WorldWideScience

Sample records for policy prescribes procedures

  1. Developing policies and procedures.

    Science.gov (United States)

    Randolph, Susan A

    2006-11-01

    The development of policies and procedures is an integral part of the occupational health nurse's role. Policies and procedures serve as the foundation for the occupational health service and are based on its vision, mission, culture, and values. The design and layout selected for the policies and procedures should be simple, consistent, and easy to use. The same format should be used for all existing and new policies and procedures. Policies and procedures should be reviewed periodically based on a specified time frame (i.e., annually). However, some policies may require a more frequent review if they involve rapidly changing external standards, ethical issues, or emerging exposures.

  2. PACS policies and procedures.

    Science.gov (United States)

    Knepper, Daniel

    2007-01-01

    Documentation of policies and procedures are critical for the proper operation and management of a picture archival and communication system (PACS). Policies, procedures, and site specific documentation may be organized in several categories. Through the use of broad categories one can easily begin to break down the specific areas which require attention and prioritize them as necessary. One way to categorize them is: administration, maintenance, support, architecture and integration, and disaster recovery/business continuity. One area that requires a great deal of focus and discipline is a policy for "change management." It is essential to have a policy in place for making changes to the information system. This would include not only changes to the system such as software upgrades, but changes to workflows such as how images are being distributed, compression settings, network settings, monitor settings, locations of workstations, integration, and disaster recovery/ business continuity. Modifying existing information technology (IT) policies and using published resources can largely simplify the development of organization specific policies and procedures.

  3. Antibiotic prescribing policy and Clostridium difficile diarrhoea.

    LENUS (Irish Health Repository)

    O'Connor, K A

    2012-02-03

    BACKGROUND: Broad-spectrum antibiotics, particularly intravenous cephalosporins, are associated with Clostridium difficile diarrhoea. Diarrhoea due to C. difficile is a growing problem in hospitals, especially among elderly patients. AIM: To establish whether changing an antibiotic policy with the aim of reducing the use of injectable cephalosporins leads to a reduction in the incidence of C. difficile diarrhoea in elderly patients. DESIGN: Retrospective analysis. METHODS: A group of patients who were subject to the new antibiotic policy from the period following July 2000, were compared with patients who were admitted prior to July 2000 and were not subject to the new policy. Infections, antibiotic prescriptions and mortality rates were determined from case notes, and C. difficle diarrhoea rates from microbiological data. RESULTS: Intravenous cephalosporin use fell from 210 to 28 defined daily doses (p < 0.001) following the change in antibiotic policy, with a corresponding increase in piperacillin-tazobactam (p < 0.001) and moxifloxacin (p < 0.001) use. The new policy led to a significant reduction in C. difficile diarrhoea cases. The relative risk of developing C. difficile infection with the old policy compared to the new policy was 3.24 (95%CI 1.07-9.84, p = 0.03). DISCUSSION: The antibiotic policy was successfully introduced into an elderly care service. It reduced both intravenous cephalosporin use and C. difficile diarrhoea.

  4. Acquisition Policy and Procedures Program

    National Research Council Canada - National Science Library

    2001-01-01

    This Instruction establishes policies, responsibilities, and procedures for the procurement of goods and services to include supplies, equipment, publications, furniture, and information technology...

  5. Planning and evaluating prescribed fires--a standard procedure

    Science.gov (United States)

    William C. Fischer

    1978-01-01

    Provides a standard format and checklist to guide the land manager through the important steps for prescribed burning. Describes the kind of information needed to prepare fire prescriptions and burning plans. Identifies the elements of a fire prescription, a burning plan, and a prescribed fire evaluation. A plan written for an actual prescribed burning is included as...

  6. Review: 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

  7. Policies and procedures for considering environmental impacts

    Science.gov (United States)

    2006-03-20

    This order updates the FAA agency-wide policies and procedures for compliance with the : National Environmental Policy Act (NEPA) and implementing regulations issued by the Council : on Environmental Quality (40 CFR parts 1500-1508). The provisions o...

  8. Assignment Procedure Biases in Randomised Policy Experiments

    DEFF Research Database (Denmark)

    Aldashev, Gani; Kirchsteiger, Georg; Sebald, Alexander

    2017-01-01

    's propensity to act reciprocally. When people are motivated by reciprocity, the choice of assignment procedure influences the RCTs’ findings. We show that even credible and explicit randomisation procedures do not guarantee an unbiased prediction of the impact of policy interventions; however, they minimise......Randomised controlled trials (RCT) have gained ground as the dominant tool for studying policy interventions in many fields of applied economics. We analyse theoretically encouragement and resentful demoralisation in RCTs and show that these might be rooted in the same behavioural trait – people...... any bias relative to other less transparent assignment procedures....

  9. 77 FR 31615 - Improving Mail Management Policies, Procedures, and Activities

    Science.gov (United States)

    2012-05-29

    ... ADMINISTRATION Improving Mail Management Policies, Procedures, and Activities AGENCY: Office of Governmentwide Policy, General Services Administration (GSA). ACTION: Notice of FMR Bulletin G-03. SUMMARY: The General... guidance to Executive Branch agencies for improving mail management policies, procedures, and activities...

  10. Carbon and black carbon in Yosemite National Park soils: sources, prescribed fire impacts, and policies

    Science.gov (United States)

    Shrestha, G.; Traina, S. J.

    2012-12-01

    We investigated the chemical and radiocarbon properties of black carbon recently deposited and accumulated in surface soils of six sites along an altitudinal gradient in Yosemite National Park, central California. The effect of prescribed (or controlled) forest burning on existing carbon and black carbon in surface soils was assessed to illuminate the role of this forest management and wildfire control strategy in the soil carbon cycle. The proportional contribution of fossil fuel or radiocarbon dead carbon versus biomass sources on these black carbon materials was analyzed to elucidate their origin, estimate their ages and explore the possible effects of prescribed burning on the amount of black carbon produced recently as well as historically. Supplementing these field results, we conducted a comparative spatial analysis of recent prescribed burn and wildfire coverage in Central California's San Joaquin Valley to approximate the effectiveness of prescribed burning for wildfire prevention. Federal and California policies pertaining to prescribed forest fires and/or black carbon were then evaluated for their effectiveness, air quality considerations, and environmental benefits. 13C NMR spectrum of soil surface char from study sites Prescribed burn coverage versus wildfires in central California

  11. Sample policies for your policy and procedure manual.

    Science.gov (United States)

    Hotta, Tracey

    2015-01-01

    A policy and procedure manual is a tool to set guidelines and expectations based on the mission and vision of an office. If a manual is not available to set guidelines, the employees may make their own decisions to solve problems, which can often result in confusion, inconsistencies, and mistakes. A well-written policy manual will also benefit the staff by providing them with a quick resource for decision-making. This will increase the quality of service by reducing the risk of potential mistakes that can be made in a busy practice.

  12. 50 CFR 260.84 - Policies and procedures.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Policies and procedures. 260.84 Section... Fishery Products for Human Consumption Miscellaneous § 260.84 Policies and procedures. The policies and... Inspection Manual. The policies and procedures are available from the Secretary to any interested party by...

  13. Medicine Availability and Prescribing Policy for Non-Communicable Diseases in the Western Balkan Countries.

    Science.gov (United States)

    Pekez-Pavlisko, Tanja; Racic, Maja; Kusmuk, Srebrenka

    2017-01-01

    During the transition processes, the Western Balkan countries were affected by conflicts and transition-related changes. Life expectancy in these countries is lower, while the mortality from non-communicable diseases (NCDs) is higher in comparison with western and northern parts of Europe. The primary aim of this study was to analyze the treatment possibilities for the most common NCDs in the Western Balkan countries. The secondary aim was to understand and compare the policies regarding prescribing-related competencies of family physicians. In June and July 2017, a document analysis was performed of national positive medicines lists, strategic documents, and clinical guidelines for the treatment of the most frequent NCDs; arterial hypertension, diabetes, hyperlipidemia, asthma, and chronic obstructive pulmonary disease (COPD). All text phrases that referred to medicines prescribing were extracted and sorted into following domains: medicine availability, prescribing policy, and medication prescribing-related competencies. Possibilities for treatment of arterial hypertension, diabetes, hyperlipidemia, asthma, and COPD vary across the Western Balkan countries. This variance is reflected in the number of registered medicines, number of parallels, and number of different combinations, as well as restrictions placed on family physicians in prescribing insulin, inhaled corticosteroids, statins and angiotensin II receptor blockers (ARBs), without consultant's recommendation. Western Balkan countries are capable of providing essential medicines for the treatment of NCDs, with full or partial reimbursement. There are some exceptions, related to statins, newer generation of oral antidiabetic agents and some of the antihypertensive combinations. Prescribing-related competences of family physicians are limited. However, this practice is not compliant to the practices of family medicine, its principles and primary care structures, and may potentially result in increased health

  14. Effect of an emergency department opioid prescription policy on prescribing patterns.

    Science.gov (United States)

    Chacko, Jerel; Greenstein, Josh; Ardolic, Brahim; Berwald, Nicole

    2017-09-01

    Staten Island University Hospital is located in NYC, where the opioid epidemic has resulted in significant mortalities from unintentional overdoses. In 2013 as a response to the rising threat to our community, our Emergency Department (ED) administration adopted a clinical practice policy focused on decreasing the prescription of controlled substances. The effects of this policy on our provider prescription patterns are presented here. A retrospective chart review of patients prescribed opioids from the ED before and after policy implementation was performed. Dates chosen for analysis was November 1, 2012 through January 31, 2013 and November 1, 2013 through January 31, 2014; these time periods were used to serve as a seasonally comparative group pre and post clinical practice policy implementation. Opioids written for the treatment of cough, and for children under eighteen were excluded from analysis. Patient age, sex, diagnoses, and prescription formulation, strength, and pill number was recorded for each patient receiving an opioid prescription. There was a drop in the total prescriptions from 1756 to 1128 without a change in the average number of pills (12.78 vs 12.44) or average total dose prescribed (69.39 vs 68.98) mg of morphine equivalent per prescription. Additionally, there were sizable reductions in opioid prescriptions written for arthralgias/myalgias, dental pain, soft tissue injuries, and headaches. The opioid clinical policy had a clear effect in decreasing the number of patients prescribed opioids. Such policies may be the key to reducing the epidemic and saving lives from unintentional opioid overdoses. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States

    Science.gov (United States)

    King, Marissa; Bearman, Peter S.

    2016-01-01

    The pharmaceutical industry spends roughly 15 billion dollars annually on detailing – providing gifts, information, samples, trips, honoraria and other inducements – to physicians in order to encourage them to prescribe their drugs. In response, several states in the United States adopted policies that restrict detailing. Some states banned gifts from pharmaceutical companies to doctors, other states simply required physicians to disclose the gifts they receive, while most states allowed unrestricted detailing. We exploit this geographic variation to examine the relationship between gift regulation and the diffusion of four newly marketed medications. Using a dataset that captures 189 million psychotropic prescriptions written between 2005 and 2009, we find that uptake of new costly medications was significantly lower in states with marketing regulation than in areas that allowed unrestricted pharmaceutical marketing. In states with gift bans, we observed reductions in market shares ranging from 39% to 83%. Policies banning or restricting gifts were associated with the largest reductions in uptake. Disclosure policies were associated with a significantly smaller reduction in prescribing than gift bans and gift restrictions. In states that ban gift-giving, peer influence substituted for pharmaceutical detailing when a relatively beneficial drug came to market and provided a less biased channel for physicians to learn about new medications. Our work suggests that policies banning or limiting gifts from pharmaceutical representatives to doctors are likely to be more effective than disclosure policies alone. PMID:27856120

  16. 45 CFR 1612.11 - Recipient policies and procedures.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recipient policies and procedures. 1612.11 Section... RESTRICTIONS ON LOBBYING AND CERTAIN OTHER ACTIVITIES § 1612.11 Recipient policies and procedures. Each recipient shall adopt written policies and procedures to guide its staff in complying with this part. ...

  17. 45 CFR 1636.5 - Recipient policies, procedures and recordkeeping.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recipient policies, procedures and recordkeeping... CORPORATION CLIENT IDENTITY AND STATEMENT OF FACTS § 1636.5 Recipient policies, procedures and recordkeeping. Each recipient shall adopt written policies and procedures to guide its staff in complying with this...

  18. 31 CFR 132.5 - Policies and procedures required.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Policies and procedures required. 132... FUNDING OF UNLAWFUL INTERNET GAMBLING § 132.5 Policies and procedures required. (a) All non-exempt participants in designated payment systems shall establish and implement written policies and procedures...

  19. 12 CFR 233.5 - Policies and procedures required.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Policies and procedures required. 233.5 Section... implement written policies and procedures reasonably designed to identify and block or otherwise prevent or... this section if— (1) It relies on and complies with the written policies and procedures of the...

  20. 45 CFR 1609.6 - Recipient policies, procedures and recordkeeping.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recipient policies, procedures and recordkeeping... CORPORATION FEE-GENERATING CASES § 1609.6 Recipient policies, procedures and recordkeeping. Each recipient shall adopt written policies and procedures to guide its staff in complying with this part and shall...

  1. 45 CFR 1637.5 - Recipient policies, procedures and recordkeeping.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recipient policies, procedures and recordkeeping... CORPORATION REPRESENTATION OF PRISONERS § 1637.5 Recipient policies, procedures and recordkeeping. Each recipient shall adopt written policies and procedures to guide its staff in complying with this part and...

  2. 45 CFR 1639.6 - Recipient policies and procedures.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recipient policies and procedures. 1639.6 Section... WELFARE REFORM § 1639.6 Recipient policies and procedures. Each recipient shall adopt written policies and procedures to guide its staff in complying with this part. ...

  3. 45 CFR 1627.8 - Recipient policies, procedures and recordkeeping.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recipient policies, procedures and recordkeeping... CORPORATION SUBGRANTS AND MEMBERSHIP FEES OR DUES § 1627.8 Recipient policies, procedures and recordkeeping. Each recipient shall adopt written policies and procedures to guide its staff in complying with this...

  4. 45 CFR 1633.4 - Recipient policies, procedures and recordkeeping.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recipient policies, procedures and recordkeeping... CORPORATION RESTRICTION ON REPRESENTATION IN CERTAIN EVICTION PROCEEDINGS § 1633.4 Recipient policies, procedures and recordkeeping. Each recipient shall adopt written policies and procedures to guide its staff...

  5. 45 CFR 1644.5 - Recipient policies and procedures.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recipient policies and procedures. 1644.5 Section... DISCLOSURE OF CASE INFORMATION § 1644.5 Recipient policies and procedures. Each recipient shall adopt written policies and procedures to implement the requirements of this part. ...

  6. 45 CFR 1626.12 - Recipient policies, procedures and recordkeeping.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recipient policies, procedures and recordkeeping... SERVICES CORPORATION RESTRICTIONS ON LEGAL ASSISTANCE TO ALIENS § 1626.12 Recipient policies, procedures and recordkeeping. Each recipient shall adopt written policies and procedures to guide its staff in...

  7. 45 CFR 1617.4 - Recipient policies and procedures.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Recipient policies and procedures. 1617.4 Section... CLASS ACTIONS § 1617.4 Recipient policies and procedures. Each recipient shall adopt written policies and procedures to guide its staff in complying with this part. ...

  8. Assessment of LANL transportation policies and procedures

    International Nuclear Information System (INIS)

    Danna, J.G.; Jennrich, E.A.; Lund, D.M.; Davis, K.D.; Hoevemeyer, S.S.

    1991-04-01

    In order to determine whether activities related to the transportation of waste at Los Alamos National Laboratory (LANL) were being conducted in accordance with DOE policy, requirements stated in applicable DOE Orders were reviewed and compared with LANL policies and procedures described in the Administrative Requirements and the On-Site Transportation Manual. The following DOE Orders were determined to pertain to waste transportation and thus reviewed to identify requirements for which LANL is responsible for satisfying: Order 5820.2A Radioactive Waste Management; Order 1540.1 Materials Transportation and Traffic Management; and Order 5480.3 Safety Requirements for the Packaging and Transportation of Hazardous Materials, Hazardous Substances, and Hazardous Wastes. The LANL On-Site Transportation Manual and the Administrative Requirements contained in the LANL Environment, Safety, and Health Manual were reviewed to verify that each of the requirements identified through the review of the Orders and 10 CFR Part 71 were being satisfied. The following Administrative Requirements were considered in this task: Shipment of Radioactive Materials; Radioactive Liquid Waste; Low-Level Radioactive Solid Waste; Chemical, Hazardous, and Mixed Waste; Polychlorinated Biphenyls; and Transuranic (TRU) Solid Waste

  9. Sexual Harrassment: Suggested Policy and Procedures for Handling Complaints.

    Science.gov (United States)

    Academe, 1983

    1983-01-01

    AAUP guidelines on establishing institutional policy and procedures for handling sexual harassment complaints are outlined. Sexual harassment is defined and procedures for both bringing and resolving a complaint are suggested. (MSE)

  10. Information security policies and procedures a practitioner's reference

    CERN Document Server

    Peltier, Thomas R

    2004-01-01

    INFORMATION SECURITY POLICIES AND PROCEDURES Introduction Corporate Policies Organizationwide (Tier 1) Policies Organizationwide Policy Document Legal Requirements Duty of Loyalty Duty of Care Other Laws and Regulations Business Requirements Where to Begin? Summary Why Manage This Process as a Project? Introduction First Things First: Identify the Sponsor Defining the Scope of Work Time Management Cost Management Planning for Quality Managing Human Resources Creating a Communications Plan Summary Planning and Preparation Introduction Objectives of Policies, Stand

  11. Policies and Procedures for the Management of Electronic Records ...

    African Journals Online (AJOL)

    This article focuses on policies and procedures for the management of electronic records in Botswana, Namibia and South Africa. Using the data collected in 2003 and 2004 as part of the author's doctoral research, the article reports that policies and procedures for the management of electronic records were non-existent in ...

  12. 48 CFR 1523.703 - Policies and procedures.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Policies and procedures. 1523.703 Section 1523.703 Federal Acquisition Regulations System ENVIRONMENTAL PROTECTION AGENCY... Environmentally Preferable Products and Services § 1523.703 Policies and procedures. ...

  13. 31 CFR 206.3 - Billing policy and procedures.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Billing policy and procedures. 206.3... SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE MANAGEMENT OF FEDERAL AGENCY RECEIPTS, DISBURSEMENTS, AND OPERATION OF THE CASH MANAGEMENT IMPROVEMENTS FUND § 206.3 Billing policy and procedures. The...

  14. Take on the issue of chronic pain with comprehensive solutions, firm policies on prescribing.

    Science.gov (United States)

    2011-08-01

    Patients who visit the ED frequently to obtain treatment for chronic pain can be frustrating and difficult to manage, but some EDs are making progress with this group by linking these patients to resources and establishing a firm policy on when narcotics will be prescribed. Experts say that while strict "no opioids" policies rarely work well, some patients can be helped when given access to more comprehensive treatment approaches. The ED at Methodist Hospital in Indianapolis has developed a multidisciplinary program that includes referrals to a primary care provider (PCP), as well as a chemical dependency specialist. All providers have access to care-management notes on the patient through the health system's electronic medical record. Patients who are non-complaint with the program risk losing access to narcotic medications when they visit the ED. The ED at Dosher Memorial Hospital in Southport, NC, has developed a policy that encourages all patients with chronic pain to seek treatment from a PCP. The hospital will help to link patients with a PCP and other resources in the region. The approach has curbed the incidence of drug-seeking behavior and helped to make the treatment of chronic pain uniform across all ED providers. Since the prevalence of pain is so high among patients in the ED, many emergency physicians are seeking added training in the treatment of pain.

  15. The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care

    DEFF Research Database (Denmark)

    Larsen, Michael Due; Schou, Mette; Kristiansen, Anja Sparre

    2014-01-01

    for the recommended PPIs pantoprazole and lansoprazole to 14.6 and 26.1 %, respectively. The effect of a large discount on expensive PPI to hospital was 14.7 %, and this decreased to 2.6 % when coordinating drug policy in hospital and primary care. CONCLUSION: The likelihood of having an expensive PPI prescribed...

  16. General statement of policy and procedures for NRC enforcement actions: Enforcement policy. Revision 1

    International Nuclear Information System (INIS)

    1998-05-01

    This document includes the US Nuclear Regulatory Commission's (NRC's or Commission's) revised General Statement of Policy and Procedure for Enforcement Actions (Enforcement Policy) as it was published in the Federal Register on May 13, 1998 (63 ER 26630). The Enforcement Policy is a general statement of policy explaining the NRC's policies and procedures in initiating enforcement actions, and of the presiding officers and the Commission in reviewing these actions. This policy statement is applicable to enforcement matters involving the radiological health and safety of the public, including employees' health and safety, the common defense and security, and the environment

  17. General statement of policy and procedures for NRC enforcement actions: Enforcement policy. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-05-01

    This document includes the US Nuclear Regulatory Commission`s (NRC`s or Commission`s) revised General Statement of Policy and Procedure for Enforcement Actions (Enforcement Policy) as it was published in the Federal Register on May 13, 1998 (63 ER 26630). The Enforcement Policy is a general statement of policy explaining the NRC`s policies and procedures in initiating enforcement actions, and of the presiding officers and the Commission in reviewing these actions. This policy statement is applicable to enforcement matters involving the radiological health and safety of the public, including employees` health and safety, the common defense and security, and the environment.

  18. Promotion of safe outcomes: Incorporating evidence into policies and procedures.

    Science.gov (United States)

    Long, Lisa English; Burkett, Karen; McGee, Susan

    2009-03-01

    This article describes the process of incorporating evidence into policies and procedures, resulting in the establishment of evidence as a basis for safe practice. The process described includes use of the Rosswurm and Larrabee model for change to evidence-based practice. The model guided the work of evidence-based practice mentors in developing a template, system, and educational plan for dissemination of evidence-based policies and procedures into patient care.

  19. 12 CFR 12.7 - Securities trading policies and procedures.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Securities trading policies and procedures. 12.7 Section 12.7 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY RECORDKEEPING AND CONFIRMATION REQUIREMENTS FOR SECURITIES TRANSACTIONS § 12.7 Securities trading policies and...

  20. 32 CFR 14.3 - Policies and procedures.

    Science.gov (United States)

    2010-07-01

    ... clearance process until such time as the Civilian Defense Counsel's services are likely to be sought. 1... QUALIFICATION OF CIVILIAN DEFENSE COUNSEL § 14.3 Policies and procedures. (a) Application procedures. (1) Civilian attorneys may be prequalified as members of the pool of attorneys eligible to represent Accused...

  1. Operating Policies and Procedures of Computer Data-Base Systems.

    Science.gov (United States)

    Anderson, David O.

    Speaking on the operating policies and procedures of computer data bases containing information on students, the author divides his remarks into three parts: content decisions, data base security, and user access. He offers nine recommended practices that should increase the data base's usefulness to the user community: (1) the cost of developing…

  2. Product assurance policies and procedures for flight dynamics software development

    Science.gov (United States)

    Perry, Sandra; Jordan, Leon; Decker, William; Page, Gerald; Mcgarry, Frank E.; Valett, Jon

    1987-01-01

    The product assurance policies and procedures necessary to support flight dynamics software development projects for Goddard Space Flight Center are presented. The quality assurance and configuration management methods and tools for each phase of the software development life cycles are described, from requirements analysis through acceptance testing; maintenance and operation are not addressed.

  3. Special Education Services: A Manual of Policies, Procedures and Guidelines

    Science.gov (United States)

    British Columbia Ministry of Education, 2013

    2013-01-01

    This resource conveys policies, procedures, and guidelines that support the delivery of special education services in British Columbia's (Canada) public schools. It was originally published in 1995 (ED414703), following an extensive provincial Special Education Review (1993-94). The purpose of this manual is to provide a single point of reference…

  4. 78 FR 69286 - Electric System Construction Policies and Procedures

    Science.gov (United States)

    2013-11-19

    ... DEPARTMENT OF AGRICULTURE Rural Utilities Service 7 CFR Part 1726 Electric System Construction Policies and Procedures CFR Correction In Title 7 of the Code of Federal Regulations, Parts 1600 to 1759, revised as of January 1, 2013, on page 246, in Sec. 1726.14, the second definition of Minor modification...

  5. 12 CFR 9.5 - Policies and procedures.

    Science.gov (United States)

    2010-01-01

    ... BANKS Regulations § 9.5 Policies and procedures. A national bank exercising fiduciary powers shall adopt... and employees do not use material inside information in connection with any decision or recommendation to purchase or sell any security; (c) Methods for preventing self-dealing and conflicts of interest...

  6. 32 CFR 168a.4 - Policy and procedures.

    Science.gov (United States)

    2010-07-01

    ... DEFENSE SCIENCE AND ENGINEERING GRADUATE FELLOWSHIPS § 168a.4 Policy and procedures. (a) Sponsoring... to pursue graduate degrees in science, engineering, or other fields of study that are designated, in... members of groups (including minorities, women, and disabled persons) that historically have been...

  7. 12 CFR 609.930 - Policies and procedures.

    Science.gov (United States)

    2010-01-01

    ....930 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ELECTRONIC COMMERCE Standards for Boards and Management § 609.930 Policies and procedures. The FCA supports E-commerce and wants to... delivery of safe and sound credit and closely related services. Through E-commerce, System institutions can...

  8. 10 CFR 26.27 - Written policy and procedures.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Written policy and procedures. 26.27 Section 26.27 Energy..., or possession of illegal drugs on or off site; (ii) The abuse of legal drugs and alcohol; and (iii... consequences of subverting or attempting to subvert the testing process; (4) Prohibit the consumption of...

  9. 32 CFR 634.35 - Chemical testing policies and procedures.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Chemical testing policies and procedures. 634.35 Section 634.35 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL INVESTIGATIONS MOTOR VEHICLE TRAFFIC SUPERVISION Traffic Supervision § 634.35...

  10. Development of Policies, Institutions and Procedures for Water Reuse

    Science.gov (United States)

    Demouche, L.; Pfiefer, J.; Hanson, A.; Skaggs, R.

    2009-12-01

    In the arid, water scarce region of New Mexico and West Texas there is growing interest in the potential for water reuse to extend existing supplies and mitigate drought shortage impacts. There are no new sources of water in New Mexico, except reclaimed water. Communities and individuals are uncertain about and have many unanswered questions about polices, institutions involved (agencies), legal and regulatory requirements, and procedures governing water reuse. Issues to be addressed by this project include: the legal ability to reuse water, ownership of water rights, downstream or third party impacts, regulatory and procedural requirements, water quality concerns, state and local agency involvement, and cost effectiveness of water reuse compared to alternative sources. Presently, there is very little implementation or directives in New Mexico policy that addresses reuse, reclamation, or recycled water. The only regulations pertaining to reuse is New Mexico Environmental Department currently allows the use of reclaimed domestic wastewater for irrigation of golf courses and green spaces, which is listed in the Policy for the Above Ground Use of Reclaimed Domestic Wastewater (NMED, 2003). This document identifies the various reclaimed quality classifications that are required for specific applications and the permits required for application. This document does not identify or address policy applications on the distribution, ownership, or trading of reclaimed water. Even though reclaimed water reuse projects are currently being implemented in many cities in the U.S., mainly for commercial and municipal irrigation (golf courses and green space), its potential has not yet been exploited. A policy analysis matrix (PAM) is being designed to identify and examine the policy framework and consequences of non-policy implementation for decision makers and interest groups and assist them in understanding the consequences of policy actions and project outcomes if no laws or

  11. Effects of pharmaceutical cost containment policies on doctors' prescribing behavior: Focus on antibiotics.

    Science.gov (United States)

    Han, Euna; Chae, Su-Mi; Kim, Nam-Soon; Park, Sylvia

    2015-09-01

    We analyzed the effect of the outpatient prescription incentive program and price cuts of listed medicines in South Korea on prescription drug expenditures and prescription behaviors, focusing on antibiotics for the most common infectious diseases. We used the National Health Insurance claims data from January 1, 2009 through December 31, 2012. For 1625 primary clinics randomly sampled, we included all claims with principal diagnoses of acute upper respiratory tract infections (URTIs, J00-J06), acute lower respiratory tract infections (LRTIs, J20-J22), or otitis media (H65, H66). An interrupted time-series analysis was conducted. Pharmaceutical spending per claim dropped immediately after the outpatient prescription incentive program only for otitis media (adults), but the secular trend shifted downward after the incentive program for all target diseases. The incentive program lowered the trend of antibiotic prescribing rate in otitis media (adults). The program was associated with an increase of the number of antibiotics prescribed in URTI (adults) and LRTI (children) and decrease in otitis media (adults). The broad markdown of drug prices reduced pharmaceutical expenditures immediately for all diseases, but without lasting effect. The direct financial incentives to physicians to reduce in prescription spending had the intended effect over time and can be an important tool to improve pharmaceutical spending management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. 78 FR 65418 - Order 1050.1F Environmental Impacts: Policies and Procedures

    Science.gov (United States)

    2013-10-31

    ... Federal Aviation Administration Order 1050.1F Environmental Impacts: Policies and Procedures AGENCY... Environmental Impacts: Policies and Procedures; Re-Opening of Comment Period. SUMMARY: This action re-opens the comment period for the notice of draft Order 1050.1F, Environmental Impacts: Policies and Procedures that...

  13. Data publication - policies and procedures from the PREPARDE project

    Science.gov (United States)

    Callaghan, Sarah; Murphy, Fiona; Tedds, Jonathan; Kunze, John; Lawrence, Rebecca; Mayernik, , Matthew S.; Whyte, Angus; Roberts, Timothy

    2013-04-01

    Data are widely acknowledged as a first class scientific output. Increases in researchers' abilities to create data need to be matched by corresponding infrastructures for them to manage and share their data. At the same time, the quality and persistence of the datasets need to be ensured, providing the dataset creators with the recognition they deserve for their efforts. Formal publication of data takes advantage of the processes and procedures already in place to publish academic articles about scientific results, enabling data to be reviewed and more broadly disseminated. Data are vastly more varied in format than papers, and so the policies required to manage and publish data must take into account the complexities associated with different data types, scientific fields, licensing rules etc. The Peer REview for Publication & Accreditation of Research Data in the Earth sciences (PREPARDE) project is JISC- and NERC-funded, and aims to investigate the policies and procedures required for the formal publication of research data. The project is investigating the whole workflow of data publication, from ingestion into a data repository, through to formal publication in a data journal. To limit the scope of the project, the focus is primarily on the policies required for the Royal Meteorological Society and Wiley's Geoscience Data Journal, though members of the project team include representatives from the life sciences (F1000Research), and will generalise the policies to other disciplines. PREPARDE addresses key issues arising in the data publication paradigm, such as: what criteria are needed for a repository to be considered objectively trustworthy; how does one peer-review a dataset; and how can datasets and journal publications be effectively cross-linked for the benefit of the wider research community and the completeness of the scientific record? To answer these questions, the project is hosting workshops addressing these issues, with interactions from key

  14. 31 CFR 132.6 - Non-exclusive examples of policies and procedures.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Non-exclusive examples of policies... Finance PROHIBITION ON FUNDING OF UNLAWFUL INTERNET GAMBLING § 132.6 Non-exclusive examples of policies and procedures. (a) In general. The examples of policies and procedures to identify and block or...

  15. 42 CFR 50.403 - What is the policy basis for these procedures?

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false What is the policy basis for these procedures? 50.403 Section 50.403 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS POLICIES OF GENERAL APPLICABILITY Public Health Service Grant Appeals Procedure § 50.403 What is the policy...

  16. Proceedings of a Workshop on Policy and Procedures for Water Management, Allocation, and Conflicting Use Resolution

    National Research Council Canada - National Science Library

    Burnham, Michael

    1996-01-01

    The Corps Hydraulics and Hydrology Branch, HQUSACE, sponsored a workshop entitled, 'Policy and Procedures for Water Management, Allocation, and Conflicting Use Resolution', on 30 January - 1 February...

  17. Philosophy, policies, and procedures - The three P's of flight-deck operations

    Science.gov (United States)

    Degani, Asaf; Wiener, Earl L.

    1991-01-01

    Standard operating procedures are drafted and provided to flightcrews to dictate the manner in which tasks are carried out. Failure to conform to Standard Operating Procedures (SOP) is frequently listed as the cause of violations, incidents, and accidents. However, procedures are often designed piecemeal, rather than being based on a sound philosophy of operations and policies that follow from such a philosophy. A framework of philosophy, policies, and procedures is proposed.

  18. 76 FR 42574 - Policies To Promote Rural Radio Service and To Streamline Allotment and Assignment Procedures

    Science.gov (United States)

    2011-07-19

    ... Matter of Policies to Promote Rural Radio Service and to Streamline Allotment and Assignment Procedures... COMMISSION 47 CFR Parts 73 and 74 Policies To Promote Rural Radio Service and To Streamline Allotment and Assignment Procedures AGENCY: Federal Communications Commission. ACTION: Final rules; announcement of...

  19. 77 FR 38338 - Proposal and Award Policies and Procedures Guide; Comments Request

    Science.gov (United States)

    2012-06-27

    ... From the Federal Register Online via the Government Publishing Office NATIONAL SCIENCE FOUNDATION Proposal and Award Policies and Procedures Guide; Comments Request AGENCY: National Science Foundation... Proposal and Award Policies and Procedures Guide. The original comment date was to end on June 25, 2012...

  20. 77 FR 32034 - Policies To Promote Rural Radio Service and To Streamline Allotment and Assignment Procedures

    Science.gov (United States)

    2012-05-31

    ... policies to promote rural radio service and to streamline allotment and assignment procedures. This notice... COMMISSION 47 CFR Part 73 Policies To Promote Rural Radio Service and To Streamline Allotment and Assignment Procedures AGENCY: Federal Communications Commission. ACTION: Final rule; announcement of effective date...

  1. 12 CFR 616.6300 - Leasing policies, procedures, and underwriting standards.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Leasing policies, procedures, and underwriting standards. 616.6300 Section 616.6300 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM LEASING § 616.6300 Leasing policies, procedures, and underwriting standards. The board of each institution...

  2. 12 CFR 233.6 - Non-exclusive examples of policies and procedures.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Non-exclusive examples of policies and....6 Non-exclusive examples of policies and procedures. (a) In general. The examples of policies and... business that may be different than the examples provided in this section. In addition, non-exempt...

  3. Procedural and documentation variations in intravenous infusion administration: a mixed methods study of policy and practice across 16 hospital trusts in England.

    Science.gov (United States)

    Furniss, Dominic; Lyons, Imogen; Franklin, Bryony Dean; Mayer, Astrid; Chumbley, Gillian; Wei, Li; Cox, Anna L; Vos, Jolien; Galal-Edeen, Galal; Blandford, Ann

    2018-04-10

    Procedural and documentation deviations relating to intravenous (IV) infusion administration can have important safety consequences. However, research on such deviations is limited. To address this we investigated the prevalence of procedural and documentation deviations in IV infusion administration and explored variability in policy and practice across different hospital trusts. We conducted a mixed methods study. This involved observations of deviations from local policy including quantitative and qualitative data, and focus groups with clinical staff to explore the causes and contexts of deviations. The observations were conducted across five clinical areas (general medicine, general surgery, critical care, paediatrics and oncology day care) in 16 National Health Service (NHS) trusts in England. All infusions being administered at the time of data collection were included. Deviation rates for procedural and documentation requirements were compared between trusts. Local data collectors and other relevant stakeholders attended focus groups at each trust. Policy details and reasons for deviations were discussed. At least one procedural or documentation deviation was observed in 961 of 2008 IV infusions (deviation rate 47.9%; 95% confidence interval 45.5-49.8%). Deviation rates at individual trusts ranged from 9.9 to 100% of infusions, with considerable variation in the prevalence of different types of deviation. Focus groups revealed lack of policy awareness, ambiguous policies, safety and practicality concerns, different organisational priorities, and wide variation in policies and practice relating to prescribing and administration of IV flushes and double-checking. Deviation rates and procedural and documentation requirements varied considerably between hospital trusts. Our findings reveal areas where local policy and practice do not align. Some policies may be impractical and lack utility. We suggest clearer evidence-based standardisation and local procedures

  4. 44 CFR 1.4 - Policy and procedures.

    Science.gov (United States)

    2010-10-01

    ... economy, and other regulatory actions contemplated for the future. (b) It is the policy of FEMA to provide... include a statement with respect to the impact of the proposed rule on small entities; holding open...

  5. Policy, Procedures and Standards for Enterprise Information Management

    Science.gov (United States)

    This policy establishes a standard approach for managing information produced by, funded by, or received per regulated reporting and/or federal-wide requirements and subsequently held or cataloged in information management systems by EPA.

  6. International Commission on Radiological Protection. History, policies, procedures

    International Nuclear Information System (INIS)

    Lindell, Bo; Dunster, H.J.; Valentin, Jack; )

    2000-01-01

    This report briefly reviews the history, mode of operation, concepts, and current policies of the International Commission on Radiological Protection (ICRP). It touches upon the objectives of the Commission's recommendations, the quantities used, the biological basis of the Commission's policy, the quantitative basis for its risk estimates, the structure of the system of protection, some problems of interpretation and application in that system, and the need for stability, consistency, and clarity in the Commission's recommendations. (author)

  7. Academic medical libraries' policies and procedures for notifying library users of retracted scientific publications.

    Science.gov (United States)

    Hughes, C

    1998-01-01

    Academic medical libraries have a responsibility to inform library users regarding retracted publications. Many have created policies and procedures that identify flawed journal articles. A questionnaire was sent to the 129 academic medical libraries in the United States and Canada to find out how many had policies and procedures for identifying retracted publications. Of the returned questionnaires, 59% had no policy and no practice for calling the attention of the library user to retracted publications. Forty-one percent of the libraries called attention to retractions with or without a formal policy for doing so. Several responding libraries included their policy statement with the survey. The increasing number of academic medical libraries that realize the importance of having policies and practices in place highlights the necessity for this procedure.

  8. 32 CFR 204.3 - Policy and procedures.

    Science.gov (United States)

    2010-07-01

    ... immediate or substantial gain or values (which may or may not be measurable in monetary terms) than those... statutes or DoD issuances require different practices or procedures, such as for: (i) Morale, welfare, and...

  9. A review and survey of policies utilized for interventional pain procedures: a need for consensus.

    Science.gov (United States)

    Kohan, Lynn; Salajegheh, Reza; Hamill-Ruth, Robin J; Yerra, Sandeep; Butz, John

    2017-01-01

    Other than the newly published anticoagulation guidelines, there are currently few recommendations to assist pain medicine physicians in determining the safety parameters to follow when performing interventional pain procedures. Little information exists regarding policies for oral intake, cumulative steroid dose limits, driving restrictions with and without sedation, and routine medication use for interventional procedures. A 16-question survey was developed on common policies currently in use for interventional pain procedures. The questionnaire was distributed through the American Society of Regional Anesthesia and Pain Medicine and American Academy of Pain Medicine. We sought to statistically analyze the range of policies being used by pain medicine physicians and to determine if there are any commonly accepted standards. A total of 337 physicians out of 4037 members responded to our survey with a response rate of 8.4%. A total of 82% of these respondents used a sedative agent while performing an interventional pain procedure. The majority of respondents required drivers after procedures, except after trigger points. A total of 47% indicated that they have an nil per os (NPO) policy for procedures without sedation. A total of 98% reported that they had an anticoagulation policy before an interventional procedure. A total of 17% indicated that the interval between steroid doses was policies regarding anticoagulation. There is an obvious need for evidence-based guidelines for these aspects of interventional pain care to improve patient safety and minimize the risk of adverse events.

  10. The philosophy and limitations of FAA aeromedical standards, policies and procedures.

    Science.gov (United States)

    1971-06-01

    Designated Aviation Medical Examiners need available basic information concerning the FAA medical certification system, the philosophy which underlies standards, policy and procedures, and certain limitations of the system. It is through such informa...

  11. 33 CFR 157.415 - Bridge resource management policy and procedures.

    Science.gov (United States)

    2010-07-01

    ... HOMELAND SECURITY (CONTINUED) POLLUTION RULES FOR THE PROTECTION OF THE MARINE ENVIRONMENT RELATING TO TANK... Petroleum Oils § 157.415 Bridge resource management policy and procedures. (a) Not later than February 1...

  12. Department of Defense Financial Management Regulation. Volume 11A. Reimbursable Operations Policy and Procedures

    National Research Council Canada - National Science Library

    1997-01-01

    .... In addition, it directs statutory and regulatory financial reporting requirements. Volume 11 A of the "DoD Financial Management Regulation" establishes policy and procedures for Department of Defense...

  13. Right and Goods: Procedural Liberalism and Educational Policy

    Science.gov (United States)

    Johnston, James Scott

    2007-01-01

    In this essay, James Scott Johnston asks what sort of liberalism is best for the educational systems of early twenty-first century, late capitalistic democratic nations, looking at the procedural liberalism extant. Two major models are John Rawls's Justice as Fairness and Jurgen Habermas's Communicative Action. Both owe their foundational…

  14. The effectiveness of sexual harassment policies and procedures at higher education institutions in South Africa

    OpenAIRE

    Pierre Joubert; Christo van Wyk; Sebastiaan Rothmann

    2011-01-01

    Orientation: Sexual harassment policies are generally in place in higher education institutions without any indication of its effectiveness as determined by the awareness of the policy. Research purpose: The aim of this study was to investigate the awareness levels of academic staff members at higher education institutions in South Africa of sexual harassment policies and procedures in their institutions. Motivation for the study: A number of high profile court cases emphasised the need for e...

  15. Policies and procedures: a tool to support the implementation of clinical guidelines?

    Science.gov (United States)

    St-Pierre, Isabelle; Davies, Barbara; Edwards, Nancy; Griffin, Patricia

    2007-01-01

    To explore the use of policies and procedures as a tool to support the implementation of clinical guidelines and to determine the relationship between organizational support and stability with nurses' perception of policy change. Secondary analysis of qualitative and quantitative data collected in the post-intervention phase of the study entitled Evaluation of the Dissemination and Utilization of Best Practice Guidelines by Registered Nurses in Ontario. Eleven agencies across Ontario, Canada. Fifty nursing staff, 32 nurse administrators and 22 clinical resource nurses (90% response) participated in semi-structured interviews. A total of 316 randomly selected nursing staff from 23 participating units in 11 agencies completed questionnaires (65% response). Qualitative data from semi-structured interviews were examined to determine whether participants had modified their policies and procedures as part of the implementation of clinical guidelines. Using SPSS 11.0 for Windows, the authors assessed, using independent t-tests, the relationship between the perception of modification of policies and procedures and the perceptions of organizational support an organisational stability. While modifications to policies and procedures were made at each agency as part of the implementation of clinical guidelines, 27% of staff disagreed that modifications had been made. Nursing staff who agreed that changes had been made to policies and procedures were significantly more likely to report positive organizational support for clinical guideline implementation. Findings suggest the need to increase nursing staffs' awareness of changes to policies and procedures during clinical guideline implementation. Furthermore, results indicate that organizational support may have a positive influence on modifications to policies and procedures that are guided by research-based clinical guideline recommendations.

  16. Health Professions and Nursing Student Loan and Scholarship Programs. Manual of Information, Policies, and Procedures.

    Science.gov (United States)

    National Institutes of Health (DHEW), Bethesda, MD. Bureau of Health Manpower Education.

    This manual covers basic policies and procedures governing four student loan and scholarship programs administered within the Bureau of Health Manpower, National Institutes of Health. An introductory chapter provides definitions, procedures, and reporting common to all programs, and this is followed by chapters describing: (1) The Health…

  17. 47 CFR 64.401 - Policies and procedures for provisioning and restoring certain telecommunications services in...

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...

  18. Fresh policies and procedures, transparency fuel ED turnaround.

    Science.gov (United States)

    2016-05-01

    The ED at Banner Payson Medical Center in Payson, AZ, has charted dramatic improvements on key metrics through a range of staff and policy changes. In just a few months, the ED has halved wait times, patient satisfaction has improved, and daily volume is up. Administrators say the secret to the success of the effort is a move to be transparent by posting key metrics regarding patient flow, a tactic that has helped the team pull together and feel a sense of accomplishment when performance goals are achieved. Administrators adjusted staff schedules to better match patient volume patterns in the ED, and they added staff to help nurses during peak hours. A new provider group enlisted the assistance of scribes during peak hours to manage the documentation workload while also enabling physicians to focus more patient interaction. Physicians hold end-of-shift huddles to review successes and challenges, and to improve physician/nurse communication. The tactic also helps develop the staff from an educational standpoint.

  19. Between government policy, clinical autonomy, and market demands: a qualitative study of the impact of the Prescribing Analysis System on behavior of physicians in South Korea.

    Science.gov (United States)

    Kim, Dong-Sook; Bae, Green; Yoo, Soo Yeon; Kang, Minah

    2015-09-21

    standards. Similarly, they appear to willingly accept situations in which they believe they should comply with patients' demands as a means of surviving in a competitive market. It is notable that physicians' negative perceptions of PAS seemed to be aggravated by suspicion and distrust regarding the purpose of this program. Because of widespread beliefs in professional autonomy, market competition, and a deep-seated distrust of the system, it would be difficult for the government to persuade physicians to change their prescribing behaviors using only the PAS. Successful implementation of the PAS will not only require its improvement as a policy tool, but also the creation of a social consensus regarding the PAS.

  20. A Bayesian procedure for estimating the causal effects of nursing home bed-hold policy.

    Science.gov (United States)

    Gutman, Roee; Intrator, Orna; Lancaster, Tony

    2017-10-03

    Nursing home bed-hold policies provide continuity of care for Medicaid beneficiaries by paying nursing homes to reserve beds so residents can return to their facility of occupancy following an acute hospitalization. In 2001, Michigan implemented bed-hold policies in nursing homes. We investigated the impact of these policies on mortality and hospitalizations using 1999-2004 quarterly data from nursing homes in Michigan and nursing homes in 11 states that did not implement such policies. Synthetic Control has been used to estimate the effects of policies by accounting for changes over time unrelated to the intervention. Synthetic Control is intended for scalar continuous outcome at each period, and assumes a single treated unit and multiple control units. We propose a Bayesian procedure to overcome these limitations. It imputes the outcomes of nursing homes in Michigan if they were not exposed to the policy by matching to non-exposed nursing homes that are associated with the exposed ones in the pre-policy period. Because sampling from a Bayesian model is computationally challenging, we describe an approximation procedure that can be implemented using existing software. Our approach can be applied to other studies that examine the impact of policies. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. 76 FR 50813 - Major Capital Investment Projects; Guidance on News Starts/Small Starts Policies and Procedures

    Science.gov (United States)

    2011-08-16

    ... Policies and Procedures AGENCY: Federal Transit Administration (FTA), DOT. ACTION: Notice. SUMMARY: This... published Guidance on New and Small Starts Policies and Procedures in September 2009. Thus, FTA is... on the New Starts and Small Starts programs. FTA is required by statute to publish policy guidance...

  2. 75 FR 29996 - Review of MMS NEPA Policies, Practices, and Procedures for OCS Oil and Gas Exploration and...

    Science.gov (United States)

    2010-05-28

    ... COUNCIL ON ENVIRONMENTAL QUALITY Review of MMS NEPA Policies, Practices, and Procedures for OCS... Environmental Policy Act (NEPA) policies, practices, and procedures for the Minerals Management Service (MMS) decisions for Outer Continental Shelf (OCS) oil and gas exploration and development. This review of MMS NEPA...

  3. Impacts of Climate Policy on Regional Air Quality, Health, and Air Quality Regulatory Procedures

    Science.gov (United States)

    Thompson, T. M.; Selin, N. E.

    2011-12-01

    Both the changing climate, and the policy implemented to address climate change can impact regional air quality. We evaluate the impacts of potential selected climate policies on modeled regional air quality with respect to national pollution standards, human health and the sensitivity of health uncertainty ranges. To assess changes in air quality due to climate policy, we couple output from a regional computable general equilibrium economic model (the US Regional Energy Policy [USREP] model), with a regional air quality model (the Comprehensive Air Quality Model with Extensions [CAMx]). USREP uses economic variables to determine how potential future U.S. climate policy would change emissions of regional pollutants (CO, VOC, NOx, SO2, NH3, black carbon, and organic carbon) from ten emissions-heavy sectors of the economy (electricity, coal, gas, crude oil, refined oil, energy intensive industry, other industry, service, agriculture, and transportation [light duty and heavy duty]). Changes in emissions are then modeled using CAMx to determine the impact on air quality in several cities in the Northeast US. We first calculate the impact of climate policy by using regulatory procedures used to show attainment with National Ambient Air Quality Standards (NAAQS) for ozone and particulate matter. Building on previous work, we compare those results with the calculated results and uncertainties associated with human health impacts due to climate policy. This work addresses a potential disconnect between NAAQS regulatory procedures and the cost/benefit analysis required for and by the Clean Air Act.

  4. The effectiveness of sexual harassment policies and procedures at higher education institutions in South Africa

    Directory of Open Access Journals (Sweden)

    Pierre Joubert

    2011-02-01

    Research purpose: The aim of this study was to investigate the awareness levels of academic staff members at higher education institutions in South Africa of sexual harassment policies and procedures in their institutions. Motivation for the study: A number of high profile court cases emphasised the need for effective policies to reduce the incidence of sexual harassment complaints. Research design, approach and method: A cross-sectional survey design was conducted amongst 161 academic staff members, representing 10 higher education institutions in South Africa. The measuring instrument that was used is the Sexual Harassment Questionnaire (SHQ that was developed specifically for this study. Main findings: The results showed that despite indications that sexual harassment policies do exist and that they are regarded as effective tools in addressing sexual harassment, the implementation of such policies is not effective and few academic staff members received training and/or guidance on the utilisation of the policy. Significant correlation coefficients were found between the elements of an effective policy and between population group and some of the elements. Practical/managerial implications: Employers across the board should regularly conduct an audit to determine the level of awareness of sexual harassment policies and procedures and plan interventions. Contribution: No other study in South Africa attempted to measure the awareness levels of academics and its impact on the management of sexual harassment.

  5. State Approval Policies and Procedures for Postsecondary Career and Technical Education

    Science.gov (United States)

    Merkley, Rodney J.; Johnston, George H.

    2007-01-01

    This study examined the final program approval for new postsecondary Career and Technical Education (CTE) programs and program review policies and procedures for existing programs based on publicly available Web sites and on follow-up interviews with representatives in the final state approving agency. The purpose of the study was to inventory the…

  6. Addressing Challenging Behaviors in Head Start: A Closer Look at Program Policies and Procedures

    Science.gov (United States)

    Quesenberry, Amanda C.; Hemmeter, Mary Louise; Ostrosky, Michaelene M.

    2011-01-01

    In this study, Head Start policies and procedures related to child guidance and addressing challenging behaviors were examined. Data were gathered from six Head Start programs in the Midwest, through interviews and document analysis. The findings provide a glimpse into how Head Start programs support children's social and emotional competence and…

  7. State Approval Policies and Procedures for Postsecondary CTE Programs. In Brief

    Science.gov (United States)

    Merkley, Rodney J.; Johnston, George H.

    2007-01-01

    This brief presents the results of a national study designed to inventory state agency approval policies and procedures for postsecondary Career and Technical Education (CTE) programs (Merkley & Johnston, forthcoming). The study was limited to the states' approval of CTE programs implemented by public, two-year degree-granting institutions and did…

  8. Risk evaluation and mitigation strategies: assessment of a medical center's policies and procedures.

    Science.gov (United States)

    Childs, Lindsey; Alexander, Earnest; Duong, Minh-Tri

    2012-05-15

    The results of a hospital's initiative to evaluate and improve compliance with federally mandated risk evaluation and mitigation strategies (REMS) are presented. Food and Drug Administration approved REMS plans are required for more than 145 drugs, but clear guidance on strategies for achieving REMS compliance is lacking. As a first step toward determining the extent of REMS compliance at a large medical center, a systematic assessment was conducted to ascertain existing policies and procedures for the use of drugs subject to REMS requirements applicable in the inpatient setting. About 123 drugs with such "inpatient-applicable" REMS requirements were identified; of those, 10 had been ordered by hospital providers during a specified 18-month time frame and were included in the assessment of policies and procedures. The assessment revealed that the hospital lacked a formal REMS policy and had no REMS-compliant procedures in place for 7 evaluated drugs (ambrisentan, buprenorphine-naloxone, darbepoetin alfa, epoetin alfa, oxycodone controlled-release tablets, prasugrel, and pregabalin). Pursuant to the compliance assessment, new procedures to help ensure the safe use of those 7 drugs were developed, and REMS-focused educational programs, order-entry system enhancements, and drug storage modifications were implemented. Quality-improvement initiatives including staff education, incorporation of REMS requirements into existing policy, development of an electronic resource, and creation of a separate storage section for drugs subject to REMS were implemented at a large academic medical center to help ensure compliance with inpatient-applicable REMS requirements.

  9. 77 FR 3102 - Procedures for Implementing the National Environmental Policy Act

    Science.gov (United States)

    2012-01-23

    ... Definitions Authority: The National Aeronautics and Space Act of 1958, as amended (51 U.S.C. 20101 et seq... policies and procedures for the early integration of environmental considerations into planning and... Applicability. This subpart applies to all organizational elements of NASA. Sec. 1216.302 Responsibilities. (a...

  10. Automated procedure for selection of optimal refueling policies for light water reactors

    International Nuclear Information System (INIS)

    Lin, B.I.; Zolotar, B.; Weisman, J.

    1979-01-01

    An automated procedure determining a minimum cost refueling policy has been developed for light water reactors. The procedure is an extension of the equilibrium core approach previously devised for pressurized water reactors (PWRs). Use of 1 1/2-group theory has improved the accuracy of the nuclear model and eliminated tedious fitting of albedos. A simple heuristic algorithm for locating a good starting policy has materially reduced PWR computing time. Inclusion of void effects and use of the Haling principle for axial flux calculations extended the nuclear model to boiling water reactors (BWRs). A good initial estimate of the refueling policy is obtained by recognizing that a nearly uniform distribution of reactivity provides low-power peaking. The initial estimate is improved upon by interchanging groups of four assemblies and is subsequently refined by interchanging individual assemblies. The method yields very favorable results, is simpler than previously proposed BWR fuel optimization schemes, and retains power cost as the objective function

  11. Prescribing Antibiotics

    DEFF Research Database (Denmark)

    Pedersen, Inge Kryger; Jepsen, Kim Sune

    2018-01-01

    The medical professions will lose an indispensable tool in clinical practice if even simple infections cannot be cured because antibiotics have lost effectiveness. This article presents results from an exploratory enquiry into “good doctoring” in the case of antibiotic prescribing at a time when...

  12. Prescribing Antibiotics

    DEFF Research Database (Denmark)

    Pedersen, Inge Kryger; Jepsen, Kim Sune

    2018-01-01

    the knowledge base in the healthcare field is shifting. Drawing on in-depth interviews about diagnosing and prescribing, the article demonstrates how the problem of antimicrobial resistance is understood and engaged with by Danish general practitioners. When general practitioners speak of managing “non...

  13. Prescribing procrastination

    Science.gov (United States)

    Thomson, George H.

    1979-01-01

    In his everyday work the family physician sees many patients whose problems have been diagnosed but for whom postponement of an active treatment plan is indicated. The physician must therefore prescribe procrastination in a carefully planned way. I describe some ideas and practical methods for doing this. PMID:529244

  14. Policies, Procedures, and Practices Regarding Sport-Related Concussion in Community College Athletes.

    Science.gov (United States)

    Paddack, Michael; DeWolf, Ryan; Covassin, Tracey; Kontos, Anthony

    2016-01-01

    College sport organizations and associations endorse concussion-management protocols and policies. To date, little information is available on concussion policies and practices at community college institutions. To assess and describe current practices and policies regarding the assessment, management, and return-to-play criteria for sport-related concussion (SRC) among member institutions of the California Community College Athletic Association (CCCAA). Cross-sectional study. Web-based survey. A total of 55 head athletic trainers (ATs) at CCCAA institutions. Data about policies, procedures, and practices regarding SRC were collected over a 3-week period in March 2012 and analyzed using descriptive statistics, the Fisher exact test, and the Spearman test. Almost half (47%) of ATs stated they had a policy for SRC assessment, management, and return to play at their institution. They reported being in compliance with baseline testing guidelines (25%), management guidelines (34.5%), and return-to-play guidelines (30%). Nearly 31% of ATs described having an SRC policy in place for academic accommodations. Conference attendance was positively correlated with institutional use of academic accommodations after SRC (r = 0.44, P = .01). The number of meetings ATs attended and their use of baseline testing were also positively correlated (r = 0.38, P = .01). At the time of this study, nearly half of CCCAA institutions had concussion policies and 31% had academic-accommodation policies. However, only 18% of ATs at CCCAA institutions were in compliance with all of their concussion policies. Our findings demonstrate improvements in the management of SRCs by ATs at California community colleges compared with previous research but a need for better compliance with SRC policies.

  15. 78 FR 55091 - Fair Housing Initiatives Program-Fiscal Year 2013 Application and Award Policies and Procedures...

    Science.gov (United States)

    2013-09-09

    ... on the Applications and Awards Procedures and Policies (AAPP) Guide, which can be found at: http... URBAN DEVELOPMENT Fair Housing Initiatives Program--Fiscal Year 2013 Application and Award Policies and Procedures--Solicitation of Comment AGENCY: Office of the Assistant Secretary for Fair Housing and Equal...

  16. A Case Study of Policies and Procedures to Address Cyberbullying at a Technology-Based Middle School

    Science.gov (United States)

    Tate, Bettina Polite

    2017-01-01

    This qualitative case study explored the policies and procedures used to effectively address cyberbullying at a technology-based middle school. The purpose of the study was to gain an in-depth understanding of policies and procedures used to address cyberbullying at a technology-based middle school in the southern United States. The study sought…

  17. Systematic procedure for generating operational policies to achieve target crystal size distribution (CSD) in batch cooling crystallization

    DEFF Research Database (Denmark)

    Abdul Samad, Noor Asma Fazli; Singh, Ravendra; Sin, Gürkan

    2011-01-01

    A systematic procedure to achieve a target crystal size distribution (CSD) under generated operational policies in batch cooling crystallization is presented. An analytical CSD estimator has been employed in the systematic procedure to generate the necessary operational policies to achieve the ta...

  18. Rationalising prescribing

    DEFF Research Database (Denmark)

    Wadmann, Sarah; Bang, Lia Evi

    2015-01-01

    with chronic care management in Denmark. We demonstrate how attempts to rationalise prescribing by informing GPs about drug effects, adverse effects and price do not satisfy GPs' knowledge needs. We argue that, for GPs, 'rational' prescribing cannot be understood in separation from the processes that enable...... 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...... of GPs as a need for practice-relevant knowledge and argue that industry sales representatives are granted opportunity to access general practice because they understand this need of GPs....

  19. Developing School Policies and Procedures for Physical Restraint and Seclusion in Nebraska Schools. A Technical Assistance Document

    Science.gov (United States)

    Peterson, Reece L.

    2010-01-01

    The purpose of this document is to provide information and guidance for Nebraska School districts in creating new, or revising existing policies and procedures related to the use of physical restraint and seclusion in school settings. The goal is to create policies that are informed by national policy directions, research, good practice and…

  20. Integrated Hatchery Operations Team: Policies and Procedures for Columbia Basin Anadromous Salmonid Hatcheries, 1994 Annual Report.

    Energy Technology Data Exchange (ETDEWEB)

    Integrated Hatchery Operations Team (Northwest Power Planning Council, Portland, OR)

    1995-01-01

    This document outlines regional policies and procedures for hatchery operations in the Columbia River Basin. The purpose of these policies is to provide regional guidelines by which all anadromous fish hatcheries will be operated. These policies will be adopted by the fisheries co-managers, and will provide guidance to operate hatcheries in an efficient and biologically sound manner. The hatchery policies presented in this manual are not intended to establish production priorities. Rather, the intent is to guide hatchery operations once production numbers are established. Hatchery operations discussed in this report include broodstock collection, spawning, incubation of eggs, fish rearing and feeding, fish release, equipment maintenance and operations, and personnel training. Decisions regarding production priorities must be provided by fishery managers through a comprehensive plan that addresses both natural and hatchery fish production. The Integrated Hatchery Operations Team is a multi-agency group called for by the Northwest Power Planning Council. This team was directed to develop new basinwide policies for managing and operating all existing and future anadromous fish hatcheries in the Columbia River Basin. The parties pledge to confer with each other and to use their authorities and resources to accomplish these mutually acceptable hatchery practices.

  1. Policy analysis of authorisation procedures for wind energy deployment in Spain

    Energy Technology Data Exchange (ETDEWEB)

    Iglesias, Guillermo, E-mail: gwig@udc.es [Universidad de A Coruna, Facultad de Ciencias Economicas y Empresariales, Campus de Elvina, s/n. A Coruna 15071 (Spain); Rio, Pablo del, E-mail: pablo.delrio@cchs.csic.es [Consejo Superior de Investigaciones Cientificas (CSIC), C/Albasanz, 26-28, Madrid 28037 (Spain); Dopico, Jesus Angel, E-mail: jesu1971@udc.es [Universidad de A Coruna, Facultad de Ciencias Economicas y Empresariales, Campus de Elvina, s/n. A Coruna 15071 (Spain)

    2011-07-15

    The aim of this paper is to analyse the administrative procedures for the granting of authorisations for the siting of wind farms in Spain, currently the competency of regional authorities. The analysis reveals some commonalities and differences between the procedures across regions. Furthermore, some aspects regarding these procedures have raised the concern of different stakeholders, including the central government and wind energy investors. A conflict between the interests of the central and regional governments can be observed. Lack of coordination between the different administrative levels and the 'more is better mentality' of regional authorities have led to a significant growth of wind energy requests for the (national) feed-in tariff. In turn, investors have complained about the discretionarity and non-transparency of those procedures and the lack of homogeneity across regions. This is likely to result in delays, uncertainty for investors and higher transaction costs. Although there has been a trend to a model which involves the use of multicriteria bidding procedures with more explicit, objective and precise criteria regarding project selection, the aforementioned problems suggest the need to improve coordination between the different administrative levels. - Highlights: > A conflict between the interests of the central and regional governments in the granting of administrative procedures can be observed. > Lack of coordination between different administrative levels have led to a significant growth of wind energy requests for the (national) feed-in tariff. > The resulting increase in the total costs of wind energy promotion has been a major concern for national policy-makers. > In turn, investors have complained about the discretionarity and non-transparency of those procedures and the lack of homogeneity across regions. > Those problems suggest the need to improve coordination between the different administrative levels.

  2. Policy analysis of authorisation procedures for wind energy deployment in Spain

    International Nuclear Information System (INIS)

    Iglesias, Guillermo; Rio, Pablo del; Dopico, Jesus Angel

    2011-01-01

    The aim of this paper is to analyse the administrative procedures for the granting of authorisations for the siting of wind farms in Spain, currently the competency of regional authorities. The analysis reveals some commonalities and differences between the procedures across regions. Furthermore, some aspects regarding these procedures have raised the concern of different stakeholders, including the central government and wind energy investors. A conflict between the interests of the central and regional governments can be observed. Lack of coordination between the different administrative levels and the 'more is better mentality' of regional authorities have led to a significant growth of wind energy requests for the (national) feed-in tariff. In turn, investors have complained about the discretionarity and non-transparency of those procedures and the lack of homogeneity across regions. This is likely to result in delays, uncertainty for investors and higher transaction costs. Although there has been a trend to a model which involves the use of multicriteria bidding procedures with more explicit, objective and precise criteria regarding project selection, the aforementioned problems suggest the need to improve coordination between the different administrative levels. - Highlights: → A conflict between the interests of the central and regional governments in the granting of administrative procedures can be observed. → Lack of coordination between different administrative levels have led to a significant growth of wind energy requests for the (national) feed-in tariff. → The resulting increase in the total costs of wind energy promotion has been a major concern for national policy-makers. → In turn, investors have complained about the discretionarity and non-transparency of those procedures and the lack of homogeneity across regions. → Those problems suggest the need to improve coordination between the different administrative levels.

  3. A Randomized Trial Testing the Impact of Narrative Vignettes vs. Guideline Summaries on Provider Response to a Professional Organization Clinical Policy for Safe Opioid Prescribing

    Science.gov (United States)

    Meisel, Zachary F.; Metlay, Joshua P.; Sinnenberg, Lauren; Kilaru, Austin S.; Grossestreuer, Anne; Barg, Frances K.; Shofer, Frances S.; Rhodes, Karin V.; Perrone, Jeanmarie

    2016-01-01

    Background Clinical guidelines are known to be underused by practitioners. In response to the challenges of treating pain amidst a prescription opioid epidemic, the American College of Emergency Physicians published an evidence-based clinical policy for opioid prescribing in 2012. Evidence-based narratives, an effective method of communicating health information in a variety of settings, offer a novel strategy for disseminating guidelines to physicians and engaging providers with clinical evidence. Objectives To compare whether narrative vignettes embedded in the American College of Emergency Physician (ACEP) daily e-newsletter improved dissemination of the clinical policy to ACEP members, and engagement of members with the clinical policy, compared to traditional summary text. Methods A prospective randomized controlled study, entitled Stories to Promote Information using Narrative (SPIN) trial, was performed. Derived from qualitative interviews with 61 ACEP physicians, 4 narrative vignettes were selected and refined, using a consensus panel of clinical and implementation experts. All ACEP members were then block randomized by state of residence to receive alternative versions of a daily emailed newsletter for a total of 24 days during a 9 week period. Narrative newsletters contained a selection of vignettes that referenced opioid prescription dilemmas. Control newsletters contained a selection of descriptive text about the clinical policy using similar length and appearance to the narrative vignettes. Embedded in the newsletters were web links to the complete vignette or traditional summary text, as well as additional links to the full ACEP clinical policy and a website providing assistance with prescription drug monitoring program enrollment. The newsletters were otherwise identical. Outcomes measured were the percentage of subjects who visited any of the web pages that contained additional guideline related information and the odds of any unique physician

  4. Notification: Audit of EPA's Adherence to Policies, Procedures and Oversight Controls Pertaining to the Administrator’s Travel

    Science.gov (United States)

    Project #OA-FY17-0382, August 28, 2017. The EPA OIG plans to begin preliminary research on the EPA’s adherence to policies, procedures and oversight controls pertaining to the Administrator’s travel to Oklahoma.

  5. Report: EPA Needs Policies and Procedures to Manage Public Pesticide Petitions in a Transparent and Efficient Manner

    Science.gov (United States)

    Report #16-P-0019, October 27, 2015. OPP’s lack of policies and procedures to manage public pesticide petitions in a transparent and efficient manner can result in unreasonable delay lawsuits costing the agency time and resources.

  6. A Policy Model for Use of Aversive and Deprivation Procedures to Decrease Problem Behaviors of Students in Special Education.

    Science.gov (United States)

    Braaten, Sheldon

    1991-01-01

    A draft policy developed by the Minneapolis (Minnesota) public schools concerning the use of aversive or deprivation procedures with students who are handicapped is presented. The policy model covers such elements as response to prior interventions; written treatment plan; informed consent; supervision; maintenance and retention of records;…

  7. Department of Defense Financial Management Regulation. Volume 13. Nonappropriated Funds Policy and Procedures

    National Research Council Canada - National Science Library

    1994-01-01

    .... In addition, it directs statutory and regulatory financial reporting requirements. This Volume prescribes standard accounting principles and practices for all DoD nonappropriated fund instrumentalities (NAFIs...

  8. Medicare program; revisions to payment policies under the physician fee schedule, and other Part B payment policies for CY 2008; revisions to the payment policies of ambulance services under the ambulance fee schedule for CY 2008; and the amendment of the e-prescribing exemption for computer generated facsimile transmissions. Final rule with comment period.

    Science.gov (United States)

    2007-11-27

    This final rule with comment period addresses certain provisions of the Tax Relief and Health Care Act of 2006, as well as making other proposed changes to Medicare Part B payment policy. We are making these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule with comment period also discusses refinements to resource-based practice expense (PE) relative value units (RVUs); geographic practice cost indices (GPCI) changes; malpractice RVUs; requests for additions to the list of telehealth services; several coding issues including additional codes from the 5-Year Review; payment for covered outpatient drugs and biologicals; the competitive acquisition program (CAP); clinical lab fee schedule issues; payment for renal dialysis services; performance standards for independent diagnostic testing facilities; expiration of the physician scarcity area (PSA) bonus payment; conforming and clarifying changes for comprehensive outpatient rehabilitation facilities (CORFs); a process for updating the drug compendia; physician self referral issues; beneficiary signature for ambulance transport services; durable medical equipment (DME) update; the chiropractic services demonstration; a Medicare economic index (MEI) data change; technical corrections; standards and requirements related to therapy services under Medicare Parts A and B; revisions to the ambulance fee schedule; the ambulance inflation factor for CY 2008; and amending the e-prescribing exemption for computer-generated facsimile transmissions. We are also finalizing the calendar year (CY) 2007 interim RVUs and are issuing interim RVUs for new and revised procedure codes for CY 2008. As required by the statute, we are announcing that the physician fee schedule update for CY 2008 is -10.1 percent, the initial estimate for the sustainable growth rate for CY 2008 is -0.1 percent, and the conversion factor (CF) for CY 2008 is $34.0682.

  9. Intimate Partner Violence Screening and Response: Policies and Procedures Across Health Care Facilities.

    Science.gov (United States)

    Williams, Jessica R; Halstead, Valerie; Salani, Deborah; Koermer, Natasha

    2016-01-01

    This study examines policies and procedures for identifying and responding to intimate partner violence (IPV) among different types of health care settings. This epidemiologic, cross-sectional, observational study design collected data from June 2014 to January 2015 through a telephone questionnaire from a stratified random sample of 288 health care facilities in Miami-Dade County, Florida. An overall response rate of 76.2% was achieved from 72 primary care clinics, 93 obstetrics/gynecology clinics, 106 pediatric clinics, and 17 emergency departments (EDs). There is a general awareness of the importance of IPV screening with 78.1% of facilities (95% CI, 73.9%-82.3%) reporting some type of IPV screening procedures. Wide variation exists, however, in how practices are implemented, with only 35.3% of facilities (95% CI, 29.5%-41.1%) implementing multicomponent, comprehensive IPV screening and response programs. Differences were also observed by setting with EDs reporting the most comprehensive programs. This study yields important empirical information regarding the extent to which IPV screening and response procedures are currently being implemented in both clinic and acute health care settings along with areas where improvements are needed. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  10. 12 CFR 614.4120 - Policies governing extensions of credit to direct lender associations and OFIs.

    Science.gov (United States)

    2010-01-01

    ... policies and procedures shall prescribe lending policies and loan underwriting standards that are consistent with sound financial and credit practices. The policies shall require a periodic review of the... policies and loan underwriting standards set forth in part 614, subpart D, and may permit lending to such...

  11. Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: findings and future implications

    Directory of Open Access Journals (Sweden)

    Brian eGodman

    2014-06-01

    Full Text Available Introduction: The appreciable growth in pharmaceutical expenditure has resulted in multiple initiatives across Europe to lower generic prices and enhance their utilisation. However, considerable variation in their use and prices. Objective: Assess the influence of multiple supply and demand-side initiatives across Europe for established medicines to enhance prescribing efficiency before a decision to prescribe a particular medicine. Subsequently utilise the findings to suggest potential future initiatives that countries could consider. Method: Analysis of different methodologies involving cross national and single country retrospective observational studies on reimbursed use and expenditure of PPIs, statins and renin-angiotensin inhibitor drugs among European countries. Results: Nature and intensity of the various initiatives appreciably influenced prescribing behaviour and expenditure, e.g. multiple measures resulted in reimbursed expenditure for PPIs in Scotland in 2010 56% below 2001 levels despite a 3 fold increase in utilisation and in the Netherlands, PPI expenditure fell by 58% in 2010 vs. 2000 despite a 3-fold increase in utilisation. A similarly picture was seen with prescribing restrictions, i.e. (i more aggressive follow-up of prescribing restrictions for patented statins and ARBs resulted in a greater reduction in the utilisation of patented statins in Austria vs. Norway and lower utilisation of patented ARBs vs. generic ACEIs in Croatia than Austria. However, limited impact of restrictions on esomeprazole in Norway with the first prescription or recommendation in hospital where restrictions do not apply. Similar findings when generic losartan became available in Western Europe. Conclusions: Multiple demand-side measures are needed to influence prescribing patterns. When combined with supply-side measures, activities can realise appreciable savings. Health authorities cannot rely on a ‘spill over’ effect between classes to affect

  12. Micro Declared Language Policy or Not?: Language-Policy-Like Statements in the Rules of Procedure of the Rwandan Parliament

    Science.gov (United States)

    Gafaranga, Joseph; Niyomugabo, Cyprien; Uwizeyimana, Valentin

    2013-01-01

    An invitation to integrate macro and micro level analyses has been extended to researchers as this integration is felt to be the way forward for language policy research (Ricento, Ideology, politics and language policies: Focus on english, John Benjamins, Amsterdam, 2000). In turn, the notion of 'micro' in language policy has been specified as…

  13. Preventing and controlling human noroviruses in South Carolina long-term care facilities: An analysis of institutional policies and procedures.

    Science.gov (United States)

    Jayasekara, Lalani; Leone, Cortney M; Sharp, Julia; Fraser, Angela

    2016-01-01

    Long-term care (LTC) facilities are the number one setting for human norovirus (HuNoV) outbreaks in the United States (60%). We aimed to determine alignment of policies and procedures in LTC facilities in South Carolina with Centers for Disease Control and Prevention (CDC) recommendations and to determine readability based on Federal Plain Language Guidelines and Microsoft Word readability statistics. Most facilities (n = 21) had procedures for hand hygiene, but recommendations for handwashing events and duration varied greatly. Less than half (n = 11) had separate procedures devoted to HuNoV outbreak control. Fifteen required disinfection of bodily fluids. Seven had procedures for exclusion of sick staff during an outbreak. Both hand hygiene and bodily fluid cleanup procedures had low mean scores for readability. Mean Flesch Reading Ease and Flesch-Kincaid Grade Level for both procedures were in the range of difficult to understand. Most LTC policies and procedures were not consistent with CDC recommendations for HuNoV. Moreover, readability of all procedures is needed so LTC workers can easily understand and implement prevention and control procedures. Published by Elsevier Inc.

  14. Patient access to electronic health record: a comparative study on laws, policies and procedures in selected countries.

    Science.gov (United States)

    Tavakoli, Nahid; Isfahani, Sakineh Saghaeiannejad; Piri, Zakiye; Amini, Afsaneh

    2013-01-01

    The e-health system must have the capability of patient access to electronic health record. The advantage of access to their record lets them have better understanding of their condition and treatment. It can also raise the reliability of consistency and correctness of data in health care system. Finally it will improve the maintenance quality of medical records and guarantee better results of medication. This study aimed to carry out a comparative study concerning laws, policies and procedures upon patients' access right to EHR in selected countries and to suggest appropriate solutions for Iran. This was a comparative descriptive study. The study population was the laws, policies and procedures of patients' access right to EHR belong to countries like Canada, Australia, New Zealand and Iran. Data were collected by taking notes on index cards. In this study in order to collect data, at first, the researcher studied the websites related to Health Ministry of the countries and existing laws and policies through related links in the websites. In next step, the health information management association websites were studied and the related data were collected. The gathered data were analyzed through content analysis. The findings of research showed that in every four countries there are generally some laws, policies and procedures. Although Canada and New Zealand concerning the number of laws and policies related to the subject subsequently are ranked after Australia, they are ranked prior to Australia regarding benefiting the laws and specified policies. Given the necessity of EHR implementing and codifying the planning of SEPAS in Iran, as there is no specified laws or procedures regarding patients' access right to EHR, the obligation of paying attention to assigning a law or at least obvious policies and procedures and providing the details is absolutely apparent.

  15. The social act of electronic medication prescribing

    NARCIS (Netherlands)

    J.E.C.M. Aarts (Jos)

    2013-01-01

    markdownabstract__Abstract__ Prescribing medication is embedded in social norms and cultures. In modern Western health care professionals and policy makers have attempted to rationalize medicine by addressing cost-effectiveness of diagnostic and therapeutic treatments and the development of

  16. EPA Order 1000.17 on Policy and Procedures of Protection of Human Research Subjects in EPA Conducted or Supported Research

    Science.gov (United States)

    This Order supersedes EPA Order 1000.17 Policy and Procedures on Protection of Human Subjects, July 30, 1999 including changes thereto, and establishes EPA responsibilities and policies for the use of human subjects in research.

  17. Response of School Districts to the New York State Concussion Awareness and Management Act: Review of Policies and Procedures

    Science.gov (United States)

    Kajankova, Maria; Oswald, Jennifer M.; Terranova, Lauren M.; Kaplen, Michael V.; Ambrose, Anne F.; Spielman, Lisa A.; Gordon, Wayne A.

    2017-01-01

    Background: By 2014, all states implemented concussion laws that schools must translate into daily practice; yet, limited knowledge exists regarding implementation of these laws. We examined the extent to which concussion management policies and procedure (P&P) documents of New York State school districts comply with the State's Concussion…

  18. 47 CFR 64.402 - Policies and procedures for the provision of priority access service by commercial mobile radio...

    Science.gov (United States)

    2010-10-01

    ... priority access service by commercial mobile radio service providers. 64.402 Section 64.402... Policies and procedures for the provision of priority access service by commercial mobile radio service providers. Commercial mobile radio service providers that elect to provide priority access service to...

  19. 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...

  20. Guidelines, Policies and Procedures for Data Publication from the PREPARDE project

    Science.gov (United States)

    Murphy, Fiona; Callaghan, Sarah; Tedds, Jonathan; Khodiyar, Varsha; Kunze, John; Lawrence, Rebecca; Mayernik, Matthew; Roberts, Timothy; Whyte, Angus

    2014-05-01

    Data publication is often proposed as a method for ensuring the proper management and curation of research data, while at the same time rewarding the data creator for their efforts in doing so. It takes advantage of the processes already in place to publish research in academic journals, but needs to build on these to take into account the fact that data are vastly more varied in structure, size and complexity than scholarly articles. Peer REview for Publication & Accreditation of Research Data in the Earth sciences (PREPARDE) was a JISC- and NERC-funded project which investigated the policies and procedures required for the formal publication of research data, using as a particular case study connections with, and papers in, Geoscience Data Journal. The focus of the project was in producing outputs that would be of direct use to the editors of Geoscience Data Journal, and which would be generalisable to other scientific domains beyond the geosciences. Several of these outputs have since been taken on and developed further by the Publishing Data Interest Group of the Research Data Alliance, along with other journals such as F1000Research and Scientific Data. In this presentation we will describe key results and conclusions from the PREPARDE project, including guidelines for recommending data repositories as partners in data publication, guidance for reviewers of Geoscience Data Journal who are reviewing datasets as well as data papers, and recommendations for standardisation of cross-linking methods to ensure that the link between the dataset and its citing paper does not become broken. The sustainability of data journals in the stable of other academic journals will also be addressed. The PREPARDE deliverables can be found on-line at http://proj.badc.rl.ac.uk/preparde/wiki/DeliverablesList

  1. Policies and Procedures That Facilitate Implementation of Evidence-Based Clinical Guidelines in U.S. Dental Schools.

    Science.gov (United States)

    Polk, Deborah E; Nolan, Beth A D; Shah, Nilesh H; Weyant, Robert J

    2016-01-01

    The aim of this study was to determine the degree to which dental schools in the United States have policies and procedures in place that facilitate the implementation of evidence-based clinical guidelines. The authors sent surveys to all 65 U.S. dental schools in 2014; responses were obtained from 38 (58%). The results showed that, of the nine policies and procedures examined, only two were fully implemented by 50% or more of the responding schools: guidelines supported through clinical faculty education or available chairside (50%), and students informed of guidelines in both the classroom and clinic (65.8%). Although 92% of the respondents reported having an electronic health record, 80% of those were not using it to track compliance with guidelines. Five schools reported implementing more policies than the rest of the schools. The study found that the approach to implementing guidelines at most of the responding schools did not follow best practices although five schools had an exemplary set of policies and procedures to support guideline implementation. These results suggest that most dental schools are currently not implementing guidelines effectively and efficiently, but that the goal of schools' having a comprehensive implementation program for clinical guidelines is achievable since some are doing so. Future studies should determine whether interventions to improve implementation in dental schools are needed.

  2. Learning from prescribing errors

    OpenAIRE

    Dean, B

    2002-01-01

    

 The importance of learning from medical error has recently received increasing emphasis. This paper focuses on prescribing errors and argues that, while learning from prescribing errors is a laudable goal, there are currently barriers that can prevent this occurring. Learning from errors can take place on an individual level, at a team level, and across an organisation. Barriers to learning from prescribing errors include the non-discovery of many prescribing errors, lack of feedback to th...

  3. 75 FR 73976 - Policies To Promote Rural Radio Service and To Streamline Allotment and Assignment Procedures

    Science.gov (United States)

    2010-11-30

    ... Assignment Procedures, MB Docket No. 09-52, FCC 09-30, 24 FCC Rcd 5239 (2009). On January 28, 2010, the... Streamline Allotment and Assignment Procedures (the ``Order''), MB Docket No. 09-52, FCC 10-24, 25 FCC Rcd... Docket No. 09-52, FCC 10-24, 25 FCC Rcd 1583 (2010). The Order adopts changes to certain procedures...

  4. Impact of North Atlantic Treaty Organization Policies and Procedures on Combined Medical Operations: Food and Water Safety and Veterinary Support.

    Science.gov (United States)

    Stevenson, Timothy H; Chevalier, Nicole A; Scher, Gregory R; Burke, Ronald L

    2016-01-01

    Effective multilateral military operations such as those conducted by the North Atlantic Treaty Organization (NATO) require close cooperation and standardization between member nations to ensure interoperability. Failure to standardize policies, procedures, and doctrine prior to the commencement of military operations will result in critical interoperability gaps, which jeopardize the health of NATO forces and mission success. To prevent these gaps from occurring, US forces must be actively involved with NATO standardization efforts such as the Committee of the Chiefs of Medical Services to ensure US interests are properly represented when NATO standards are developed and US doctrine and procedures will meet the established NATO requirements.

  5. Exploring the role of organizational policies and procedures in promoting research utilization in registered nurses

    Directory of Open Access Journals (Sweden)

    Moralejo Donna

    2007-06-01

    Full Text Available Abstract Background Policies and procedures (P&Ps have been suggested as one possible strategy for moving research evidence into practice among nursing staff in hospitals. Research in the area of P&Ps is limited, however. This paper explores: 1 nurses' use of eight specific research-based practices (RBPs and RBP overall, 2 nurses' use and understanding of P&Ps, and 3 the role of P&Ps in promoting research utilization. Methods Staff nurses from the eight health regions governing acute care services across the Canadian province of Newfoundland and Labrador completed an anonymous questionnaire regarding their use of eight RBPs and associated P&Ps. Data were also obtained from authorities in six of the eight regions about existing relevant P&Ps. We used descriptive statistics and multivariate regression analysis to assess the relationship between key independent variables and self-reported use of RBP. Results Use of the eight RBPs ranged from 7.8% to 88.6%, depending on the practice. Nurses ranked P&P manuals as their number one source of practice knowledge. Most respondents (84.8% reported that the main reason they consult the P&P manual is to confirm they are practicing according to agency rules. Multivariate regression analysis identified three significant predictors of being a user versus non-user of RBP overall: awareness, awareness by regular use, and persuasion. Six significant predictors of being a consistent versus less consistent user of RBP overall were also identified: perception of P&P existence, unit, nursing experience, personal experience as a source of practice knowledge, number of existing research-based P&Ps, and lack of time as a barrier to consulting P&P manuals. Conclusion Findings suggest that nurses use P&Ps to guide their practice. However, the mere existence of P&Ps is not sufficient to translate research into nursing practice. Individual and organizational factors related to nurses' understanding and use of P&Ps also play

  6. Medication errors: prescribing faults and prescription errors.

    Science.gov (United States)

    Velo, Giampaolo P; Minuz, Pietro

    2009-06-01

    1. 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. 2. 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. 3. Inadequate knowledge or competence and incomplete information about clinical characteristics and previous treatment of individual patients can result in prescribing faults, including the use of potentially inappropriate medications. 4. An unsafe working environment, complex or undefined procedures, and inadequate communication among health-care personnel, particularly between doctors and nurses, have been identified as important underlying factors that contribute to prescription errors and prescribing faults. 5. Active interventions aimed at reducing prescription errors and prescribing faults are strongly recommended. These should be focused on the education and training of prescribers and the use of on-line aids. The complexity of the prescribing procedure should be reduced by introducing automated systems or uniform prescribing charts, in order to avoid transcription and omission errors. Feedback control systems and immediate review of prescriptions, which can be performed with the assistance of a hospital pharmacist, are also helpful. Audits should be performed periodically.

  7. Conflicts of Interest in Clinical Guidelines: Update of U.S. Preventive Services Task Force Policies and Procedures.

    Science.gov (United States)

    Ngo-Metzger, Quyen; Moyer, Virginia; Grossman, David; Ebell, Mark; Woo, Meghan; Miller, Therese; Brummer, Tana; Chowdhury, Joya; Kato, Elisabeth; Siu, Albert; Phillips, William; Davidson, Karina; Phipps, Maureen; Bibbins-Domingo, Kirsten

    2018-01-01

    The U.S. Preventive Services Task Force (USPSTF) provides independent, objective, and scientifically rigorous recommendations for clinical preventive services. A primary concern is to avoid even the appearance of members having special interests that might influence their ability to judge evidence and formulate unbiased recommendations. The conflicts of interest policy for the USPSTF is described, as is the formal process by which best practices were incorporated to update the policy. The USPSTF performed a literature review, conducted key informant interviews, and reviewed conflicts of interest policies of ten similar organizations. Important findings included transparency and public accessibility; full disclosure of financial relationships; disclosure of non-financial relationships (that create the potential for bias and compromise a member's objective judgment); disclosure of family members' conflicts of interests; and establishment of appropriate reporting periods. Controversies in best practices include the threshold of financial disclosures, ease of access to conflicts of interest policies and declarations, vague definition of non-financial biases, and request for family members' conflicts of interests (particularly those that are non-financial in nature). The USPSTF conflicts of interest policy includes disclosures for immediate family members, a clear non-financial conflicts of interest definition, long look-back period and application of the policy to prospective members. Conflicts of interest is solicited from all members every 4 months, formally reviewed, adjudicated, and made publicly available. The USPSTF conflicts of interest policy is publicly available as part of the USPSTF Procedure Manual. A continuous improvement process can be applied to conflicts of interest policies to enhance public trust in members of panels, such as the USPSTF, that produce clinical guidelines and recommendations. Copyright © 2018 American Journal of Preventive Medicine

  8. Supplementary nurse prescribing.

    Science.gov (United States)

    Hay, Alison; Bradley, Eleanor; Nolan, Peter

    To explore the attitudes of multidisciplinary team members to nurse prescribing and to establish its perceived advantages and disadvantages. Five focus groups were conducted with a range of healthcare professionals in one trust. A total of 46 participants took part in the study A structured schedule was used during each discussion to elicit group members' views on supplementary nurse prescribing. The data were analysed thematically and key themes and concepts were identified. These are summarised under five main headings: what is supplementary prescribing?; why introduce supplementary prescribing?; perceived benefits of supplementary prescribing; concerns about supplementary prescribing; and skills necessary for supplementary prescribing. Analysis of the data suggests that although teams were generally supportive of nurse prescribing they are largely confused about what is being recommended and why. There was concern about how nurse prescribing will be implemented and its potential to disrupt team functioning. A considerable amount of preparation will be required to ensure that nurse prescribers have the organisational and team support to adapt to their new roles.

  9. Fair play in energy policy decisions: Procedural fairness, outcome fairness and acceptance of the decision to rebuild nuclear power plants

    International Nuclear Information System (INIS)

    Visschers, Vivianne H.M.; Siegrist, Michael

    2012-01-01

    To raise public acceptance of new energy policies, promoting the fairness of the outcomes and of the decision-making procedure has been suggested. Very few studies have examined the role of fairness in public acceptance of rebuilding nuclear power plants. Therefore, using a large mail survey, we investigated the public’s acceptance of the decision to rebuild nuclear power plants in Switzerland by 2020. The study examined the influence of procedural fairness and outcome fairness on the acceptance of this decision, as well as other factors such as risk perception and benefit perception. Additionally, we investigated the moderating influence of general attitudes towards nuclear power on the relation between fairness and decision acceptance. Results indicated that outcome fairness strongly increased decision acceptance, along with general attitudes towards nuclear power and perceived economic benefits. Procedural fairness had only a small impact on decision acceptance. The influence of fairness on decision acceptance did not seem to depend on general nuclear attitudes. Our findings imply that, in the case of rebuilding nuclear power plants, perceived benefits and outcome fairness are important determinants of acceptance of the decision, while procedural fairness only has a limited impact. - Highlights: ► We investigated the role of fairness in the acceptance of a nuclear policy decision. ► Outcome fairness strongly influenced decision acceptance regarding nuclear power plants. ► The role of procedural fairness was relatively small in this respect. ► Also, nuclear attitudes and perceived economic benefits affected decision acceptance. ► Outcome fairness seems more relevant for decision acceptance than procedural fairness.

  10. 48 CFR 3004.470-2 - Policy.

    Science.gov (United States)

    2010-10-01

    ... unclassified information. MD 4300.1, entitled Information Technology Systems Security, and the DHS Sensitive Systems Handbook, prescribe the policies and procedures on security for Information Technology resources... 3004.470-2 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND SECURITY, HOMELAND SECURITY...

  11. Policies and Procedures for Accessing Archived NASA Data via the Web

    Science.gov (United States)

    James, Nathan

    2011-01-01

    The National Space Science Data Center (NSSDC) was established by NASA to provide for the preservation and dissemination of scientific data from NASA missions. This white paper will address the NSSDC policies that govern data preservation and dissemination and the various methods of accessing NSSDC-archived data via the web.

  12. 76 FR 70664 - Policy Statement on Grant Stamp Procedure in Routine Director Orders

    Science.gov (United States)

    2011-11-15

    ... better serve the public, to streamline Board processes, and to remove uncertainty. DATES: Effective Date: This policy statement is effective on December 15, 2011. FOR FURTHER INFORMATION CONTACT: Amy C. Ziehm... stakeholders, thereby removing the uncertainty that Board stakeholders might encounter as they wait for the...

  13. A methodological protocol for selecting and quantifying low-value prescribing practices in routinely collected data: an Australian case study.

    Science.gov (United States)

    Brett, Jonathan; Elshaug, Adam G; Bhatia, R Sacha; Chalmers, Kelsey; Badgery-Parker, Tim; Pearson, Sallie-Anne

    2017-05-03

    Growing imperatives for safety, quality and responsible resource allocation have prompted renewed efforts to identify and quantify harmful or wasteful (low-value) medical practices such as test ordering, procedures and prescribing. Quantifying these practices at a population level using routinely collected health data allows us to understand the scale of low-value medical practices, measure practice change following specific interventions and prioritise policy decisions. To date, almost all research examining health care through the low-value lens has focused on medical services (tests and procedures) rather than on prescribing. The protocol described herein outlines a program of research funded by Australia's National Health and Medical Research Council to select and quantify low-value prescribing practices within Australian routinely collected health data. We start by describing our process for identifying and cataloguing international low-value prescribing practices. We then outline our approach to translate these prescribing practices into indicators that can be applied to Australian routinely collected health data. Next, we detail methods of using Australian health data to quantify these prescribing practices (e.g. prevalence of low-value prescribing and related costs) and their downstream health consequences. We have approval from the necessary Australian state and commonwealth human research ethics and data access committees to undertake this work. The lack of systematic and transparent approaches to quantification of low-value practices in routinely collected data has been noted in recent reviews. Here, we present a methodology applied in the Australian context with the aim of demonstrating principles that can be applied across jurisdictions in order to harmonise international efforts to measure low-value prescribing. The outcomes of this research will be submitted to international peer-reviewed journals. Results will also be presented at national and

  14. Notification: Audit of EPA’s Adherence to Policies, Procedures and Oversight Controls Pertaining to the Administrator’s Travel (2nd notification)

    Science.gov (United States)

    Project #OA-FY17-0382, October 6, 2017 - The EPA OIG plans to expand the scope of preliminary research on the EPA’s adherence to policies, procedures and oversight controls pertaining to the Administrator’s travel.

  15. 23 CFR 630.1106 - Policy and procedures for work zone safety management.

    Science.gov (United States)

    2010-04-01

    ..., and/or guidance for the systematic consideration and management of work zone impacts, to be... that define strategies and approaches to be used based on project and highway characteristics and... procedures to determine project-specific services; (5) Appropriate work zone safety and mobility training for...

  16. Designing strategies to implement research-based policies and procedures: a set of recommendations for nurse leaders based on the PARiHS framework.

    Science.gov (United States)

    Squires, Janet E; Reay, Trish; Moralejo, Donna; Lefort, Sandra M; Hutchinson, Alison M; Estabrooks, Carole A

    2012-05-01

    Organizational policies and procedures are one vehicle for translating research into nursing practice and improving quality and patient and organizational outcomes. However, their existence alone is not sufficient to ensure use. In this article, we describe the Promoting Action on Research Implementation in Health Services framework and how nurse leaders can use the framework to support the implementation of research-based policies and procedures.

  17. Defense Logistics: Enhanced Policy and Procedures Needed to Improve Management of Sensitive Conventional Ammunition

    Science.gov (United States)

    2016-02-01

    making adjustments to the electronic record if necessary, tracking of SRC I ammunition by serial number, and the shipment of SRC I ammunition in the...remaining depots regarding the physical inventory process and process for adjusting the electronic record, if necessary. For five military service...Air Force to reexamine the current security policy that permits less than full inspection of vehicles, such as trash trucks, that could easily

  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...... (approximately) showed no significant change compared to control or no overall positive findings. We identified 79 eligible studies which described 96 separate interventions to change prescribing behaviour. Of these interventions, 49 (51%, 41%-61%) showed a positive significant change compared to the control...

  19. Understanding Australian healthcare workers' uptake of influenza vaccination: examination of public hospital policies and procedures.

    Science.gov (United States)

    Seale, Holly; Kaur, Rajneesh; MacIntyre, C Raina

    2012-09-19

    In Australia, whether to provide free influenza vaccine to health care workers (HCWs) is a policy decision for each hospital or jurisdiction, and is therefore not uniform across the country. This study explored hospital policies and practices regarding occupational influenza vaccination of HCWs in Australia. A study using qualitative methodology, which included semi-structured interviews, was undertaken with hospital staff involved with the delivery of occupational influenza vaccination from three states in Australia. The 29 participants were responsible for vaccinating staff in 82 hospitals. Major themes in the responses were the lack of resources and the difficulties participants faced in procuring any additional support or funding from their institutions. All study sites provided vaccine free of charge to employees via on-site clinics or mobile carts, and used multiple strategies to inform and educate their staff. In some instances, declination forms had been adopted, however their use was associated with resourcing issues, animosity, and other problems. Participants who were responsible for multiple sites were more likely to recount lower vaccination coverage figures at their hospitals. From these interviews, it is clear that hospitals are implementing multiple strategies to educate, promote, and deliver the vaccine to staff. However, resources and support are not always available to assist with the vaccination campaign. The reality for many hospitals is that there is limited capacity to implement the vaccination campaigns at the levels high enough to raise compliance rates. Further research needs to be conducted to quantify the factors contributing to higher uptake in the Australian hospital setting.

  20. Policies and Procedures for Accessing Archived NASA Lunar Data via the Web

    Science.gov (United States)

    James, Nathan L.; Williams, David R.

    2011-01-01

    The National Space Science Data Center (NSSDC) was established by NASA to provide for the preservation and dissemination of scientific data from NASA missions. This paper describes the policies specifically related to lunar science data. NSSDC presently archives 660 lunar data collections. Most of these data (423 units) are stored offline in analog format. The remainder of this collection consists of magnetic tapes and discs containing approximately 1.7 TB of digital lunar data. The active archive for NASA lunar data is the Planetary Data System (PDS). NSSDC has an agreement with the PDS Lunar Data Node to assist in the restoration and preparation of NSSDC-resident lunar data upon request for access and distribution via the PDS archival system. Though much of NSSDC's digital store also resides in PDS, NSSDC has many analog data collections and some digital lunar data sets that are not in PDS. NSSDC stands ready to make these archived lunar data accessible to both the research community and the general public upon request as resources allow. Newly requested offline lunar data are digitized and moved to near-line storage devices called digital linear tape jukeboxes. The data are then packaged and made network-accessible via FTP for the convenience of a growing segment of the user community. This publication will 1) discuss the NSSDC processes and policies that govern how NASA lunar data is preserved, restored, and made accessible via the web and 2) highlight examples of special lunar data requests.

  1. When Medication Is Prescribed

    Science.gov (United States)

    ... page please turn Javascript on. Feature: Depression When Medication Is Prescribed Past Issues / Fall 2009 Table of ... you have about the medicine. —NIMH Types of Medications There are several types of medications used to ...

  2. Learning from escaped prescribed fire reviews [Abstract

    Science.gov (United States)

    Anne Black; Dave Thomas; James Saveland

    2011-01-01

    Over the past decade, the wildland fire community has developed a number of innovative methods for conducting a review following escape of a prescribed fire. The stated purpose been to identify methods that not only meet policy requirements, but to reduce future escapes. Implicit is the assumption that a review leads to learning. Yet, as organizational learning expert...

  3. Commentary: More implications of the 2008 amendments to the Americans with Disabilities Act: influencing institutional policies, practices, and procedures.

    Science.gov (United States)

    DeLisa, Joel; Silverstein, Robert; Thomas, Peter

    2011-06-01

    The Americans with Disabilities Act (ADA) is a civil rights law designed to ensure that qualified individuals with disabilities are not discriminated against by covered entities. Under the ADA, colleges of medicine were expected to focus their attention on implementing policies that facilitated equal educational opportunity, not on the threshold question of whether an individual was considered "disabled enough" to be protected by the law. In this issue, Allen and Smith examine the implications of the 2008 ADA Amendments Act (ADAAA) for medical education, focusing on the potential for the ADAAA to eliminate the threshold question and allow individuals seeking protection to bring their cases to trial.The authors of this commentary argue that the ADAAA also has important implications for institutions like colleges of medicine and the National Board of Medical Examiners that must not be overlooked. The impact of the ADAAA on colleges of medicine will depend in large part on how they historically viewed their obligations under the ADA. Those institutions that focused on eliminating all vestiges of disability discrimination by implementing comprehensive, system-wide, evidence-based policies, practices, and procedures related to reasonable accommodations and academic modifications/adjustments will experience little or no impact under the ADAAA. Those colleges that attempted to avoid or minimize compliance with the ADA by focusing on whether an individual achieved sufficient disability status to be protected by the law will need to pay closer attention to the development and implementation of nondiscrimination policies, particularly policies relating to reasonable accommodations and academic modifications/adjustments.

  4. Practitioner-recommended policies and procedures for children exposed to domestic violence.

    Science.gov (United States)

    Black, Sally; Dempsey, Sandra H; Davis, Martha B

    2010-11-01

    Children exposed to domestic violence experience higher rates of psychosocial, behavioral, and physical problems. Current policy recommendations are that health care providers offer regular screening and treatment for childhood exposure to domestic violence (CEDV). However, screening recommendations have been slow to take hold. The purpose of this study was to identify recommended practices of CEDV, as reported by practitioners. Interviews were held with 24 experienced service providers from 14 agencies. Respondents provided practical suggestions for CEDV screening and intervention. Suggestions included refinement of screening tools for maximum validity and reliability, improved integration of DV education into medical training and practice, on-site DV resources in pediatric settings, and establishment of formal partnerships between human service organizations that promoted ongoing collaborative activities. Next steps are to evaluate outcomes for evidence-based practice.

  5. When Procedural Legitimacy Equals Nothing: Civil Society and Foreign Trade Policy in Brazil and Mexico

    Directory of Open Access Journals (Sweden)

    Vinícius Rodrigues Vieira

    2016-01-01

    Full Text Available Abstract Non-state actors contribute with inputs to the elaboration of the national interest in trade negotiations, thus enhancing its legitimacy. Nevertheless, does the participation of those actors necessarily equal influence on the part of all segments of civil society on policymaking? To answer the question, I argue that procedural legitimacy should be evaluated not only in relation to the inputs society provides to the State, but should also consider whether officials actually analyse societal contributions in decision-making. I demonstrate the empirical application of the model based upon Brazil's experience in multilateral trade negotiations during the 2000s, using Mexico as a shadow case. I conclude that foreign trade policymaking can only be democratised if, in procedural legitimacy, the State attributes equal weight to contributions from all types of societal actors, including civil society organisations and organised social movements, which tend to have less material resources and power than interest groups such as business associations and labour unions.

  6. Nurse practitioner prescribing: an international perspective

    Directory of Open Access Journals (Sweden)

    Fong J

    2015-10-01

    financial conditions/climate in which NPs prescribe. Such research may give a better understanding of not only NP's true prescribing capacity currently but also inform future NP prescribing policy. Keywords: nurse practitioner, prescribing

  7. Electronic prescribing reduces prescribing error in public hospitals.

    Science.gov (United States)

    Shawahna, Ramzi; Rahman, Nisar-Ur; Ahmad, Mahmood; Debray, Marcel; Yliperttula, Marjo; Declèves, Xavier

    2011-11-01

    To examine the incidence of prescribing errors in a main public hospital in Pakistan and to assess the impact of introducing electronic prescribing system on the reduction of their incidence. Medication errors are persistent in today's healthcare system. The impact of electronic prescribing on reducing errors has not been tested in developing world. Prospective review of medication and discharge medication charts before and after the introduction of an electronic inpatient record and prescribing system. Inpatient records (n = 3300) and 1100 discharge medication sheets were reviewed for prescribing errors before and after the installation of electronic prescribing system in 11 wards. Medications (13,328 and 14,064) were prescribed for inpatients, among which 3008 and 1147 prescribing errors were identified, giving an overall error rate of 22·6% and 8·2% throughout paper-based and electronic prescribing, respectively. Medications (2480 and 2790) were prescribed for discharge patients, among which 418 and 123 errors were detected, giving an overall error rate of 16·9% and 4·4% during paper-based and electronic prescribing, respectively. Electronic prescribing has a significant effect on the reduction of prescribing errors. Prescribing errors are commonplace in Pakistan public hospitals. The study evaluated the impact of introducing electronic inpatient records and electronic prescribing in the reduction of prescribing errors in a public hospital in Pakistan. © 2011 Blackwell Publishing Ltd.

  8. Prescribing practices for malaria in a rural Ugandan hospital ...

    African Journals Online (AJOL)

    Prescriptions were considered to conform to the new antimalarial policy if artemether-lumefantrine was prescribed for uncomplicated malaria or quinine for treatment failure or complicated malaria. Results: The most frequently prescribed antimalarials for uncomplicated and complicated malaria were artemetherlumefantrine ...

  9. 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...... (approximately) showed no significant change compared to control or no overall positive findings. We identified 79 eligible studies which described 96 separate interventions to change prescribing behaviour. Of these interventions, 49 (51%, 41%-61%) showed a positive significant change compared to the control...... or inconclusive. Positive studies (+) were those that demonstrated a statistically significant change in the majority of outcomes measured at level of p change in the opposite direction and inconclusive studies...

  10. Patient and prescriber determinants for the choice between amoxicillin and broader-spectrum antibiotics: a nationwide prescription-level analysis.

    Science.gov (United States)

    Blommaert, Adriaan; Coenen, Samuel; Gielen, Birgit; Goossens, Herman; Hens, Niel; Beutels, Philippe

    2013-10-01

    Bacterial resistance to antibiotics, driven by antibiotic consumption, imposes a major threat to the effective treatment of bacterial infections. In addition to reducing the amount of antibiotics prescribed, avoiding broad-spectrum antibiotics could extend the lifetime of the current arsenal of antibiotic substances. Therefore, we documented prescriber and patient characteristics associated with the choice between amoxicillin and broader-spectrum alternatives (co-amoxiclav or moxifloxacin) in recent years in Belgium. Complete reimbursement claims data (2002-09) for antibiotic prescriptions in outpatient care, including patient and prescriber characteristics, were collected for both young children (1-5 years) and the adult population (30-60 years). A backwards selection procedure within generalized estimating equations retained the most relevant determinants. The age, gender and social category of the patient were found to be predictive of the extent to which amoxicillin was prescribed instead of the broader-spectrum alternatives, with female patients generally taking a higher proportion of amoxicillin than male patients. The age category of 40-44-year-old prescribers exhibited a preference for broad-spectrum antibiotics compared with both younger and older age groups. Significant interactions between the region and the prescriber's qualification (general practitioner or paediatrician) on the choice of antibiotic for children were found. Patient (age, gender and social category) and prescriber characteristics (age, gender, region and qualification) had an influence on whether amoxicillin or the alternative broad-spectrum antibiotics were prescribed. These findings should help policy makers to better target future campaigns to promote prudent prescribing of antibiotics.

  11. Prescribers and pharmaceutical representatives: why are we still meeting?

    Science.gov (United States)

    Fischer, Melissa A; Keough, Mary Ellen; Baril, Joann L; Saccoccio, Laura; Mazor, Kathleen M; Ladd, Elissa; Von Worley, Ann; Gurwitz, Jerry H

    2009-07-01

    Research suggests that pharmaceutical marketing influences prescribing and may cause cognitive dissonance for prescribers. This work has primarily been with physicians and physician-trainees. Questions remain regarding why prescribers continue to meet with pharmaceutical representatives (PRs). To describe the reasons that prescribers from various health professions continue to interact with PRs despite growing evidence of the influence of these interactions. Multi-disciplinary focus groups with 61 participants held in practice settings and at society meetings. Most prescribers participating in our focus groups believe that overall PR interactions are beneficial to patient care and practice health. They either trust the information from PRs or feel that they are equipped to evaluate it independently. Despite acknowledgement of study findings to the contrary, prescribers state that they are able to effectively manage PR interactions such that their own prescribing is not adversely impacted. Prescribers describe few specific strategies or policies for these interactions, and report that policies are not consistently implemented with all members of a clinic or institution. Some prescribers perceive an inherent contradiction between academic centers and national societies receiving money from pharmaceutical companies, and then recommending restriction at the level of the individual prescriber. Prescribers with different training backgrounds present a few novel reasons for these meetings. Despite evidence that PR detailing influences prescribing, providers from several health professions continue to believe that PR interactions improve patient care, and that they can adequately evaluate and filter information presented to them by PRs. Focus group comments suggest that cultural change is necessary to break the norms that exist in many settings. Applying policies consistently, considering non-physician members of the healthcare team, working with trainees, restructuring

  12. Opioid Prescribing PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    2017-07-06

    This 60 second public service announcement is based on the July 2017 CDC Vital Signs report. Higher opioid prescribing puts patients at risk for addiction and overdose. Learn what can be done about this serious problem.  Created: 7/6/2017 by Centers for Disease Control and Prevention (CDC).   Date Released: 7/6/2017.

  13. 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…

  14. Psychotropic prescribing in HIV

    African Journals Online (AJOL)

    2012-11-02

    Nov 2, 2012 ... symptoms may occur in the context of fluctuating attention, sleep/wake disturbance and poor orientation. Anti-psychotics. Importantly, with regard to prescribing antipsychotics, HIV-positive patients may be more susceptible to extra-pyramidal side-effects (EPSEs), neuroleptic malignant syndrome and tardive.

  15. 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.

  16. Radiation control standards and procedures

    Energy Technology Data Exchange (ETDEWEB)

    1956-12-14

    This manual contains the Radiation Control Standards'' and Radiation Control Procedures'' at Hanford Operations which have been established to provide the necessary control radiation exposures within Irradiation Processing Department. Provision is also made for including, in the form of Bulletins'', other radiological information of general interest to IPD personnel. The purpose of the standards is to establish firm radiological limits within which the Irradiation Processing Department will operate, and to outline our radiation control program in sufficient detail to insure uniform and consistent application throughout all IPD facilities. Radiation Control Procedures are intended to prescribe the best method of accomplishing an objective within the limitations of the Radiation Control Standards. A procedure may be changed at any time provided the suggested changes is generally agreeable to management involved, and is consistent with department policies and the Radiation Control Standards.

  17. Corporate Policies and Procedures on Advertising & Promotion. Report of the Sub-Council on Advertising and Promotion of the National Business Council for Consumer Affairs.

    Science.gov (United States)

    National Business Council for Consumer Affairs, Washington, DC.

    This report is the result of efforts to encourage thoughtful individual corporate action in maintaining up-to-date internal policies and procedures relating to the functions of advertising and promotion. Information for the report was gathered by sending letters to the chief executives of major national advertisers requesting a personal review of…

  18. Declining rates of sterilisation reversal procedures in western Australian women from 1990 to 2008: the relationship with age, hospital type and government policy changes.

    Science.gov (United States)

    Jama-Alol, Khadra A; Bremner, Alexandra P; Pereira, Gavin; Stewart, Louise M; Malacova, Eva; Moorin, Rachael; Preen, David B

    2017-11-25

    Female sterilisation is usually performed on an elective basis at perceived family completion, however, around 1-3% of women who have undergone sterilisation elect to undergo sterilisation reversal (SR) at a later stage. The trends in SR rates in Western Australia (WA), proportions of SR procedures between hospital types (public and private), and the effects of Federal Government policies on these trends are unknown. Using records from statutory state-wide data collections of hospital separations and births, we conducted a retrospective descriptive study of all women aged 15-49 years who underwent a SR procedure during the period 1st January 1990 to 31st December 2008 (n = 1868 procedures). From 1991 to 2007 the annual incidence rate of SR procedures per 10,000 women declined from 47.0 to 3.6. Logistic regression modelling showed that from 1997 to 2001 the odds of women undergoing SR in a private hospital as opposed to all other hospitals were 1.39 times higher (95% CI 1.07-1.81) and 7.51 times higher (95% CI 5.46-10.31) from 2002 to 2008. There were significant decreases in SR rates overall and among different age groups after the Federal Government interventions. Rates of SR procedures in WA have declined from 1990 to 2008, particularly following policy changes such as the introduction of private health insurance (PHI) policies. This suggests decisions to undergo SR may be influenced by Federal Government interventions.

  19. 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....

  20. Social determinants of prescribed and non-prescribed medicine use

    Directory of Open Access Journals (Sweden)

    García-Altés Anna

    2010-05-01

    Full Text Available Abstract Background The aim of the present study was to describe the use of prescribed and non prescribed medicines in a non-institutionalised population older than 15 years of an urban area during the year 2000, in terms of age and gender, social class, employment status and type of Primary Health Care. Methods Cross-sectional study. Information came from the 2000 Barcelona Health Interview Survey. The indicators used were the prevalence of use of prescribed and non-prescribed medicines in the two weeks prior to the interview. Descriptive analyses, bivariate and multivariate logistic regression analyses were carried out. Results More women than men took medicines (75.8% vs. 60% respectively. The prevalence of use of prescribed medicines increased with age while the prevalence of non-prescribed use decreased. These age differences are smaller among those with poor perceived health. In terms of social class, a higher percentage of men with good health in the more advantaged classes took non-prescribed medicines compared with disadvantaged classes (38.7% vs 31.8%. In contrast, among the group with poor health, more people from the more advantaged classes took prescribed medicines, compared with disadvantaged classes (51.4% vs 33.3%. A higher proportion of people who were either retired, unemployed or students, with good health, used prescribed medicines. Conclusion This study shows that beside health needs, there are social determinants affecting medicine consumption in the city of Barcelona.

  1. 21 CFR 1404.610 - What procedures does the Office of National Drug Control Policy use in suspension and debarment...

    Science.gov (United States)

    2010-04-01

    ... handle the actions as informally as practicable, consistent with principles of fundamental fairness. (a... Control Policy use in suspension and debarment actions? 1404.610 Section 1404.610 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) General Principles...

  2. Opioid Analgesic Prescribing Practices of Dental Professionals in the United States.

    Science.gov (United States)

    Steinmetz, C N; Zheng, C; Okunseri, E; Szabo, A; Okunseri, C

    2017-07-01

    The prescription of opioid analgesics by dental professionals is widespread in the United States. Policy makers, government agencies, and professional organizations consider this phenomenon a growing public health concern. This study examined trends in the prescription of opioid analgesics for adults by dental professionals and associated factors in the United States. Data from the Medical Expenditure Panel Survey (1996-2013) were analyzed. Descriptive statistics were calculated separately for each year. Logistic regression analyses were conducted to estimate the overall trend during the period with and without adjusting for dental procedures and personal characteristics. Survey weights were incorporated to handle the sampling design. The prescription of opioid analgesics following dental care increased over time. After adjusting for sociodemographic factors, source of payment, and type of dental procedure, the odds ratio (OR) of prescribing opioid analgesics following a dental visit per each decade difference was 1.28 (95% confidence interval [CI], 1.19-1.38). Surgical, root canal, and implant procedures had the highest rates of opioid prescriptions and the greatest increases in rates over the study period. After adjusting for personal characteristics and type of dental procedure, the OR of receiving a prescription for opioids comparing blacks, Asians, and Hispanics to whites was 1.29 (95% CI, 1.17-1.41), 0.57 (95% CI, 0.47-0.70), and 0.84 (95% CI, 0.75-0.95), respectively. Opioid analgesic prescriptions following dental visits increased over time after adjusting for personal characteristics and type of dental procedure. The odds of receiving a prescription for opioids were higher for certain racial/ethnic minority groups. Knowledge Transfer Statement: This study highlights dental professionals prescribing practices of opioid analgesics by following dental treatments in the United States. With this knowledge, appropriate guidelines, protocols, and policies can be

  3. Declining rates of sterilization procedures in Western Australian women from 1990 to 2008: the relationship with age, hospital type, and government policy changes.

    Science.gov (United States)

    Jama-Alol, Khadra A; Bremner, Alexandra P; Stewart, Louise M; Kemp-Casey, Anna; Malacova, Eva; Moorin, Rachael; Shirangi, Adeleh; Preen, David B

    2016-09-01

    To describe trends in age-specific incidence rates of female sterilization (FS) procedures in Western Australia and to evaluate the effects of the introduction of government-subsidized contraceptive methods and the implementation of the Australian government's baby bonus policy on FS rates. Population-based retrospective descriptive study. Not applicable. All women ages 15-49 undergoing an FS procedure during the period January 1, 1990, to December 31, 2008 (n = 47,360 procedures). Records from statutory statewide data collections of hospitals separations and births were extracted and linked. Trends in FS procedures and the influence on these trends of the introduction of government policies: subsidization of long-acting reversible contraceptives (Implanon and Mirena) and the Australian baby bonus initiative. The annual incidence rate of FS procedures declined from 756.9 per 100,000 women in 1990 to 155.2 per 100,000 women in 2008. Compared with the period 1990-1994, women ages 30-39 years were 47% less likely (rate ratio [RR] = 0.53; 95% confidence interval [CI], 0.39-0.72) to undergo sterilization during the period 2005-2008. Adjusting for overall trend, there were significant decreases in FS rates after government subsidization of Implanon (RR = 0.89; 95% CI, 0.82-0.97) and Mirena (RR = 0.81; 95% CI, 0.73-0.91) and the introduction of the baby bonus (RR = 0.70; 95% CI, 0.61-0.81). Rates of female sterilization procedures in Western Australia have declined substantially across all age groups in the last two decades. Women's decisions to undergo sterilization procedures may be influenced by government interventions that increase access to long-term reversible contraceptives or encourage childbirth. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Cultural competency in health care and its implications for pharmacy Part 3B: emphasis on pharmacy education policy, procedures, and climate.

    Science.gov (United States)

    O'Connell, Mary Beth; Jackson, Anita N; Karaoui, Lamis R; Rodriguez de Bittner, Magaly; Chen, Aleda M H; Echeverri, Margarita; Vyas, Deepti; Poirier, Therese; Lee, Shin-Yu; O'Neil, Christine K

    2013-12-01

    The Institute of Medicine has stated that greater diversity within health care professionals leads to improved patient outcomes. Therefore, greater diversity within academia and student bodies is required to create future diverse health care professionals. Cultural sensitivity is required from recruitment to physical environment for administrators, faculty, staff, and students. University, college, and department recruitment, search committees, hiring practices, and admissions policies and procedures need to be assessed to determine whether they reflect the applicant pool and patient populations in their regions and whether they are culturally sensitive to a wide variety of cultures. The mission, vision, policies, procedures, curriculums, and environments should also be created or reviewed, modified, and/or expanded to ensure that no administrator, faculty member, staff member, or student is discriminated against or disadvantaged because of cultural beliefs or practices. In addition to discussing the interplay between cultural sensitivity and academic policies, procedures, and environments, this article briefly discusses specific cultural issues related to religion, spirituality, race, ethnicity, gender, age, marital status, veterans, physical, mental, and learning disabilities, and sexual orientation diversity. © 2013 Pharmacotherapy Publications, Inc.

  5. 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.

  6. [Evaluation of policies in the procedures for food handling to prevent nosocomial infections in general hospitals and public institutions of health in Mexico].

    Science.gov (United States)

    Villanueva Martínez, Sebastián; Macías-Hernández, Alejandro Ernesto; de la Torre-Rosas, Alethse; Polanco González, Carlos

    2014-01-01

    To evaluate the implementation and proper use of policies and procedures for food handling to prevent nosocomial gastrointestinal infections in major General Hospitals and Public Institutions of Health in Mexico. We performed a cross-sectional study of food services in 54 second-level general hospitals from these institutions: Mexican Institute of Social Security (IMSS), Institute of Security and Social Services for State Workers (ISSSTE), and the Ministry of Health (SESA). A questionnaire was made to identify risk factors for food contamination. In the statistical analysis, we determined the relative frequency of food handling complying with the norm; a qualitative analysis was performed using an intentional non-probabilistic sampling, targeting department heads, managers, and operational staff. The qualitative variables were verified through non-parametric tests. From 54 hospitals evaluated, 81% had procedure and operation manuals, 35% prepared and stored food according to NOM-251-SSA1-2009, 52% performed ongoing training, 62% had a record of microbiological analysis done to staff and 81% done to foods, and 31% had first in first out (FIFO) temperature control systems. Second-level health institutions in Mexico have deficiencies in the implementation of norms and procedures to handle, store, and prepare food that can lead to gastrointestinal outbreaks of nosocomial infections in patients, health staff, and visitors. In order to ensure the quality of food preparation for distribution and consumption in hospitals, it is necessary that food services comply with current norms and regulations, updating policies and procedures, and training their staff continuously.

  7. Beyond the basics: refills by electronic prescribing.

    Science.gov (United States)

    Goldman, Roberta E; Dubé, Catherine; Lapane, Kate L

    2010-07-01

    E-prescribing is part of a new generation of electronic solutions for the medical industry that may have great potential for improving work flow and communication between medical practices and pharmacies. In the US, it has been introduced with minimal monitoring of errors and general usability. This paper examines refill functionality in e-prescribing software. A mixed method study including focus groups and surveys was conducted. Qualitative data were collected in on-site focus groups or individual interviews with clinicians and medical office staff at 64 physician office practices. Focus group participants described their experiences with the refill functionality of e-prescribing software, provided suggestions for improving it, and suggested improvements in office procedures and software functionality. Overall, approximately 50% reduction in time spent each day on refills was reported. Overall reports of refill functionality were positive; but clinicians and staff identified numerous difficulties and glitches associated managing prescription refills. These glitches diminished over time. Benefits included time saved as well as patient convenience. Potential for refilling without thought because of the ease of use was noted. Clinicians and staff appreciated the ability to track whether patients are filling and refilling prescriptions. E-prescribing software for managing medication refills has not yet reached its full potential. To reduce work flow barriers and medication errors, software companies need to develop error reporting systems and response teams to deal effectively with problems experienced by users. Examining usability issues on both the medical office and pharmacy ends is required to identify the behavioral and cultural changes that accompany technological innovation and ease the transition to full use of e-prescribing software. 2010 Elsevier Ireland Ltd. All rights reserved.

  8. Immigration policy, practices, and procedures: The impact on the mental health of Mexican and Central American youth and families.

    Science.gov (United States)

    Torres, Stephanie A; Santiago, Catherine DeCarlo; Walts, Katherine Kaufka; Richards, Maryse H

    2018-03-05

    Currently, 15 million Mexican and Central American individuals live in the United States, with this number projected to rise in the next few decades (Lesser & Batalova, 2017; Zong & Batalova, 2017). Research has begun to investigate the impact of the nation's immigration practices and policies on immigrant Latino/a families and youth. Current immigration policies can create vulnerabilities, including fear and mistrust, discrimination, limited access to services, parent-child separation, and poverty. These experiences increase risk for poor mental health outcomes and may exacerbate prior exposure to traumas in the home country (e.g., violence) and during migration (e.g., extortion). This paper reviews current immigration policies for arriving Mexican and Central American immigrants and links to mental health among documented and undocumented immigrant families and youth. A discussion of positive policies and resources that may mitigate the damaging impact of immigration-related stress is included. Finally, social justice implications for clinicians and researchers are discussed, with culturally sensitive interventions, advocacy, and dissemination of research and policy as primary recommendations. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  9. Ensuring due process in the IACUC and animal welfare setting: considerations in developing noncompliance policies and procedures for institutional animal care and use committees and institutional officials.

    Science.gov (United States)

    Hansen, Barbara C; Gografe, Sylvia; Pritt, Stacy; Jen, Kai-Lin Catherine; McWhirter, Camille A; Barman, Susan M; Comuzzie, Anthony; Greene, Molly; McNulty, Justin A; Michele, Daniel Eugene; Moaddab, Naz; Nelson, Randall J; Norris, Karen; Uray, Karen D; Banks, Ron; Westlund, Karin N; Yates, Bill J; Silverman, Jerald; Hansen, Kenneth D; Redman, Barbara

    2017-10-01

    Every institution that is involved in research with animals is expected to have in place policies and procedures for the management of allegations of noncompliance with the Animal Welfare Act and the U.S. Public Health Service Policy on the Humane Care and Use of Laboratory Animals. We present here a model set of recommendations for institutional animal care and use committees and institutional officials to ensure appropriate consideration of allegations of noncompliance with federal Animal Welfare Act regulations that carry a significant risk or specific threat to animal welfare. This guidance has 3 overarching aims: 1 ) protecting the welfare of research animals; 2 ) according fair treatment and due process to an individual accused of noncompliance; and 3 ) ensuring compliance with federal regulations. Through this guidance, the present work seeks to advance the cause of scientific integrity, animal welfare, and the public trust while recognizing and supporting the critical importance of animal research for the betterment of the health of both humans and animals.-Hansen, B. C., Gografe, S., Pritt, S., Jen, K.-L. C., McWhirter, C. A., Barman, S. M., Comuzzie, A., Greene, M., McNulty, J. A., Michele, D. E., Moaddab, N., Nelson, R. J., Norris, K., Uray, K. D., Banks, R., Westlund, K. N., Yates, B. J., Silverman, J., Hansen, K. D., Redman, B. Ensuring due process in the IACUC and animal welfare setting: considerations in developing noncompliance policies and procedures for institutional animal care and use committees and institutional officials. © FASEB.

  10. Trends in thyroid hormone prescribing and consumption in the UK

    Directory of Open Access Journals (Sweden)

    Hickey Janis L

    2009-05-01

    Full Text Available Abstract Background Thyroid hormone replacement is one of the most commonly prescribed and cost effective treatments for a chronic disease. There have been recent changes in community prescribing policies in many areas of the UK that have changed patient access to necessary medications. This study aimed to provide a picture of thyroid hormone usage in the UK and to survey patient opinion about current community prescribing policies for levothyroxine. Methods Data on community prescriptions for thyroid hormones in England between 1998 and 2007, provided by the Department of Health, were collated and analysed. A survey of UK members of a patient support organisation (the British Thyroid Foundation who were taking levothyroxine was carried out. Results The amount of prescribed thyroid hormones used in England has more than doubled, from 7 to almost 19 million prescriptions, over the last 10 years. The duration of prescriptions has reduced from 60 to 45 days, on average over the same time. Two thousand five hundred and fifty one responses to the patient survey were received. Thirty eight percent of levothyroxine users reported receiving prescriptions of 28 days' duration. 59% of respondents reported being dissatisfied with 28-day prescribing. Conclusion Amongst users of levothyroxine, there is widespread patient dissatisfaction with 28-day prescription duration. Analysis of the full costs of 28-day dispensing balanced against the potential savings of reduced wastage of thyroid medications, suggests that this is unlikely to be an economically effective public health policy.

  11. Beyond Synthesis: Augmenting Systematic Review Procedures with Practical Principles to Optimise Impact and Uptake in Educational Policy and Practice

    Science.gov (United States)

    Green, Chris; Taylor, Celia; Buckley, Sharon; Hean, Sarah

    2016-01-01

    Whilst systematic reviews, meta-analyses and other forms of synthesis are considered amongst the most valuable forms of research evidence, their limited impact on educational policy and practice has been criticised. In this article, we analyse why systematic reviews do not benefit users of evidence more consistently and suggest how review teams…

  12. 10 CFR Appendix A to Subpart C of... - Procedures, Interpretations and Policies for Consideration of New or Revised Energy Conservation...

    Science.gov (United States)

    2010-01-01

    .... (2) Engineering and life-cycle cost analysis of design options. The DOE and its contractor will perform engineering and life-cycle cost analyses of the design options. (3) Review by expert group and... the engineering and life-cycle cost analysis of design options and the policies stated in section 5(c...

  13. Human factors evaluation of remote afterloading brachytherapy. Supporting analyses of human-system interfaces, procedures and practices, training and organizational practices and policies. Volume 3

    Energy Technology Data Exchange (ETDEWEB)

    Callan, J.R.; Kelly, R.T.; Quinn, M.L. [Pacific Science & Engineering Group, San Diego, CA (United States)] [and others

    1995-07-01

    A human factors project on the use of nuclear by-product material to treat cancer using remotely operated afterloaders was undertaken by the Nuclear Regulatory Commission. The purpose of the project was to identify factors that contribute to human error in the system for remote afterloading brachytherapy (RAB). This report documents the findings from the second, third, fourth, and fifth phases of the project, which involved detailed analyses of four major aspects of the RAB system linked to human error: human-system interfaces; procedures and practices; training practices and policies; and organizational practices and policies, respectively. Findings based on these analyses provided factual and conceptual support for the final phase of this project, which identified factors leading to human error in RAB. The impact of those factors on RAB performance was then evaluated and prioritized in terms of safety significance, and alternative approaches for resolving safety significant problems were identified and evaluated.

  14. Human factors evaluation of remote afterloading brachytherapy. Supporting analyses of human-system interfaces, procedures and practices, training and organizational practices and policies. Volume 3

    International Nuclear Information System (INIS)

    Callan, J.R.; Kelly, R.T.; Quinn, M.L.

    1995-07-01

    A human factors project on the use of nuclear by-product material to treat cancer using remotely operated afterloaders was undertaken by the Nuclear Regulatory Commission. The purpose of the project was to identify factors that contribute to human error in the system for remote afterloading brachytherapy (RAB). This report documents the findings from the second, third, fourth, and fifth phases of the project, which involved detailed analyses of four major aspects of the RAB system linked to human error: human-system interfaces; procedures and practices; training practices and policies; and organizational practices and policies, respectively. Findings based on these analyses provided factual and conceptual support for the final phase of this project, which identified factors leading to human error in RAB. The impact of those factors on RAB performance was then evaluated and prioritized in terms of safety significance, and alternative approaches for resolving safety significant problems were identified and evaluated

  15. 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.

  16. Prescribed burning weather in Minnesota.

    Science.gov (United States)

    Rodney W. Sando

    1969-01-01

    Describes the weather patterns in northern Minnesota as related to prescribed burning. The prevailing wind direction, average wind speed, most persistent wind direction, and average Buildup Index are considered in making recommendations.

  17. 12 CFR 550.140 - Must I adopt and follow written policies and procedures in exercising fiduciary powers?

    Science.gov (United States)

    2010-01-01

    ... with any decision or recommendation to purchase or sell any security. (c) Your methods for preventing... procedures in exercising fiduciary powers? 550.140 Section 550.140 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY FIDUCIARY POWERS OF SAVINGS ASSOCIATIONS Exercising Fiduciary Powers...

  18. 41 CFR 301-71.108 - What internal policies and procedures must we establish for travel authorization?

    Science.gov (United States)

    2010-07-01

    ... and procedures must we establish for travel authorization? 301-71.108 Section 301-71.108 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Authorization § 301-71.108...

  19. 41 CFR 301-71.309 - What internal policies and procedures must we establish governing travel advances?

    Science.gov (United States)

    2010-07-01

    ... and procedures must we establish governing travel advances? 301-71.309 Section 301-71.309 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Accounting for Travel Advances § 301...

  20. 41 CFR 301-71.207 - What internal policies and procedures must we establish for travel reimbursement?

    Science.gov (United States)

    2010-07-01

    ... AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Claims for Reimbursement... should submit a travel claim (including whether to use a standard form or an agency form and whether the... and procedures must we establish for travel reimbursement? 301-71.207 Section 301-71.207 Public...

  1. Evaluating Higher Education Policy in Turkey: Assessment of the Admission Procedure to Architecture, Planning, and Engineering Schools

    Science.gov (United States)

    Cubukcu, Kemal Mert; Cubukcu, Ebru

    2009-01-01

    The admission procedure to higher education institutions in Turkey is based on the student's high school grades and Central University Entrance Examination (CUEE) score, with a much greater weight on the latter. However, whether the CUEE is an appropriate measure in the admission process to universities is still a much-debated question. This study…

  2. An examination of the cost reimbursement policies and procedures followed by DoD when providing services to private organizations.

    OpenAIRE

    Conn, Michael David

    1991-01-01

    Approved for public release; distribution is unlimited This thesis examines the billing policies followed by the Department of Defense (DoD) in recovering costs incurred from providing services to private enterprises. Examples studied include DoD assistance provided to the Paramount Pictures Corporation in the production of the motion pictures Top Gun and The Hunt for Red October, as well as to the Exxon Corporation for assistance provided in the Exxon Valdez oil-spill cl...

  3. Availability of prescribed medicines for elders at Sekou-Toure ...

    African Journals Online (AJOL)

    Many older people are unable to afford even basic treatment, let alone, the medications needed to control chronic diseases that become more prevalent in older age. This study was conducted to assess the implementation of the Tanzania national exemption policy on availability of prescribed medicines in elderly people.

  4. HIV management by nurse prescribers compared with doctors at a ...

    African Journals Online (AJOL)

    HIV management by nurse prescribers compared with doctors at a paediatric centre in Gaborone, Botswana. ... Task shifting remains a promising strategy to scale up and sustain adult and paediatric ART more effectively, particularly where provider shortages threaten ART rollout. Policies guiding ART services in southern ...

  5. Adapting a Markov Monte Carlo simulation model for forecasting the number of Coronary Artery Revascularisation Procedures in an era of rapidly changing technology and policy

    Directory of Open Access Journals (Sweden)

    Knuiman Matthew

    2008-06-01

    Full Text Available Abstract Background Treatments for coronary heart disease (CHD have evolved rapidly over the last 15 years with considerable change in the number and effectiveness of both medical and surgical treatments. This period has seen the rapid development and uptake of statin drugs and coronary artery revascularization procedures (CARPs that include Coronary Artery Bypass Graft procedures (CABGs and Percutaneous Coronary Interventions (PCIs. It is difficult in an era of such rapid change to accurately forecast requirements for treatment services such as CARPs. In a previous paper we have described and outlined the use of a Markov Monte Carlo simulation model for analyzing and predicting the requirements for CARPs for the population of Western Australia (Mannan et al, 2007. In this paper, we expand on the use of this model for forecasting CARPs in Western Australia with a focus on the lack of adequate performance of the (standard model for forecasting CARPs in a period during the mid 1990s when there were considerable changes to CARP technology and implementation policy and an exploration and demonstration of how the standard model may be adapted to achieve better performance. Methods Selected key CARP event model probabilities are modified based on information relating to changes in the effectiveness of CARPs from clinical trial evidence and an awareness of trends in policy and practice of CARPs. These modified model probabilities and the ones obtained by standard methods are used as inputs in our Markov simulation model. Results The projected numbers of CARPs in the population of Western Australia over 1995–99 only improve marginally when modifications to model probabilities are made to incorporate an increase in effectiveness of PCI procedures. However, the projected numbers improve substantially when, in addition, further modifications are incorporated that relate to the increased probability of a PCI procedure and the reduced probability of a CABG

  6. Adapting a Markov Monte Carlo simulation model for forecasting the number of coronary artery revascularisation procedures in an era of rapidly changing technology and policy.

    Science.gov (United States)

    Mannan, Haider R; Knuiman, Matthew; Hobbs, Michael

    2008-06-25

    Treatments for coronary heart disease (CHD) have evolved rapidly over the last 15 years with considerable change in the number and effectiveness of both medical and surgical treatments. This period has seen the rapid development and uptake of statin drugs and coronary artery revascularization procedures (CARPs) that include Coronary Artery Bypass Graft procedures (CABGs) and Percutaneous Coronary Interventions (PCIs). It is difficult in an era of such rapid change to accurately forecast requirements for treatment services such as CARPs. In a previous paper we have described and outlined the use of a Markov Monte Carlo simulation model for analyzing and predicting the requirements for CARPs for the population of Western Australia (Mannan et al, 2007). In this paper, we expand on the use of this model for forecasting CARPs in Western Australia with a focus on the lack of adequate performance of the (standard) model for forecasting CARPs in a period during the mid 1990s when there were considerable changes to CARP technology and implementation policy and an exploration and demonstration of how the standard model may be adapted to achieve better performance. Selected key CARP event model probabilities are modified based on information relating to changes in the effectiveness of CARPs from clinical trial evidence and an awareness of trends in policy and practice of CARPs. These modified model probabilities and the ones obtained by standard methods are used as inputs in our Markov simulation model. The projected numbers of CARPs in the population of Western Australia over 1995-99 only improve marginally when modifications to model probabilities are made to incorporate an increase in effectiveness of PCI procedures. However, the projected numbers improve substantially when, in addition, further modifications are incorporated that relate to the increased probability of a PCI procedure and the reduced probability of a CABG procedure stemming from changed CARP preference

  7. CRIMINAL LEGAL POLICY OF REPUBLIC OF MACEDONIA IN CASE OF CRIMES RELATED TO ABUSE OF THE PROCEDURE FOR BANKRUPTCY

    Directory of Open Access Journals (Sweden)

    Kristina Balabanova

    2015-07-01

    Full Text Available The bankruptcy procedure is essentially a legal procedure which is governed by bankruptcy law, but there is interweaving of economics and rights because over the company, which is an economic entity is conducted legal proceedings. Interdisciplinary is reflected in the fact that under the authority of the law and the authority of the bodies which the law sets as carriers of the proceedings, bankruptcy judges, Trustees, I dismissed the economic problems of enterprises or dismissed major issues that could not initially be neat and loose during the normal operation of enterprises. Fans in terms of bankruptcy are based on the dating of the economic environment, most frequently as a result of a decision of the management.

  8. Understanding State Regulation of Biosimilars and Effect on Prescribers.

    Science.gov (United States)

    Yale, Katerina; Awosika, Olabola; Rengifo-Pardo, Monica; Ehrlich, Alison

    2017-10-01

    Biologics are a mainstay of treatment for many dermatologic conditions, however the high costs can be prohibitive for many patients. A growing market of biosimilar drugs is emerging with the hope of providing patients access to more affordable medications. While the FDA has created an abbreviated licensure pathway for these drugs, states are still in the process of creating regulations regarding their substitution for reference biologics. This article looks to raise awareness of the current federal regulations and the differences among state regulations regarding the use of biosimilars. Fifty percent of states have passed legislation regarding procedures for substitution of biosimilars in the pharmacy. All states require biosimilars to have FDA-approved "interchangeable" status, however states vary on other requirements such as: prescriber and patient notification, pharmaceutical record keeping, publicly-accessible list of interchangeable products, and cost regulations. Some of the issues surrounding biosimilar regulation include difficulty obtaining interchangeability status from the FDA, resistance to the physician notification requirement, and concern for traceability of adverse reactions. Physicians must be aware of current federal and state regulations regarding biosimilars and help inform policy makers of the potential benefits and shortcoming of biosimilar legislation. J Drugs Dermatol. 2017;16(10):995-1000..

  9. 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

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

    Directory of Open Access Journals (Sweden)

    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

  11. An evaluation of prescribing trends and patterns of claims within the Preferred Drugs Initiative in Ireland (2011-2016): an interrupted time-series study.

    LENUS (Irish Health Repository)

    McDowell, Ronald

    2018-04-20

    To examine the impact of the Preferred Drugs Initiative (PDI), an Irish health policy aimed at enhancing evidence-based cost-effective prescribing, on prescribing trends and the cost of prescription medicines across seven medication classes.

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

    NARCIS (Netherlands)

    Kimpen, JLL; van Houten, M.A.

    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

  13. ELECTORAL PRESCRIBERS. WHO ARE THEY?

    Directory of Open Access Journals (Sweden)

    Constantin SASU

    2016-12-01

    Full Text Available The decision to vote and choosing among the candidates is an extremely important one with repercussions on everyday life by determining, in global mode, its quality for the whole society. Therefore the whole process by which the voter decides becomes a central concern. Prescribers, supposed to have a big influence on the electoral market, are a component of the microenvironment political organizations. These are people who occupy important positions that can influence the behavior of others. In the political environment, prescribers are known under the name of "opinion formers", "opinion leaders", "mediators" (Beciu, 2009 or "influencers" (Keller and Berry, 2003 Weimann, 1994. This paper aims to review the central opinions on what is the influence prescribers, opinion makers on voting behavior, voting and decisions on whether and how they act?

  14. Prescribing antibiotics in general practice:

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene

    Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how......) and the Danish Microbiology Database (performed microbiological testing). We will assess and quantify the use of microbiological testing prior to antibiotic prescription. Furthermore we will investigate associations between GP characteristics, use of microbiological investigations and description patterns...

  15. Environmental procedures

    International Nuclear Information System (INIS)

    1992-01-01

    The European Bank has pledged in its Agreement to place environmental management at the forefront of its operations to promote sustainable economic development in central and eastern Europe. The Bank's environmental policy is set out in the document titled, Environmental Management: The Bank's Policy Approach. This document, Environmental Procedures, presents the procedures which the European Bank has adopted to implement this policy approach with respect to its operations. The environmental procedures aim to: ensure that throughout the project approval process, those in positions of responsibility for approving projects are aware of the environmental implications of the project, and can take these into account when making decisions; avoid potential liabilities that could undermine the success of a project for its sponsors and the Bank; ensure that environmental costs are estimated along with other costs and liabilities; and identify opportunities for environmental enhancement associated with projects. The review of environmental aspects of projects is conducted by many Bank staff members throughout the project's life. This document defines the responsibilities of the people and groups involved in implementing the environmental procedures. Annexes contain Environmental Management: The Bank's Policy Approach, examples of environmental documentation for the project file and other ancillary information

  16. Psychologists' right to prescribe – should prescribing privileges be ...

    African Journals Online (AJOL)

    Current changes in legislation regarding prescription rights increase the possibility of non-medical practitioners being authorised to presctibe medication. There has been ongoing debate about granting psychologists in South Africa a limited right to prescribe (RTP) psychotropic medication. The main reasons advanced for ...

  17. Antibiotic policy

    OpenAIRE

    Gyssens, Inge

    2011-01-01

    There is a clear association between antibiotic use and resistance both on individual and population levels. In the European Union, countries with large antibiotic consumption have higher resistance rates. Antibiotic resistance leads to failed treatments, prolonged hospitalisations, increased costs and deaths. With few new antibiotics in the Research & Development pipeline, prudent antibiotic use is the only option to delay the development of resistance. Antibiotic policy consists of prescrib...

  18. Philosophy, policy and procedures of the World Organisation for Animal Health for the development of standards in animal welfare.

    Science.gov (United States)

    Petrini, A; Wilson, D

    2005-08-01

    Animal welfare was identified as a priority for the World Organisation for Animal Health (OIE) in the 2001-2005 OIE Strategic Plan. Member Countries recognised that, as animal protection is a complex, multi-faceted public policy issue which includes important scientific, ethical, economic and political dimensions, the OIE needed to develop a detailed vision and strategy incorporating and balancing these dimensions. A permanent working group on animal welfare was established in order to provide guidance to the OIE in its work on the development of science-based standards and guidelines. The Working Group decided to give priority to the welfare of animals used in agriculture and aquaculture, and that, within those groups, the topics of transportation, slaughter for human consumption and killing for disease control purposes would be addressed first. Some guiding principles were approved by the International Committee of OIE Member Countries during the 72nd General Session in May 2004, and these have been followed by four specific guidelines on the priority topics listed above.

  19. 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

  20. Automation bias in electronic prescribing.

    Science.gov (United States)

    Lyell, David; Magrabi, Farah; Raban, Magdalena Z; Pont, L G; Baysari, Melissa T; Day, Richard O; Coiera, Enrico

    2017-03-16

    Clinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk. Automation bias (AB) occurs when users over-rely on CDS, reducing vigilance in information seeking and processing. Evidence of AB has been found in other clinical tasks, but has not yet been tested with e-prescribing. This study tests for the presence of AB in e-prescribing and the impact of task complexity and interruptions on AB. One hundred and twenty students in the final two years of a medical degree prescribed medicines for nine clinical scenarios using a simulated e-prescribing system. Quality of CDS (correct, incorrect and no CDS) and task complexity (low, low + interruption and high) were varied between conditions. Omission errors (failure to detect prescribing errors) and commission errors (acceptance of false positive alerts) were measured. Compared to scenarios with no CDS, correct CDS reduced omission errors by 38.3% (p < .0001, n = 120), 46.6% (p < .0001, n = 70), and 39.2% (p < .0001, n = 120) for low, low + interrupt and high complexity scenarios respectively. Incorrect CDS increased omission errors by 33.3% (p < .0001, n = 120), 24.5% (p < .009, n = 82), and 26.7% (p < .0001, n = 120). Participants made commission errors, 65.8% (p < .0001, n = 120), 53.5% (p < .0001, n = 82), and 51.7% (p < .0001, n = 120). Task complexity and interruptions had no impact on AB. This study found evidence of AB omission and commission errors in e-prescribing. Verification of CDS alerts is key to avoiding AB errors. However, interventions focused on this have had limited success to date. Clinicians should remain vigilant to the risks of CDS failures and verify CDS.

  1. Generic medicine and prescribing: A quick assessment

    Directory of Open Access Journals (Sweden)

    Mainul Haque

    2017-01-01

    Full Text Available Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts. The Food and Drug Administration (FDA describes that generic drugs are essential possibilities that allow better access to healthcare for all Americans. They are replicas of brand-name drugs and are the identical as those of brand-name drugs in dosage form, safety, strength, route of administration, quality, performance features, and anticipated to use. Healthcare authorities and users can be guaranteed that FDA-approved generic drug products have met the same stiff principles as the innovator drug. The company that made Bayer aspirin fought in court enthusiastically to keep generic versions off the shelves, in the 1920s. The company lost in court, and consumers suddenly had an array of choices in generic aspirin. The Supreme Court of India uttering ‘the Supreme Court's ruling will prevent companies from further seeking unwarranted patents on HIV and other essential medicines.’ Generic medicine cannot be sold at a price higher than the branded medicine, so it is regularly a low-priced option. Thereafter, both the end user and the government who pay for part of the price of the medicine under the Pharmaceutical Benefits Scheme in Australia are benefitted. The treatment of diseases using essential drugs, prescribed by their generic names, has been emphasised by the WHO and many national health policies. Although there are some improvements in generic medicine prescribing, it has been advised by the WHO that ‘countries should intensify efforts to measure and regularly monitor medicine prices and availability, and adopt policy measures to address the issues identified.’

  2. 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 internal...

  3. Electronic prescribing in pediatrics: toward safer and more effective medication management.

    Science.gov (United States)

    Johnson, Kevin B; Lehmann, Christoph U

    2013-04-01

    This technical report discusses recent advances in electronic prescribing (e-prescribing) systems, including the evidence base supporting their limitations and potential benefits. Specifically, this report acknowledges that there are limited but positive pediatric data supporting the role of e-prescribing in mitigating medication errors, improving communication with dispensing pharmacists, and improving medication adherence. On the basis of these data and on the basis of federal statutes that provide incentives for the use of e-prescribing systems, the American Academy of Pediatrics recommends the adoption of e-prescribing systems with pediatric functionality. This report supports the accompanying policy statement from the American Academy of Pediatrics recommending the adoption of e-prescribing by pediatric health care providers.

  4. 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.

  5. Which prosthetic foot to prescribe?

    OpenAIRE

    De Asha, AR; Barnett, CT; Struchkov, V; Buckley, JG

    2017-01-01

    Introduction: \\ud Clinicians typically use findings from cohort studies to objectively inform judgements regarding the potential (dis)advantages of prescribing a new prosthetic device. However, before finalising prescription a clinician will typically ask a patient to 'try out' a change of prosthetic device while the patient is at the clinic. Observed differences in gait when using the new device should be the result of the device’s mechanical function, but could also conceivably be due to pa...

  6. 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.

  7. Consumer satisfaction with antipsychotic medication-monitoring appointments: the role of consumer-prescriber communication patterns.

    Science.gov (United States)

    Reich, Catherine M; Hack, Samantha M; Klingaman, Elizabeth A; Brown, Clayton H; Fang, Li Juan; Dixon, Lisa B; Jahn, Danielle R; Kreyenbuhl, Julie A

    2018-06-01

    The study was designed to explore patterns of prescriber communication behaviors as they relate to consumer satisfaction among a serious mental illness sample. Recordings from 175 antipsychotic medication-monitoring appointments between veterans with psychiatric disorders and their prescribers were coded using the Roter Interaction Analysis System (RIAS) for communication behavioral patterns. The frequency of prescriber communication behaviors (i.e., facilitation, rapport, procedural, psychosocial, biomedical, and total utterances) did not reliably predict consumer satisfaction. The ratio of prescriber to consumer utterances did predict consumer satisfaction. Consistent with client-centered care theory, antipsychotic medication consumers were more satisfied with their encounters when their prescriber did not dominate the conversation. Therefore, one potential recommendation from these findings could be for medication prescribers to spend more of their time listening to, rather than speaking with, their SMI consumers.

  8. Medicare Provider Data - Part D Prescriber

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Part D Prescriber Public Use File (PUF) provides information on prescription drugs prescribed by individual physicians and other health care providers and paid...

  9. Management of science policy, sociology of science policy and economics of science policy

    CERN Document Server

    Ruivo, Beatriz

    2017-01-01

    'Management of science policy, sociology of science policy and economics of science policy' is a theoretical essay on the scientific foundation of science policy (formulation, implementation, instruments and procedures). It can be also used as a textbook.

  10. 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.

  11. Assessment of Rational Prescribing of Antihypertensive Drug ...

    African Journals Online (AJOL)

    Results: The average number of drugs prescribed per encounter was 2.9. Encounters with injections were 0.5%. The percentage of drugs prescribed by generic name was 31.6%. All the drugs prescribed were from the National Essential Drugs List. Calcium antagonists were the most frequently used group of drugs (41.3%), ...

  12. Non-prescribed antimicrobial use and associated factors among customers in drug retail outlet in Central Zone of Tigray, northern Ethiopia: a cross-sectional study.

    Science.gov (United States)

    Gebrekirstos, Negash Hadera; Workneh, Birhanu Demeke; Gebregiorgis, Yosef Sibhatu; Misgina, Kebede Haile; Weldehaweria, Negassie Berhe; Weldu, Meresa Gebremedhin; Belay, Hailay Siyum

    2017-01-01

    Non-prescribed antimicrobial use and their resistance are among the main public health problems, worldwide. In Ethiopia, particularly in the northern part, the magnitude of non-prescribed antimicrobial use and its major determinants is not yet well known. Thus, this study was done to assess the magnitude of non-prescribed anti-microbial use and associated factors among customers in drug retail outlet in Central Zone, Tigray, Ethiopia. A drug retail outlet based cross-sectional study was conducted among adults aged 18 years and above. A multistage sampling procedure was used to select study participants. Data were collected using a structured questionnaire by druggists under the supervision of pharmacists. Data were entered into EpiInfo software version 3.5.4. Binary logistic regression was used to identify independently associated variables in bivariate and multivariable analyses using SPSS version 21. Odds Ratios with 95% confidence intervals were estimated. From 829 study samples, a total of 780 respondents participated in this study with a response rate of 94.1%. Of 367 respondents who received non-prescribed antimicrobial, 249 (67.8%), 121 (33%), and 94 (25.6%) of them were males, secondary school and paid employed respectively. The magnitude of non-prescribed antimicrobial use was 47.1% (95% CI: 43.8, 50.5). The factors which were independently associated with non-prescribed antimicrobial use were male sex [AOR = 1.72, 95% CI = 1.21, 2.44], seeking modern health care in private/Non-Governmental Organization (NGO) [AOR =0.47, 95% CI; 0.23, 0.98], moderate waiting time in health care facilities [AOR = 1.92, 95% CI; 1.20, 3.09], delayed waiting time in health care facilities [AOR = 1.56, 95% CI; 1.03, 2.38], ever received antimicrobial [AOR = 3.51, 95% CI; 2.45, 5.02], and frequency of purchasing non-prescribed antimicrobial (1-3 times and 4 times, [AOR = 2.04, 95% CI; 1.36, 3.06] and [AOR = 2.66, 95% CI; 1.24, 5.68] respectively). The magnitude of

  13. The concept of the conservative operating policy

    International Nuclear Information System (INIS)

    Idita, S.A.

    1997-01-01

    In the context of the nuclear operating environment, the conservative operating policy is one that promotes a culture of moderation and caution. This policy requires compliance with the intent of the Reactor Operation Licence (ROL) and adherence with the limitations stipulated in the facility Operating Policies and Principles (OPP). While ROL is the document prescribing the laws governing the operation and maintenance the OPP are the statements defining the boundaries within which the facility will be operated. A conservative operating policy, that is well understood by all plant facility personnel provides assurance that plant operation and maintenance will be carried out in compliance with approved operating and maintenance procedures. In an abnormal plant operating situation where OPP's may be challenged, the provision of 'Abnormal Plant Operating Procedures' (APOP's) will stipulate actions designed to return the plant to a condition where normal procedures can be followed i.e. acceptably within OPP limitations. When in a NPP an operating scenario will develop where the the situation is not covered by normal approved operating procedures a conservative operating policy will empower the duty Shift Supervisor (SS) to initiate actions that will move the plant in the 'safe direction'. The paper enumerates the decisions which the SS has to make in order to ensure that the reactor power is correctly controlled, the reactor fuel remains cooled and the radioactivity remains contained. It is stressed that a corporate operating policy will be of little use if its existence is known only by corporate management. To be effective, and to be instrumental in the promotion of a facility safety culture, the conservative operating philosophy must be known about and fully understood by all personnel working at a nuclear facility. It is up to management to 'get the word out' and lead by example. (author)

  14. Disclosure of industry payments to prescribers: industry payments might be a factor impacting generic drug prescribing.

    Science.gov (United States)

    Qian, Jingjing; Hansen, Richard A; Surry, Daniel; Howard, Jennifer; Kiptanui, Zippora; Harris, Ilene

    2017-07-01

    Pharmaceutical companies paid at least $3.91bn to prescribers in 2013, yet evidence indicating whether industry payments shift prescribing away from generics is limited. This study examined the association between amount of industry payments to prescribers and generic drug prescribing rates among Medicare Part D prescribers. A cross-sectional analysis was conducted among 770 095 Medicare Part D prescribers after linking the 2013 national Open Payments data with 2013 Medicare Provider Utilization and Payment data. The exposure variable was the categorized amount of total industry payments to prescribers (i.e., meals, travel, research, and ownership). The outcome was prescriber's annual generic drug prescribing rate. Multivariable generalized linear regression models were used to examine the association between the amount of industry payments and prescriber's annual generic drug prescribing rates, controlling for prescriber's demographic and practice characteristics. In this sample, over one-third (38.0%) of Medicare Part D prescribers received industry payments in 2013. The mean annual generic drug prescribing rate was highest among prescribers receiving no payments and lowest among those receiving more than $500 of industry payments (77.5% vs. 71.3%, respectively; p industry payments was independently associated with prescribers' generic drug prescribing rate; higher payments corresponded with lower generic drug prescribing rates. Other prescriber characteristics associated with higher annual generic drug prescribing rate included male sex, non-northeast region, specialty, and patient volume. Receipt of industry payments was associated with a decreased rate of generic drug prescribing. How this affects patient care and total medical costs warrants further study. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  15. A comparison of prescribing and non-prescribing nurses in the management of people with diabetes.

    Science.gov (United States)

    Courtenay, Molly; Carey, Nicola; Gage, Heather; Stenner, Karen; Williams, Peter

    2015-12-01

    The aim of this study were to compare nurse prescribers and non-prescribers managing people with diabetes in general practice regarding: (a) patient characteristics; (b) activities and processes of care; (c) patient outcomes (self-management, clinical indicators, satisfaction) and (d) resource implications and costs. Over 28,000 nurses in the UK can prescribe the same medicines as doctors provided that it is in their level of experience and competence. Over 30%, mostly in general practice, prescribe medicines for patients with diabetes. A comparative case study. Nurses managing care of people with Type 2 diabetes were recruited in twelve general practices in England; six could prescribe, six could not. Patients, recruited by nurses, were followed up for 6 months (2011-2012). The patient sample comprised 131 in prescriber sites, 83 in non-prescriber sites. Patients of prescribers had been diagnosed and cared for by the nurse longer than those of non-prescribers. There were no differences in reported self-care activities or HbA1c test results between the patients of prescribers and non-prescribers. Mean HbA1c decreased significantly in both groups over 6 months. Patients of prescribers were more satisfied. Consultation duration was longer for prescribers (by average of 7·7 minutes). Non-prescribing nurses sought support from other healthcare professionals more frequently. Most prescribing nurses were on a higher salary band than non-prescribers. Clinical outcomes of patients managed by prescribing and non-prescribing diabetes nurses are similar. Prescribing nurses had longer relationships with their patients and longer consultations, possibly contributing to higher satisfaction with care. Employment costs of prescribing nurses are potentially higher. © 2015 John Wiley & Sons Ltd.

  16. 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

  17. Reappraisal of visiting policies and procedures of patient's family information in 188 French ICUs: a report of the Outcomerea Research Group.

    Science.gov (United States)

    Garrouste-Orgeas, Maité; Vinatier, Isabelle; Tabah, Alexis; Misset, Benoit; Timsit, Jean-François

    2016-12-01

    The relatives of intensive care unit (ICU) patients must cope with both the severity of illness of their loved one and the unfamiliar and stressful ICU environment. This hardship may lead to post-intensive care syndrome. French guidelines provide recommendations on welcoming and informing families of ICU patients. We questioned whether and how they are applied 5 years after their publication. We conducted a large survey among French ICUs to evaluate their visiting policies and how information was provided to patient's family. A questionnaire was built up by intensivists and nurses. French ICUs were solicited, and the questionnaire was sent to all participating ICUs, for being filled in by the unit medical and/or nursing head. Data regarding the hospital and ICU characteristics, the visiting policy and procedures, and the management of family information were collected. Among the 289 French ICUs, 188 (65 %) participated. Most ICUs have a waiting room 118/188 (62.8 %) and a dedicated room for meeting the family 152/188 (80.8 %). Of the 188 ICUs, 45 (23.9 %) were opened on a 24-h-a-day basis. In the remaining ICUs, the time period allowed for visits was 4.75 ± 1.83 h (median 5 h). In ICUs where visiting restrictions were reported, open visiting was allowed for end-of-life situations in 107/143 (74.8 %). Children are allowed to visit a patient in 164/188 (87.2 %) regardless of their age in 97/164 (59.1 %) of ICUs. Families received an information leaflet in 168/188 (89.3 %). Information was provided to families through structured meetings in 149/188 (79.2 %) of ICUs at patient admission with participation of nurses and nursing assistants in 133/188 (70.4 %) and 55/188 (29.2 %), respectively. Information delivered to the family was reported in the patient chart by only 111/188 ICUs (59 %). Participation in care was infrequent. Although French ICUs do not follow the consensus recommendations, slow progress exists compared to previous reports

  18. 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.

  19. 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 

  20. High-Risk Prescribing to Medicaid Enrollees Receiving Opioid Analgesics: Individual- and County-Level Factors.

    Science.gov (United States)

    Heins, Sara E; Sorbero, Mark J; Jones, Christopher M; Dick, Andrew W; Stein, Bradley D

    2018-01-05

    Prescription opioid overdoses have increased dramatically in recent years, with the highest rates among Medicaid enrollees. High-risk prescribing includes practices associated with overdoses and a range of additional opioid-related problems. To identify individual- and county-level factors associated with high-risk prescribing among Medicaid enrollees receiving opioids. In a four-states, cross-sectional claims data study, Medicaid enrollees 18-64 years old with a new opioid analgesic treatment episode 2007-2009 were identified. Multivariate regression analyses were conducted to identify factors associated with high-risk prescribing, defined as high-dose opioid prescribing (morphine equivalent daily dose ≥100 mg for >6 days), opioid overlap, opioid-benzodiazepine overlap. High-risk prescribing occurred in 39.4% of episodes. Older age, rural county of residence, white race, and major depression diagnosis were associated with higher rates of all types of high-risk prescribing. Individuals with prior opioid, alcohol, and hypnotic/sedative use disorder diagnoses had lower odds of high-dose opioid prescribing but higher odds of opioid overlap and opioid-benzodiazepine overlap than individuals without such disorders. High-dose opioid prescribing in Massachusetts was less common than in California, Illinois, and New York, whereas the rate of benzodiazepine overlap in Massachusetts was more common than in other states. Conclusions/Importance: High-risk prescribing was common and associated with several important demographic, clinical, and community factors. Findings can be used to inform targeted interventions designed to reduce such prescribing, and given state variation observed, further research is needed to better understand the effects of state policies on high-risk prescribing.

  1. Prevalence and Predictors of Inappropriate Medications Prescribing ...

    African Journals Online (AJOL)

    Data analysis involved use of World Health Organization (WHO) prescribing indicators, Updated 2002 Beer's criteria and DRUG-REAX® system software package of MICROMEDEX (R) Healthcare Series to assess the prescribing pattern, identify potentially inappropriate medications and potential drug-drug interactions, ...

  2. Antibiotic prescribing patterns among healthcare professionals at ...

    African Journals Online (AJOL)

    Countries have come to place heavy reliance on antibiotics, a phenomena that has contributed to widespread resistant bacteria. Unless antibiotic prescribing patterns are kept in check, the spread of resistant bacteria will lead to a proliferation of dreadful diseases. In this study, antibiotic prescribing patterns at Van Velden ...

  3. Ministerial Decree of 26 October 1966 concerning Regulations governing the procedure for granting of the clearance certificate prescribed by Section 34 of the Decree of the President of the Republic No. 185 of 13 February 1964 for category B commercial operations concerning ores, source materials and radioactive materials within the meaning of Section 4 of Act No. 1860 of 31 December 1962

    International Nuclear Information System (INIS)

    1966-01-01

    This Decree was made in implementation of DPR No. 185 which prescribes that a clearance certificate will be required from the Ministry of Industry within 30 days of the conclusion of the enquiry concerning the application for such a certificate. (NEA) [fr

  4. Neuropharmacology and mental health nurse prescribers.

    Science.gov (United States)

    Skingsley, David; Bradley, Eleanor J; Nolan, Peter

    2006-08-01

    To outline the development and content of a 'top-up' neuropharmacology module for mental health nurse prescribers and consider how much pharmacology training is required to ensure effective mental health prescribing practice. Debate about the content of prescribing training courses has persisted within the United Kingdom since the mid-1980s. In early 2003 supplementary prescribing was introduced and gave mental health nurses the opportunity to become prescribers. The challenge of the nurse prescribing curriculum for universities is that they have only a short time to provide nurses from a range of backgrounds with enough knowledge to ensure that they meet agreed levels of competency for safe prescribing. There is growing concern within mental health care that the prescribing of medication in mental health services falls short of what would be deemed good practice. Over the past two decades, nurse training has increasingly adopted a psychosocial approach to nursing care raising concerns that, although nurses attending prescribing training may be able to communicate effectively with service users, they may lack the basic knowledge of biology and pharmacology to make effective decisions about medication. Following the completion of a general nurse prescribing course, mental health nurses who attended were asked to identify their specific needs during the evaluation phase. Although they had covered basic pharmacological principles in their training, they stated that they needed more specific information about drugs used in mental health; particularly how to select appropriate drug treatments for mental health conditions. This paper describes how the nurses were involved in the design of a specific module which would enable them to transfer their theoretical leaning to practice and in so doing increase their confidence in their new roles. The findings of this study suggest that the understanding and confidence of mental health nurse prescribers about the drugs they

  5. http://www.phrp.com.au/issues/february-2017-volume-27-issue-1-2/dynamic-simulation-modelling-of-policy-responses-to-reduce-alcohol-related-harms-rationale-and-procedure-for-a-participatory-approach/

    Directory of Open Access Journals (Sweden)

    Jo-An Atkinson

    2017-02-01

    Full Text Available Development of effective policy responses to address complex public health problems can be challenged by a lack of clarity about the interaction of risk factors driving the problem, differing views of stakeholders on the most appropriate and effective intervention approaches, a lack of evidence to support commonly implemented and acceptable intervention approaches, and a lack of acceptance of effective interventions. Consequently, political considerations, community advocacy and industry lobbying can contribute to a hotly contested debate about the most appropriate course of action; this can hinder consensus and give rise to policy resistance. The problem of alcohol misuse and its associated harms in New South Wales (NSW, Australia, provides a relevant example of such challenges. Dynamic simulation modelling is increasingly being valued by the health sector as a robust tool to support decision making to address complex problems. It allows policy makers to ask ‘what-if’ questions and test the potential impacts of different policy scenarios over time, before solutions are implemented in the real world. Participatory approaches to modelling enable researchers, policy makers, program planners, practitioners and consumer representatives to collaborate with expert modellers to ensure that models are transparent, incorporate diverse evidence and perspectives, are better aligned to the decision-support needs of policy makers, and can facilitate consensus building for action. This paper outlines a procedure for embedding stakeholder engagement and consensus building in the development of dynamic simulation models that can guide the development of effective, coordinated and acceptable policy responses to complex public health problems, such as alcohol-related harms in NSW.

  6. Evaluating the impact of the administrative procedure and the landscape policy on grid connected PV systems (GCPVS) on-floor in Spain in the period 2004–2008: To which extent a limiting factor?

    International Nuclear Information System (INIS)

    Hoz, Jordi de la; Martín, Helena; Martins, Blanca; Matas, José; Miret, Jaume

    2013-01-01

    The growth of the Spanish photovoltaic (PV) sector in the period 2004–2008 rendered Spain a prominent place among top worldwide countries. Yet, this growth was rather uneven across the different Spanish regions which raised the interest on the drivers ultimately effecting these disparities. Especially controversial were the arguments about the influence of the administrative procedure and the landscape policy on the development of GCPVS on-floor. This study therefore discloses both two elements and evaluates their impact in a group of PV prominent Spanish regions and Catalonia, the latter used as a benchmark because of its comprehensive and stringent regulation on landscape protection, which was accused by the PV industry of thwarting the development of the GCPVS on-floor. Both quantitative and qualitative analyses were carried out. In particular two indexes were elaborated to determine the consistency of the arguments pointing to the landscape protection policy as a decisive barrier to GCPVS growth. First, when the analysis is made in relative terms, the ranking of PV prominent regions changes and many of the differences vanish. Second, rather than the preeminence of a landscape protection policy what really matters for GCPVS on-floor growth is the administrative procedure and the processing enabling its implementation. - Highlights: • The study of PV evolution relative to land availability bends regional differences. • Regions with lower administrative complexity are likely to have better PV ratios. • Landscape protection policy is not per se a barrier to GCPVS on-floor growth. • The administrative procedure was not proven a tool of energy planning in Catalonia. • Pointing the drivers of PV regional differences demands a keen analysis of data

  7. Prescribing Errors Involving Medication Dosage Forms

    Science.gov (United States)

    Lesar, Timothy S

    2002-01-01

    CONTEXT Prescribing errors involving medication dose formulations have been reported to occur frequently in hospitals. No systematic evaluations of the characteristics of errors related to medication dosage formulation have been performed. OBJECTIVE To quantify the characteristics, frequency, and potential adverse patient effects of prescribing errors involving medication dosage forms . DESIGN Evaluation of all detected medication prescribing errors involving or related to medication dosage forms in a 631-bed tertiary care teaching hospital. MAIN OUTCOME MEASURES Type, frequency, and potential for adverse effects of prescribing errors involving or related to medication dosage forms. RESULTS A total of 1,115 clinically significant prescribing errors involving medication dosage forms were detected during the 60-month study period. The annual number of detected errors increased throughout the study period. Detailed analysis of the 402 errors detected during the last 16 months of the study demonstrated the most common errors to be: failure to specify controlled release formulation (total of 280 cases; 69.7%) both when prescribing using the brand name (148 cases; 36.8%) and when prescribing using the generic name (132 cases; 32.8%); and prescribing controlled delivery formulations to be administered per tube (48 cases; 11.9%). The potential for adverse patient outcome was rated as potentially “fatal or severe” in 3 cases (0.7%), and “serious” in 49 cases (12.2%). Errors most commonly involved cardiovascular agents (208 cases; 51.7%). CONCLUSIONS Hospitalized patients are at risk for adverse outcomes due to prescribing errors related to inappropriate use of medication dosage forms. This information should be considered in the development of strategies to prevent adverse patient outcomes resulting from such errors. PMID:12213138

  8. A solid grounding: prescribing skills training.

    Science.gov (United States)

    Kirkham, Deborah; Darbyshire, Daniel; Gordon, Morris; Agius, Steven; Baker, Paul

    2015-06-01

    Prescribing is an error-prone process for all doctors, from those who are newly qualified through to those at consultant level. Newly qualified doctors write the majority of in-patient prescriptions and therefore represent an opportunity for safety improvement. Attention to prescribing as a patient-safety issue and potential educational interventions to help improve the situation have been published, but offer little to inform educators why and how any interventions may succeed. In order to identify areas of good practice, and to provide evidence of areas requiring further investigation and innovation, we aimed to ascertain the full range of prescribing practices for final-year medical students and newly qualified doctors across a large geopolitical region of the UK. A questionnaire methodology was used. One questionnaire was sent to those responsible for final-year education, and a further, different questionnaire was sent to those responsible for the training of newly qualified doctors, asking about prescribing education in their locality. Questionnaires were sent to 15 hospitals in total. Prescribing is an error-prone process for all doctors Twelve hospitals contributed to final-year medical student data: a response rate of 80 per cent. A variety of methods, including student assistantship, pharmacist-led skills sessions and practical assessment, were offered to varying degrees. Free-text responses identified opportunities for different prescribing education and support. All 15 hospitals provided data on doctors' education, with interventions including e-learning, assessment and support from ward-based pharmacists. Current education focuses on the technical and knowledge-based paradigm of prescribing. Human factors and the impact of electronic prescribing should play a part in future developments in prescribing education. © 2015 John Wiley & Sons Ltd.

  9. Medication prescribing errors: data from seven Lebanese hospitals.

    Science.gov (United States)

    Al-Hajje, Amal; Awada, Sanaa; Rachidi, Samar; Chahine, Nazih Bou; Azar, Rania; Zein, Salam; Hneine, Anna-Maria; Dalloul, Nadia; Sili, Georges; Salameh, Pascale

    2012-01-01

    Medication prescribing errors are made all over the world. However, exact data about them are lacking in Lebanon. Our objective was to describe medication errors, including drug-drug interactions in medication orders given to patients admitted to Lebanese hospitals. A prospective study was carried out on 313 patients taken from seven Lebanese hospitals; 1826 medication orders were assessed for errors and 456 drug-drug interactions were found. Data was entered and analyzed on SPSS. Around 40% of medication orders were judged to comprise at least one prescribing error, mainly no ordering of parameters monitoring (20%), unnecessary medication (9%), and no indication (7%). Errors occurred mainly in the pediatrics (50%) and internal medicine wards (40%). Having an infectious or gastrointestinal problem almost doubled the risk of medication prescribing error. Antiulcer agents, NSAIDs, antibiotics and steroidal agents were the medications mainly involved. Meanwhile, 12 adverse medication events were reported, with an odds ratio of association to a medication error of 7.4 (p = 0.004). As for drug-drug interaction (DDI), prescriptions comprised zero to 29 interactions, involving medications with low margin of safety such as acenocoumarol, amiodarone and valproate. Pharmacodynamic interactions were mainly found (60%). The majority of DDI were of high clinical significance and well documented (80%), with moderate (59%) to major (17%) severity. These results highlight the urgency of an intervention to improve patients' outcomes and avoid deleterious impact of inadequate medication use in Lebanon. The presence of a clinical pharmacist, the inclusion of computerized systems and the application of drug management policies are suggested to decrease medication prescribing errors and enhance the physician attention to DDI.

  10. Eliciting general practitioners' salient beliefs towards prescribing: a qualitative study based on the Theory of Planned Behaviour in Greece.

    Science.gov (United States)

    Tsiantou, V; Shea, S; Martinez, L; Agius, D; Basak, O; Faresjö, T; Moschandreas, J; Samoutis, G; Symvoulakis, E K; Lionis, C

    2013-04-01

    Prescribing represents an important medical action especially in primary care. However, irrational prescribing is common and has an impact on clinical and economic outcomes. Therefore, there is a growing need to rationalize prescribing. Knowledge of influential factors is crucial for achieving this. The aim of the present study was to identify the behavioural, normative and control beliefs of GPs regarding prescribing in Greece. Focus group sessions were conducted in three geographically defined areas in Greece. GPs working in the private and public sector in primary care settings were invited to participate. Transcripts from focus groups were content analysed using the Theory of Planned Behaviour (TPB) as the theoretical framework. GPs acknowledged prescribing as the most important method for treating diseases in primary health care, with significant impact on patient's health and quality of life. The expectations of patients and their families were extremely influential during prescribing. Pharmaceutical sales representatives, other GPs and specialists, as well as public health authorities influenced prescribing. GPs admitted that factors such as the income of the patient, the limited time available and special situations such as prescribing through a third person or prescribing following patients' prescription requests for medicines that they have previously purchased over the counter through pharmacies may facilitate or hinder their prescribing decision. This elicitation study shed light into GPs' beliefs regarding prescribing. Factors that are not common in the usual European setting were revealed, such as the influence of the patients' family and special situations during prescribing. Thus, various issues were highlighted that should inform the development of items for inclusion in a forthcoming TPB-based questionnaire. The results of this study revealed also certain issues that can affect the design of policies aiming at the rationalization of prescribing.

  11. Medicare Part D Prescriber Interactive Dataset

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data - Part D Prescriber Public...

  12. Antibiotics prescribing practices in oral implantology among jordanian dentists. A cross sectional, observational study

    Directory of Open Access Journals (Sweden)

    Hamdan Ahmad AS

    2011-07-01

    Full Text Available Abstract Background In oral implantology, there is no consensus on the most appropriate regimen for antibiotics prescribing, the decision to prescribe antibiotic is usually based on procedure, patient and clinician related factors. The aim of this study was to investigate the rationale of antibiotic prescribing among Jordanian clinicians who practice oral implantology. Findings The target sample for the study was the 250 Jordan Dental Implant Group members. A five page questionnaire contained 41 questions, both closed and open questions were used to collect data. Statistical analysis was performed using SPSS Windows 16.0 (SPSS Inc., Chicago, IL, USA. Descriptive statistics were generated. The response rate was (70.4% 176/250. Mean age was 37.2 yrs, 49.4% always prescribe antibiotics mainly oral amoxicillin and amoxicillin with clavulinic acid. Antibiotics prescribing increased with flap raising, multiple implants and sinus or bone augmentation. Patient medical condition, periodontitis and oral hygiene were the most important clinical factors in antibiotic prescribing, non-clinical factors were; reading scientific materials, courses and lectures, knowledge gained during training, and the effectiveness and previous experience with the drug. Conclusions Wide variations in antibiotics types, routes, dose and duration of administration were found. Recommendations on antibiotic prescribing are needed to prevent antibiotic overprescribing and misuse.

  13. 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.

  14. The Quality of Prescribing for Psychiatric Patients

    DEFF Research Database (Denmark)

    Sørensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt

    2014-01-01

    The Quality of Prescribing for Psychiatric Patients Soerensen 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...... need to improve the quality in prescribing for psychiatric patients....

  15. The Quality of Prescribing for Psychiatric Patients

    DEFF Research Database (Denmark)

    Sørensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt

    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...... need to improve the quality in prescribing for psychiatric patients....

  16. Pharmaco-epistemology for the prescribing geriatrician.

    Science.gov (United States)

    Le Couteur, David G; Kendig, Hal

    2008-03-01

    Clinicians are becoming more reliant on their interpretation of clinical trial information to guide prescribing rather than their clinical skills. Thus to improve prescribing, it is increasingly important for clinicians to have an appreciation of epistemology (the science of knowledge and its interpretation) and the broader social context of knowledge. The insights of epistemologists can be useful in understanding the different ways in which clinical trials data are interpreted.

  17. Drug Utilization and Inappropriate Prescribing in Centenarians.

    Science.gov (United States)

    Hazra, Nisha C; Dregan, Alex; Jackson, Stephen; Gulliford, Martin C

    2016-05-01

    To use primary care electronic health records (EHRs) to evaluate prescriptions and inappropriate prescribing in men and women at age 100. Population-based cohort study. Primary care database in the United Kingdom, 1990 to 2013. Individuals reaching the age of 100 between 1990 and 2013 (N = 11,084; n = 8,982 women, n = 2,102 men). Main drug classes prescribed and potentially inappropriate prescribing according to the 2012 American Geriatrics Society Beers Criteria. At the age of 100, 73% of individuals (79% of women, 54% of men) had received one or more prescription drugs, with a median of 7 (interquartile range 0-12) prescription items. The most frequently prescribed drug classes were cardiovascular (53%), central nervous system (CNS) (53%), and gastrointestinal (47%). Overall, 32% of participants (28% of men, 32% of women) who received drug prescriptions may have received one or more potentially inappropriate prescriptions, with temazepam and amitriptyline being the most frequent. CNS prescriptions were potentially inappropriate in 23% of individuals, and anticholinergic prescriptions were potentially inappropriate in 18% of individuals. The majority of centenarians are prescribed one or more drug therapies, and the prescription may be inappropriate for up to one-third of these individuals. Research using EHRs offers opportunities to understand prescribing trends and improve pharmacological care of the oldest adults. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

  18. The Relationship of Students' Awareness on Drug Policy, Procedures, and Intervention Programs to the Drug and Alcohol Use on College Campuses: A Correlational Study

    Science.gov (United States)

    Love-Quick, Sharon J.

    2016-01-01

    One of the most pressing concerns that universities and colleges face today is the drug and alcohol abuse of students. In order to address this, there is a need to strengthen university policies in order to mitigate the increasing rate and cases of drug and alcohol abuse among students. The purpose of this quantitative study was to examine the…

  19. Benefits of not Prescribing Prophylactic Antibiotics After Third Molar Surgery.

    Science.gov (United States)

    Prajapati, Anchal; Prajapati, Aalap; Sathaye, Swati

    2016-06-01

    The aim of the study is to reinstate the fact that antibiotics are not required as prophylaxis for third molar surgery. So the standard of care after extraction of mandibular third molar surgery for all healthy patients should be a good anti-inflammatory regimen rather than a antibiotic prophylaxis. Surgical removal of impacted mandibular third molar is the most common procedure and many complications are usually encountered in this procedure like-pain, trismus, infection, swelling, inflammation and nerve damage. Now, the question that arises is does the age old practice of prescribing postoperative antibiotics solve these problems or adds on some new. The data collected and analysed in our observational study, however, reinstates that instead, it is the proper aseptic precautions and good anti-inflammatory regimen that are more important than the prophylactic antibiotics (Pasupathy and Alexander in J Craniofac Surg, 2011). Moreover, giving antibiotics means opening up the loopholes to bacterial resistance. A retrospective analysis of the data collected from 40 patients coming to the department of Dental and Implant Surgery, Karamsad, Anand between October 2014 and December 2014, operated for third molar surgery was carried out. Data from 40 patients requiring disimpaction of mandibular third molar was analysed. Postoperatively, only anti-inflammatory medication was prescribed to all the patients. None of the patients showed any of the signs or symptoms of infection.

  20. Non- medical prescribing in Australasia and the UK: the case of podiatry.

    Science.gov (United States)

    Borthwick, Alan M; Short, Anthony J; Nancarrow, Susan A; Boyce, Rosalie

    2010-01-05

    The last decade has witnessed a rapid transformation in the role boundaries of the allied health professions, enabled through the creation of new roles and the expansion of existing, traditional roles. A strategy of health care 'modernisation' has encompassed calls for the redrawing of professional boundaries and identities, linked with demands for greater workforce flexibility. Several tasks and roles previously within the exclusive domain of medicine have been delegated to, or assumed by, allied health professionals, as the workforce is reshaped to meet the challenges posed by changing demographic, social and political contexts. The prescribing of medicines by non-medically qualified healthcare professionals, and in particular the podiatry profession, reflects these changes. Using a range of key primary documentary sources derived from published material in the public domain and unpublished material in private possession, this paper traces the development of contemporary UK and Australasian podiatric prescribing, access, supply and administration of medicines. Documentary sources include material from legislative, health policy, regulatory and professional bodies (including both State and Federal sources in Australia). Tracing a chronological, comparative, socio-historical account of the emergence and development of 'prescribing' in podiatry in both Australasia and the UK enables an analysis of the impact of health policy reforms on the use of, and access to, medicines by podiatrists. The advent of neo-liberal healthcare policies, coupled with demands for workforce flexibility and role transfer within a climate of demographic, economic and social change has enabled allied health professionals to undertake an expanding number of tasks involving the sale, supply, administration and prescription of medicines. As a challenge to medical dominance, these changes, although driven by wider healthcare policy, have met with resistance. As anticipated in the theory of

  1. 41 CFR 301-75.3 - What governing policies and procedures must we establish related to pre-employment interview travel?

    Science.gov (United States)

    2010-07-01

    ... and procedures must we establish related to pre-employment interview travel? 301-75.3 Section 301-75.3 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY RESPONSIBILITIES 75-PRE-EMPLOYMENT INTERVIEW TRAVEL General Rules § 301-75.3 What governing...

  2. Correction: Correction to 'Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department' [Annals of Emergency Medicine 63 (2014) 247-258.e18].

    Science.gov (United States)

    Godwin, Steven A; Burton, John H; Gerardo, Charles J; Hatten, Benjamin W; Mace, Sharon E; Silvers, Scott M; Fesmire, Francis M

    2017-11-01

    Due to a miscommunication during the process of transferring this manuscript from our editorial team to Production, the Members of the American College of Emergency Physicians Clinical Policies Committee (Oversight Committee) were not properly indexed in PubMed. This has now been corrected online. This has now been corrected online. The publisher would like to apologize for any inconvenience caused. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  3. Control of invasive weeds with prescribed burning

    Science.gov (United States)

    DiTomaso, Joseph M.; Brooks, Matthew L.; Allen, Edith B.; Minnich, Ralph; Rice, Peter M.; Kyser, Guy B.

    2006-01-01

    Prescribed burning has primarily been used as a tool for the control of invasive late-season annual broadleaf and grass species, particularly yellow starthistle, medusahead, barb goatgrass, and several bromes. However, timely burning of a few invasive biennial broadleaves (e.g., sweetclover and garlic mustard), perennial grasses (e.g., bluegrasses and smooth brome), and woody species (e.g., brooms and Chinese tallow tree) also has been successful. In many cases, the effectiveness of prescribed burning can be enhanced when incorporated into an integrated vegetation management program. Although there are some excellent examples of successful use of prescribed burning for the control of invasive species, a limited number of species have been evaluated. In addition, few studies have measured the impact of prescribed burning on the long-term changes in plant communities, impacts to endangered plant species, effects on wildlife and insect populations, and alterations in soil biology, including nutrition, mycorrhizae, and hydrology. In this review, we evaluate the current state of knowledge on prescribed burning as a tool for invasive weed management.

  4. Individually Prescribed Instruction--Mathematics (IPI--Math). Product Development Report No. 17.

    Science.gov (United States)

    Jung, Steven M.

    This report summarizes the mathematics component of Individually Prescribed Instruction (IPI). The first section outlines the overall goals, specific objectives, and philosophy of IPI; the organization of the materials; and the procedures for their use, with emphasis on the altered role of both students and teachers. The next section describes the…

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

    NARCIS (Netherlands)

    de Vries, C.S; van Diepen, N.M; de Jong-van den Berg, L T W

    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.

  6. The use of prescribed and non-prescribed medication by Dutch children.

    NARCIS (Netherlands)

    Dijk, L. van; Lindert, H. van

    2002-01-01

    Background: Most research on the use of medication focuses on adults. Children, however, use medication too, most of which is prescribed by GP's. Children also use non-prescribed medication (f.e. bought in the drugstore), but the extent to which is not known. Moreover, it is not known to what extent

  7. 29 CFR 4221.14 - PBGC-approved arbitration procedures.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false PBGC-approved arbitration procedures. 4221.14 Section 4221... LIABILITY FOR MULTIEMPLOYER PLANS ARBITRATION OF DISPUTES IN MULTIEMPLOYER PLANS § 4221.14 PBGC-approved arbitration procedures. (a) Use of PBGC-approved arbitration procedures. In lieu of the procedures prescribed...

  8. Hybrid Security Policies

    Directory of Open Access Journals (Sweden)

    Radu CONSTANTINESCU

    2006-01-01

    Full Text Available Policy is defined as the rules and regulations set by the organization. They are laid down by management in compliance with industry regulations, law and internal decisions. Policies are mandatory. Security policies rules how the information is protected against security vulnerabilities and they are the basis for security awareness, training and vital for security audits. Policies are focused on desired results. The means of achieving the goals are defined on controls, standards and procedures.

  9. An evaluation of prescribing practices for community-acquired pneumonia (CAP) in Mongolia.

    Science.gov (United States)

    Dorj, Gereltuya; Hendrie, Delia; Parsons, Richard; Sunderland, Bruce

    2013-10-03

    states that injections should not be prescribed. The high level of inappropriate prescribing for mild/moderate CAP highlights the need to develop comprehensive and reliable procedures nationwide to improve prescribing practices in Mongolia.

  10. Determinants associated with veterinary antimicrobial prescribing in farm animals in the Netherlands: a qualitative study.

    Science.gov (United States)

    Speksnijder, D C; Jaarsma, A D C; van der Gugten, A C; Verheij, T J M; Wagenaar, J A

    2015-04-01

    Antimicrobial use in farm animals might contribute to the development of antimicrobial resistance in humans and animals, and there is an urgent need to reduce antimicrobial use in farm animals. Veterinarians are typically responsible for prescribing and overseeing antimicrobial use in animals. A thorough understanding of veterinarians' current prescribing practices and their reasons to prescribe antimicrobials might offer leads for interventions to reduce antimicrobial use in farm animals. This paper presents the results of a qualitative study of factors that influence prescribing behaviour of farm animal veterinarians. Semi-structured interviews with eleven farm animal veterinarians were conducted, which were taped, transcribed and iteratively analysed. This preliminary analysis was further discussed and refined in an expert meeting. A final conceptual model was derived from the analysis and sent to all the respondents for validation. Many conflicting interests are identifiable when it comes to antimicrobial prescribing by farm animal veterinarians. Belief in the professional obligation to alleviate animal suffering, financial dependency on clients, risk avoidance, shortcomings in advisory skills, financial barriers for structural veterinary herd health advisory services, lack of farmers' compliance to veterinary recommendations, public health interests, personal beliefs regarding the veterinary contribution to antimicrobial resistance and major economic powers are all influential determinants in antimicrobial prescribing behaviour of farm animal veterinarians. Interventions to change prescribing behaviour of farm animal veterinarians could address attitudes and advisory skills of veterinarians, as well as provide tools to deal with (perceived) pressure from farmers and advisors to prescribe antimicrobials. Additional (policy) measures could probably support farm animal veterinarians in acting as a more independent animal health consultant. © 2014 Blackwell

  11. e-Learning initiatives to support prescribing

    Science.gov (United States)

    Maxwell, Simon; Mucklow, John

    2012-01-01

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

  12. Prescribing trends for sodium valproate in Ireland.

    Science.gov (United States)

    Murphy, Sinéad; Bennett, Kathleen; Doherty, Colin P

    2016-03-01

    This study was undertaken to describe prescribing practice for the anti-convulsant drug (AED) Sodium Valproate (VPA) in an Irish population of woman of childbearing age during the period of the emergence of new data showing a high rate of developmental abnormalities in offspring of women who took VPA during pregnancy. All prescriptions dispensed from community pharmacies in Ireland between 2008 and 2013 inclusive were examined for women aged 16-44 years from all three drug reimbursement schemes in Ireland. Numbers of prescriptions and women on AEDs were identified, as was the rural/urban distribution of the drug along with co-prescribing of folic acid and the oral contraceptive pill. All data analysis was conducted using SAS v9.3. The rate of prescribing of VPA in Ireland declined slightly from 3.5/1000 per eligible population in 2008 to 3.14/1000 in 2013. While rates of prescribing fell for epilepsy, there appeared to be a rise in prescription for other indications of VPA. In 2013, co-prescription of folic acid or oral contraceptives was relatively low across all community schemes. Finally, an address distant from academic specialist centers predicted a higher exposure to VPA. Recently the European Medicine's Agency suggested that alternatives to VPA be considered before prescribing to women of childbearing age. Despite this, the rate of VPA prescribing in Ireland appears to be increasing for indications other than epilepsy. It may be necessary to improve the dissemination of information about the potential negative effects of VPA in this population. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  13. 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.

  14. Antibiotic prescribing patterns in the pediatric emergency department at Georgetown Public Hospital Corporation: a retrospective chart review.

    Science.gov (United States)

    Sharma, Suparna; Bowman, Clive; Alladin-Karan, Bibi; Singh, Narendra

    2016-04-19

    The increase in antimicrobial-resistant infections has led to significant morbidity, mortality, and healthcare costs. The impact of antimicrobial resistance is greatest on low-income countries, which face the double burden of fewer antibiotic choices and higher rates of infectious diseases. Currently, Guyana has no national policy on rational prescribing. This study aims to characterize antibiotic prescribing patterns in children discharged from the emergency department at Georgetown Public Hospital Corporation (GPHC), as per the World Health Organization (WHO) prescribing indicators. A retrospective chart review of pediatric patients (aged 1 month-13 years) seen in the GPHC emergency department between January and December 2012 was conducted. Outpatient prescriptions for eligible patients were reviewed. Patient demographics, diagnosis, and drugs prescribed were recorded. The following WHO Prescribing Indicators were calculated: i) average number of drugs prescribed per patient encounter, ii) percentage of encounters with an antibiotic prescribed, iii) percentage of antibiotics prescribed by generic name, and iv) percentage of antibiotics prescribed from essential drugs list or formulary. Eight hundred eleven patient encounters were included in the study. The mean patient age was 5.55 years (s = 3.98 years). 59.6 % (n = 483) patients were male. An average of 2.5 drugs were prescribed per encounter (WHO standard is 2.0). One or more antibiotic was prescribed during 36.9 % (n = 299) of all encounters (WHO standard is 30 %). 90.83 % of antibiotics were prescribed from the essential drugs formulary list and 30 % of the prescriptions included the drug's generic name. The average duration of antibiotic therapy was 5.73 days (s = 3.53 days). Of the 360 antibiotics prescribed, 74.7 % (n = 269) were broad-spectrum. B-lactam penicillins were prescribed most frequently (51.4 %), with amoxicillin being the most popular choice (33.9 %). The

  15. Antimalarial prescribing patterns in state hospitals and selected ...

    African Journals Online (AJOL)

    slowdown of progression to resistance could be achieved by improving prescribing practice, drug quality, and patient compliance. Objective: To determine the antimalarial prescribing pattern and to assess rational prescribing of chloroquine by prescribers in government hospitals and parastatals in Lagos State. Methods: ...

  16. Surface cleanliness measurement procedure

    Science.gov (United States)

    Schroder, Mark Stewart; Woodmansee, Donald Ernest; Beadie, Douglas Frank

    2002-01-01

    A procedure and tools for quantifying surface cleanliness are described. Cleanliness of a target surface is quantified by wiping a prescribed area of the surface with a flexible, bright white cloth swatch, preferably mounted on a special tool. The cloth picks up a substantial amount of any particulate surface contamination. The amount of contamination is determined by measuring the reflectivity loss of the cloth before and after wiping on the contaminated system and comparing that loss to a previous calibration with similar contamination. In the alternative, a visual comparison of the contaminated cloth to a contamination key provides an indication of the surface cleanliness.

  17. Association of Prescription Drug Monitoring Program Use With Opioid Prescribing and Health Outcomes: A Comparison of Program Users and Nonusers.

    Science.gov (United States)

    Deyo, Richard A; Hallvik, Sara E; Hildebran, Christi; Marino, Miguel; Springer, Rachel; Irvine, Jessica M; O'Kane, Nicole; Van Otterloo, Joshua; Wright, Dagan A; Leichtling, Gillian; Millet, Lisa M; Carson, Jody; Wakeland, Wayne; McCarty, Dennis

    2018-02-01

    Prescription drug monitoring programs (PDMPs) are a response to the prescription opioid epidemic, but their effects on prescribing and health outcomes remain unclear, with conflicting reports. We sought to determine if prescriber use of Oregon's PDMP led to fewer high-risk opioid prescriptions or overdose events. We conducted a retrospective cohort study from October 2011 through October 2014, using statewide PDMP data, hospitalization registry, and vital records. Early PDMP registrants (n = 927) were matched with clinicians who never registered during the study period, using baseline prescribing metrics in a propensity score. Generalized estimating equations were used to examine prescribing trends after PDMP registration, using 2-month intervals. We found a statewide decline in measures of per capita opioid prescribing. However, compared with nonregistrants, PDMP registrants did not subsequently have significantly fewer patients receiving high-dose prescriptions, overlapping opioid and benzodiazepine prescriptions, inappropriate prescriptions, prescriptions from multiple prescribers, or overdose events. At baseline, frequent PDMP users wrote fewer high-risk opioid prescriptions than infrequent users; this persisted during follow-up with few significant group differences in trend. Thus, although opioid prescribing declined statewide after implementing the PDMP, registrants did not show greater declines than nonregistrants. Factors other than PDMP use may have had greater influence on prescribing trends. Refinements in the PDMP program and related policies may be necessary to increase PDMP effects. Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

  18. Optimization of electronic prescribing in pediatric patients

    NARCIS (Netherlands)

    Maat, B.

    2014-01-01

    Improving pediatric patient safety by preventing medication errors that may result in adverse drug events and consequent healthcare expenditure,is a worldwide challenge to healthcare. In pediatrics, reported medication error rates in general, and prescribing error rates in particular, vary between

  19. Cost Evaluation of Commonly Prescribed Antihypertensive Drugs ...

    African Journals Online (AJOL)

    %), Alpha methyl dopa (10%), Beta Blockers (8.5%), combination of ... It was concluded that the prescribing of the new generation drugs i.e. Calcium channel blockers, ACE inhibitors with supposedly little or no metabolic side effects is a new ...

  20. Antimalarial Drugs for Pediatrics - Prescribing and Dispensing ...

    African Journals Online (AJOL)

    Purpose: To assess dispensing and prescribing practices with regard to antimalarial drugs for pediatrics in private pharmacies and public hospitals in Dar es Salaam, Tanzania. Methods: This was a cross-sectional, descriptive study that assessed the knowledge and practice of 200 drug dispensers in the private community ...

  1. PRESCRIBING PATTERN OF NON-STEROIDAL ANTI ...

    African Journals Online (AJOL)

    2015-03-01

    Mar 1, 2015 ... scribed NSAID (62.2%) followed by Diclofenac potassi- um (13.7%) and Tenoxicam and Piroxicam were least prescribed (0.1%). Salicylates were the highest pre- scribed class of NSAIDs (62.2%), followed by Acetic acid derivatives (23.1%), Propionic acid derivatives. (14.1%), Cox-2-selective inhibitors ...

  2. Clinician compliance with laboratory monitoring and prescribing ...

    African Journals Online (AJOL)

    urban SA ART sites to describe clinician compliance with tenofovir prescribing and monitoring guidelines in HIVinfected adults on firstline ART. Methods. We included treatmentnaive patients aged ≥16 years who started firstline tenofovirbased ART between 2010 and 2012 at Khayelitsha and Themba Lethu clinics in Cape ...

  3. Influence of hospitalization on potentially inappropriate prescribing ...

    African Journals Online (AJOL)

    prescribing among elderly patients in a Malaysian community. Muhammad Eid Akkawi, Mohamad Haniki Nik Mohamed. Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia. *For correspondence: Email: mhdeidak@gmail.com; Tel: 0060-186675232. Sent for review: 25 September 2017.

  4. Prescribed burning in the North Central States.

    Science.gov (United States)

    Linda R. Donoghue; Von J. Johnson

    1975-01-01

    Describes 5 years of prescribed burning in the North Central States from 1968 through 1972. Provides information concerning participating agencies, burned-acreage, purpose-of-burn, fuels, and weather. Also examines other aspects such as ignition and burning techniques, hours-to-complete, time of fire start, and cost-per-acre.

  5. 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...

  6. Prescribing Patterns of Methylphenidate and Atomoxetine for ...

    African Journals Online (AJOL)

    Purpose: To determine the prescribing pattern of methylphenidate and atomoxetine to patients with. Attention-Deficit/Hyperactivity Disorder (ADHD) in South Africa. Methods: A retrospective, cross-sectional pharmacoepidemiological study was conducted based on the data from a medical aid administrator in South Africa for ...

  7. Prescribing Patterns of Methylphenidate and Atomoxetine for ...

    African Journals Online (AJOL)

    Purpose: To determine the prescribing pattern of methylphenidate and atomoxetine to patients with Attention-Deficit/Hyperactivity Disorder (ADHD) in South Africa. Methods: A retrospective, cross-sectional pharmacoepidemiological study was conducted based on the data from a medical aid administrator in South Africa for ...

  8. Learning from escaped prescribed fire reviews

    Science.gov (United States)

    Anne E. Black; Dave Thomas; James Saveland; Jennifer D. Ziegler

    2011-01-01

    The U.S. wildland fire community has developed a number of innovative methods for conducting a review following escape of a prescribed fire (expanding on the typical regional or local reviews, to include more of a learning focus - expanded After Action Reviews, reviews that incorporate High Reliability Organizing, Facilitated Learning Analyses, etc). The stated purpose...

  9. [Prescribing, the perspectives of health professionals].

    Science.gov (United States)

    Debout, Christophe; Lescot, Thomas; Loyer, Frédérique; Ambrosino, Florence

    2016-10-01

    While, in France, various health professionals are authorised to prescribe, they approach this activity in a different way, depending on the professional category to which they belong. The areas and products concerned are specific to each profession, and inevitably evolve. This article presents the different perspectives of a doctor, a midwife and a nurse. Copyright © 2016. Published by Elsevier Masson SAS.

  10. Cost-benefit considerations in the development of policies and procedures for controlling indoor exposure to radon and its decay products

    International Nuclear Information System (INIS)

    Puskin, J.S.; Guimond, R.J.; Napolitano, S.; Nelson, C.B.

    1989-01-01

    The applicability of ALARA to the problem of controlling residential radon levels is limited. Cost-benefit considerations can nevertheless be useful in guiding policy in this area. From a societal perspective, the cost-benefit balance for mitigating radon in homes to the EPA action level of 4 pCi/L, or lower, is generally better than for most programs aimed at reducing environmental risks. Reduction of radon levels in new homes tends to be less costly; moreover, reduced radon levels in new construction may be achievable with a net cost savings to the homeowner due to concomitant decreases in energy expenses. Since programs to reduced radon exposure rely on voluntary actions by homeowners, the societal cost-benefit balance cannot dictate the extent of radon mitigation efforts. However, both economic incentives and governmental guidance can influence these efforts. Cost-benefit analysis can be an important tool in formulating such guidance

  11. Regulation of genomic and biobanking research in Africa: a content analysis of ethics guidelines, policies and procedures from 22 African countries.

    Science.gov (United States)

    de Vries, Jantina; Munung, Syntia Nchangwi; Matimba, Alice; McCurdy, Sheryl; Ouwe Missi Oukem-Boyer, Odile; Staunton, Ciara; Yakubu, Aminu; Tindana, Paulina

    2017-02-02

    The introduction of genomics and biobanking methodologies to the African research context has also introduced novel ways of doing science, based on values of sharing and reuse of data and samples. This shift raises ethical challenges that need to be considered when research is reviewed by ethics committees, relating for instance to broad consent, the feedback of individual genetic findings, and regulation of secondary sample access and use. Yet existing ethics guidelines and regulations in Africa do not successfully regulate research based on sharing, causing confusion about what is allowed, where and when. In order to understand better the ethics regulatory landscape around genomic research and biobanking, we conducted a comprehensive analysis of existing ethics guidelines, policies and other similar sources. We sourced 30 ethics regulatory documents from 22 African countries. We used software that assists with qualitative data analysis to conduct a thematic analysis of these documents. Surprisingly considering how contentious broad consent is in Africa, we found that most countries allow the use of this consent model, with its use banned in only three of the countries we investigated. In a likely response to fears about exploitation, the export of samples outside of the continent is strictly regulated, sometimes in conjunction with regulations around international collaboration. We also found that whilst an essential and critical component of ensuring ethical best practice in genomics research relates to the governance framework that accompanies sample and data sharing, this was most sparingly covered in the guidelines. There is a need for ethics guidelines in African countries to be adapted to the changing science policy landscape, which increasingly supports principles of openness, storage, sharing and secondary use. Current guidelines are not pertinent to the ethical challenges that such a new orientation raises, and therefore fail to provide accurate guidance

  12. Non-prescribed antimicrobial use and associated factors among customers in drug retail outlet in Central Zone of Tigray, northern Ethiopia: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Negash Hadera Gebrekirstos

    2017-06-01

    Full Text Available Abstract Background Non-prescribed antimicrobial use and their resistance are among the main public health problems, worldwide. In Ethiopia, particularly in the northern part, the magnitude of non-prescribed antimicrobial use and its major determinants is not yet well known. Thus, this study was done to assess the magnitude of non-prescribed anti-microbial use and associated factors among customers in drug retail outlet in Central Zone, Tigray, Ethiopia. Methods A drug retail outlet based cross-sectional study was conducted among adults aged 18 years and above. A multistage sampling procedure was used to select study participants. Data were collected using a structured questionnaire by druggists under the supervision of pharmacists. Data were entered into EpiInfo software version 3.5.4. Binary logistic regression was used to identify independently associated variables in bivariate and multivariable analyses using SPSS version 21. Odds Ratios with 95% confidence intervals were estimated. Results From 829 study samples, a total of 780 respondents participated in this study with a response rate of 94.1%. Of 367 respondents who received non-prescribed antimicrobial, 249 (67.8%, 121 (33%, and 94 (25.6% of them were males, secondary school and paid employed respectively. The magnitude of non-prescribed antimicrobial use was 47.1% (95% CI: 43.8, 50.5. The factors which were independently associated with non-prescribed antimicrobial use were male sex [AOR = 1.72, 95% CI = 1.21, 2.44], seeking modern health care in private/Non-Governmental Organization (NGO [AOR =0.47, 95% CI; 0.23, 0.98], moderate waiting time in health care facilities [AOR = 1.92, 95% CI; 1.20, 3.09], delayed waiting time in health care facilities [AOR = 1.56, 95% CI; 1.03, 2.38], ever received antimicrobial [AOR = 3.51, 95% CI; 2.45, 5.02], and frequency of purchasing non-prescribed antimicrobial (1–3 times and 4 times, [AOR = 2.04, 95% CI; 1.36, 3.06] and [AOR = 2

  13. Iran's health policymakers' views on barriers and facilitators of nurse prescribing in their context: A qualitative study

    Directory of Open Access Journals (Sweden)

    Azar Darvishpour

    2016-01-01

    Full Text Available Background: In most countries, one of the main reasons for developing more advanced roles for nurses is to improve access to care in the context of limited number of doctors. It is considered that the introduction of major policy initiatives, such as nurse prescribing, requires high-level discussion and policy development to ensure successful implementation. This study aimed to identify the barriers and facilitators of nurse prescribing based on policymakers' views in Iran. Materials and Methods: This qualitative study was based on conventional content analysis approach. A purposeful sample of 14 participants were recruited, including 6 members of the Nursing Board, 6 members of the Iranian Nursing Organization, and 2 senior employees of Iran's Ministry of Health and Medical Education. Data were gathered through in-depth semi-structured interviews. Interviews were audio-recorded and transcribed verbatim. Results: The four emerged categories as facilitators of nurse prescribing were labeled “positive views of health policymakers,” “human resources capabilities,” “non-medical prescribing experiences,” and “governmental and non-governmental organizational activities.” The four extracted categories as barriers of nurse prescribing were “socio-cultural factors,” “organizational factors,” “educational barriers,” and “human barriers.” Conclusions: Barriers and facilitating factors should be considered in order to bring about organizational policy changes and improve perspectives. Nurse prescribing requires the efforts of involved managers and authorities for development and modernization. The results of this study can serve as a compressed resource for policymakers and managers to identify the effective issues on nurse prescribing and can help them to plan for the implementation of nurse prescribing.

  14. Knowledge of antibiotic resistance and antibiotic prescription practices among prescribers in the Brong Ahafo Region of Ghana; a cross-sectional study.

    Science.gov (United States)

    Asante, Kwaku Poku; Boamah, Ellen Abrafi; Abdulai, Martha Ali; Buabeng, Kwame Ohene; Mahama, Emmanuel; Dzabeng, Francis; Gavor, Edith; Annan, Edith Andrews; Owusu-Agyei, Seth; Gyansa-Lutterodt, Martha

    2017-06-20

    Antibiotic resistance (ABR) has become a major public health challenge in most parts of the world including Ghana and is a major threat to gain in bacterial disease control. The role of prescribers in the control of antibiotics is identified as crucial in developing interventions to control ABR. To guide policy recommendations on ABR, a study was carried out among prescribers to identify gaps in their knowledge of ABR and to document their prescription practices. A cross-sectional survey was conducted among prescribers from both public and private facilities in the Brong Ahafo Region of Ghana using both quantitative and qualitative methods in 2014. Three hundred and seventy nine prescribers participated in the quantitative study and a subset of 33 participated in in-depth interviews. Majority (50.0%) of the prescribers interviewed were nurses. Most (51.0%) of the prescribers were located in hospitals. Knowledge of ABR was high among all the prescribers. About 80.0% percent of all prescribers agreed that the antibiotics that are currently used could lose its efficacy in future. There is no singular formal source of information on antibiotic resistance. The prescribers held a strong perception that antibiotic resistance is imminent though their knowledge on various resistant bacterial strains was limited. Prescribers attributed ABR burden to factors such as poor prescription practices and limited ABR control measures. The prescription practices of the prescribers vary but were mostly inappropriate among the lower cadre. The knowledge of ABR is high among prescribers. There is however a gap in the knowledge and perception of optimal antibiotic prescription practices among prescribers. There is the need for a formal source of information on ABR to support prescriber's antibiotic prescription practices.

  15. Opioid Prescribing Patterns and Patient Outcomes by Prescriber Type in the Oregon Prescription Drug Monitoring Program.

    Science.gov (United States)

    Fink, Patrick B; Deyo, Richard A; Hallvik, Sara E; Hildebran, Christi

    2017-11-16

    Prescription drug monitoring programs (PDMPs) were created to facilitate responsible use of controlled substances. In Oregon, physicians, physician's assistants (MDs/DOs/PAs), dentists, nurse practitioners (NPs), and naturopathic physicians (NDs) may prescribe opioids, but differences in prescribing practices, patient mix, and patient outcomes among prescriber types have not been characterized. De-identified Oregon PDMP data from October 2011 through October 2014 were linked with vital records and a statewide hospital discharge registry. The disciplines of registered prescribers were identified by board affiliations. Prescription profiles associated with opioid overdose risk were tabulated for patients with at least one registered prescriber. Opioid-related hospitalizations and deaths were identified using ICD-9 and ICD-10 codes. There were 5,935 prescribers registered during the study period. Patients of NPs or NDs received more high-risk opioid prescriptions than patients of MDs/DOs/PAs. For example, they received greater proportions of high-dose prescriptions (NP 12.9%, ND 15%, MD/DO/PA 11.1%), and had greater opioid-related hospitalization (NP 1.7%, ND 3.1%, MD/DO/PA 1.2%; P prescriptions came from prescribers in other disciplines. Our analysis suggests significant differences in opioid prescription profiles and opioid-related hospitalization and mortality among patients receiving opioid prescriptions from nurse practitioners, naturopathic physicians, or medical clinicians in Oregon. However, these differences appear largely due to differences in patient mix between provider types rather than discipline-specific prescribing practices. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  16. Negotiating jurisdiction in the workplace: a multiple-case study of nurse prescribing in hospital settings.

    Science.gov (United States)

    Kroezen, M; Mistiaen, P; van Dijk, L; Groenewegen, P P; Francke, A L

    2014-09-01

    This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and healthcare professionals renegotiate formal policies in the workplace. This paper studies the division of jurisdictional control over prescribing between nurse specialists and medical specialists in the workplace, and examines the relationship between workplace jurisdiction and legal jurisdiction over prescribing. Data collection took place in the Netherlands during the first half of 2013. The study used in-depth interviews with fifteen nurse specialists and fourteen medical specialists, non-participant observation of nurse specialists' prescribing consultations and document analysis. Great variety was found in the extent to which and way in which nurse specialists' legal prescriptive authority had been implemented. These findings suggest that there is considerable discrepancy between the division of jurisdictional control over prescribing at the macro (legal) level and the division at the micro (workplace) level. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Mahoney, Diane Feeney; Ladd, Elissa

    2010-01-01

    The purpose of this study was to gain understanding about nurse practitioners' (NPs') prescriptive decision making for geriatric patients with attention to pharmaceutical marketing influences. Prior research has focused on physician prescribers and identified suboptimal practices. Because the majority of medications are prescribed to older adults, NPs in geriatric practice were targeted as an information-rich group to interview about prescribing issues. Given the exploratory nature of this research, qualitative focus group methods were employed using content analysis. Fifteen NPs were recruited at an annual national geriatric NP conference. They worked in all regions of the United States, had an average of 9 years prescribing experience, and participated in 1 of the 2 focus groups. The key theme that emerged was that they were more than a prescriber. Findings revealed overwhelming consistency among the NP participants that their nursing background instilled a holistic approach that encompassed both nondrug and therapeutic drug options and skepticism about drug marketing, as well as offered a positive difference by tailoring to their patients' biophysical, psychological, and economic needs with an involvement in the interplay of geriatric care issues not typically addressed by physicians. The participants' reported approaches were in alignment with geriatric prescribing recommendations. Copyright 2010 Mosby, Inc. All rights reserved.

  18. Prescription Drug Monitoring Programs Are Associated With Sustained Reductions In Opioid Prescribing By Physicians.

    Science.gov (United States)

    Bao, Yuhua; Pan, Yijun; Taylor, Aryn; Radakrishnan, Sharmini; Luo, Feijun; Pincus, Harold Alan; Schackman, Bruce R

    2016-06-01

    State prescription drug monitoring programs are promising tools to rein in the epidemic of prescription opioid overdose. We used data from a national survey to assess the effects of these programs on the prescribing of opioid analgesics and other pain medications in ambulatory care settings at the point of care in twenty-four states from 2001 to 2010. We found that the implementation of a prescription drug monitoring program was associated with more than a 30 percent reduction in the rate of prescribing of Schedule II opioids. This reduction was seen immediately following the launch of the program and was maintained in the second and third years afterward. Effects on overall opioid prescribing and prescribing of non-opioid analgesics were limited. Increased use of these programs and the adoption of new policies and practices governing their use may have contributed to sustained effectiveness. Future studies are needed to evaluate the policies' comparative effectiveness. Project HOPE—The People-to-People Health Foundation, Inc.

  19. What Does ePrescribing Mean for Patients? A Case Study of the Perspectives of Hospital Renal Patients

    Directory of Open Access Journals (Sweden)

    Lisa Lee

    2015-11-01

    Full Text Available BACKGROUND: Hospital ePrescribing systems are expected to improve quality of care for patients, yet the perspectives of patients themselves have seldom been explored in the context of ePrescribing deployments.OBJECTIVE: We sought to understand the significance of ePrescribing for patients through a case study of renal in-patients on a hospital ward, before and after the introduction of an ePrescribing system.METHODS: Three data sources were drawn on as part of the case study: interviews with representatives from national patient groups (n = 10, in-patients on a renal ward (n = 11 pre-implementation; n = 12 post-implementation and fieldnotes (n = 25 of observations made on the case study ward. Data were analysed thematically focusing on: (1 perceived benefits of ePrescribing; (2 patient awareness and understanding of the medications prescribed and (3 patient views on medicines reconciliation at admission and discharge.RESULTS: While ePrescribing was viewed positively overall, its implementation in the case study site failed to address the lack of patient involvement in the prescribing process and poor medication counselling upon discharge. Importantly, the limited impact of the ePrescribing system in these particular areas appeared to be the result of institutional and cultural practices rather than solely technological factors.CONCLUSIONS: The introduction of ePrescribing systems offers new opportunities to improve sharing of knowledge and communication with all those involved in the patient’s care pathways, including patients, carers and healthcare professionals across diverse care settings. Achieving this will, first and foremost, require significant cultural and policy shifts in how the patient’s role is perceived by clinicians in relation to medicines management.

  20. Antibiotic prescribing in general practice--the rhythm of the week: a cross-sectional study.

    Science.gov (United States)

    Kuehlein, Thomas; Szecsenyi, Joachim; Gutscher, Andreas; Laux, Gunter

    2010-12-01

    Overprescribing of antibiotics in primary care is a worldwide phenomenon. Prescriptions can be used to reduce the uncertainty inherent in general practice. We assumed a heightened prescribing rate on Fridays because of more uncertainty before the pending weekend. Cross-sectional study from a general practice research database with 102 140 patients of 32 practices in Germany. Prescribing rates of antibiotics on different days of the week were analysed. In order to evaluate the influence of the weekday within a multivariate setting, we used SAS PROC GENMOD. This procedure was parameterized accordingly to account for the cluster design of the study. The prescribing rate of antibiotics on Fridays was 23.3% higher than the average of the other days of the working week (6.04% versus 4.90%, P overprescribing.

  1. Clinical Styles and Practice Policies: Influence on Communication with Patients Regarding Worrisome Prescription Drug Monitoring Program Data.

    Science.gov (United States)

    Hildebran, Christi; Leichtling, Gillian; Irvine, Jessica M; Cohen, Deborah J; Hallvik, Sara E; Deyo, Richard A

    2016-11-01

    Clinician communication with patients regarding worrisome findings in Prescription Drug Monitoring Programs (PDMPs) may influence patient responses and subsequent care. The authors studied the range of approaches clinicians report when communicating with patients in this situation and how practice policies and procedures may influence this communication. Qualitative interviews of clinician PDMP users. Oregon registrants in the state's PDMP. Thirty-three clinicians practicing in pain management, emergency medicine, primary care, psychiatry, dentistry, and surgery. The authors conducted semi-structured interviews via telephone with clinicians who routinely used the PDMP. A multidisciplinary team used a grounded theory approach to identify ways clinicians reported using information from the PDMP when communicating with patients, and policies that influenced that communication. Clinicians reported using a range of approaches for communicating about PDMP results, from openly sharing, to questioning patients without disclosing access to the PDMP, to avoiding the conversation. Clinicians also reported practice policies and procedures that influenced communication with their patients about prescribing and ongoing care, including policies that normalized use of the PDMP with all patients and those that facilitated difficult conversations by providing a rationale not to prescribe in certain circumstances. Clinicians' self-reported approaches to sharing PDMP findings and communicating prescribing decisions with patients vary and may be facilitated by appropriate practice policies. Such communication may have implications for patient engagement and alliance building. More research is needed to identify best practices and potential guidelines for effectively communicating about PDMP findings, as this may enhance health outcomes. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Medications prescribing pattern toward insured patients.

    Science.gov (United States)

    Al-Mohamadi, Ameen; Al-Harbi, Atika Mohammed; Manshi, Areej Mansour; Rakkah, Mona Majdi

    2014-01-01

    The rising costs of health care continue to make health insurance important for many countries. Health insurance may cover different aspects of health care in Saudi Arabia including the prescribed drugs. Physicians usually have different personal attitudes toward insured and uninsured patients. This study is to investigate the prescribing behavior of physicians to those groups of patients in the private setting. A prospective study was conducted during the period between October 2011 and January 2012, in three Saudi private hospitals. Prescriptions for insured and uninsured patients were randomly selected and analyzed. Data regarding diagnosis, age, gender, co-morbidity, number of items and the total cost of the medication in Saudi Riyals (SR) were collected through a chart review form. Three thousand sixty six patients' prescriptions were included in this study, 34.7% of them were females. 273 patients (75.2%) were insured while 90 were not. 24.8% were patients who paid cash. Majority (57.6%) of the patients were with diabetes plus hypertension and other co-morbidity. 20.7% of patients were taking three medications or less, while 67.8% were taking 4-10 and 11.6% were taking more than 10 medications. Analysis of differences showed that, patients who were insured have a higher number of prescribed medications (p ⩽ 0.001), and a higher total price of prescription than those who were paying cash only (p ⩽ 0.001). In a more confirmatory step, all uninsured patients (n = 90) were closely matched in the age, gender, diagnosis and hospital with similar 90 insured patients. Results of this matching process confirmed the above findings. Physicians in private setting are more likely to prescribe more drugs and/or brand drugs to insured patients than for uninsured patients. Further studies to view the reasons behind this behavior and strategies to prevent such actions are needed.

  3. The Impact of Quality Assurance Initiatives and Workplace Policies and Procedures on HIV/AIDS-Related Stigma Experienced by Patients and Nurses in Regions with High Prevalence of HIV/AIDS.

    Science.gov (United States)

    Hewko, Sarah J; Cummings, Greta G; Pietrosanu, Matthew; Edwards, Nancy

    2018-02-23

    Stigma is commonly experienced by people living with HIV/AIDS and by those providing care to HIV/AIDS patients. Few intervention studies have explored the impact of workplace policies and/or quality improvement on stigma. We examine the contribution of health care workplace policies, procedures and quality assurance initiatives, and self- and peer-assessed individual nurse practices, to nurse-reported HIV/AIDS-stigma practices toward patients living with HIV/AIDS and nurses in health care settings. Our sample of survey respondents (n = 1157) included managers (n = 392) and registered/enrolled nurses (n = 765) from 29 facilities in 4 countries (South Africa, Uganda, Jamaica, Kenya). This is one of the first studies in LMIC countries to use hierarchical linear modeling to examine the contributions of organizational and individual factors to HIV/AIDS stigma. Based on our results, we argue that organizational interventions explicitly targeting HIV/AIDS stigma are required to reduce the incidence, prevalence and morbidity of HIV/AIDS.

  4. Regulations and Procedures Manual

    Energy Technology Data Exchange (ETDEWEB)

    Young, Lydia J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2011-07-25

    The purpose of the Regulations and Procedures Manual (RPM) is to provide LBNL personnel with a reference to University and Lawrence Berkeley National Laboratory (LBNL or Laboratory) policies and regulations by outlining normal practices and answering most policy questions that arise in the day-to-day operations of Laboratory organizations. Much of the information in this manual has been condensed from detail provided in LBNL procedure manuals, Department of Energy (DOE) directives, and Contract DE-AC02-05CH11231. This manual is not intended, however, to replace any of those documents. RPM sections on personnel apply only to employees who are not represented by unions. Personnel policies pertaining to employees represented by unions may be found in their labor agreements. Questions concerning policy interpretation should be directed to the LBNL organization responsible for the particular policy. A link to the Managers Responsible for RPM Sections is available on the RPM home page. If it is not clear which organization is responsible for a policy, please contact Requirements Manager Lydia Young or the RPM Editor.

  5. 75 deaths in asthmatics prescribed home nebulisers.

    Science.gov (United States)

    Sears, M R; Rea, H H; Fenwick, J; Gillies, A J; Holst, P E; O'Donnell, T V; Rothwell, R P

    1987-02-21

    The circumstances surrounding the deaths of 75 asthmatic patients who had been prescribed a domiciliary nebuliser driven by an air compressor pump for administration of high dose beta sympathomimetic drugs were investigated as part of the New Zealand national asthma mortality study. Death was judged unavoidable in 19 patients who seemed to have precipitous attacks despite apparently good long term management. Delays in seeking medical help because of overreliance on beta agonist delivered by nebuliser were evident in 12 cases and possible in a further 11, but these represented only 8% of the 271 verified deaths from asthma in New Zealanders aged under 70 during the period. Evidence for direct toxicity of high dose beta agonist was not found. Nevertheless, the absence of serum potassium and theophylline concentrations and of electrocardiographic monitoring in the period immediately preceding death precluded firm conclusions whether arrhythmias might have occurred due to these factors rather than to hypoxia alone. In most patients prescribed domiciliary nebulisers death was associated with deficiencies in long term and short term care similar to those seen in patients without nebulisers. Discretion in prescribing home nebulisers, greater use of other appropriate drugs, including adequate corticosteroids, and careful supervision and instruction of patients taking beta agonist by nebuliser should help to reduce the mortality from asthma.

  6. 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

  7. Influence of a systems-based approach to prescribing errors in a pediatric resident clinic.

    Science.gov (United States)

    Condren, Michelle; Honey, Brooke L; Carter, Sandra M; Ngo, Nelson; Landsaw, Jeremy; Bryant, Cheryl; Gillaspy, Stephen

    2014-01-01

    To measure the difference in prescribing error rates between 2 clinics, 1 with a system in place to reduce errors and 1 with no such system; to determine variables that affect the likelihood of prescription errors. This was a retrospective study at 2 university-based general pediatric clinics utilizing the same electronic medical record (EMR) system. Clinic 1 employed pharmacists who provided daily prescription review, provider feedback and education, and EMR customization to decrease errors. Clinic 2 had no systems in place for reducing prescribing errors. Prescriptions written by resident physicians over 2 months were identified and reviewed. A total of 1361 prescriptions were reviewed, 40.7% from clinic 1 and 59.3% from clinic 2. Errors were found in 201 prescriptions (14.8%). Clinics 1 and 2 had error rates of 11% and 17.5%, respectively (P = .0012). The odds of a prescription error at clinic 2 were 1.7 times the odds of a prescription error at clinic 1. Logistic regression identified clinic, nonpediatric resident, liquid dose forms, and younger patient age as significant predictors of prescription errors. Half of the errors could have been prevented with consistent use of a custom medication list within the EMR. We found 37% fewer prescribing errors in a clinic with systems in place for prescribing error detection and prevention. Pediatric clinics should explore systematic procedures for identifying, resolving, and providing education about prescribing errors to reduce patient risk. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  8. Information Security - Data Loss Prevention Procedure

    Science.gov (United States)

    The purpose of this procedure is to extend and provide specificity to the Environmental Protection Agency (EPA) Information Security Policy regarding data loss prevention and digital rights management.

  9. 40 CFR 89.404 - Test procedure overview.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Test procedure overview. 89.404... (CONTINUED) CONTROL OF EMISSIONS FROM NEW AND IN-USE NONROAD COMPRESSION-IGNITION ENGINES Exhaust Emission Test Procedures § 89.404 Test procedure overview. (a) The test consists of prescribed sequences of...

  10. FDA's expanding postmarket authority to monitor and publicize food and consumer health product risks: the need for procedural safeguards to reduce "transparency" policy harms in the post-9/11 regulatory environment.

    Science.gov (United States)

    Roller, Sarah Taylor; Pippins, Raqiyyah R; Ngai, Jennifer W

    2009-01-01

    This article provides a summary of the expansion of FDA's discretionary authority in the post-9/11 period, particularly with respect to FDA's authority to monitor and publicize potential health risks linked to food, dietary supplements, nonprescription drugs, and other consumer health products. In addition, this article evaluates the need for FDA to establish procedural safeguards to reduce the significant risks of unintended and undue harm to people and regulated companies that can result from adverse publicity in the more "transparent" post 9/11 FDA regulatory environment. Specifically, Part I summarizes the amendments to the FDCA enacted during the post-9/11 period that have expanded FDA's postmarket authority to monitor, evaluate, and publicize potential health risks linked to food, dietary supplements, nonprescription drugs and other consumer health products marketed in the United States, in conjunction with FDA's Sentinel Initiative, Reportable Food Registry, and other adverse event reporting requirements. Part II discusses the convergence of FDA's expanded postmarket authority to publicize product-related risks with President Obama's transparency initiative aimed at fostering "open government" through increased public access to government information. In addition, Part II considers the nature of the procedural safeguards needed in the post-9/11 FDA regulatory environment, in view of FDA's historical record and illustrative cases that help expose how adverse "transparency" surrounding FDA warning letters, recalls and safety alerts concerning products in the marketplace can have undue and unintended prejudicial and harmful effects for the people and companies that are legally responsible for such products. Finally, based on these analysis, this article concludes with some observations concerning the nature of the procedural safeguards needed to reduce the significant risks of "transparency" policy harms in the pos-9/11 regulatory environment.

  11. Pollutant Assessments Group procedures manual: Volume 2, Technical procedures

    Energy Technology Data Exchange (ETDEWEB)

    1992-03-01

    This is volume 2 of the manuals that describes the technical procedures currently in use by the Pollution Assessments Group. This manual incorporates new developments in hazardous waste assessment technology and administrative policy. Descriptions of the equipment, procedures and operations of such things as radiation detection, soil sampling, radionuclide monitoring, and equipment decontamination are included in this manual. (MB)

  12. Prescribing practices in two health care facilities in Warri, Southern ...

    African Journals Online (AJOL)

    ... overuse of antibiotics and low rate generic prescribing still occur in the health facilities studied. Drug availability, clinician\\'s level of training, cost of drugs, feedback from patients and socio-economic status of patients are major factors influencing prescribing in the facilities. Keywords: Drug prescribing, Indicators, Practices, ...

  13. Antibiotic Utilization and Prescribing Patterns in a Nigerian ...

    African Journals Online (AJOL)

    The study of prescribing pattern seeks to monitor, evaluate and suggest a modification in prescriber's prescribing habits so as to make medical care rational and cost effective. Information about antibiotic use pattern is necessary for a constructive approach to problems that arise from multiple antibiotics available. To identify ...

  14. Using relative humidity to predict spotfire probability on prescribed burns

    Science.gov (United States)

    John R. Weir

    2007-01-01

    Spotfires have and always will be a problem that burn bosses and fire crews will have to contend with on prescribed burns. Weather factors (temperature, wind speed and relative humidity) are the main variables burn bosses can use to predict and monitor prescribed fire behavior. At the Oklahoma State University Research Range, prescribed burns are conducted during...

  15. Prevalence and Correlates of “High Dose” Antipsychotic Prescribing ...

    African Journals Online (AJOL)

    of high dose prescriptions. We also noted a change in the patterns of antipsyhotics prescribed at this center. In a previous study on psychotropic drug prescribing at this hospital in 2007,[21] it was found that haloperidol was the most commonly prescribed antipsychotic drug, followed by chlorpromazine and trifluoperazine.

  16. Perspectives on prescribed fire in the south: does ethnicity matter?

    Science.gov (United States)

    Siew Hoon Lim; J.M. Bowker; Cassandra Y. Johnson; H. Ken Cordell

    2009-01-01

    Using a household survey and regression methods, we assessed preferences for prescribed fire in the southern United States. We found that the majority of the respondents favored the use of prescribed fire. However, we observed pronounced racial variation in opinions on prescribed fire and its side effects. African Americans and Hispanics were less supportive and were...

  17. The effects of nurse prescribing: A systematic review

    NARCIS (Netherlands)

    Gielen, S.C.; Dekker, J.; Francke, A.L.; Mistiaen, P.; Kroezen, M.

    2014-01-01

    Background: In 2008, we conducted a systematic review on the effects of nurse prescribing using studies with a comparative design. In view of the growing number of countries that are introducing nurse prescribing and the fact that several studies into nurse prescribing have been conducted recently,

  18. 9 CFR 97.2 - Administrative instructions prescribing commuted traveltime.

    Science.gov (United States)

    2010-01-01

    ... prescribing commuted traveltime. 97.2 Section 97.2 Animals and Animal Products ANIMAL AND PLANT HEALTH... ANIMAL PRODUCTS OVERTIME SERVICES RELATING TO IMPORTS AND EXPORTS § 97.2 Administrative instructions prescribing commuted traveltime. Each period of overtime and holiday duty as prescribed in § 97.1 shall in...

  19. 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

    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...

  20. The effects of nurse prescribing: a systematic review.

    NARCIS (Netherlands)

    Gielen, S.C.; Dekker, J.; Francke, A.L.; Mistiaen, P.; Kroezen, M.

    2014-01-01

    Background: In 2008, we conducted a systematic review on the effects of nurse prescribing using studies with a comparative design. In view of the growing number of countries that are introducing nurse prescribing and the fact that several studies into nurse prescribing have been conducted recently,

  1. Quantization Procedures

    International Nuclear Information System (INIS)

    Cabrera, J. A.; Martin, R.

    1976-01-01

    We present in this work a review of the conventional quantization procedure, the proposed by I.E. Segal and a new quantization procedure similar to this one for use in non linear problems. We apply this quantization procedures to different potentials and we obtain the appropriate equations of motion. It is shown that for the linear case the three procedures exposed are equivalent but for the non linear cases we obtain different equations of motion and different energy spectra. (Author) 16 refs

  2. Impact of prescription drug monitoring programs and pill mill laws on high-risk opioid prescribers: A comparative interrupted time series analysis.

    Science.gov (United States)

    Chang, Hsien-Yen; Lyapustina, Tatyana; Rutkow, Lainie; Daubresse, Matthew; Richey, Matt; Faul, Mark; Stuart, Elizabeth A; Alexander, G Caleb

    2016-08-01

    Prescription drug monitoring programs (PDMPs) and pill mill laws were implemented to reduce opioid-related injuries/deaths. We evaluated their effects on high-risk prescribers in Florida. We used IMS Health's LRx Lifelink database between July 2010 and September 2012 to identify opioid-prescribing prescribers in Florida (intervention state, N: 38,465) and Georgia (control state, N: 18,566). The pre-intervention, intervention, and post-intervention periods were: July 2010-June 2011, July 2011-September 2011, and October 2011-September 2012. High-risk prescribers were those in the top 5th percentile of opioid volume during four consecutive calendar quarters. We applied comparative interrupted time series models to evaluate policy effects on clinical practices and monthly prescribing measures for low-risk/high-risk prescribers. We identified 1526 (4.0%) high-risk prescribers in Florida, accounting for 67% of total opioid volume and 40% of total opioid prescriptions. Relative to their lower-risk counterparts, they wrote sixteen times more monthly opioid prescriptions (79 vs. 5, pprescription-filling patients receiving opioids (47% vs. 19%, pprescriptions (-536 patients/month, 95% confidence intervals [CI] -829 to -243; -847 prescriptions/month, CI -1498 to -197), morphine equivalent dose (-0.88mg/month, CI -1.13 to -0.62), and total opioid volume (-3.88kg/month, CI -5.14 to -2.62). Low-risk providers did not experience statistically significantly relative reductions, nor did policy implementation affect the status of being high- vs. low- risk prescribers. High-risk prescribers are disproportionately responsive to state policies. However, opioids-prescribing remains highly concentrated among high-risk providers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Science and technology policy

    DEFF Research Database (Denmark)

    Who is responsible for environmental and technological policy in Denmark? And how are those "policy-makers" made accountable to the public for their decisions?   This report attempts to answer these important questions by presenting the Danish contribution to the EU-funded project, Analysing Public...... Accountability Procedures in Europe.   The first chapter presents Danish public accountability procedures and places them in historical perspective. The other chapters are case studies of genetically modified food, transport policy in the Copenhagen area with a focus on the Metro, and local waste management...

  4. The Howling Prescribed Natural Fire - long-term effects on the modernization of planning and implementation of wildland fire management

    Science.gov (United States)

    Tom Zimmerman; Laurie Kurth; Mitchell Burgard

    2011-01-01

    Wildland fire management policy and practices have long been driven by the occurrence of significant events. The Howling Prescribed Natural Fire in Glacier National Park in 1994 is a prime example of a significant historical fire event that provided the impetus for program changes and modifications that modernized wildland fire management at the local, regional, and...

  5. Refining metformin prescribing in New Zealand.

    Science.gov (United States)

    Jayathissa, Sisira; Dixon, Paul; Bruce, Raymond; Reith, David

    2017-03-24

    Metformin is the mainstay of treatment of type 2 diabetes. However, there has been significant concern on prescribing metformin in patients with renal impairment as a result of metformin-associated lactic acidosis (MALA). Recent studies have cast doubt on the existence of MALA purely related to metformin use. Medsafe recently initiated changes to datasheet so lower doses of metformin could be used in patients with GFR down to 15ml/min. In this paper we outline the context and implications of this change.

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

    Science.gov (United States)

    Schwarzenbrunner, Thomas

    2014-12-01

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

  7. 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.

  8. 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.

  9. Regulations and Procedures Manual

    Energy Technology Data Exchange (ETDEWEB)

    Young, Lydia [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2010-09-30

    The purpose of the Regulations and Procedures Manual (RPM) is to provide Laboratory personnel with a reference to University and Lawrence Berkeley National Laboratory policies and regulations by outlining the normal practices and answering most policy questions that arise in the day-to-day operations of Laboratory departments. Much of the information in this manual has been condensed from detail provided in Laboratory procedure manuals, Department of Energy (DOE) directives, and Contract DE-AC02-05CH11231. This manual is not intended, however, to replace any of those documents. The sections on personnel apply only to employees who are not represented by unions. Personnel policies pertaining to employees represented by unions may be found in their labor agreements. Questions concerning policy interpretation should be directed to the department responsible for the particular policy. A link to the Managers Responsible for RPM Sections is available on the RPM home page. If it is not clear which department should be called, please contact the Associate Laboratory Director of Operations.

  10. Qualitative analysis of multi-disciplinary round-table discussions on the acceleration of benefits and data analytics through hospital electronic prescribing (ePrescribing systems

    Directory of Open Access Journals (Sweden)

    Kathrin Cresswell

    2016-07-01

    Full Text Available Background: Electronic systems that facilitate prescribing, administration and dispensing of medicines (ePrescribing systems are at the heart of international efforts to improve the safety, quality and efficiency of medicine management. Considering the initial costs of procuring and maintaining ePrescribing systems, there is a need to better understand how to accelerate and maximise the financial benefits associated with these systems. Objectives: We sought to investigate how different sectors are approaching the realisation of returns on investment from ePrescribing systems in U.K. hospitals and what lessons can be learned for future developments and implementation strategies within healthcare settings. Methods: We conducted international, multi-disciplinary, round-table discussions with 21 participants from different backgrounds including policy makers, healthcare organisations, academic researchers, vendors and patient representatives. The discussions were audio-recorded, transcribed and then thematically analysed with the qualitative analysis software NVivo10. Results: There was an over-riding concern that realising financial returns from ePrescribing systems was challenging. The underlying reasons included substantial fixed costs of care provision, the difficulties in radically changing the medicines management process and the lack of capacity within NHS hospitals to analyse and exploit the digital data being generated. Any future data strategy should take into account the need to collect and analyse local and national data (i.e. within and across hospitals, setting comparators to measure progress (i.e. baseline measurements and clear standards guiding data management so that data are comparable across settings. Conclusions: A more coherent national approach to realising financial benefits from ePrescribing systems is needed as implementations progress and the range of tools to collect information will lead to exponential data growth. The

  11. Civilian primary care prescribing psychologist in an army medical center.

    Science.gov (United States)

    Shearer, David S

    2012-12-01

    The present article discusses the integration of a civilian prescribing psychologist into a primary care clinic at Madigan Army Medical Center. A description of the role of the prescribing psychologist in this setting is provided. The author asserts that integrating prescribing psychology into primary care can improve patient access to skilled behavioral health services including psychotherapeutic and psychopharmacologic treatment. Potential benefits to the primary care providers (PCPs) working in primary care clinics are discussed. The importance of collaboration between the prescribing psychologist and PCP is emphasized. Initial feedback indicates that integration of a prescribing psychologist into primary care has been well received in this setting.

  12. Non- medical prescribing in Australasia and the UK: the case of podiatry

    Directory of Open Access Journals (Sweden)

    Nancarrow Susan A

    2010-01-01

    Full Text Available Abstract Background The last decade has witnessed a rapid transformation in the role boundaries of the allied health professions, enabled through the creation of new roles and the expansion of existing, traditional roles. A strategy of health care 'modernisation' has encompassed calls for the redrawing of professional boundaries and identities, linked with demands for greater workforce flexibility. Several tasks and roles previously within the exclusive domain of medicine have been delegated to, or assumed by, allied health professionals, as the workforce is reshaped to meet the challenges posed by changing demographic, social and political contexts. The prescribing of medicines by non-medically qualified healthcare professionals, and in particular the podiatry profession, reflects these changes. Methods Using a range of key primary documentary sources derived from published material in the public domain and unpublished material in private possession, this paper traces the development of contemporary UK and Australasian podiatric prescribing, access, supply and administration of medicines. Documentary sources include material from legislative, health policy, regulatory and professional bodies (including both State and Federal sources in Australia. Results Tracing a chronological, comparative, socio-historical account of the emergence and development of 'prescribing' in podiatry in both Australasia and the UK enables an analysis of the impact of health policy reforms on the use of, and access to, medicines by podiatrists. The advent of neo-liberal healthcare policies, coupled with demands for workforce flexibility and role transfer within a climate of demographic, economic and social change has enabled allied health professionals to undertake an expanding number of tasks involving the sale, supply, administration and prescription of medicines. Conclusion As a challenge to medical dominance, these changes, although driven by wider healthcare

  13. Prescribing by nurse practitioners: Insights from a New Zealand study.

    Science.gov (United States)

    Poot, Betty; Zonneveld, Rebecca; Nelson, Katherine; Weatherall, Mark

    2017-10-01

    Nurse practitioners (NPs) in New Zealand have been able to prescribe medicines since 2001; however, little is known about their prescribing practice. This study describes the NPs who prescribe community-dispensed medicines, the patients, and identifies the most frequently prescribed medications. A retrospective search of the Ministry of Health pharmaceutical collection was completed from 2013 to 2015. NP registration number, patient age, gender, deprivation index, and the name and date of dispensed medication, including the New Zealand pharmaceutical schedule therapeutic group, were identified. NPs prescribe a broad range of medications across all therapeutic groups with antibacterial and analgesics being the most commonly prescribed medicines. This is comparable to all prescribers in New Zealand and NPs in Australia. The majority of patients lived in the more deprived areas of New Zealand indicating that NPs are working in areas of greater health need. The majority of NPs registered in New Zealand prescribe medicines. Those in primary care prescribe the most medications. NPs prescribe a broad range of medicines across all drug therapeutic groups. The patients seen by NPs often live in the most deprived areas of New Zealand. Understanding prescribing patterns will help to inform curricular development and continuing education programs for NPs. ©2017 American Association of Nurse Practitioners.

  14. Personal and professional challenges of nurse prescribing in Ireland.

    Science.gov (United States)

    McBrien, Barry

    This article presents the challenges regarding the development of a collaborative practice agreement in order to undertake nurse prescribing in an emergency department in a large teaching hospital. Nurse prescribing has been introduced quite recently in Ireland. Although there is a plethora of knowledge regarding the topic, there are many personal and professional challenges in relation to this emerging role. The nurse prescribing initiative in Ireland is continually developing and many nurses now have the authority to prescribe from almost the same range of medicines as doctors. Prescribing has the potential to improve job satisfaction, autonomy and ultimately improves patient outcomes. However, nurses need to be cognisant of the impact it can have on the dynamics of the healthcare team. An analysis of some complexities of nurse prescribing is given, in conjunction with reflective thoughts on a clinical incident in the area of morphine prescribing.

  15. The Impact of Prescription Drug Monitoring Programs and Prescribing Guidelines on Emergency Department Opioid Prescribing: A Multi-Center Survey.

    Science.gov (United States)

    Pomerleau, Adam C; Nelson, Lewis S; Hoppe, Jason A; Salzman, Matthew; Weiss, Paul S; Perrone, Jeanmarie

    2017-05-01

    Emergency department (ED) providers are high volume but low quantity prescribers of opioid analgesics (OA). Few studies have examined differences in opioid prescribing decisions specifically among ED providers. The aim of this study was to describe OA prescribing decisions of ED providers at geographically diverse centers, including utilization of prescribing guidelines and prescription drug monitoring programs (PDMP). This was a multi-center cross-sectional Web-based survey of ED providers who prescribe OA. Respondents were asked about their OA prescribing decisions, their use of PDMPs, and their use of prescribing guidelines. Data was analyzed using descriptive statistics and chi-square tests of association were used to assess the relationship between providers' opioid prescribing decisions and independent covariates. The total survey population was 957 individuals and 515 responded to the survey for an overall response rate of 54%. The frequency respondents prescribed different types of pain medication was variable between centers. of respondents were registered to access a PDMP, and were not aware whether their state had a PDMP. Forty percent (172/426) of respondents used OA prescribing guidelines, while 24% (103/426) did not, and 35% (151/426) were unaware of prescribing guidelines. No significant differences in OA prescribing decisions were found between groups either by use of PDMP or by guideline adherence. In this multi-center survey study of ED clinicians, OA prescribing varied between centers The utilization of prescribing guidelines and PDMPs was not associated with differences in OA prescribing decisions. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  16. 7 CFR 28.162 - Procedure.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Procedure. 28.162 Section 28.162 Agriculture..., TESTING, AND STANDARDS Regulations Under the United States Cotton Standards Act Adjustment of Contract... and in instituting and conducting arbitrations and appeals shall be as prescribed in the articles...

  17. States With Prescription Drug Monitoring Mandates Saw A Reduction In Opioids Prescribed To Medicaid Enrollees.

    Science.gov (United States)

    Wen, Hefei; Schackman, Bruce R; Aden, Brandon; Bao, Yuhua

    2017-04-01

    Prescription drug monitoring programs are promising tools to use in addressing the prescription opioid epidemic, yet prescribers' participation in these state-run programs remained low as of 2014. Statutory mandates for prescribers to register with their state's program, use it, or both are believed to be effective tools to realize the programs' full potential. Our analysis of aggregate Medicaid drug utilization data indicates that state mandates for prescriber registration or use adopted in 2011-14 were associated with a reduction of 9-10 percent in population-adjusted numbers of Schedule II opioid prescriptions received by Medicaid enrollees and amounts of Medicaid spending on these prescriptions. This effect was largely associated with mandates of registration, which were comprehensive in all adopting states, and not with mandates of use, which were largely limited in scope or strength before 2015. Our findings support the use of mandates of registration in prescription drug monitoring programs as an effective and relatively low-cost policy. Future research should further assess the value of strong mandates of use to ensure safer and more appropriate prescribing of opioids. Project HOPE—The People-to-People Health Foundation, Inc.

  18. Physician prescribing of opioid agonist treatments in provincial correctional facilities in Ontario, Canada: A survey.

    Directory of Open Access Journals (Sweden)

    Fiona G Kouyoumdjian

    Full Text Available Substance use and substance use disorders are common in people who experience detention or incarceration in Canada, and opioid agonist treatment (OAT may reduce the harms associated with substance use disorders. We aimed to define current physician practice in provincial correctional facilities in Ontario with respect to prescribing OAT and to identify potential barriers and facilitators to prescribing OAT.We invited all physicians practicing in the 26 provincial correctional facilities for adults in Ontario to participate in an online survey.Twenty-seven physicians participated, with representation from most correctional facilities in Ontario. Of participating physicians, 52% reported prescribing methadone and 48% reported prescribing buprenorphine/naloxone to patients in provincial correctional facilities. Nineteen percent of participants reported initiating methadone treatment and 11% reported initiating buprenorphine/naloxone for patients in custody. Participants identified multiple barriers to initiating OAT in provincial correctional facilities including concerns about medication diversion and safety, concerns about initiating treatment in patients who are not currently using opioids, lack of linkage with community-based providers and the Ministry of Community Safety and Correctional Services policy. Identified facilitators to initiating OAT were support from institutional health care staff and administrative staff, adequate resources for program delivery and access to linkage with community-based OAT providers.This study identifies opportunities to improve OAT programs and to improve access to OAT for persons in provincial correctional facilities in Ontario.

  19. A transdisciplinary approach to understanding the health effects of wildfire and prescribed fire smoke regimes

    Science.gov (United States)

    Williamson, G. J.; Bowman, D. M. J. S.; Price, O. F.; Henderson, S. B.; Johnston, F. H.

    2016-12-01

    Prescribed burning is used to reduce the occurrence, extent and severity of uncontrolled fires in many flammable landscapes. However, epidemiologic evidence of the human health impacts of landscape fire smoke emissions is shaping fire management practice through increasingly stringent environmental regulation and public health policy. An unresolved question, critical for sustainable fire management, concerns the comparative human health effects of smoke from wild and prescribed fires. Here we review current knowledge of the health effects of landscape fire emissions and consider the similarities and differences in smoke from wild and prescribed fires with respect to the typical combustion conditions and fuel properties, the quality and magnitude of air pollution emissions, and the potential for dispersion to large populations. We further examine the interactions between these considerations, and how they may shape the longer term smoke regimes to which populations are exposed. We identify numerous knowledge gaps and propose a conceptual framework that describes pathways to better understanding of the health trade-offs of prescribed and wildfire smoke regimes.

  20. 'Doing the right thing': factors influencing GP prescribing of antidepressants and prescribed doses.

    Science.gov (United States)

    Johnson, Chris F; Williams, Brian; MacGillivray, Stephen A; Dougall, Nadine J; Maxwell, Margaret

    2017-06-17

    Antidepressant prescribing continues to increase, with 5-16% of adults receiving antidepressants annually. Total prescribing growth is due in part to increased long-term use, greater selective serotonin re-uptake inhibitor (SSRI) use and the use of higher SSRI doses. Evidence does not support routine use of higher SSRI doses for depression treatment, and factors influencing the use of such doses are not well known. The aim of this study was to explore factors influencing GPs' use of antidepressants and their doses to treat depression. Semi-structured interviews with a purposive sample of 28 practising GPs; sampled by antidepressant prescribing volume, practice size and deprivation level. A topic guide drawing on past literature was used with enough flexibility to allow additional themes to emerge. Interviews were audio-recorded and transcribed verbatim. Framework analysis was employed. Constant comparison and disconfirmation were carried out across transcripts, with data collection being interspersed with analysis by three researchers. The thematic framework was then systematically applied to the data and conceptualised into an overarching explanatory model. Depression treatment involved ethical and professional imperatives of 'doing the right thing' for individuals by striving to achieve the 'right care fit'. This involved medicalised and non-medicalised patient-centred approaches. Factors influencing antidepressant prescribing and doses varied over time from first presentation, to antidepressant initiation and longer-term treatment. When faced with distressed patients showing symptoms of moderate to severe depression GPs were confident prescribing SSRIs which they considered as safe and effective medicines, and ethically and professionally appropriate. Many GPs were unaware that higher doses lacked greater efficacy and onset of action occurred within 1-2 weeks, preferring to wait 8-12 weeks before increasing or switching. Ongoing pressures to maintain

  1. Drug use evaluation of antibiotics prescribed in a Jordanian hospital outpatient and emergency clinics using WHO prescribing indicators

    International Nuclear Information System (INIS)

    Al-Niemat, Sahar I.; Bloukh, Diana T.; Al-Harasis, Manal D.; Al-Fanek, Alen F.; Salah, Rehab K.

    2008-01-01

    Objective was to evaluate the use of antibiotics prescribed in hospital outpatient and emergency clinics in King Hussein Medical Centre (KHMC) using WHO prescribing indicators in an attempt to rationalize the use of antibiotics in the Royal Medical Services. We retrospectively surveyed a sample of 187,822 antibiotic prescriptions obtained from 5 outpatient pharmacies in KHMC written over the period of 3 consecutive months May 2007 to July 2007. The percentage of encounters of an antibiotic prescribed was calculated using the methodology recommended by the WHO. An additional indicator, the percentage share of different antibiotics was also included to identify the frequency prescribed from those antibiotics. The average percentage of prescriptions involving antibiotics was 35.6% out of 187,822 prescriptions surveyed. From these, 65,500 antibiotic prescriptions were observed. Penicillins most frequently amoxcillins and Quinolones most frequently ciprofloxacinllin and norfloxacillin were the most commonly prescribed antibiotics with an average percentage of 31.8% and 27.5%. The average prescribing rate for the other antibiotic categories was as follows: macrolides 5.2%, cephalosporins 16% and amoxcillins/clavulanate 5.4%. The high percentage of prescriptions involving antibiotics observed in KHMC pharmacies requires rational use of antibiotics and judicious prescribing by Military prescribers. An insight into factors influencing antibiotic prescribing patterns and adherence to antibiotic prescribing guidelines by the Military prescribers is warranted. (author)

  2. Accreditation Criteria: Policies, Procedures, and Standards

    Science.gov (United States)

    Accrediting Council for Independent Colleges and Schools, 2010

    2010-01-01

    The Accrediting Council for Independent Colleges and Schools ("ACICS" or "Council") supports the concept that periodic evaluation entered into voluntarily by institutions and their peers enhances the quality of the educational process and demonstrates that self regulation of a profession is superior to outside regulation. This has been the…

  3. Military Personnel Casualty Matters, Policies, and Procedures

    Science.gov (United States)

    1991-12-27

    Same Daughter Mr. Thomas (NMI) Edison 5222 Lightbulb Dr, Arkon, OH 4 4 Father(3) ,Ii 10. REMARKS (CoUnvo on mpau# shEoot If nemw’y) *Item 5d continued...i, . : .j - .- .4. Department of Defense . S INSTRUCTIONAD-A269 412 111111 4 December 27, 1991 NUMBER 1300.18 ASD(FM&P) SUBJECT: Military Personnel...and Associated S P b Terms," December A, 1989 (d) DoD Directive 5010.38, "Internal Management Control Program," April 14, 1987 (e) through (m), see

  4. Prescriber compliance with black box warnings in older adult patients.

    Science.gov (United States)

    Ricci, Judith R; Coulen, Charmaine; Berger, Jan E; Moore, Marsha C; McQueen, Angela; Jan, Saira A

    2009-11-01

    Patients prescribed medications with US Food and Drug Administration-issued black box warnings (BBWs) warrant additional vigilance by prescribers because these drugs can cause serious adverse drug events. Seniors are at greater risk for adverse drug events due to increased medication burden and greater health vulnerability. To improve our understanding of the prescribing and patient-monitoring practices of physicians prescribing medications with a BBW to patients age >or=65 years in an ambulatory care setting. A retrospective cohort study of administrative pharmacy and medical claims identified 58,190 patients age >or=65 years in the Horizon Blue Cross Blue Shield of New Jersey beneficiary population with >or=1 claim for >or=1 of the 8 targeted medications between January 1, 2005, and December 31, 2005. Medications included carbamazepine, amiodarone, ketoconazole, loop diuretics, methotrexate, cyclosporine, metformin and combinations, and cilostazol. Patients were followed 12 months from the index prescription date to evaluate prescriber compliance with BBWs using operationalized definitions of compliance. Patients prescribed drugs with a drug-laboratory warning had lower rates of prescriber BBW compliance (0.7%-24.9%) than patients prescribed drugs with a drug-disease warning (84.7%-90.2%). Administrative claims analysis identified low rates of prescriber compliance with BBWs in managing patients age >or=65 years. Claims analysis may be a cost-effective strategy to monitor prescriber compliance with BBWs in older patients at higher risk.

  5. Prescribing Analysis for 2–5 Years Old Children in Bandung During Year 2012

    Directory of Open Access Journals (Sweden)

    Ami A. Pratiwi

    2014-03-01

    Full Text Available Despite the fact that irrational use of drugs will give medication errors effect or cause the unwanted side effects. The National Drug Policy (KONAS has developed drug policies that involve all stake-holders in Indonesia in order to minimize the irrational drug use. This study aims to analyze drug prescribing for 2–5 years old children in 14 pharmacies in Bandung during 2012. Approximately 2,195 prescription sheets from 14 pharmacies in Bandung were collected and analyzed by using prescribing indicators from the World Health Organization (WHO. We found an average number of 3.54 drugs in a prescription-sheet. We also found that 75% and 0% of all patients received antibiotics and injection, respectively. In particular, approximately 8% and 33% of all prescribed drugs were included in generic drug list and National List of Essential Medicines (DOEN, respectively. Based on data from the WHO and KONAS, it can be interpreted that the average number of drugs in a prescription-sheet is still high and the use of antibiotics is significantly higher compared to the use of antibiotics in other developing countries. Also, we summarized that the use of drugs according to generic drug list and DOEN are still low.

  6. Separation of prescribing and dispensing in Malaysia: the history and challenges.

    Science.gov (United States)

    Tiong, John Jeh Lung; Mai, Chun Wai; Gan, Pou Wee; Johnson, James; Mak, Vivienne Sook Li

    2016-08-01

    This article serves as an update to the work by Shafie et al. (2012) which previously reviewed the benefits of policies separating prescribing and dispensing in various countries to advocate its implementation in Malaysia. This article seeks to strengthen the argument by highlighting not only the weaknesses of the Malaysian health care system from the historical, professional and economic viewpoints but also the shortcomings of both medical and pharmacy professions in the absence of separation of dispensing. It also provides a detailed insight into the ongoing initiatives taken to consolidate the role of pharmacists in the health care system in the advent of separation of dispensing. Under the two tier system in Malaysia at present, the separation of prescribing and dispensing is implemented only in government hospitals. The absence of this separation in the private practices has led to possible profit-oriented medical and pharmacy practices which hinder safe and cost-effective delivery of health services. The call for separation of dispensing has gained traction over the years despite various hurdles ranging from the formidable resistance from the medical fraternity to the public's scepticism towards the new policy. With historical testament and present evidence pointing towards the merits of a system in which doctors prescribe and pharmacists dispense, the implementation of this health care model is justified. © 2016 The Authors. IJPP © 2016 Royal Pharmaceutical Society.

  7. Dentist-prescribed home bleaching: current status.

    Science.gov (United States)

    Dunn, J R

    1998-08-01

    White teeth have been an indicator of physical attractiveness throughout history. Only recently have we been able to whiten teeth with few side effects, making tooth bleaching a popular and effective dental treatment. The American Dental Association (ADA) has established guidelines on safety and effectiveness for tooth bleaching. External stains from aging or inherent dark color are more responsive to bleaching than internal stains. Dentist-prescribed home bleaching--including a careful dental exam, custom-fabricated trays, tacky high-viscosity gels, adequate instructions, and recall exams--has been shown to be an effective method for bleaching teeth. Trays can be worn overnight or during the day with similar effectiveness. The bleaching effect can last up to 3 years with more than 50% success.

  8. [Prescribing medication in 2013: legal aspects].

    Science.gov (United States)

    Berland-Benhaïm, C; Bartoli, C; Karsenty, G; Piercecchi-Marti, M-D

    2013-11-01

    To describe the legal framework of medicine prescription in France in 2013. With the assistance of lawyer and forensic pathologist, consultation (legifrance.gouv.fr), analysis, summary of French laws and rules surrounding drugs prescriptions to humans for medical purpose. Free medicine prescription is an essential feature of a doctor's action. To prescribe involve his responsibility at 3 levels: deontological, civilian and penal. Aim of the rules of medicine prescription is to preserve patient's safety and health. Doctors are encouraged to refer to recommendations and peer-reviewed publication every time the prescriptions go out of the case planned by law. Knowledge and respect of medicine prescription legal rules is essential for a good quality practice. Medical societies have a major role to improve medicine use among practitioners. Copyright © 2013. Published by Elsevier Masson SAS.

  9. 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......Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark; 4Institute of Biomedicine, Aarhus University, Aarhus, 5Centre of Emergency Medicine Research, Aarhus University Hospital & Aarhus University, Aarhus, Denmark; 6Aalborg University Hospital, Psychiatry and 7Aalborg University...... the severity of potential clinical consequences and identify possible predictive factors of PIP.METHODS: The study was designed as a prospective study of PIP using medication reviews. Patients who were admitted during a 4 month period (August 2013 - November 2013) to a psychiatric university hospital were...

  10. DNA Brick Crystals with Prescribed Depth

    Science.gov (United States)

    Ke, Yonggang; Ong, Luvena L.; Sun, Wei; Song, Jie; Dong, Mingdong; Shih, William M.; Yin, Peng

    2014-01-01

    We describe a general framework for constructing two-dimensional crystals with prescribed depth and sophisticated three-dimensional features. These crystals may serve as scaffolds for the precise spatial arrangements of functional materials for diverse applications. The crystals are self-assembled from single-stranded DNA components called DNA bricks. We demonstrate the experimental construction of DNA brick crystals that can grow to micron-size in the lateral dimensions with precisely controlled depth up to 80 nanometers. They can be designed to display user-specified sophisticated three-dimensional nanoscale features, such as continuous or discontinuous cavities and channels, and to pack DNA helices at parallel and perpendicular angles relative to the plane of the crystals. PMID:25343605

  11. Ibuprofen in paediatrics: pharmacology, prescribing and controversies.

    Science.gov (United States)

    Moriarty, Camilla; Carroll, Will

    2016-12-01

    Ibuprofen, a propionic acid derivative, is a non-steroidal anti-inflammatory drug. The oral formulation is widely used in paediatric practice and after paracetamol it is one of the most common drugs prescribed for children in hospital. The treatment of fever with antipyretics such as ibuprofen is controversial as fever is the normal response of the body to infection and unless the child becomes distressed or symptomatic, fever alone should not be routinely treated. Combined treatment with paracetamol and ibuprofen is commonly undertaken but almost certainly is not helpful. This article aims to describe the indications and mode of action of the drug, outline its pharmacokinetics and highlight the important key messages regarding its use in clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. Civil Procedure.

    Science.gov (United States)

    Byer, Robert

    1997-01-01

    Briefly reviews the historical development of civil procedure (the rules that dictate how a civil case can proceed through the courts) and identifies some of its main components. Discusses procedures such as subject matter jurisdiction, personal jurisdiction, venue, discovery, motions practice, pleadings, pretrial conference, and trials. (MJP)

  13. Adolescents and benzodiazepines: prescribed use, self-medication and intoxication.

    Science.gov (United States)

    Pedersen, W; Lavik, N J

    1991-07-01

    In a longitudinal study of 1230 people aged 13-18 years from the Greater Oslo Area, the past-year prevalence of anxiolytic or hypnotic use was 10%, which is higher than previously reported. The majority gave therapeutic reasons as a motive for using these drugs. However, most of the use was unprescribed. The parents, and especially the mother, were the most important suppliers. A minority gave intoxication as a motive for using these drugs. In this group, the suppliers were mainly peers and the illegal market. Neither the unprescribed nor the prescribed therapeutic use show any association with use of drugs such as alcohol and cannabis. There is, however, a strong association between the unprescribed use of benzodiazepines by young people and by their parents. This suggests a pattern of learning and role modelling, which must be regarded as problematic for public health policy. Those who use the drugs to become intoxicated have particularly poor mental health, and they use many other drugs as well. This group probably runs a special risk of developing more serious drug abuse.

  14. Assessing the contribution of prescribing in primary care by nurses and professionals allied to medicine: a systematic review of literature

    Directory of Open Access Journals (Sweden)

    Bhanbhro Sadiq

    2011-12-01

    Full Text Available Abstract Background Safe and timely access to effective and appropriate medication through primary care settings is a major concern for all countries addressing both acute and chronic disease burdens. Legislation for nurses and other professionals allied to medicine to prescribe exists in a minority of countries, with more considering introducing legislation. Although there is variation in the range of medicines permitted to be prescribed, questions remain as to the contribution prescribing by nurses and professionals allied to medicine makes to the care of patients in primary care and what is the evidence on which clinicians, commissioners of services and policy makers can consider this innovation. Methods A integrative review of literature on non-medical prescribing in primary care was undertaken guided by dimensions of health care quality: effectiveness, acceptability, efficiency and access. Results 19 papers of 17 empirical studies were identified which provided evidence of patient outcome of non medical prescribing in primary care settings. The majority were undertaken in the UK with only one each from the USA, Canada, Botswana and Zimbabwe. Only two studies investigated clinical outcomes of non-medical prescribing. Seven papers reported on qualitative designs and four of these had fewer than ten participants. Most studies reported that non medical prescribing was widely accepted and viewed positively by patients and professionals. Conclusions Primary health care is the setting where timely access to safe and appropriate medicines is most critical for the well-being of any population. The gradual growth over time of legislative authority and in the numbers of non-medical prescribers, particularly nurses, in some countries suggests that the acceptability of non-medical prescribing is based on the perceived value to the health care system as a whole. Our review suggests that there are substantial gaps in the knowledge base to help evidence

  15. A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe.

    Science.gov (United States)

    Keyworth, Chris; Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary

    2017-08-01

    Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors' e-portfolio). The participants were able to provide examples of how they would use

  16. Tendencies in applied policy research

    DEFF Research Database (Denmark)

    Jensen, Sophie Danneris; Jensen, Tanja Dall

    2018-01-01

    Within the policy area addressing long-term unemployed individuals with health and social problems in addition to unemployment, we have witnessed three parallel developments over the last decades: The development of active labour market policies (ALMP) extending conditionality and economic...... incentives to the more vulnerable groups of unemployed individuals; of New Public Management (NMP) focused on increasing efficiency and lowering expenditures through performance measurement and standardization of procedures, and; of evidence based policy research (EBPR) that seek to support policy efforts...

  17. Antiepileptic drug prescribing before, during and after pregnancy

    DEFF Research Database (Denmark)

    Charlton, Rachel; Garne, Ester; Wang, Hao

    2015-01-01

    pregnancy were co-prescribed with high-dose folic acid: ranging from 1.0% (CI95 0.3-1.8%) in Emilia Romagna to 33.5% (CI95 28.7-38.4%) 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...... 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......-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. © 2015 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd....

  18. Assessment of the Appropriateness of Antibiotic Prescriptions in Lesotho Public Hospitals: A Novel Methodology Based on Principles of Antibiotic Prescribing.

    Science.gov (United States)

    Adorka, Matthias; Mitonga, Honoré Kabwebwe; Lubbe, Martie; Serfontein, Jan; Allen, Kirk

    2014-02-04

    The study primarily aimed at assessing the appropriateness of antibiotic prescriptions in a section of public health institutions in Lesotho using an assessment tool formulated from principles of antibiotic prescribing. Relevant data on procedures of infection diagnosis and prescribed antibiotics were collected from both inpatient and outpatient case reports for a one-month period in five public hospitals in Lesotho. These were analyzed for the appropriateness of the prescribed antibiotics. Prescription appropriateness assessment was based on conformities of prescribed antibiotics to criteria developed from pertinent principles of antibiotic prescribing. Assessed prescriptions, 307 inpatient and 865 outpatient prescriptions in total, were classified into categories of appropriateness based on extents to which they satisfied conditions defined by combinations of criteria in the assessment tool. Antibiotic prescriptions from inpatient and outpatient departments of study site hospitals were categorized into groups of different degrees of appropriateness. A total of 32.2% inpatient prescriptions and 78.4% outpatient prescriptions assessed were appropriately written for the empiric treatment of infections for which bacterial pathogens were considered absolute or possible etiologies. The use of prescription assessment tools based on principles of antibiotic prescribing is a feasible option of assessing the appropriateness of antibiotic prescriptions, particularly in low-income countries where expert panels cannot be formed.

  19. 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.

  20. Evaluation of a diabetes nurse specialist prescribing project.

    Science.gov (United States)

    Wilkinson, Jill; Carryer, Jenny; Adams, Jeffery

    2014-08-01

    To evaluate the diabetes nurse specialist prescribing project with the aim of determining whether diabetes nurse specialist prescribing is safe and effective and to inform the implementation and extension of registered nurse prescribing. Registered nurses in many countries are able to prescribe medicines, but in New Zealand, prior to the diabetes nurse specialist project, nurse practitioners were the only nurses who could prescribe medicines. New regulations allowed the nurses to prescribe a limited number of prescription medicines. The study was a process and outcome clinical programme evaluation. The project took place between April-September 2011 and involved 12 diabetes nurse specialist in four localities. Quantitative data were collected from clinical records maintained by the diabetes nurse specialist for the project (1274 patients and 3402 prescribing events), from surveys with stakeholders (general practitioners, n = 30; team members, n = 19; and patients, n = 89) and audits from patient notes (n = 117) and prescriptions (n = 227), and qualitative data from interviews with project participants (n = 18) and patients (n = 19). All data were analysed descriptively. Diabetes nurse specialist prescribing was determined to be safe, of high quality and appropriate. It brought important benefits to the effectiveness of specialist diabetes services, was acceptable to patients and was supported by the wider healthcare team. These findings are consistent with the findings reported in the international literature about nurse prescribing in a range of different practice areas. Clarification of the education and competence requirements and resourcing for the ongoing supervision of nurses is recommended if the prescribing model is to be extended. Diabetes nurse specialist prescribing improved access to medicines by providing a more timely service. Nurses felt more satisfied with their work because they could independently provide a complete episode of care

  1. Characteristics of methadone maintenance treatment patients prescribed opioid analgesics

    Science.gov (United States)

    Glenn, Matthew C.; Sohler, Nancy L.; Starrels, Joanna L.; Maradiaga, Jeronimo; Jost, John J.; Arnsten, Julia H.; Cunningham, Chinazo O.

    2016-01-01

    Background Opioid analgesic use and disorders have dramatically increased among the general American population and those receiving methadone maintenance treatment (MMT). Most research among MMT patients focuses on opioid analgesics misuse or disorders; few studies focus on MMT patients prescribed opioid analgesics. We describe demographic, clinical, and substance use characteristics of MMT patients prescribed opioid analgesics and compare them to MMT patients not prescribed opioid analgesics. Methods We conducted a cross-sectional secondary data analysis using screening interviews from a parent study. From 2012–2015, we recruited adults from 3 MMT Bronx clinics. Questionnaire data included: patterns of opioid analgesic use, substance use, comorbid illnesses, and demographic characteristics. Our main dependent variable was patients’ report of currently taking prescribed opioid analgesics. To compare characteristics between MMT patients prescribed and not prescribed opioid analgesics, we conducted chi-squared tests, t-tests, and Mann-Whitney U tests. Results Of 611 MMT patients, most reported chronic pain (62.0%), HCV infection (52.1%), and currently using illicit substances (64.2%). Of the 29.8% who reported currently taking prescribed opioid analgesics, most misused their opioid analgesics (57.5%). Patients prescribed (versus not prescribed) opioid analgesics were more likely to report HIV infection (aOR=1.6, 95% CI: 1.1–2.3) and chronic pain (aOR=7.6, 95% CI: 4.6–12.6). Conclusion Among MMT patients primarily in three Bronx clinics, nearly one-third reported taking prescribed opioid analgesics. Compared to patients not prescribed opioid analgesics, those prescribed opioid analgesics were more likely to report chronic pain and HIV infection. However, between these patients, there was no difference in illicit substance use. These findings highlight the complexity of addressing chronic pain in MMT patients. PMID:26731299

  2. Characteristics of methadone maintenance treatment patients prescribed opioid analgesics.

    Science.gov (United States)

    Glenn, Matthew C; Sohler, Nancy L; Starrels, Joanna L; Maradiaga, Jeronimo; Jost, John J; Arnsten, Julia H; Cunningham, Chinazo O

    2016-01-01

    Opioid analgesic use and disorders have dramatically increased among the general American population and those receiving methadone maintenance treatment (MMT). Most research among MMT patients focuses on opioid analgesics misuse or disorders; few studies focus on MMT patients prescribed opioid analgesics. We describe demographic, clinical, and substance use characteristics of MMT patients prescribed opioid analgesics and compare them with MMT patients not prescribed opioid analgesics. We conducted a cross-sectional secondary data analysis using screening interviews from a parent study. From 2012 to 2015, we recruited adults from 3 MMT Bronx clinics. Questionnaire data included patterns of opioid analgesic use, substance use, comorbid illnesses, and demographic characteristics. Our main dependent variable was patients' report of currently taking prescribed opioid analgesics. To compare characteristics between MMT patients prescribed and not prescribed opioid analgesics, we conducted chi-square tests, t tests, and Mann-Whitney U tests. Of 611 MMT patients, most reported chronic pain (62.0%), hepatitis C virus (HCV) infection (52.1%), and current use of illicit substances (64.2%). Of the 29.8% who reported currently taking prescribed opioid analgesics, most misused their opioid analgesics (57.5%). Patients prescribed (versus not prescribed) opioid analgesics were more likely to report human immunodeficiency virus (HIV) infection (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI]: 1.1-2.3) and chronic pain (aOR = 7.6, 95% CI: 4.6-12.6). Among MMT patients primarily in 3 Bronx clinics, nearly one third reported taking prescribed opioid analgesics. Compared with patients not prescribed opioid analgesics, those prescribed opioid analgesics were more likely to report chronic pain and HIV infection. However, between these patients, there was no difference in illicit substance use. These findings highlight the complexity of addressing chronic pain in MMT patients.

  3. Photodigitizing procedures

    Science.gov (United States)

    Kilgore, P. D.; Gottbrath, J. H.

    1984-02-01

    This report documents procedures and programs for efficiently running the Photo Digitizing System at the Naval Biodynamics Laboratory. Procedures have been tested and have been found to be effective. Any future acquisitions of programs or changes to current programs should be incorporated in these procedures. On-going research programs use high speed instrumentation cameras to record the motion of test subjects during biodynamic experiments. The films are digitized and the 3-dimensional motion is reconstructed and analyzed. Experimental research is performed to determine the effects of aircraft crashes, ship motion, vibration, aircraft ejection and parachute opening forces on the health and performance of Navy personnel.

  4. Writer`s guide for technical procedures

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-01

    A primary objective of operations conducted in the US Department of Energy (DOE) complex is safety. Procedures are a critical element of maintaining a safety envelope to ensure safe facility operation. This DOE Writer`s Guide for Technical Procedures addresses the content, format, and style of technical procedures that prescribe production, operation of equipment and facilities, and maintenance activities. The DOE Writer`s Guide for Management Control Procedures and DOE Writer`s Guide for Emergency and Alarm Response Procedures are being developed to assist writers in developing nontechnical procedures. DOE is providing this guide to assist writers across the DOE complex in producing accurate, complete, and usable procedures that promote safe and efficient operations that comply with DOE orders, including DOE Order 5480.19, Conduct of Operations for DOE Facilities, and 5480.6, Safety of Department of Energy-Owned Nuclear Reactors.

  5. Nuclear Waste Fund cash management procedures

    International Nuclear Information System (INIS)

    1988-04-01

    The Nuclear Waste Policy Act if 1982 (NWPA) provided for the Office of Radioactive Waste Management (OCRWM) to adopt financial and accounting methods comparable to those used by private industry, including borrowing and investing authority. This document describes the procedures OCRWM follows to meet its borrowing and investing authority under the NWPA. These procedures are a supplement to, and are, therefore, not intended to supersede, existing Departmental policies and procedures

  6. Reducing prescribing errors through creatinine clearance alert redesign.

    Science.gov (United States)

    Melton, Brittany L; Zillich, Alan J; Russell, Scott A; Weiner, Michael; McManus, M Sue; Spina, Jeffrey R; Russ, Alissa L

    2015-10-01

    Literature has shown that computerized creatinine clearance alerts reduce errors during prescribing, and applying human factors principles may further reduce errors. Our objective was to apply human factors principles to creatinine clearance alert design and assess whether the redesigned alerts increase usability and reduce prescribing errors compared with the original alerts. Twenty Veterans Affairs (VA) outpatient providers (14 physicians, 2 nurse practitioners, and 4 clinical pharmacists) completed 2 usability sessions in a counterbalanced study to evaluate original and redesigned alerts. Each session consisted of fictional patient scenarios with 3 medications that warranted prescribing changes because of renal impairment, each associated with creatinine clearance alerts. Quantitative and qualitative data were collected to assess alert usability and the occurrence of prescribing errors. There were 43% fewer prescribing errors with the redesigned alerts compared with the original alerts (P = .001). Compared with the original alerts, redesigned alerts significantly reduced prescribing errors for allopurinol and ibuprofen (85% vs 40% and 65% vs 25%, P = .012 and P = .008, respectively), but not for spironolactone (85% vs 65%). Nine providers (45%) voiced confusion about why the alert was appearing when they encountered the original alert design. When laboratory links were presented on the redesigned alert, laboratory information was accessed 3.5 times more frequently. Although prescribing errors were high with both alert designs, the redesigned alerts significantly improved prescribing outcomes. This investigation provides some of the first evidence on how alerts may be designed to support safer prescribing for patients with renal impairment. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Prescribing for children at the interfaces of care.

    Science.gov (United States)

    Terry, David; Sinclair, Anthony

    2012-08-01

    Prescribing for children at the primary-secondary/tertiary care interface is more complex than that for adults. Children often need unlicensed medicines and there may be issues over who will prescribe such items. There may also be issues in obtaining unlicensed medicines (specials) from community pharmacists. This article reviews the current arrangements in England relating to prescribing for children at the interfaces of care and describes the following: prescribing responsibility, shared-care arrangements, medication continuity on admission and discharge from hospital, unlicensed medicines, continuing-care medication arrangements and highlights potential service changes to maintain access to medicines for children.

  8. 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.

  9. Brand Medications and Medicare Part D: How Eye Care Providers' Prescribing Patterns Influence Costs.

    Science.gov (United States)

    Newman-Casey, Paula Anne; Woodward, Maria A; Niziol, Leslie M; Lee, Paul P; De Lott, Lindsey B

    2018-03-01

    To quantify costs of eye care providers' Medicare Part D prescribing patterns for ophthalmic medications and to estimate the potential savings of generic or therapeutic drug substitutions and price negotiation. Retrospective cross-sectional study. Eye care providers prescribing medications through Medicare Part D in 2013. Medicare Part D 2013 prescriber public use file and summary file were used to calculate medication costs by physician specialty and drug. Savings from generic or therapeutic drug substitutions were estimated for brand drugs. The potential savings from price negotiation was estimated using drug prices negotiated by the United States Veterans Administration (USVA). Total cost of brand and generic medications prescribed by eye care providers. Eye care providers accounted for $2.4 billion in total Medicare part D prescription drug costs and generated the highest percentage of brand name medication claims compared with all other providers. Brand medications accounted for a significantly higher proportion of monthly supplies by volume, and therefore, also by total cost for eye care providers compared with all other providers (38% vs. 23% by volume, P brand medications when available, $148 million would be saved (7% savings); if generic and therapeutic substitutions were made, $882 million would be saved (42% savings). If Medicare negotiated the prices for ophthalmic medications at USVA rates, $1.09 billion would be saved (53% savings). Eye care providers prescribe more brand medications by volume than any other provider group. Efforts to reduce prescription expenditures by eye care providers should focus on increasing the use of generic medications, primarily through therapeutic substitutions. Policy changes enabling Medicare to negotiate prescription drug prices could decrease costs to Medicare. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  10. Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees.

    Science.gov (United States)

    Wen, Hefei; Hockenberry, Jason M

    2018-04-02

    Overprescribing of opioids is considered a major driving force behind the opioid epidemic in the United States. Marijuana is one of the potential nonopioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose. Marijuana liberalization, including medical and adult-use marijuana laws, has made marijuana available to more Americans. To examine the association of state implementation of medical and adult-use marijuana laws with opioid prescribing rates and spending among Medicaid enrollees. This cross-sectional study used a quasi-experimental difference-in-differences design comparing opioid prescribing trends between states that started to implement medical and adult-use marijuana laws between 2011 and 2016 and the remaining states. This population-based study across the United States included all Medicaid fee-for-service and managed care enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose. State implementation of medical and adult-use marijuana laws from 2011 to 2016. Opioid prescribing rate, measured as the number of opioid prescriptions covered by Medicaid on a quarterly, per-1000-Medicaid-enrollee basis. State implementation of medical marijuana laws was associated with a 5.88% lower rate of opioid prescribing (95% CI, -11.55% to approximately -0.21%). Moreover, the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38% lower rate of opioid prescribing (95% CI, -12.20% to approximately -0.56%). The potential of marijuana liberalization to reduce the use and consequences of prescription opioids among Medicaid enrollees deserves consideration during the policy discussions about marijuana reform and the opioid epidemic.

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

    Science.gov (United States)

    van Bijnen, Evelien M E; den Heijer, Casper D J; Paget, W John; Stobberingh, Ellen E; Verheij, Robert A; Bruggeman, Cathrien A; Pringle, Mike; Goossens, Herman; Schellevis, François G

    2011-10-28

    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 appropriateness of antibiotic prescribing in primary care in Europe by collecting and combining patterns of antibiotic resistance patterns and antibiotic prescription patterns in primary care. We will also evaluate the appropriateness of national antibiotic prescription guidelines in relation to resistance patterns. Antibiotic resistance will be studied in an opportunistic sample from the community in nine European countries. Resistance data will be collected by taking a nose swab of persons (N = 4,000 per country) visiting a primary care practice for a non-infectious disease. Staphylococcus aureus and Streptococcus pneumoniae will be isolated and tested for resistance to a range of antibiotics in one central laboratory. Data on antibiotic prescriptions over the past 5 years will be extracted from the electronic medical records of General Practitioners (GPs). The results of the study will include the prevalence and resistance data of the two species and 5 years of antibiotic prescription data in nine European countries. The odds of receiving an effective antibiotic in each country will be calculated as a measure for the appropriateness of prescribing. Multilevel analysis will be used to assess the appropriateness of prescribing. Relevant treatment guidelines of the nine participating countries will be evaluated using a standardized instrument and related to the resistance patterns in that country. This study will provide valuable and unique data concerning resistance patterns and prescription behaviour in primary care in nine European countries. It will provide evidence-based recommendations for antibiotic treatment guidelines that take resistance patterns into account which will be useful for

  12. Enhancing the quality of antibiotic prescribing in Primary Care: Qualitative evaluation of a blended learning intervention

    Directory of Open Access Journals (Sweden)

    Hare Monika

    2010-05-01

    Full Text Available Abstract Background The Stemming the Tide of Antibiotic Resistance (STAR Educational Program aims to enhance the quality of antibiotic prescribing and raise awareness about antibiotic resistance among general medical practitioners. It consists of a seven part, theory-based blended learning program that includes online reflection on clinicians' own practice, presentation of research evidence and guidelines, a practice-based seminar focusing on participants' own antibiotic prescribing and resistance rates in urine samples sent from their practice, communication skills training using videos of simulated patients in routine surgeries, and participation in a web forum. Effectiveness was evaluated in a randomised controlled trial in which 244 GPs and Nurse Practitioners and 68 general practices participated. This paper reports part of the process evaluation of that trial. Methods Semi-structured, digitally recorded, and transcribed telephone interviews with 31 purposively sampled trial participants analysed using thematic content analysis. Results The majority of participants reported increased awareness of antibiotic resistance, greater self-confidence in reducing antibiotic prescribing and at least some change in consultation style and antibiotic prescribing behaviour. Reported practical changes included adopting a practice-wide policy of antibiotic prescription reduction. Many GPs also reported increased insight into patients' expectations, ultimately contributing to improved doctor-patient rapport. The components of the intervention put forward as having the greatest influence on changing clinician behaviour were the up-to-date research evidence resources, simple and effective communication skills presented in on-line videos, and presentation of the practice's own antibiotic prescribing levels combined with an overview of local resistance data. Conclusion Participants regarded this complex blended learning intervention acceptable and feasible, and

  13. Enhancing the quality of antibiotic prescribing in primary care: qualitative evaluation of a blended learning intervention.

    Science.gov (United States)

    Bekkers, Marie-Jet; Simpson, Sharon A; Dunstan, Frank; Hood, Kerry; Hare, Monika; Evans, John; Butler, Christopher C

    2010-05-07

    The Stemming the Tide of Antibiotic Resistance (STAR) Educational Program aims to enhance the quality of antibiotic prescribing and raise awareness about antibiotic resistance among general medical practitioners. It consists of a seven part, theory-based blended learning program that includes online reflection on clinicians' own practice, presentation of research evidence and guidelines, a practice-based seminar focusing on participants' own antibiotic prescribing and resistance rates in urine samples sent from their practice, communication skills training using videos of simulated patients in routine surgeries, and participation in a web forum. Effectiveness was evaluated in a randomised controlled trial in which 244 GPs and Nurse Practitioners and 68 general practices participated. This paper reports part of the process evaluation of that trial. Semi-structured, digitally recorded, and transcribed telephone interviews with 31 purposively sampled trial participants analysed using thematic content analysis. The majority of participants reported increased awareness of antibiotic resistance, greater self-confidence in reducing antibiotic prescribing and at least some change in consultation style and antibiotic prescribing behaviour. Reported practical changes included adopting a practice-wide policy of antibiotic prescription reduction. Many GPs also reported increased insight into patients' expectations, ultimately contributing to improved doctor-patient rapport. The components of the intervention put forward as having the greatest influence on changing clinician behaviour were the up-to-date research evidence resources, simple and effective communication skills presented in on-line videos, and presentation of the practice's own antibiotic prescribing levels combined with an overview of local resistance data. Participants regarded this complex blended learning intervention acceptable and feasible, and reported wide-ranging, positive changes in attitudes and clinical

  14. Effect of a weight-based prescribing method within an electronic health record on prescribing errors.

    Science.gov (United States)

    Ginzburg, Regina; Barr, Wendy B; Harris, Marissa; Munshi, Shibani

    2009-11-15

    The effect of a weight-based prescribing method within the electronic health record (EHR) on the rate of prescribing errors was studied. A report was generated listing all patients who received a prescription by a clinic provider for either infants' or children's acetaminophen or ibuprofen from January 1 to July 28, 2005 (preintervention group) and from July 29 to December 30, 2005 (postintervention group). Patients were included if they were 12 years old or younger, had a prescription ordered for infants' or children's acetaminophen or ibuprofen within the EHR, and had a weight documented in the chart on the visit day. The dosing range for acetaminophen was 10-15 mg/kg every four to six hours as needed, and the regimen for ibuprofen was 5-10 mg/kg every six to eight hours as needed. Dosing errors were defined as overdosage of strength, overdosage of regimen, underdosage of strength, under-dosage of regimen, and incomprehensible dosing directions. Totals of 316 and 224 patient visits were analyzed from the preintervention and postintervention groups, respectively. Significantly more medication errors were found in the preintervention group than in the postintervention group (103 versus 46, p = 0.002). Significantly fewer strength overdosing errors occurred in the postintervention group (8.9% versus 4.0%, p = 0.028). An automated weight-based dosing calculator integrated into an EHR system in the outpatient setting significantly reduced medication prescribing errors for antipyretics prescribed to pediatric patients. This effect appeared to be strongest for reducing overdose errors.

  15. Oculoplastic procedures

    Science.gov (United States)

    ... procedures may be done on the: Eyelids Eye sockets Eyebrows Cheeks Tear ducts Face or forehead These ... eyes. These lenses help protect your eyes and shield them from the bright lights of the surgical ...

  16. 40 CFR 86.1111-87 - Test procedures for PCA testing.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 19 2010-07-01 2010-07-01 false Test procedures for PCA testing. 86... Light-Duty Trucks § 86.1111-87 Test procedures for PCA testing. (a)(1) For heavy-duty engines, the prescribed test procedure for PCA testing is the Federal Test Procedure as described in subparts N, I, and P...

  17. Forcing the issue on radiation policy

    International Nuclear Information System (INIS)

    Rockwell, T.

    1999-01-01

    For those frustrated by an inability to get a fair hearing on evidence that challenges current radiation policy, the recent case of a group of tobacco interests suing the US Environmental Protection Agency (EPA) in Federal court on its policy on second-hand smoke has important implications for radiation policy. The issue was only tangentially about tobacco; its main thrust was at EPA's arbitrary and capricious rule-making process. The EPA is at least as vulnerable to the same charges in the radiation area, particularly with respect to radon. Radiation protection is associated in many people's minds with the US Nuclear Regulatory Commission (NRC), but other agencies have also been involved. Radon, like second-hand smoke, has been tolerated for generations, and EPA has the burden of proving that it is a public hazard. The law and the unwritten rules of science are quite explicit in defining what must be done to make such a finding. In the case of radon, there is no prior basis for public concern. In fact, the public uses radium spas with radon concentrations up to one million times as high as the EPA permissible limit. In many countries, such spa usage is formally prescribed by physicians and paid for by national health insurance. The health effects, if any, from radon, as from second-hand smoke, are hard to quantify. But, this does not justify--in either case--the EPA's straying from its published criteria and procedures for testing whether such health effects occur. A Federal court has now demonstrated its willingness to judge and strike down the EPA's actions regarding second-hand smoke on their own merits, without attempting to be an arbiter of science. The result is a welcome breath of fresh air and an object lesson for those concerned about the mounting costs of treating radon as a major public health hazard

  18. 31 CFR 596.500 - Licensing procedures.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Licensing procedures. 596.500 Section... Licenses, Authorizations and Statements of Licensing Policy § 596.500 Licensing procedures. For provisions relating to licensing procedures, see part 501, subpart E, of this chapter. Licensing actions taken...

  19. 31 CFR 575.500 - Licensing procedures.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Licensing procedures. 575.500 Section..., and Statements of Licensing Policy § 575.500 Licensing procedures. For provisions relating to licensing procedures, see part 501, subpart E, of this chapter. Licensing actions taken pursuant to part 501...

  20. 31 CFR 595.500 - Licensing procedures.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Licensing procedures. 595.500 Section..., Authorizations, and Statements of Licensing Policy § 595.500 Licensing procedures. For provisions relating to licensing procedures, see part 501, subpart E, of this chapter. Licensing actions taken pursuant to part 501...

  1. 31 CFR 545.500 - Licensing procedures.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Licensing procedures. 545.500 Section..., Authorizations and Statements of Licensing Policy § 545.500 Licensing procedures. For provisions relating to licensing procedures, see part 501, subpart E, of this chapter. Licensing actions taken pursuant to part 501...

  2. 31 CFR 597.500 - Licensing procedures.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Licensing procedures. 597.500 Section... Licenses, Authorizations, and Statements of Licensing Policy § 597.500 Licensing procedures. For provisions relating to licensing procedures, see part 501, subpart E, of this chapter. Licensing actions taken...

  3. 31 CFR 538.500 - Licensing procedures.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Licensing procedures. 538.500 Section..., and Statements of Licensing Policy § 538.500 Licensing procedures. For provisions relating to licensing procedures, see part 501, subpart E, of this chapter. Licensing actions taken pursuant to part 501...

  4. 31 CFR 540.500 - Licensing procedures.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Licensing procedures. 540.500 Section... REGULATIONS Licenses, Authorizations, and Statements of Licensing Policy § 540.500 Licensing procedures. For provisions relating to licensing procedures, see part 501, subpart E, of this chapter. Licensing actions...

  5. 31 CFR 585.500 - Licensing procedures.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Licensing procedures. 585.500 Section... Licenses, Authorizations, and Statements of Licensing Policy § 585.500 Licensing procedures. For provisions relating to licensing procedures, see part 501, subpart E, of this chapter. Licensing actions taken...

  6. 31 CFR 560.500 - Licensing procedures.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Licensing procedures. 560.500 Section..., Authorizations and Statements of Licensing Policy § 560.500 Licensing procedures. For provisions relating to licensing procedures, see part 501, subpart E, of this chapter. Licensing actions taken pursuant to part 501...

  7. The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations

    Directory of Open Access Journals (Sweden)

    Neda Ratanawongsa

    2017-01-01

    Full Text Available Widespread electronic health record (EHR implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1 the adoption of RxNorm; (2 standardized naming and picklist options for high alert medications such as insulin; (3 the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4 enhanced bidirectional communication with pharmacy partners; and (5 informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations.

  8. 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.

  9. Simple Macroeconomic Policies and Welfare: A Quantitative Assessment

    Directory of Open Access Journals (Sweden)

    Eurilton Araújo

    2014-09-01

    Full Text Available We quantitatively compare three macroeconomic policies in a cash-credit goods framework. The policies are: the optimal one; another one that fully smoothes out oscillations in output; and a simple one that prescribes constant values for tax and monetary growth rates. As often found in the related literature, the welfare gains or losses from changing from a given policy to another are small. We also show that the simple policy dominates the one that leads to constant output.

  10. 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

    , as a normal routine for accounting. The GPs were not aware of the ongoing cost supervision study. Additional cost information software was introduced on 1 January 1993 to 20 practices with 28 GPs. The software assisted the GPs in a semiautomatic way to identify and prescribe the cheapest drugs. The subjects......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...... expenditure per DDD. Cost containment procedures should be more intensive than just giving the doctors a computer-assisted decision aid...

  11. 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.

  12. Forum: Psychotropic prescribing in HIV | Reid | Southern African ...

    African Journals Online (AJOL)

    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, ...

  13. Estimating fuel consumption during prescribed fires in Arkansas

    Science.gov (United States)

    Virginia L. McDaniel; James M. Guldin; Roger W. Perry

    2012-01-01

    While prescribed fire is essential to maintaining numerous plant communities, fine particles produced in smoke can impair human health and reduce visibility in scenic areas. The Arkansas Smoke Management Program was established to mitigate the impacts of smoke from prescribed fires. This program uses fuel loading and consumption estimates from standard fire-behavior...

  14. Seed bank response to prescribed fire in the central Appalachians.

    Science.gov (United States)

    Thomas M. Schuler; Melissa Thomas Van-Gundy; Mary B. Adams; W. Mark. Ford

    2010-01-01

    Pre- and post-treatment seed-bank characteristics of woody species were compared after two prescribed fires in a mesic mixed-oak forest in the central Appalachians. Nineteen woody species were identified from soil samples. Mean species richness declined but evenness did not after prescribed burning. The...

  15. Prescribing of drugs for the treatment of migraine with specific ...

    African Journals Online (AJOL)

    Migraine affects between 5.15% of males and 13,5-31% of females in South Africa. Little is known about the prescribing patterns of anti-migraine drugs in South Africa. The aim of the study was to investigate the prescribing of drugs for the treatment of migraine (ATC Group NOZC), with specific emphasis on sumatriptan, in a ...

  16. Ten-year responses of oak regeneration to prescribed fire

    Science.gov (United States)

    Erik Berg; Barry Clinton; Jim Vose; Wayne. Swank

    2011-01-01

    Prescribed fire has proven effective in controlling vegetative competition of oak regeneration across many sites in the southeastern US most fire investigations have been performed in the Piedmont and Coastal Plain. Land managers lake definitive knowledge on how to use prescribed fire to improve long-term oak regeneration success in the southern Appalachians. Several...

  17. Foreignising as translation strategy in prescribed books for second ...

    African Journals Online (AJOL)

    Foreignising as translation strategy in prescribed books for second-language learners. ... This is a prescribed book for Afrikaans second-language learners in Grade 11 in the Limpopo Province. The story ... The translation is placed even more firmly within this mould because yet another language and culture come into play.

  18. Prescribing Patterns and Medicine Use at the University Teaching ...

    African Journals Online (AJOL)

    Results:A total of 1486 drugs encounters were prescribed from both adult and paediatric outpatient wings in 2015. The average number of drugs per prescription was. 2.5(SD±1.58), with a range of 1 to 7 drugs per prescription. The antibiotic and injection-prescribing rate was 53.7% and 11.8%respectively. Generic ...

  19. Scope and nature of prescribing decisions made by general practitioners

    NARCIS (Netherlands)

    Denig, P; Witteman, CLM

    Background: This study describes cognitive processes of doctors who are deciding on the treatment for a patient. This helps to uncover how prescribing decisions could benefit from (computerised) support. Methods: While thinking aloud, 61 general practitioners made prescribing decisions for five

  20. Causes of prescribing errors in hospital inpatients: a prospective study.

    Science.gov (United States)

    Dean, Bryony; Schachter, Mike; Vincent, Charles; Barber, Nick

    2002-04-20

    To prevent errors made during the prescription of drugs, we need to know why they arise. Theories of human error used to understand the causes of mistakes made in high-risk industries are being used in health-care. They have not, however, been applied to prescribing errors, which are a great cause of patient harm. Our aim was to use this approach to investigate the causes of such errors. Pharmacists at a UK teaching hospital prospectively identified 88 potentially serious prescribing errors. We interviewed the prescribers who made 44 of these, and analysed our findings with human error theory. Our results suggest that most mistakes were made because of slips in attention, or because prescribers did not apply relevant rules. Doctors identified many risk factors-work environment, workload, whether or not they were prescribing for their own patient, communication within their team, physical and mental well-being, and lack of knowledge. Organisational factors were also identified, and included inadequate training, low perceived importance of prescribing, a hierarchical medical team, and an absence of self-awareness of errors. To reduce prescribing errors, hospitals should train junior doctors in the principles of drug dosing before they start prescribing, and enforce good practice in documentation. They should also create a culture in which prescription writing is seen as important, and formally review interventions made by pharmacists, locum arrangements, and the workload of junior doctors, and make doctors aware of situations in which they are likely to commit errors.

  1. Investigation into the prescribing patterns and cost of antidiabetic ...

    African Journals Online (AJOL)

    and soluble insulin aspartame and protamine) together accounted for 63% of all the insulin prescribed, and 67% of the total cost of prescribed insulin. Almost 39% (n = 62 717) of the “combination therapy” prescriptions were for a sulfonylurea in combination with a biguanide plus at least one other antidiabetic product.

  2. Prescribing of meprobamate-containing combination analgesics in ...

    African Journals Online (AJOL)

    ... 32 mg caffeine and 150 mg meprobamate. The originator product constituted 3.72% of prescribing frequency (average cost: R30.42) compared with 70.63% for the most popular generic (average cost: R11.65). Conclusions: Prescribers should be conscious of the benefits and risks of the active ingredient combinations.

  3. Sources of drug information and their influence on the prescribing ...

    African Journals Online (AJOL)

    Background: Pharmaceutical drug promotion is a means of informing health professionals about new drugs. The approach is often times unethical and inappropriate and may promote irrational prescribing. Dearth of information on impact of pharmaceutical drug promotion on prescribing behaviour of doctors in developing ...

  4. Defining antimicrobial prescribing quality indicators: what is a new prescription?

    NARCIS (Netherlands)

    Boesten, J.; Harings, L.; Winkens, B.; Knottnerus, A.; Weijden, G.D.E.M. van der

    2011-01-01

    : Since guidelines on antibiotic drug treatment often focus on appropriate first choice drugs, assessment of guideline adherence should only concentrate on the first drug prescribed, and not on subsequent antibiotics prescribed after failure of the first one. PURPOSE: To determine a valid cut-off

  5. Prescribing Patterns and Inappropriate Use of Medications in Elderly ...

    African Journals Online (AJOL)

    Prescribing Patterns and Inappropriate Use of Medications in Elderly Outpatients in a Tertiary Hospital in Nigeria. ... Tropical Journal of Pharmaceutical Research ... Purpose: To determine the prescribing patterns and occurrence of potentially inappropriate medications (PIM) among elderly outpatients visiting a tertiary ...

  6. Prevalence and Correlates of “High Dose” Antipsychotic Prescribing ...

    African Journals Online (AJOL)

    Background: High dose antipsychotic prescribing is common in psychiatric care, despite a lack of its benefit from research evidence. While several studies have explored the prevalence and factors associated with high dose antipsychotic prescribing, no such report has emanated from a developing country like Nigeria.

  7. Medication discussion between nurse prescribers and people with diabetes

    DEFF Research Database (Denmark)

    Sibley, Andrew; Latter, Sue; Richard, Claude

    2011-01-01

    Aim. This paper is a report of a study to identify the content of, and participation in, medicine discussion between nurse prescribers and people with diabetes in England. Background. Diabetes affects 246 million people worldwide and effective management of medicines is an essential component...... of successful disease control. There are now over 20,000 nurse independent prescribers in the UK, many of whom frequently prescribe for people with diabetes. With this responsibility comes a challenge to effectively communicate with patients about medicines. National guidelines on medicines communication have...... recently been issued, but the extent to which nurse prescribers are facilitating effective medicine-taking in diabetes remains unknown. Methods. A purposive sample of 20 nurse prescribers working with diabetes patients audio-recorded 59 of their routine consultations and a descriptive analysis...

  8. Biosecurity procedures for the environmental management of carcasses burial sites in Korea.

    Science.gov (United States)

    Kim, Geon-Ha; Pramanik, Sudipta

    2016-12-01

    Avian influenza and foot-and-mouth disease are two main contagious pathogenic viral disease which are responsible for the massive burials of livestock in Korea since burial is the primary measure to control these outbreaks. Biosecurity is a set of preventive measures designed to prevent the risk of spreading of these infectious diseases. The main objective of this paper is to discuss about the requirements of biosecurity and develop protocol outlines for environmental management of burial sites in Korea. Current practice prescribes to minimize the potential for on-farm pollution and the spread of the infectious diseases. Specific biosecurity procedures such as proper assessment of leachate quality, safe handling and disposal of leachate, adequate leachate pollution monitoring, necessary seasonal management of burial site, and appropriate sterilization process must be carried out to prevent the indirect transmission of pathogens from the burial sites. Policy makers should acquire robust knowledge of biosecurity for establishing more effective future legislation for carcasses disposal in Korea.

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

    Directory of Open Access Journals (Sweden)

    Lavan AH

    2016-06-01

    Full Text Available Amanda H Lavan, Paul F Gallagher, Denis O’Mahony Department of Geriatric Medicine, Cork University Hospital, University College Cork, Cork, Ireland Abstract: 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

  10. Evaluation of a medication order writing standards policy in a regional health authority

    Science.gov (United States)

    Raymond, Colette B.; Coates, Jan; Woloschuk, Donna M. M.

    2013-01-01

    Background: The Winnipeg Regional Health Authority (WRHA) implemented a medication order writing standards (MOWS) policy (including banned abbreviations) to improve patient safety. Widespread educational campaigns and direct prescriber feedback were implemented. Methods: We audited orders within the WRHA from 2005 to 2009 and surveyed all WRHA staff in 2011 about the policy and suggestions for improving education and compliance. Results: Overall, orders containing banned abbreviations, acronyms or symbols numbered 2261/8565 (26.4%) preimplementation. After WRHA-wide didactic education, the proportion declined to 1358/5461 (24.9%) (p = 0.043) and then, with targeted prescriber feedback, to 1186/6198 (19.1%) (p < 0.0001). A survey of 723 employees showed frequent violations of the MOWS, despite widespread knowledge of the policy. Respondents supported ongoing efforts to enforce the policy within the WRHA. Nonprescribers were significantly more likely than prescribers to agree with statements regarding enhancing compliance by defining prescriber/transcriber responsibilities and placing sanctions on noncompliant prescribers. Discussion: Education, raising general awareness and targeted feedback to prescribers alone are insufficient to ensure compliance with MOWS policies. WRHA staff supported ongoing communication, improved tools such as compliant preprinted orders and reporting and feedback about medication incidents. A surprising number of respondents supported placing sanctions on noncompliant prescribers. Conclusion: Serial audits and targeted interventions such as direct prescriber feedback improve prescription quality in inpatient hospital settings. Education plus direct prescriber feedback had a greater impact than education alone on improving compliance with a MOWS policy. Future efforts at the WRHA to improve compliance will require an expanded focus on incentives, resources and development of action plans that involve all affected staff, not just prescribers

  11. States With Prescription Drug Monitoring Mandates Saw Reduction In Opioids Prescribed To Medicaid Enrollees

    Science.gov (United States)

    Wen, Hefei; Schackman, Bruce R.; Aden, Brandon; Bao, Yuhua

    2017-01-01

    Prescription drug monitoring programs are promising tools to use in addressing the prescription opioid epidemic, yet prescribers’ participation in these state-run programs remains low as of 2014. Statutory mandates for prescribers to register with their state’s program, use it, or both are believed to be effective tools to realize the programs’ full potential. Our analysis of aggregate Medicaid drug utilization data indicates that state mandates for prescriber registration or use adopted in 2011–14 were associated with a reduction of 9–10 percent in population-adjusted numbers of Schedule II opioid prescriptions received by Medicaid enrollees and amounts of Medicaid spending on these prescriptions. This effect was largely associated with mandates of registration, which were comprehensive in all adopting states, and not with mandates of use, which were largely limited in scope or strength before 2015. Our findings support the use of mandates of registration in prescription drug monitoring programs as an effective and relatively low-cost policy. Future research should further assess the value of strong mandates of use to ensure safer and more appropriate prescribing of opioids. PMID:28373340

  12. A meta-synthesis study of literature review and systematic review published in nurse prescribing.

    Science.gov (United States)

    Darvishpour, Azar; Joolaee, Soodabeh; Cheraghi, Mohammad Ali

    2014-01-01

    Prescribing represents a new aspect of practice for nurses. To make qualitative results more accessible to clinicians, researchers, and policy makers, individuals are urged to synthesize findings from related studies. Therefore this study aimed to aggregate and interpret existing literature review and systematic studies to obtain new insights on nurse prescription. This was a qualitative meta synthesis study using Walsh and Downe process. In order to obtain data all Digital National Library of Medicine's databases, search engines and several related sites were used. Full texts with "review and nurs* prescri* " words in the title or abstract in English language and published without any time limitation were considered. After eliminating duplicate and irrelevant studies, 11 texts were selected. Data analysis was conducted using qualitative content analysis. Multiple codes were compared based on the differences and similarities and divided to the categories and themes. The results from the meta synthesis of the 11 studies revealed 8 themes namely: leading countries in prescribing, views, features, infrastructures, benefits, disadvantages, facilitators and barriers of nursing prescription that are discussed in this article. The results led to a schematic model. Despite the positive view on nurse prescribing, there are still issues such as legal, administrative, weak research and educational deficiencies in academic preparation of nurses that needs more effort in these areas and requires further research.

  13. Tough Policies, Incredible Policies?

    OpenAIRE

    Andres Velasco; Alejandro Neut

    2003-01-01

    We revisit the question of what determines the credibility of macroeconomic policies here, of promises to repay public debt. Almost all thinking on the issue has focused on governments' strategic decision to default (or erode the value of outstanding debt via inflation/devaluation). But sometimes governments default not because they want to, but because they cannot avoid it: adverse shocks leave them no option. We build a model in which default/devaluation can occur deliberately (for strategi...

  14. Manual on service business for policy research

    International Nuclear Information System (INIS)

    1999-01-01

    The contents of this book are summary of service business for policy research : conception classification and ways of service business for policy research, propel procedure of service business for policy research on system of committee, management, choice, contract, evaluation and post management, related regulation on service business for policy research : management regulation on service business for policy research, guide of evaluation for service business for policy research, estimation standard of policy research cost, law arrangement of national contract, required document on service business for policy research, and application manual for PRISM.

  15. Dental prescribing in Wales and associated public health issues.

    Science.gov (United States)

    Karki, A J; Holyfield, G; Thomas, D

    2011-01-08

    Dental prescribing data in Wales have not been studied in detail previously. The analysis of national data available from Health Solutions Wales showed that dental prescribing in Wales accounted for 9% of total antibacterial prescribing in primary care in 2008. Penicillin and metronidazole constituted the bulk of antibiotics prescribed by dentists. Since the publication of National Institute for Health and Clinical Excellence (NICE) guidance (March 2008) on prophylaxis against infective endocarditis, dental prescriptions for amoxicillin 3g sachets and clindamycin capsules have decreased. Dental prescriptions for fluoride preparations increased in number from 2007 to 2008. Dental prescribing of controlled drugs raises no concern. The figure for antibiotic prescribing in Wales is similar to that of England. Nevertheless, the figure seems a little high, indicating potential inappropriate prescribing behaviour among dentists. Antibiotic resistance is a major public health issue and many patients each year die from infections from bacterial strains that are resistant to one or more antibiotics. Inappropriate use of antibiotics is a major cause of antibiotic resistance and every effort should be made to reduce the number of inappropriate antibiotic prescriptions in dental practice.

  16. Prescribing smoked cannabis for chronic noncancer pain

    Science.gov (United States)

    Kahan, Meldon; Srivastava, Anita; Spithoff, Sheryl; Bromley, Lisa

    2014-01-01

    Objective To offer preliminary guidance on prescribing smoked cannabis for chronic pain before the release of formal guidelines. Quality of evidence We reviewed the literature on the analgesic effectiveness of smoked cannabis and the harms of medical and recreational cannabis use. We developed recommendations on indications, contraindications, precautions, and dosing of smoked cannabis, and categorized the recommendations based on levels of evidence. Evidence is mostly level II (well conducted observational studies) and III (expert opinion). Main message Smoked cannabis might be indicated for patients with severe neuropathic pain conditions who have not responded to adequate trials of pharmaceutical cannabinoids and standard analgesics (level II evidence). Smoked cannabis is contraindicated in patients who are 25 years of age or younger (level II evidence); who have a current, past, or strong family history of psychosis (level II evidence); who have a current or past cannabis use disorder (level III evidence); who have a current substance use disorder (level III evidence); who have cardiovascular or respiratory disease (level III evidence); or who are pregnant or planning to become pregnant (level II evidence). It should be used with caution in patients who smoke tobacco (level II evidence), who are at increased risk of cardiovascular disease (level III evidence), who have anxiety or mood disorders (level II evidence), or who are taking higher doses of opioids or benzodiazepines (level III evidence). Cannabis users should be advised not to drive for at least 3 to 4 hours after smoking, for at least 6 hours after oral ingestion, and for at least 8 hours if they experience a subjective “high” (level II evidence). The maximum recommended dose is 1 inhalation 4 times per day (approximately 400 mg per day) of dried cannabis containing 9% delta-9-tetrahydrocannabinol (level III evidence). Physicians should avoid referring patients to “cannabinoid” clinics (level

  17. Effect of policy change on the prescription pattern of antimalarial ...

    African Journals Online (AJOL)

    However three years into the change in policy, Artemether/Lumefantrine (AL) was the most prescribed, recording 25.2% as against 0.8% a year prior to the change in policy (2004).This was followed by Artesunate/Amodiaquine (AA) and Artesunate/Mefloquine (AM), 24.3% and 23.6% respectively. Artemisinin monotherapies ...

  18. Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers' antibiotic prescribing knowledge.

    Science.gov (United States)

    Blumenthal, Kimberly G; Shenoy, Erica S; Hurwitz, Shelley; Varughese, Christy A; Hooper, David C; Banerji, Aleena

    2014-01-01

    Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy. Our objectives were (1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy, and (2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline. We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again 6 weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy. Of 323 unique responders, 42% (95% CI, 37-48%) reported no prior education in drug allergy. When considering those who responded to both surveys (n = 213), we observed a significant increase in knowledge about PCN skin testing (35% vs 54%; P allergy over time (54% vs 80%; P allergy was severe significantly improved (77% vs 92%; P = .03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly. Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of inpatients with drug allergy, more research is needed to evaluate hospital policies and sustainable educational tools. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  19. Qualitative interviews regarding pharmacist prescribing in the community setting.

    Science.gov (United States)

    Feehan, Michael; Durante, Richard; Ruble, Jim; Munger, Mark A

    2016-09-15

    The perceived demand for and barriers to pharmacist prescribing in the community pharmacy setting were studied. Qualitative interviews were conducted with 19 consumers, 20 community pharmacists, and 8 reimbursement decision-makers from payer organizations between April and June 2015. Respondents were invited to participate in a daylong interview process online. Interviews with consumers and pharmacists were conducted using online bulletin board technology. Telephone interviews were conducted with reimbursement decision-makers. As with all qualitative research, the sample sizes used were restrictive and sufficient to gauge the perceptions of those respondents only. Interview responses were not intended to be generalizable to the groups or populations from which the respondents came. There was a continuum of interest in pharmacist prescribing across the three constituencies. Consumers were predominantly resistant to the notion; however, one third were more positive about the idea. Community pharmacists were more open, particularly when prescribing was restricted to a limited set of conditions or medications. Reimbursement decision-makers were most receptive to the notion. Key barriers to pharmacist prescribing included low awareness of current pharmacist prescribing authority among consumers, concerns about the adequacy of pharmacist training, potential conflicts of interest when the prescriber was also a dispenser, and potential liability issues. Consumer respondents were generally resistant to the notion of pharmacist prescribing, with most viewing pharmacists as dispensers and not prescribers. Community pharmacists were more open to the idea, while reimbursement decision-makers were the most receptive to the notion of pharmacist prescribing. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  20. Buprenorphine prescribing practice trends and attitudes among New York providers.

    Science.gov (United States)

    Kermack, Andrea; Flannery, Mara; Tofighi, Babak; McNeely, Jennifer; Lee, Joshua D

    2017-03-01

    Buprenorphine office-based opioid maintenance is an increasingly common form of treatment for opioid use disorders. However, total prescribing has not kept pace with the current opioid and overdose epidemic and access remains scarce among the underserved. This study sought to assess current provider attitudes and clinical practices among a targeted sample of primarily New York City public sector buprenorphine prescribers. A cross-sectional online survey purposefully sampled buprenorphine prescribers in NYC with a focus on those serving Medicaid and uninsured patient populations. Expert review of local provider networks, snowball referrals, and in-person networking generated an email list, which received a survey link. A brief 25-question instrument queried provider and practice demographics, prescribing practices including induction approaches and attitudes regarding common hot topics (e.g., buprenorphine diversion, prescriber patient limits, insurance issues, ancillary treatments). Of 132 email invitations, N=72 respondents completed (n=64) or partially completed (n=8) the survey between January and April 2016. Most (79%) were Medicaid providers in non-psychiatric specialties (72%), working in a hospital-based or community general practice (51%), and board-certified in addiction medicine or psychiatry (58%). Practice sizes were generally 100 patients or fewer (71%); many providers (64%) individually prescribed buprenorphine Buprenorphine diversion was not rated as an important practice barrier. In conclusion, this targeted survey of buprenorphine prescribers in NYC treating primarily underserved populations showed a consistent pattern of part-time prescribing to modest volumes of patients, routine use of unobserved buprenorphine induction, and primarily elective referrals to psychosocial counseling. Barriers to prescribing included prior authorization requirements, lack of clinical resources (space, staff) and psychiatric services. Federal and local efforts to

  1. Protection of the environment. Regulatory policy P-223

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-02-01

    This regulatory policy describes the principles and factors that guide the Canadian Nuclear Safety Commission (CNSC) in regulating the development, production and use of nuclear energy and the production, possession and use of nuclear substances, prescribed equipment and prescribed information in order to prevent unreasonable risk to the environment in a manner that is consistent with Canadian environmental policies, acts and regulations and with Canada's international obligations. This policy applies to all regulatory decisions made by the Commission or its staff. (author)

  2. Radiochemical procedures

    International Nuclear Information System (INIS)

    Lyon, W.S.

    1982-01-01

    The modern counting instrumentation has largely obviated the need for separation processes in the radiochemical analysis but problems in low-level radioactivity measurement, environmental-type analyses, and special situations caused in the last years a renaissance of the need for separation techniques. Most of the radiochemical procedures, based on the classic works of the Manhattan Project chemists of the 1940's, were published in the National Nuclear Energy Series (NNES). Improvements such as new solvent extraction and ion exchange separations have been added to these methods throughout the years. Recently the Los Alamos Group have reissued their collected Radiochemical Procedures containing a short summary and review of basic inorganic chemistry - 'Chemistry of the Elements on the Basis of Electronic Configuration'. (A.L.)

  3. The Supply of Prescription Opioids: Contributions of Episodic-Care Prescribers and High-Quantity Prescribers.

    Science.gov (United States)

    Schneberk, Todd; Raffetto, Brian; Kim, David; Schriger, David L

    2017-12-21

    We determine episodic and high-quantity prescribers' contribution to opioid prescriptions and total morphine milligram equivalents in California, especially among individuals prescribed large amounts of opioids. This was a cross-sectional descriptive analysis of opioid prescribing patterns during an 8-year period using the de-identified Controlled Substance Utilization Review and Evaluation System (CURES) database, the California subsection of the prescription drug monitoring program. We took a 10% random sample of all patients and stratified them by the amount of prescription opioids obtained during their maximal 90-day period. We identified "episodic prescribers" as those whose prescribing pattern included short-acting opioids on greater than 95% of all prescriptions, fewer than or equal to 31 pills on 95% of all prescriptions, only 1 prescription in the database for greater than 90% of all patients to whom they gave opioids, fewer than 6 prescriptions in the database to greater than 99% of patients given opioids, and fewer than 540 prescriptions per year. We identified top 5% prescribers by their morphine milligram equivalents per day in the database. We examined the relationship between patient opioid prescriptions and provider type, with the primary analysis performed on the patient cohort who received only short-acting opioids in an attempt to avoid guideline-concordant palliative, oncologic, and addiction care, and a secondary analysis performed on all patients. Among patients with short-acting opioid only, episodic prescribers (14.6% of 173,000 prescribers) wrote at least one prescription to 25% of 2.7 million individuals but were responsible for less than 9% of the 10.5 million opioid prescriptions and less than 3% of the 3.9 billion morphine milligram equivalents in our sample. Among individuals with high morphine milligram equivalents use, episodic prescribers were responsible for 2.8% of prescriptions and 0.6% of total morphine milligram equivalents

  4. INITIATION AND CONDUCT OF ADMINISTRATIVE PROCEDURE

    Directory of Open Access Journals (Sweden)

    Milan Stipic

    2013-12-01

    Full Text Available General administrative procedure act contains legal norms that are valid for all identical cases. In addition to the general, there are special administrative procedures, customized to the specific administrative areas. Procedure initiation is regulated. Administrative procedure can be initiated at the request of the proponent and ex officio. When the official determines that the conditions for the conduct of administrative procedure are met, before making a decision, all the facts and circumstances relevant to the resolution of administrative matter have to be identified. When there are no legal requirements for the initiation of procedures, the official shall make a decision to reject the application of the party. The procedure is initiated ex officio when stipulated by law or when protection of public interest requires it. When initiating procedure ex officio, the public authority shall take into consideration the petition or other information that indicate the need to protect the public interest. In such cases the applicant is not a party, and the official is obliged to notify the applicant, if initiation of procedures is not accepted ex officio. Based on the notification, the applicant has a right to complain, including the situation when there is no response within the prescribed period of 30 days. Public authority may, therefore it is not obliged to, initiate administrative procedure by public announcement only in a situation where the parties are unknown, while it is obliged to initiate procedure by public announcement when this method of initiating the procedure is prescribed by law. Initiation of procedure with public announcement occurs in rare cases. Due to the application of efficiency and cost-effectiveness principle, two or more administrative procedures can be merged into one procedure by a conclusion. The condition for this is that the rights or obligations of the parties are based on the same legal basis and on the same or

  5. Time series analysis of California's prescription monitoring program: impact on prescribing and multiple provider episodes.

    Science.gov (United States)

    Gilson, Aaron M; Fishman, Scott M; Wilsey, Barth L; Casamalhuapa, Carlos; Baxi, Hassan

    2012-02-01

    Prescription monitoring programs (PMPs) are designed to reduce medication diversion by identifying individuals obtaining the same medication from multiple providers (termed multiple provider episodes [MPEs]). This study determined whether recent changes to California's PMP influenced: 1) the extent that practitioners issue prescriptions for a variety of Schedule II opioids; and 2) the incidence of MPEs involving these opioids. Intervention time series of California's PMP data was used to determine the effect of requiring practitioners to transition from using triplicate prescription forms for Schedule II medications to security forms for all controlled substances. Outcome measures included changes in number of prescriptions issued for Schedule II long-acting or short-acting (SA) opioids and the MPEs involving these medications. Requiring a security form was associated with a sustained prescribing increase for SA hydromorphone, meperidine, and SA oxycodone; no prescribing changes were found for SA fentanyl, methadone, and SA morphine, or for any long-acting opioids. The same policy change, however, increased MPEs involving all opioids. Further effort is required to determine how California's PMP can continue to ensure availability of prescription opioids for medical use while better mitigating their diversion. Statistical model-building was used to evaluate the influence of changes to California's prescription monitoring program. The extent that practitioners prescribe Schedule II opioids and the incidence of people receiving prescriptions from multiple providers were measured. Such research illustrates the viability of evaluating drug control program impact on prescribing practice and potential diversion behaviors. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

  6. Prescriber-pharmacist collaboration: re-engineering the partnership to optimize pain patient care.

    Science.gov (United States)

    Ruble, James H

    2013-12-01

    The Walgreen Companies recently settled a Drug Enforcement Administration (DEA) administrative action and other investigations arising in connection with a controlled substance distribution facility in Florida and several of its retail pharmacies. These DEA enforcement actions upon a national chain pharmacy have resulted in a series of policies and professional practices that appear to functionally disrupt continuity of patient care. The policy issues transcend the professions and go to the core of our responsibilities to patients. It is unfortunate that regulations intended to prevent diversion also dramatically disrupt interprofessional relations. Based on public statements of professional organizations, unification on this issue seems possible. This presents an opportunity to revisit collaboration among prescribers and pharmacists in legislative and regulatory advocacy. A uniform definition of "legitimate medical purpose" is needed to maximize patient access to needed pharmacotherapy while remaining vigilant for diversion.

  7. Environmental Impact Assessment: A Procedure.

    Science.gov (United States)

    Stover, Lloyd V.

    Prepared by a firm of consulting engineers, this booklet outlines the procedural "whys and hows" of assessing environmental impact, particularly for the construction industry. Section I explores the need for environmental assessment and evaluation to determine environmental impact. It utilizes a review of the National Environmental Policy Act and…

  8. An experienced physiotherapist prescribing and administering corticosteroid and local anaesthetic injections to the shoulder in an Australian orthopaedic service, a non-inferiority randomised controlled trial and economic analysis: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Marks, Darryn; Bisset, Leanne; Thomas, Michael; O'Leary, Shaun; Comans, Tracy; Ng, Shu Kay; Conaghan, Philip G; Scuffham, Paul

    2014-12-21

    The early management of orthopaedic outpatients by physiotherapists may be useful in reducing public hospital waiting lists. Physiotherapists in Australia are prevented by legislation and funding models from investigating, prescribing, injecting and referring autonomously. This gap in service is particularly noticeable in the management of shoulder pain in early-access physiotherapy services, as patients needing corticosteroid injection face delays or transfer to other services for this procedure. This trial will investigate the clinical (decision making and outcomes) and economic feasibility of a physiotherapist prescribing and delivering corticosteroid and local anaesthetic injections for shoulder pain in an Australian public hospital setting. A double-blinded (patient and assessor) non-inferiority randomised controlled trial will compare an orthopaedic surgeon and a physiotherapist prescribing and delivering corticosteroid injections to the shoulder. Agreement in decision making between the two clinicians will be investigated, and economic information will be obtained for estimating disease burden and an economic evaluation. The surgeon and the physiotherapist will independently assess patients, and 64 eligible participants will be randomised to receive subacromial injection of corticosteroid and local anaesthetic from either the surgeon or the physiotherapist. Post-injection, all participants will receive physiotherapy. The primary outcome measure will be the Shoulder Pain and Disability Index measured at baseline, and at 6 and 12 weeks post-injection. Analysis will be conducted on an intention-to-treat basis and compared to a per-protocol analysis. A cost-utility analysis will be undertaken from the perspective of the health funder. Findings will assist policy makers and services in improving access for orthopaedic patients. Australia and New Zealand Clinical Trials Registry: 12612000532808 First registered: 21 May 2012. First participant randomized: 16

  9. 49 theses on energy policy

    International Nuclear Information System (INIS)

    Michaelis, H.

    1977-01-01

    The theses presented refer to the following subjects: 1) economic growth and energy consumption, 2) energy policy and primary energies, 3) nuclear energy, 4) licensing procedures, 5) administrative problems, 6) international integration of energy policy, and 7) long-term forecasts. (GG) [de

  10. Pharmaceutical interventions in medications prescribed for administration via enteral tubes in a teaching hospital

    Directory of Open Access Journals (Sweden)

    Carolina Justus Buhrer Ferreira Neto

    2016-01-01

    Full Text Available Abstract Objective: to analyze the impact of guidelines regarding errors in medications prescribed for administration through enteral tubes. Method: quantitative study, in three phases, undertaken in internal medicine, neurology and an intensive care unit in a general teaching hospital. In Phase 1, the following was undertaken: a protocol for dilution and unit-dose repackaging and administration for 294 medications via enteral tubes; a decision flowchart; operational-standard procedures for dilution and unit-dose repackaging of oral pharmaceutical forms and for administration of medications through enteral tubes. In phase 2, errors in 872 medications prescribed through enteral tubes, in 293 prescriptions for patients receiving inpatient treatment between March and June, were investigated. This was followed by training of the teams in relation to the guidelines established. In Phase 3, pharmaceutical errors and interventions in 945 medications prescribed through enteral tubes, in 292 prescriptions of patients receiving inpatient treatment between August and September, were investigated prospectively. The data collected, in a structured questionnaire, were compiled in the Microsoft Office Excel(r program, and frequencies were calculated. Results: 786 errors were observed, 63.9% (502 in Phase 2, and 36.1% (284 in Phase 3. In Phase 3, a reduction was ascertained in the frequency of prescription of medications delivered via enteral tubes, medications which were contraindicated, and those for which information was not available. Conclusion: guidelines and pharmaceutical interventions were determined in the prevention of errors involving medications delivered through enteral tubes.

  11. Tracking error constrained robust adaptive neural prescribed performance control for flexible hypersonic flight vehicle

    Directory of Open Access Journals (Sweden)

    Zhonghua Wu

    2017-02-01

    Full Text Available A robust adaptive neural control scheme based on a back-stepping technique is developed for the longitudinal dynamics of a flexible hypersonic flight vehicle, which is able to ensure the state tracking error being confined in the prescribed bounds, in spite of the existing model uncertainties and actuator constraints. Minimal learning parameter technique–based neural networks are used to estimate the model uncertainties; thus, the amount of online updated parameters is largely lessened, and the prior information of the aerodynamic parameters is dispensable. With the utilization of an assistant compensation system, the problem of actuator constraint is overcome. By combining the prescribed performance function and sliding mode differentiator into the neural back-stepping control design procedure, a composite state tracking error constrained adaptive neural control approach is presented, and a new type of adaptive law is constructed. As compared with other adaptive neural control designs for hypersonic flight vehicle, the proposed composite control scheme exhibits not only low-computation property but also strong robustness. Finally, two comparative simulations are performed to demonstrate the robustness of this neural prescribed performance controller.

  12. Dynamical implications of prescribing part of a coupled system: Results from a low-order model

    Directory of Open Access Journals (Sweden)

    A. T. Wittenberg

    1998-01-01

    Full Text Available It is a common procedure in climate modelling to specify dynamical system components from an external source; a prominent example is the forcing of an atmospheric model with observed sea surface temperatures. In this paper, we examine the dynamics of such forced models using a simple prototype climate system. A particular fully coupled run of the model is designated the "true" solution, and an ensemble of perturbed initial states is generated by adding small errors to the "true" initial state. The perturbed ensemble is then integrated for the same period as the true solution, using both the fully-coupled model and a model in which the ocean is prescribed exactly from the true solution at every time step. Although the prescribed forcing is error-free, the forced-atmosphere ensemble is shown to converge to spurious solutions. Statistical tests show that neither the time-mean state nor the variability of the forced ensemble is consistent with the fully-coupled system. A stability analysis reveals the source of the inconsistency, and suggests that such behaviour may be a more general feature of models with prescribed subsystems. Possible implications for model validation and predictability are discussed.

  13. Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation in an English hospital.

    Science.gov (United States)

    Puaar, Seetal Jheeta; Franklin, Bryony Dean

    2017-10-10

    Few studies have applied a systems approach to understanding the causes of specific prescribing errors in the context of hospital electronic prescribing (EP). A comprehensive understanding of underlying causes is essential for developing effective interventions to improve prescribing safety. Our objectives were to explore prescribers' perspectives of the causes of errors occurring with EP and to make recommendations to maximise benefits and minimise risks. We studied a large hospital using inpatient EP. From April to June 2016, semistructured interviews were conducted with purposively sampled prescribers involved with a prescribing error. Interviews explored prescribers' perceived causes of the error and views about EP; they were audio-recorded and transcribed verbatim. Data were thematically analysed against a framework based on Reason's accident causation model, with a focus on identifying latent conditions. Twenty-five interviews explored causes of 32 errors. Slips and rule-based mistakes were the most common active failures. Error causation was multifactorial; environmental, individual, team, task and technology error-producing conditions were all influenced by EP. There were three broad groups of latent conditions: the EP system's functionality and design; the organisation's decisions around EP implementation and use; and prescribing behaviours in the context of EP. Errors were associated with the design of EP itself and its integration within the healthcare environment. Findings suggest that EP vendors should focus on revolutionising interface design and usability issues, bearing in mind the wider healthcare context in which such software is used. Healthcare organisations should draw upon human factors principles when implementing EP. Consideration of work environment, infrastructure, training, prescribing responsibilities and behaviours should be considered to address local issues identified. © Article author(s) (or their employer(s) unless otherwise stated

  14. Challenges to nurse prescribers of a no-antibiotic prescribing strategy for managing self-limiting respiratory tract infections.

    Science.gov (United States)

    Rowbotham, Samantha; Chisholm, Anna; Moschogianis, Susie; Chew-Graham, Carolyn; Cordingley, Lis; Wearden, Alison; Peters, Sarah

    2012-12-01

    To report a qualitative study of the experiences of nurse prescribers in managing patients with self-limiting respiratory tract infections. Patients frequently attend primary care with respiratory tract infections. Although a no-prescribing strategy is recommended for these consultations, general practitioners frequently prescribe antibiotics, citing non-clinical reasons such as patient pressure. Nurses increasingly manage people with respiratory tract infections, but research has not yet explored their experiences within such consultations. Semi-structured interviews and focus groups. Fifteen semi-structured interviews and three focus groups (n=5, n=4, and n=12) with a purposive sample of nurse prescribers (n=34) and other non-medical prescribers (n=2) were conducted between November 2009-November 2010. A qualitative approach was used to develop conceptual categories from the dataset, and emerging themes were explored in subsequent interviews/focus groups. Although participants reported experiencing numerous challenges within these consultations, they believed that they possessed some of the communication skills to deal effectively with patients without prescribing antibiotics. Participants reported that protocols supported their decision-making and welcomed the benefits of peer support in dealing with 'demanding' patients. However, the newness of nurses and other non-medical prescribers to the prescribing role meant that some were cautious in dealing with patients with respiratory tract infections. Training for nurses and other non-medical prescribers should focus on building their confidence and skills to manage people with respiratory tract infections without recourse to antibiotics. Further work should seek to explore which strategies are most effective in managing respiratory tract infections while maintaining patient satisfaction with care. © 2012 Blackwell Publishing Ltd.

  15. Retrospective evaluation of antimicrobial prescribing pattern in a ...

    African Journals Online (AJOL)

    This was followed by quinolones and cephalosporin. Ciprofloxacin and cephalexin were the most commonly prescribed quinolones and cephalosporins respectively. Gentamycin was ... Conclusion: Broad spectrum and older generation antibacterials were the predominantly utilized antimicrobials in this survey. Agents like ...

  16. Prescribing Patterns and Cost of Antihypertensive Drugs in Private ...

    African Journals Online (AJOL)

    blockers (28.5 %), calcium channel blockers (19.8 %), hydralazine/losartan (18.5 %) and angiotensin converting enzyme inhibitors (11.5 %). Antihypertensives prescribed as monotherapy included atenolol (23.2 %), bendrofluazide (22 %), frusemide ...

  17. Prescribing psychotropic drugs to adults with an intellectual disability

    Science.gov (United States)

    Trollor, Julian N; Salomon, Carmela; Franklin, Catherine

    2016-01-01

    SUMMARY Mental illness is common in people with intellectual disability. They may also have physical health problems which can affect their mental state. Difficulties in communication can contribute to mental health problems being overlooked. These may present with changes in behaviour. Psychological management is usually preferable to prescribing psychotropic drugs. Behavioural approaches are the most appropriate way to manage challenging behaviour. If a drug is considered, prescribers should complete a thorough diagnostic assessment, exclude physical and environmental contributions to symptoms, and consider medical comorbidities before prescribing. Where possible avoid psychotropics with the highest cardiometabolic burden. Prescribe the minimum effective dose and treatment length, and regularly monitor drug efficacy and adverse effects. There is insufficient evidence to support the use of psychotropics for challenging behaviour. They should be avoided unless the behaviour is severe and non-responsive to other treatments. PMID:27756975

  18. 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

  19. 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....

  20. Factor analysis improves the selection of prescribing indicators

    DEFF Research Database (Denmark)

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

    2006-01-01

    OBJECTIVE: To test a method for improving the selection of indicators of general practitioners' prescribing. METHODS: We conducted a prescription database study including all 180 general practices in the County of Funen, Denmark, approximately 472,000 inhabitants. Principal factor analysis was used...... to model correlation between 19 register-based indicators for the quality of non-steroidal anti-inflammatory drug (NSAID) prescribing. RESULTS: The correlation between indicators ranged widely from 0 to 0.93. Factor analysis revealed three dimensions of quality: (1) "Coxib preference", comprising...... 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....

  1. 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.

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

    Czech Academy of Sciences Publication Activity Database

    Duintjer Tebbens, Jurjen; Meurant, G.

    2014-01-01

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

  3. Pharmacist supplementary prescribing: a step toward more independence?

    Science.gov (United States)

    Dawoud, Dalia; Griffiths, Peter; Maben, Jill; Goodyer, Larry; Greene, Russell

    2011-09-01

    Supplementary prescribing (SP) is a drug therapy management model implemented in the United Kingdom since 2003. It is a voluntary partnership between an independent prescriber; a supplementary prescriber, for example, nurse or pharmacist; and the patient, to implement an agreed patient-specific clinical management plan (CMP). To investigate pharmacist prescribers' views and experiences of the early stages of SP implementation. A qualitative, longitudinal study design was used. A purposive, maximum variability sample of 16 pharmacist supplementary prescribers, trained in Southern England, participated. Eleven were hospital pharmacists, owing to the overrepresentation of hospital pharmacists in the first cohort. Two semistructured interviews were conducted with each participant, at 3 and 6 months after their registration as prescribers. The Framework approach was used for data collection, management, and analysis. Three typologies of pharmacists' experiences were identified: "a blind alley", "a stepping stone" and "a good fit". Despite some delays in its implementation, SP was seen as a step forward. Some participants also believed that it improved patient care and pharmacists' integration in the health care team and increased their job satisfaction. However, there was a concern that SP, as first implemented, was bureaucratic and limited pharmacists' freedom in their decision making. Hence, pharmacists were more supportive of the then imminent introduction of a pharmacist independent prescribing (IP) role. Despite challenges, the SP role represented a step forward for pharmacists in the United Kingdom. It is possible that pharmacist SP can coexist with IP in the areas suitable for CMP use. Elsewhere, SP is likely to become more of a "stepping stone" to an IP role than the preferred model for pharmacist prescribing. Future research needs to objectively assess the outcomes of pharmacist SP, preferably in comparison with IP, to inform decision making among pharmacists

  4. Electronic prescribing in ambulatory practice: promises, pitfalls, and potential solutions.

    Science.gov (United States)

    Papshev, D; Peterson, A M

    2001-07-01

    To examine advantages of and obstacles to electronic prescribing in the ambulatory care environment. MEDLINE and International Pharmaceutical Abstract searches were conducted for the period from January 1980 to September 2000. Key words were electronic prescribing, computerized physician order entry, prior authorization, drug utilization review, and consumer satisfaction. In September 2000, a public search engine (www.google.com) was used to find additional technical information. In addition, pertinent articles were cross-referenced to identify other resources. Articles, symposia proceedings, and organizational position statements published in the United States on electronic prescribing and automation in healthcare are cited. Electronic prescribing can eliminate the time gap between point of care and point of service, reduce medication errors, improve quality of care, and increase patient satisfaction. Considerable funding requirements, segmentation of healthcare markets, lack of technology standardization, providers' resistance to change, and regulatory indecisiveness create boundaries to the widespread use of automated prescribing. The potential solutions include establishing a standardizing warehouse or a router and gaining stakeholder support in implementation of the technology. Electronic prescribing can provide immense benefits to healthcare providers, patients, and managed care. Resolution of several obstacles that limit feasibility of this technology will determine its future.

  5. Why Did My Doctor Prescribe Birth Control Pills for My Acne?

    Science.gov (United States)

    ... Search English Español Why Did My Doctor Prescribe Birth Control Pills for My Acne? KidsHealth / For Teens / Why Did My Doctor Prescribe Birth Control Pills for My Acne? Print My doctor prescribed ...

  6. Drug prescribing pattern in three levels of health care facilities in the ...

    African Journals Online (AJOL)

    tabulation and goodness of fit. Results showed that there is significant statistical differences in the number of drugs prescribed per patient encounter, percentage of encounter with an injection prescribed, in adherence to WHO prescribing ...

  7. A survey of the criteria for prescribing in cases of borderline refractive errors

    Directory of Open Access Journals (Sweden)

    Einat Shneor

    2016-01-01

    Conclusions: The prescribing criteria found in this study are broadly comparable with those in previous studies and with published prescribing guidelines. Subtle indications suggest that optometrists may become more conservative in their prescribing criteria with experience.

  8. 48 CFR 1401.301 - Policy.

    Science.gov (United States)

    2010-10-01

    ... implement or supplement the FAR under the DIAR System. The regulation, as part of the FAR system, is issued... prescribed in Part 318, Chapter 5 of the Departmental Manual (318 DM 5) and the procedures in FAR Subpart 1.5... Departmental Manual (209 DM 4.1A). ...

  9. Health policy and outlook.

    Science.gov (United States)

    Gleichmann, U

    2002-01-01

    Health policy has great influence on the daily work of every cardiologist. The influence of progress of practical cardiology on health policy in our country on the one hand and the influence of health policy on cardiology on the other hand are discussed, In the 1970s cardiac rehabilitation in special rehabilitation clinics was developed as a consequence of the usual therapy at that time with longer periods of bedrest and late invasive diagnostic procedures. Patients got a right on rehabilitation by law. However, in the 1980s the increasing number of rehabilitation clinics in our country and their budgets caused the first controversial discussion on health policy in our society, which was primarily thought to be a scientific one. At that time one of the first guidelines of the Commission of Clinical Cardiology as to coronary dilatation demanded in necessity of immediate cardiac surgery. To get more influence on the ongoing discussion the group of chief clinical cardiologists founded their own working group which had later on considerable influence on policy and scientific work of our society. Overall, the awareness of the need for active health policy was developed relatively late. For instance, the register of nationwide heart catheterization procedures was started in the early 1980s but was not used to influence health policies, for establishment of new catheterization facilities. At present, the development of cardiology is limited by budget and total number of cardiac operations is reduced, so it is time to remember the highly effective conservative "soft" therapy of atherosclerosis with a combination of drugs and changing lifestyle which is well evaluated in prospective studies. It is time to apply and reevaluate the chances of primary and secondary prevention of atherosclerosis and heart insufficiency. New non-invasive techniques as MRT and PET and therapeutic techniques as genetic or stem cell therapy will influence cost and health policy in the near future.

  10. Prescribing Optimization Method for Improving Prescribing in Elderly Patients Receiving Polypharmacy Results of Application to Case Histories by General Practitioners

    NARCIS (Netherlands)

    Drenth-van Maanen, A. Clara; van Marum, Rob J.; Knol, Wilma; van der Linden, Carolien M. J.; Jansen, Paul A. F.

    2009-01-01

    Background: Optimizing polypharmacy is often difficult, and critical appraisal of medication use often leads to one or more changes. We developed the Prescribing Optimization Method (POM) to assist physicians, especially general practitioners (GPs), in their attempts to optimize polypharmacy in

  11. Pharmacy students teaching prescribers strategies to lower prescription drug costs for underserved patients.

    Science.gov (United States)

    Stebbins, Marilyn R; Frear, Meghan E; Cutler, Timothy W; Lightwood, James M; Fingado, Amanda R; Lai, Cindy J; Lipton, Helene Levens

    2013-09-01

    The rising costs of health care and, in particular, prescription drugs remains a challenge. Health professionals' ability to promote cost-effective prescription drug use is critical, yet this subject is not included consistently in the curriculum of most health professional schools. As experts in prescription drug selection, use, and cost, pharmacists are in a unique position to help manage prescription drug regimens for the best therapeutic outcome, while also helping to keep patients' out-of-pocket (OOP) prescription drug costs low. In addition to promoting interprofessional collaboration, pharmacy student-led lectures may provide an effective means to teach prescription drug cost-savings strategies to other health professional students and current prescribers. To describe and evaluate the impact of a 60- to 90-minute standardized, case-based lecture on prescribers' attitudes and knowledge about drug cost-containment strategies. Four trained pharmacy students delivered a lecture that focused on strategies to help underserved patients with their OOP prescription drug costs. This lecture was given to health professional students and prescribers across disciplines. For purposes of this study, underserved patients included those with no drug insurance, those with limited financial resources who were unable to pay for their prescription drugs, and those whose drug insurance had significant gaps in coverage (e.g., Medicare Part D patients). Lectures targeted future and current prescribers and were delivered in multiple settings (e.g., residents' seminars, medical grand rounds, required health policy courses for medical and nursing students). Pretest/posttest surveys were administered to assess the impact of the lecture on learners' (a) knowledge of strategies to improve underserved patients' access to needed prescription drugs; (b) willingness to address and discuss cost issues with patients; (c) likelihood of collaborating with other health care professionals; and (d

  12. 48 CFR 304.7100 - Policy.

    Science.gov (United States)

    2010-10-01

    ... MATTERS Review and Approval of Proposed Contract Actions 304.7100 Policy. (a) The HCA (non-delegable) shall establish review and approval procedures for proposed contract actions to ensure that— (1) Contractual documents are in conformance with law, established policies and procedures, and sound business...

  13. Activists' Influence Tactics and Corporate Policies

    Science.gov (United States)

    de Bakker, Frank G. A.; den Hond, Frank

    2008-01-01

    Corporations increasingly pay attention to issues of social responsibility, but their policies and procedures to articulate such responsibilities are not just a result of the good will of top management. Often, such policies and procedures are devised because some stakeholders raised their voice on issues relating to the interests of employees,…

  14. 32 CFR 237a.4 - Procedures.

    Science.gov (United States)

    2010-07-01

    ... business organizations of DoD policies, plans, programs, and procedures which have an impact on business or... development; (b) Procurement; (c) Contract management; (d) Small business opportunity; (e) DoD policies... which offer the opportunity to promote U.S. scientific and technical leadership); and (d) Civic and...

  15. 77 FR 44174 - Procedures for Safety Investigations

    Science.gov (United States)

    2012-07-27

    ... of safety investigations. The rule is intended to state clearly the Board's policy and procedures for... statutory authority, when appropriate, following standard safety investigation policies, practices, and... has adhered to the regulatory philosophy and the applicable principles of regulation as set forth in...

  16. The policies

    International Nuclear Information System (INIS)

    Laruelle, Ph.; Snegaroff, Th.; Moreau, S.; Tellenne, C.; Brunel, S.

    2005-01-01

    Fourth chapter of the book on the geo-policy of the sustainable development, this chapter deal with the different and international policies concerned by the problem. The authors analyze the american energy attitude and policy, the economical equilibrium facing the environmental equilibrium for the european policy, the sanctified and sacrificed nature and the japanese attitude, India and China, the great fear of the 21 century and the sustainable development in Africa. (A.L.B.)

  17. Decreasing Prescribing Errors During Pediatric Emergencies: A Randomized Simulation Trial.

    Science.gov (United States)

    Larose, Guylaine; Levy, Arielle; Bailey, Benoit; Cummins-McManus, Barbara; Lebel, Denis; Gravel, Jocelyn

    2017-03-01

    To evaluate whether a clinical aid providing precalculated medication doses decreases prescribing errors among residents during pediatric simulated cardiopulmonary arrest and anaphylaxis. A crossover randomized trial was conducted in a tertiary care hospital simulation center with residents rotating in the pediatric emergency department. The intervention was a reference book providing weight-based precalculated doses. The control group used a card providing milligram-per-kilogram doses. The primary outcome was the presence of a prescribing error, defined as a dose varying by ≥20% from the recommended dose or by incorrect route. Residents were involved in 2 sets of paired scenarios and were their own control group. Primary analysis was the difference in mean prescribing error proportions between both groups. Forty residents prescribed 1507 medications or defibrillations during 160 scenarios. The numbers of prescribing errors per 100 bolus medications or defibrillations were 5.1 (39 out of 762) and 7.5 (56 out of 745) for the intervention and control, respectively, a difference of 2.4 (95% confidence interval [CI], -0.1 to 5.0). However, the intervention was highly associated with lower risk of 10-fold error for bolus medications (odds ratio 0.27; 95% CI, 0.10 to 0.70). For medications administered by infusion, prescribing errors occurred in 3 out of 76 (4%) scenarios in the intervention group and 13 out of 76 (22.4%) in the control group, a difference of 13% (95% CI, 3 to 23). A clinical aid providing precalculated medication doses was not associated with a decrease in overall prescribing error rates but was highly associated with a lower risk of 10-fold error for bolus medications and for medications administered by continuous infusion. Copyright © 2017 by the American Academy of Pediatrics.

  18. A Validation Study of Homeopathic Prescribing and Patient Care Indicators

    Directory of Open Access Journals (Sweden)

    Munmun Koley

    2014-10-01

    Full Text Available A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H, Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items and patient care indicators (5 items. Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791. The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations – Pearson's r from 0.58 (95% CI: 0.52-0.65 to 0.74 (95% CI: 0.69-0.78. The patient care indicators, except item 2, showed acceptable correlations – Pearson's r from 0.40 (95% CI: 0.31-0.48 to 0.82 (95% CI: 0.78-0.85. The instrument also showed high discriminant validity (prescribing indicators P<0.0001 and patient care indicators P<0.0001. Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development.

  19. Contraceptive Provision to Adolescent Females Prescribed Teratogenic Medications.

    Science.gov (United States)

    Stancil, Stephani L; Miller, Melissa; Briggs, Holley; Lynch, Daryl; Goggin, Kathy; Kearns, Gregory

    2016-01-01

    Rates of adult women receiving contraceptive provision when simultaneously prescribed a known teratogen are alarmingly low. The prevalence of this behavior among pediatric providers and their adolescent patients is unknown. The objective of this study was to describe pediatric provider behaviors for prescribing teratogens concurrently with counseling, referral, and/or prescribing of contraception (collectively called contraceptive provision) in the adolescent population. A retrospective review was conducted examining visits in 2008-2012 by adolescents aged 14 to 25 years in which a known teratogen (US Food and Drug Administration pregnancy risk category D or X) was prescribed. The electronic medical records were queried for demographic information, evidence of contraceptive provision, and menstrual and sexual histories. The data were analyzed using standard statistical methods. Within 4172 clinic visits, 1694 females received 4506 prescriptions for teratogenic medications. The most commonly prescribed teratogens were topiramate, methotrexate, diazepam, isotretinoin, and enalapril. The subspecialties prescribing teratogens most frequently were neurology, hematology-oncology, and dermatology. Overall, contraceptive provision was documented in 28.6% of the visits. Whites versus nonwhites and older versus younger girls were more likely to receive contraceptive provision. The presence of a federal risk mitigation system for the teratogen also increased the likelihood of contraceptive provision. Our data demonstrate female adolescents prescribed teratogens receive inadequate contraception provision, which could increase their risk for negative pregnancy outcomes. Although the presence of a federal risk mitigation system appears to improve contraceptive provision, these systems are costly and, in some instances, difficult to implement. Efforts to improve provider practices are needed. Copyright © 2016 by the American Academy of Pediatrics.

  20. Prescribed burning supports grassland biodiversity - A multi-species study

    Science.gov (United States)

    Valkó, Orsolya; Deák, Balázs; Magura, Tibor; Török, Péter; Kelemen, András; Tóth, Katalin; Horváth, Roland; Nagy, Dávid; Debnár, Zsuzsanna; Zsigrai, György; Kapocsi, István; Tóthmérész, Béla

    2017-04-01

    During ancient times, fire was an important factor shaping European landscapes. Nowadays, prescribed burning can be one of the most effective conservation tools for the management of open landscapes, controlling dominant species, reducing accumulated litter or decreasing wildfire risk. In a prescribed burning experiment, we studied the effects of fire on dry alkaline grasslands. We tested whether autumn prescribed burning can be an alternative conservation measure in these grasslands. We selected six sites in Hungary: in three sites, prescribed burning was applied in November 2011, while three sites remained unburnt. We studied the effects of fire on soil characteristics, plant biomass and on the vegetation and arthropod assemblages (isopods, spiders, ground beetles and rove beetles). Soluble salt content increased significantly in the burnt sites, but soil pH, organic matter, potassium and phosphorous did not change. We found that prescribed fire had several positive effects from the nature conservation viewpoint. Diversity and the number of flowering shoots were higher, and the cover of the dominant grass was lower in the burnt sites. Graminoid biomass was lower, while total, green and forb biomass were higher in the burnt plots compared to the control ones. Our findings suggest that prescribed burning fire did not harm arthropods; species-level analyses showed that out of the most abundant invertebrate species, the abundance of ten was not affected, one decreased and one increased after burning. Our findings highlight that mosaic prescribed fire is a viable management tool in open landscapes, because it supports plant diversity and does not threaten arthropods.

  1. High-Dose Opioid Prescribing and Opioid-Related Hospitalization: A Population-Based Study.

    Directory of Open Access Journals (Sweden)

    Kimberly Fernandes

    Full Text Available To examine the impact of national clinical practice guidelines and provincial drug policy interventions on prevalence of high-dose opioid prescribing and rates of hospitalization for opioid toxicity.Interventional time-series analysis.Ontario, Canada, from 2003 to 2014.Ontario Drug Benefit (ODB beneficiaries aged 15 to 64 years from 2003 to 2014.Publication of Canadian clinical practice guidelines for use of opioids in chronic non-cancer pain (May 2010 and implementation of Ontario's Narcotics Safety and Awareness Act (NSAA; November 2011.Three outcomes were explored: the rate of opioid use among ODB beneficiaries, the prevalence of opioid prescriptions exceeding 200 mg and 400 mg morphine equivalents per day, and rates of opioid-related emergency department visits and hospital admissions.Over the 12 year study period, the rate of opioid use declined 15.2%, from 2764 to 2342 users per 10,000 ODB eligible persons. The rate of opioid use was significantly impacted by the Canadian clinical practice guidelines (p-value = .03 which led to a decline in use, but no impact was observed by the enactment of the NSAA (p-value = .43. Among opioid users, the prevalence of high-dose prescribing doubled (from 4.2% to 8.7% over the study period. By 2014, 40.9% of recipients of long-acting opioids exceeded daily doses of 200 mg morphine or equivalent, including 55.8% of long-acting oxycodone users and 76.3% of transdermal fentanyl users. Moreover, in the last period, 18.7% of long-acting opioid users exceeded daily doses of 400 mg morphine or equivalent. Rates of opioid-related emergency department visits and hospital admissions increased 55.0% over the study period from 9.0 to 14.0 per 10,000 ODB beneficiaries from 2003 to 2013. This rate was not significantly impacted by the Canadian clinical practice guidelines (p-value = .68 or enactment of the NSAA (p-value = .59.Although the Canadian clinical practice guidelines for use of opioids in chronic non

  2. 15 CFR 15.31 - Policy.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Policy. 15.31 Section 15.31 Commerce and Foreign Trade Office of the Secretary of Commerce LEGAL PROCEEDINGS Statement of Policy and Procedures Regarding Indemnification of Department of Commerce Employees § 15.31 Policy. (a) The Department...

  3. 10 CFR 706.10 - Policy.

    Science.gov (United States)

    2010-01-01

    ... SECURITY POLICIES AND PRACTICES RELATING TO LABOR-MANAGEMENT RELATIONS Security Policies and Procedures in... published decisions. This policy does not preclude adoption of special arrangements which may be required for reasons of program security at any stage of the proceedings in particular areas. ...

  4. School Capital Policies, Regulations and Guidelines.

    Science.gov (United States)

    Alberta Dept. of Education, Edmonton. Finance and Administration Div.

    This document is a compendium of the policies, regulations, and guidelines that govern provincial school capital funding in Alberta. The compendium supplements the general framework of policies, guidelines, and procedures contained in the earlier Management and Finance Plan (MFP). Each section of the compendium contains a set of policies,…

  5. Prescribing medical cannabis in Canada: Are we being too cautious?

    Science.gov (United States)

    Lake, Stephanie; Kerr, Thomas; Montaner, Julio

    2015-04-30

    There has been much recent discussion and debate surrounding cannabis in Canada, including the prescribing of medical cannabis for therapeutic purposes. Certain commentators - including the Canadian Medical Association (CMA) - have denounced the prescribing of cannabis for medical purposes due to a perceived lack of evidence related to the drug's efficacy, harms, and mechanism of action. In this commentary, we present arguments in favour of prescribing medical cannabis in Canada. We believe the anti-cannabis position taken by CMA and other commentators is not entirely evidence-based. Using the example of neuropathic pain, we present and summarize the clinical evidence surrounding smoked or vapourized cannabis, including recent evidence pertaining to the effectiveness of cannabis in comparison to existing standard pharmacotherapies for neuropathy. Further, we outline how the concerns expressed regarding cannabis' mechanism of action are inconsistent with current decision-making processes related to the prescribing of many common pharmaceuticals. Finally, we discuss potential secondary public health benefits of prescribing cannabis for pain-related disorders in Canada and North America.

  6. Antibiotic resistance and irrational prescribing in paediatric clinics in Greece.

    Science.gov (United States)

    Toska, Aikaterini; Geitona, Mary

    Greece is among the countries with the highest rates of antimicrobial resistance (AMR) and simultaneous antibiotic consumption. The aim of this study was to assess the perceptions and knowledge of AMR and irrational antibiotic prescribing of nurses working in paediatric hospitals in Greece. A self-administered questionnaire was distributed to nurses in paediatric hospitals and paediatric clinics in Greece. Descriptive and multivariate statistical analyses were performed. Levels of significance were two-tailed and statistical significance was p=0.05. A total of 87% of participants reported irrational prescribing to be an important cause of AMR. Diagnostic uncertainty was stated by 55.5% as the main cause of irrational antibiotic prescribing and 94% suggested the use of protocols and guidelines as the main measure to control overprescribing. Parental demand for antibiotics in hospitals has increased according to 51.8% of respondents. Strong correlation was observed between social-demographic characteristics and antibiotic resistance, as well as irrational prescribing. Assessing nurses' knowledge and perceptions of antimicrobial resistance and irrational prescribing is vital as nurses actively participate in the antibiotics administration process and antimicrobial management in Greece. Their involvement could contribute to educate patients and parents on the public-health implications of overprescribing and antimicrobial resistance.

  7. 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.

  8. Prescribing Privileges for Psychologists: A Public Service or Hazard?

    Directory of Open Access Journals (Sweden)

    Shaheen E. Lakhan

    2007-07-01

    Full Text Available The privilege to prescribe pharmacotherapeutics has been granted in limited areas to psychologists. The psychologist's role in society may be approaching a great evolution that can dramatically impact the state of mental healthcare and the discipline of psychiatry. Opponents argue drug company funding and cheaper non-PhD psychological professionals fuel the movement for prescription rights for PhD level psychologists. However, proponents claim that this right would equip psychologists with greater psychotherapeutic modalities and the capability of having richer doctor-patient relationships to diagnose and treat underserved populations. Nonetheless, the paucity of prescribing psychologist studies cannot allow the biopsychosocial community to make firm opinions, let alone a decision on this debate. This article reviews the history of clinical psychology and highlights the potential divergence into collaborative clinical and health psychologists and autonomous prescribing psychologists.

  9. Developing a policy manual.

    Science.gov (United States)

    Hotta, Tracey A

    2013-01-01

    Do you really need to have a policy and procedure in the office? Frequently they are seen sitting on the shelf, collecting dust. The answer is yes for a number of very important reasons. A policy and procedure manual is a tool to set guidelines and expectations on the basis of the mission and vision of the office. A well-written manual is a powerful training tool for new staff so they can get a feel for the office culture. Furthermore, it is a provincial or state legislative requirement that can reduce management's concern about potential legal issues or problems. If an office does not have a manual to set guidelines, the employees may be forced to make their own decisions to solve problems, which can often result in confusion, inconsistencies, and mistakes.

  10. Prescribing and the core curriculum for tomorrow's doctors: BPS curriculum in clinical pharmacology and prescribing for medical students

    Science.gov (United States)

    Ross, Sarah; Maxwell, Simon

    2012-01-01

    Prescribing is one of the commonest tasks expected of new doctors and is a complex process involving a mixture of knowledge, judgement and skills. Preparing graduates to be prescribers is one of the greatest challenges of modern undergraduate medical education and there is some evidence to suggest that training could be improved. The aims of this article are (i) to review some of the challenges of delivering effective prescribing education, (ii) to provide a clear statement of the learning outcomes in clinical pharmacology and prescribing that should be expected of all medical graduates and (iii) to describe a curriculum that might enable students to achieve these outcomes. We build on the previous curriculum recommendations of the British Pharmacological Society and take into account those of other key bodies, notably the General Medical Council. We have also reviewed relevant evidence from the literature and set our work in the context of recent trends in medical education. We divide our recommended learning objectives into four sections: principles of clinical pharmacology, essential drugs, essential therapeutic problems and prescribing skills. Although these will not necessarily be accepted universally we believe that they will help those who design and map undergraduate curricula to explore potential gaps and identify improvements. PMID:22288524

  11. Prescribing Safety Assessment 2016: Delivery of a national prescribing assessment to 7343 UK final-year medical students.

    Science.gov (United States)

    Maxwell, Simon R J; Coleman, Jamie J; Bollington, Lynne; Taylor, Celia; Webb, David J

    2017-10-01

    Newly graduated doctors write a large proportion of prescriptions in UK hospitals but recent studies have shown that they frequently make prescribing errors. The prescribing safety assessment (PSA) has been developed as an assessment of competence in relation to prescribing and supervising the use of medicines. This report describes the delivery of the PSA to all UK final-year medical students in 2016 (PSA2016). The PSA is a 2-hour online assessment comprising eight sections which cover various aspects of prescribing defined within the outcomes of undergraduate education identified by the UK General Medical Council. Students sat one of four PSA 'papers', which had been standard-set using a modified Angoff process. A total of 7343 final-year medical students in all 31 UK medical schools sat the PSA. The overall pass rate was 95% with the pass rates for the individual papers ranging from 93 to 97%. The PSA was re-sat by 261 students who had failed and 80% of those candidates passed. The internal consistency (Cronbach's alpha) of the four papers ranged from 0.74 to 0.77 (standard error of measurement 4.13-4.24%). There was a statistically significant variation in performance between medical school cohorts (F = 32.6, P medical students were able to meet a prespecified standard of prescribing competence. © 2017 The British Pharmacological Society.

  12. Design objectives with non-zero prescribed support displacements

    DEFF Research Database (Denmark)

    Pedersen, Pauli; Pedersen, Niels Leergaard

    2011-01-01

    When non-zero prescribed support displacements are involved in addition to design independent loads for a continuum/structure, then the objectives of minimum compliance (total elastic energy) and of maximum strength lead to different designs. This is verified by the presented sensitivities. Designs...... from neither of the two objectives are characterized by uniformly distributed energy density. However, simple iterations with the goal of obtaining uniform energy density show that the strength is favored by this approach. These observations leads to a rejection of the objectives of compliance...... and discussed in detail for different combinations of non-zero prescribed support displacements and design independent loads....

  13. Physicians' knowledge of and willingness to prescribe naloxone to reverse accidental opiate overdose: challenges and opportunities.

    Science.gov (United States)

    Beletsky, Leo; Ruthazer, Robin; Macalino, Grace E; Rich, Josiah D; Tan, Litjen; Burris, Scott

    2007-01-01

    Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a "take-home" dose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored.

  14. Impact of prescription drug-monitoring program on controlled substance prescribing in the ED.

    Science.gov (United States)

    McAllister, Matthew W; Aaronson, Patrick; Spillane, Joe; Schreiber, Mark; Baroso, Genelyn; Kraemer, Dale; Smotherman, Carmen; Gray-Eurom, Kelly

    2015-06-01

    In 2009, Florida initiated a statewide prescription drug-monitoring program (PDMP) to encourage safer prescribing of controlled substances and reduce drug abuse and diversion. Data supporting the utility of such programs in the emergency department (ED) is scarce. This study sought to determine the effect of PDMP data on controlled substance prescribing from the ED. In this pre-post study utilizing a historical control, pharmacists in the ED provided prescribers with a summary of the PDMP data for their patients. The number of controlled substances prescribed in the intervention group was compared with that prescribed in the historical control to determine if the intervention resulted in a change in the average number of controlled substance prescribed. Among the 710 patients evaluated, providing prescribers with PDMP data did not alter the average number of controlled substance per patient prescribed (0.23 controlled substances per patient in the historical control compared with 0.28 controlled substances per patient in the intervention group; 95% confidence interval [CI], -0.016 to 0.116; P = .125). All prescribers surveyed indicated that having PDMP data altered their controlled substance prescribing and felt more comfortable prescribing controlled substances. Although the results did not demonstrate a change in the average number of controlled substances prescribed when prescribers were provided with PDMP data, results from the survey indicate that prescribers felt the data altered their prescribing of controlled substances, and thus were more contented prescribing controlled substances. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. New staff contract policy

    CERN Multimedia

    HR Department

    2006-01-01

    Following discussion at TREF and on the recommendation of the Finance Committee, Council approved a new staff contract policy, which became effective on 1 January 2006. Its application is covered by a new Administrative Circular No. 2 (Rev. 3) 'Recruitment, appointment and possible developments regarding the contractual position of staff members'. The revised circular replaces the previous Circulars No. 9 (Rev. 3) 'Staff contracts' and No. 2 (Rev. 2) 'Guidelines and procedures concerning recruitment and probation period for staff members'. The main features of the new contract policy are as follows: The new policy provides chances for long-term employment for all staff recruits staying for four years without distinguishing between those assigned to long-term or short-term activities when joining CERN. In addition, it presents a number of simplifications for the award of ICs. There are henceforth only 2 types of contract: Limited Duration (LD) contracts for all recruitment and Indefinite Contracts (IC) for...

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

    Directory of Open Access Journals (Sweden)

    D'Onofrio David J

    2012-03-01

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

  17. PRINCIPLES AND PROCEDURES ON FISCAL

    Directory of Open Access Journals (Sweden)

    Morar Ioan Dan

    2011-07-01

    Full Text Available Fiscal science advertise in most analytical situations, while the principles reiterated by specialists in the field in various specialized works The two components of taxation, the tax system relating to the theoretical and the practical procedures relating to tax are marked by frequent references and invocations of the underlying principles to tax. This paper attempts a return on equity fiscal general vision as a principle often invoked and used to justify tax policies, but so often violated the laws fiscality . Also want to emphasize the importance of devising procedures to ensure fiscal equitable treatment of taxpayers. Specific approach of this paper is based on the notion that tax equity is based on equality before tax and social policies of the executive that would be more effective than using the other tax instruments. I want to emphasize that if the scientific approach to justify the unequal treatment of the tax law is based on the various social problems of the taxpayers, then deviates from the issue of tax fairness justification explaining the need to promote social policies usually more attractive to taxpayers. Modern tax techniques are believed to be promoted especially in order to ensure an increasing level of high efficiency at the expense of the taxpayers obligations to ensure equality before the law tax. On the other hand, tax inequities reaction generates multiple recipients from the first budget plan, but finalities unfair measures can not quantify and no timeline for the reaction, usually not known. But while statistics show fluctuations in budgetary revenues and often find in literature reviews and analysis relevant to a connection between changes in government policies, budget execution and outcome. The effects of inequality on tax on tax procedures and budgetary revenues are difficult to quantify and is among others to this work. Providing tax equity without combining it with the principles of discrimination and neutrality

  18. Policies and procedures related to testing for weak D phenotypes and administration of Rh immune globulin: results and recommendations related to supplemental questions in the Comprehensive Transfusion Medicine survey of the College of American Pathologists.

    Science.gov (United States)

    Sandler, S Gerald; Roseff, Susan D; Domen, Ronald E; Shaz, Beth; Gottschall, Jerome L

    2014-05-01

    Advances in RHD genotyping offer an opportunity to update policies and practices for testing weak D phenotypes and administration of Rh immune globulin to postpartum women. To repeat questions from a 1999 College of American Pathologists proficiency test survey, to evaluate current practices for testing for weak D and administration of Rh immune globulin, and to determine whether there is an opportunity to begin integrating RHD genotyping in laboratory practice. The College of American Pathologists Transfusion Medicine Resource Committee sent questions from the 1999 survey to laboratories that participated in the 2012 proficiency test survey. The results of the 2012 survey were compared with those from 1999. Results from published RHD genotyping studies were analyzed to determine if RHD genotyping could improve current policies and practices for serological Rh typing. More than 3100 survey participants responded to the 2012 questions. The most significant finding was a decrease in the number of transfusion services performing a serological weak D test on patients as a strategy to manage those with a weak D as Rh negative (from 58.2% to 19.8%, P policies and practices could improve the accuracy of Rh typing results, reduce unnecessary administration of Rh immune globulin in women with a weak D, and decrease transfusion of Rh-negative red blood cells in most recipients with a serological weak D phenotype.

  19. Prescribers' interactions with medication alerts at the point of prescribing: A multi-method, in situ investigation of the human-computer interaction.

    Science.gov (United States)

    Russ, Alissa L; Zillich, Alan J; McManus, M Sue; Doebbeling, Bradley N; Saleem, Jason J

    2012-04-01

    Few studies have examined prescribers' interactions with medication alerts at the point of prescribing. We conducted an in situ, human factors investigation of outpatient prescribing to uncover factors that influence the prescriber-alert interaction and identify strategies to improve alert design. Field observations and interviews were conducted with outpatient prescribers at a major Veterans Affairs Medical Center. Physicians, clinical pharmacists, and nurse practitioners were recruited across five primary care clinics and eight specialty clinics. Prescribers were observed in situ as they ordered medications for patients and resolved alerts. Researchers collected 351 pages of typed notes across 102 hours of observations and interviews. An interdisciplinary team identified emergent themes via inductive qualitative analysis. Altogether, 320 alerts were observed among 30 prescribers and their interactions with 146 patients. Qualitative analysis uncovered 44 emergent themes and 9 overarching factors, which were organized into a framework that describes the prescriber-alert interaction. Prescribers' ability to act on alerts was impeded by the alert interface, which did not adequately support all prescriber types. This empiric study produced a novel framework for understanding the prescriber-alert interaction. Results revealed key components of the alert interface that influence prescribers and indicate a need for more universal design. Actionable design recommendations are presented and may be used to enhance alert design and patient safety. Published by Elsevier Ireland Ltd.

  20. Patients' intention to consume prescribed and non-prescribed medicines: A study based on the theory of planned behaviour in selected European countries.

    Science.gov (United States)

    Kamekis, A; Bertsias, A; Moschandreas, J; Petelos, E; Papadakaki, M; Tsiantou, V; Saridaki, A; Symvoulakis, E K; Souliotis, K; Papadakis, N; Faresjö, T; Faresjö, A; Martinez, L; Agius, D; Uncu, Y; Sengezer, T; Samoutis, G; Vlcek, J; Abasaeed, A; Merkouris, B; Lionis, C

    2018-02-01

    Polypharmacy has a significant impact on patients' health with overall expenditure on over-the-counter (OTC) medicines representing a substantial burden in terms of cost of treatment. The aim of this study, which was conducted within the framework of a European Project funded by the European Union under the Seventh Framework Programme and was entitled OTC-SOCIOMED, was to report on possible determinants of patient behaviour regarding the consumption of medicines, and particularly OTCs, in the context of primary care. A multicentre, cross-sectional study was designed and implemented in well-defined primary healthcare settings in Cyprus, the Czech Republic, France, Greece, Malta and Turkey. Patients completed a questionnaire constructed on the basis of the theory of planned behaviour (TPB), which was administered via face-to-face interviews. The percentage of patients who had consumed prescribed medicines over a 6-month period was consistently high, ranging from 79% in the Czech Republic and 82% in Turkey to 97% in Malta and 100% in Cyprus. Reported non-prescribed medicine consumption ranged from 33% in Turkey to 92% in the Czech Republic and 97% in Cyprus. TPB behavioural antecedents explained 43% of the variability of patients' intention to consume medicines in Malta and 24% in Greece, but only 3% in Turkey. Subjective norm was a significant predictor of the intention to consume medicines in all three countries (Greece, Malta and Turkey), whereas attitude towards consumption was a significant predictor of the expectation to consume medicines, if needed. This study shows that parameters such as patients' beliefs and influence from family and friends could be determining factors in explaining the high rates of medicine consumption. Factors that affect patients' behavioural intention towards medicine consumption may assist in the formulation of evidence-based policy proposals and inform initiatives and interventions aimed at increasing the appropriate use of medicines

  1. Policy Innovation in Innovation Policy

    DEFF Research Database (Denmark)

    Borras, Susana

    as with national and sub-national governments in Europe, all of them introducing interesting novelties in their innovation policy. These changes refer to different aspects of policy, mainly the content of policy initiatives towards science, technology and innovation; the instruments governments are using...... to achieve their goals; and the actors in the policy system that are being mobilised in pursuing these goals. This paper deals with these policy changes, paying special attention to the novelties introduced since the early 1990s in Europe. The perspective of this paper deals mainly on the changes introduced...... at the EU level, and mentions similar trends taking place at national and sub-national levels. The questions that guide the contents here are essentially three, namely, what are the main traits of innovation policies in Europe since the 1990s and how have the EU and different national governments approached...

  2. 69-74 A Retrospective Analysis of Prescribing Prac

    African Journals Online (AJOL)

    user

    survey as per WHO drug use indicators. A retrospective analysis of a total of 2024 prescriptions randomly sampled in the outpatient pharmacies of the four selected hospitals was done by well-trained pharmacists. A standard data collection tool developed by the WHO was used for assessing prescribing indicators. These.

  3. Prescribing Errors in Cardiovascular Diseases in a Tertiary Health ...

    African Journals Online (AJOL)

    Prescription errors are now known to be contributing to a large number of deaths during the treatment of cardiovascular diseases. However, there is paucity of information about these errors occurring in health facilities in Nigeria. The objective of this study was to investigate the prevalence of prescribing errors in ...

  4. Analysis of paediatric prescribing profiles in two health-funding ...

    African Journals Online (AJOL)

    Objective.To investigate the adequacy of two large South. African medical administrative databases in providing prescribing profiles for paediatricians and general practitioners (GPs) respectively. Design. Statistical analysis of data captured during. 1994. Data were analysed retrospectively with frequency analysis and ...

  5. Prescribed fire effects on erosion parameters in a perennial grassland

    Science.gov (United States)

    Mary E. O' Dea; D. Phillip Guertin

    2003-01-01

    A 2-year field experiment was undertaken to quantify theinteracting effects of a late-spring prescribed burn and summerrainfall on seasonal runoff and erosion in a southern Arizonagrassland. Six blocks with walled subplots (n = 24) were installedon a hillslope to measure changes to plant, soil, and hydrologicvariables in response to treatments. Increased bulk density,...

  6. Prescribing Patterns and Cost of Antihypertensive Drugs in Private ...

    African Journals Online (AJOL)

    Nx 6110

    Antihypertensive agents are used to prevent morbidity and mortality related to hypertension. Prescribing patterns and the cost of some antihypertensive were studied for 600 patients attending medical clinics in four private hospitals in Dar es. Salaam using the WHO drug use indicator forms. The average number of drugs ...

  7. Drug prescribing patterns for outpatients in three hospitals in north ...

    African Journals Online (AJOL)

    Background: Information about drug utilization at the out patient departments of the Hospitals in Ethiopia is scanty although a large segment of the patients are being served at the outpatient departments. Objective: To evaluate and compare patterns of drug prescribing practiced in the outpatient departments of three ...

  8. Prescribing of meprobamate-containing combination analgesics in ...

    African Journals Online (AJOL)

    I Truter

    2016-06-29

    Jun 29, 2016 ... medicine classes, especially sedatives and anxiolytics. It is possible that males in this study were prescribed a lower percentage of anxiolytic agents, and that they were using meprobamate-containing analgesics for their anxiolytic, rather than their analgesic, effect and hence the higher frequency of.

  9. CDC Vital Signs–Opioid Prescribing

    Centers for Disease Control (CDC) Podcasts

    2017-07-06

    This podcast is based on the July 2017 CDC Vital Signs report. Higher opioid prescribing puts patients at risk for addiction and overdose. Learn what can be done about this serious problem.  Created: 7/6/2017 by Centers for Disease Control and Prevention (CDC).   Date Released: 7/6/2017.

  10. Smoke management guide for prescribed and wildland fire: 2001 edition.

    Science.gov (United States)

    Colin C. Hardy; Roger D. Ottmar; Janice L Peterson; John E. Core; Paula Seamon

    2001-01-01

    The National Wildfire Coordinating Group's (NWCG) Fire Use Working Team has assumed overall responsibility for sponsoring the development and production of this revised Smoke Management Guide for Prescribed and Wildland Fire (the "Guide"). The Mission Statement for the Fire Use Working Team includes the need to coordinate and advocate the use of fire to...

  11. Patterns of prescribing and utilization of asthma medications in a ...

    African Journals Online (AJOL)

    Purpose: To assess the prescribing patterns of asthma medications in a hospital in Dubai, United Arab. Emirates (UAE) with regard to the ... outpatient respiratory diseases clinic of a tertiary hospital in Dubai, UAE over a 3-month period. Patients were asked to complete a ... and quality assurance. There are three types of.

  12. Extent of Occurrence of Prescribing Errors in a Private Tertiary ...

    African Journals Online (AJOL)

    Background: Correct prescription writing has a great influence on the fate of medicine therapy and health of patients. Errors in prescribing may be classified into two main types: errors of omission and errors of commission. Errors of omission are where a prescription is incomplete whereas errors of commission contain ...

  13. Retrospective Evaluation of Analgesics Prescribing Pattern in a ...

    African Journals Online (AJOL)

    The study was designed to retrospectively evaluate the analgesics prescribing pattern in the Accident and Emergency (A and E) Unit of University of Benin Teaching Hospital, Benin City. The data was retrieved from the pharmacy archives type of analgesics and its routes of administration whether oral or parenteral in all ...

  14. Guidelines prescribed by general practitioners to patients with acute ...

    African Journals Online (AJOL)

    The aim of this study was to investigate the guidelines prescribed by general practitioners (GPs) to patients with acute low back pain (ALBP) regarding 'return to work'. Methods: A systematic sample of 212 GPs, selected from a list supplied by the Health Professions Council of South Africa (HPCSA), was selected to complete ...

  15. Behaviour and effects of prescribed fire in masticated fuelbeds

    Science.gov (United States)

    Eric Knapp; J. Morgan Varner; Matt Busse; Carl Skinner; Carol Shestak

    2011-01-01

    Mechanical mastication converts shrub and small tree fuels into surface fuels, and this method is being widely used as a treatment to reduce fire hazard. The compactness of these fuelbeds is thought to moderate fire behaviour, but whether standard fuel models can accurately predict fire behaviour and effects is poorly understood. Prescribed burns were conducted in...

  16. Antibiotic prescribing practice in management of cough and/or ...

    African Journals Online (AJOL)

    Introduction: The increase in resistance of many pathogens to currently available antibiotics has been recognized as life-threatening problem. The development of drug resistance is promoted by irrational prescribing behavior. Inappropriate use of antibiotics is attributed by overprescription, inadequate dosage and use for ...

  17. Note on the surface wave due to the prescribed elevation

    Indian Academy of Sciences (India)

    Home; Journals; Pramana – Journal of Physics; Volume 62; Issue 1. Note on the surface wave due to the prescribed elevation. Niranjan Das. Brief Reports Volume 62 Issue 1 January 2004 pp 135-142. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/pram/062/01/0135-0142 ...

  18. Rationalising prescribing: Evidence, marketing and practice-relevant knowledge.

    Science.gov (United States)

    Wadmann, Sarah; Bang, Lia E

    2015-06-01

    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 of GPs as a need for practice-relevant knowledge and argue that industry sales representatives are granted opportunity to access general practice because they understand this need of GPs. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. 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...

  20. An assessment of factors influencing the prescribing of antibiotics in ...

    African Journals Online (AJOL)

    Patients aware of the dangers, to the community, of over-prescribing, expected antibiotics 64% of the time as opposed to 90% of the patients who were unaware of the dangers. Conclusion: Several non-clinical factors, such as patient expectation and doctors' perception of this expectation, were associated with antibiotic ...

  1. [Prescribing diuretics: what a practitioner needs to know].

    Science.gov (United States)

    Richard, C; Saudan, P; Ernandez, T

    2015-02-25

    Diuretics are among the most frequently prescribed drugs. Most of them act by inhibiting sodium reabsorption in various nephron segments. By understanding their pharmacological characteristics, it is possible to adapt the type of diuretic to different clinical situations. Practical aspects of their use, including in heart failure, cirrhosis, the nephrotic syndrome and renal failure, are discussed.

  2. Aspen response to prescribed fire and wild ungulate herbivory

    Science.gov (United States)

    Steve Kilpatrick; Diane Abendroth

    2001-01-01

    Land management agencies in northwest Wyoming have implemented an active prescribed fire program to address historically altered fire regimes, regenerate aspen, and improve overall watershed functions. Treated clones are susceptible to extensive browsing from elk concentrated on supplemental feedgrounds and from wintering moose. Previous attempts at fire-induced aspen...

  3. Airborne characterization of smoke marker ratios from prescribed burning

    Science.gov (United States)

    A. P. Sullivan; A. A. May; T. Lee; G. R. McMeeking; S. M. Kreidenweis; S. K. Akagi; R. J. Yokelson; S. P. Urbanski; J. L. Collett

    2014-01-01

    A Particle-Into-Liquid Sampler - Total Organic Carbon (PILS-TOC) and fraction collector system was flown aboard a Twin Otter aircraft sampling prescribed burning emissions in South Carolina in November 2011 to obtain smoke marker measurements. The fraction collector provided 2 min time-integrated offline samples for carbohydrate (i.e., smoke markers levoglucosan,...

  4. 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...

  5. Factors Influencing Prescribing Practices of Medical Practitioners in ...

    African Journals Online (AJOL)

    However, other factors including physicians' level of education and experience, frequency of visits ... modified to improve physicians' prescribing behavior [5,6]. In developing countries many factors have been ... Doctors, Assistant Medical Officers and Clinical. Officers. A descriptive cross sectional study was used to.

  6. Concomitant prescribing of benzodiazepines during antidepressant therapy in the elderly

    NARCIS (Netherlands)

    van Dijk, KN; de Vries, CS; ter Huume, K; van den Berg, PB; Brouwers, JRBJ; van den Berg, LTWD

    2002-01-01

    A follow-up study was performed in two ambulatory cohorts aged greater than or equal to65 to investigate whether the prevalence and incidence of anxiolytic/hypnotic benzodiazepine drug prescribing is comparable between users of serotonin reuptake inhibitors (SSRIs) and users of tricyclic

  7. 42 CFR 423.160 - Standards for electronic prescribing.

    Science.gov (United States)

    2010-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality... SCRIPT Standard, Implementation Guide, Version 5, Release 0, (Version 5.0) May 12, 2004 (incorporated by... Prescriber/Pharmacist Interface SCRIPT Standard, Implementation Guide, Version 8, Release 1, (Version 8.1...

  8. Exploring the Prevalence of Malaria and Prescribing Pattern of ...

    African Journals Online (AJOL)

    Background: The primary healthcare is the entry point of the populace into the healthcare sector and is aimed at providing effective and efficient healthcare services. It is paramount to prescribe drugs correctly; especially malaria which remains a major public health problem in Nigeria and a leading causes of outpatient visits ...

  9. Prescribing of methylphenidate to children and adolescents in South ...

    African Journals Online (AJOL)

    Background: Pharmacoepidemiological studies on ADHD are limited in South Africa. The primary aim was to analyse the prescribing of methylphenidate to patients aged 18 years and younger in the private health care sector. Methods: Data for a one-month period in 2004 were obtained from a large medical aid ...

  10. Prescribing of methylphenidate to children and adolescents in South ...

    African Journals Online (AJOL)

    2008-11-13

    Nov 13, 2008 ... Background: Pharmacoepidemiological studies on ADHD are limited in South Africa. The primary aim was to analyse the prescribing of methylphenidate to patients aged 18 years and younger in the private health care sector. Methods: Data for a one-month period in 2004 were obtained from a large ...

  11. Prescribing patterns of methylphenidate in a South African patient ...

    African Journals Online (AJOL)

    ADHD) in children. The primary aim of the study was to investigate the prescribing patterns of methylphenidate of a medical aid patient population in a private sector and to compare the results with previous studies. An exposure cohort drug ...

  12. Appropriateness of Omeprazole Prescribing in Quebec’s Senior Population

    Directory of Open Access Journals (Sweden)

    Jean-Pierre Grégoire

    2000-01-01

    Full Text Available BACKGROUND: Prescribing omeprazole for the treatment of digestive disorders accounts for an important part of the costs in Quebec’s drug benefit plan. In July 1993, the Quebec drug program listed omeprazole, with restriction, in its formulary. On January 1, 1994, this restriction was lifted; since then, omeprazole has been listed in the regular provincial formulary.

  13. Impacts of prescribed fire on soil loss and soil quality

    NARCIS (Netherlands)

    Shakesby, Richard A.; Martins Bento, Celia; Ferreira, Carla S.S.; Ferreira, António J.D.; Stoof, C.R.; Urbanek, Emilia; Walsh, Rory P.D.

    2015-01-01

    Prescribed (controlled) fire has recently been adopted as an important wildfire-fighting strategy in the Mediterranean. Relatively little research, however, has assessed its impacts on soil erosion and soil quality. This paper investigates hillslope-scale losses of soil, organic matter and

  14. Topical antibiotic monotherapy prescribing practices in acne vulgaris.

    Science.gov (United States)

    Hoover, William D; Davis, Scott A; Fleischer, Alan B; Feldman, Steven R

    2014-04-01

    The aim of this study is to evaluate the frequency of dosing topical antibiotics as monotherapy in the treatment of acne vulgaris, and physician specialty prescribing these medications. This study is a retrospective review of all visits with a sole diagnosis of acne vulgaris (ICD-9-CM code 706.1) found on the National Ambulatory Medical Care Survey (NAMCS) in 1993-2010. We recorded the number of visits surveyed where acne vulgaris was the sole diagnosis, number of visits where topical antibiotics were the only treatment prescribed, and the specialty of physician in each encounter. Topical erythromycin or clindamycin were the sole medication prescribed in 0.81% of the visits recorded, with 60% of these prescriptions arising from dermatologists and 40% from non-dermatologists. The trend of prescribing topical antibiotic monotherapy is declining (p acnes to topical antibiotic regimens has led to the need to re-evaluate the use of topical antibiotics in the treatment of acne vulgaris. While the rate of topical antibiotic monotherapy is declining, their use should be reserved for situations where the direct need for antibiotics arises. If a clinician feels that antibiotics are a necessary component to acne therapy, they should be used as part of a combination regimen.

  15. Although Relatively Few, "Doctor Shoppers" Skew Opioid Prescribing

    Science.gov (United States)

    ... Behavior Smoking Stimulant Drug Therapy for ADHD Stress Withdrawal See All NIDA Notes Articles Get this Publication Cite this article APA Style MLA Style AMA Style NIDA. (2014, May 27). Although Relatively Few, “Doctor Shoppers” Skew Opioid Prescribing. Retrieved from https://www.drugabuse.gov/news- ...

  16. Patterns of prescribing and utilization of asthma medications in a ...

    African Journals Online (AJOL)

    Purpose: To assess the prescribing patterns of asthma medications in a hospital in Dubai, United Arab Emirates (UAE) with regard to the demographic pattern of the population. Methods: One hundred fifty four patients, 83 male and 71 female, were randomly selected from the outpatient respiratory diseases clinic of a tertiary ...

  17. Out-Patient Prescribing Practices at Mbagathi District Hospital ...

    African Journals Online (AJOL)

    Objective: To assess medicine use practices by using WHO prescribing and patient care indicators in Mbagathi Hospital outpatient department. Design: A hospital based retrospective study. Setting: Mbagathi District Hospital outpatient department between 1st January to 30th June 2012. Main outcome measures: Measures ...

  18. Vegetation dynamics after a prescribed fire in the southern Appalachians

    Science.gov (United States)

    Katherine J. Elliott; Ronald L. Hendrick; Amy E. Major; James M. Vose; Wayne T. Swank

    1999-01-01

    In April 1995, the USDA Forest Service conducted a prescribed burn along with a south-facing slope of Southern Appalachian watershed, Nantahala National Forest, western NC. Fire had been excluded for over 70 years and the purpose of the burn was to create a mosaic of fire intensities to restore a degraded pine/hardwood community and to stimulate forage production and...

  19. The effects of fepeated prescribed burning on Pinus ponderosa growth

    Science.gov (United States)

    David L. Peterson; Stephen S. Sackett; Lindsay J. Robinson; Sally M. Haase

    1994-01-01

    The effect of repeated prescribed burning on long term growth of Pinus ponderosa in northern Arizona was examined. Fire treatments for hazard reduction were initiated in 1976,and growthwas evaluated in 1988 for fire rotations of 1, 2, 4, 6, 8, and 10 years. Dendroecological analysis shows that there were only small changes in treegrowth (compared tocontrols) in the...

  20. Prescribed burning experiences in Italy: an integrated approach to prevent forest fires

    Directory of Open Access Journals (Sweden)

    Ascoli D

    2012-02-01

    Full Text Available Prescribed burning is used in many geographical areas for multiple and integrated objectives (wildfire prevention, habitat conservation, grazing management. In Europe the collaboration between researchers and fire professionals has brought to implement this technique over increasing areas (~104 ha year-1, effectively and efficiently. In Italy prescribed burning has not been much studied and it is rarely applied. A new interest is recently rising. Some Regions particularly threatened by wildfires have updated their legislation and set up procedures to authorize prescribed fire experiments and interventions. From 2004 to 2011 several scientific, operative and training experiences have been carried out at a regional level (Basilicata, Campania, Friuli Venezia Giulia, Piemonte, Sardegna, Toscana. The present paper aims to: (i document and compare these regional programs; (ii discuss their frameworks and limitations; (iii provide information about objectives, prescriptions, methods and results. The study has involved Universities, Forest Corps, Civil Protection, Municipalities, Parks and professionals from Italy and other Countries. Interventions have regarded integrated objectives (fire hazard reduction; habitat conservation; forest and grazing management, and involved several vegetation types (broadleaved and conifer forests; Mediterranean and Continental shrublands; grasslands. Studies on fire behaviour and ecology have helped to set prescriptions for specific objectives and environments. Results have been transferred to professionals through training sessions. Several common elements are outlined: integrated objectives, multidisciplinary character, training and research products. Ecological questions, certification to the use of fire, communication to local communities and the proposal of new studies, are some of the issues outlined in the discussion. The present study is the first review at national level and we hope it will help to deepen the