WorldWideScience

Sample records for policy prescribes procedures

  1. 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.

  2. 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...

  3. Pharmaceutical policies: effects of financial incentives for prescribers.

    Science.gov (United States)

    Rashidian, Arash; Omidvari, Amir-Houshang; Vali, Yasaman; Sturm, Heidrun; Oxman, Andrew D

    2015-08-04

    The proportion of total healthcare expenditures spent on drugs has continued to grow in countries of all income categories. Policy-makers are under pressure to control pharmaceutical expenditures without adversely affecting quality of care. Financial incentives seeking to influence prescribers' behaviour include budgetary arrangements at primary care and hospital settings (pharmaceutical budget caps or targets), financial rewards for target behaviours or outcomes (pay for performance interventions) and reduced benefit margin for prescribers based on medicine sales and prescriptions (pharmaceutical reimbursement rate reduction policies). This is the first update of the original version of this review. To determine the effects of pharmaceutical policies using financial incentives to influence prescribers' practices on drug use, healthcare utilisation, health outcomes and costs (expenditures). We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (searched 29/01/2015); MEDLINE, Ovid SP (searched 29/01/2015); EMBASE, Ovid SP (searched 29/01/2015); International Network for Rational Use of Drugs (INRUD) Bibliography (searched 29/01/2015); National Health Service (NHS) Economic Evaluation Database (searched 29/01/2015); EconLit - ProQuest (searched 02/02/2015); and Science Citation Index and Social Sciences Citation Index, Institute for Scientific Information (ISI) Web of Knowledge (citation search for included studies searched 10/02/2015). We screened the reference lists of relevant reports and contacted study authors and organisations to identify additional studies. We included policies that intend to affect prescribing by means of financial incentives for prescribers. Included in this category are pharmaceutical budget caps or targets, pay for performance and drug reimbursement rate reductions and other financial policies, if they were specifically targeted at prescribing or drug utilisation. Policies in this review were defined as laws, rules

  4. Evaluating Alternative Prescribed Burning Policies to Reduce Net Economic Damages from Wildfire

    OpenAIRE

    D. Evan Mercer; Jeffrey P. Prestemon; David T. Butry; John M. Pye

    2007-01-01

    We estimate a wildfire risk model with a new measure of wildfire output, intensity-weighted risk and use it in Monte Carlo simulations to estimate welfare changes from alternative prescribed burning policies. Using Volusia County, Florida as a case study, an annual prescribed burning rate of 13% of all forest lands maximizes net welfare; ignoring the effects on wildfire intensity may underestimate optimal rates of prescribed burning. Our estimated supply function for prescribed fire services ...

  5. Evaluating alternative prescribed burning policies to reduce net economic damages from wildfire

    Science.gov (United States)

    D. Evan Mercer; Jeffrey P. Prestemon; David T. Butry; John M. Pye

    2007-01-01

    We estimate a wildfire risk model with a new measure of wildfire output, intensity-weighted risk and use it in Monte Carlo simulations to estimate welfare changes from alternative prescribed burning policies. Using Volusia County, Florida as a case study, an annual prescribed burning rate of 13% of all forest lands maximizes net welfare; ignoring the effects on...

  6. 41 CFR 102-85.5 - By what authority is the pricing policy in this part prescribed?

    Science.gov (United States)

    2010-07-01

    ... pricing policy in this part prescribed? 102-85.5 Section 102-85.5 Public Contracts and Property Management...-PRICING POLICY FOR OCCUPANCY IN GSA SPACE Pricing Policy-General § 102-85.5 By what authority is the pricing policy in this part prescribed? (a) General authority is granted in the Federal Property and...

  7. Association Between Academic Medical Center Pharmaceutical Detailing Policies and Physician Prescribing.

    Science.gov (United States)

    Larkin, Ian; Ang, Desmond; Steinhart, Jonathan; Chao, Matthew; Patterson, Mark; Sah, Sunita; Wu, Tina; Schoenbaum, Michael; Hutchins, David; Brennan, Troyen; Loewenstein, George

    2017-05-02

    In an effort to regulate physician conflicts of interest, some US academic medical centers (AMCs) enacted policies restricting pharmaceutical representative sales visits to physicians (known as detailing) between 2006 and 2012. Little is known about the effect of these policies on physician prescribing. To analyze the association between detailing policies enacted at AMCs and physician prescribing of actively detailed and not detailed drugs. The study used a difference-in-differences multivariable regression analysis to compare changes in prescribing by physicians before and after implementation of detailing policies at AMCs in 5 states (California, Illinois, Massachusetts, Pennsylvania, and New York) that made up the intervention group with changes in prescribing by a matched control group of similar physicians not subject to a detailing policy. Academic medical center implementation of policies regulating pharmaceutical salesperson visits to attending physicians. The monthly within-drug class market share of prescriptions written by an individual physician for detailed and nondetailed drugs in 8 drug classes (lipid-lowering drugs, gastroesophageal reflux disease drugs, diabetes drugs, antihypertensive drugs, hypnotic drugs approved for the treatment of insomnia [sleep aids], attention-deficit/hyperactivity disorder drugs, antidepressant drugs, and antipsychotic drugs) comparing the 10- to 36-month period before implementation of the detailing policies with the 12- to 36-month period after implementation, depending on data availability. The analysis included 16 121 483 prescriptions written between January 2006 and June 2012 by 2126 attending physicians at the 19 intervention group AMCs and by 24 593 matched control group physicians. The sample mean market share at the physician-drug-month level for detailed and nondetailed drugs prior to enactment of policies was 19.3% and 14.2%, respectively. Exposure to an AMC detailing policy was associated with a

  8. University Policies and Procedures on Sexual Harassment.

    Science.gov (United States)

    McIntyre, Jerilyn S.

    Sexual harassment complaints are challenges to the abuse of power in certain kinds of communicative relationships, and sexual harassment policies and procedures are ways of defining the responsible exercise of power and providing the means to address grievances that result from irresponsible and potentially harmful uses of power in those…

  9. Improving antimicrobial prescribing: implementation of an antimicrobial i.v.-to-oral switch policy.

    Science.gov (United States)

    McCallum, A D; Sutherland, R K; Mackintosh, C L

    2013-01-01

    Antimicrobial stewardship programmes reduce the risk of hospital associated infections (HAI) and antimicrobial resistance, and include early intravenous-to-oral switch (IVOS) as a key stewardship measure. We audited the number of patients on intravenous antimicrobials suitable for oral switch, assessed whether prescribing guidelines were followed and reviewed prescribing documentation in three clinical areas in the Western General Hospital, Edinburgh, in late 2012. Following this, the first cycle results and local guidelines were presented at a local level and at the hospital grand rounds, posters with recommendations were distributed, joint infection consult and antimicrobial rounds commenced and an alert antimicrobial policy was introduced before re-auditing in early 2013. We demonstrate suboptimal prescribing of intravenous antimicrobials, with 43.9% (43/98) of patients eligible for IVOS at the time of auditing. Only 56.1% (55/98) followed empiric prescribing recommendations. Documentation of antimicrobial prescribing was poor with stop dates recorded in 14.3%, indication on prescription charts in 18.4% and in the notes in 90.8%. The commonest reason for deferring IVOS was deteriorating clinical condition or severe sepsis. Further work to encourage prudent antimicrobial prescribing and earlier consideration of IVOS is required.

  10. Windscale inquiry and policy-making procedures

    Energy Technology Data Exchange (ETDEWEB)

    Von Moltke, K

    1978-07-01

    Policy decisions on the development and installation of nuclear facilities often strain both the time and human resources of a country, some countries having taken steps to involve the national government in specific siting decisions and shifting the constitutional balance in response to popular dissent. Challenges to nuclear facilities could be met by limiting the scope of intervenors and the use of judicial review. The 100-day Windscale Inquiry in the United Kingdom represents the most costly review any country has had of a specific nuclear policy and has international implications. A chronology of the inquiry illustrates how the debate evolved into a vote on whether nuclear energy should be developed at all and effectively cut off other avenues of recourse. The traditional procedures for planning are shown to be inadequate for setting nuclear energy policy without the intervention of Parliament. 18 references.

  11. 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

    2017-01-01

    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. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. 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

    decreased from 33.5 to 9.4 %, corresponding to a risk ratio of 0.28. In primary care after discharge, 13.4 % of esomeprazole use was initiated in the hospital, and this was 8.4 % for PPIs in general. After the change of hospital drug policy, this decreased to 6.5 % for esomeprazole and increased......AIM: This study had two aims: Firstly, to describe how prescriptions for proton pump inhibitor (PPI) in primary care were influenced by a change of the hospital drug policy, and secondly, to describe if a large discount on an expensive PPI (esomeprazole) to a hospital would influence prescribing...... policy on prescribings in primary care was measured by the likelihood of having a high-cost PPI prescribed before and after change of drug policy. RESULTS: In total, 9,341 hospital stays in 2009 and 2010 were included. The probability of a patient to be prescribed an expensive PPI after discharge...

  13. Medical school gift restriction policies and physician prescribing of newly marketed psychotropic medications: difference-in-differences analysis.

    Science.gov (United States)

    King, Marissa; Essick, Connor; Bearman, Peter; Ross, Joseph S

    2013-01-30

    To examine the effect of attending a medical school with an active policy on restricting gifts from representatives of pharmaceutical and device industries on subsequent prescribing behavior. Difference-in-differences approach. 14 US medical schools with an active gift restriction policy in place by 2004. Prescribing patterns in 2008 and 2009 of physicians attending one of the schools compared with physicians graduating from the same schools before the implementation of the policy, as well as a set of contemporary matched controls. Probability that a physician would prescribe a newly marketed medication over existing alternatives of three psychotropic classes: lisdexamfetamine among stimulants, paliperidone among antipsychotics, and desvenlafaxine among antidepressants. None of these medications represented radical breakthroughs in their respective classes. For two of the three medications examined, attending a medical school with an active gift restriction policy was associated with reduced prescribing of the newly marketed drug. Physicians who attended a medical school with an active conflict of interest policy were less likely to prescribe lisdexamfetamine over older stimulants (adjusted odds ratio 0.44, 95% confidence interval 0.22 to 0.88; P=0.02) and paliperidone over older antipsychotics (0.25, 0.07 to 0.85; P=0.03). A significant effect was not observed for desvenlafaxine (1.54, 0.79 to 3.03; P=0.20). Among cohorts of students who had a longer exposure to the policy or were exposed to more stringent policies, prescribing rates were further reduced. Exposure to a gift restriction policy during medical school was associated with reduced prescribing of two out of three newly introduced psychotropic medications.

  14. 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

  15. 32 CFR 14.3 - Policies and procedures.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Policies and procedures. 14.3 Section 14.3... QUALIFICATION OF CIVILIAN DEFENSE COUNSEL § 14.3 Policies and procedures. (a) Application procedures. (1... the subject of any sanction or disciplinary action by any court, bar, or other competent governmental...

  16. 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.

  17. 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

  18. 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.

  19. 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

  20. Simple multicomponent batch distillation procedure with a variable reflux policy

    Directory of Open Access Journals (Sweden)

    A. N. García

    2014-06-01

    Full Text Available This paper describes a shortcut procedure for batch distillation simulation with a variable reflux policy. The procedure starts from a shortcut method developed by Sundaram and Evans in 1993 and uses an iterative cycle to calculate the reflux ratio at each moment. The functional relationship between the concentrations at the bottom and the dome is evaluated using the Fenske equation and is complemented with the equations proposed by Underwood and Gilliland. The results of this procedure are consistent with those obtained using a fast method widely validated in the relevant literature.

  1. 32 CFR 168a.4 - Policy and procedures.

    Science.gov (United States)

    2010-07-01

    ... to pursue graduate degrees in science, engineering, or other fields of study that are designated, in... DEFENSE SCIENCE AND ENGINEERING GRADUATE FELLOWSHIPS § 168a.4 Policy and procedures. (a) Sponsoring... nationwide competition in which all appropriate actions have been taken to encourage applications from...

  2. 21 CFR 203.34 - Policies and procedures; administrative systems.

    Science.gov (United States)

    2010-04-01

    ... distribution security and audit system, including conducting random and for-cause audits of sales... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Policies and procedures; administrative systems...; administrative systems. Each manufacturer or authorized distributor of record that distributes drug samples shall...

  3. ODIN. Online Database Information Network: ODIN Policy & Procedure Manual.

    Science.gov (United States)

    Townley, Charles T.; And Others

    Policies and procedures are outlined for the Online Database Information Network (ODIN), a cooperative of libraries in south-central Pennsylvania, which was organized to improve library services through technology. The first section covers organization and goals, members, and responsibilities of the administrative council and libraries. Patrons…

  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 609.930 - Policies and procedures.

    Science.gov (United States)

    2010-01-01

    .... Before engaging in E-commerce, you must weigh its business risks against its benefits. You must also....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...

  6. 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 Section 206.3 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE MANAGEMENT OF FEDERAL AGENCY RECEIPTS...

  7. 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

  8. 2 CFR 3185.30 - What policies and procedures must I follow?

    Science.gov (United States)

    2010-01-01

    ... INSTITUTE OF MUSEUM AND LIBRARY SERVICES NONPROCUREMENT DEBARMENT AND SUSPENSION § 3185.30 What policies and procedures must I follow? The IMLS policies and procedures that you must follow are the policies and... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false What policies and procedures must I follow...

  9. Basic policy of JMTR refurbishment and regulatory procedure

    International Nuclear Information System (INIS)

    Tobita, Kenji

    2012-04-01

    The JMTR refurbishment started from FY2007 had been completed on the end of the FY2010. The refurbishment works carried out on about 60 items nuclear reactor systems, (about 40 of facilities and about 20 constructions) with no trouble. This report review the basic policy of JMTR refurbishment, such as a selection of facilities/equipments for the refurbishment and the determination method of specifications for repairs. The deliberation and discussion by the safety review committee of Oarai Research and Development Center in the Japan Atomic Energy Agency and nuclear regulatory procedure are included in this report. (author)

  10. 23 CFR 630.1106 - Policy and procedures for work zone safety management.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Policy and procedures for work zone safety management... Policy and procedures for work zone safety management. (a) Each agency's policy and processes, procedures, and/or guidance for the systematic consideration and management of work zone impacts, to be...

  11. 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

  12. 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...

  13. 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.

  14. 15 CFR 291.6 - Additional requirements; Federal policies and procedures.

    Science.gov (United States)

    2010-01-01

    ... and Foreign Trade NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, DEPARTMENT OF COMMERCE NIST... requirements; Federal policies and procedures. Recipients and subrecipients are subject to all Federal laws and Federal and Department of Commerce policies, regulations, and procedures applicable to Federal financial...

  15. Responding to Self-Harm: A Documentary Analysis of Agency Policy and Procedure

    Science.gov (United States)

    Paul, Sally; Hill, Malcolm

    2013-01-01

    This paper reports on the findings of a documentary analysis of policies and procedures relating to self-harm from a range of organisations working with young people in the UK. It identifies the extent to which policies and/or procedures relating to self-harm are available for service providers and offers a wider understanding of the concepts of…

  16. Policies and Procedures for Foreign Exchange Agencies. First Edition.

    Science.gov (United States)

    Hartman, Donald D.

    The guide details the policy of the Jefferson County (Alabama) Board of Education policy concerning international exchange of students (travel both to and from United States) in elementary and secondary grades. The first section specifies the standards by which the county will evaluate all international exchange agencies concerning structure,…

  17. 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...

  18. 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.

  19. 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)

  20. 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.

  1. 76 FR 213 - National Environmental Policy Act Implementing Procedures

    Science.gov (United States)

    2011-01-03

    ... due to, for example, a threatened violation of applicable environmental, safety, and health... legally enforceable rights, benefits, or responsibilities, substantive or procedural, not otherwise... failed in indoor tests. Whether the explosives or propellants were tested indoors or outdoors, the...

  2. Rationalising prescribing

    DEFF Research Database (Denmark)

    Wadmann, Sarah; Bang, Lia Evi

    2015-01-01

    Initiatives in the name of 'rational pharmacotherapy' have been launched to alter what is seen as 'inappropriate' prescribing practices of physicians. Based on observations and interviews with 20 general practitioners (GPs) in 2009-2011, we explored how attempts to rationalise prescribing interac...

  3. 12 CFR 612.2165 - Policies and procedures.

    Science.gov (United States)

    2010-01-01

    ..., preserve the integrity and independence of the supervisory process, and prevent the improper use of... employees may purchase any real or personal property of a System institution acquired by such institution... demonstrating compliance with standards-of-conduct decisions and board policy; (12) Establish reporting...

  4. 33 CFR 236.5 - Policy and procedure.

    Science.gov (United States)

    2010-07-01

    ... manage when directly integrated with the implementation or management of the water resource development... created by a water resource development to be recommended for implementation by the Corps of Engineers. (3... DEFENSE WATER RESOURCE POLICIES AND AUTHORITIES: CORPS OF ENGINEERS PARTICIPATION IN IMPROVEMENTS FOR...

  5. 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...

  6. 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…

  7. 12 CFR 616.6300 - Leasing policies, procedures, and underwriting standards.

    Science.gov (United States)

    2010-01-01

    ... property and associated risks; (e) Property tax and sales tax reporting; (f) Title and ownership of leased... engaged in lease underwriting must adopt a written policy (or policies). Management, at the direction of the board, must develop procedures that reflect lease practices that control risk and comply with all...

  8. 75 FR 70557 - Endocrine Disruptor Screening Program; Draft Policies and Procedures for Screening Safe Drinking...

    Science.gov (United States)

    2010-11-17

    ... comments by referencing a Code of Federal Regulations (CFR) part or section number. iii. Explain why you... the record in accordance with section 554 of the Administrative Procedure Act (APA). (15 U.S.C. 2615(a... referencing by parties unfamiliar with the referenced regulation. C. When do these policies and procedures...

  9. 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...

  10. MyHealthAtVanderbilt: policies and procedures governing patient portal functionality

    Science.gov (United States)

    Rosenbloom, S Trent; Stenner, Shane P; Anders, Shilo; Muse, Sue; Johnson, Kevin B; Jirjis, Jim; Jackson, Gretchen Purcell

    2011-01-01

    Explicit guidelines are needed to develop safe and effective patient portals. This paper proposes general principles, policies, and procedures for patient portal functionality based on MyHealthAtVanderbilt (MHAV), a robust portal for Vanderbilt University Medical Center. We describe policies and procedures designed to govern popular portal functions, address common user concerns, and support adoption. We present the results of our approach as overall and function-specific usage data. Five years after implementation, MHAV has over 129 800 users; 45% have used bi-directional messaging; 52% have viewed test results and 45% have viewed other medical record data; 30% have accessed health education materials; 39% have scheduled appointments; and 29% have managed a medical bill. Our policies and procedures have supported widespread adoption and use of MHAV. We believe other healthcare organizations could employ our general guidelines and lessons learned to facilitate portal implementation and usage. PMID:21807648

  11. 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

  12. 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.

  13. 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...... 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......-medical issues,” they refer to routines, clinical expertise, experiences with their patients, and decision-making based more on contextual circumstances than molecular conditions—and on the fact that such conditions can be hard to assess. This article’s contribution to knowledge about how new and global health...

  14. Library and Archival Security: Policies and Procedures To Protect Holdings from Theft and Damage.

    Science.gov (United States)

    Trinkaus-Randall, Gregor

    1998-01-01

    Firm policies and procedures that address the environment, patron/staff behavior, general attitude, and care and handling of materials need to be at the core of the library/archival security program. Discussion includes evaluating a repository's security needs, collections security, security in non-public areas, security in the reading room,…

  15. A Review of Cash Management Policies, Procedures and Practices of Mississippi's Institutions of Higher Learning.

    Science.gov (United States)

    Mississippi State Legislature, Jackson. Performance Evaluation and Expenditure Review Committee.

    This report to the Mississippi Legislature presents the findings of a review of the cash management policies, procedures, and practices of the State Board of Trustees of Institutions of Higher Learning (IHL). The methodology involved review of: applicable Mississippi statutes; standards promulgated by the National Association of College and…

  16. 2 CFR 801.30 - What policies and procedures must I follow?

    Science.gov (United States)

    2010-01-01

    ...? 801.30 Section 801.30 Grants and Agreements Federal Agency Regulations for Grants and Agreements DEPARTMENT OF VETERANS AFFAIRS NONPROCUREMENT DEBARMENT AND SUSPENSION § 801.30 What policies and procedures... § 801.220 in this part (2 CFR 801.220). ...

  17. 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

  18. 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.

  19. 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…

  20. Policies and procedures in the workplace: how health care organizations compare.

    Science.gov (United States)

    Loo, R

    1993-01-01

    Many organizations are implementing programs and services to manage the human and economic costs of stress. A mail survey was conducted of 500 randomly selected Canadian organizations having at least 500 employees. The survey tapped four major areas: organizational policies and procedures for managing stress; programs and services offered; perceived benefits and constraints for the organization; and projected future directions in this area. Analyses of returns from 210 organizations-43 health and 167 non-health-revealed various findings. For example, over half of health care organizations have policies and procedures as opposed to less than half of non-health care organizations. Also, health care organizations place greater emphasis on smoking cessation, weight control programs and on stress management training. Although some Canadian organizations are addressing stress, much more could and should be done, especially by organizations that do not yet recognize the impact of stress on employees and their work performance.

  1. Library Operations Policies and Procedures, Volume 2. Central Archive for Reusable Defense Software (CARDS)

    Science.gov (United States)

    1994-02-28

    use and customize those policies and procedures applicable to the implementor’s situation. It is not the intent of this manual to restrict the library...improvements. Pare 10 ka•- V •DkI U Release Manager The Release Manager provides franchisees with media copies of existing libraries, as needed. Security...implementors, and potential library franchisees . Security Team The Security Team assists the Security Officer with security analysis. Team members are

  2. 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.

  3. The impact of the 'Better Care Better Value' prescribing policy on the utilisation of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for treating hypertension in the UK primary care setting: longitudinal quasi-experimental design.

    Science.gov (United States)

    Baker, Amanj; Chen, Li-Chia; Elliott, Rachel A; Godman, Brian

    2015-09-10

    In April/2009, the UK National Health Service initiated four Better Care Better Value (BCBV) prescribing indicators, one of which encouraged the prescribing of cheaper angiotensin-converting enzyme inhibitors (ACEIs) instead of expensive angiotensin receptor blockers (ARBs), with 80 % ACEIs/20 % ARBs as a proposed, and achievable target. The policy was intended to save costs without affecting patient outcomes. However, little is known about the actual impact of the BCBV indicator on ACEIs/ARBs utilisation and cost-savings. Therefore, this study aimed to evaluate the impact of BCBV policy on ACEIs/ARBs utilisation and cost-savings, including exploration of regional variations of the policy's impact. This cross-sectional study used data from the UK Clinical Practice Research Datalink. Segmented time-series analysis was applied to monthly ACEIs prescription proportion, adjusted number of ACEIs/ARBs prescriptions and costs. Overall, the proportion of ACEIs prescription decreased during the study period from 71.2% in April/2006 to 70.7% in March/2012, with a small but a statistically significant pre-policy reduction in its monthly trend of 0.02% (p < 0.001). Instantly after its initiation, the policy was associated with a sudden reduction in the proportion of ACEIs prescription; however, it resulted in a statistically significant increase in the post-policy monthly trend of ACEIs prescription proportion of 0.013% (p < 0.001), resulting in an overall post-policy slope of -0.007%. Despite this post-policy induced increment, the policy failed to achieve the 80% target, which resulted in missing a potential cost-saving opportunity. The pre-policy trend of the adjusted number of ACEIs/ARBs prescriptions was increasing; however, their trends declined after the policy implementation. The policy affected neither total ACEIs/ARBs cost nor individual ACEIs or ARBs costs. ACEIs/ARBs utilisation was not affected by the BCBV policy. The small increase in post-policy ACEIs

  4. 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.

  5. Policy Implementation of Working Procedures of Information and Documentation Officer at Cimahi City

    Directory of Open Access Journals (Sweden)

    Karina Intan Permatasari

    2015-12-01

    Full Text Available Since one year after the enactment of Public Information Disclosure Rights Number 14 of 2008 in April 2010, all government in Indonesia shall establish Information and Documentation Officer (PPID and all supporting instruments. Cimahi itself had made Cimahi Mayor Regulation No. 4 of 2011 on the Working Procedures and Documentation Information Management Officer at Cimahi in response to the main policy. However, despite being implemented for 3 years, implementation of this policy is not in accordance with UU KIP sought to assess and analyse the factors that cause these obstacles by using the theory of Charles O. Jones who focuses on organizational aspects, aspects of the interpretation and application of aspects of using qualitative research methods.

  6. 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.

  7. 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.

  8. 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...

  9. 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

  10. 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

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false What procedures does the Office of National Drug 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 Relating to Suspension and Debarment...

  11. 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

    ... Environmental Policy Act (NEPA) policies, practices, and procedures for the Minerals Management Service (MMS... applies NEPA in its management of Outer Continental Shelf oil and gas exploration and development and make recommendations for revisions. The scope of the review is intended to be holistic, i.e. from leasing decisions to...

  12. 76 FR 50813 - Major Capital Investment Projects; Guidance on News Starts/Small Starts Policies and Procedures

    Science.gov (United States)

    2011-08-16

    ... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Major Capital Investment Projects; Guidance on News Starts/Small Starts Policies and Procedures AGENCY: Federal Transit Administration (FTA... Administration (FTA) to publish policy guidance on the New and Small Starts capital project review and evaluation...

  13. 12 CFR 550.140 - Must I adopt and follow written policies and procedures in exercising fiduciary powers?

    Science.gov (United States)

    2010-01-01

    ... 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 § 550.140 Must I adopt and follow written policies and procedures in exercising fiduciary powers? You...

  14. 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…

  15. Policy and procedures for classification of Class III groundwater at UMTRA Project sites

    International Nuclear Information System (INIS)

    1989-03-01

    The US Environmental Protection Agency (EPA) has recently proposed groundwater regulations for the US Department of Energy's )DOE) Uranium Mill Tailings Remedial Action (UMTRA) Project. These regulations allow the application of supplemental standards at UMTRA Project sites in specific situations. The designation of groundwater as Class III permits the application of supplemental standards. This document discusses a final UMTRA Project policy and procedures for identifying Class III groundwater, including identification of a review area, definition of water quality, quantification of aquifer yield, and identification of methods reasonably employed for public water supply systems. These items, either individually or collectively, need to be investigated in order to determine if groundwaters at UMTRA Project sites are Class III. This document provides a framework for the DOE to determine Class III groundwaters

  16. 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

  17. 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...

  18. Understanding the determinants of antimicrobial prescribing within hospitals: the role of "prescribing etiquette".

    Science.gov (United States)

    Charani, E; Castro-Sanchez, E; Sevdalis, N; Kyratsis, Y; Drumright, L; Shah, N; Holmes, A

    2013-07-01

    There is limited knowledge of the key determinants of antimicrobial prescribing behavior (APB) in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in antimicrobial stewardship programs. Qualitative semistructured interviews were conducted with doctors (n = 10), pharmacists (n = 10), and nurses and midwives (n = 19) in 4 hospitals in London. Interviews were conducted until thematic saturation was reached. Thematic analysis was applied to the data to identify the key determinants of antimicrobial prescribing behaviors. The APB of healthcare professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behavior of clinical leaders or seniors influences practice of junior doctors. Senior doctors consider themselves exempt from following policy and practice within a culture of perceived autonomous decision making that relies more on personal knowledge and experience than formal policy. Prescribers identify with the clinical groups in which they work and adjust their APB according to the prevailing practice within these groups. A culture of "noninterference" in the antimicrobial prescribing practice of peers prevents intervention into prescribing of colleagues. These sets of cultural rules demonstrate the existence of a "prescribing etiquette," which dominates the APB of healthcare professionals. Prescribing etiquette creates an environment in which professional hierarchy and clinical groups act as key determinants of APB. To influence the antimicrobial prescribing of individual healthcare professionals, interventions need to address prescribing etiquette and use clinical leadership within existing clinical groups to influence practice.

  19. 41 CFR 301-70.600 - What governing policies and procedures must we establish related to threatened law enforcement...

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What governing policies and procedures must we establish related to threatened law enforcement/investigative employees? 301-70.600 Section 301-70.600 Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES AGENCY...

  20. The Devil Is in the Details: Development of Policy and Procedure in the Battle River Project

    Science.gov (United States)

    Gleddie, Doug L.

    2012-01-01

    Objective: Guidelines from a variety of jurisdictions for the health-promoting schools (HPS) approach include healthy school policy as a critical element. Research also supports the importance of policy; however, there seems to be a lack of information on how to develop and implement policy. The article examines the processes involved in one…

  1. 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.

  2. National environmental policy act disclosure of air quality impacts for prescribed fire projects in national forests in the Pacific Southwest Region

    Science.gov (United States)

    Suraj Ahuja; Laurie Perrot

    2008-01-01

    A key purpose of the National Environmental Policy Act (NEPA) is to “promote effortswhich will prevent or eliminate damage to the environment and biosphere and stimulate thehealth and welfare of man” (NEPA, Sec 2). The Council on Environmental Quality states “theNEPA process is intended to help public officials make decisions that...

  3. Fiscal policy surveillance in the enlarged European Union: Procedural checks or simple arithmetic?

    NARCIS (Netherlands)

    Groenendijk, Nico; Batten, Jonathan A.; Kearney, Colm

    2006-01-01

    In its recommendation on the 2004 update of the Broad Economic Policy Guidelines (BEPGs), the European Commission (2004) issued country-specific recommendations for fiscal policy in the Central and Eastern European (CEE) countries that have recently joined the European Union (EU) (henceforth the

  4. 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

  5. 78 FR 47047 - Proposed Policy for Discontinuance of Certain Instrument Approach Procedures

    Science.gov (United States)

    2013-08-02

    ... the cancellation of certain Non-directional Beacon (NDB) and Very High Frequency (VHF) Omnidirectional... approach procedures. The FAA proposes specific criteria to guide the identification and selection of... selection of potential NDB and VOR procedures for cancellation. Once the criteria are established and the...

  6. 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...

  7. 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.

  8. 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

  9. 76 FR 66721 - New Policies and Procedural Requirements for the Electronic Submission of Discretionary Grant...

    Science.gov (United States)

    2011-10-27

    ... electronic submission of discretionary grant applications through the government-wide grants application site... Procedural Requirements for the Electronic Submission of Discretionary Grant Applications AGENCY: Division of... requirements for the electronic submission of discretionary grant applications. Overview Information: The...

  10. 77 FR 3102 - Procedures for Implementing the National Environmental Policy Act

    Science.gov (United States)

    2012-01-23

    ..., organizational changes, and procurement of routine goods and services. (ii) Issuance of procedural rules, manuals... routine data collection and analysis activities. (vi) Preparation and dissemination of information, including document mailings, publications, classroom materials, conferences, speaking engagements, Web sites...

  11. Opioid Prescribing PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    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.

  12. 78 FR 38989 - New Policies and Procedural Requirements for Electronic Submission of State Plans, and Program...

    Science.gov (United States)

    2013-06-28

    .... Report (FFR). Child Abuse and Neglect State Grant Form SF-425: Federal Financial Part 1. Report (FFR... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families New Policies and..., for Mandatory Grant Programs AGENCY: Office of Administration (OA), Administration for Children and...

  13. 76 FR 18942 - Policies To Promote Rural Radio Service and To Streamline Allotment and Assignment Procedures

    Science.gov (United States)

    2011-04-06

    ... absence of other Tribal-owned or Tribal-oriented media of mass communications in the area, or a showing... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Parts 73 and 74 [MB Docket No. 09-52; FCC 11-28] Policies... Communications Commission. ACTION: Final rule. SUMMARY: In this document, the Commission adopted a number of...

  14. 77 FR 2916 - Policies To Promote Rural Radio Service and To Streamline Allotment and Assignment Procedures

    Science.gov (United States)

    2012-01-20

    ... bidding credit to Tribes with no interests in media of mass communications, for a total maximum bidding.... ADDRESSES: Peter Doyle or Thomas Nessinger, Federal Communications Commission, Media Bureau, Audio Division... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 73 [MB Docket No. 09-52; FCC 11-190] Policies To...

  15. 34 CFR 668.134 - Institutional policies and procedures for requesting documentation and receiving secondary...

    Science.gov (United States)

    2010-07-01

    ... STUDENT ASSISTANCE GENERAL PROVISIONS Immigration-Status Confirmation § 668.134 Institutional policies and... immigration status of applicants for title IV, HEA student financial assistance who claim to meet the... eligible noncitizen until the institution has provided the student the opportunity to submit the...

  16. 78 FR 35909 - Endocrine Disruptor Screening Program; Final Policies and Procedures for Screening Safe Drinking...

    Science.gov (United States)

    2013-06-14

    ... for Responsible Medicine (PCRM), ACC, BCS, and CLA and the Endocrine Policy Forum (EPF)) indicated... chemicals and drinking water contaminants. G. Other Topics 1. Cost sharing. ACC, CLA, EPF, and CPDA stated... should strictly disallow CBI claims. The ACC, CLA, and EPF commented that FFDCA authorized, and EPA...

  17. 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.

  18. DoD Program for Stability of Civilian Employment: Policies, Procedures, and Programs Manual

    Science.gov (United States)

    1990-09-01

    history of treatment for mental or emotional problems) .......................................... 91 Severe distortion of limbs and/or spine (e.g., dwarfism ...Cancer-a history of cancer with complete recovery .................. 88 Cancer-undergoing surgical and/or medical treatment ............. 89 Mental...and therefore, the treatment each registrant must receive. e. Activities planning to fill positions through competitive procedures should

  19. 77 FR 72237 - Policies To Promote Rural Radio Service and To Streamline Allotment and Assignment Procedures

    Science.gov (United States)

    2012-12-05

    ...) (section 307(b)) for new AM construction permits, as well as new FM allotments, in already well- served... petitioners argued that the new procedures ``ignore current marketplace realities,'' causing radio stations to..., whether ``potential services,'' such as vacant FM allotments or granted but unbuilt construction permits...

  20. 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.

  1. 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

  2. The social act of electronic medication prescribing.

    Science.gov (United States)

    Aarts, Jos

    2013-01-01

    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 guidelines and protocols based on the outcomes of clinical studies. These notions of cost-effectiveness and evidence-based medicine have also been embedded in technology such as electronic prescribing systems. Such constraining systems may clash with the reality of clinical practice, where formal boundaries of responsibility and authorization are often blurred. Such systems may therefore even impede patient care. Medication is seen as the essence of medical practice. Prescribing is a social act. In a hospital medications may be aimed at treating a patient for a specific condition, in primary care the professional often meets the patient with her or his social and cultural notions of a health problem. The author argues that the design and implementation of electronic prescribing systems should address the social and cultural context of prescribing. Especially in primary care, where health problems are often ill defined and evidence-based medicine guidelines do not always work as intended, studies need to take into account the sociotechnical character of electronic prescribing systems.

  3. A pilot qualitative study to explore stakeholder opinions regarding prescribing quality indicators

    NARCIS (Netherlands)

    Martirosyan, L.; Markhorst, J.; Denig, P.; Haaijer-Ruskamp, F.M.; Braspenning, J.C.

    2012-01-01

    BACKGROUND: Information on prescribing quality of diabetes care is required by health care providers, insurance companies, policy makers, and the public. Knowledge regarding the opinions and preferences of all involved parties regarding prescribing quality information is important for effective use

  4. A pilot qualitative study to explore stakeholder opinions regarding prescribing quality indicators

    NARCIS (Netherlands)

    Martirosyan, Liana; Markhorst, Joekie; Denig, Petra; Haaijer-Ruskamp, Flora M.; Braspenning, Joze

    2012-01-01

    Background: Information on prescribing quality of diabetes care is required by health care providers, insurance companies, policy makers, and the public. Knowledge regarding the opinions and preferences of all involved parties regarding prescribing quality information is important for effective use

  5. 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... ALLOWANCES AGENCY RESPONSIBILITIES 75-PRE-EMPLOYMENT INTERVIEW TRAVEL General Rules § 301-75.3 What governing policies and procedures must we establish related to pre-employment interview travel? You must establish...

  6. 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.

  7. 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.

  8. 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…

  9. 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

  10. 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.

  11. Increasing Internal Stakeholder Consensus about a University Science Center's Outreach Policies and Procedures

    Science.gov (United States)

    Fisher, Richard D.

    For decades the United States has tried to increase the number of students pursuing science, technology, engineering, and mathematics (STEM) education and careers. Educators and policy makers continue to seek strategies to increase the number of students in the STEM education pipeline. Public institutions of higher education are involved in this effort through education and public outreach (EPO) initiatives. Arizona State University opened its largest research facility, the new Interdisciplinary Science and Technology Building IV (ISTB4) in September, 2012. As the new home of the School of Earth & Space Exploration (SESE), ISTB4 was designed to serve the school's dedication to K-12 education and public outreach. This dissertation presents a menu of ideas for revamping the EPO program for SESE. Utilizing the Delphi method, I was able to clarify which ideas would be most supported, and those that would not, by a variety of important SESE stakeholders. The study revealed that consensus exists in areas related to staffing and expansion of free programming, whereas less consensus exist in the areas of fee-based programs. The following most promising ideas for improving the SESE's EPO effort were identified and will be presented to SESE's incoming director in July, 2013: (a) hire a full-time director, theater manager, and program coordinator; (b) establish a service-learning requirement obligating undergraduate SESE majors to serve as docent support for outreach programs; (c) obligate all EPO operations to advise, assist, and contribute to the development of curricula, activities, and exhibits; (d) perform a market and cost analysis of other informational education venues offering similar programming; (3) establish a schedule of fee-based planetarium and film offerings; and (f) create an ISTB4 centric, fee-based package of programs specifically correlated to K12 education standards that can be delivered as a fieldtrip experience.

  12. On the risk to low doses (<100 mSv) of ionizing radiation during medical imaging procedures - IOMP policy statement

    International Nuclear Information System (INIS)

    Pradhan, A.S.

    2013-01-01

    The science committee of International Organization for Medical Physics (IOMP) developed a policy statement on the predictions of radiation-induced cancers and cancer deaths in patients exposed to low doses (<100 mSv) of ionizing radiation during medical imaging; this statement has been approved by the IOMP council. In order to attract the attention of medical physicists, an editorial (1) titled 'Risk of Medical Imaging' that includes the said statement has recently been published in Medical Physics journal of American Association of Physicists in Medicine (AAPM). As stated, IOMP represents 80 national and 6 regional medical physics organizations and 18,000 medical physicists worldwide. The IOMP affiliated bodies/organizations in different countries (such as Association of Medical Physicists of India, AMPI) have been encouraged to reproduce the IOMP statement in their journals/newsletters for the benefit of larger community of medical physicists. The IOMP statement is reproduced below (readers may also go through the supportive literature listed in references). It is hoped that this policy statement will have some deterrent influence on the continued propagation of unproven risk related to medical imaging procedures conducted with small doses.

  13. Changing doctor prescribing behaviour

    DEFF Research Database (Denmark)

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

    1999-01-01

    Collaboration on Effective Professional Practice. This register is kept up to date by searching the following databases for reports of relevant research: DHSS-DATA; EMBASE; MEDLINE; SIGLE; Resource Database in Continuing Medical Education (1975-1994), along with bibliographies of related topics, hand searching......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...... of key journals and personal contact with content area experts. Randomised controlled trials and non-equivalent group designs with pre- and post-intervention measures were included. Outcome measures were those used by the study authors. For each study we determined whether these were positive, negative...

  14. Prescribed fire research in Pennsylvania

    Science.gov (United States)

    Patrick Brose

    2009-01-01

    Prescribed fire in Pennsylvania is a relatively new forestry practice because of the State's adverse experience with highly destructive wildfires in the early 1900s. The recent introduction of prescribed fire raises a myriad of questions regarding its correct and safe use. This poster briefly describes the prescribed fire research projects of the Forestry Sciences...

  15. 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.

  16. 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…

  17. 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.

  18. 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.

  19. Best available control measures for prescribed burning

    International Nuclear Information System (INIS)

    Smith, A.M.; Stoneman, C.S.

    1992-01-01

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

  20. 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.

  1. 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.

  2. 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...... the GPs’ prescribing behaviour is influenced by selected factors. Method The study consists of a register-based study and a questionnaire study. The register-based study is based on data from the Register of Medicinal Product Statistics (prescribed antibiotics), Statistics Denmark (socio-demographic data...

  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. Prescribed burning: a topical issue

    Directory of Open Access Journals (Sweden)

    Bovio G

    2013-11-01

    Full Text Available Prescribed burning is a promising technique for the prevention of forest fires in Italy. The research deepened several ecological and operative aspects. However, legal issues need to be thoroughly investigated.

  5. 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.

  6. Safe prescribing: a titanic challenge.

    Science.gov (United States)

    Routledge, Philip A

    2012-10-01

    The challenge to achieve safe prescribing merits the adjective 'titanic'. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the 'Seven C's'. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. © 2012 The Author. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  7. Safe prescribing: a titanic challenge

    Science.gov (United States)

    Routledge, Philip A

    2012-01-01

    The challenge to achieve safe prescribing merits the adjective ‘titanic’. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the ‘Seven C's’. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. PMID:22738396

  8. Introduction to prescribed fires in Southern ecosystems

    Science.gov (United States)

    Thomas A. Waldrop; Scott L. Goodrick

    2012-01-01

    This publication is a guide for resource managers on planning and executing prescribed burns in Southern forests and grasslands. It includes explanations of reasons for prescribed burning, environmental effects, weather, and techniques as well as general information on prescribed burning.

  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. 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

  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. 76 FR 800 - Policy and Procedural Change Regarding the Publication of Notices of Funding Opportunities in the...

    Science.gov (United States)

    2011-01-06

    ... Web site, http://www.grants.gov , in accordance with the policy directive issued by the Office of... posted at http://www.grants.gov by following the universal resource locator (URL) link included in the synopsis, or by visiting ETA's Web site at http://www.doleta.gov . DATES: Effective Date: January 6, 2011...

  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

    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

  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

    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.

  15. 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

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

    Science.gov (United States)

    Courtenay, Molly; Carey, Nicola; Stenner, Karen

    2012-06-01

    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. 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. 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 < 0.001). 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 allied health professional prescribers. This

  17. 18 CFR 2.300 - Statement of policy concerning allegations of fraud, abuse, or similar grounds under section 601...

    Science.gov (United States)

    2010-04-01

    ... of this policy statement do not establish a binding norm but instead provide general guidance. In... challenged and are subject to further consideration. The procedure prescribed conforms with the NGPA's..., Pub. L. 95-621, 92 Stat. 3350, (15 U.S.C. 3301-3432)) [47 FR 6262, Feb. 11, 1982] Statement of...

  18. 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.

  19. A study of antibiotic prescribing

    DEFF Research Database (Denmark)

    Jaruseviciene, L.; Radzeviciene-Jurgute, R.; Jurgutis, A.

    2012-01-01

    Background. Globally, general practitioners (GPs) write more than 90% of all antibiotic prescriptions. This study examines the experiences of Lithuanian and Russian GPs in antibiotic prescription for upper respiratory tract infections, including their perceptions of when it is not indicated...... clinically or pharmacologically. Methods. 22 Lithuanian and 29 Russian GPs participated in five focus group discussions. Thematic analysis was used to analyse the data. Results. We identified four main thematic categories: patients' faith in antibiotics as medication for upper respiratory tract infections......; patient potential to influence a GP's decision to prescribe antibiotics for upper respiratory tract infections; impediments perceived by GPs in advocating clinically grounded antibiotic prescribing with their patients, and strategies applied in physician-patient negotiation about antibiotic prescribing...

  20. 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?

  1. 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...

  2. 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...

  3. 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...

  4. Mediation and Due Process Procedures in Special Education: An Analysis of State Policies. Final Report. Project FORUM.

    Science.gov (United States)

    Ahearn, Eileen M.

    This survey of 50 states and 3 of 10 non-state U.S. jurisdictions concerning state due process procedures focuses mainly on the use of mediation as a form of dispute resolution that offers an alternative to due process hearings in special education. A background section discusses the definition of mediation and the mediation process. Survey…

  5. 48 CFR Appendix I to Chapter 2 - Policy and Procedures for the DOD Pilot Mentor-Protege Program

    Science.gov (United States)

    2010-10-01

    ... the DOD Pilot Mentor-Protege Program I Appendix I to Chapter 2 Federal Acquisition Regulations System... and Procedures for the DOD Pilot Mentor-Protege Program I-100Purpose. (a) This Appendix I to 48 CFR Chapter 2 implements the Pilot Mentor-Protégé Program (hereafter referred to as the “Program”) established...

  6. 75 FR 71391 - Implementation of Conflicts of Interest Policies and Procedures by Swap Dealers and Major Swap...

    Science.gov (United States)

    2010-11-23

    ... regulations establish conflicts of interest requirements for swap dealers (SDs) and major swap participants...-AC96 and SD-MSP Conflicts of Interest, by any of the following methods: Agency Web site, via its... mandates that the required conflicts of interest systems and procedures ``address such other issues as the...

  7. To prescribe codeine or not to prescribe codeine?

    Science.gov (United States)

    Fleming, Marc L; Wanat, Matthew A

    2014-09-01

    A recently published study in Pediatrics by Kaiser et al. (2014; Epub April 21, DOI: 10.1542/peds.2013-3171) reported that on average, over the past decade, children aged 3 to 17 were prescribed approximately 700,000 prescriptions for codeine-containing products each year in association with emergency department (ED) visits. Although, guidelines from the American Academy of Pediatrics issued warnings in 1997 and reaffirmed their concerns regarding the safety and effectiveness of codeine in 2006, it is still often prescribed for pain and cough associated with upper respiratory infection. With the impending rescheduling of hydrocodone combination products to Schedule II, physicians and mid-level prescribers may be compelled to prescribe codeine-containing products (e.g., with acetaminophen) due to reduced administrative burden and limits on Schedule II prescriptive authority for nurse practitioners and physician assistants in some states. This commentary expounds on the safety and effectiveness concerns of codeine, with a primary focus on patients in the ED setting.

  8. 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 ...

  9. Determinants of the range of drugs prescribed in general practice: a cross-sectional analysis.

    NARCIS (Netherlands)

    Bakker, D.H. de; Coffie, D.S.V.; Heerdink, E.R.; Dijk, L. van; Groenewegen, P.P.

    2007-01-01

    BACKGROUND: Current health policies assume that prescribing is more efficient and rational when general practitioners (GPs) work with a formulary or restricted drugs lists and thus with a limited range of drugs. Therefore we studied determinants of the range of drugs prescribed by general

  10. 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

  11. 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

  12. 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

  13. Prescribed burning for understory restoration

    Science.gov (United States)

    Kenneth W. Outcalt

    2006-01-01

    Because the longleaf ecosystem evolved with and is adapted to frequent fire, every 2 to 8 years, prescribed burning is often useful for restoring understory communities to a diverse ground layer of grasses, herbs, and small shrubs. This restoration provides habitat for a number of plant and animal species that are restricted to or found mostly in longleaf pine...

  14. 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.

  15. 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

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

    Science.gov (United States)

    Lockwood, Emily B; Fealy, Gerard M

    2008-10-01

    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. 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. 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. 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. 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 new understandings on the views of senior clinicians concerning nurse prescribing at a

  17. 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.’

  18. 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...

  19. 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

  20. Attitudes of physicians and pharmacists towards International Non-proprietary Name prescribing in Belgium.

    Science.gov (United States)

    Van Bever, Elien; Elseviers, Monique; Plovie, Marijke; Vandeputte, Lieselot; Van Bortel, Luc; Vander Stichele, Robert

    2015-03-01

    International Non-proprietary Name (INN) prescribing is the use of the name of the active ingredient(s) instead of the brand name for prescribing. In Belgium, INN prescribing began in 2005 and a major policy change occurred in 2012. The aim was to explore the opinions of Dutch-speaking general practitioners (GPs) and pharmacists. An electronic questionnaire with 39 five-point Likert scale statements and one open question was administered in 2013. Multivariate analysis was performed with multiple linear regression on a sum score for benefit statements and for drawback statements. Answers to the open question were qualitatively analysed. We received 745 valid responses with a representable sample for both subgroups. Participants perceived the motives to introduce INN prescribing as purely economic (to reduce pharmaceutical expenditures for the government and the patient). Participants accepted the concept of INN prescribing, but 88% stressed the importance of guaranteed treatment continuity, especially in older, chronic patients, to prevent patient confusion, medication non-adherence and erroneous drug use. In conclusion, the current way in which INN prescribing is applied in Belgium leads to many concerns among primary health professionals about patient confusion and medication adherence. Slightly adapting the current concept of INN prescribing to these concerns can turn INN prescribing into one of the major policies in Belgium to reduce pharmaceutical expenditures and to stimulate rational drug prescribing. © 2014 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

  1. 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.

  2. Can we influence prescribing patterns?

    Science.gov (United States)

    Sbarbaro, J A

    2001-09-15

    A variety of programming techniques and methods of training have been employed to change physician behavior. Didactic continuing medical education lectures and clinical guidelines have had minimal impact, although endorsement of national professional guidelines by local opinion leaders appears to have a positive influence on the impact of professional guidelines. Interactive, hands-on workshops, performance reporting, and peer/patient feedback are also effective. Changing prescribing habits has been equally difficult. Drug utilization letters involving both pharmacist and physician have more impact than do letters sent only to the physician. Academic detailing, when properly executed, has been consistently effective. When combined with these strategies, closed formularies become a powerful tool in changing prescribing behavior.

  3. 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.

  4. 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...

  5. 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.

  6. DOE program guide for universities and other research groups. Part I. DOE Research and Development Programs; Part II. DOE Procurement and Assistance Policies/Procedures

    Energy Technology Data Exchange (ETDEWEB)

    1980-03-01

    This guide addresses the DOE responsibility for fostering advanced research and development of all energy resources, both current and potential. It is intended to provide, in a single publication, all the fundamental information needed by an institution to develop a potential working relationship with DOE. Part I describes DOE research and development programs and facilities, and identifies areas of additional research needs and potential areas for new research opportunities. It also summarizes budget data and identifies the DOE program information contacts for each program. Part II provides researchers and research administrators with an introduction to the DOE administrative policies and procedures for submission and evaluation of proposals and the administration of resulting grants, cooperative agreements, and research contracts. (RWR)

  7. 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.

  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. Dutch Travel Health Nurses: Prepared to Prescribe?

    NARCIS (Netherlands)

    Overbosch, Femke W.; Koeman, Susan C.; van den Hoek, Anneke; Sonder, Gerard J. B.

    2012-01-01

    Background. In travel medicine, as in other specialties, independent prescribing of medication has traditionally been the domain of practitioners like physicians, dentists, and midwives. However, a 2011 ruling in the Netherlands expands independent prescribing and introduces supplementary

  10. The quality of outpatient antimicrobial prescribing

    DEFF Research Database (Denmark)

    Malo, Sara; Bjerrum, Lars; Feja, Cristina

    2013-01-01

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

  11. 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.

  12. Effects of prescribed fires on soil properties: A review.

    Science.gov (United States)

    Alcañiz, M; Outeiro, L; Francos, M; Úbeda, X

    2018-02-01

    Soils constitute one of the most valuable resources on earth, especially because soil is renewable on human time scales. During the 20th century, a period marked by a widespread rural exodus and land abandonment, fire suppression policies were adopted facilitating the accumulation of fuel in forested areas, exacerbating the effects of wildfires, leading to severe degradation of soils. Prescribed fires emerged as an option for protecting forests and their soils from wildfires through the reduction of fuels levels. However such fires can serve other objectives, including stimulating the regeneration of a particular plant species, maintaining biological diversity or as a tool for recovering grasslands in encroached lands. This paper reviews studies examining the short- and long- term impacts of prescribed fires on the physical, chemical and biological soil properties; in so doing, it provides a summary of the benefits and drawbacks of this technique, to help determine if prescribed fires can be useful for managing the landscape. From the study conducted, we can affirm that prescribed fires affects soil properties but differ greatly depending on soil initial characteristics, vegetation or type of fire. Also, it is possible to see that soil's physical and biological properties are more strongly affected by prescribed fires than are its chemical properties. Finally, we conclude that prescribed fires clearly constitute a disturbance on the environment (positive, neutral or negative depending on the soil property studied), but most of the studies reviewed report a good recovery and their effects could be less pronounced than those of wildfires because of the limited soil heating and lower fire intensity and severity. Copyright © 2017. Published by Elsevier B.V.

  13. Nurse prescribing for inpatient pain in the United Kingdom: a national questionnaire survey.

    Science.gov (United States)

    Stenner, Karen L; Courtenay, Molly; Cannons, Karin

    2011-07-01

    Nurses make a valuable contribution to pain services and have the potential to improve the safety and effectiveness of pain management. A recent addition to the role of the specialist pain nurse in the United Kingdom has been the introduction of prescribing rights, however there is a lack of literature about their role in prescribing pain medication. The aim of this study was to develop a profile of the experience, role and prescribing practice of these nurses. A descriptive questionnaire survey. 192 National Health Service public hospital inpatient pain services across the United Kingdom. 161 qualified nurse prescribers were invited to participate, representing 98% of known nurse prescribers contributing to inpatient pain services. The survey was completed in November 2009 by 137 nurses; a response rate of 85%. Compared with nurse prescribers in the United Kingdom in general, participants were highly qualified and experienced pain specialists. Fifty-six percent had qualified as a prescriber in the past 3 years and 22% reported that plans were underway for more nurses to undertake a nurse prescribing qualification. Although all participants worked in inpatient pain services, 35% also covered chronic pain (outpatient) services and 90% treated more than one pain type. A range of pain medications were prescribed, averaging 19.5 items per week. The role contained a strong educational component and contributed to informing organisational policy on pain management. Prescribing was said to improve nurses' ability to promote evidence-based practice but benefits were limited by legislation on prescribing controlled drugs. Findings demonstrate that pain nurses are increasingly adopting prescribing as part of their advanced nurse role. This has implications for the development needs of pain nurses in the United Kingdom and the future role development of nurses in other countries. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. 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

  15. 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.

  16. 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.

  17. Nurse prescribing in dermatology: doctors' and non-prescribing nurses' views.

    Science.gov (United States)

    Stenner, Karen; Carey, Nicola; Courtenay, Molly

    2009-04-01

    This paper is a report of a study conducted to explore doctor and non-prescribing nurse views about nurse prescribing in the light of their experience in dermatology. The cooperation of healthcare professionals and peers is of key importance in enabling and supporting nurse prescribing. Lack of understanding of and opposition to nurse prescribing are known barriers to its implementation. Given the important role they play, it is necessary to consider how the recent expansion of nurse prescribing rights in England impacts on the views of healthcare professionals. Interviews with 12 doctors and six non-prescribing nurses were conducted in 10 case study sites across England between 2006 and 2007. Participants all worked with nurses who prescribed for patients with dermatological conditions in secondary or primary care. Thematic analysis was conducted on the interview data. Participants were positive about their experiences of nurse prescribing having witnessed benefits from it, but had reservations about nurse prescribing in general. Acceptance was conditional upon the nurses' level of experience, awareness of their own limitations and the context in which they prescribed. Fears that nurses would prescribe beyond their level of competence were expected to reduce as understanding and experience of nurse prescribing increased. Indications are that nurse prescribing can be acceptable to doctors and nurses so long as it operates within recommended parameters. Greater promotion and assessment of standards and criteria are recommended to improve understanding and acceptance of nurse prescribing.

  18. 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)

  19. Prescribing Safety in Ambulatory Care: Physician Perspectives

    National Research Council Canada - National Science Library

    Rundall, Thomas G; Hsu, John; Lafata, Jennifer E; Fung, Vicki; Paez, Kathryn A; Simpkins, Jan; Simon, Steven R; Robinson, Scott B; Uratsu, Connie; Gunter, Margaret J; Soumerai, Stephen B; Selby, Joseph V

    2005-01-01

    .... We asked about current safety practices, perceptions of ambulatory prescribing safety. Using a content analysis approach, three investigators independently coded responses into thematic categories...

  20. 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, ...

  1. Psychiatric Prescribers' Experiences With Doctor Shoppers.

    Science.gov (United States)

    Worley, Julie; Johnson, Mary; Karnik, Niranjan

    2015-01-01

    Doctor shopping is a primary method of prescription medication diversion. After opioids, benzodiazepines and stimulants are the next most common prescription medications used nonmedically. Studies have shown that patients who engage in doctor shopping find it fun, exciting, and easy to do. There is a lack of research on the prescriber's perspective on the phenomenon of doctor shopping. This study investigates the experiences of prescribers in psychiatry with patients who engage in doctor shopping. Fifteen prescribers including psychiatrists and psychiatric nurse practitioners working in outpatient psychiatry were interviewed to elicit detailed information about their experiences with patients who engage in doctor shopping. Themes found throughout the interview were that psychiatric prescribers' experience with patients who engage in doctor shopping includes (a) detecting red flags, (b) negative emotional responding, (c) addressing the patient and the problem, and (d) inconsistently implementing precautions. When red flags were detected when prescribing controlled drugs, prescribers in psychiatry experienced both their own negative emotional responses such as disappointment and resentment as well as the negative emotions of the patients such as anger and other extreme emotional responses. Psychiatric prescribers responded to patient's doctor shopping in a variety of ways such as changing their practice, discharging the patients or taking steps to not accept certain patients identified as being at risk for doctor shopping, as well as by talking to the patient and trying to offer them help. Despite experiencing doctor shopping, the prescribers inconsistently implemented precautionary measures such as checking prescription drug monitoring programs. © The Author(s) 2015.

  2. Influences on the prescribing of new drugs.

    Science.gov (United States)

    Tobin, Luke; de Almedia Neto, Abelio C; Wutzke, Sonia; Patterson, Craig; Mackson, Judith; Weekes, Lynn; Williamson, Margaret

    2008-01-01

    The aim of this study was to identify the factors that influence prescribing of new drugs among general practitioners, endocrinologists and psychiatrists. Four focus groups were conducted with GPs, endocrinologists and psychiatrists on sources of awareness and influences on prescribing of new drugs. Pharmaceutical companies were the most important source for becoming aware of new drugs. There were many influences on the decision to prescribe a new drug, the most important being efficacy, safety, cost and advantage over existing therapies. Endocrinologists placed greater emphasis on evidence from clinical trials and scientific conferences, and psychiatrists and GPs placed more weight on pharmaceutical representatives, colleagues and specialists. New drug prescribing occurs in a complex environment with many influences. Effective interventions to promote rational, safe and effective prescribing of new drugs will need to be cognisant of these factors.

  3. Antipsychotic prescribing in older people.

    Science.gov (United States)

    Neil, Wendy; Curran, Stephen; Wattis, John

    2003-09-01

    older people. There is a need to redress this balance to ensure that the prescribing of antipsychotics in older people is evidence based.

  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. Antibiotic prescribing in dental practice in Belgium.

    Science.gov (United States)

    Mainjot, A; D'Hoore, W; Vanheusden, A; Van Nieuwenhuysen, J-P

    2009-12-01

    To assess the types and frequency of antibiotic prescriptions by Belgian dentists, the indications for antibiotic prescription, and dentists' knowledge about recommended practice in antibiotic use. In this cross-sectional survey, dental practitioners were asked to record information about all antibiotics prescribed to their patients during a 2-week period. The dental practitioners were also asked to complete a self-administered questionnaire regarding demographic data, prescribing practices, and knowledge about antibiotic use. A random sample of 268 Belgian dentists participated in the survey. During the 2-week period, 24 421 patient encounters were recorded; 1033 patients were prescribed an antibiotic (4.2%). The median number of prescriptions per dentist for the 2 weeks was 3. Broad spectrum antibiotics were most commonly prescribed: 82% of all prescriptions were for amoxycillin, amoxycillin-clavulanic acid and clindamycin. Antibiotics were often prescribed in the absence of fever (92.2%) and without any local treatment (54.2%). The most frequent diagnosis for which antibiotics were prescribed was periapical abscess (51.9%). Antibiotics were prescribed to 63.3% of patients with periapical abscess and 4.3% of patients with pulpitis. Patterns of prescriptions were confirmed by the data from the self-reported practice. Discrepancies between observed and recommended practice support the need for educational initiatives to promote rational use of antibiotics in dentistry in Belgium.

  6. 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

  7. Nurse prescribing in general practice: a qualitative study of job satisfaction and work-related stress.

    Science.gov (United States)

    Cousins, Rosanna; Donnell, Christine

    2012-04-01

    Studies examining the impact nurse prescribing have largely focused on the efficacy of the service. It was suggested in pro-prescribing policy arguments that extending the nursing role to include prescribing would increase job satisfaction. This assertion has not been fully explored. To investigate the impact of independent prescribing for experienced nurse practitioners (NPs) working in general practice. In-depth interviews were conducted with six NPs who each had at least 3 years experience of independent prescribing in a busy inner city general practice. Analysis of interview data yielded two main themes: as independent prescribers NPs experienced increased levels of both job satisfaction and work-related stress. Increased satisfaction was associated with having greater autonomy and being able to provide more holistic care. Increased work-related stress emerged from greater job demands, perceived insufficient support and perceived effort-reward imbalance that centred upon the enhanced role not being recognized in terms of an increase in grade and pay. Independent prescribing increases job satisfaction for NPs in general practice, but there is also evidence of stressors associated with the role. It is important that NPs in general practice are encouraged and supported towards providing the effective patient-centred care in the community envisaged by current UK government. We acknowledge that the results presented in this paper are based on a sample limited to one city; however, it provides information that has important implications for the well being of NPs and ultimately patient care.

  8. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Meetings of Interest Online Education Job Board CME Policies CBN Fellowship Certificate Research Grant Program Resources All Resources Approved Procedures Patient Safety Vignettes Dr. Mason Historical Library Governing Documents Guidelines Access and Insurance Position and ...

  9. Emergency procedures

    International Nuclear Information System (INIS)

    Abd Nasir Ibrahim; Azali Muhammad; Ab Razak Hamzah; Abd Aziz Mohamed; Mohammad Pauzi Ismail

    2004-01-01

    The following subjects are discussed - Emergency Procedures: emergency equipment, emergency procedures; emergency procedure involving X-Ray equipment; emergency procedure involving radioactive sources

  10. Modeling of outpatient prescribing process in iran: a gateway toward electronic prescribing system.

    Science.gov (United States)

    Ahmadi, Maryam; Samadbeik, Mahnaz; Sadoughi, Farahnaz

    2014-01-01

    Implementation of electronic prescribing system can overcome many problems of the paper prescribing system, and provide numerous opportunities of more effective and advantageous prescribing. Successful implementation of such a system requires complete and deep understanding of work content, human force, and workflow of paper prescribing. The current study was designed in order to model the current business process of outpatient prescribing in Iran and clarify different actions during this process. In order to describe the prescribing process and the system features in Iran, the methodology of business process modeling and analysis was used in the present study. The results of the process documentation were analyzed using a conceptual model of workflow elements and the technique of modeling "As-Is" business processes. Analysis of the current (as-is) prescribing process demonstrated that Iran stood at the first levels of sophistication in graduated levels of electronic prescribing, namely electronic prescription reference, and that there were problematic areas including bottlenecks, redundant and duplicated work, concentration of decision nodes, and communicative weaknesses among stakeholders of the process. Using information technology in some activities of medication prescription in Iran has not eliminated the dependence of the stakeholders on paper-based documents and prescriptions. Therefore, it is necessary to implement proper system programming in order to support change management and solve the problems in the existing prescribing process. To this end, a suitable basis should be provided for reorganization and improvement of the prescribing process for the future electronic systems.

  11. Prescribing Practices and Polypharmacy in Kitovu Hospital

    African Journals Online (AJOL)

    admin

    1Division of Medicine and Therapeutics, Centre for Medical Education, The Queen's ... This audit of prescribing practices explores recent trends at Kitovu Hospital, Uganda ..... This creates a cycle of poor ... interventions to remedy these is vital.

  12. Customization in prescribing for bipolar disorder.

    Science.gov (United States)

    Hodgkin, Dominic; Volpe-Vartanian, Joanna; Merrick, Elizabeth L; Horgan, Constance M; Nierenberg, Andrew A; Frank, Richard G; Lee, Sue

    2012-06-01

    For many disorders, patient heterogeneity requires physicians to customize their treatment to each patient's needs. We test for the existence of customization in physicians' prescribing for bipolar disorder, using data from a naturalistic clinical effectiveness trial of bipolar disorder treatment (STEP-BD), which did not constrain physician prescribing. Multinomial logit is used to model the physician's choice among five combinations of drug classes. We find that our observed measure of the patient's clinical status played only a limited role in the choice among drug class combinations, even for conditions such as mania that are expected to affect class choice. However, treatment of a patient with given characteristics differed widely depending on which physician was seen. The explanatory power of the model was low. There was variation within each physician's prescribing, but the results do not suggest a high degree of customization in physicians' prescribing, based on our measure of clinical status. Copyright © 2011 John Wiley & Sons, Ltd.

  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. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

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

    2007-01-01

    to the patients. Topical, dermatological medications and medications not used regularly were excluded. RESULTS: 212 patients were prescribed 1621 medications by their GPs at baseline. In all, 640 (39.5%) of the medications had one or more inappropriate ratings in the 10 criteria making up the MAI. The main part...... is good. However, the majority of patients used one or more medications with inappropriate ratings. The inappropriate prescribing relates to specific therapeutic groups and criteria, which should be targeted in future interventions....

  15. A qualitative study of GPs' and PCO stakeholders' views on the importance and influence of cost on prescribing.

    Science.gov (United States)

    Prosser, Helen; Walley, Tom

    2005-03-01

    With prescribing expenditure rising and evidence of prescribing costs variation, general practitioners (GPs) in the UK are under increasing pressure to contain spending. The introduction of cash-limited, unified budgets and increased monitoring of prescribing within Primary Care Organizations (PCO) are intended to increase efficiency and enhance GPs financial responsibility. Whilst GPs regularly receive data on the costs of their prescribing and also performance against a set prescribing budget, little is known about the extent to which GPs take cost into account in their prescribing decisions. This study undertook a qualitative exploration of the attitudes of various stakeholders on the relative importance and influence of cost on general practice prescribing. In order to explore a plurality of perspectives, data were obtained from focus groups and a series of individual semi-structured interviews with GPs and key PCO stakeholders. The data suggest that although almost all GPs believed costs should be taken into account when prescribing, there was great variation in the extent to which this was applied and to how sensitive GPs were to costs. Cost was secondary to clinical effectiveness and safety, whilst individual patient need was emphasized above other forms of rationality or notions of opportunity costs. Conflict was apparent between a PCO policy of cost-containment and GPs' resistance to cost-cutting. GPs largely applied simple cost-minimization while cost-consideration was undermined by contextual factors. Implications for research and policy are discussed.

  16. Impact of smoke from prescribed burning: Is it a public health concern?

    Science.gov (United States)

    Haikerwal, Anjali; Reisen, Fabienne; Sim, Malcolm R; Abramson, Michael J; Meyer, Carl P; Johnston, Fay H; Dennekamp, Martine

    2015-05-01

    Given the increase in wildfire intensity and frequency worldwide, prescribed burning is becoming a more common and widespread practice. Prescribed burning is a fire management tool used to reduce fuel loads for wildfire suppression purposes and occurs on an annual basis in many parts of the world. Smoke from prescribed burning can have a substantial impact on air quality and the environment. Prescribed burning is a significant source of fine particulate matter (PM2.5 aerodynamic diameterprescribed burning on air quality particularly focussing on PM2.5. We have summarised available case studies from Australia including a recent study we conducted in regional Victoria, Australia during the prescribed burning season in 2013. The studies reported very high short-term (hourly) concentrations of PM2.5 during prescribed burning. Given the increase in PM2.5 concentrations during smoke events, there is a need to understand the influence of prescribed burning smoke exposure on human health. This is important especially since adverse health impacts have been observed during wildfire events when PM2.5 concentrations were similar to those observed during prescribed burning events. Robust research is required to quantify and determine health impacts from prescribed burning smoke exposure and derive evidence based interventions for managing the risk. Given the increase in PM2.5 concentrations during PB smoke events and its impact on the local air quality, the need to understand the influence of PB smoke exposure on human health is important. This knowledge will be important to inform policy and practice of the integrated, consistent, and adaptive approach to the appropriate planning and implementation of public health strategies during PB events. This will also have important implications for land management and public health organizations in developing evidence based objectives to minimize the risk of PB smoke exposure.

  17. Practical guide for defending the rights of refugee children and refugee unaccompanied minors in South Africa: policy review, processes, procedures & practical experience

    CSIR Research Space (South Africa)

    Shabangu, T

    2008-06-01

    Full Text Available CHAPTER?8:?ACCESS?TO?SOCIAL?SERVICE?AND?LOCAL?INTEGRATION? 52 Introduction? 52 International?Policy?Frameworks? 52 Relevant?National?Legislation? 53 CHAPTER?9:?ACCESS?TO?HOUSING?AND?SHELTER? 56 Introduction? 56 International?Policy?Frameworks? 56....? Section? 28? of? the? Bill? of? Rights? outlines? children?s?rights?and?states?that:??Every?child?has?the?right??to?basic?nutrition,?shelter,?basic?health?care? services?and?social...

  18. Wildland fires and dwarf mistletoes: A literature review of ecology and prescribed burning

    Science.gov (United States)

    Martin E. Alexander; Frank G. Hawksworth

    1975-01-01

    Wildfires play a multiple role in the distribution of dwarf mistletoes - they may either inhibit or encourage these parasites depending primarily on the size and intensity of the burn. Many reports suggest that fire exclusion policies of the past half century have resulted in increased dwarf mistletoe levels as, well as increased fire behavior potential. Prescribed...

  19. 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

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

    Science.gov (United States)

    Cresswell, Kathrin; Coleman, Jamie; Smith, Pam; Swainson, Charles; Slee, Ann; Sheikh, Aziz

    2016-07-04

    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. 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. 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. 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. 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 move towards more sophisticated closed-loop systems that integrate

  2. Air Pollution Episodes Associated with Prescribed Burns

    Science.gov (United States)

    Hart, M.; Di Virgilio, G.; Jiang, N.

    2017-12-01

    Air pollution events associated with wildfires have been associated with extreme health impacts. Prescribed burns are an important tool to reduce the severity of wildfires. However, if undertaken during unfavourable meteorological conditions, they too have the capacity to trigger extreme air pollution events. The Australian state of New South Wales has increased the annual average area treated by prescribed burn activities by 45%, in order to limit wildfire activity. Prescribed burns need to be undertaken during meteorological conditions that allow the fuel load to burn, while still allowing the burn to remain under control. These conditions are similar to those that inhibit atmospheric dispersion, resulting in a fine balance between managing fire risk and managing ambient air pollution. During prescribed burns, the Sydney air shed can experience elevated particulate matter concentrations, especially fine particulates (PM2.5) that occasionally exceed national air quality standards. Using pollutant and meteorological data from sixteen monitoring stations in Sydney we used generalized additive model and CART analyses to profile the meteorological conditions influencing air quality during planned burns. The insights gained from this study will help improve prescribed burn scheduling in order to reduce the pollution risk to the community, while allowing fire agencies to conduct this important work.

  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. Antibiotic Use in Cold and Flu Season and Prescribing Quality: A Retrospective Cohort Study.

    Science.gov (United States)

    Alsan, Marcella; Morden, Nancy E; Gottlieb, Joshua D; Zhou, Weiping; Skinner, Jonathan

    2015-12-01

    Excessive antibiotic use in cold and flu season is costly and contributes to antibiotic resistance. The study objective was to develop an index of excessive antibiotic use in cold and flu season and determine its correlation with other indicators of prescribing quality. We included Medicare beneficiaries in the 40% random sample denominator file continuously enrolled in fee-for-service benefits for 2010 or 2011 (7,961,201 person-years) and extracted data on prescription fills for oral antibiotics that treat respiratory pathogens. We collapsed the data to the state level so they could be merged with monthly flu activity data from the Centers for Disease Control and Prevention. Linear regression, adjusted for state-specific mean antibiotic use and demographic characteristics, was used to estimate how antibiotic prescribing responded to state-specific flu activity. Flu-activity associated antibiotic use varied substantially across states-lowest in Vermont and Connecticut, highest in Mississippi and Florida. There was a robust positive correlation between flu-activity associated prescribing and use of medications that often cause adverse events in the elderly (0.755; Pantibiotic use was positively correlated with prescribing high-risk medications to the elderly and negatively correlated with beta-blocker use after myocardial infarction. These findings suggest that excessive antibiotic use reflects low-quality prescribing. They imply that practice and policy solutions should go beyond narrow, antibiotic specific, approaches to encourage evidence-based prescribing for the elderly Medicare population.

  5. 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

  6. 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.

  7. 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......, Aalborg; Denmark OBJECTIVES: Prescribing for adult psychiatric patients is often highly complex due to the nature of psychiatric conditions, but also due to somatic comorbidity. Therefore, the aim of this study was to identify prevalence and types of potential inappropriate prescribing (PIP), asses...... 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...

  8. 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......, Aalborg; Denmark OBJECTIVES: Prescribing for adult psychiatric patients is often highly complex due to the nature of psychiatric conditions, but also due to somatic comorbidity. Therefore, the aim of this study was to identify prevalence and types of potential inappropriate prescribing (PIP), asses...... 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...

  9. Beyond procedures: team reflection in a rail control centre to enhance resilience

    NARCIS (Netherlands)

    Siegel, A.W.; Schraagen, Johannes Martinus Cornelis

    2017-01-01

    Resilience engineering concepts can complement proceduralization of complex sociotechnical systems (STS). Proceduralization aims at defining precise and quantified system objectives, and at defining a process that describes and prescribes how to achieve those objectives. Although proceduralization

  10. Beyond procedures : Team reflection in a rail control centre to enhance resilience

    NARCIS (Netherlands)

    Siegel, A.W.; Schraagen, J.M.C.

    2017-01-01

    Resilience engineering concepts can complement proceduralization of complex sociotechnical systems (STS). Proceduralization aims at defining precise and quantified system objectives, and at defining a process that describes and prescribes how to achieve those objectives. Although proceduralization

  11. e-Learning initiatives to support prescribing.

    Science.gov (United States)

    Maxwell, Simon; Mucklow, John

    2012-10-01

    Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  12. 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

  13. 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…

  14. Evoking prescribed spike times in stochastic neurons

    Science.gov (United States)

    Doose, Jens; Lindner, Benjamin

    2017-09-01

    Single cell stimulation in vivo is a powerful tool to investigate the properties of single neurons and their functionality in neural networks. We present a method to determine a cell-specific stimulus that reliably evokes a prescribed spike train with high temporal precision of action potentials. We test the performance of this stimulus in simulations for two different stochastic neuron models. For a broad range of parameters and a neuron firing with intermediate firing rates (20-40 Hz) the reliability in evoking the prescribed spike train is close to its theoretical maximum that is mainly determined by the level of intrinsic noise.

  15. Blueprint for prescriber continuing education program.

    Science.gov (United States)

    2012-06-01

    On October 25, 2011, the Center for Drug Evaluation and Research (CDER) of the Food and Drug Administration (FDA) posted online this Blueprint for Prescriber Continuing Education, labeled "final," relating to extended-release and long-acting opioids. The pending FDA Risk Evaluation Management Strategy (REMS) requires prescriber education. This document provides guidance to sponsors of these dosage forms in developing the prescvriber education component of their REMS. This report was posted online by the federal agency on October 25, 2011 at: http://www.fda.gov/downloads/drugs/drugsafety/informationbydrugclass/ucm277916.pdf. It is in the public domain.

  16. 69-74 A Retrospective Analysis of Prescribing Prac

    African Journals Online (AJOL)

    user

    A Retrospective Analysis of Prescribing Practice Based on WHO Prescribing Indicators at Four. Selected Hospitals of West ... Key words: World Health Organization, prescribing indicators, rational drug use. INTRODUCTION. Indicators of ... factors, the risk of irrational prescribing could raise several folds. Irrational use of ...

  17. 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: ...

  18. 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

  19. An unhealthy public-private tension: pharmacy ownership, prescribing, and spending in the Philippines.

    Science.gov (United States)

    James, Chris D; Peabody, John; Solon, Orville; Quimbo, Stella; Hanson, Kara

    2009-01-01

    Physicians' links with pharmacies may create perverse financial incentives to overprescribe, prescribe products with higher profit margins, and direct patients to their pharmacy. Interviews with pharmacy customers in the Philippines show that those who use pharmacies linked to public-sector physicians had 5.4 greater odds of having a prescription from such physicians and spent 49.3 percent more than customers using other pharmacies. For customers purchasing brand-name medicines, switching to generics would reduce drug spending by 58 percent. Controlling out-of-pocket spending on drugs requires policies to control financial links between doctors and pharmacies, as well as tighter regulation of nongeneric prescribing.

  20. 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...

  1. 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

  2. Prescribing Behavior of General Practitioners : Competition Matters!

    NARCIS (Netherlands)

    Schaumans, C.B.C.

    2014-01-01

    Background: General Practitioners have limited means to compete. As quality is hard to observe by patients, GPs have incentives to signal quality by using instruments patients perceive as quality. Objectives: We investigate whether GPs exhibit different prescribing behavior (volume and value of

  3. Prescribing behavior of general practitioners : Competition matters!

    NARCIS (Netherlands)

    Schaumans, C.B.C.

    Background General Practitioners (GP) have limited means to compete. As quality is hard to observe by patients, GPs have incentives to signal quality by using instruments patients perceive as quality. Objectives I investigate whether GPs prescribe more units when confronted with more competition. As

  4. 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 ...

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

    African Journals Online (AJOL)

    It was also concluded that generic prescription should be encouraged among prescribers to lessen the financial burden of patients because drugs marketed under generic names are usually cheaper than those with brand names. Key words: Brand, Generic,Prescription, Antihypertensives,Cost. [Nig. Jnl Health & Biomedical ...

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

    African Journals Online (AJOL)

    2015-03-01

    Mar 1, 2015 ... Design: A total of 3800 prescriptions containing. NSAIDs were analyzed for information on drug name, the number of NSAIDs per prescription, the presence of ACE inhibitors and diuretics alongside. NSAIDs and NSAIDs prescribed in generic or brand names. Results: The results showed that Aspirin was ...

  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. 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 ...

  9. An atmospheric dispersion index for prescribed burning

    Science.gov (United States)

    Leonidas G. Lavdas

    1986-01-01

    A numerical index that estimates the atmosphere's capacity to disperse smoke from prescribed burning is described. The physical assumptions and mathematical development of the index are given in detail. A preliminary interpretation of dispersion index values is offered. A FORTRAN subroutine package for computing the index is included.

  10. [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.

  11. OpenPrescribing: normalised data and software tool to research trends in English NHS primary care prescribing 1998-2016.

    Science.gov (United States)

    Curtis, Helen J; Goldacre, Ben

    2018-02-23

    We aimed to compile and normalise England's national prescribing data for 1998-2016 to facilitate research on long-term time trends and create an open-data exploration tool for wider use. We compiled data from each individual year's national statistical publications and normalised them by mapping each drug to its current classification within the national formulary where possible. We created a freely accessible, interactive web tool to allow anyone to interact with the processed data. We downloaded all available annual prescription cost analysis datasets, which include cost and quantity for all prescription items dispensed in the community in England. Medical devices and appliances were excluded. We measured the extent of normalisation of data and aimed to produce a functioning accessible analysis tool. All data were imported successfully. 87.5% of drugs were matched exactly on name to the current formulary and a further 6.5% to similar drug names. All drugs in core clinical chapters were reconciled to their current location in the data schema, with only 1.26% of drugs not assigned a current chemical code. We created an openly accessible interactive tool to facilitate wider use of these data. Publicly available data can be made accessible through interactive online tools to help researchers and policy-makers explore time trends in prescribing. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Delivered volumes of enteral nutrition exceed prescribed volumes.

    Science.gov (United States)

    Walker, Renee Nichole; Utech, Anne; Velez, Maria Eugenia; Schwartz, Katie

    2014-10-01

    Enteral nutrition (EN) provisions are typically calculated based on a 24-hour infusion period. However, feedings are often interrupted for daily activities, procedures, or gastrointestinal intolerance. The study's objective was to determine the delivered EN quantities provided to stable hospitalized patients, using cellular time and measured volumes to verify our EN calculation adjustment. A supply of consecutively numbered ready-to-hang (RTH) EN product was delivered to the bedside of 26 inpatients with established EN tolerance at goal rates on various types of nursing units. The dietitian weighed the volume remaining in the infusing product and recorded the measurement time. On the following days, the dietitian continued to weigh the infusing RTH product and the empty RTH bottles saved by nursing. The primary outcome was the difference between the prescribed and delivered EN provisions, which was calculated with a paired t test. Patients received significantly more calories in the delivered enteral feeding (mean [SD], 1678 [385] kcal) than prescribed calories in the EN order (1489 [246 kcal]; t = 3.736, P = .001), adjusting for observed time. No significant differences were found between nursing units, product, and rate. EN delivered may actually exceed ordered amounts by 5%–21% (mean, 12%) with feeding pump inaccuracy as the primary contributing factor. This differs from what others have found. Our findings support using a volume-based ordering system vs a rate-based ordering system for more accurate EN delivery.

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  14. 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.

  15. Indicators for the automated analysis of drug prescribing quality.

    Science.gov (United States)

    Coste, J; Séné, B; Milstein, C; Bouée, S; Venot, A

    1998-01-01

    Irrational and inconsistent drug prescription has considerable impact on morbidity, mortality, health service utilization, and community burden. However, few studies have addressed the methodology of processing the information contained in these drug orders used to study the quality of drug prescriptions and prescriber behavior. We present a comprehensive set of quantitative indicators for the quality of drug prescriptions which can be derived from a drug order. These indicators were constructed using explicit a priori criteria which were previously validated on the basis of scientific data. Automatic computation is straightforward, using a relational database system, such that large sets of prescriptions can be processed with minimal human effort. We illustrate the feasibility and value of this approach by using a large set of 23,000 prescriptions for several diseases, selected from a nationally representative prescriptions database. Our study may result in direct and wide applications in the epidemiology of medical practice and in quality control procedures.

  16. Accounting for medical variation: the case of prescribing activity in a New Zealand general practice sample.

    Science.gov (United States)

    Davis, P B; Yee, R L; Millar, J

    1994-08-01

    Medical practice variation is extensive and well documented, particularly for surgical interventions, and raises important questions for health policy. To date, however, little work has been carried out on interpractitioner variation in prescribing activity in the primary care setting. An analytical model of medical variation is derived from the literature and relevant indicators are identified from a study of New Zealand general practice. The data are based on nearly 9,500 completed patient encounter records drawn from over a hundred practitioners in the Waikato region of the North Island, New Zealand. The data set represents a 1% sample of all weekday general practice office encounters in the Hamilton Health District recorded over a 12-month period. Overall levels of prescribing, and the distribution of drug mentions across diagnostic groupings, are broadly comparable to results drawn from international benchmark data. A multivariate analysis is carried out on seven measures of activity in the areas of prescribing volume, script detail, and therapeutic choice. The analysis indicates that patient, practitioner and practice attributes exert little systematic influence on the prescribing task. The principal influences are diagnosis, followed by practitioner identity. The pattern of findings suggests also that the prescribing task cannot be viewed as an undifferentiated activity. It is more usefully considered as a process of decision-making in which 'core' judgements--such as the decision to prescribe and the choice of drug--are highly predictable and strongly influenced by diagnosis, while 'peripheral' features of the task--such as choosing a combination drug or prescribing generically--are less determinate and more subject to the exercise of clinical discretion.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. 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.

  18. 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.

  19. 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

  20. Medication reconciliation and prescribing reviews by pharmacy technicians in a geriatric ward

    DEFF Research Database (Denmark)

    Buck, Thomas Croft; Gronkjaer, Louise Smed; Duckert, Marie-Louise

    2013-01-01

    OBJECTIVE: Incomplete medication histories obtained on hospital admission are responsible for more than 25% of prescribing errors. This study aimed to evaluate whether pharmacy technicians can assist hospital physicians' in obtaining medication histories by performing medication reconciliation an...... reconciliation and focused medication reviews. Further randomized, controlled studies including a larger number of patients are required to elucidate whether these observations are of significance and of importance for securing patient safety....... and prescribing reviews. A secondary aim was to evaluate whether the interventions made by pharmacy technicians could reduce the time spent by the nurses on administration of medications to the patients. METHODS: This observational study was conducted over a 7 week period in the geriatric ward at Odense...... University Hospital, Denmark. Two pharmacy technicians conducted medication reconciliation and prescribing reviews at the time of patients' admission to the ward. The reviews were conducted according to standard operating procedures developed by a clinical pharmacist and approved by the Head of the Geriatric...

  1. 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

  2. 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

  3. Secular trends in opioid prescribing in the USA

    Directory of Open Access Journals (Sweden)

    Pezalla EJ

    2017-02-01

    Full Text Available Edmund J Pezalla,1 David Rosen,2 Jennifer G Erensen,2 J David Haddox,2,3 Tracy J Mayne2 1Bioconsult, LLC, Wethersfield, 2Purdue Pharma L.P., Stamford, CT, 3Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA Abstract: Opioid abuse and misuse in the USA is a public health crisis. The use of prescription opioid analgesics increased substantially from 2002 through 2010, then plateaued and began to decrease in 2011. This study examined prescriptions of branded and generic immediate- and extended-release opioid analgesics from 1992 to 2016. This was juxtaposed against state and federal policies designed to decrease overutilization and abuse, as well as the launch of new opioid products, including opioids with abuse-deterrent properties (OADPs. The data indicate that these health policies, including the utilization and reimbursement of OADPs, have coincided with decreased opioid utilization. The hypothesis that OADPs will paradoxically increase opioid prescribing is not supported. Keywords: OADP, prescription, utilization trends, legislation, opioids

  4. Does non-medical prescribing make a difference to patients?

    Science.gov (United States)

    Carey, Nicola; Stenner, Karen

    This article examines the literature on non-medical prescribing to establish its impact on UK healthcare. It discusses how better access to medication through non-medical prescribing can improve patient safety and patient-centred care, and how nurse prescribing can help ensure quality of care in the NHS during the current financial crisis.

  5. 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 ...

  6. Out-Patient Prescribing Practices at Mbagathi District Hospital ...

    African Journals Online (AJOL)

    On average, each patient was prescribed 3.85 types of drugs. A total of 835 drugs were prescribed by generic name, accounting for 25.6% of total number of drugs prescribed (1,506). Out of 391 sampled prescriptions, 266 had antibiotics accounting for (68.0%). A relatively small proportion of the prescriptions, 9.5% had an ...

  7. 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...

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

    Science.gov (United States)

    Nicholson, Susan C; Peterson, Janet; Yektashenas, Behin

    2012-02-01

    The US FDA Amendments Act of 2007 was signed into law on 27 September 2007. A provision of this law granted the FDA new powers to enhance drug safety by requiring the pharmaceutical industry to develop Risk Evaluation and Mitigation Strategies (REMS). REMS are deemed necessary when a question exists as to whether the benefits of a drug outweigh its risks. REMS constitute a safety plan with several potential components, including a medication guide, a communication plan, elements to ensure safe use and an implementation system to help guide the prescribers, pharmacists and patients. This applies to existing drugs on the market, new drug applications (NDAs), abbreviated NDAs (generics) and biologics licence applications. REMS represent an 'upgrade' from previously required risk minimization action plans, based on the strengthening of FDA powers of authority and enforceability to incur monetary penalties against individuals representing the pharmaceutical industry who fail to comply. For illustrative purposes, we chose the drug romiplostim (Nplate®) to present an REMS, as all components were utilized to help assuage risks associated with the drug. Romiplostim is an FDA-approved drug used to treat thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura that has a significant adverse safety profile based on the risk of changes in bone marrow reticulin formation and bone marrow fibroses, and other associated risks. This review of current REMS policy is intended to provide the prescriber with a better understanding of current modalities in FDA-mandated drug safety programmes, which will impact day-to-day healthcare provider practices.

  9. [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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. Controlled Substance Prescribing Patterns--Prescription Behavior Surveillance System, Eight States, 2013.

    Science.gov (United States)

    Paulozzi, Leonard J; Strickler, Gail K; Kreiner, Peter W; Koris, Caitlin M

    2015-10-16

    or benzodiazepine of choice is unexplained. Most opioid prescribing occurs among a small minority of prescribers. Most of the prescriptions by top-decile prescribers probably are written by general, family medicine, internal medicine, and midlevel practitioners. The source of payment varied by state, for reasons that are unclear. Persons who are prescribed opioids also are commonly prescribed benzodiazepine sedatives despite the risk for additive depressant effects. States can use their prescription drug monitoring programs to generate population-based measures for the prescribing of controlled substances and for behaviors that suggest their misuse. Comparing data with other states and tracking changes in these measures over time can be useful in measuring the effect of policies designed to reduce prescription drug misuse.

  16. “Comprehensive emission measurements from prescribed ...

    Science.gov (United States)

    Simultaneous aerial- and ground-based emission sampling was conducted during prescribed burns at Eglin Air Force Base in November 2012 on a short grass/shrub field and a pine forest. Cumulative emission samples for volatile organic comounds, elemental carbon, organic carbon, chlorinated dioxins and furans, and PM2.5 and continuous samples for black carbon, particle size, and CO2 were taken. Aerial instruments were lofted using a 5 m diameter, helium-filled aerostat that was maneuvered with two remotely-controlled tethers mounted on all-terrain vehicles. A parallel set of instruments on the ground made simultaneous measurements, allowing for a comparison of ground level versus elevated measurements. Ground instruments were supplemented by additional measurements of polycyclic aromatic hydrocarbons and particle aerosol absorption and light scattering. Raw biomass was also gathered on site and tested in a laboratory combustion facility using the same array of instruments. This work compares emissions derived from aerial and ground sampling as well as field and laboratory results. This abstract will likely be the first ever prescribed burn study to compare laboratory and field emission results with results from aerial and and ground sampling. As such it will inform sampling methods for future events and determine the ability of laboratory simulations to mimic events inthe field.

  17. 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.

  18. 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

  19. Implementing nurse prescribing: a case study in diabetes.

    Science.gov (United States)

    Stenner, Karen; Carey, Nicola; Courtenay, Molly

    2010-03-01

    This paper is a report of a study exploring the views of nurses and team members on the implementation of nurse prescribing in diabetes services. Nurse prescribing is adopted as a means of improving service efficiency, particularly where demand outstretches resources. Although factors that support nurse prescribing have been identified, it is not known how these function within specific contexts. This is important as its uptake and use varies according to mode of prescribing and area of practice. A case study was undertaken in nine practice settings across England where nurses prescribed medicines for patients with diabetes. Thematic analysis was conducted on qualitative data from 31 semi-structured interviews undertaken between 2007 and 2008. Participants were qualified nurse prescribers, administrative staff, physicians and non-nurse prescribers. Nurses prescribed more often following the expansion of nurse independent prescribing rights in 2006. Initial implementation problems had been resolved and few current problems were reported. As nurses' roles were well-established, no major alterations to service provision were required to implement nurse prescribing. Access to formal and informal resources for support and training were available. Participants were accepting and supportive of this initiative to improve the efficiency of diabetes services. The main factors that promoted implementation of nurse prescribing in this setting were the ability to prescribe independently, acceptance of the prescribing role, good working relationships between doctors and nurses, and sound organizational and interpersonal support. The history of established nursing roles in diabetes care, and increasing service demand, meant that these diabetes services were primed to assimilate nurse prescribing.

  20. Growth of nurse prescribing competence: facilitators and barriers during education.

    Science.gov (United States)

    Hopia, Hanna; Karhunen, Anne; Heikkilä, Johanna

    2017-10-01

    To describe facilitators and barriers in relation to the growth of nurse prescribing competence from the perspective of the nurses studying in a prescribing programme. The number of nurses enrolled in a nurse prescribing programme is rapidly increasing in Finland. However, few studies on nurse prescribing education are available and therefore research is needed, particularly from the point of view of nurses studying in the programme. The descriptive, qualitative study used the text of student online learning diaries as data during a 14-month prescribing programme. The sample consisted of 31 nurses, public health nurses or midwives enrolled in a prescribing programme at a university of applied sciences. The data were analysed using the inductive analysis method. The growth of nurses' prescribing competence was facilitated by learning clinical examination of the patient, networking with peers, receiving support from the workplace and supervisors, doctors' positive attitude towards nurse prescribing and being able to apply competencies directly to nursing practice. The barriers to the growth of nurses' prescribing competence were unclear job description, incomplete care plans and concerns about how consultation with doctors will be organised and realised. The results show that, for the purpose of developing the new role and position of nurse prescribers, educators and nursing managers must invest more in staff awareness of nurse prescribing education and also offer more support to nurse prescribers in their workplaces. The results of this study can be used especially in countries where nurse prescribing education is only in the process of being planned or has just been started. Heads of nursing and educators in prescribing education will benefit from the results when creating expanded job descriptions for nurses and supporting networking between students during the period of training. © 2016 John Wiley & Sons Ltd.

  1. 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.

  2. What Factors Affect Physicians’ Decisions to Prescribe Opioids in Emergency Departments?

    Directory of Open Access Journals (Sweden)

    Lauren E. Sinnenberg BA

    2017-01-01

    Full Text Available Objective: With 42% of all emergency department visits in the United States related to pain, physicians who work in this setting are tasked with providing adequate pain management to patients with varying primary complaints and medical histories. Complicating this, the United States is in the midst of an opioid overdose epidemic. State governments and national organizations have developed guidelines and legislation to curtail opioid prescriptions in acute care settings, while also incentivizing providers for patient satisfaction and completeness of pain control. In order to inform future policies that focus on provider pain medication prescribing, we sought to characterize the factors physicians weigh when considering treating pain with opioids in the emergency department. Methods: We conducted and transcribed open-ended, semistructured qualitative interviews with 52 physicians at a national emergency medicine conference. Results: Participants reported a wide range of factors contributing to their opioid prescribing patterns related to three domains: 1 provider assessment of pain characteristics, 2 patient-based considerations, and 3 practice environment. Pain characteristics include the characteristics of various acute and chronic pain syndromes, including physicians’ empathy due to their own experiences with pain. Patient characteristics include “trustworthiness,” race and ethnicity, and the concern for risk of misuse. Factors related to the practice environment include hospital policy, legislation/regulation, and guidelines. Conclusion: The decision to prescribe opioids to patients in the emergency department is complex and nuanced. Physicians are interested in guidance and are concerned about the competing pressures placed on their opioid prescribing due to incentives related to patient satisfaction scores on one hand and inflexible policies that do not allow for individualized, patient-centered decisions on the other.

  3. 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

  4. 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)

  5. 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)

  6. Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study.

    Science.gov (United States)

    Swinglehurst, Deborah; Greenhalgh, Trisha; Russell, Jill; Myall, Michelle

    2011-11-03

    To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Ethnographic case study. Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Potential threats to patient safety and characteristics of good practice. Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as "exceptions" by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge. Clinicians were often unaware of this input and it did not feature in policy

  7. [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.

  8. Designing magnets with prescribed magnetic fields

    International Nuclear Information System (INIS)

    Liu Liping

    2011-01-01

    We present a novel design method capable of finding the magnetization densities that generate prescribed magnetic fields. The method is based on the solution to a simple variational inequality and the resulting designs have simple piecewise-constant magnetization densities. By this method, we obtain new designs of magnets that generate commonly used magnetic fields: uniform magnetic fields, self-shielding fields, quadrupole fields and sextupole fields. Further, it is worth noting that this method is not limited to the presented examples, and in particular, three-dimensional designs can be constructed in a similar manner. In conclusion, this novel design method is anticipated to have broad applications where specific magnetic fields are important for the performance of the devices.

  9. 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/.

  10. 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.

  11. 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.

  12. 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

  13. Antiepileptic drug prescribing before, during and after pregnancy

    DEFF Research Database (Denmark)

    Charlton, Rachel; Garne, Ester; Wang, Hao

    2015-01-01

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

  14. Prescribing practices amid the OxyContin crisis: examining the effect of print media coverage on opioid prescribing among physicians.

    Science.gov (United States)

    Borwein, Alexandra; Kephart, George; Whelan, Emma; Asbridge, Mark

    2013-12-01

    The pain medication OxyContin (hereafter referred to as oxycodone extended release) has been the subject of sustained, and largely negative, media attention in recent years. We sought to determine whether media coverage of oxycodone extended release in North American newspapers has led to changes in prescribing of the drug in Nova Scotia, Canada. An interrupted time-series design examined the effect of media attention on physicians' monthly prescribing of opioids. The outcome measures were, for each physician, the monthly proportions of all opioids prescribed and the proportion of strong opioids prescribed that were for oxycodone extended release. The exposure of interest was media attention defined as the number of articles published each month in 27 North American newspapers. Variations in media effects by provider characteristics (specialty, prescribing volume, and region) were assessed. Within-provider changes in the prescribing of oxycodone extended release in Nova Scotia were observed, and they followed changes in media coverage. Oxycodone extended release prescribing rose steadily prior to receiving media attention. Following peak media attention in the United States, the prescribing of oxycodone extended release slowed. Likewise, following peak coverage in Canadian newspapers, the prescribing of oxycodone extended release declined. These patterns were observed across prescriber specialties and by prescriber volume, though the magnitude of change in prescribing varied. This study demonstrates that print media reporting of oxycodone extended release in North American newspapers, and its continued portrayal as a social problem, coincided with reductions in the prescribing of oxycodone extended release by physicians in Nova Scotia. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

  15. Analysis of the prescribed burning practice in the pine forest of northwestern Portugal.

    Science.gov (United States)

    Fernandes, P; Botelho, H

    2004-01-01

    The ignition of low-intensity fires in the dormant season in the pine stands of north-western Portugal seeks to reduce the existing fuel hazard without compromising site quality. The purpose of this study is to characterise this practice and assess its effectiveness, based on information resulting from the normal monitoring process at the management level, and using operational guidelines, fire behaviour models and a newly developed method to classify prescribed fire severity. Although the region's humid climate strongly constrains the activity of prescribed fire, 87% of the fires analysed were undertaken under acceptable meteorological and fuel moisture conditions. In fact, most operations achieved satisfactory results. On average, prescribed fire reduces by 96% the potential intensity of a wildfire occurring under extreme weather conditions, but 36% of the treated sites would still require heavy fire fighting resources to suppress such fire, and 17% would still carry it in the tree canopy. Only 10% of the prescribed burns have an excessive impact on trees or the forest floor, while 89% (normal fire weather) or 59% (extreme fire weather) comply with both ecological integrity maintenance and wildfire protection needs. Improved planning and monitoring procedures are recommended in order to overcome the current deficiencies.

  16. 32 CFR 110.5 - Procedures.

    Science.gov (United States)

    2010-07-01

    ... enrolled in the basic or advanced course. Payments are as prescribed in the DoD Military Pay and Allowances... procedures applicable to ROTC units of their respective Military Services. (2) When discrepancies are noted... of the date the discrepancy was noted. ...

  17. Military Publications, Index of Test Operations Procedures

    Science.gov (United States)

    1981-10-01

    serial number, aad design information for majur components. Prescribes vehicle, major component, and system descrip- tive elements required; such as...mount operating characteristics. Discusses preparation for test, instrumentation, and facil- ities. Describes procedures for force measurement, carriage...backlash and accuracy, turret friction, gun balance, manual handcrank force , manual response ratio, weapon and sighting system backlash, power controller

  18. 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...

  19. 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

  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. 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 us...... appropriate and inappropriate prescribing, as revealed by the correlation of the indicators in the first factor. CONCLUSION: Correlation and factor analysis is a feasible method that assists the selection of indicators and gives better insight into prescribing patterns....

  2. A 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.

  3. Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation.

    Science.gov (United States)

    Mills, Pamela Ruth; Weidmann, Anita Elaine; Stewart, Derek

    2017-12-01

    Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation

  4. [Generic drugs: good or bad? Physician's knowledge of generic drugs and prescribing habits].

    Science.gov (United States)

    García, A J; Martos, F; Leiva, F; Sánchez de la Cuesta, F

    2003-01-01

    In this article we analyze the responses of 1220 Spanish physicians who participated in a survery about generic drugs. A previously validated questionnaire was sent to physicians through the Spanish Medical Councils of the different provinces. Four items were analyzed: what doctors know about generic drugs (knowledge); physicians' prescribing habits concerning these drugs (attitude and professional competence); how prescription of generic drugs effects pharmaceutical costs amd, finally, what doctors believe a generic drug should be. The influence of physician-related variables (age, type of contract, specialty, workload, etc.) on prescribing of generic drugs was also analyzed. In view of the results, we believe that to rationalize expenditure through and appropriate policy on generic drugs Spanish health authorities should offer more and better training and information (clear and independent) about what generic drugs are.

  5. Internal Control Organization Procedure

    OpenAIRE

    Radu Dorin Lenghel

    2013-01-01

    Internal control represents the totality of policies and procedures adopted by management, which contribute: to the fulfilment of managerial objectives, to the prevention and detection of frauds or errors, to the accuracy and exhaustiveness of accounting entries, as well as to the preparation in due course of financial accounting information. Internal control represents a managerial instrument which assures the fulfilment of objectives of the entity, being an ongoing process in which administ...

  6. 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.

  7. Impact of generic substitution decision support on electronic prescribing behavior.

    Science.gov (United States)

    Stenner, Shane P; Chen, Qingxia; Johnson, Kevin B

    2010-01-01

    To evaluate the impact of generic substitution decision support on electronic (e-) prescribing of generic medications. The authors analyzed retrospective outpatient e-prescribing data from an academic medical center and affiliated network for July 1, 2005-September 30, 2008 using an interrupted time-series design to assess the rate of generic prescribing before and after implementing generic substitution decision support. To assess background secular trends, e-prescribing was compared with a concurrent random sample of hand-generated prescriptions. Proportion of generic medications prescribed before and after the intervention, evaluated over time, and compared with a sample of prescriptions generated without e-prescribing. The proportion of generic medication prescriptions increased from 32.1% to 54.2% after the intervention (22.1% increase, 95% CI 21.9% to 22.3%), with no diminution in magnitude of improvement post-intervention. In the concurrent control group, increases in proportion of generic prescriptions (29.3% to 31.4% to 37.4% in the pre-intervention, post-intervention, and end-of-study periods, respectively) were not commensurate with the intervention. There was a larger change in generic prescribing rates among authorized prescribers (24.6%) than nurses (18.5%; adjusted OR 1.38, 95% CI 1.17 to 1.63). Two years after the intervention, the proportion of generic prescribing remained significantly higher for e-prescriptions (58.1%; 95% CI 57.5% to 58.7%) than for hand-generated prescriptions ordered at the same time (37.4%; 95% CI 34.9% to 39.9%) (p<0.0001). Generic prescribing increased significantly in every specialty. Implementation of generic substitution decision support was associated with dramatic and sustained improvements in the rate of outpatient generic e-prescribing across all specialties.

  8. Textbook and Instructional Materials Adoption Policy and Procedures. Policy Brief

    Science.gov (United States)

    Dumas, Paul

    2006-01-01

    In the U.S.-affiliated Pacific, the U.S. Department of Education (U.S. ED) and the U.S. Department of the Interior (DOI) are responsible for assisting State educational agencies (SEAs) in the development of planning and accountability systems to meet the requirements of the "No Child Left Behind Act of 2001" (NCLB) requirements and…

  9. Electronic prescribing: criteria for evaluating handheld prescribing systems and an evaluation of a new, handheld, wireless wide area network (WWAN) prescribing system.

    Science.gov (United States)

    Goldblum, O M

    2001-02-01

    The objectives of this study were: 1) to establish criteria for evaluating handheld computerized prescribing systems; and 2) to evaluate out-of-box performance and features of a new, Palm Operating System (OS)-based, handheld, wireless wide area network (WWAN) prescribing system. The system consisted of a Palm Vx handheld organizer, a Novatel Minstrel V wireless modem, OmniSky wireless internet access and ePhysician ePad 1.1, the Palm OS electronic prescribing software program. A dermatologist familiar with healthcare information technology conducted an evaluation of the performance and features of a new, handheld, WWAN electronic prescribing system in an office practice during a three-month period in 2000. System performance, defined as transmission success rate, was determined from data collected during the three-month trial. Evaluation criteria consisted of an analysis of features found in electronic prescribing systems. All prescriptions written for all patients seen during a three-month period (August - November, 2000) were eligible for inclusion. Prescriptions written for patients who intended to fill them at pharmacies without known facsimile receiving capabilities were excluded from the study. The performance of the system was evaluated using data collected during the study. Criteria for evaluating features of electronic prescribing systems were developed and used to analyze the system employed in this study. During this three-month trial, 200 electronic prescriptions were generated for 132 patients included in the study. Of these prescriptions, 92.5 percent were successfully transmitted to pharmacies. Transmission failures resulted from incorrect facsimile numbers and non-functioning facsimile machines. Criteria established for evaluation of electronic prescribing systems included System (Hardware & Software), Costs, System Features, Printing & Transmission, Formulary & Insurance, Customization, Drug Safety and Security. This study is the first effort to

  10. 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.

  11. Operational use of prescribed fire in southern California chaparral

    Science.gov (United States)

    Ron Dougherty; Philip J. Riggan

    1982-01-01

    The use of prescribed fire in the chaparral could reduce the incidence and impacts of severe wildfires and enhance watershed re-sources. This paper describes the operational planning needed for a successful prescribed fire and discusses the recent experience with this technique on the Cleveland National Forest.

  12. 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.

  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. 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

    never did. After adjusting for patient and GP characteristics, prescribing style in the group of GPs from Russia was about three times more heterogeneous than the prescribing style in the group of GPs from Denmark – Median Odds Ratio ( 6.8, 95%CI 3.1;8.8 ) and ( 2.6, 95%CI 2.2;4.4 ) respectively...

  15. Benefits of nurse prescribing for patients in pain: nurses' views.

    Science.gov (United States)

    Stenner, Karen; Courtenay, Molly

    2008-07-01

    This paper is a report of a study to explore nurses' views on the benefits of adopting the role of prescribing for patients with acute and chronic pain. It was envisioned that the advent of nurse prescribing would be beneficial to the efficiency and effectiveness of the United Kingdom National Health Service. Research to date does indeed indicate that nurse prescribing can be beneficial to patients, nurses and the health service in general. Despite the expansion of nurse prescribing, there is little evidence of its impact according to nurses working in specialist areas, such as with patients in acute and chronic pain. Interviews were conducted during 2006 and 2007 with 26 nurses qualified to prescribe medicines for patients in acute and chronic pain. This was a qualitative study and a thematic analysis was conducted. Nurses reported a number of benefits, including faster access to treatment, improved quality of care, more appropriate prescribing of medication, improved safety, improved relations and communication with patients, greater efficiency and cost effectiveness. Nurses benefited from increased job satisfaction, credibility with patients and healthcare professionals and also gained knowledge through prescribing. There is potential for the benefits of nurse prescribing to be expanded beyond the United Kingdom in settings where nurses hold similar roles in the treatment of pain, although further research using a wider range of research methods is recommended to substantiate these findings.

  16. Impacts of prescribed fire on Pinus rigida Mill

    Science.gov (United States)

    Nicholas J. Carlo; Heidi J. Renninger; Kenneth L. Clark; Karina V.R. Schäfer

    2016-01-01

    A comparative analysis of the impacts of prescribed fire on three upland forest stands in the Northeastern Atlantic Plain, NJ, USA, was conducted. Effects of prescribed fire on water use and gas exchange of overstory pines were estimated via sap-flux rates and photosynthetic measurements on Pinus rigida Mill. Each study site had two sap-flux plots...

  17. 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, ...

  18. 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...

  19. Prescribed burning in the South: trends, purpose, and barriers

    Science.gov (United States)

    Terry K. Haines; Rodney L. Busby; David A. Cleaves

    2001-01-01

    The results of a survey of fire management officials concerning historical and projected prescribed burning activity in the South are reported. Prescribed burning programs on USDA Forest Service and private and State-owned lands are described in terms of area burned by ownership and State, intended resource benefits, barriers to expanded burning, and optimum burning...

  20. 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.

  1. Computational opioid prescribing: a novel application of clinical pharmacokinetics.

    Science.gov (United States)

    Linares, Oscar A; Linares, Annemarie L

    2011-01-01

    We implemented a pharmacokinetics-based mathematical modeling technique using algebra to assist prescribers with point-of-care opioid dosing. We call this technique computational opioid prescribing (COP). Because population pharmacokinetic parameter values are needed to estimate drug dosing regimen designs for individual patients using COP, and those values are not readily available to prescribers because they exist scattered in the vast pharmacology literature, we estimated the population pharmacokinetic parameter values for 12 commonly prescribed opioids from various sources using the bootstrap resampling technique. Our results show that opioid dosing regimen design, evaluation, and modification is feasible using COP. We conclude that COP is a new technique for the quantitative assessment of opioid dosing regimen design evaluation and adjustment, which may help prescribers to manage acute and chronic pain at the point-of-care. Potential benefits include opioid dose optimization and minimization of adverse opioid drug events, leading to potential improvement in patient treatment outcomes and safety.

  2. 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...

  3. Occupational PAH Exposures during Prescribed Pile Burns

    Science.gov (United States)

    Robinson, M. S.; Anthony, T. R.; Littau, S. R.; Herckes, P.; Nelson, X.; Poplin, G. S.; Burgess, J. L.

    2008-01-01

    Wildland firefighters are exposed to particulate matter and gases containing polycyclic aromatic hydrocarbons (PAHs), many of which are known carcinogens. Our objective was to evaluate the extent of firefighter exposure to particulate and PAHs during prescribed pile burns of mainly ponderosa pine slash and determine whether these exposures were correlated with changes in urinary 1-hydroxypyrene (1-HP), a PAH metabolite. Personal and area sampling for particulate and PAH exposures were conducted on the White Mountain Apache Tribe reservation, working with 21 Bureau of Indian Affairs/Fort Apache Agency wildland firefighters during the fall of 2006. Urine samples were collected pre- and post-exposure and pulmonary function was measured. Personal PAH exposures were detectable for only 3 of 16 PAHs analyzed: naphthalene, phenanthrene, and fluorene, all of which were identified only in vapor-phase samples. Condensed-phase PAHs were detected in PM2.5 area samples (20 of 21 PAHs analyzed were detected, all but naphthalene) at concentrations below 1 μg m−3. The total PAH/PM2.5 mass fractions were roughly a factor of two higher during smoldering (1.06 ± 0.15) than ignition (0.55 ± 0.04 μg mg−1). There were no significant changes in urinary 1-HP or pulmonary function following exposure to pile burning. In summary, PAH exposures were low in pile burns, and urinary testing for a PAH metabolite failed to show a significant difference between baseline and post-exposure measurements. PMID:18515848

  4. Analysis of Out Door Patients' Prescriptions According to World Health Organization (WHO) Prescribing Indicators Among Private Hospitals in Western India.

    Science.gov (United States)

    Shelat, Prakash R; Kumbar, Shivaprasad Kalakappa

    2015-03-01

    Prescription is document through which doctor, patient and pharmacist are communicated. Many a times if these documents are not properly written or misinterpreted it can affect management of patients. WHO established prescribing indicators to analyse prescription and promoted rational use of drugs and better management of patients. To study the prescription pattern according to WHO prescribing indicators among private hospitals. The observational, prospective study carried out at different private hospitals at metro city in Western India to study the prescription pattern among private hospital. Study was conducted at different private hospitals of metro city. A total of 250 prescriptions of outdoor patients from various departments of private hospitals were collected for a period of three months (August to October) 2012 and evaluated. The study was analysed using Z-test. Patient details like age and gender was not written in all (100%) prescriptions. It was noticed that dose, direction of drug and duration of treatment was not completely written in 90%, 74% and 80% of prescriptions respectively. Abbreviations were used in all (100%) prescriptions. Doctor's medical registration number was mentioned in 0% prescriptions. Total 869 drugs were prescribed in 250 prescriptions. Average number of drug prescribed was 3.38±1.79 (Mean±SD). It was reported that Group II (3 to 4 encoutner) was significantly higher as compared to Group I (less than or equal to 2 encoutner) and Group III( more than four encounter). It was significantly (pprivate hospitals and antibiotics was commonly prescribed in private sector. Therefore, strict policy to good prescribing practice and strict antibiotic policy in outdoor patients are required to promote rational use of drugs.

  5. 37 CFR 204.3 - General policy.

    Science.gov (United States)

    2010-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false General policy. 204.3 Section 204.3 Patents, Trademarks, and Copyrights COPYRIGHT OFFICE, LIBRARY OF CONGRESS COPYRIGHT OFFICE AND PROCEDURES PRIVACY ACT: POLICIES AND PROCEDURES § 204.3 General policy. The Copyright Office serves primarily...

  6. 48 CFR 1552.232-74 - Payments-simplified acquisition procedures financing.

    Science.gov (United States)

    2010-10-01

    ... acquisition procedures financing. 1552.232-74 Section 1552.232-74 Federal Acquisition Regulations System... Provisions and Clauses 1552.232-74 Payments—simplified acquisition procedures financing. As prescribed in... acquisition procedures financing. Payments—Simplified Acquisition Procedures Financing (JUN 2006) Simplified...

  7. 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

  8. 38 CFR 6.15 - Cash value; special endowment at age 96 plan policy.

    Science.gov (United States)

    2010-07-01

    ... policy year; all values and net single premiums are as prescribed by the Secretary and published in VA... thereafter shall be the reserve as set forth in the policy together with any dividend accumulations. For each month after the first policy year the reserve at the end of the preceding policy year shall be increased...

  9. 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

  10. 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.

  11. [Access to medicines prescribed for acute health conditions in adults in South and Northeast Brazil].

    Science.gov (United States)

    Paniz, Vera Maria Vieira; Cechin, Isabel Carolina Coelho Flores; Fassa, Anaclaudia Gastal; Piccini, Roberto Xavier; Tomasi, Elaine; Thumé, Elaine; Silveira, Denise Silva da; Facchini, Luiz Augusto

    2016-01-01

    This was a cross-sectional study within Brazil's Project for the Expansion and Consolidation of Family Health, 2005, with the objective of universal and free access to the medication prescribed in the last medical appointment for acute health problems and to estimate the degree to which access may have improved with inclusion of the medicines in prevailing policies and programs. The sample included 4,060 adults living in the area of primary health care units in 41 municipalities in South and Northeast Brazil. Access was greater in the South (83.2%) than in the Northeast (71%), and free access was similar (37%), with a greater share by the Family Health Program (FHP) when compared to the traditional model, especially in the Northeast. Some 60% of prescribed medicines and 50% of those on the National List of Essential Medicines (RENAME) were paid for. No variation was observed in the proportion of medicines present on the prevailing RENAME list and access. However, 40% of the medicines that were paid for can currently be obtained through the Popular Pharmacy Program. The latter program appears to emerge as a new way to guarantee access to medicines prescribed in the health system.

  12. 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

  13. Prokinetics prescribing in paediatrics: evidence on cisapride, domperidone, and metoclopramide.

    Science.gov (United States)

    Mt-Isa, Shahrul; Tomlin, Stephen; Sutcliffe, Alastair; Underwood, Martin; Williamson, Paula; Croft, Nicholas M; Ashby, Deborah

    2015-04-01

    Domperidone and metoclopramide are prokinetics commonly prescribed off-label to infants and younger children in an attempt to treat gastro-oesophageal reflux symptoms. Another prokinetic drug, cisapride, was used but withdrawn in 2000 in the United Kingdom because of serious arrhythmic adverse events. Medicines and Healthcare Products Regulatory Agency issued safety warnings for domperidone in May 2012 and restricted its indications. We report here national primary care prescribing trends and safety signals of these drugs in children. We used data from the General Practice Research Database between 1990 and 2006 for children <18 years. Descriptive statistics and Poisson regressions were performed to characterise prescribing trends. We examined safety signals in nested case-control studies. The proportion of children <2 years old being prescribed one of the medications doubled during the study period. Prescriptions of domperidone increased 10-fold, mainly following the withdrawal of cisapride in 2000. Prescriptions of metoclopramide did not change significantly. Despite the increase in prescriptions of domperidone, no new safety signals were identified. These data showed dramatic changes in prescribing of cisapride and domperidone despite the lack of good-quality supporting evidence. It is possible that these prescribing trends were influenced by published guidelines. Even if produced without robust efficacy and safety evidence, published guidelines can influence clinicians and consequently affect prescribing. Therefore, improving the evidence base on prokinetics to inform future guidelines is vital. The lack of new safety signals during this period would support the development of suitable powered clinical studies.

  14. 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.

  15. Antimicrobial prescribing behaviour in dogs and cats by Belgian veterinarians.

    Science.gov (United States)

    Van Cleven, Alexia; Sarrazin, Steven; de Rooster, Hilde; Paepe, Dominique; Van der Meeren, Sofie; Dewulf, Jeroen

    2018-03-17

    The objective of this study is to survey general prescribing behaviour by Belgian companion animal veterinarians and to assess agreement of these practices with current treatment guidelines. Therefore an online survey was administered with five realistic and frequently occurring first-line cases to primary-care veterinary practitioners. For each case a predefined pattern of questions were asked about whether or not they would prescribe antimicrobials, if they would prescribe a non-antimicrobial treatment and if they would perform additional diagnostic steps. The responses were compared with recommendations in national guidelines and recent literature. The overall most prescribed antimicrobials were potentiated amoxicillin (43.0 per cent), fluoroquinolones (14.7 per cent), third-generation and fourth-generation cephalosporins (10.9 per cent) and tetracyclines (10.9 per cent). Only 48.3 per cent of the veterinarians complied with the guidelines in nearly all of the clinical scenarios (ie, prescribing antimicrobials when indicated, not prescribing antimicrobials when it is not indicated). Moreover, when prescribing highest priority critically important antimicrobials, susceptibility testing on bacterial cultures was performed in only 12.4 per cent of the prescriptions. The results showed that the prescribing behaviour of antimicrobial compounds by primary-care veterinary practitioners in dogs and cats is often not in agreement with national guidelines. Focus in improvement of this prescribing behaviour should be on performing the appropriate diagnostic steps and decreasing the use of highest priority critically important antimicrobials. © British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. 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.

  17. 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

    2018-06-01

    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

  18. Non-medical prescribing of chemotherapy: engaging stakeholders to maximise success?

    Science.gov (United States)

    Lennan, Elaine

    2014-01-01

    introduced over the past decade.Little research has been conducted in acute care and none in the chemotherapy setting.Cancer policy recommends the introduction of nurse-led chemotherapy clinics.What this paper addsNon-medical prescribing (NMP) in chemotherapy is appropriate with the right model of practice.Well-established professional relationships are a key to success.NMP is not appropriate in isolation of the multidisciplinary team (MDT).Implications for practice and/or policyNurses need to demonstrate the value of non-medical prescribing in chemotherapy using available metrics.Models of practice need to ensure good communication channels, MDT working, and transparency of prescribing.

  19. Prescribing in prison: minimizing psychotropic drug diversion in correctional practice.

    Science.gov (United States)

    Pilkinton, Patricia D; Pilkinton, James C

    2014-04-01

    Correctional facilities are a major provider of mental health care throughout the United States. In spite of the numerous benefits of providing care in this setting, clinicians are sometimes concerned about entering into correctional care because of uncertainty in prescribing practices. This article provides an introduction to prescription drug use, abuse, and diversion in the correctional setting, including systems issues in prescribing, commonly abused prescription medications, motivation for and detection of prescription drug abuse, and the use of laboratory monitoring. By understanding the personal and systemic factors that affect prescribing habits, the clinician can develop a more rewarding correctional practice and improve care for inmates with mental illness.

  20. Pharmacy and primary care perspectives on e-prescribing in a rural community: A focused ethnography.

    Science.gov (United States)

    Kooienga, Sarah; Singh, Reshmi L

    , technological and communication dimensions are essential in understanding e-prescribing across settings and addressing digital divides in our health care system. Implications for interprofessional pharmacy education were addressed. Understanding the rural context and the need for role adaptability has implications for health care policy. Additional research is needed on the role of the rural pharmacist and how best to interact with primary care providers and patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Quasi-periodic solutions of nonlinear beam equation with prescribed frequencies

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Jing [College of Information Technology, Jilin Agricultural University, Changchun 130118 (China); Gao, Yixian, E-mail: gaoyx643@nenu.edu.cn; Li, Yong [School of Mathematics and Statistics, and Center for Mathematics and Interdisciplinary Sciences, Northeast Normal University, Changchun 130024 (China)

    2015-05-15

    Consider the one dimensional nonlinear beam equation u{sub tt} + u{sub xxxx} + mu + u{sup 3} = 0 under Dirichlet boundary conditions. We show that for any m > 0 but a set of small Lebesgue measure, the above equation admits a family of small-amplitude quasi-periodic solutions with n-dimensional Diophantine frequencies. These Diophantine frequencies are the small dilation of a prescribed Diophantine vector. The proofs are based on an infinite dimensional Kolmogorov-Arnold-Moser iteration procedure and a partial Birkhoff normal form. .

  2. Quasi-periodic solutions of nonlinear beam equation with prescribed frequencies

    International Nuclear Information System (INIS)

    Chang, Jing; Gao, Yixian; Li, Yong

    2015-01-01

    Consider the one dimensional nonlinear beam equation u tt + u xxxx + mu + u 3 = 0 under Dirichlet boundary conditions. We show that for any m > 0 but a set of small Lebesgue measure, the above equation admits a family of small-amplitude quasi-periodic solutions with n-dimensional Diophantine frequencies. These Diophantine frequencies are the small dilation of a prescribed Diophantine vector. The proofs are based on an infinite dimensional Kolmogorov-Arnold-Moser iteration procedure and a partial Birkhoff normal form. 

  3. 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.

  4. A drug utilisation study investigating prescribed daily doses of ...

    African Journals Online (AJOL)

    and drug groups. Design. Retrospective drug utilisation study using data .... drugs that were prescribed 20 or fewer times during the period under ... occurs in women and men at different ages and with different severity. group. On average, men ...

  5. 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

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

    African Journals Online (AJOL)

    Retrospective evaluation of antimicrobial prescribing pattern in a tertiary hospital in Nigeria. ... Annals of Biomedical Sciences ... prescription in University of Benin Teaching Hospital, Benin City, Nigeria over a period of seven years. Materials ...

  7. On a class of graphs with prescribed mean curvature

    International Nuclear Information System (INIS)

    Duong Minh Duc; Costa Salavessa, I.M. de

    1989-11-01

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

  8. Potentially inappropriate prescribing in older patients admitted to psychiatric hospital

    NARCIS (Netherlands)

    Rongen, S.; Kramers, C.; O'Mahony, D.; Feuth, T.; Olde Rikkert, M.G.M.; Ahmed, A.I.A.

    2016-01-01

    OBJECTIVES: The objectives of this study are to determine the prevalence of potentially inappropriate prescribing including potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs) and to assess related risk factors in older people with major psychiatric illness.

  9. 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....

  10. Research Article Antimalarial Drugs for Pediatrics - Prescribing and ...

    African Journals Online (AJOL)

    Erah

    2011-03-23

    Mar 23, 2011 ... is a need to institute measures to ensure rational prescribing, dispensing and use of antimalarial drugs in pediatrics. ... facilities, strategies to control behaviour in the private sector are ..... changes were implemented in 2006 in.

  11. Antibiotic prescribing practice and adherence to guidelines in ...

    African Journals Online (AJOL)

    clinical outcomes, including death, and consume more healthcare resources.[2] Globally 700 ... Individual prescribing decisions affect the population level of resistance. .... professionals (doctors, nurses, dentists and primary care drug therapist ...

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  13. 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

  14. Existence of conformal metrics on spheres with prescribed Paneitz curvature

    International Nuclear Information System (INIS)

    Ben Ayed, Mohamed; El Mehdi, Khalil

    2003-07-01

    In this paper we study the problem of prescribing a fourth order conformal invariant (the Paneitz curvature) on the n-spheres, with n ≥ 5. Using tools from the theory of critical points at infinity, we provide some topological conditions on the level sets of a given function defined on the sphere, under which we prove the existence of conformal metric with prescribed Paneitz curvature. (author)

  15. Nurse prescriber-patient consultations: a case study in dermatology.

    Science.gov (United States)

    Courtenay, Molly; Carey, Nicola; Stenner, Karen

    2009-06-01

    This paper is a report of a study exploring the content and processes in consultations between nurse prescribers and patients with dermatological conditions. Communication skills, consultation time, information and follow-up are central to the treatment and management of patients with dermatological conditions. The contribution nurses make to the care of these patients has great potential. A multiple case study was conducted with 10 practice settings across England in which nurses prescribed medicines for patients with dermatological conditions. Data were collected between June 2006 and September 2007 using semi-structured interviews (n = 40), patient questionnaires (n = 165/200) and videotaped observations of nurse consultations (n = 40). Data analysis included thematic analysis, descriptive statistics, chi-square and non-parametric tests. Nurses believed that their holistic approach to assessment, combined with their prescribing knowledge, improved prescribing decisions. Listening and explanation of treatments were aspects of nurse communication that were rated highly by patients. Listening and dealing sensitively with emotions were also aspects of the videotaped consultations that were rated highly by assessors. Nurses were less consistent in providing information about medicines. Triangulated data from this study suggest that nurse prescribing enhances the care of patients with dermatological conditions through improved prescribing decisions. If patients are to be more involved in this decision-making, nurses must give them more information about their medicines. The benefits of prescribing were most evident in the practices of dermatology specialist nurses. Further evidence is required to identify whether prescribing by specialist nurses offers similar benefits in other therapeutic areas.

  16. Existence of conformal metrics on spheres with prescribed Paneitz curvature

    CERN Document Server

    Ben-Ayed, M

    2003-01-01

    In this paper we study the problem of prescribing a fourth order conformal invariant (the Paneitz curvature) on the n-spheres, with n >= 5. Using tools from the theory of critical points at infinity, we provide some topological conditions on the level sets of a given function defined on the sphere, under which we prove the existence of conformal metric with prescribed Paneitz curvature.

  17. Sorafenib prescribed by gastroenterologists and hepatologists for hepatocellular carcinoma

    Science.gov (United States)

    Kaplan, David E.; Mehta, Rajni; D’Addeo, Kathryn; Valderrama, Adriana; Taddei, Tamar H.

    2018-01-01

    Abstract Sorafenib is the only Food and Drug Administration (FDA)-approved first-line therapy shown to have survival benefit for patients with advanced hepatocellular carcinoma (HCC). Patients with advanced HCC are often but not exclusively transferred from non-oncologists to oncologists to initiate systemic therapy. The objective of this study was to assess whether sorafenib prescribing by non-oncologists has any impact on utilization, adverse effects, cost or outcome. This was a retrospective cohort study utilizing data from patients prescribed sorafenib for HCC within Veterans Health Administration hospitals with 100% chart abstraction to confirm HCC diagnosis, identify prescribing provider specialty (oncology versus gastroenterology/hepatology), and obtain data required for cancer staging by the Barcelona Clinic Liver Cancer (BCLC) system. The primary outcome was overall survival from the time of sorafenib prescription. A total of 4903 patients who prescribed sorafenib for HCC were identified, for whom 340 patients (6.9%) were prescribed drug by a non-oncologist (Onc). BCLC Stage, age, Child–Turcotte–Pugh score, and comorbidity indices were similar between patients prescribed sorafenib by oncologists and non-oncologists. Oncologists more often discontinued sorafenib due to progression, whereas non-oncologists were more likely to continue sorafenib until death resulting in greater pill utilization and cost. Overall survival in both unadjusted and multivariable models showed no significant impact of prescriber type on survival (222 vs 217 days, P = .96), confirmed with propensity-matched subcohorts. Similar survival outcomes were observed for patients with HCC prescribed sorafenib by non-oncologists and oncologists, suggesting that non-oncologists with expertise in the management of HCC can safely and effectively administer sorafenib. PMID:29369224

  18. 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

  19. 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.

  20. 32 CFR 172.3 - Policy.

    Science.gov (United States)

    2010-07-01

    ... SALES OF SURPLUS PERSONAL PROPERTY § 172.3 Policy. (a) Cash or cash equivalents in the prescribed amounts shall accompany bid deposits for a bid to be considered responsive. Similarly, cash or cash...-level costs incurred in operation of the recyclable program. (2) After reimbursement of the cost...

  1. [Antibiotic prescribing in acute respiratory tract infections in general practice].

    Science.gov (United States)

    Malo, S; Bjerrum, L; Feja, C; Lallana, M J; Poncel, A; Rabanaque, M J

    2015-06-01

    Antimicrobial resistance is a worldwide threat to public health. Acute respiratory tract infections are the main reason for antibiotic prescribing in the Spanish paediatric population. The aim of the study was to describe the frequency of antibiotic prescription and their pattern of use in acute respiratory tract infections diagnosed in children in Primary Care in Aragón (Spain). A study was conducted over a 1-year period on children between 0 and 14 years-old, recording all episodes of acute otitis, acute pharyngotonsillitis, non-specific upper respiratory infection, and acute bronchitis. The proportion of episodes within each diagnosis receiving an antibiotic prescription was calculated, and the prescribing pattern was determined. Half (50%) of the children in Aragón were diagnosed with a respiratory tract infection during the study period. Non-specific upper respiratory infection was the most frequent diagnosis. An antibiotic was prescribed in 75% of pharyngotonsillitis episodes, 72% of otitis, 27% of bronchitis, and 16% of non-specific upper respiratory infections. Broad spectrum antibiotics, mainly amoxicillin and amoxicillin-clavulanic, were predominantly prescribed. Antibiotic prescribing in respiratory tract infections in children was generally high, and the choice of antibiotics was probably inappropriate in a high percentage of cases. Therefore an improvement in antibiotic prescribing in children appears to be needed. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  2. Unused Opioid Pills After Outpatient Shoulder Surgeries Given Current Perioperative Prescribing Habits.

    Science.gov (United States)

    Kumar, Kanupriya; Gulotta, Lawrence V; Dines, Joshua S; Allen, Answorth A; Cheng, Jennifer; Fields, Kara G; YaDeau, Jacques T; Wu, Christopher L

    2017-03-01

    In the past 16 years, the number of prescription opioids sold in the United States, as well as deaths from prescription opioids, has nearly quadrupled. However, the overall amount of pain reported by patients has not changed significantly. Specific information about opioid prescriptions in the perioperative period is lacking. Of the studies that have been published, investigators have shown that the majority of patients have unused postoperative opioid pills. Moreover, patients appear to lack information about disposal of unused opioid pills. To compare the number of pills prescribed versus the numbers left unused after outpatient shoulder surgeries at an orthopaedic surgery institution. Case series; Level of evidence, 4. In this prospective, observational study, 100 patients (age >18 years) undergoing outpatient shoulder surgery (rotator cuff repair, labral repair, stabilization/Bankart repair, debridement) were enrolled. Follow-ups were conducted via surveys on postoperative days (PODs) 7, 14, 28, and 90. The primary outcome was the number of unused pills from the originally prescribed medication. For all procedure types, the median (Q1, Q3) number of prescribed pills was 60 (40, 80). On POD 90, patients reported a median (Q1, Q3) of 13 (0, 32) unused pills; patients who underwent rotator cuff repairs had the lowest number of pills remaining (median [Q1, Q3], 0 [0, 16]), whereas patients who had stabilization/Bankart repairs had the highest number of unused pills (median [Q1, Q3], 37 [29, 50]). Patient satisfaction with pain management ranged from an average of 70% to 90%. Only 25 patients received instructions or education about opioid disposal. Most outpatient shoulder surgery patients who underwent certain operations were prescribed more opioid analgesics than they consumed. Patient education regarding the disposal of opioids was lacking.

  3. 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.

  4. 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 ...

  5. Protocol: mixed-methods study to evaluate implementation, enforcement, and outcomes of U.S. state laws intended to curb high-risk opioid prescribing.

    Science.gov (United States)

    McGinty, Emma E; Stuart, Elizabeth A; Caleb Alexander, G; Barry, Colleen L; Bicket, Mark C; Rutkow, Lainie

    2018-02-26

    , mandatory PDMP query, opioid prescribing cap, and pill mill laws is timely given a dynamic policy environment in which numerous states pass, revise, implement, and enforce varied laws to address opioid prescribing each year. Findings will inform enactment, implementation, and enforcement of these laws in additional states.

  6. 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.)

  7. 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

  8. 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

  9. "What they see is what you get": Prescribing antibiotics for respiratory tract infections in primary care: Do high prescribers diagnose differently? An analysis of German routine data.

    Science.gov (United States)

    Hueber, Susann; Kuehlein, Thomas; Gerlach, Roman; Tauscher, Martin; Schedlbauer, Angela

    2017-01-01

    Characteristics of high and low prescribers of antibiotics in German primary care were analysed using population data. We aimed to evaluate differences in prescribing rates and factors being associated with high prescribing, and whether high prescribers made the diagnosis of perceived bacterial infections more often. Routine data were provided by the Bavarian Association of Statutory Health Insurance Physicians. Routine data are delivered by primary care practices on a quarterly basis. We analysed data from 2011 and 2012. Patients older than 15 years with respiratory tract infections consulting a primary care physician were selected (6.647 primary care practices). Patient and physician characteristics associated with high prescribing were identified using stepwise logistic regression. Mean prescribing rate of antibiotics was 24.9%. Prescribing rate for high prescribers was 43.5% compared to 8.5% for low prescribers. High prescribers made the diagnosis of perceived bacterial infections more often (Mhigh = 64.5%, Mlow = 45.2%). In the adjusted regression model, perceived bacterial infections were strongly associated with high prescribing (OR = 13.9, 95% CI [10.2, 18.8]). Treating patients with comorbidities was associated with lower prescribing of antibiotics (OR = 0.6, 95% CI [0.4, 0.8]). High prescribers had a higher practice volume, a higher degree of prescribing dominance, and were situated more often in deprived areas and in rural settings. Compared to findings of studies in other European countries, prescribing rates were low. There was a considerable difference between prescribing rates of high and low prescribers. Diagnostic labelling was the best predictor for high prescribing. Current guidelines recommend considering antibiotic treatment for patients with co-morbidities. In our study, treating a large number of high-risk patients was not associated with high prescribing.

  10. 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.

  11. 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…

  12. 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.

  13. 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.

  14. A Validation Study of Homeopathic Prescribing and Patient Care Indicators

    Science.gov (United States)

    Koley, Munmun; Saha, Subhranil; Ghosh, Shubhamoy; Nag, Goutam; Kundu, Monojit; Mondal, Ramkumar; Purkait, Rajib; Patra, Supratim

    2014-01-01

    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. PMID:25379474

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

    Science.gov (United States)

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

    2013-04-01

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

  16. 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.

  17. A model of methods for influencing prescribing: Part I. A review of prescribing models, persuasion theories, and administrative and educational methods.

    Science.gov (United States)

    Raisch, D W

    1990-04-01

    The purpose of this literature review is to develop a model of methods to be used to influence prescribing. Four bodies of literature were identified as being important for developing the model: (1) Theoretical prescribing models furnish information concerning factors that affect prescribing and how prescribing decisions are made. (2) Theories of persuasion provide insight into important components of educational communications. (3) Research articles of programs to improve prescribing identify types of programs that have been found to be successful. (4) Theories of human inference describe how judgments are formulated and identify errors in judgment that can play a role in prescribing. This review is presented in two parts. This article reviews prescribing models, theories of persuasion, studies of administrative programs to control prescribing, and sub-optimally designed studies of educational efforts to influence drug prescribing.

  18. Circus: A Replicated Procedure Call Facility

    Science.gov (United States)

    1984-08-01

    298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 client client stubs ...... ...... ..... ..... runtime libary stub compiler binding agent...runtime libary Figure 1: Structure of the Circus system replicated procedure call paired message protocol unreliable datagrams Figure 2: Circus...114-121. [11) Digit &! Equipment Corporation, Intel Corporation, a.nd Xerox Corporation. The Ethernet: A Local Area Networlc. September 1080. [12

  19. 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

  20. 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 total cost, P total cost attributable to eye care providers is driven by glaucoma medications, accounting for $1.2 billion (54% of total cost; 72% of total volume). The second costliest category, dry eye medications, was attributable mostly to a single medication, cyclosporine ophthalmic emulsion (Restasis, Allergan, Irvine, CA), which has no generic alternative, accounting for $371 million (17% of total cost; 4% of total volume). If generic medications were substituted for 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

  1. 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

  2. 48 CFR 1503.500-71 - Procedures.

    Science.gov (United States)

    2010-10-01

    ... for: (1) A written code of business ethics and conduct and an ethics training program for all employees; (2) Periodic reviews of company business practices, procedures, policies and internal controls...

  3. 32 CFR 191.6 - Procedures.

    Science.gov (United States)

    2010-07-01

    .... (7) Develop procedures for and implement a program to eliminate sexual harassment in Component work places, consistent with DoD Policy on Sexual Harassment memorandums, and to ensure compliance with the...

  4. Sustainability Policy and Environmental Policy

    OpenAIRE

    John C. V. Pezzey

    2001-01-01

    A theoretical, representative agent economy with a depletable resource stock, polluting emissions and productive capital is used to contrast environmental policy, which internalises externalised environmental values, with sustainability policy, which achieves some form of intergenerational equity. The obvious environmental policy comprises an emissions tax and a resource stock subsidy, each equal to the respective external cost or benefit. Sustainability policy comprises an incentive affectin...

  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. Prescribed and self-reported seasonal training of distance runners.

    Science.gov (United States)

    Hewson, D J; Hopkins, W G

    1995-12-01

    A survey of 123 distance-running coaches and their best runners was undertaken to describe prescribed seasonal training and its relationship to the performance and self-reported training of the runners. The runners were 43 females and 80 males, aged 24 +/- 8 years (mean +/- S.D.), training for events from 800 m to the marathon, with seasonal best paces of 86 +/- 6% of sex- and age-group world records. The coaches and runners completed a questionnaire on typical weekly volumes of interval and strength training, and typical weekly volumes and paces of moderate and hard continuous running, for build-up, pre-competition, competition and post-competition phases of a season. Prescribed training decreased in volume and increased in intensity from the build-up through to the competition phase, and had similarities with 'long slow distance' training. Coaches of the faster runners prescribed longer build-ups, greater volumes of moderate continuous running and slower relative paces of continuous running (r = 0.19-0.36, P training close to competition pace. The mean training volumes and paces prescribed by the coaches were similar to those reported by the runners, but the correlations between prescribed and reported training were poor (r = 0.2-0.6). Coaches may therefore need to monitor their runners' training more closely.

  7. Variations in Metformin Prescribing for Type 2 Diabetes.

    Science.gov (United States)

    Goldberg, Tiffany; Kroehl, Miranda E; Suddarth, Kathleen Heist; Trinkley, Katy E

    2015-01-01

    Reasons for suboptimal metformin prescribing are unclear, but may be due to perceived risk of lactic acidosis. The purpose of this study is to describe provider attitudes regarding metformin prescribing in various patient situations. An anonymous, electronic survey was distributed electronically to 76 health care providers across the nation. The 14-item survey contained demographic questions and questions related to prescribing of metformin for T2DM in various patient situations, including suboptimal glycemic control, alcohol use, history of lactic acidosis, and varying degrees of severity for certain health conditions, including renal and hepatic dysfunction, chronic obstructive pulmonary disease, and heart failure. There were a total of 100 respondents. For suboptimal glycemic control, most providers (75%) would increase metformin from 1500 to 2000 mg daily; however, 25% would add an alternate agent, such as a sulfonylurea (18%) or dipeptidyl peptidase-4 inhibitor (7%). Although 51% of providers would stop metformin based on serum creatinine thresholds, the remainder would rely on glomerular filtration rate thresholds of <60 mL/min (15%), <30 mL/min (33%), or <15 mL/min (1%) to determine when to stop metformin. For heart failure, 45% of providers would continue metformin as currently prescribed regardless of severity. Most providers would adjust metformin for varying severity of hepatic dysfunction (74%) and alcohol abuse (40%). Despite evidence supporting the cardiovascular benefits of metformin, provider attitudes toward prescribing metformin are suboptimal in certain patient situations and vary greatly by provider. © Copyright 2015 by the American Board of Family Medicine.

  8. Characteristics of prescribers whose patients shop for opioids: results from a cohort study.

    Science.gov (United States)

    Cepeda, M Soledad; Fife, Daniel; Berlin, Jesse A; Mastrogiovanni, Gregory; Yuan, Yingli

    2012-01-01

    Little is known about the prevalence of opioid shoppers in clinical practices and the relation between prescriber characteristics and the risk of having opioid shoppers. Describe the prevalence of opioid shoppers in prescribers' practices. Assess the relation between prescribers' characteristics and patient opioid shopping behavior. Retrospective cohort study using a large US retail prescription database. Patients with ≥1 opioid dispensing were followed 18 months. These patients' prescribers are the focus of the study. A patient was a "shopper" if he or she had opioid prescriptions written by ≥1 prescriber with ≥1 day of overlap filled at ≥3 pharmacies and a "heavy shopper" if he or she had ≥5 shopping episodes. The proportions of shoppers by prescriber and the proportion of prescribers with ≥1 shopper or heavy shopper were calculated. Among 858,290 opioid prescribers, most (87 percent) had no shoppers and 98 percent had no heavy shoppers. Prescribers who were aged 70-79 years, male, or who prescribed schedule II opioids had an increased likelihood of having shoppers. As the number of patients for whom a prescriber prescribed opioids increased, the proportion of shoppers also increased. Prescribers with 66 or more patients receiving opioids, who represented 25 percent of prescribers, prescribed for 82 percent of all shoppers. The great majority of opioid prescribers appear to have no shoppers in their practice. Any educational program will be more cost effective if targeted to prescribers of schedule II opioids with a large volume of patients requiring opioids.

  9. Prescribing Oxygen for Cluster Headache: A Guide for the Provider.

    Science.gov (United States)

    Tepper, Stewart J; Duplin, Jessica; Nye, Barbara; Tepper, Deborah E

    2017-10-01

    Oxygen is the standard of care for acute treatment of cluster headache. CMS, the US Centers for Medicaid and Medicare Services, has made the indefensible decision to not cover oxygen for cluster headache for patients with Medicaid and Medicare insurance, despite the evidence and professional guidelines. Commercial insurance generally covers oxygen for cluster headache. This is a "how-to" guide for successfully prescribing oxygen in the US. Prescription information is provided that can be incorporated as dot phrases, smart sets, or other standard templates for prescribing oxygen for cluster patients. In many states, oxygen is affordable and can be prescribed for Medicaid and Medicare patients who wish to pay cash. Welding or nonmedical grade industrial oxygen is almost the same cost as medical oxygen. However, it is less pure, lacks the same inspection of tanks, and is delivered without regulators to provide appropriate flow rates. Patients who pay cash should be strongly encouraged to buy medical oxygen. © 2017 American Headache Society.

  10. [Prescribing antibiotics for sore throat: a persistent habit].

    Science.gov (United States)

    Damoiseaux, Roger A M J; Venekamp, Roderick P

    2015-01-01

    Recently the revision of the guideline of the Dutch College of General Practitioners on sore throat has been published. Again, one of the key messages is restricting the use of antibiotics. In the Netherlands general practitioners prescribe antibiotics in 50% of cases of tonsillitis. Although there has been a decrease in the number of antibiotic prescriptions for tonsillitis in the last 30 years, they are still being prescribed twice as often as is recommended by the guideline. The beliefs of both patient and doctor play an important role in prescribing and better communication might help to improve the situation. Public campaigns can also help by providing the best knowledge on the effectiveness of antibiotics to the public.

  11. 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.

  12. 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.

  13. Statin prescribing according to gender, age and indication

    DEFF Research Database (Denmark)

    Wallach-Kildemoes, Helle; Støvring, Henrik; Holme Hansen, Ebba

    2016-01-01

    RATIONALES, AIMS AND OBJECTIVES: The increasing dispensing of statins has raised concern about the appropriateness of prescribing to various population groups. We aimed to (1) investigate incident and prevalent statin prescribing according to indication, gender and age and (2) relate prescribing...... patterns to evidence on beneficial and adverse effects. METHODS: A cohort of Danish inhabitants (n = 4 424 818) was followed in nationwide registries for dispensed statin prescriptions and hospital discharge information. We calculated incidence rates (2005-2009), prevalence trends (2000-2010) and absolute...... numbers of statin users according to register proxies for indication, gender and age. RESULTS: In 2010, the prevalence became highest for ages 75-84 and was higher in men than women (37% and 33%, respectively). Indication-specific incidences and prevalences peaked at ages around 65-70, but in myocardial...

  14. Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial.

    Science.gov (United States)

    Meeker, Daniella; Knight, Tara K; Friedberg, Mark W; Linder, Jeffrey A; Goldstein, Noah J; Fox, Craig R; Rothfeld, Alan; Diaz, Guillermo; Doctor, Jason N

    2014-03-01

    "Nudges" that influence decision making through subtle cognitive mechanisms have been shown to be highly effective in a wide range of applications, but there have been few experiments to improve clinical practice. To investigate the use of a behavioral "nudge" based on the principle of public commitment in encouraging the judicious use of antibiotics for acute respiratory infections (ARIs). Randomized clinical trial in 5 outpatient primary care clinics. A total of 954 adults had ARI visits during the study timeframe: 449 patients were treated by clinicians randomized to the posted commitment letter (335 in the baseline period, 114 in the intervention period); 505 patients were treated by clinicians randomized to standard practice control (384 baseline, 121 intervention). The intervention consisted of displaying poster-sized commitment letters in examination rooms for 12 weeks. These letters, featuring clinician photographs and signatures, stated their commitment to avoid inappropriate antibiotic prescribing for ARIs. Antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses in baseline and intervention periods, adjusted for patient age, sex, and insurance status. Baseline rates were 43.5% and 42.8% for control and poster, respectively. During the intervention period, inappropriate prescribing rates increased to 52.7% for controls but decreased to 33.7% in the posted commitment letter condition. Controlling for baseline prescribing rates, we found that the posted commitment letter resulted in a 19.7 absolute percentage reduction in inappropriate antibiotic prescribing rate relative to control (P = .02). There was no evidence of diagnostic coding shift, and rates of appropriate antibiotic prescriptions did not diminish over time. Displaying poster-sized commitment letters in examination rooms decreased inappropriate antibiotic prescribing for ARIs. The effect of this simple, low-cost intervention is comparable in magnitude to costlier, more

  15. [Medication reconciliation errors according to patient risk and type of physician prescriber identified by prescribing tool used].

    Science.gov (United States)

    Bilbao Gómez-Martino, Cristina; Nieto Sánchez, Ángel; Fernández Pérez, Cristina; Borrego Hernando, Mª Isabel; Martín-Sánchez, Francisco Javier

    2017-01-01

    To study the frequency of medication reconciliation errors (MREs) in hospitalized patients and explore the profiles of patients at greater risk. To compare the rates of errors in prescriptions written by emergency physicians and ward physicians, who each used a different prescribing tool. Prospective cross-sectional study of a convenience sample of patients admitted to medical, geriatric, and oncology wards over a period of 6 months. A pharmacist undertook the medication reconciliation report, and data were analyzed for possible associations with risk factors or prescriber type (emergency vs ward physician). A total of 148 patients were studied. Emergency physicians had prescribed for 68 (45.9%) and ward physicians for 80 (54.1%). A total of 303 MREs were detected; 113 (76.4%) patients had at least 1 error. No statistically significant differences were found between prescriber types. Factors that conferred risk for a medication error were use polypharmacy (odds ratio [OR], 3.4; 95% CI, 1.2-9.0; P=.016) and multiple chronic conditions in patients under the age of 80 years (OR, 3.9; 95% CI, 1.1-14.7; P=.039). The incidence of MREs is high regardless of whether the prescriber is an emergency or ward physician. The patients who are most at risk are those taking several medications and those under the age of 80 years who have multiple chronic conditions.

  16. 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...

  17. 20 CFR 703.110 - Other forms of endorsements and policies.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Other forms of endorsements and policies. 703... Insurance Carriers § 703.110 Other forms of endorsements and policies. Where the form of endorsement prescribed by § 703.109 is not appropriate when used in conjunction with a form of policy approved for use by...

  18. Physician Prescribing Practices of Vitamin D in a Psychiatric Hospital.

    Science.gov (United States)

    Mulcahy, Kimberly B; Trigoboff, Eileen; Opler, Lewis; Demler, Tammie Lee

    2016-01-01

    Vitamin D supplementation has become an increasingly popular prescribing practice, despite our limited knowledge of both the definition and degree of deficiency as well as the expected benefits or risks of exogenous administration. Many of the hypothesized benefits of vitamin D supplementation include a variety of improvements in mental health; however, these claims are not consistently or robustly supported by current research. In this paper, we provide a brief overview of what is currently known about vitamin D deficiency and about outcomes of supplementation as well as a summary of the data relative to prescribing practices for inpatients in an urban psychiatric hospital.

  19. Privacy Policy

    Science.gov (United States)

    ... Home → NLM Privacy Policy URL of this page: https://medlineplus.gov/privacy.html NLM Privacy Policy To ... out of cookies in the most popular browsers, http://www.usa.gov/optout_instructions.shtml. Please note ...

  20. 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...

  1. How Stakeholder Assessment of E-Prescribing Can Help Determine Incentives to Facilitate Management of Care: A Delphi Study.

    Science.gov (United States)

    DeMuro, Paul R; Ash, Joan; Middleton, Blackford; Fletcher, Justin; Madison, Cecelia J

    2017-11-01

    Little research has been conducted on the quality, benefits, costs, and financial considerations associated with health information technology (HIT), particularly informatics technologies such as e-prescribing, from the perspective of all of its stakeholders. To (a) identify the stakeholders involved in e-prescribing and (b) identify and rank order the positives and negatives of e-prescribing from the perspective of stakeholders in order to create a framework for payers, integrated delivery systems, policymakers and legislators, and those who influence public policy to assist them in the development of incentives and payment mechanisms that result in the better management of care. The Delphi method was used to enlist a panel of experts in e-prescribing, informatics, and/or HIT who have published in the field. This panel was presented with the results of initial research and an online survey of questions that sought to prioritize the quality, benefit, cost, and financial effects of e-prescribing from the perspective of each stakeholder. Eleven experts completed the first survey, which contained a list of stakeholders and positives and negatives associated with e-prescribing. Nine of the 11 experts completed the second survey, and 7 experts completed the final survey. From the results of these 3 surveys, a framework was presented to 5 framework experts, who were representatives from payers, integrated delivery systems, policymakers and legislators, and those who influence public policy. These framework experts were interviewed regarding the usefulness of the framework from their perspectives. The experts added stakeholders and many positives and negatives to the initial list and rank ordered the positives and negatives of e-prescribing from the perspective of each stakeholder. The aggregate results were summarized by stakeholder category. The positives and negatives were categorized as health, finance, effort, time, management, or data concerns. The framework experts

  2. 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.

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

    Science.gov (United States)

    D'Onofrio, David J; Abel, David L; Johnson, Donald E

    2012-03-14

    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.

  4. 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.)

  5. Trade Policy

    OpenAIRE

    Murray Gibbs

    2007-01-01

    In an otherwise insightful and thoughtful article, Sebastian Pfotenhauer (Trade Policy Is Science Policy,” Issues, Fall 2013) might better have entitled his contribution “Trade Policy Needs to Be Reconciled with Science Policy.” The North American Free Trade Agreement (NAFTA) and the agreements administered by the World Trade Organization, particularly the General Agreement on Tariffs and Trade (GATT) and the Technical Barriers to Trade (TBT), were adopted to promote international trade and i...

  6. What supports hospital pharmacist prescribing in Scotland? - A mixed methods, exploratory sequential study.

    Science.gov (United States)

    Fisher, J; Kinnear, M; Reid, F; Souter, C; Stewart, D

    2018-05-01

    While approximately half of all qualified hospital pharmacist independent prescribers (PIPs) in Scotland are active prescribers, there are major differences in prescribing activity across geographical areas. This study aimed to explore, through focus groups, interviews and a questionnaire, hospital PIPs' perceptions of factors associated with prescribing activity and to investigate the infrastructure required to better support active prescribing by PIPs. Findings reinforced the perceived positive impact of supportive pharmacy leadership within the organisation, recognition that prescribing is integral to the clinical pharmacist role and a work environment conducive to prescribing. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  7. Pretreatment procedures

    International Nuclear Information System (INIS)

    Anon.

    1989-01-01

    It is frequently in the patient's best interest that radiation treatments are initiated soon after the decision to treat is made. However, it is essential to good radiation therapy that the patient's treatment course be planned and beam-modifying devices be fabricated with utmost care prior to treatment. The objectives of the treatment, along with the treatment parameters and techniques necessary to achieve these objectives, must be discussed prior to initiating planning procedures. Determination of the target volume is made by the radiation oncologist; this is based on knowledge of the history of the tumor, the patterns of spread of the disease, and on diagnostic findings during the work-up of each patient. It is then necessary to obtain several measurements of the patient and also to identify the position of the target volume and of adjacent normal organs with respect to known external skin marks before the actual treatment planning is begun. Such localization can be done through several methods. The two most commonly used methods are radiographic and computed tomography (CT), both of which are discussed in this chapter. The measurements often include contours of the patient's external surface, usually in the axial plane of the central axis of the beam, and often in multiple levels within the region to be treated. Three dimensional localization and treatment planning requires thorough understanding of geometry as well as of patient positioning and immobilization. This chapter attempts to clarify some of these complicated but essential preparations for treatment

  8. Does the number of siblings affect health in midlife? Evidence from the Swedish Prescribed Drug Register

    Directory of Open Access Journals (Sweden)

    Anna Baranowska-Rataj

    2016-11-01

    Full Text Available Background: In many societies, growing up in a large family is associated with receiving less parental time, attention, and financial support. As a result, children with a large number of siblings may have worse physical and mental health outcomes than children with fewer siblings. Objective: Our objective is to examine the long-term causal effects of sibship size on physical and mental health in modern Sweden. Methods: We employ longitudinal data covering the entire Swedish population from the Multigenerational Register and the Medical Birth Register. This data includes information on family size and on potential confounders such as parental background. We use the Prescribed Drug Register to identify the medicines that have been prescribed and dispensed. We use instrumental variable models with multiple births as instruments to examine the causal effects of family size on the health outcomes of children, as measured by receiving medicines at age 45. Results: Our results indicate that in Sweden, growing up in a large family does not have a detrimental effect on physical and mental health in midlife. Contribution: We provide a systematic overview of the health-related implications of growing up in a large family. We adopt a research design that gives us the opportunity to make causal inferences about the long-term effects of family size. Moreover, our paper provides evidence on the links between family size and health outcomes in the context of a developed country that implements policies oriented towards reducing social inequalities in health and other living conditions.

  9. 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 ...

  10. Improving the prescribing of antibiotics for urinary tract infection.

    Science.gov (United States)

    Peterson, G M; Stanton, L A; Bergin, J K; Chapman, G A

    1997-04-01

    In recent years there have been changes in the recommended antibiotic treatment for urinary tract infections (UTIs). In particular, the use of amoxycillin or co-trimoxazole is now discouraged, with amoxycillin-potassium clavulanate, cephalexin and trimethoprim becoming first-line agents for uncomplicated lower UTIs. To examine whether academic detailing, performed by a pharmacist, could modify prescribing practices for antibiotics used in the treatment of UTI in the community setting. The intervention was conducted in Southern Tasmania, using the remainder of the State as a control area. The target group of general practitioners was sent educational material designed to assist in the appropriate prescribing of antibiotics in the treatment of UTI. A pharmacist then visited each general practitioner and discussed the rational use of antibiotics for UTIs directly with him/her. Outcomes were measured using evaluation feedback from the general practitioners and pharmacoepidemiological data, which were not linked to diagnosis. The key variable examined was the total defined daily doses (DDDs) dispensed for the recommended first-line agents (amoxycillin-potassium clavulanate, cephalexin and trimethoprim) compared with amoxycillin (3 g single-dose form) and co-trimoxazole. The educational programme was very well received by the general practitioners. Changes in the prescribing of antibiotics commonly used for UTIs were evident in both study regions over the course of the study, but the improvements were significantly greater in the intervention area. Educational programmes utilizing academic detailing by pharmacists can modify prescribing practices within the community setting.

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

    African Journals Online (AJOL)

    Sources of drug information and their influence on the prescribing behaviour of doctors in a teaching hospital in Ibadan, Nigeria. ... Drug information was sourced from colleagues (161, 98.8%), reference books (158, 96.9%), pharmaceutical sales representatives-PSRs (152, 93.2%), promotion materials (151, 92.6%), ...

  12. 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 ...

  13. 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...

  14. 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...

  15. Planning for prescribed burning in the inland northwest.

    Science.gov (United States)

    Robert E. Martin; John D. Dell

    1978-01-01

    Fire has historically played a role in forests and ranges of the inland Northwest. This guide has been prepared to help managers understand the role of fire and the potential uses of fire and to plan for fire use in managing these lands. Sections deal with these topics, and steps in planning a prescribed burn are outlined. A sample burning situation illustrates the...

  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. 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.

  18. 42 CFR 423.160 - Standards for electronic prescribing.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Standards for electronic prescribing. 423.160 Section 423.160 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality...

  19. 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.

  20. Heart failure guidelines and prescribing in primary care across Europe

    Directory of Open Access Journals (Sweden)

    Hobbs FD Richard

    2005-08-01

    Full Text Available Abstract Background Major international differences in heart failure treatment have been repeatedly described, but the reasons for these differences remain unclear. National guideline recommendations might be a relevant factor. This study, therefore, explored variation of heart failure guideline recommendations in Europe. Methods Treatment recommendations of 14 national guidelines published after 1994 were analyzed in relation to the heart failure treatment guideline of the European Society of Cardiology. To test potential relations between recommendations and prescribing, national prescribing patterns as obtained by a European study in primary care (IMPROVEMENT-HF were related to selected recommendations in those countries. Results Besides the 14 national guidelines used by primary care physicians in the countries contacted, the European guideline was used in four countries, and separate guidelines for specialists and primary care were available in another four countries. Two countries indicated that no guideline was used up to 2000. Comprehensiveness of the guidelines varied with respect to length, literature included and evidence ratings. Relevant differences in treatment recommendations were seen only in drug classes where evidence had changed recently (β-blockers and spironolactone. The relation between recommendation and prescribing for selected recommendations was inconsistent among countries. Conclusion Differences in guideline recommendations are not sufficient to explain variation of prescribing among countries, thus other factors must be considered.

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

    DEFF Research Database (Denmark)

    Linnet, Kristján; Halldórsson, Matthías; Thengilsdóttir, Gudrún

    2013-01-01

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

  2. 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 ...

  3. 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 ...

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

    NARCIS (Netherlands)

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

    2004-01-01

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

  5. 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...

  6. [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.

  7. 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.

  8. Prescribed wind shear modelling with the actuator line technique

    DEFF Research Database (Denmark)

    Mikkelsen, Robert Flemming; Sørensen, Jens Nørkær; Troldborg, Niels

    2007-01-01

    A method for prescribing arbitrary steady atmospheric wind shear profiles combined with CFD is presented. The method is furthermore combined with the actuator line technique governing the aerodynamic loads on a wind turbine. Computation are carried out on a wind turbine exposed to a representative...

  9. 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 ...

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

    African Journals Online (AJOL)

    of 1000 mg/day is considered as high dose prescribing. Furthermore ... genetic variations.[16] ... Annals of Medical and Health Sciences Research | Jan-Mar 2013 | Vol 3 | Issue 1 |. 63 ... the unreliability of the CPZeq criteria in the view of an increasing use of ... We obtained ethical clearance from the Ethics and Research.

  11. 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

  12. 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,...

  13. Prescribing of Antidiabetic Medicines before, during and after Pregnancy

    DEFF Research Database (Denmark)

    Charlton, Rachel A; Klungsøyr, Kari; Neville, Amanda J

    2016-01-01

    AIM: To explore antidiabetic medicine prescribing to women before, during and after pregnancy in different regions of Europe. METHODS: A common protocol was implemented across seven databases in Denmark, Norway, The Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women...

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

    NARCIS (Netherlands)

    Florentinus, S.R.

    2006-01-01

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

  15. 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 ...

  16. 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 ...

  17. 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 ...

  18. 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 ...

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

    African Journals Online (AJOL)

    Selected by stratified random sampling, 100 physician and 97 nurse prescriber encounters were retrospectively reviewed for successful documentation of eight separate clinically relevant variables: pill count charted; chief complaint listed; social history updated; disclosure reviewed; physical exam; laboratory testing; World ...

  20. Scheduling prescribed burns for hazard reduction in the southeast

    Science.gov (United States)

    Stephen S. Sackett

    1975-01-01

    Twelve-year studies in the southeastern Coastal Plain revealed that pine stands should be burned every three years to reduce natural fuels and thus forestall damage from possible wildfires. Rates of overstory growth were not significantly different in burned and unburned stands. Guidelines for prescribed burning of pine stands in this region are presented.

  1. Vegetation Responses to Prescribed Burning of Grazed Shortgrass Steppe

    Science.gov (United States)

    Over the past century, fire has been widely suppressed in the western Great Plains, in part due to potential negative effects on forage production for livestock. More recently, interest in the use of prescribed fire in shortgrass steppe has increased due to potential applications for wildlife manage...

  2. Prescribed burning with spot fires in the Georgia Coastal Plain

    Science.gov (United States)

    R. W. Johansen

    1984-01-01

    The use of prescribed fire in the management of pine forests is common throughout much of the South, but one recurring problem that worries the forest landowner is not having enough suitable burning weather to satisfactorily complete all scheduled fires. Being able to burn areas considerably faster, without causing undue damage, could be a solution.

  3. An experimental prescribed burn to reduce fuel hazard in chaparral

    Science.gov (United States)

    Lisle R. Green

    1970-01-01

    The feasibility of reducing fuel hazard in chaparral during safe weather conditions was studied in an experimental prescribed burn in southern California. Burning was done under fuel and weather conditions when untreated brush would not bum readily. Preparatory treatment included smashing of brush on strips with a bulldozer, and reduction of moisture content of leaves...

  4. Effects of Prescribed Burning on Grazed Shortgrass Steppe

    Science.gov (United States)

    Over the past century, fire has been widely suppressed in the western Great Plains, in part due to potential negative effects on forage production for livestock. Interest in the use of prescribed fire in shortgrass steppe has increased recently due to applications for wildlife management, control of...

  5. 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.

  6. 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

  7. Antibiotic prescribing practices for catheter urine culture results.

    Science.gov (United States)

    Chiu, Jonathan; Thompson, G William; Austin, Thomas W; Hussain, Zafar; John, Michael; Bombassaro, Anne Marie; Connelly, Sarah E; Elsayed, Sameer

    2013-01-01

    The literature suggests that positive results of catheter urine cultures frequently lead to unnecessary antimicrobial prescribing, which therefore represents an important target for stewardship. To assess the appropriateness of antibiotic prescribing in response to the results of urine cultures from patients with indwelling urinary catheters. This retrospective study was conducted at a tertiary care centre and involved adults with indwelling urinary catheters from whom urine specimens were obtained for culture. Patients with positive or negative culture results were identified from microbiology laboratory reports. The medical records of consecutive patients were screened to select a sample of 80 inpatients (40 per group). Abstracted patient histories were independently evaluated by an expert panel of 3 infectious diseases consultants blinded to the decisions of prescribers and of fellow panelists. The primary end point was concordance of each patient's treatment decision (with respect to the indication) between the expert panel (based on majority agreement, i.e., at least 2 of the 3 expert panelists) and the prescriber. The secondary end points were unnecessary days of therapy and selected outcomes over a predefined period after urine was obtained for culture. A total of 591 charts were screened to generate the targeted number of patients. Baseline demographic characteristics were comparable for the 2 groups, except antibiotic exposure before urine collection was significantly more frequent for the group with negative culture results. The treatment decision was concordant in 40% (16/40) of the patients with a positive culture result and 85% (34/40) of those with a negative culture result (p < 0.001). The most common reason for discordance was administration of antibiotics when not indicated (23 of 24 patients with a positive result and 5 of 6 patients with a negative result), which accounted for 165 and 32 unnecessary days of therapy per 1000 inpatient

  8. 10 CFR 11.5 - Policy.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Policy. 11.5 Section 11.5 Energy NUCLEAR REGULATORY COMMISSION CRITERIA AND PROCEDURES FOR DETERMINING ELIGIBILITY FOR ACCESS TO OR CONTROL OVER SPECIAL NUCLEAR MATERIAL General Provisions § 11.5 Policy. It is the policy of the Nuclear Regulatory Commission to carry...

  9. Interacting factors associated with Low antibiotic prescribing for respiratory tract infections in primary health care - a mixed methods study in Sweden.

    Science.gov (United States)

    Strandberg, Eva Lena; Brorsson, Annika; André, Malin; Gröndal, Hedvig; Mölstad, Sigvard; Hedin, Katarina

    2016-07-18

    Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners' audit registrations. Qualitative data were collected through observations and semi-structured interviews. From the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioner's diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual. Low prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses' triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged

  10. 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

  11. Inappropriate prescribing and adverse drug events in older people

    Directory of Open Access Journals (Sweden)

    Gallagher Paul F

    2009-01-01

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

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

    LENUS (Irish Health Repository)

    Hamilton, Hilary J

    2009-01-01

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

  13. 7 CFR 1205.520 - Procedure for obtaining reimbursement.

    Science.gov (United States)

    2010-01-01

    ... application forms may be filed. In any such case, the reimbursement application shall show the names... Cotton Board shall make reimbursement to the importer. For joint applications, the reimbursement shall be... procedures prescribed in this section. (a) Application form. An importer shall obtain a reimbursement...

  14. Identification of risks associated with the prescribing and dispensing of oral anticancer medicines in Ireland.

    LENUS (Irish Health Repository)

    Hammond, Lisa

    2012-09-09

    Background Oral anticancer medicines (OAM) facilitate transfer of cancer care into the community, where safeguards developed in hospitals that control their prescribing, dispensing and administration may not exist. Objective To determine if the systems of prescribing and dispensing OAM in Ireland facilitate clinical verification of the prescription, thereby ensuring treatment is tailored and appropriate for the patient. Setting Randomly selected community pharmacies in Ireland and all Irish hospitals with cancer services. Method A questionnaire was sent to a random selection of Irish community pharmacists. A different questionnaire was sent to all Irish hospitals treating cancer patients. One hundred OAM prescriptions were retrospectively reviewed, to assess the information presented and the potential barriers to a community pharmacist performing a clinical verification of the prescription. Main outcome measure Community pharmacist survey: problems experienced when dispensing OAM and risk factors identified with the current system. Hospital pharmacist survey: proportion of hospitals that clinically verify prescriptions for parenteral versus oral anticancer medicines and associated policies. OAM prescription review: proportion of OAM prescriptions that contained sufficient information for a community pharmacist to clinically verify the prescription and safely dispense the medication. Results Sixty-four percent of community pharmacist respondents felt they did not have enough information available to them to safely dispense these prescriptions, and 74 % felt that patients are at risk with the current Irish system of prescribing and dispensing OAM. Irish hospitals do not have systems to ensure that all OAM prescriptions are clinically verified by a pharmacist. Seventeen different agents were prescribed on the prescriptions reviewed. The information provided to the community pharmacist would have allowed them to clinically verify 7 % of the OAM prescriptions

  15. An analysis and comparison of commonly available United Kingdom prescribing resources.

    Science.gov (United States)

    Cox, A R; Butt, T F; Ferner, R E

    2010-08-01

    Safe prescribing requires accurate and practical information about drugs. Our objective was to measure the utility of current sources of prescribing guidance when used to inform practical prescribing decisions, and to compare current sources of prescribing guidance in the UK with idealized prescribing guidance. We developed 25 clinical scenarios. Two independent assessors rated and ranked the performance of five common sources of prescribing guidance in the UK when used to answer the clinical scenarios. A third adjudicator facilitated review of any disparities. An idealized list of contents for prescribing guidance was developed and sent for comments to academics and users of prescribing guidance. Following consultation an operational check was used to assess compliance with the idealized criteria. The main outcome measures were relative utility in answering the clinical scenarios and compliance with the idealized prescribing guidance. Current sources of prescribing guidance used in the UK differ in their utility, when measured using clinical scenarios. The British National Formulary (BNF) and EMIS LV were the best performing sources in terms of both ranking [mean rank 1·24 and 2·20] and rating [%excellent or adequate 100% and 72%]. Current sources differed in the extent to which they fulfilled criteria for ideal prescribing guidance, but the BNF, and EMIS LV to a lesser extent, closely matched the criteria. We have demonstrated how clinical scenarios can be used to assess prescribing guidance resources. Producers of prescribing guidance documents should consider our idealized template. Prescribers require high-quality information to support their practice. Our test was helpful in distinguishing between prescribing resources. Producers of prescribing guidance should consider the utility of their products to end-users, particularly in those more complex areas where prescribers may need most support. Existing UK prescribing guidance resources differ in their

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

    Directory of Open Access Journals (Sweden)

    LASZLO-ZOLTAN SZTANKOVSZKY

    2015-11-01

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

  17. Robust approximation-free prescribed performance control for nonlinear systems and its application

    Science.gov (United States)

    Sun, Ruisheng; Na, Jing; Zhu, Bin

    2018-02-01

    This paper presents a robust prescribed performance control approach and its application to nonlinear tail-controlled missile systems with unknown dynamics and uncertainties. The idea of prescribed performance function (PPF) is incorporated into the control design, such that both the steady-state and transient control performance can be strictly guaranteed. Unlike conventional PPF-based control methods, we further tailor a recently proposed systematic control design procedure (i.e. approximation-free control) using the transformed tracking error dynamics, which provides a proportional-like control action. Hence, the function approximators (e.g. neural networks, fuzzy systems) that are widely used to address the unknown nonlinearities in the nonlinear control designs are not needed. The proposed control design leads to a robust yet simplified function approximation-free control for nonlinear systems. The closed-loop system stability and the control error convergence are all rigorously proved. Finally, comparative simulations are conducted based on nonlinear missile systems to validate the improved response and the robustness of the proposed control method.

  18. Antimicrobial agents are societal drugs: how should this influence prescribing?

    Science.gov (United States)

    Sarkar, Paul; Gould, Ian M

    2006-01-01

    This paper is concerned with how those who prescribe antimicrobials should consider the wider repercussions of their actions. It is accepted that in an ecological system, pressure will cause evolution; this is also the case with antimicrobials, the result being the development of resistance and the therapeutic failure of drugs. To an extent, this can be ameliorated through advances by the pharmaceutical industry, but that should not stop us from critically appraising our use and modifying our behavior to slow this process down. Up to 50% of prescribing in human medicine and 80% in veterinary medicine and farming has been considered questionable. The Alliance for the Prudent Use of Antimicrobials (APUA) was approached by the WHO to review the situation. Their recommendations include decreasing the prescribing of antibacterials for nonbacterial infections. In the UK, there has been an initiative called "the path of least resistance". This encourages general practitioners to avoid prescribing or reduce the duration of prescriptions for conditions such as upper respiratory tract infections and uncomplicated urinary tract infections; this approach has been successful. Another recommendation is to reduce the prescribing of broad-spectrum antibacterials. In UK hospitals, the problems identified with the inappropriate use of antibacterials are insufficient training in infectious disease, difficulty in selecting empirical antibacterial therapy, poor use of available microbiological information, the fear of litigation and the fact that the majority of antibacterials are prescribed by the least experienced doctors. With close liaison between the laboratories and clinicians, and the development of local protocols, this can be addressed. Another recommendation is to tighten the use of antibacterial prophylaxis and to improve patient compliance. Through a combination of improved education for doctors and patients, and improved communication skills, these problems can be

  19. Coordination through databases can improve prescribed burning as a conservation tool to promote forest biodiversity.

    Science.gov (United States)

    Ramberg, Ellinor; Strengbom, Joachim; Granath, Gustaf

    2018-04-01

    Prescribed fires are a common nature conservation practice. They are executed by several parties with limited coordination among them, and little consideration for wildfire occurrences and habitat requirements of fire-dependent species. Here, we gathered data on prescribed fires and wildfires in Sweden during 2011-2015 to (i) evaluate the importance and spatial extent of prescribed fires compared to wildfires and (ii) illustrate how a database can be used as a management tool for prescribed fires. We found that on average only 0.006% (prescribed 65%, wildfires 35%) of the Swedish forest burns per year, with 58% of the prescribed fires occurring on clearcuts. Also, both wildfires and prescribed fires seem to be important for the survival of fire-dependent species. A national fire database would simplify coordination and make planning and evaluation of prescribed fires more efficient. We propose an adaptive management strategy to improve the outcome of prescribed fires.

  20. CHANGING PRESCRIBING CULTURE - A FOCUS ON CODEINE POSTPARTUM.

    Science.gov (United States)

    Al-Adhami, Noor; Whitfield, Karen; North, Angela

    2016-09-01

    To eliminate the prescribing of codeine and codeine combination products postpartum to improve safety in breast fed infants.Concerns have been raised over the use of codeine and codeine combination products during breast feeding after the death of a neonate whose mother had been prescribed codeine postpartum. High concentrations of morphine were found in the infant's blood and this was attributed to the mother being a CYP2D6 ultrafast metaboliser.1 METHODS: The evidence surrounding the safety of codeine and codeine combination products in children, during the postpartum period and specifically for breast fed infants was collated. The evidence was presented to key stakeholders including obstetricians, midwives, safety and quality representatives, nurse unit managers and acute pain team representatives. Postpartum analgesia was discussed and an agreed protocol developed. Training and education sessions were undertaken to obstetric medical and nursing staff. The evidence that was presented to key stakeholders included:▸ Reports over the safety concerns surrounding the use of codeine and codeine combination products during breast feeding▸ Guidelines and contraindications about the use of codeine in children that had been issued by international regulatory bodies (US Food and Drug Administration and European Medicines Agency).▸ Recommendations from the Australian Medicines Handbook to avoid in breast feeding2 ▸ Recommendations from Hale's Medications and Mothers Milk that reported limited data and had made a recent re-classification from L3 (limited data-probably compatible) to L4 (limited data-possibly hazardous).3 Before presenting the evidence to key stakeholders and undertaking training to nursing and medical staff, more than 90% of postpartum women were prescribed a codeine containing product as part of their 'as required' analgesic regimen.Since the intervention, codeine combination products have now been almost completely eliminated on medication

  1. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011.

    Science.gov (United States)

    Hicks, Lauri A; Bartoces, Monina G; Roberts, Rebecca M; Suda, Katie J; Hunkler, Robert J; Taylor, Thomas H; Schrag, Stephanie J

    2015-05-01

    Appropriate antibiotic prescribing is an essential strategy to reduce the spread of antibiotic resistance. US prescribing practices have not been thoroughly characterized. We analyzed outpatient antibiotic prescribing data to identify where appropriate antibiotic prescribing interventions could have the most impact. Oral antibiotic prescriptions dispensed during 2011 were extracted from the IMS Health Xponent database. The number of prescriptions and census denominators were used to calculate prescribing rates. Prescription totals were calculated for each provider specialty. Regression modeling was used to examine the association between socioeconomic and population health factors and prescribing rates. Healthcare providers prescribed 262.5 million courses of antibiotics in 2011(842 prescriptions per 1000 persons). Penicillins and macrolides were the most common antibiotic categories prescribed. The most commonly prescribed individual antibiotic agent was azithromycin. Family practitioners prescribed the most antibiotic courses (24%). The prescribing rate was higher in the South census region (931 prescriptions per 1000 persons) than in the West (647 prescriptions per 1000 persons; P 1.0). Efforts to characterize antibiotic prescribing practices should focus on the South census region and family practitioners. Further understanding of the factors leading to high prescribing among key target populations will inform appropriate prescribing interventions. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  2. 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

  3. A 5-year retrospective audit of prescribing by a critical care outreach team.

    Science.gov (United States)

    Wilson, Mark

    2018-05-01

    UK prescribing legislation changes made in 2006 and 2012 enabled appropriately qualified nurses to prescribe any licensed medication, and all controlled drugs in schedule 2-5 of the Misuse of Drugs Regulations 2001, for any medical condition within their clinical competence. Critical Care Outreach nurses who are independent nurse prescribers are ideally placed to ensure that acutely ill patients receive treatment without delay. The perceived challenge was how Critical Care Outreach nurses would be able to safely prescribe for a diverse patient group. This study informs this developing area of nurse prescribing in critical care practice. The aims of the audit were to: identify which medications were prescribed; develop a critical care outreach formulary; identify the frequency, timing and number of prescribing decisions being made; identify if prescribing practice changed over the years and provide information for our continuing professional development. This article reports on data collected from a 5-year retrospective audit; of prescribing activity undertaken by nine independent nurse prescribers working in a 24/7 Critical Care Outreach team of a 600-bedded district general hospital in the UK. In total, 8216 medication items were prescribed, with an average of 2·6 prescribed per shift. The most commonly prescribed items were intravenous fluids and analgesia, which were mostly prescribed at night and weekends. The audit has shown that Critical Care Outreach nurse prescribing is feasible in a whole hospital patient population. The majority of prescribing occurred after 16:00 and at night. Further research would be beneficial, particularly looking at patient outcomes following reviews from prescribing critical care outreach nurses. The audit is one of the only long-term studies that describes prescribing practice in Critical Care Outreach teams in the UK. © 2017 British Association of Critical Care Nurses.

  4. Spin-singlet quantum Hall states and Jack polynomials with a prescribed symmetry

    International Nuclear Information System (INIS)

    Estienne, Benoit; Bernevig, B. Andrei

    2012-01-01

    We show that a large class of bosonic spin-singlet Fractional Quantum Hall model wavefunctions and their quasihole excitations can be written in terms of Jack polynomials with a prescribed symmetry. Our approach describes new spin-singlet quantum Hall states at filling fraction ν=(2k)/(2r-1) and generalizes the (k,r) spin-polarized Jack polynomial states. The NASS and Halperin spin-singlet states emerge as specific cases of our construction. The polynomials express many-body states which contain configurations obtained from a root partition through a generalized squeezing procedure involving spin and orbital degrees of freedom. The corresponding generalized Pauli principle for root partitions is obtained, allowing for counting of the quasihole states. We also extract the central charge and quasihole scaling dimension, and propose a conjecture for the underlying CFT of the (k,r) spin-singlet Jack states.

  5. Simulating prescribed particle densities in the grand canonical ensemble using iterative algorithms.

    Science.gov (United States)

    Malasics, Attila; Gillespie, Dirk; Boda, Dezso

    2008-03-28

    We present two efficient iterative Monte Carlo algorithms in the grand canonical ensemble with which the chemical potentials corresponding to prescribed (targeted) partial densities can be determined. The first algorithm works by always using the targeted densities in the kT log(rho(i)) (ideal gas) terms and updating the excess chemical potentials from the previous iteration. The second algorithm extrapolates the chemical potentials in the next iteration from the results of the previous iteration using a first order series expansion of the densities. The coefficients of the series, the derivatives of the densities with respect to the chemical potentials, are obtained from the simulations by fluctuation formulas. The convergence of this procedure is shown for the examples of a homogeneous Lennard-Jones mixture and a NaCl-CaCl(2) electrolyte mixture in the primitive model. The methods are quite robust under the conditions investigated. The first algorithm is less sensitive to initial conditions.

  6. New staff contract policy

    CERN Document Server

    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...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    . This study aimed to explore experiences of GPs in Lithuania and the Russian Federation with regard to antibiotic prescription for upper respiratory tract infections. By such means it might be possible to reveal external enabling factors that influence antibiotic prescribing in these countries. Method. Five...... for political leadership to encourage clinically grounded antibiotic use; over-the-counter sale of antibiotics; designation of antibiotics as reimbursable medications; supervision by external oversight institutions; lack of guidelines for the treatment of upper respiratory tract infections; and pharmaceutical......Abstract Introduction. General practitioners (GPs) write about 80% of all antibiotic prescriptions, the greatest number of them for patients with respiratory tract infections. However, there is a lack of research targeting the influence of external factors on antibiotic prescribing by physicians...

  8. Improving prescribing practices with rapid diagnostic tests (RDTs)

    DEFF Research Database (Denmark)

    Burchett, Helen E D; Leurent, Baptiste; Baiden, Frank

    2017-01-01

    OBJECTIVES: The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts...... packages, supervision, supplies and community sensitisation. OUTCOME MEASURES: Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider...... characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for m...

  9. Drug prescribing and use among elderly people in Spain.

    Science.gov (United States)

    Mas, X; Laporte, J R; Frati, M E; Busquet, L; Arnau, J M; Ibañez, L; Séculi, E; Capellà, D; Arbonés, G

    1983-05-01

    As a result of the lack of an adequate regulation, the supply and the use of medicines is irrational in Spain. In order to know the characteristics of the prescription and use of drugs among the elderly, two drug utilization studies were carried out. The first study was an analysis of 981 prescriptions from an outpatient clinic of the Spanish Social Security. The results show that a high proportion of fixed-dose combinations were prescribed and that drugs without any demonstrated therapeutic value are often prescribed for the elderly. The second study was a survey of 389 individuals randomly chosen among people affiliated with a pensioners' club. The results show that drug use is highly prevalent among the elderly, that many medicines without any demonstrated benefit are being taken, and that potentially harmful drugs were being used by a high proportion of patients without medical follow-up. The prevalence of the use of some particular groups of drugs is also presented.

  10. Drug Policy in Bulgaria.

    Science.gov (United States)

    Dimova, Antoniya; Rohova, Maria; Atanasova, Elka; Kawalec, Paweł; Czok, Katarzyna

    2017-09-01

    Bulgaria has a mixed public-private health care financing system. Health care is financed mainly from compulsory health insurance contributions and out-of-pocket payments. Out-of-pocket payments constitute a large share of the total health care expenditure (44.14% in 2014). The share of drugs expenditure for outpatient treatment was 42.3% of the total health care expenditure in 2014, covered mainly by private payments (78.6% of the total pharmaceutical expenditure). The drug policy is run by the Ministry of Health (MoH), the National Council on Prices and Reimbursement of Medicinal Products, and the Health Technology Assessment Commission. The MoH defines diseases for which the National Health Insurance Fund (NHIF) pays for medicines. The National Council on Prices and Reimbursement of Medicinal Products maintains a positive drug list (PDL) and sets drug prices. Health technology assessment was introduced in 2015 for medicinal products belonging to a new international nonproprietary name group. The PDL defines prescription medicines that are paid for by the NHIF, the MoH, and the health care establishments; exact patient co-payments and reimbursement levels; as well as the ceiling prices for drugs not covered by the NHIF, including over-the-counter medicines. The reimbursement level can be 100%, 75%, or up to 50%. The PDL is revised monthly in all cases except for price increase. Physicians are not assigned with pharmaceutical budgets, there is a brand prescribing practice, and the substitution of prescribed medicines by pharmacists is prohibited. Policies toward cost containment and effectiveness increase include introduction of a reference pricing system, obligation to the NHIF to conduct mandatory centralized bargaining of discounts for medicinal products included in the PDL, public tendering for medicines for hospital treatment, reduction of markup margins of wholesalers and retailers, patient co-payment, and the introduction of health technology assessment

  11. Efficient compliance with prescribed bounds on operational parameters by means of hypothesis testing using reactor data

    International Nuclear Information System (INIS)

    Sermer, P.; Olive, C.; Hoppe, F.M.

    2000-01-01

    - A common problem in any reactor operations is to comply with a requirement that certain operational parameters are constrained to lie within some prescribed bounds. The fundamental issue which is to be addressed in any compliance description can be stated as follows: The compliance definition, compliance procedures and allowances for uncertainties in data and accompanying methodologies, should be well defined and justifiable. To this end, a mathematical framework for compliance, in which the computed or measured estimates of process parameters are considered random variables, is described in this paper. This allows a statistical formulation of the definition of compliance with licence or otherwise imposed limits. An important aspect of the proposed methodology is that the derived statistical tests are obtained by a Monte Carlo procedure using actual reactor operational data. The implementation of the methodology requires a routine surveillance of the reactor core in order to perform the underlying statistical tests. The additional work required for surveillance is balanced by the fact that the resulting actions on the reactor operations, implemented in station procedures, make the reactor 'safer' by increasing the operating margins. Furthermore, increased margins are also achieved by efficient solution techniques which may allow an increase in reactor power. A rigorous analysis of a compliance problem using statistical hypothesis testing based on extreme value probability distributions and actual reactor operational data leads to effective solutions in the areas of licensing, nuclear safety, reliability and competitiveness of operating nuclear reactors. (author)

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

    OpenAIRE

    Stålsby Lundborg, Cecilia

    1999-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-01-01

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

  14. Diagnosis of aged prescribed burning plumes impacting an urban area.

    Science.gov (United States)

    Lee, Sangil; Kim, Hyeon K; Yan, Bo; Cobb, Charles E; Hennigan, Chris; Nichols, Sara; Chamber, Michael; Edgerton, Eric S; Jansen, John J; Hu, Yongtao; Zheng, Mei; Weber, Rodney J; Russell, Armistead G

    2008-03-01

    An unanticipated wind shift led to the advection of plumes from two prescribed burning sites that impacted Atlanta, GA, producing a heavy smoke event late in the afternoon on February 28, 2007. Observed PM2.5 concentrations increased to over 140 microg/m3 and O3 concentrations up to 30 ppb in a couple of hours, despite the late hour in February when photochemistry is less vigorous. A detailed investigation of PM2.5 chemical composition and source apportionment analysis showed that the increase in PM2.5 mass was driven mainly by organic carbon (OC). However, both results from source apportionment and an observed nonlinear relationship between OC and PM2.5 potassium (K) indicate that the increased OC was not due solely to primary emissions. Most of the OC was water-soluble organic carbon (WSOC) and was dominated by hydrophobic compounds. The data are consistent with large enhancements in isoprenoid (isoprene and monoterpenes) and other volatile organic compounds emitted from prescribed burning that led to both significant O3 and secondary organic aerosol (SOA) production. Formation of oligomers from oxidation products of isoprenoid compounds or condensation of volatile organic compounds (VOCs) with multiple functional groups emitted during prescribed burning appears to be a major component of the secondary organic contributor of the SOA. The results from this study imply that enhanced emissions due to the fire itself and elevated temperature in the burning region should be considered in air quality models (e.g., receptor and emission-based models) to assess impacts of prescribed burning emissions on ambient air quality.

  15. Gaseous and particulate emissions from prescribed burning in Georgia.

    Science.gov (United States)

    Lee, Sangil; Baumann, Karsten; Schauer, James J; Sheesley, Rebecca J; Naeher, Luke P; Meinardi, Simone; Blake, Donald R; Edgerton, Eric S; Russell, Armistead G; Clements, Mark

    2005-12-01

    Prescribed burning is a significant source of fine particulate matter (PM2.5) in the southeastern United States. However, limited data exist on the emission characteristics from this source. Various organic and inorganic compounds both in the gas and particle phase were measured in the emissions of prescribed burnings conducted at two pine-dominated forest areas in Georgia. The measurements of volatile organic compounds (VOCs) and PM2.5 allowed the determination of emission factors for the flaming and smoldering stages of prescribed burnings. The VOC emission factors from smoldering were distinctly higher than those from flaming except for ethene, ethyne, and organic nitrate compounds. VOC emission factors show that emissions of certain aromatic compounds and terpenes such as alpha and beta-pinenes, which are important precursors for secondary organic aerosol (SOA), are much higher from active prescribed burnings than from fireplace wood and laboratory open burning studies. Levoglucosan is the major particulate organic compound (POC) emitted for all these studies, though its emission relative to total organic carbon (mg/g OC) differs significantly. Furthermore, cholesterol, an important fingerprint for meat cooking, was observed only in our in situ study indicating a significant release from the soil and soil organisms during open burning. Source apportionment of ambient primary fine particulate OC measured at two urban receptor locations 20-25 km downwind yields 74 +/- 11% during and immediately after the burns using our new in situ profile. In comparison with the previous source profile from laboratory simulations, however, this OC contribution is on average 27 +/- 5% lower.

  16. Physicians' tacit and stated policies for determining patient benefit and referral to cardiac rehabilitation.

    Science.gov (United States)

    Beckstead, Jason W; Pezzo, Mark V; Beckie, Theresa M; Shahraki, Farnaz; Kentner, Amanda C; Grace, Sherry L

    2014-01-01

    The benefits of prescribing cardiac rehabilitation (CR) for patients following heart surgery is well documented; however, physicians continue to underuse CR programs, and disparities in the referral of women are common. Previous research into the causes of these problems has relied on self-report methods, which presume that physicians have insight into their referral behavior and can describe it accurately. In contrast, the research presented here used clinical judgment analysis (CJA) to discover the tacit judgment and referral policies of individual physicians. The specific aims were to determine 1) what these policies were, 2) the degree of self-insight that individual physicians had into their own policies, 3) the amount of agreement among physicians, and 4) the extent to which judgments were related to attitudes toward CR. Thirty-six Canadian physicians made judgments and decisions regarding 32 hypothetical cardiac patients, each described on 5 characteristics (gender, age, type of cardiovascular procedure, presence/absence of musculoskeletal pain, and degree of motivation) and then completed the 19 items of the Attitude towards Cardiac Rehabilitation Referral scale. Consistent with previous studies, there was wide variation among physicians in their tacit and stated judgment policies, and self-insight was modest. On the whole, physicians showed evidence of systematic gender bias as they judged women as less likely than men to benefit from CR. Insight data suggest that 1 in 3 physicians were unaware of their own bias. There was greater agreement among physicians in how they described their judgments (stated policies) than in how they actually made them (tacit policies). Correlations between attitude statements and CJA measures were modest. These findings offer some explanation for the slow progress of efforts to improve CR referrals and for gender disparities in referral rates.

  17. Physicians’ Tacit and Stated Policies for Determining Patient Benefit and Referral to Cardiac Rehabilitation

    Science.gov (United States)

    Beckstead, Jason W.; Pezzo, Mark V.; Beckie, Theresa M.; Shahraki, Farnaz; Kentner, Amanda C.; Grace, Sherry L.

    2015-01-01

    Background The benefits of prescribing cardiac rehabilitation (CR) for patients following heart surgery is well documented. However physicians continue to underutilize CR programs and disparities in the referral of women are common. Previous research into the causes of these problems has relied on self-report methods which presume that physicians have insight into their referral behavior and can describe it accurately. In contrast, the research presented here employed clinical judgment analysis (CJA) to discover the tacit judgment and referral policies of individual physicians. Purpose The specific aims were to determine 1) what these policies were, 2) the degree of self-insight that individual physicians had into their own policies, 3) the amount of agreement among physicians, and 4) the extent to which judgments were related to attitudes toward CR. Method Thirty-six Canadian physicians made judgments and decisions regarding 32 hypothetical cardiac patients, each described on five characteristics (gender, age, type of surgical procedure, presence/absence of musculoskeletal pain, and degree of motivation) and then completed the 19 items of the Attitude towards Cardiac Rehabilitation Referral instrument. Results There was wide variation among physicians in their tacit and stated judgment policies. Physicians exhibited greater agreement in what they believed they were doing (stated policies) than in what they actually did (tacit policies). Nearly one-third of the physicians showed evidence of systematic, and perhaps subliminal, gender bias as they judged women as less likely than men to benefit from CR. Correlations between attitude statements and CJA measures were modest. Conclusions These findings offer some explanation for the slow progress of efforts to improve CR referrals and for gender disparities in referral rates. PMID:23784848

  18. Nurse prescribing in Spain: The law and the curriculum.

    Science.gov (United States)

    Romero-Collado, Angel; Raurell-Torreda, Marta; Zabaleta-Del-Olmo, Edurne; Rascon-Hernan, Carolina; Homs-Romero, Erica

    2017-09-01

    In this cross-sectional study, we explored course content related to pharmacology and/or healthcare products and supplies in all nursing degree programs in Spain. Changes in nurse-prescribing legislation in Spain require that nurses take a certification course before prescribing over-the-counter products and medications. Using a cross-sectional descriptive study, between July and September 2014, the degree programs of all centers that offer a degree in nursing in Spain were examined, selecting those with course information available online. All centers offered at least one pharmacology course. One-third of the required courses had content related to pharmacology and healthcare products/supplies. The analysis showed that the course content and training received during the current nursing degree program provides the knowledge and skills needed to prescribe healthcare products/supplies and medications that do not now require a doctor's prescription, without the need for additional training and certification. It is essential that government regulation of nursing education be aligned with nursing competencies, curriculum standards, clinical practice, and evidence-based research to provide the maximum level of confidence for nursing professionals and their patients. © 2017 John Wiley & Sons Australia, Ltd.

  19. Robust Adaptive Neural Control of Morphing Aircraft with Prescribed Performance

    Directory of Open Access Journals (Sweden)

    Zhonghua Wu

    2017-01-01

    Full Text Available This study proposes a low-computational composite adaptive neural control scheme for the longitudinal dynamics of a swept-back wing aircraft subject to parameter uncertainties. To efficiently release the constraint often existing in conventional neural designs, whose closed-loop stability analysis always necessitates that neural networks (NNs be confined in the active regions, a smooth switching function is presented to conquer this issue. By integrating minimal learning parameter (MLP technique, prescribed performance control, and a kind of smooth switching strategy into back-stepping design, a new composite switching adaptive neural prescribed performance control scheme is proposed and a new type of adaptive laws is constructed for the altitude subsystem. Compared with previous neural control scheme for flight vehicle, the remarkable feature is that the proposed controller not only achieves the prescribed performance including transient and steady property but also addresses the constraint on NN. Two comparative simulations are presented to verify the effectiveness of the proposed controller.

  20. Florida panther habitat use response to prescribed fire

    Science.gov (United States)

    Dees, Catherine S.; Clark, Joseph D.; van Manen, Frank T.

    2001-01-01

    The Florida panther (Puma concolor coryi) is one of the most endangered mammals in the world, with only 30-50 adults surviving in and around Florida Panther National Wildlife Refuge and the adjacent Big Cypress National Preserve. Managers at these areas conduct annual prescribed burns in pine (Pinus sp.) as a cost-effective method of managing wildlife habitat. Our objectives were to determine if temporal and spatial relationships existed between prescribed fire an panther use of pine. to accomplish this, we paired fire-event data from the Refuge an the Preserve with panther radiolocations collected between 1989 and 1998, determined the time that had elapsed since burning had occurred in management units associated with the radiolocations, and generated a frequency distribution based on those times. We then generated ant expected frequency distribution, based on random use relative to time since burning. This analysis revealed that panther use of burned pine habitats was greatest during the first year after a management unit was burned. Also, compositional analysis indicated that panthers were more likely to position their home ranges in areas that contained pine. We conclude that prescribed burning is important to panther ecology. We suggest that panthers were attracted to effects of shorter burning intervals on vegetation composition and evaluate the landscape-scale changes that would result. 

  1. Clinical implications of patient-provider agreements in opioid prescribing.

    Science.gov (United States)

    Kraus, Carl N; Baldwin, Alan T; Curro, Frederick A; McAllister, R G

    2015-01-01

    In June, 2012 the United States Food and Drug Administration (FDA) developed a "blueprint" for prescriber education as a means of directing Certified Medical Education (CME) activities that included content which would meet the regulatory requirements of the class-wide, longacting/ extended-release (LA-ER) opioid Risk Evaluation Mitigation Strategies (REMS). Within the blueprint is the suggested adoption of Patient-Provider Agreements (PPAs) to be used in association with opioid prescribing, but, to our knowledge, there have been no reported evaluations of the role played by opioid-agent PPAs in clinical practice, or of the perceptions of this regulatory mandate by clinicians. Therefore, we conducted a survey regarding PPA perceptions by opioid prescribers that was posted for five weeks on a well-trafficked online CME service provider (Medscape). Of the 1,232 respondents (reflecting a 99.5% completion rate), 52.4% treat acute or chronic pain with opioids. The survey identified an improvement of opioid safe-use education (21% of respondents) as the most frequently selected beneficial element of PPAs. Conversely, the challenges to adoption included time constraints (21% of physicians) as well as lack of evidence that PPAs will reduce drug misuse, and the lack of a uniform, patient-friendly PPA. Based on our survey, clinicians consider the PPA of potential value, but data regarding the utility of such an instrument are lacking.

  2. Treatment of impetigo: oral antibiotics most commonly prescribed.

    Science.gov (United States)

    Bolaji, Ranti S; Dabade, Tushar S; Gustafson, Cheryl J; Davis, Scott A; Krowchuk, Daniel P; Feldman, Steven R

    2012-04-01

    Impetigo is a highly contagious, superficial skin disease that is frequently seen in children. While data support the use of topical antibiotics for treatment, the medications actually prescribed in practice are not well documented. To determine the prescribing pattern of dermatologists and nondermatologists when treating impetigo and the demographics of the patients treated. National Ambulatory Medical Care Survey data on office visits for impetigo were analyzed from 1997 to 2007. Patient demographics and the treatments for impetigo were recorded. During this 10-year period, dermatologists managed an estimated 274,815 impetigo visits and nondermatologists an estimated 3,722,462 visits. Both dermatologists and nondermatologists most frequently prescribed oral antibiotics to treat impetigo. Topical antibiotics were second most common, and a variety of combination treatments were used. Oral antibiotics are the most common class of medications used to treat impetigo. There is an opportunity for physicians to take advantage of the equally efficacious topical antibiotics for treating impetigo. A shift towards topical antibiotics would likely decrease morbidity (resulting from adverse effects) associated with use of oral agents.

  3. Impact of prescribed burning on a heathland inhabiting spider community

    Directory of Open Access Journals (Sweden)

    Krause, Rolf Harald

    2016-04-01

    Full Text Available Heathlands can provide refuge for many stenotopic and endangered arthropods, if habitat management practices are applied. A management measure that is rarely being used today, but which has the potential to support diversity of arthropod communities, is prescribed burning. In this study we investigated the effects of prescribed burning on spider assemblages on a burned site with Calluna vulgaris in the nature reserve Lueneburg Heath, northwest Germany. We used pitfall trapping with a sampling design of 39 traps over a period of one year and 17 sampling intervals on a burned and a control site. We compared overall species richness, activity abundance patterns and community composition of the two sites, with a particular focus on stenotopic and endangered species. We collected 5116 adult spiders and 99 species altogether in a relatively small sampling area. This number of species represents nearly one third of the regional species pool of heathland spider species. Twelve species occurred exclusively on the burned site in contrast to 28 species exclusively found on the unburned site. Although we found more than twice as many spider individuals and higher mean species richness on the control site than on the burned site, the species richness of red-listed spiders was higher on the burned site. Especially the fact that we found 24 endangered species on the burned site and only 20 on the control site indicates that the applied measure of prescribed burning can foster certain endangered spider species and contribute to preserving the overall biodiversity of heathland ecosystems.

  4. ENERGY POLICY

    OpenAIRE

    Avrupa Topluluğu Enstitüsü, Marmara Üniversitesi

    2015-01-01

    John Mitchell considers EU policies on energy supply security; Tera Allas on energy security of supply in the UK: the way forward; Peter Odell assesses public/private partnerships on the UKCS; Olivier Appert provides an overview of French energy policy.

  5. Energy policy

    International Nuclear Information System (INIS)

    Forrester, J.W.

    1979-01-01

    The author places the energy problem in the context of world economy. The various obstacles encountered in the United States to spell out a viable national energy policy are cited. A certain number of practical proposals is given to lead to an 'effective policy' which would allow energy economy at the same time as energy development, that is, including nuclear energy [fr

  6. The pharmacist as prescriber: a discourse analysis of newspaper media in Canada.

    Science.gov (United States)

    Schindel, Theresa J; Given, Lisa M

    2013-01-01

    Legislation to expand the scope of practice for pharmacists to include authority to independently prescribe medications in Alberta, Canada was announced in 2006 and enacted in April 2007. To date, very little research has explored public views of pharmacist prescribing. This study analyzes newspaper media coverage of pharmacist prescribing 1 year before and 2 years after prescribing was implemented. News items related to pharmacist prescribing were retrieved from 2 national, Canadian newspapers and 5 local newspapers in Alberta over a 3-year period after the announcement of pharmacist prescribing. A purposive sample of 66 texts including news items, editorials, and letters were retrieved electronically from 2 databases, Newscan and Canadian Newsstand. This study uses social positioning theory as a lens for analyzing the discourse of pharmacist prescribing. The results demonstrate a binary positioning of the debate on pharmacist prescribing rights. Using social positioning theory as a lens for analysis, the results illustrate self- and other-positioning of pharmacists' expected roles as prescribers. Themes related to the discourse on pharmacist prescribing include qualifications, diagnosis, patient safety, physician support, and conflict of interest. Media representations of pharmacist prescribing point to polarized views that may serve to shape public, pharmacist, physician, and others' opinions of the issue. Multiple and contradictory views of pharmacist prescribing coexist. Pharmacists and pharmacy organizations are challenged to bring clarity and consistency about pharmacist prescribing to better serve the public interest in understanding options for health care services. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Pharmaceutical policies in European countries.

    Science.gov (United States)

    Barros, Pedro Pita

    2010-01-01

    Pharmaceutical expenditures have an important role in Europe. The attempts to control expenditure have used a wide range of policy measures. We reviewed the main measures adopted by the European Union countries, especially in countries where governments are the largest third-party payers. To complement a literature review on the topic, data was gathered from national reviews of health systems and direct inquiries to several government bodies. Almost all countries regulate prices of pharmaceutical products. Popular policy measures include international referencing to set prices (using as benchmark countries that have set lower prices), internal reference pricing systems to promote price competition in domestic markets, and positive lists for reimbursement to promote consumption of generics (including in some cases substitution by pharmacists of drugs prescribed by physicians). Despite the wide range of policy measures, it is not possible to identify a "silver bullet" to control pharmaceutical expenditures. We also identified two main policy challenges: policy coordination among countries within the European Union to maintain incentives for R&D at the global level, and the development of new relationships with the pharmaceutical industry; namely, the so-called risk-sharing agreements between the pharmaceutical industry and governments/regulators (or large third-party payers).

  8. Incremental Effect of the Addition of Prescriber Restrictions on a State Medicaid's Pharmacy-Only Patient Review and Restriction Program.

    Science.gov (United States)

    Keast, Shellie L; Pham, Timothy; Teel, Ashley; Nesser, Nancy J

    2017-08-01

    Patient review and restriction programs (PRRPs), used by state Medicaid programs to limit potential abuse and misuse of opioids and related controlled medications, often restrict members to a single pharmacy for controlled medications. While most states use a restricted pharmacy access model, not all states include restricted prescriber access. Oklahoma Medicaid (MOK) added a restricted prescriber access feature to its PRRP in July 2014. To evaluate the incremental effect that the addition of a prescriber restriction to MOK's pharmacy-only PRRP had on the pharmacy and resource utilization of the enrolled members. MOK members with at least 6 months of enrollment in the pharmacy-only PRRP were restricted to a maximum of 3 prescribers for controlled substances in July 2014 and were identified as "cases." Using a propensity score method, cases were matched to controls from the MOK non-PRRP enrolled population based on demographics and baseline health care utilization. Data from January 1, 2014, through December 31, 2014, were evaluated. Each member's monthly health care resource utilization, defined in terms of medical and pharmacy costs, prescription counts, and opioid use per member per month (PMPM), was analyzed. A difference-indifferences (DID) regression estimated the change in resource utilization following the July 2014 policy change. This study included 378 controls and 126 cases after propensity matching. No differences were noted for daily morphine equivalents, benzodiazepine prescriptions, or maintenance prescriptions. There were decreases in mean PMPM use for both groups for short-acting opioid (SAO) claims (P evidence that overall opioid claims were affected, the addition of prescriber restrictions may have resulted in an incremental change to SAO, prescriber, and pharmacy use in the PRPP population. Use of PRRPs may be an effective tool in reducing inappropriate use of prescription opioids within payer systems. The question remains whether these changes

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

    DEFF Research Database (Denmark)

    Rasmussen, Lotte; Valentin, Julie; Gesser, Katarina Margareta

    2016-01-01

    The aim of this study was to measure the validity of the prescriber information recorded in the Danish National Prescription Registry (DNPR). The prescriber information recorded in the pharmacies' electronic dispensing system was considered to represent the prescriber information recorded...... in the DNPR. Further, the problem of validity of the prescriber information pertains only to non-electronic prescriptions, as these are manually entered into the dispensing system. The recorded prescriber information was thus validated against information from a total of 2,000 non-electronic prescriptions...... at five Danish community pharmacies. The validity of the recorded prescriber information was measured at the level of the individual prescriber and the prescriber type, respectively. The proportion of non-electronic prescriptions with incorrect registrations was 22.4% (95% Confidence Interval (CI): 20...

  10. Potentially inappropriate prescribing to older patients in primary care in the Netherlands: a retrospective longitudinal study

    NARCIS (Netherlands)

    Bruin-Huisman, Linette; Abu-Hanna, Ameen; van Weert, Henk C. P. M.; Beers, Erna

    2017-01-01

    potentially inappropriate prescribing (PIP) is associated with adverse health effects in older patients. PIP comprises prescription of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). to estimate the prevalence of PIMs and PPOs among older patients in primary

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

    LENUS (Irish Health Repository)

    McGowan, Bernie M

    2011-03-01

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

  12. Policy, inquiries, and the courts

    International Nuclear Information System (INIS)

    Jowell, J.

    1982-01-01

    In relation to nuclear power policy, two objectives of a liberal democracy are examined: the accountability of the decision-maker to the public; and the efficient and effective implementation of management policy. The places of Parliament, administrative law, planning constraints and the public enquiry are discussed, with special reference to legal aspects of the procedure at the public enquiry to ensure that it is as fair and effective as possible. (U.K.)

  13. 48 CFR 2052.242-71 - Procedures for Resolving Differing Professional Views.

    Science.gov (United States)

    2010-10-01

    ... Differing Professional Views. 2052.242-71 Section 2052.242-71 Federal Acquisition Regulations System NUCLEAR... Clauses 2052.242-71 Procedures for Resolving Differing Professional Views. As prescribed in 2042.570-2(b... contracting officer. Procedures for Resolving NRC Contractor Differing Professional Views (DPVs) (OCT 1999) (a...

  14. Information behavior and workplace procedures: The case of emergency-department triage

    DEFF Research Database (Denmark)

    Hertzum, Morten

    In workplace contexts the performance of many information tasks is prescribed in procedures. Knowledge of the relationship between workplace procedures and actors’ real information behavior is important to understanding information behavior. We explore this relationship by looking at how emergency...... clinicians’ information behavior relates to clinical triage guidelines....

  15. Variation in the Viral Hepatitis and HIV Policies and Practices of Methadone Maintenance Programs.

    Science.gov (United States)

    Jessop, Amy B; Hom, Jeffrey K; Burke, Monika

    Patients prescribed methadone maintenance treatment (MMT) demonstrate elevated prevalence of hepatitis B virus (HBV), hepatitis C virus, and HIV. Government agencies recommend testing for these infections in MMT programs, but uptake is limited. We audited infection-related policies and practices of all 14 MMT programs in Philadelphia, Pennsylvania, in 2015. Results were tabulated and compared with the results from a 2010 audit of 10 of 12 MMT programs. The audit focused on which patients are tested, timing and frequency, specific tests ordered, vaccination, and communication of test results. Written policies were nonspecific, offering little guidance on appropriate testing. The principal change in policy between 2010 and 2015 involved adding clearer guidance for communication of results to patients. In 2010 and 2015, all MMT programs tested new patients for hepatitis C virus antibodies, although retesting of existing patients varied. HBV testing increased from 2010 to 2015, though it was not uniform, with 5 programs testing for HBV surface antibodies and 10 programs testing for HBV surface antigens. Six programs assessed hepatitis vaccination status, but only 1 administered vaccines. In 2010, city-sponsored HIV antibody testing was available at all MMT programs. Without this program in 2015, few MMT programs conducted HIV testing. Despite limited hepatitis and HIV screening in MMT programs nationally, this study shows that testing can be incorporated into routine procedures. MMT programs are positioned to play an integral role in the identification of patients with chronic infections, but additional guidance and resources are required to maximize their impact.

  16. Data Policy

    Directory of Open Access Journals (Sweden)

    Mark A Parsons

    2013-07-01

    Full Text Available The first purpose of data policy should be to serve the objectives of the organization or project sponsoring the collection of the data. With research data, data policy should also serve the broader goals of advancing scientific and scholarly inquiry and society at large. This is especially true with government-funded data, which likely comprise the vast majority of research data. Data policy should address multiple issues, depending on the nature and objectives of the data. These issues include data access requirements, data preservation and stewardship requirements, standards and compliance mechanisms, data security issues, privacy and ethical concerns, and potentially even specific collection protocols and defined data flows. The specifics of different policies can vary dramatically, but all data policies need to address data access and preservation. Research data gain value with use and must therefore be accessible and preserved for future access. This article focuses on data access. While policy might address multiple issues, at a first level it must address where the data stand on what Lyon (2009 calls the continuum of openness. Making data as openly accessible as possible provides the greatest societal benefit, and a central purpose of data policy is to work toward ethically open data access. An open data regime not only maximizes the benefit of the data, it also simplifies most of the other issues around effective research data stewardship and infrastructure development.

  17. Public policy, rationality and reason

    Directory of Open Access Journals (Sweden)

    Rodolfo Canto Sáenz

    2015-07-01

    Full Text Available This work suggests the incorporation of practical reason in the design, implementation and evaluation of public policies, alongside instrumental rationality. It takes two proposals that today point in this direction: Rawls distinction between reasonable (practical reason and rational (instrumental reason and what this author calls the CI Procedure (categorical imperative procedure and Habermas model of deliberative democracy. The main conclusion is that the analysis of public policies can not be limited to rather narrow limits of science, but requires the contribution of political and moral philosophy.

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

    Science.gov (United States)

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

    2016-03-01

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

  19. Factors influencing pharmacists' adoption of prescribing: qualitative application of the diffusion of innovations theory.

    Science.gov (United States)

    Makowsky, Mark J; Guirguis, Lisa M; Hughes, Christine A; Sadowski, Cheryl A; Yuksel, Nese

    2013-09-14

    In 2007, Alberta became the first Canadian jurisdiction to grant pharmacists a wide range of prescribing privileges. Our objective was to understand what factors influence pharmacists' adoption of prescribing using a model for the Diffusion of Innovations in healthcare services. Pharmacists participated in semi-structured telephone interviews to discuss their prescribing practices and explore the facilitators and barriers to implementation. Pharmacists working in community, hospital, PCN, or other settings were selected using a mix of random and purposive sampling. Two investigators independently analyzed each transcript using an Interpretive Description approach to identify themes. Analyses were informed by a model explaining the Diffusion of Innovations in health service organizations. Thirty-eight participants were interviewed. Prescribing behaviours varied from non-adoption through to product, disease, and patient focused use of prescribing. Pharmacists' adoption of prescribing was dependent on the innovation itself, adopter, system readiness, and communication and influence. Adopting pharmacists viewed prescribing as a legitimization of previous practice and advantageous to instrumental daily tasks. The complexity of knowledge required for prescribing increased respectively in product, disease and patient focused prescribing scenarios. Individual adopters had higher levels of self-efficacy toward prescribing skills. At a system level, pharmacists who were in practice settings that were patient focused were more likely to adopt advanced prescribing practices, over those in product-focused settings. All pharmacists stated that physician relationships impacted their prescribing behaviours and individual pharmacists' decisions to apply for independent prescribing privileges. Diffusion of Innovations theory was helpful in understanding the multifaceted nature of pharmacists' adoption of prescribing. The characteristics of the prescribing model itself which

  20. Implementation of BNCT treatment planning procedures

    International Nuclear Information System (INIS)

    Capala, J.; Ma, R.; Diaz, A.Z.; Chanana, A.D.; Coderre, J.A.

    2001-01-01

    Estimation of radiation doses delivered during boron neutron capture therapy (BNCT) requires combining data on spatial distribution of both the thermal neutron fluence and the 10 B concentration, as well as the relative biological effectiveness of various radiation dose components in the tumor and normal tissues. Using the treatment planning system created at Idaho National Engineering and Environmental Laboratory and the procedures we had developed for clinical trials, we were able to optimize the treatment position, safely deliver the prescribed BNCT doses, and carry out retrospective analyses and reviews. In this paper we describe the BNCT treatment planning process and its implementation in the ongoing dose escalation trials at Brookhaven National Laboratory. (author)

  1. Ecological effects of prescribed fire season: a literature review and synthesis for managers

    Science.gov (United States)

    Eric E. Knapp; Becky L. Estes; Carl N. Skinner

    2009-01-01

    Prescribed burning may be conducted at times of the year when fires were infrequent historically, leading to concerns about potential adverse effects on vegetation and wildlife. Historical and prescribed fire regimes for different regions in the continental United States were compared and literature on season of prescribed burning synthesized. In regions and vegetation...

  2. Response of northern bats (Myotis septentrionalis) to prescribed fires in eastern Kentucky forests

    Science.gov (United States)

    Michael J. Lacki; Daniel R. Cox; Luke E. Dodd; Matthew B. Dickinson

    2009-01-01

    Prescribed fire is becoming a common management tool for restoring forests of North America; however, effects of prescribed fire on forest-dwelling bats remain unclear. During 2006 and 2007, we monitored prey availability, diet, foraging behavior, and roost selection of adult female northern bats (Myotis septentrionalis) before and after 2 prescribed...

  3. Effects of a prescribed fire on water use and photosynthetic capacity of pitch pines

    Science.gov (United States)

    Heidi J. Renninger; Kenneth L. Clark; Nicholas Skowronski; Karina V.R. Schäfer

    2013-01-01

    Although wildfires are important in many forested ecosystems, increasing suburbanization necessitates management with prescribed fires. The physiological responses of overstory trees to prescribed fire has received little study and may differ from typical wildfires due to the lower intensity and timing of prescribed fire in the dormant season. Trees may be negatively...

  4. 30 CFR 285.103 - When may MMS prescribe or approve departures from these regulations?

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false When may MMS prescribe or approve departures... CONTINENTAL SHELF General Provisions § 285.103 When may MMS prescribe or approve departures from these regulations? (a) The MMS may prescribe or approve departures from these regulations when departures are...

  5. Influences on Prescribed Burning Activity and Costs in the National Forest System

    Science.gov (United States)

    David A. Cleaves; Jorge Martinez; Terry K. Haines

    2000-01-01

    The results of a survey concerning National Forest System prescribed burning activity and costs from 1985 to 1995 are examined. Ninety-five of one hundred and fourteen national forests responded. Acreage burned and costs for conducting burns are reported for four types of prescribed fires slash reduction; management-ignited fires; prescribed natural fires; and brush,...

  6. Visual Impacts of Prescribed Burning on Mixed Conifer and Giant Sequoia Forests

    Science.gov (United States)

    Lin Cotton; Joe R. McBride

    1987-01-01

    Prescribed burning programs have evolved with little concern for the visual impact of burning and the potential prescribed burning can have in managing the forest scene. Recent criticisms by the public of the prescribed burning program at Sequoia National Park resulted in an outside review of the National Park fire management programs in Sequoia, Kings Canyon, and...

  7. Derivation and validation of a multivariable model to predict when primary care physicians prescribe antidepressants for indications other than depression

    Directory of Open Access Journals (Sweden)

    Wong J

    2018-04-01

    Full Text Available Jenna Wong, Michal Abrahamowicz, David L Buckeridge, Robyn Tamblyn Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada Objective: Physicians commonly prescribe antidepressants for indications other than depression that are not evidence-based and need further evaluation. However, lack of routinely documented treatment indications for medications in administrative and medical databases creates a major barrier to evaluating antidepressant use for indications besides depression. Thus, the aim of this study was to derive a model to predict when primary care physicians prescribe antidepressants for indications other than depression and to identify important determinants of this prescribing practice. Methods: Prediction study using antidepressant prescriptions from January 2003–December 2012 in an indication-based electronic prescribing system in Quebec, Canada. Patients were linked to demographic files, medical billings data, and hospital discharge summary data to create over 370 candidate predictors. The final prediction model was derived on a random 75% sample of the data using 3-fold cross-validation integrated within a score-based forward stepwise selection procedure. The performance of the final model was assessed in the remaining 25% of the data. Results: Among 73,576 antidepressant prescriptions, 32,405 (44.0% were written for indications other than depression. Among 40 predictors in the final model, the most important covariates included the molecule name, the patient’s education level, the physician’s workload, the prescribed dose, and diagnostic codes for plausible indications recorded in the past year. The final model had good discrimination (concordance (c statistic 0.815; 95% CI, 0.787–0.847 and good calibration (ratio of observed to expected events 0.986; 95% CI, 0.842–1.136. Conclusion: In the absence of documented treatment indications, researchers may be able to use

  8. Economic impact of electronic prescribing in the hospital setting: A systematic review.

    Science.gov (United States)

    Ahmed, Zamzam; Barber, Nick; Jani, Yogini; Garfield, Sara; Franklin, Bryony Dean

    2016-04-01

    To examine evidence on the economic impact of electronic prescribing (EP) systems in the hospital setting. We conducted a systematic search of MEDLINE, EMBASE, PsycINFO, International Pharmaceutical Abstracts, the NHS Economic Evaluation Database, the European Network of Health Economic Evaluation Database and Web of Science from inception to October 2013. Full and partial economic evaluations of EP or computerized provider order entry were included. We excluded studies assessing prescribing packages for specific drugs, and monetary outcomes that were not related to medicines. A checklist was used to evaluate risk of bias and evidence quality. The search yielded 1160 articles of which three met the inclusion criteria. Two were full economic evaluations and one a partial economic evaluation. A meta-analysis was not appropriate as studies were heterogeneous in design, economic evaluation method, interventions and outcome measures. Two studies investigated the financial impact of reducing preventable adverse drug events. The third measured savings related to various aspects of the system including those related to medication. Two studies reported positive financial effects. However the overall quality of the economic evidence was low and key details often not reported. There seems to be some evidence of financial benefits of EP in the hospital setting. However, it is not clear if evidence is transferable to other settings. Research is scarce and limited in quality, and reported methods are not always transparent. Further robust, high quality research is required to establish if hospital EP is cost effective and thus inform policy makers' decisions. Copyright © 2016. Published by Elsevier Ireland Ltd.

  9. Potential value of electronic prescribing in health economic and outcomes research

    Directory of Open Access Journals (Sweden)

    Catherine E Cooke

    2010-11-01

    Full Text Available Catherine E Cooke1, Brian J Isetts2, Thomas E Sullivan3, Maren Fustgaard4, Daniel A Belletti51PosiHealth Inc., Ellicott City, MD, USA; 2Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis, MN, USA; 3Women’s Health Center, Danvers, MA, USA; 4Assistant Director for Regional Outcomes Research, 5Associate Director for Regional Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USAAbstract: Improving access and quality while reducing expenditures in the United States health system is expected to be a priority for many years. The use of health information technology (HIT, including electronic prescribing (eRx, is an important initiative in efforts aimed at improving safety and outcomes, increasing quality, and decreasing costs. Data from eRx has been used in studies that document reductions in medication errors, adverse drug events, and pharmacy order-processing time. Evaluating programs and initiatives intended to improve health care can be facilitated through the use of HIT and eRx. eRx data can be used to conduct research to answer questions about the outcomes of health care products, services, and new clinical initiatives with the goal of providing guidance for clinicians and policy makers. Given the recent explosive growth of eRx in the United States, the purpose of this manuscript is to assess the value and suggest enhanced uses and applications of eRx to facilitate the role of the practitioner in contributing to health economics and outcomes research.Keywords: electronic prescribing, outcomes research, health information technology

  10. European survey on principles of prudent antibiotic prescribing teaching in undergraduate students.

    Science.gov (United States)

    Pulcini, C; Wencker, F; Frimodt-Møller, N; Kern, W V; Nathwani, D; Rodríguez-Baño, J; Simonsen, G S; Vlahović-Palčevski, V; Gyssens, I C

    2015-04-01

    We surveyed European medical schools regarding teaching of prudent antibiotic prescribing in the undergraduate curriculum. We performed a cross-sectional survey in 13 European countries (Belgium, Croatia, Denmark, France, Germany, Italy, Netherlands, Norway, Serbia, Slovenia, Spain, Switzerland, United Kingdom) in 2013. Proportional sampling was used, resulting in the selection of two to four medical schools per country. A standardized questionnaire based on literature review and validated by a panel of experts was sent to lecturers in infectious diseases, medical microbiology and clinical pharmacology. In-depth interviews were conducted with four lecturers. Thirty-five of 37 medical schools were included in the study. Prudent antibiotic use principles were taught in all but one medical school, but only four of 13 countries had a national programme. Interactive teaching formats were used less frequently than passive formats. The teaching was mandatory for 53% of the courses and started before clinical training in 71%. We observed wide variations in exposure of students to important principles of prudent antibiotic use among countries and within the same country. Some major principles were poorly covered (e.g. reassessment and duration of antibiotic therapy, communication skills). Whereas 77% of the respondents fully agreed that the teaching of these principles should be prioritized, lack of time, mainly due to rigid curriculum policies, was the main reported barrier to implementation. Given the study design, these are probably optimistic results. Teaching of prudent antibiotic prescribing principles should be improved. National and European programmes for development of specific learning outcomes or competencies are urgently needed. Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  11. 41 CFR 109-27.5007-1 - Procedures.

    Science.gov (United States)

    2010-07-01

    ...-INVENTORY MANAGEMENT 27.50-Inventory Management Policies, Procedures, and Guidelines § 109-27.5007-1 Procedures. The following procedures shall be established for taking physical inventory of stocks subjected to quantity controls as well as those under financial control: (a) Completion of a physical inventory...

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

    Directory of Open Access Journals (Sweden)

    Mehdi Mohammadi

    2015-10-01

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

  13. Prescribing antibiotics to pediatric dengue: increasing risk of bacterial resistance

    Directory of Open Access Journals (Sweden)

    Dhanunjaya Sandopa

    2018-03-01

    Full Text Available Background Use of antibiotics to treat self-limiting viral infections like dengue fever (DF without any co-morbid conditions in pediatric patients is common practice in India, and a major contribution of the inappropriate use of antibiotics in the country. Objective To provide an analysis of diagnosis, grading, and prescribing of antibiotics in pediatric inpatients with DF in a tertiary care teaching hospital in India. Methods Data from case sheets of all pediatric inpatients (n=370 diagnosed with DF without co-morbid conditions were collected with regards to diagnosis, grading, presence, and appropriateness of antibiotic usage according to the 2009 WHO Guidelines, the National Vector Borne Disease Control Program (NVBDCP of India Guidelines, and the Hospital Infection Society (HIS Guidelines. Results Platelet count determination (50% of the cases was the major diagnostic method for dengue. Inappropriate grading of DF was seen in 20% of patients. Almost 75% of the 370 dengue cases were prescribed antibiotics for the expressed purpose of avoiding hospital-acquired infections. A single antibiotic was given in 225 cases (60.81%, 2 antibiotics in 33 (8.91 % cases, and 3 antibiotics in 9 (2.43% cases. Conclusions From the results it is clear that antibiotics were prescribed to treat DF where the antibiotics do not have any role. DF is a self-limiting viral infection that can be treated with proper management of hemodynamic status with IV fluids. To avoid the usage of antibiotics in the treatment of dengue, awareness has to be created in healthcare professionals regarding the treatment guidelines for dengue and appropriate use of antibiotics to avoid hospital acquired infections.

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

    International Nuclear Information System (INIS)

    Mazurek, M.A.; Cofer, W.R. III; Levine, J.S.

    1990-10-01

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

  15. [Computer-aided prescribing: from utopia to reality].

    Science.gov (United States)

    Suárez-Varela Ubeda, J; Beltrán Calvo, C; Molina López, T; Navarro Marín, P

    2005-05-31

    To determine whether the introduction of computer-aided prescribing helped reduce the administrative burden at primary care centers. Descriptive, cross-sectional design. Torreblanca Health Center in the province of Seville, southern Spain. From 29 October 2003 to the present a pilot project involving nine pharmacies in the basic health zone served by this health center has been running to evaluate computer-aided prescribing (the Receta XXI project) with real patients. All patients on the center's list of patients who came to the center for an administrative consultation to renew prescriptions for medications or supplies for long-term treatment. Total number of administrative visits per patient for patients who came to the center to renew prescriptions for long-term treatment, as recorded by the Diraya system (Historia Clinica Digital del Ciudadano, or Citizen's Digital Medical Record) during the period from February to July 2004. Total number of the same type of administrative visits recorded by the previous system (TASS) during the period from February to July 2003. The mean number of administrative visits per month during the period from February to July 2003 was 160, compared to a mean number of 64 visits during the period from February to July 2004. The reduction in the number of visits for prescription renewal was 60%. Introducing a system for computer-aided prescribing significantly reduced the number of administrative visits for prescription renewal for long-term treatment. This could help reduce the administrative burden considerably in primary care if the system were used in all centers.

  16. Drilling supervision procedure for the Exploratory Shaft Facility: Final draft

    International Nuclear Information System (INIS)

    1986-11-01

    Drilling supervision will be undertaken in the Exploratory Shaft Facility (ESF) for boreholes drilled primarily for the purpose of hydrologic testing, downhole mechanical/thermal testing, sampling for laboratory testing, and for the placement of instrumentation. The primary purpose of this procedure is documentation of drilling activities prescribed by other procedures. Supervision of drilling includes designation of positions of authority, lines of communication, and methodology of supervising, monitoring, and documenting drilling and associated activities. The rationale for the specific applications of core drilling is provided by the test procedures for each activity. 2 figs

  17. Orientations of infinite graphs with prescribed edge-connectivity

    DEFF Research Database (Denmark)

    Thomassen, Carsten

    2016-01-01

    We prove a decomposition result for locally finite graphs which can be used to extend results on edge-connectivity from finite to infinite graphs. It implies that every 4k-edge-connected graph G contains an immersion of some finite 2k-edge-connected Eulerian graph containing any prescribed vertex...... set (while planar graphs show that G need not containa subdivision of a simple finite graph of large edge-connectivity). Also, every 8k-edge connected infinite graph has a k-arc-connected orientation, as conjectured in 1989....

  18. Anomalies in the prescribing of soft contact lens power.

    Science.gov (United States)

    Young, Graeme; Moody, Kurt; Sulley, Anna

    2009-01-01

    To determine the proportion of prescribed soft lenses rounded to the nearest half diopter and any variations from country to country and between lens types. Marketing data were obtained for soft lenses supplied during a 1-year period for lenses representing each of the following categories: mid-water hydrogel (MWH), silicone hydrogel, daily disposable, and toric silicone hydrogel (TSH). The data were analyzed for several countries/regions. Spherical lenses were analyzed in the range 1.00 to 5.75 D for plus and minus powers, and toric lenses in the range 0.50 to 5.75 D. This ensured a similar number of lenses in full or half diopter powers were compared with quarter and three-quarter diopter powers, and that there was no enforced rounding due to nonavailability of powers. By comparing the proportion of lenses from the 2 power groups, the proportion of lenses rounded to the nearest half diopter was estimated. It was assumed that half the difference between the totals of the 2 power groups represented those lenses dispensed to the nearest half diopter and, therefore, dispensed inaccurately; this was termed the "rounding rate" (RR). The power distribution curve for the sphere powers spiked in half diopter steps, illustrated a bias toward prescribing full and half diopter powers. With all lenses, the RR varied widely between countries. For the MWH, this ranged from 1.7% (Canada) to 11.6% (Iberia). The RRs were 2 to 3 times higher for plus than minus power lenses, however, this also varied by country. Overall, the RRs were lower for the silicone hydrogel and daily disposable contact lenses compared with the MWH, in particular for France and Iberia. The TSH results showed the greatest consistency between countries, with RRs ranging from 3.9% (Germany) to 9.5% (Rest of Europe). Most countries showed similar or lower RRs for TSH compared with MWH although, for some countries (e.g., United Kingdom, Nordic), these were higher. There was less difference in RRs for TSH lenses

  19. Prescribed curvature tensor in locally conformally flat manifolds

    Science.gov (United States)

    Pina, Romildo; Pieterzack, Mauricio

    2018-01-01

    A global existence theorem for the prescribed curvature tensor problem in locally conformally flat manifolds is proved for a special class of tensors R. Necessary and sufficient conditions for the existence of a metric g ¯ , conformal to Euclidean g, are determined such that R ¯ = R, where R ¯ is the Riemannian curvature tensor of the metric g ¯ . The solution to this problem is given explicitly for special cases of the tensor R, including the case where the metric g ¯ is complete on Rn. Similar problems are considered for locally conformally flat manifolds.

  20. 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...... minimization as well as that of direct strength maximization; we choose the objective of obtaining uniform energy density and show by examples that the obtained solutions are close to fulfilling also strength maximization, with the price of increased compliance. Optimal design examples are presented...