.

  14. Photographic cockpit model for prescribing multifocals.

    Science.gov (United States)

    Powell, J H

    1992-01-01

    Recent interest in the relevancy of near vision tests for presbyopic aircrew members has led to the development of a photographic cockpit model. This model is used to prescribe more accurately for flying personnel. Prescriptions can be evaluated by use of trial lenses. This allows the aircrew members to experience the effect of viewing instruments in the cockpit of a C-130 aircraft.

  15. How to prescribe physical exercise in rheumatology

    OpenAIRE

    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...

  16. Self-reported confidence in prescribing skills correlates poorly with assessed competence in fourth-year medical students.

    Science.gov (United States)

    Brinkman, David J; Tichelaar, Jelle; van Agtmael, Michiel A; de Vries, Theo P G M; Richir, Milan C

    2015-07-01

    The objective of this study was to investigate the relationship between students' self-reported confidence and their objectively assessed competence in prescribing. We assessed the competence in several prescribing skills of 403 fourth-year medical students at the VU University Medical Center, the Netherlands, in a formative simulated examination on a 10-point scale (1 = very low; 10 = very high). Afterwards, the students were asked to rate their confidence in performing each of the prescribing skills on a 5-point Likert scale (1 = very unsure; 5 = very confident). Their assessments were then compared with their self-confidence ratings. Students' overall prescribing performance was adequate (7.0 ± 0.8), but they lacked confidence in 2 essential prescribing skills. Overall, there was a weak positive correlation (r = 0.2, P confidence and actual competence. Therefore, this study suggests that self-reported confidence is not an accurate measure of prescribing competence, and that students lack insight into their own strengths and weaknesses in prescribing. Future studies should focus on developing validated and reliable instruments so that students can assess their prescribing skills.

  17. Linguistic Theory and Actual Language.

    Science.gov (United States)

    Segerdahl, Par

    1995-01-01

    Examines Noam Chomsky's (1957) discussion of "grammaticalness" and the role of linguistics in the "correct" way of speaking and writing. It is argued that the concern of linguistics with the tools of grammar has resulted in confusion, with the tools becoming mixed up with the actual language, thereby becoming the central element in a metaphysical…

  18. El Observatorio Gemini - Status actual

    Science.gov (United States)

    Levato, H.

    Se hace una breve descripción de la situación actual del Observatorio Gemini y de las últimas decisiones del Board para incrementar la eficiencia operativa. Se hace también una breve referencia al uso argentino del observatorio.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    NARCIS (Netherlands)

    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'

  1. Antibiotic prescribing in primary care, adherence to guidelines and unnecessary prescribing - an Irish perspective

    Directory of Open Access Journals (Sweden)

    Murphy Marion

    2012-05-01

    Full Text Available Abstract Background Information about antibiotic prescribing practice in primary care is not available for Ireland, unlike other European countries. The study aimed to ascertain the types of antibiotics and the corresponding conditions seen in primary care and whether general practitioners (GPs felt that an antibiotic was necessary at the time of consultation. This information will be vital to inform future initiatives in prudent antibiotic prescribing in primary care. Methods Participating GPs gathered data on all antibiotics prescribed by them in 100 consecutive patients’ consultations as well as data on the conditions being treated and whether they felt the antibiotic was necessary. Results 171 GPs collected data on 16,899 consultations. An antibiotic was prescribed at 20.16% of these consultations. The majority were prescribed for symptoms or diagnoses associated with the respiratory system; the highest rate of prescribing in these consultations were for patients aged 15–64 years (62.23%. There is a high rate of 2nd and 3rd line agents being used for common ailments such as otitis media and tonsillitis. Amoxicillin, which is recommended as 1st line in most common infections, was twice as likely to be prescribed if the prescription was for deferred used or deemed unnecessary by the GP. Conclusion The study demonstrates that potentially inappropriate prescribing is occurring in the adult population and the high rate of broad-spectrum antimicrobial agents is a major concern. This study also indicates that amoxicillin may be being used for its placebo effect rather than specifically for treatment of a definite bacterial infection.

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

    OpenAIRE

    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...

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

    Science.gov (United States)

    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

  4. ATHENA: an actual antihydrogen annihilation

    CERN Multimedia

    2002-01-01

    This is an image of an actual matter-antimatter annihilation due to an atom of antihydrogen in the ATHENA experiment, located on the Antiproton Decelerator (AD) at CERN since 2001. The antiproton produces four charged pions (yellow) whose positions are given by silicon microstrips (pink) before depositing energy in CsI crystals (yellow cubes). The positron also annihilates to produce back-to-back gamma rays (red).

  5. Responsible prescribing for upper respiratory tract infections.

    Science.gov (United States)

    Turnidge, J

    2001-01-01

    Upper respiratory tract infections (URTIs) are responsible for a large amount of community antibacterial use worldwide. Recent systematic reviews have demonstrated that most URTIs resolve naturally, even when bacteria are the cause. The high consumer expectation for antibacterials in URTIs requires intervention by the general practitioner and a number of useful strategies have been developed. Generic strategies, including eliciting patient expectations, avoiding the term 'just a virus', providing a value-for-money consultation, providing verbal and written information, empowering patients, conditional prescribing, directed education campaigns, and emphasis on symptomatic treatments, should be used as well as discussion of alternative medicines when relevant. The various conditions have differing rates of bacterial infection and require different approaches. For acute rhinitis, laryngitis and tracheitis, viruses are the only cause and, therefore, antibacterials are never required. In acute sore throat (pharyngitis) Streptococcus pyogenes is the only important bacterial cause. A scoring system can help to increase the likelihood of distinguishing a streptococcal as opposed to viral infection, or alternatively patients should be given antibacterials only if certain conditions are fulfilled. Strategies for treating acute otitis media vary in different countries. Most favour the strategy of prescribing antibacterials only when certain criteria are fulfilled, delaying antibacterial prescribing for at least 24 hours. In otitis media with effusion, on the other hand, there is no primary role for antibacterials, as the condition resolves naturally in almost all patients aged >3 months. Detailed strategies for acute sinusitis have not been worked out but restricting antibacterial prescribing to certain clinical complexes is currently recommended by several authorities because of the high natural resolution rate.

  6. Best available control measures for prescribed burning

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  8. Local and regional smoke impacts from prescribed fires

    Science.gov (United States)

    Price, Owen F.; Horsey, Bronwyn; Jiang, Ningbo

    2016-10-01

    Smoke from wildfires poses a significant threat to affected communities. Prescribed burning is conducted to reduce the extent and potential damage of wildfires, but produces its own smoke threat. Planners of prescribed fires model the likely dispersion of smoke to help manage the impacts on local communities. Significant uncertainty remains about the actual smoke impact from prescribed fires, especially near the fire, and the accuracy of smoke dispersal models. To address this uncertainty, a detailed study of smoke dispersal was conducted for one small (52 ha) and one large (700 ha) prescribed fire near Appin in New South Wales, Australia, through the use of stationary and handheld pollution monitors, visual observations and rain radar data, and by comparing observations to predictions from an atmospheric dispersion model. The 52 ha fire produced a smoke plume about 800 m high and 9 km long. Particle concentrations (PM2.5) reached very high peak values (> 400 µg m-3) and high 24 h average values (> 100 µg m-3) at several locations next to or within ˜ 500 m downwind from the fire, but low levels elsewhere. The 700 ha fire produced a much larger plume, peaking at ˜ 2000 m altitude and affecting downwind areas up to 14 km away. Both peak and 24 h average PM2.5 values near the fire were lower than for the 52 ha fire, but this may be because the monitoring locations were further away from the fire. Some lofted smoke spread north against the ground-level wind direction. Smoke from this fire collapsed to the ground during the night at different times in different locations. Although it is hard to attribute particle concentrations definitively to smoke, it seems that the collapsed plume affected a huge area including the towns of Wollongong, Bargo, Oakdale, Camden and Campbelltown (˜ 1200 km2). PM2.5 concentrations up to 169 µg m-3 were recorded on the morning following the fire. The atmospheric dispersion model accurately predicted the general

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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

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

    NARCIS (Netherlands)

    Langemeijer, J.J.M.; Wildt, D.J. de; Groot, G. de; 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 surviva

  12. Are angiotensin converting enzyme inhibitors superior to beta blockers in retarding progressive renal function decline?

    NARCIS (Netherlands)

    vanEssen, GG; Apperloo, AJ; Rensma, PL; Stegeman, CA; Sluiter, WJ; deZeeuw, D; deJong, PE

    1997-01-01

    We questioned the superiority of angiotensin converting enzyme (ACE) inhibitors to beta blocking drugs with regard to renal function outcome in patients with mild to moderate renal insufficiency and normal to moderately elevated blood pressure (BP). We therefore studied 89 patients in a prospective

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

    Science.gov (United States)

    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

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

    OpenAIRE

    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...

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

    DEFF Research Database (Denmark)

    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...

  16. How People Actually Use Thermostats

    Energy Technology Data Exchange (ETDEWEB)

    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.

  17. Pharmaceutical policies : effects of financial incentives for prescribers

    NARCIS (Netherlands)

    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

  18. The pitfalls of prescribing for family and friends

    OpenAIRE

    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.

  19. Soil heating and impact of prescribed burning

    Science.gov (United States)

    Stoof, Cathelijne

    2016-04-01

    Prescribed burning is highly uncommon in the Netherlands, where wildfire awareness is increasing but its risk management does not yet include fuel management strategies. A major exception is on two military bases, that need to burn their fields in winter and spring to prevent wildfires during summer shooting practice. Research on these very frequent burns has so far been limited to effects on biodiversity, yet site managers and policy makers have questions regarding the soil temperatures reached during these burns because of potential impact on soil properties and soil dwelling fauna. In March 2015, I therefore measured soil and litter temperatures under heath and grass vegetation during a prescribed burn on military terrain in the Netherlands. Soil and litter moisture were sampled pre- and post-fire, ash was collected, and fireline intensity was estimated from flame length. While standing vegetation was dry (0.13 g water/g biomass for grass and 0.6 g/g for heather), soil and litter were moist (0.21 cm3/cm3 and 1.6 g/g, respectively). Soil heating was therefore very limited, with maximum soil temperature at the soil-litter interface remaining being as low as 6.5 to 11.5°C, and litter temperatures reaching a maximum of 77.5°C at the top of the litter layer. As a result, any changes in physical properties like soil organic matter content and bulk density were not significant. These results are a first step towards a database of soil heating in relation to fuel load and fire intensity in this temperate country, which is not only valuable to increase understanding of the relationships between fire intensity and severity, but also instrumental in the policy debate regarding the sustainability of prescribed burns.

  20. Prescribing tests must have curriculum support

    Directory of Open Access Journals (Sweden)

    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.

  1. Leveraging hospital formularies for improved prescribing.

    Science.gov (United States)

    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

  2. How to prescribe physical exercise in rheumatology

    Directory of Open Access Journals (Sweden)

    S. Maddali Bongi

    2011-06-01

    Full Text Available 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 exercise should: aim to improve firstly local symptoms and then general health; respect the pain threshold; be a part of a treatment including pharmacological therapies and other rehabilitation techniques, be administered by skilled physiotherapist under the guide of a rheumatologist, be different according to different diseases, disease phases and patient expectations.

  3. The Quality of Prescribing for Psychiatric Patients

    DEFF Research Database (Denmark)

    Soerensen, A L; Nielsen, L P; Poulsen, B K;

    2014-01-01

    The Quality of Prescribing for Psychiatric PatientsSoerensen AL1,2, Nielsen LP3,4, Poulsen BK3, Lisby M3,5, Mainz J6,7 1Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Denmark; 2University College of Northern Denmark; 3......-drug interactions involved propranolol, erythromycin, simvastatin and promethazine. After adjusting for age, gender, alcohol/substance abuse, number of prescriptions, number of somatic diagnoses and level of kidney function, only polypharmacy (>5 prescriptions) increased the odds for a PIP significantly; OR=4...

  4. Analyzing transaction workflows in an ePrescribing system.

    Science.gov (United States)

    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

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

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

    OpenAIRE

    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.

  9. Glaucoma Therapy: Prescribing Pattern and Cost Analysis

    Directory of Open Access Journals (Sweden)

    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.

  10. A simple aid to digoxin prescribing.

    Science.gov (United States)

    Taggart, A J; McDevitt, D G; Johnston, G D

    1987-01-01

    We have designed a simple nomogram for predicting digoxin dosage and have tested it prospectively in two consecutive studies. These were both conducted in hospital inpatients who were not already taking digoxin but who required drug therapy for atrial tachyarrhythmias and/or cardiac failure. Study I. Sixty-seven patients received digoxin according to the nomogram and 50 completed the ten day course of the study. Forty-one of these patients were eligible for the final analysis. On the tenth day of treatment, 28 patients were within the therapeutic range for plasma digoxin (0.8 to 2.0 ng.ml-1), 12 were subtherapeutic (less than 0.8 ng.ml) and one was potentially toxic (greater than 2.0 ng.ml-1). Study II. Thirty patients completed the second study. Digoxin was prescribed according to the nomogram with the addition of a dosage correction based on the plasma digoxin level on Day 3. On the tenth day of treatment, 24 patients were within the therapeutic range, one in the subtherapeutic and 5 in the potentially toxic. This simple digoxin nomogram, with or without the Day 3 dosage correction, should prove to be a useful aid to prescribing in patients who do not require rapid digitalisation. It is particularly relevant to elderly inpatients with atrial tachyarrhythmias and/or cardiac failure. PMID:3428337

  11. Cimentaciones actuales de los rascacielos de Chicago

    Directory of Open Access Journals (Sweden)

    López Ruiz, Álvaro

    1972-05-01

    Full Text Available The main characteristics of the land and the supporting rock are given, and the pattern of present performance of Chicago's deep foundations is briefly described. This city probably has some of the highest skyscrapers in the world with deep foundations resting on rock, and possibly as well, the highest building with foundations resting on soil. The construction of piles of large diameter, resting on rock and concreted dry, as prescribed by the City Code, is the weak point which sometimes makes it necessary to insert a permanent lining tube deep into the rock in order to obtain the required leaktightness, or to pump out significant quantities of water from the bottom of the excavations. The latter can cause the dragging away of earth from adjacent foundations resting on soil at a higher level, as with the drift of the phreatic level, with the consequent risk of producing appreciable subsidence, and even undermining. To overcome this problem we carried out for the first time in Chicago, a pre-sealing, by means of chemical injections, of the supporting rock of the periphery piles of some deep foundations, by drilling into the centre of each pile, which has also been useful as a means of examining the subsoil before proceeding to the perforation of each pile. This operation was carried out on the large diameter piles of the foundations of the Northern Trust Bank skyscraper, at present under construction, with very satisfactory results. The method of pre-sealing the rock used and the results obtained are described.Se presentan las características principales del terreno y de la roca de apoyo y se describe someramente la forma de ejecución actual de las cimentaciones profundas de Chicago. Esta ciudad tendrá (en breve varios de los rascacielos más altos del mundo apoyados en cimentaciones profundas sobre roca y, posiblemente, también el edificio más alto apoyado sobre suelo. La construcción de pilotes de gran diámetro apoyados sobre roca y

  12. Early Diagnosis, Timely Treatment

    Medline Plus

    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. ...

  13. Antibiotic prescribing in primary care: first choice and restrictive prescribing are two different traits.

    NARCIS (Netherlands)

    Roosmalen, M.S van; Braspenning, J.C.C.; Smet, P.A.G.M. de; Grol, R.P.T.M.

    2007-01-01

    OBJECTIVE: To investigate the quality of antibiotic prescribing in primary care using quality indicators and the relatedness of these indicators. To determine the influence of general practice and practice population characteristics on the indicator scores. METHODS: Data on performance were collecte

  14. Tendencias Actuales del Constitucionalismo Latinoamericano

    Directory of Open Access Journals (Sweden)

    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.

  15. Tendencias actuales del constitucionalismo latinoamericano

    Directory of Open Access Journals (Sweden)

    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.

  16. Should dermatologists prescribe hormonal contraceptives for acne?

    Science.gov (United States)

    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

  17. Lorentzian Einstein metrics with prescribed conformal infinity

    CERN Document Server

    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.

  18. Proton Pump Inhibitors and the Prescribing Cascade.

    Science.gov (United States)

    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

  19. The actual goals of geoethics

    Science.gov (United States)

    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

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

    LENUS (Irish Health Repository)

    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.

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

    Science.gov (United States)

    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

  2. Antiepileptic drug prescribing before, during and after pregnancy

    DEFF Research Database (Denmark)

    Charlton, Rachel; Garne, Ester; Wang, Hao;

    2015-01-01

    and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choice of AEDs and co-prescribing of folic acid were evaluated. Results In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy...... co-prescribed with high-dose folic acid: ranging from 1.0% (CI950.3–1.8%) in Emilia Romagna to 33.5% (CI9528.7–38.4%) in Wales. Conclusion The country's differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evidence base. The low co......-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearing age taking AEDs about the need to offer and receive complete preconception care....

  3. Prescribing style and variation in antibiotic prescriptions for sore throat

    DEFF Research Database (Denmark)

    Cordoba Currea, Gloria Cristina; Siersma, Volkert Dirk; Lopez-Valcarcel, Beatriz Gonzalez;

    2015-01-01

    Background: Variation in prescription of antibiotics in primary care can indicate poor clinical practice that contributes to the increase of resistant strains. General Practitioners (GPs), as a professional group, are expected to have a fairly homogeneous prescribing style. In this paper, we...... describe variation in prescribing style within and across groups of GPs from six countries. Methods: Cross-sectional study with the inclusion of 457 GPs and 6394 sore throat patients. We describe variation in prescribing antibiotics for sore throat patients across six countries and assess whether variation...... in “prescribing style” – understood as a subjective tendency to prescribe – has an important effect on variation in prescription of antibiotics by using the concept of prescribing style as a latent variable in a multivariable model. We report variation as a Median Odds Ratio (MOR) which is the transformation...

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

    OpenAIRE

    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....

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

    Science.gov (United States)

    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

  6. Using Computer-Generated Feedback to Improve Physician Prescribing

    OpenAIRE

    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...

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

    OpenAIRE

    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...

  8. The case of pharmacist prescribing policy in Israel

    OpenAIRE

    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...

  9. Prescribed Travel Schedules for Fatigue Management

    Science.gov (United States)

    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.

  10. How and when to prescribe sodium fluoride.

    Science.gov (United States)

    Shambaugh, G E

    1989-03-01

    Sodium fluoride has now been used for 24 years in an effort to slow down or arrest sensorineural hearing nerve deterioration in patients with stapedial otosclerosis or after stapedectomy, as well as in patients with pure cochlear otosclerosis. Extensive clinical experience in thousands of patients with this therapy has demonstrated its value in arresting previously progressive sensorineural hearing loss. For a long time there were those who objected to this therapy on the basis that it had not been adequately proven by double-blind, placebo-controlled studies. They have been answered by Bretlau's study in Denmark and Fisch's from Switzerland; both investigators confirmed on small groups the value of sodium fluoride by double-blind, placebo-controlled studies. Extensive research by Professor Petrovic of Strasbourg while at our tissue culture laboratory at Northwestern University demonstrated the action of sodium fluoride on bone. A nicely designed study with radioactive strontium by Linthicum, House, and Althaus demonstrated its value in promoting maturation of a spongiotic focus. Today there is no reason to hesitate in prescribing this useful, effective, and safe medication to promote maturation of otospongiotic lesions, and thus to slow down or to arrest progression in sensorineural hearing loss.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Improving Prescribing Practices in Primary Care

    OpenAIRE

    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 ...

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

    LENUS (Irish Health Repository)

    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.

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

    OpenAIRE

    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...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    LENUS (Irish Health Repository)

    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.

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Prescriber adoption of newly approved selective COX-2 inhibitors

    NARCIS (Netherlands)

    Layton, Deborah; Souverein, Patrick C.; Heerdink, Eibert R.; Shakir, Saad A. W.; Egberts, A. G. C.

    2008-01-01

    Introduction There is no consistent definition of prescribers who adopt new drug treatments early. This study examines if COX-2 inhibitors (coxibs) were prescribed by subsets of practitioners and describes GP adoption patterns of coxibs and existing NSAIDs over time. Methods A population-based drug

  20. Legal and actual central bank independence

    OpenAIRE

    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...

  1. Factor analysis improves the selection of prescribing indicators

    DEFF Research Database (Denmark)

    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....

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

    OpenAIRE

    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...

  3. How often do general practitioners prescribe antibiotics for otitis media and the most common respiratory tract infections?

    Directory of Open Access Journals (Sweden)

    Jørund Straand

    2009-11-01

    Full Text Available  ABSTRACTObjective:  Design:  Setting:  Material:  Results:  Conclusion:  Key words:  Antibiotics, general practice, diagnoses, respiratory tract infections, otitis media, pharmacoepidemiologyExcept for upper respiratory tract infection, antibiotic treatment is the rule not an exception, forall the diagnoses studied. In general practice, improved communication- and prescribing-skills are probablyessentials for implementing a more evidence based treatment of otitis media, and the common respiratorytract infections. The significance of patient related factors for seeing a GP (or not and for (not expectingantibiotics for otitis media and the common respiratory tract infections should be explored in future research.Antibiotics were issued during 57% of all contacts for the included diagnoses, ranging from 22%(upper respiratory tract infection to 91% (tonsillitis. All patients who had first time office consultations fortonsillitis, acute bronchitis and pneumonia, were prescribed antibiotics. One out of three patients who consultedthe doctor on the telephone for these diagnoses, were also prescribed an antibiotic.8610 physician-patient contacts, and 4909 antibiotic prescriptions for otitis media, upper respiratorytract infection, tonsillitis, sinusitis, acute bronchitis, and pneumonia.Cross sectional, multipractice study.GPs in the Norwegian county of Møre & Romsdal. Data were recorded during two months.To examine how frequently general practitioners actually prescribe antibiotics for patientscontacting them for otitis media, and the most common respiratory tract infection diagnoses, – by the type ofdoctor-patient contact during prescribing, and patients' age and sex.

  4. Bridging the gap: improving safe prescribing from university to workplace.

    Science.gov (United States)

    Ward, Stephen; Wasson, Gemma

    2016-10-01

    One of the challenges for Foundation Year 1 junior doctors is to apply the theoretical pharmacology from their undergraduate years into practical prescribing. The EQUIP study in 2009 investigated the causes of prescribing errors by junior doctors. Respondents in the study reported deficiencies in their education for prescribing skills and error prevention. The study suggested more could be done during undergraduate education to link theory with practice. This article describes an initiative from a hospital clinical pharmacy team to address this gap in contextual prescribing skills. Final year medical students (FY0s) were allocated to the Belfast Trust for an 11 week placement. The Clinical Pharmacy team developed a 3 h FY0 workshop focusing on practical prescribing scenarios identified as high risk by local medicines safety teams. The workshops included simulated case studies requiring the FY0 student to discuss medicine use with patients, prescribe admission drug charts and use local guidelines to safely prescribe high risk medicines. Each student was assessed using direct observation of procedural skills (DOPS). Feedback was overwhelmingly positive. Students appreciated the practical elements of the workshop. Initially there was an over-reliance on written medication history without verbally engaging the patient. Following pharmacist feedback before the DOPS students demonstrated a clear improvement in patient communication. Feedback from the FY0 students also identified additional learning needs that formed the basis of further teaching. PMID:27395012

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

    Science.gov (United States)

    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

  6. Actual Causation in CP-logic

    CERN Document Server

    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.

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

    Data.gov (United States)

    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...

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

    Data.gov (United States)

    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...

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

    Data.gov (United States)

    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...

  10. Medicare Part D Prescriber Look-up Tool

    Data.gov (United States)

    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....

  11. The pitfalls of prescribing for family and friends.

    Science.gov (United States)

    Bird, Sara

    2016-02-01

    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. The Medical Board of Australia states medical practitioners should avoid providing medical care to anyone with whom they have a close personal relationship. Medical defence organisations may exclude treatment of family members from doctors' insurance cover. Think very carefully before you prescribe for family and friends. It is only considered ethically and professionally appropriate to prescribe in exceptional circumstances, and there are potential risks to you and your family member or friend if you do. PMID:27041799

  12. Prime Hook National Wildlife Refuge 1993 Prescribed Fire Program

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — When environmental and weather conditions are right prescribed fire will be used for the reduction of hazardous fuels, wildlife habitat management and the...

  13. Vasodilatory mechanisms of beta receptor blockade.

    OpenAIRE

    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...

  14. Perspectives on prescribing in nursing homes in Helsinki

    OpenAIRE

    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...

  15. Potential prescribing omissions vs polypharmacy among elderly patients

    OpenAIRE

    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: ...

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

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

    OpenAIRE

    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, ...

  19. Impact of prescribed burning on blanket peat hydrology

    OpenAIRE

    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...

  20. Fluorine prescribing practice of paediatricians in Berlin, Germany

    OpenAIRE

    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 ...

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

    OpenAIRE

    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...

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

    Directory of Open Access Journals (Sweden)

    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

  3. ASSESSEMENT OF PRESCRIBING PATTERN IN BORUMEDA HOSPITAL NORTH EAST ETHIOPIA

    Directory of Open Access Journals (Sweden)

    Assen M

    2015-09-01

    Full Text Available Introduction: Appropriate drug utilization has a huge contribution to global reduction in morbidity and mortality with its consequent medical, social and economic benefits [1]. Inappropriate prescribing is known all over the world as a major problem of health care delivery. Drug Utilization Reviews (DURs are useful for obtaining information about drug usage patterns and for identifying high cost drugs, which are of economic interest Objectives: To assess prescribing pattern in medical outpatient department (OPD of Boru Meda Hospital, North East, Ethiopia Methods: A retrospective, descriptive, cross-sectional study was conducted. A total of 385 prescriptions were randomly collected from the OPD prescription papers existing from Jan 2012 to Dec 2012. The prescriptions were analyzed in the context of adherence to some of WHO core prescribing indicators. Result: Average number of drugs was 1.88. 80.02% prescriptions had drugs prescribed by generic name. Antibiotics were prescribed in 34.57% and 6.06% prescriptions had injectable preparations. (85.26% of drugs were from essential drugs list for Ethiopia (EDL (3rd edition. Conclusion: On the basis of the finding of this study, antibiotics use, adherence to essential drug list and generic prescription showed deviation from the standard recommended by WHO. This calls for sustained interventional strategies and periodic audit at all levels of health care to avoid the negative consequences of inappropriate prescriptions. On the other hand, poly-pharmacy, injectable prescribing were not found to be a problem in this study.

  4. Conterminous U.S. actual evapotranspiration data

    Data.gov (United States)

    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...

  5. Self-Actualization, Liberalism, and Humanistic Education.

    Science.gov (United States)

    Porter, Charles Mack

    1979-01-01

    The relationship between personality factors and political orientation has long been of interest to psychologists. This study tests the hypothesis that there is no significant relationship between self-actualization and liberalism-conservatism. The hypothesis is supported. (Author)

  6. Does fire severity influence shrub resprouting after spring prescribed burning?

    Science.gov (United States)

    Fernández, Cristina; Vega, José A.; Fonturbel, Teresa

    2013-04-01

    Prescribed burning is commonly used to reduce the risk of severe wildfire. However, further information about the associated environmental effects is required to help forest managers select the most appropriate treatment. To address this question, we evaluated if fire severity during spring prescribed burning significantly affects the resprouting ability of two common shrub species in shrubland under a Mediterranean climate in NW Spain. Fire behaviour and temperatures were recorded in tagged individuals of Erica australis and Pterospartum tridentatum during prescribed burning. The number and length of resprouted shoots were measured three times (6, 12 and 18 months) after the prescribed burning. The influence of a series of fire severity indicators on some plant resprouting vigour parameters was tested by canonical correlation analysis. Six months and one year after prescribed burning, soil burn severity (measured by the absolute reduction in depth of the organic soil layer, maximum temperatures in the organic soil layer and the mineral soil surface during burning and the post-fire depth of the organic soil layer) reduced the resprouting vigour of E. australis and P. tridentatum. In contrast, direct measurements of fire effects on plants (minimum branch diameter, duration of temperatures above 300 °C in the shrub crown and fireline intensity) did not affect the post-fire plant vigour. Soil burn severity during spring prescribed burning significantly affected the short-term resprouting vigour in a mixed heathland in Galicia. The lack of effects eighteen months after prescribed burning indicates the high resilience of these species and illustrates the need to conciliate fire prevention and conservation goals.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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

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

    LENUS (Irish Health Repository)

    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.

  10. Asthma medication prescribing before, during and after pregnancy

    DEFF Research Database (Denmark)

    Charlton, Rachel A; Pierini, Anna; Klungsøyr, Kari;

    2016-01-01

    OBJECTIVES: To explore utilisation patterns of asthma medication before, during and after pregnancy as recorded in seven European population-based databases. DESIGN: A descriptive drug utilisation study. SETTING: 7 electronic healthcare databases in Denmark, Norway, the Netherlands, Italy (Emilia...... pregnancy. MAIN OUTCOME MEASURES: The percentage of deliveries where the woman received an asthma medicine prescription, based on prescriptions issued (UK) or dispensed (non-UK), during the year before, throughout or during the year following pregnancy. Asthma medicine prescribing patterns were described...... for 3-month time periods and the choice of asthma medicine and changes in prescribing over the study period were evaluated in each database. RESULTS: In total, 1 165 435 deliveries were identified. The prevalence of asthma medication prescribing during pregnancy was highest in the UK and Wales databases...

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

    LENUS (Irish Health Repository)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Recursive dynamics algorithm for multibody systems with prescribed motion

    Science.gov (United States)

    Jain, Abhinandan; Rodriguez, Guillermo

    1993-10-01

    This paper uses spatial operator techniques to develop a new algorithm for the dynamics of multibody systems with hinges undergoing prescribed motion. This algorithm is spatially recursive, and its computational complexity grows only linearly with the number of degrees of freedom in the system. Its structure is a hybrid of known recursive forward and inverse dynamics algorithms for regular multibody systems. Changes to the prescribed/nonprescribed nature of hinges can be implemented during run time since they are handled with very low overhead in the algorithm.

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

    OpenAIRE

    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...

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

    DEFF Research Database (Denmark)

    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....

  16. Humanistic Education and Self-Actualization Theory.

    Science.gov (United States)

    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)

  17. Developing Human Resources through Actualizing Human Potential

    Science.gov (United States)

    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,…

  18. Actual global problems of radiation protection

    International Nuclear Information System (INIS)

    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)

  19. Whiteheadian Actual Entitities and String Theory

    Science.gov (United States)

    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.

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

    Data.gov (United States)

    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...

  1. Identification of Associations Between Prescribed Medications and Cancer

    DEFF Research Database (Denmark)

    Pottegård, Anton; Friis, Søren; Christensen, René dePont;

    2016-01-01

    PURPOSE: We present a systematic screening for identifying associations between prescribed drugs and cancer risk using the high quality Danish nationwide health registries. METHODS: We identified all patients (cases) with incident cancer in Denmark during 2000-2012 (n=278,485) and matched each ca...

  2. A Nurse Prescribing Programme Incorporating e-Learning

    Science.gov (United States)

    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…

  3. Practices in prescribing protein substitutes for PKU in Europe

    DEFF Research Database (Denmark)

    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...

  4. Antibiotic prescribing in dutch nursing homes: how appropriate is it?

    NARCIS (Netherlands)

    Buul, L.W. van; Veenhuizen, R.B.; Achterberg, W.P.; Schellevis, F.G.; Essink, R.T.; Greeff, S.C. de; Natsch, S.S.; Steen, J.T. van der; Hertogh, C.M.P.M.

    2015-01-01

    OBJECTIVE: To investigate the appropriateness of decisions to prescribe or withhold antibiotics for nursing home (NH) residents with infections of the urinary tract (UTI), respiratory tract (RTI), and skin (SI). DESIGN: Prospective study. SETTING: Ten NHs in the central-west region of the Netherland

  5. Antibiotic prescribing in Dutch nursing homes: how appropriate is it?

    NARCIS (Netherlands)

    Buul, L.W. van; Veenhuizen, R.B.; Achterberg, W.P.; Schellevis, F.G.; Essink, R.T.G.M.; Greeff, S.C. de; Natsch, S.; Steen, J.T. van der; Hertogh, C.M.P.M.

    2015-01-01

    Objective: To investigate the appropriateness of decisions to prescribe or withhold antibiotics for nursing home (NH) residents with infections of the urinary tract (UTI), respiratory tract (RTI), and skin (SI). Design: Prospective study. Setting: Ten NHs in the central-west region of the Netherland

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

    NARCIS (Netherlands)

    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

  7. Enabling factors for antibiotic prescribing for upper respiratory tract infections

    DEFF Research Database (Denmark)

    Jaruseviciene, Lina; Radzeviciene Jurgute, Ruta; Bjerrum, Lars;

    2013-01-01

    Abstract Introduction. General practitioners (GPs) write about 80% of all antibiotic prescriptions, the greatest number of them for patients with respiratory tract infections. However, there is a lack of research targeting the influence of external factors on antibiotic prescribing by physicians....

  8. Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing.

    Science.gov (United States)

    Broom, Alex; Broom, Jennifer; Kirby, Emma

    2014-06-01

    The prospect of an 'antimicrobial perfect storm' in the coming decades through the emergence and proliferation of multi-resistant organisms has become an urgent public health concern. With limited drug discovery solutions foreseeable in the immediate future, and with evidence that resistance can be ameliorated by optimisation of prescribing, focus currently centres on antibiotic use. In hospitals, this is manifest in the development of stewardship programs that aim to alter doctors' prescribing behaviour. Yet, in many clinical contexts, doctors' antibiotic prescribing continues to elude best practice. In this paper, drawing on qualitative interviews with 30 Australian hospital-based doctors in mid-2013, we draw on Bourdieu's theory of practice to illustrate that 'sub-optimal' antibiotic prescribing is a logical choice within the habitus of the social world of the hospital. That is, the rules of the game within the field are heavily weighted in favour of the management of immediate clinical risks, reputation and concordance with peer practice vis-à-vis longer-term population consequences. Antimicrobial resistance is thus a principal of limited significance in the hospital. We conclude that understanding the habitus of the hospital and the logics underpinning practice is a critical step toward developing governance practices that can respond to clinically 'sub-optimal' antibiotic use.

  9. Serial pharmacological prescribing practices for tic management in Tourette syndrome.

    Science.gov (United States)

    Farag, Mena; Stern, Jeremy S; Simmons, Helen; Robertson, Mary M

    2015-11-01

    Pharmacological treatments for Tourette syndrome (TS) vary in efficacy between different patients. The evidence base is limited as even high quality controlled studies tend to be of relatively short duration which may lose relevance in clinical usage. Patients are frequently treated with serial agents in the search for efficacy and tolerability. The success of this strategy has not been previously documented. We examined 400 consecutive TS patients seen over a 10-year period, some with a longer prior history in other clinics; 255/400 (64%) were prescribed medication. We present this heterogeneous cohort in terms of the number of drugs they had tried, and as a proxy measure of some benefit of the last drug used, whether it had been prescribed under our supervision for ≥ 5 months. The most commonly prescribed medications were aripiprazole (64%), clonidine (40%), risperidone (30%) and sulpiride (29%) with changes in prescribing practises over the period examined. The number of different drugs tried were one (n = 155), two (n = 69), three (n = 36), four (n = 14), five (n = 15), six (n = 5), seven (n = 2) and eight (n = 1). The data illustrate the difficulty in drug treatment of tics and suggest that even after trials of several agents there is potential benefit in trying further options.

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

    NARCIS (Netherlands)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Trends in Antibiotic Prescribing in Adults in Dutch General Practice

    NARCIS (Netherlands)

    M.B. Haeseker (Michiel); N.H.T.M. Dukers-Muijrers (Nicole); C.J.P.A. Hoebe (Christian); C.A. Bruggeman (Cathrien); J.W.L. Cals (Jochen); A. Verbon (Annelies)

    2012-01-01

    textabstractBackground: Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this stud

  13. 20 CFR 220.115 - Need to follow prescribed treatment.

    Science.gov (United States)

    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...

  14. 20 CFR 416.930 - Need to follow prescribed treatment.

    Science.gov (United States)

    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...

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

    Science.gov (United States)

    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

  16. Inappropriate prescribing and adverse drug events in older people

    Directory of Open Access Journals (Sweden)

    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.

  17. Impact of prescribed burning on blanket peat hydrology

    Science.gov (United States)

    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.

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

    LENUS (Irish Health Repository)

    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.

  19. ACTUALIZATION OF SELF EDUCATION OF SENIOR PUPILS

    OpenAIRE

    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...

  20. The remote experiment position in actual taxonomy

    OpenAIRE

    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 ...

  1. What galvanic vestibular stimulation actually activates

    OpenAIRE

    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,...

  2. Can professionals actually enable occupational justice?

    OpenAIRE

    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 ...

  3. El valor actual de la Universidad

    Directory of Open Access Journals (Sweden)

    Fernando Sancén Contreras

    2003-01-01

    Full Text Available El presente artículo aborda el concepto mismo de valor, y se le concibe como una creación y una práctica individual y social. Definir el valor actual de la Universidad lleva a una discusión que se resuelve en la búsqueda de lo que ella ha de significar para la sociedad actual. El valor que tradicionalmente se le atribuye —transmisión de conocimientos e investigación— es ya inoperante dado que sus funciones centrales se realizan con éxito fuera de Ella. Por eso se postula el valor de la Universidad en la incorporación de la imaginación creativa para formar a los estudiantes en la conciencia y la responsabilidad de crear su futuro personal y el de la sociedad. Dicho valor no se limita al pasado ni al presente; asume a éstos como lo que da forma al futuro. Enseñar e investigar los asuntos de la sociedad y de sus miembros para construir su futuro a través de una actitud imaginativa, creadora, es el valor actual de la Universidad.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    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 ...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    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...

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

    Science.gov (United States)

    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

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

    OpenAIRE

    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...

  10. Dobutamine stress echo is superior to exercise stress testing in achieving target heart rate among patients on beta blockers.

    Science.gov (United States)

    Sabbath, Adam; Pack, Michael; Markiewicz, Richard; John, Jooby; Gaballa, Mohamed; Goldman, Steven; Thai, Hoang

    2005-01-01

    Published guidelines recommend continuing beta-adrenergic receptor blockade in patients undergoing stress testing. We evaluated the role of pharmacological versus exercise stress testing in achieving target heart rate (THR) among patients on beta-adrenergic blockade. We compared data from 140 patients who underwent dobutamine stress echo (DSE) and 143 patients who underwent exercise treadmill testing (ETT). In both groups, beta-adrenergic blocker was continued at the time of stress testing. Overall, patients undergoing DSE achieved THR more frequently than ETT. With beta-adrenergic blockade, DSE patients met THR more frequently than ETT patients (p < 0.001). Without beta-adrenergic blockade, there was no difference between either modality in achieving THR. In both DSE and ETT patients, absence of beta-adrenergic blockade increased the odds of achieving THR [odds ratio (OR): 2.46, p = 0.042 and OR: 7.44, p < 0.001, respectively]. Atropine use with DSE increased the odds of achieving THR (OR: 3.76, p = 0.006). In conclusion, pharmacological stress testing appears to be superior to exercise stress testing in achieving THR among patients on beta-adrenergic blockade.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    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...

  14. Towards Designing Android Faces after Actual Humans

    DEFF Research Database (Denmark)

    Vlachos, Evgenios; Schärfe, Henrik

    2015-01-01

    Using their face as their prior affective interface, android robots and other agents embody emotional facial expressions, and convey messages on their identity, gender, age, race, and attractiveness. We are examining whether androids can convey emotionally relevant information via their static...... human) and its’ Original (the actual human). The emotional judgments were achieved through an online survey with video-stimuli and questionnaires, following a forced-choice design. Analysis of the results indicated that the emotional judgments for the Geminoid-DK highly depend on the emotional judgments...... of the robotic task, in order to increase the chance of sustaining a more emotional interaction....

  15. Prescribing under the Influence: The Business of Breastmilk Substitutes

    Directory of Open Access Journals (Sweden)

    Rosa Rios

    2016-09-01

    Full Text Available This study draws on a general theoretical framework comprising of a decision maker (a doctor, perceived moral intensity of the issue (breastfeeding substitute prescription, and the situational environment (hospital policy, pharma company promotions, and mother’s beliefs regarding breastfeeding to explain the physician’s role and influence on mothers’ infant feeding choices when prescribing infant formula in Kuwait, Middle East. Moral intensity is an issue-contingent model that suggests ethical decisions vary in terms of how much a moral imperative is present in a situation. The moral intensity of the issue is assessed using six components. Path Least Squares results indicate the following moral intensity components have significant impact on prescription behavior: magnitude of consequences, probability of effect, and temporal immediacy. Company promotion and hospital policy also significantly influence doctor’s prescription of infant formula. Doctors appear to disengage from the consequences of over prescribing infant formula.

  16. A model for solving the prescribed burn planning problem

    OpenAIRE

    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...

  17. Moderating Benzodiazepine Use in the Elderly: Curbing physicians' prescribing practices

    OpenAIRE

    Huston, Patricia G.

    1992-01-01

    In Quebec, the elderly receive 4.5 prescriptions per year for sedative-hypnotic medications, most of which are benzodiazepines. Similar rates have been documented in the rest of Canada and other Western countries. Physician prescribing practices must be moderated, as the incidence of cognitive dysfunction, injury, and hidden disorders associated with benzodiazepine use in the elderly is on the rise. Strategies to moderate sleeping pill use are discussed; a revised, less toxic approach to mana...

  18. Moderating Benzodiazepine Use in the Elderly: Curbing physicians' prescribing practices.

    Science.gov (United States)

    Huston, P G

    1992-10-01

    In Quebec, the elderly receive 4.5 prescriptions per year for sedative-hypnotic medications, most of which are benzodiazepines. Similar rates have been documented in the rest of Canada and other Western countries. Physician prescribing practices must be moderated, as the incidence of cognitive dysfunction, injury, and hidden disorders associated with benzodiazepine use in the elderly is on the rise. Strategies to moderate sleeping pill use are discussed; a revised, less toxic approach to managing insomnia is presented. PMID:21221306

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

    OpenAIRE

    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...

  20. Moderating Benzodiazepine Use in the Elderly: Curbing physicians' prescribing practices.

    Science.gov (United States)

    Huston, P G

    1992-10-01

    In Quebec, the elderly receive 4.5 prescriptions per year for sedative-hypnotic medications, most of which are benzodiazepines. Similar rates have been documented in the rest of Canada and other Western countries. Physician prescribing practices must be moderated, as the incidence of cognitive dysfunction, injury, and hidden disorders associated with benzodiazepine use in the elderly is on the rise. Strategies to moderate sleeping pill use are discussed; a revised, less toxic approach to managing insomnia is presented.

  1. Analysis for commonly prescribed non-sedating antihistamines

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    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...

  3. Special Needs to Prescribe Exercise Intensity for Scientific Studies

    OpenAIRE

    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...

  4. Root Disease, Longleaf Pine Mortality, and Prescribed Burning

    Energy Technology Data Exchange (ETDEWEB)

    Otrosina, W.J; C.H. Walkinshaw; S.J. Zarnoch; S-J. Sung; B.T. Sullivan

    2001-01-01

    Study to determine factors involved in decline of longleaf pine associated with prescribed burning. Trees having symptoms were recorded by crown rating system based upon symptom severity-corresponded to tree physiological status-increased in hot burn plots. Root pathogenic fungi widespread throughout the study site. Histological studies show high fine root mortality rate in the hot burn treatment. Decline syndrome is complexed by root pathogens, soil factors, root damage and dysfunction.

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

    Science.gov (United States)

    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

  6. Evaluation of prescribing indicators and pattern among dermatological outpatients in a teaching hospital of central Nepal

    Directory of Open Access Journals (Sweden)

    Manohar Pradhan

    2016-08-01

    Full Text Available Background: Evaluation of prescribing indicators by proper analysis of prescriptions under the guidelines of World Health Organization enables us to detect some of the common problems of prescribing.Methodology: This study was conducted on randomly selected 325 prescriptions of dermatological outpatients of teaching hospital of College of Medical Sciences Bharatpur (Nepal with an objective to detect the problems of prescribing as well as to delineate the pattern of medicines prescribing.Results: Total number of medicines prescribed on these prescriptions was 743. The average number of medicines per encounter was 2.28. Antihistamines, antifungals, corticosteroids and antibiotics were four most frequently prescribed therapeutic classes. One systemic as well as one topical medicine belonging to same therapeutic class was prescribed on about one-third of totally analyzed prescriptions. Cetrizine was the most common individually prescribed medicine and fluconazole was the most commonly prescribed antifungal. Medicines prescribed by their generic name were 15.07% and those prescribed from national essential medicines list were 23.42%.Conclusion: This study reveals polypharmacy, inclination of prescribers for branded medicines and prescribing out of national formulary as problems. Educational and managerial interventions are required to rationalize the prescribing practice.JCMS Nepal. 2016;12(2:44-9.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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.

  9. Comparison of CRBRP standards to DOE prescribed standards

    International Nuclear Information System (INIS)

    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

  10. Prescribing pattern of antidiabetic drugs in Indore city hospital

    Directory of Open Access Journals (Sweden)

    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%.

  11. Synthesis of log-periodic antennas with prescribed geometry

    Science.gov (United States)

    Yatskevich, V. A.

    1985-09-01

    The synthesis of log-periodic dipole antennas for wideband shortwave or ultrashort-wave communication systems is shown, assuming a prescribed array geometry with the oscillator connected to the smallest dipole and with currents in or voltages across the dipoles predetermined for best approximation of the prescribed radiation pattern. The problem of synthesis reduces to calculation of the y-parameters of the connecting four-pole networks which will yield the prescribed amplitude-phase distribution. The procedure begins with synthesis of purely reactive and thus lossless four-pole networks for a fixed single frequency, preferably for the lower limit of the frequency range so that the frequency characteristics of those y-parameters can then be calculated directly without need for additional data, while the input impedance of the antenna is made purely resistive. A reactive feed system is synthesized next according to conventional methodology, which has been simplified for a series rather than parallel feed system. Minimum-phase four-pole networks are considered for physical realization of mathematically established frequency characteristics with reactive circuit elements.

  12. Tendencias y Direcciones Del Teatro Chileno Actual

    Directory of Open Access Journals (Sweden)

    Sergio Pereira Poza

    1997-01-01

    Full Text Available Este artículo se propone entregar una visión panorámica del teatro contemporáneo en Chile en el contexto de lo que se ha denominado la crisis de la modernidad. A partir de la premisa de que las muestras tendenciales del teatro de hoy son el resultado del proceso de revisión que vive la cultura de la modernidad, el trabajo se ocupa, primeramente, de examinar las características que presenta en el mundo occidental el recusamiento de la modernidad y sus reflejos en el teatro actual y en el nuevo teatro chileno. En un segundo momento, se estudian los términos con los que nuestro teatro responde a la crisis en desarrollo, proponiendo las tres direcciones que muestra la práctica escénica contemporánea en Chile: Teatro Verbal, Teatro Espectáculo y Teatro Gestual

  13. La filosofía alemana actual

    OpenAIRE

    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...

  14. Actual service life prediction of building components

    DEFF Research Database (Denmark)

    Aagaard, Niels-Jørgen; Brandt, Erik; Hansen, Ernst Jan de Place

    2014-01-01

    , the paper presents an analysis of service life of buildings as such with respect to the use of the building partially based on analysis of data from the nationwide Danish register of buildings and housing as well as turnover in the Danish construction industry from refurbishment and demolition activities...... a condensed method for assessment of life cycle costs for buildings. Estimation of life cycle costs has traditionally been based on predicted service life for building components in terms of technical performance. This paper suggests a method for taking into account other contributing factors...... such as economics, aesthetics and use of the building. Each of these factors is regarded as a stochastic variable and can be seen as competing causes of bringing service life to an end. A model is proposed for combining such variables resulting in the actual service life of building components. Furthermore...

  15. What galvanic vestibular stimulation actually activates

    Directory of Open Access Journals (Sweden)

    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.

  16. Can professionals actually enable occupational justice?

    Directory of Open Access Journals (Sweden)

    Elizabeth Townsend

    2013-08-01

    Full Text Available : 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 began. The journey continues by highlighting resources – namely a YouTube film: Reaching Out: Today’s Activist Occupational Therapy and selected English language references from occupational science and occupational therapy that display an emerging knowledge bank for six population-based occupational justice practices which could be enriched with resources in other languages and fields. The journey ends with reflections on the complex professional power relations that need careful attention by professionals who intend to enable occupational justice.

  17. 7 CFR 1437.101 - Actual production history.

    Science.gov (United States)

    2010-01-01

    ... Determining Yield Coverage Using Actual Production History § 1437.101 Actual production history. Actual production history (APH) is the unit's record of crop yield by crop year for the APH base period. The APH... 7 Agriculture 10 2010-01-01 2010-01-01 false Actual production history. 1437.101 Section...

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

    DEFF Research Database (Denmark)

    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)....

  19. Rapidly increasing prescribing of proton pump inhibitors in primary care despite interventions

    DEFF Research Database (Denmark)

    Haastrup, Peter; Paulsen, Maja Skov; Zwisler, Jon Eik;

    2014-01-01

    Background: Guideline and reimbursement modifications have been introduced to optimize prescribing of antisecretory medication in Danish general practice. Impacts of the interventions have not been evaluated. Objectives: To analyse developments in prescribing of antisecretory medication in Denmar...

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

    LENUS (Irish Health Repository)

    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.

  1. Drug Use Evaluation of Three Widely Prescribed Antibiotics in a

    Directory of Open Access Journals (Sweden)

    Mehdi Mohammadi

    2015-10-01

    Full Text Available Background: Drug utilization studies are helpful in understanding the current practice. We have conducted a retrospective study to evaluate the relevant use of a group of most commonly prescribed antibiotics in a teaching hospital in Iran.  The results of this study may be of help for clinicians to improve the patient care.Methods: Patients who received parenteral ceftazidim, vancomycin and amikacin from December2010 to May 2011 were enrolled in this study. Patient’s data including demographic, length of Hospital stay, drug allergy, first and final diagnosis were recorded in a predesigned data collection form. American Hospital Formulary Services (AHFS book were used as a reference for evaluation of study drug indication and dosing according to diagnosis and microbiological culture. Defined Daily Dose (DDD of each drug extracted from Anatomic and Therapeutic Chemical classification system (ATC/DDD and drug usage data evaluated by calculating the ratio of prescribed drug to its DDD.Results: The ratio of prescribed daily dose to DDD was 0.78, 0.95 and 0.86 for amikacin, ceftazidime and vancomycin respectively. Between amikacin group, 43 patients (86% received drug empirically, the number of empiric treatments for ceftazidim and vancomycin were 45(90% and 44 patients (88%. The renal function tests (Blood Urea Nitrogen, Serum Creatinin were evaluated in 56% of amikacin group, 64% in ceftazidime group and 78% in vancomycin group.Conclusion: The results of this study indicate the need to establish continuing medical education (CME courses for physicians to familiarize them with standards required to use and monitor these agents.

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

    International Nuclear Information System (INIS)

    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)

  3. La estructura resistente en la arquitectura actual

    Directory of Open Access Journals (Sweden)

    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

  4. Impact of prescribed diabatic heating on short range weather forecasts

    Science.gov (United States)

    Marx, L.; Shukla, J.

    1984-01-01

    Using the 9 layer general circulation model developed at the Goddard Laboratory for Atmospheric Sciences (GLAS), several 4 to 5 day integrations were made to assess the impact that latent heating processes (supersaturation and moist convective) have on the model forecasts. In an earlier study by Shukla (1981) it was hypothesized that because of strong interaction between dynamics and moist convection, small initial errors grow very fast and make short range forecasting difficult. The purpose of this study was to examine if prescribed heating rates can improve the forecasts for a few days.

  5. Study of Prescribing Pattern for Rational Drug Therpay

    Directory of Open Access Journals (Sweden)

    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 .

  6. Doctors and Drugs : How Swedish Emergency and Family Physicians Understand Drug Prescribing

    OpenAIRE

    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...

  7. Pharmacist prescribing in the United Kingdom and the implication for the Nigerian context

    OpenAIRE

    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...

  8. Evaluation of prescribing indicators in prescriptions of private practitioners in Kolkata, India

    Directory of Open Access Journals (Sweden)

    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

  9. Prescribing pattern of antimicrobials in various clinical departments of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    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

  10. The Great Boundary Crossing: Perceptions on Training Pharmacists as Supplementary Prescribers in the UK

    Science.gov (United States)

    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…

  11. Repeat prescribing: scale, problems and quality management in ambulatory care patients.

    NARCIS (Netherlands)

    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

  12. Prescribing trends for dabigatran etexilate in primary care.

    LENUS (Irish Health Repository)

    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.

  13. The involvement of prescribed drugs in road trauma.

    Science.gov (United States)

    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

  14. Timing of Administration: For Commonly-Prescribed Medicines in Australia

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    Gagandeep Kaur

    2016-04-01

    Full Text Available Chronotherapy involves the administration of medication in coordination with the body’s circadian rhythms to maximise therapeutic effectiveness and minimise/avoid adverse effects. The aim of this study is to investigate the “time of administration” recommendations on chronotherapy for commonly-prescribed medicines in Australia. This study also aimed to explore the quality of information on the timing of administration presented in drug information sources, such as consumer medicine information (CMI and approved product information (PI. Databases were searched for original research studies reporting on the impact of “time of administration” of the 30 most commonly-prescribed medicines in Australia for 2014. Further, time of administration recommendations from drug information sources were compared to the evidence from chronotherapy trials. Our search revealed 27 research studies, matching the inclusion and exclusion criteria. In 56% (n = 15 of the research studies, the therapeutic effect of the medicine varied with the time of administration, i.e., supported chronotherapy. For some medicines (e.g., simvastatin, circadian-based optimal administration time was evident in the information sources. Overall, dedicated studies on the timing of administration of medicines are sparse, and more studies are required. As it stands, information provision to consumers and health professionals about the optimal “time” to take medications lags behind emerging evidence.

  15. Potentially inappropriate prescribing in an Irish elderly population in primary care.

    LENUS (Irish Health Repository)

    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.

  16. An overiew of non medical prescribing across one strategic health authority: a questionnaire survey

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    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

  17. An evaluation of the appropriateness and safety of nurse and midwife prescribing in Ireland.

    LENUS (Irish Health Repository)

    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.

  18. Does a computerized price comparison module reduce prescribing costs in general practice?

    DEFF Research Database (Denmark)

    Vedsted, Peter; Nielsen, Jørgen Nørskov; Olesen, Frede

    1997-01-01

    OBJECTIVE: We aimed to assess the trends in prescribed defined daily doses (DDD) and drug expenses before and after the introduction of a computerized cost containment module into the computer record system of a defined group of GPs. The GPs' expectations for and experiences with the module were...... comprised 158 practices including 231 GPs in Aarhus County, Denmark. Questionnaires were sent to the 20 intervention practices. The main outcome measures were prescribed DDD, reimbursement for prescribed drugs, and reimbursement per prescribed DDD quarterly during 1992 and 1993. RESULTS: Compared...... with the controls there were no changes in prescribed DDD, reimbursement for prescribed drugs, and reimbursement per prescribed DDD in the intervention group after the introduction of the module. CONCLUSION: Simply giving a random group of GPs computer assistance to choose less expensive drugs did not reduce...

  19. DRUG UTILIZATION STUDY OF PSYCHOTROPIC DRUGS PRESCRIBED IN PSYCHIATRY OPD OF L. N. MEDICAL COLLEGE ASSOCIATED J. K. HOSPITAL, BHOPAL DISTRICT, MADHYA PRADESH

    Directory of Open Access Journals (Sweden)

    Richa

    2016-06-01

    Full Text Available BACKGROUND Utilization pattern of drugs varies from place to place and is influenced by differing patient characteristics, type of disease prevalent, cultural and environmental influences, socioeconomic states, availability of newer drugs and prescribing habit of physicians. 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. Psychotropic drugs have had a remarkable impact in psychiatric practice. However, their utilization in actual clinical practice, effectiveness and safety in real life situation needs continuous studies. So our aim to study the prevalence of psychiatric morbidity and analyse drug prescribing pattern in various psychiatric illnesses. METHODOLOGY A prospective cross sectional study was carried out for 6 months (Dec. 2014 - May. 2015 in psychiatry OPD of L. N. Medical College, Bhopal. Patients of all ages and both sexes were included in the study and 600 prescriptions were randomly selected. RESULT Antipsychotic drugs (75.33% were most frequently prescribed psychotropic drugs in various psychiatric disorders followed by Anti-Depressants (48.33% and Anxiolytics (26%. CONCLUSION This study shows that antipsychotics are the most common antipsychotic drugs prescribed in patients with psychotic illness. Depression is the most common disease. Prescription rate was higher in men between 21-40 yrs. age

  20. Airborne characterization of smoke marker ratios from prescribed burning

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    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.

  1. Potentially inappropriate prescribing in older primary care patients.

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    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

  2. Evaluation of trends of drug-prescribing patterns based on WHO prescribing indicators at outpatient departments of four hospitals in southern Ethiopia

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    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

  3. Impact of Early Electronic Prescribing on Pharmacists’ Clarification Calls in Four Community Pharmacies Located in St John’s, Newfoundland

    OpenAIRE

    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...

  4. Validity of the Prescriber Information in the Danish National Prescription Registry.

    Science.gov (United States)

    Rasmussen, Lotte; Valentin, Julie; Gesser, Katarina Margareta; Hallas, Jesper; Pottegård, Anton

    2016-10-01

    The aim of this study was to measure the validity of the prescriber information recorded in the Danish National Prescription Registry (DNPR). The prescriber information recorded in the pharmacies' electronic dispensing system was considered to represent the prescriber information recorded in the DNPR. Further, the problem of validity of the prescriber information pertains only to non-electronic prescriptions, as these are manually entered into the dispensing system. The recorded prescriber information was thus validated against information from a total of 2000 non-electronic prescriptions at five Danish community pharmacies. The validity of the recorded prescriber information was measured at the level of the individual prescriber and the prescriber type, respectively. The proportion of non-electronic prescriptions with incorrect registrations was 22.4% (95% confidence interval (CI): 20.6-24.3) when considering individual prescriber identifiers and 17.8% (95% CI: 16.1-19.5) when considering prescriber type. When excluding prescriptions specifically registered as 'missing prescriber identifier', the proportions decreased to 9.5% (95% CI: 8.2-11.0) and 4.1% (95% CI: 3.2-5.1), respectively. The positive predictive values for the classification of prescriber types were in the range of 94.0-99.2%, while the sensitivity ranged between 64.6% and 91.8%. With a maximum of 14% non-electronic prescriptions of all prescriptions in the DNPR in 2015, this corresponds to correct classification of prescriber types in the DNPR of at least 97.5%. In conclusion, the prescriber information in the DNPR was found to be valid, especially in recent years. Researchers should be aware of the low sensitivity towards prescriptions from private practicing specialists.

  5. Design of Ultraspherical Window Functions with Prescribed Spectral Characteristics

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    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.

  6. Intensity in phonological intervention: is there a prescribed amount?

    Science.gov (United States)

    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

  7. Congruence between international guidelines and mite specific immunotherapy prescribing practices.

    Science.gov (United States)

    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

  8. Risk evaluation and mitigation strategies (REMS): educating the prescriber.

    Science.gov (United States)

    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

  9. Protocol for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study: a cluster randomised controlled trial using ePrescribing data

    Science.gov (United States)

    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

  10. Quality Improvement Initiative to Decrease Variability of Emergency Physician Opioid Analgesic Prescribing

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    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

  11. Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists.

    LENUS (Irish Health Repository)

    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

  12. 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.

    LENUS (Irish Health Repository)

    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.

  13. Comparisons of anti-diabetic prescriptions of private practitioners and hospital prescribers: A survey

    Directory of Open Access Journals (Sweden)

    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.

  14. The prescribing physician's influence on consumer choice between medically equivalent pharmaceuticals

    OpenAIRE

    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...

  15. Stakeholders' views on granting prescribing authority to pharmacists in Nigeria: a qualitative study.

    Science.gov (United States)

    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

  16. Specialist pediatric palliative care prescribing practices: A large 5-year retrospective audit

    Directory of Open Access Journals (Sweden)

    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

  17. Drug information for patients: bringing together the messages from prescriber, pharmacist and manufacturer *

    OpenAIRE

    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...

  18. Clinical Comparative Effectiveness of Independent Non-Medical Prescribers for Type 2 Diabetes

    OpenAIRE

    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 ...

  19. Repeat prescribing: a role for community pharmacists in controlling and monitoring repeat prescriptions.

    OpenAIRE

    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...

  20. Potentially inappropriate prescribing and cost outcomes for older people: a national population study.

    LENUS (Irish Health Repository)

    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.

  1. River ecosystem response to prescribed vegetation burning on Blanket Peatland.

    Directory of Open Access Journals (Sweden)

    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.

  2. River ecosystem response to prescribed vegetation burning on Blanket Peatland.

    Science.gov (United States)

    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

  3. Prescribed fire effects on biological control of leafy spurge

    Science.gov (United States)

    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.

  4. Information Rx: prescribing good consumerism and responsible citizenship.

    Science.gov (United States)

    Adams, Samantha; de Bont, Antoinette

    2007-12-01

    Recent medical informatics and sociological literature has painted the image of a new type of patient--one that is reflexive and informed, with highly specified information needs and perceptions, as well as highly developed skills and tactics for acquiring information. Patients have been re-named "reflexive consumers." At the same time, literature about the questionable reliability of web-based information has suggested the need to create both user tools that have pre-selected information and special guidelines for individuals to use to check the individual characteristics of the information they encounter. In this article, we examine suggestions that individuals must be assisted in developing skills for "reflexive consumerism" and what these particular skills should be. Using two types of data (discursive data from websites and promotional items, and supplementary data from interviews and ethnographic observations carried out with those working to sustain these initiatives), we examine how users are directly addressed and discussed. We argue that these initiatives prescribe skills and practices that extend beyond finding and assessing information on the internet and demonstrate that they include ideals of consumerism and citizenship.

  5. Inhaled Drug Delivery: A Practical Guide to Prescribing Inhaler Devices

    Directory of Open Access Journals (Sweden)

    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.

  6. Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior

    Science.gov (United States)

    Tang, Yan; Chang, Chung-Chou H.; Lave, Judith R.; Gellad, Walid F.; Huskamp, Haiden A.; Donohue, Julie M.

    2016-01-01

    Background Physicians face the choice of multiple ingredients when prescribing drugs in many therapeutic categories. For conditions with considerable patient heterogeneity in treatment response, customizing treatment to individual patient needs and preferences may improve outcomes. Aims of the Study To assess variation in the diversity of antipsychotic prescribing for mental health conditions, a necessary although not sufficient condition for personalizing treatment. To identify patient caseload, physician, and organizational factors associated with the diversity of antipsychotic prescribing. Methods Using 2011 data from Pennsylvania’s Medicaid program, IMS Health’s HCOS™ database, and the AMA Masterfile, we identified 764 psychiatrists who prescribed antipsychotics to ≥10 patients. We constructed three physician-level measures of diversity/concentration of antipsychotic prescribing: number of ingredients prescribed, share of prescriptions for most preferred ingredient, and Herfindahl-Hirschman index (HHI). We used multiple membership linear mixed models to examine patient caseload, physician, and healthcare organizational predictors of physician concentration of antipsychotic prescribing. Results There was substantial variability in antipsychotic prescribing concentration among psychiatrists, with number of ingredients ranging from 2-17, share for most preferred ingredient from 16%-85%, and HHI from 1,088-7,270. On average, psychiatrist prescribing behavior was relatively diversified; however, 11% of psychiatrists wrote an average of 55% of their prescriptions for their most preferred ingredient. Female prescribers and those with smaller shares of disabled or serious mental illness patients had more concentrated prescribing behavior on average. Discussion Antipsychotic prescribing by individual psychiatrists in a large state Medicaid program varied substantially across psychiatrists. Our findings illustrate the importance of understanding physicians

  7. Transfer Pricing Based on Actual versus Standard Costs

    OpenAIRE

    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...

  8. Trends in the Association Between Prescribed and Non-Prescribed Use of Tranquillisers or Sedatives Among Adolescents in 22 European Countries

    Directory of Open Access Journals (Sweden)

    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.

  9. ‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people.

    OpenAIRE

    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...

  10. ‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people

    OpenAIRE

    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...

  11. 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

    OpenAIRE

    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...

  12. Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients: a before and after study.

    OpenAIRE

    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. An Analysis of Personal Factors that Determine Carrie’s Self -Actual-ization in Sister Carrie

    Institute of Scientific and Technical Information of China (English)

    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.

  14. Legal barriers to effective ecosystem management: exploring linkages between liability, regulations, and prescribed fire.

    Science.gov (United States)

    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

  15. Legal barriers to effective ecosystem management: exploring linkages between liability, regulations, and prescribed fire.

    Science.gov (United States)

    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

  16. Antiaging treatments have been legally prescribed for approximately thirty years.

    Science.gov (United States)

    Ukraintseva, Svetlana V; Arbeev, Konstantin G; Michalsky, Anatoly I; Yashin, Anatoly I

    2004-06-01

    There is an interesting divergence between the achievements of geriatrics and gerontology. On the one hand, during the last 30 years physicians in many developed countries have successfully prescribed several medicines to cure various symptoms of senescence. On the other hand, the influence of such medicines on human life span practically has not been studied. The most common of the relevant medicines are nootropic piracetam, gamma-aminobutyric acid (GABA), selegiline, Ginkgo biloba, pentoxifylline, cerebrolysin, solcoseryl, ergoloid, vinpocetin, sertraline, and estrogens, among others. Available data from human clinical practices and experimental animal studies indicate that treatments with these drugs improve learning, memory, brain metabolism, and capacity. Some of these drugs increase tolerance to various stresses such as oxygen deficit and exercise, stimulate the regeneration of neurons in the old brain, and speed up the performance of mental and physical tasks. This means that modern medicine already has "antiaging" treatments at its disposal. However, the influence of such treatments on the mean and maximal life span of humans, and on the age trajectory of a human survival curve has been poorly studied. The increase in human life expectancy at birth in the second half of the last century was mostly caused by the better survival at the old and oldest old rather than at the young ages. In parallel, the consumption of brain protective and regenerative drugs has been expanding in the elderly population. We provide evidence in support of the idea that the consumption of medicines exerting antiaging properties may contribute to the increase in human longevity.

  17. Polypharmacy patterns: unravelling systematic associations between prescribed medications.

    Directory of Open Access Journals (Sweden)

    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

  18. Acute oxygen therapy: a review of prescribing and delivery practices

    Directory of Open Access Journals (Sweden)

    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

  19. Dispensing physicians and prescribing pharmacists: economic considerations for the UK.

    Science.gov (United States)

    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

  20. Long-term oxygen therapy: Are we prescribing appropriately?

    Directory of Open Access Journals (Sweden)

    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

  1. Notification prescribing the quantities of radioisotopes and others

    International Nuclear Information System (INIS)

    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.)

  2. 26 CFR 1.953-2 - Actual United States risks.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Actual United States risks. 1.953-2 Section 1... (CONTINUED) INCOME TAXES Controlled Foreign Corporations § 1.953-2 Actual United States risks. (a) In general. For purposes of paragraph (a) of § 1.953-1, the term “United States risks” means risks described...

  3. Facebook as a Library Tool: Perceived vs. Actual Use

    Science.gov (United States)

    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…

  4. A Study of Self-Actualization and Facilitative Communication.

    Science.gov (United States)

    Omizo, Michael M.

    1981-01-01

    Examined the relationship between self-actualization measures and ability in facilitative communication of trainees from counseling, social work, and psychology programs to determine if differences existed between the three groups. Self-actualization indexes were significantly correlated with ability in facilitative communication. (RC)

  5. The Self-Actualization of Polk Community College Students.

    Science.gov (United States)

    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…

  6. School Guidance Counselors' Perceptions of Actual and Preferred Job Duties

    Science.gov (United States)

    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…

  7. 25 CFR 900.54 - Should the property management system prescribe internal controls?

    Science.gov (United States)

    2010-04-01

    ... 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) To... 25 Indians 2 2010-04-01 2010-04-01 false Should the property management system prescribe...

  8. Prescribing of pain medication in palliative care: a survey in general practice

    NARCIS (Netherlands)

    S.D. Borgsteede; L. Deliens; W.W.A. Zuurmond; F.G. Schellevis; D.L. Willems; G. van der Wal; J.T.M. van Eijk

    2009-01-01

    Purpose To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands. Methods In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed pop

  9. Prescribing of pain medication in palliative care: a survey in general practice.

    NARCIS (Netherlands)

    Borgsteede, S.D.; Deliens, L.; Zuurmond, W.W.A.; Schellevis, F.; Willems, D.L.; Wal, G. van der; Eijk, J.T.M. van

    2009-01-01

    PURPOSE: To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands. METHODS: In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed p

  10. Prescribing pattern in orthopedics outpatient department of a medical college in India

    Directory of Open Access Journals (Sweden)

    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

  11. Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice

    DEFF Research Database (Denmark)

    Llor, Carl; Bjerrum, Lars; Munck, Anders;

    2013-01-01

    BACKGROUND: The aim of this study was to describe the antibiotic prescribing rate in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to analyse predictors for antibiotic prescribing and to explore the influence of the use C-reactive protein (CRP) rapid test. ME...

  12. Is self-medication with antibiotics in Europe driven by prescribed use?

    NARCIS (Netherlands)

    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

  13. Hydrologic response and recovery to prescribed fire and vegetation removal in a small rangeland catchment

    Science.gov (United States)

    Prescribed fire can be used to return wild lands to their natural fire cycle, control invasive weeds, and reduce fuel loads, but there are gaps in the understanding of post-disturbance responses of vegetation and hydrology. The impact of a prescribed fire and subsequent aspen cutting on evapotransp...

  14. Trends in co-prescribing of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in Ireland.

    LENUS (Irish Health Repository)

    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.

  15. Pharmaceutical care and its relationship to prescribing behaviour of general practitioners.

    NARCIS (Netherlands)

    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

  16. Antibiotic Prescribing Review as a Component of an Infectious Disease Course.

    Science.gov (United States)

    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.…

  17. Cross-national comparison of prescribing patterns in Australian and dutch nursing homes

    NARCIS (Netherlands)

    Taxis, Katja; Kochen, Sjoerd; Geerens, Sanne; Wouters, Hans; Boersma, Froukje; Maring, Jan G.; Mulder, Hans; Pavlovic, Jugoslav; Stevens, Gerard; McLachlan, Andrew J.; Pont, Lisa

    2014-01-01

    Background: Prescribing quality is a major issue in nursing home patients. Few cross-national comparisons of prescribing patterns have been carried out in this population. Objectives: To compare prevalence of medication use in nursing home patients between Australia and The Netherlands. Methods: An

  18. Shift in antibiotic prescribing patterns in relation to antibiotic expenditure in paediatrics

    NARCIS (Netherlands)

    Kimpen, JLL; van Houten, M.A.

    1998-01-01

    In paediatrics, antibiotics are among the most commonly prescribed drugs. Because of an overall rise in health care costs, lack of uniformity in drug prescribing and the emergence of antibiotic resistance, monitoring and control of antibiotic use is of growing concern and strict antibiotic policies

  19. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices.

    LENUS (Irish Health Repository)

    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.

  20. Appropriateness of antibiotic prescribing for upper respiratory tract infections in general practice

    DEFF Research Database (Denmark)

    Sigurðardóttir, Nanna Rún; Nielsen, Anni Brit Sternhagen; Munck, Anders;

    2015-01-01

    antibiotics (Iceland = 75.8% vs. Denmark = 59.3%), but Danish GPs had a higher percentage of inappropriate antibiotic prescribing for sinusitis, and Icelandic GPs for pharyngotonsillitis. No differences were found for acute otitis media (AOM). The different antibiotic prescribing patterns between Denmark...

  1. Rational use of medicines: prescribing indicators at different levels of health care

    Directory of Open Access Journals (Sweden)

    Maria Beatriz Cardoso Ferreira

    2013-06-01

    Full Text Available This multicenter study aimed to investigate prescribing patterns of drugs at different levels of health care delivery in university-affiliated outpatient clinics located in eight cities in the South and Midwest of Brazil. All prescriptions collected were analyzed for various items, including WHO prescribing indicators. A total of 2,411 prescriptions were analyzed, and 469 drugs were identified. The number of drugs prescribed per encounter, the frequency of polypharmacy, and the percentage of encounters with at least one injection or antibiotic prescribed were higher in centers providing primary health care services, compared to those where this type of care is not provided. Most drugs (86.1% were prescribed by generic name. In centers with primary health care services, drug availability was higher, drugs included in the National and Municipal Lists of Essential Medicines were more frequently prescribed, and patients were given more instructions. However, warnings and non-pharmacological measures were less frequently recommended. This study reveals trends in drug prescribing at different levels of health care delivery in university-affiliated outpatient clinics and indicates possible areas for improvement in prescribing practices.

  2. The appropriateness of prescribing antibiotics in the community in Europe: study design.

    NARCIS (Netherlands)

    Bijnen, E.M.E. van; Heijer, C.D.J. den; Paget, W.J.; Stobberingh, E.E.; Verheij, R.A.; Bruggeman, C.A.; Pringle, M.; Goossens, H.; Schellevis, F.G.

    2011-01-01

    Background: Over 90% of all antibiotics in Europe are prescribed in primary care. It is important that antibiotics are prescribed that are likely to be effective; however, information about antibiotic resistance in the community is incomplete. The aim of our study is to investigate the appropriatene

  3. The appropriateness of prescribing antibiotics in the community in Europe: study design

    NARCIS (Netherlands)

    Bijnen, E.M. van; Heijer, C. den; Paget, W.J.; Stobberingh, E.E.; Verheij, R.A.; Bruggeman, C.A.; Pringle, M.; Goossens, H.; Schellevis, F.G.

    2011-01-01

    ABSTRACT: BACKGROUND: Over 90% of all antibiotics in Europe are prescribed in primary care. It is important that antibiotics are prescribed that are likely to be effective; however, information about antibiotic resistance in the community is incomplete. The aim of our study is to investigate the app

  4. Salient beliefs and intentions to prescribe antibiotics for patients with a sore throat.

    Science.gov (United States)

    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

  5. Volume-constrained minimizers for the prescribed curvature problem in periodic media

    CERN Document Server

    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.

  6. Factors Influencing Successful Prescribing by Intern Doctors: A Qualitative Systematic Review

    Directory of Open Access Journals (Sweden)

    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.

  7. Monitoring of Patients Aged 0–2 Years Drug Prescribing Pattern Used Indicator from WHO

    Directory of Open Access Journals (Sweden)

    Ahmad Priyadi

    2013-03-01

    Full Text Available The aim of this study was to evaluate drug used by patients 0–2 years old using five World Health Organization guideline for prescribing indicators, which include average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotics, injection prescribed, and drugs prescribed from essential drugs list or formulary. Outpatient prescription of patients 0–2 years old period Januari–Desember 2012 were collected retrospectively in one of health facility in Bandung. Average number of drugs per encounter was gained by dividing 6350 drugs with 2741 prescriptions. Percentage of using generic drugs was 9,19 %, antibiotics were 67,53 % and no injections per encounters, whereas percentage of drugs prescribed from essential drugs list was 45,02 %. The result showed that usage of generic drugs and essential drugs were low while the usage of antibiotics is relatively higher than World Health Organization recommendation.

  8. An audit of prescribing practices for benzodiazepines and Z-drugs.

    LENUS (Irish Health Repository)

    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.

  9. Encouraging good antimicrobial prescribing practice: A review of antibiotic prescribing policies used in the South East Region of England

    Directory of Open Access Journals (Sweden)

    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.

  10. Dispensing of non-prescribed antibiotics in Jordan

    Directory of Open Access Journals (Sweden)

    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

  11. Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients: a before and after study.

    Directory of Open Access Journals (Sweden)

    Johanna I Westbrook

    2012-01-01

    Full Text Available BACKGROUND: Considerable investments are being made in commercial electronic prescribing systems (e-prescribing in many countries. Few studies have measured or evaluated their effectiveness at reducing prescribing error rates, and interactions between system design and errors are not well understood, despite increasing concerns regarding new errors associated with system use. This study evaluated the effectiveness of two commercial e-prescribing systems in reducing prescribing error rates and their propensities for introducing new types of error. METHODS AND RESULTS: We conducted a before and after study involving medication chart audit of 3,291 admissions (1,923 at baseline and 1,368 post e-prescribing system at two Australian teaching hospitals. In Hospital A, the Cerner Millennium e-prescribing system was implemented on one ward, and three wards, which did not receive the e-prescribing system, acted as controls. In Hospital B, the iSoft MedChart system was implemented on two wards and we compared before and after error rates. Procedural (e.g., unclear and incomplete prescribing orders and clinical (e.g., wrong dose, wrong drug errors were identified. Prescribing error rates per admission and per 100 patient days; rates of serious errors (5-point severity scale, those ≥3 were categorised as serious by hospital and study period; and rates and categories of postintervention "system-related" errors (where system functionality or design contributed to the error were calculated. Use of an e-prescribing system was associated with a statistically significant reduction in error rates in all three intervention wards (respectively reductions of 66.1% [95% CI 53.9%-78.3%]; 57.5% [33.8%-81.2%]; and 60.5% [48.5%-72.4%]. The use of the system resulted in a decline in errors at Hospital A from 6.25 per admission (95% CI 5.23-7.28 to 2.12 (95% CI 1.71-2.54; p<0.0001 and at Hospital B from 3.62 (95% CI 3.30-3.93 to 1.46 (95% CI 1.20-1.73; p<0.0001. This

  12. The antecedents of herbal product actual purchase in Malaysia

    Directory of Open Access Journals (Sweden)

    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.

  13. BAP Position Statement: Off-label prescribing of psychotropic medication to children and adolescents.

    Science.gov (United States)

    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

  14. BAP Position Statement: Off-label prescribing of psychotropic medication to children and adolescents.

    Science.gov (United States)

    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.

  15. Taking stock: provider prescribing practices in the presence and absence of ACT stock

    Directory of Open Access Journals (Sweden)

    Jones Caroline

    2011-08-01

    Full Text Available Abstract Background Globally, the monitoring of prompt and effective treatment for malaria with artemisinin combination therapy (ACT is conducted largely through household surveys. This measure; however, provides no information on case management processes at the health facility level. The aim of this review was to assess evidence from health facility surveys on malaria prescribing practices using ACT, in the presence and absence of ACT stock, at time and place where treatment was sought. Methods A systematic search of published literature was conducted. Findings were collated and data extracted on proportion of patients prescribed ACT and alternative anti-malarials in the presence and absence of ACT stock. Results Of the 14 studies identified in which ACT prescription for uncomplicated malaria in the public sector was evaluated, just six, from three countries (Kenya, Uganda and Zambia, reported this in the context of ACT stock. Comparing facilities with ACT stock to facilities without stock (i ACT prescribing was significantly higher in all six studies, increasing by a range of 21.3% in children Conclusions Prescriber practices vary based on ACT availability. Although ACT prescriptions increased and alternative anti-malarials prescriptions decreased in the presence of ACT stock, ACT was prescribed in the absence, and alternative anti-malarials were prescribed in the presence of, ACT. Presence of stock alone does not ensure that treatment guidelines are followed. More health facility surveys, together with qualitative research, are needed to understand the role of ACT stock-outs on provider prescribing behaviours and preferences.

  16. Prescribing patterns of antihypertensive drugs in geriatric population in tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Renoy Philip

    2016-03-01

    Full Text Available Hypertension is one of the major chronic diseases with high mortality and morbidity in the today’s world. Present study was to assess the prescribing pattern of antihypertensive medications in geriatric population suffering mainly from hypertension with or without co morbidities like Diabetes Mellitus (DM. A prospective observational study was carried out for a period of six months in an in-patient general medicine department. Elderly patients who have been diagnosed with pure hypertension as per JNC 7 guidelines and hypertension with co- morbid condition like diabetes mellitus and patients receiving or prescribed with antihypertensive drugs were included. A total of 150 prescriptions were analyzed. The present study revealed that there were 93 patients with pure Hypertension and 57 patients with co morbid conditions like Diabetes Mellitus (DM. Among antihypertensive drugs in pure hypertensive cases, 53.76% of cases were prescribed with monotherapy, followed by 46.23% by combination therapy. The commonly prescribed antihypertensive monotherapy is calcium channel blockers. The most commonly prescribed combination therapy in severe cases was angiotensin receptor blockers with diuretics. This prescribing pattern of antihypertensives was as per Joint National Committee-7report on hypertension. In case of geriatric patients suffering from hypertension with Type 2 diabetes mellitus, most commonly prescribed antihypertensive as monotherapy was found to be amlodipine and combination therapy was telmisartan + hydrochlorothiazide.

  17. Causes and consequences of e-prescribing errors in community pharmacies

    Directory of Open Access Journals (Sweden)

    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 

  18. Incidences of new prescribing by British child and adolescent psychiatrists: a prospective study over 12 months.

    Science.gov (United States)

    Clark, Andrew F

    2004-03-01

    Little is known about the epidemiology of pharmacotherapy in the treatment of child psychiatric disorder. This study reports on the systematic prospective collection of instances of new prescribing by child and adolescent mental health services serving a population of approximately four million people in North West England. Diagnostic and demographic information regarding new prescribing by child and adolescent mental health services within Greater Manchester and Lancashire was systematically collected prospectively over two 6-month periods between 2000 and 2002. Within the 12 months studied, there were 845 instances of a drug being newly prescribed to a child or adolescent in the treatment of a psychiatric disorder. In total, 48 different drugs were prescribed for 25 different diagnoses. The eight most commonly prescribed drugs were methylphenidate, methylphenidate/placebo trial, paroxetine, fluoxetine, risperidone, imipramine, dexamphetamine and melatonin, accounting for 73% of all prescribing. There was marked variation between services in the amount of prescribing with significant correlation between prescription of stimulants and prescription of selective serotonin reuptake inhibitor antidepressants. Prescription of medications in the treatment of child psychiatric disorder has become a significant part of child and adolescent mental health practice. However, the evidence base underpinning this usage remains limited, and further high quality therapeutic clinical trials are urgently needed.

  19. Antibiotic prescribing in DR Congo: a knowledge, attitude and practice survey among medical doctors and students.

    Directory of Open Access Journals (Sweden)

    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.

  20. Actual Versus Perceived Risk of Victimization and Handgun Ownership

    OpenAIRE

    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 ...