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Sample records for prescribed limits desenvolvimento

  1. Os limites do desenvolvimento e do turismo

    Directory of Open Access Journals (Sweden)

    Menezes Teixeira Coriolano, Luzia Neide

    2003-01-01

    Full Text Available This paper is a historical analysis of the background and evolution of the concept of development and the limits to development, supported by links with economic science, thus pervading all social sciences. The assumptions of developmentalist theories, the so-called modernization theories, are shown and identified as traditional, conservative and consensual, thus differing from critical theories which adopt the assumptions of historical materialism. The paper examines those aspects of globalization which pertain to new approaches to development, whereby tourism becomes a link between the local and the global. The study explains how and why development is an unequal and joint process. Underdevelopment is a result of the structural adjustments which determine concentration of wealth and income, generating poverty as the ultimate expression of social inequality. It is shown that development only takes place when people benefit, when a human scale is reached, that tourism can both connect with concentrated economic growth and promote social development, otherwise known as local development

  2. Development of the natural gas engine Mercedes-Benz 12 liters given the limits of the law of EEV (Enhanced Environmentally Friendly Vehicle) emissions below the prescribed limits; Desenvolvimento do motor a gas natural Mercedes-Bens 12 litros atendendo os limites da legislacao de emissoes EEV (Enhanced Environmentally Friendly Vehicle) inferiores aos limites prescritos para Euro 5

    Energy Technology Data Exchange (ETDEWEB)

    Marques Neto, J.A.; Wunderlich, C.; Miletovic, C.; Biazetti, W. [DaimlerChrysler do Brasil Ltda., Sao Bernardo do Campo, SP (Brazil)

    2004-07-01

    The development of combustion for engines, has been focused in reducing of pollutants emissions limits and the compressed natural gas, as a fuel, achieves good results, resulted by the combustion dynamic from Otto cycle, values under the lower specific emissions limits, if compared with diesel cycle engines. Although the optimization of fuel maps and the using of a two-ways oxidation catalysator, in function of the lower particulate matters emissions, was possible to get the engine certification by TUV Germany in agreement with the EEV emissions limits. To sum up, this paper has principal subject to present the natural gas engine M447hLAG powered by Mercedes-Benz with power 240 kW and torque 1250 Nm , as a commercial advantage for markets with the respective legislation with lower emissions limits. (author)

  3. Desenvolvimento territorial rural no Brasil: limites e potencialidades dos CONSADs

    Directory of Open Access Journals (Sweden)

    Antonio César Ortega

    2007-06-01

    Full Text Available A motivação principal desse trabalho é avaliar a capacidade da abordagem territorial em contribuir com o enfrentamento da pobreza e das desigualdades sociais brasileiras, representando uma alternativa de geração de emprego e renda em territórios rurais deprimidos. Por meio dos Consórcios de Segurança Alimentar e Desenvolvimento Local (CONSADs analisa-se as potencialidades e as dificuldades que essa estratégia vem enfrentando para estabelecer a cooperação entre o poder público e a sociedade civil voltada para o fomento, o apoio logístico e a canalização de recursos para as iniciativas territoriais, projetos e ações estruturantes que visam a geração de emprego e renda, com a garantia de segurança alimentar e do desenvolvimento local.This paper aims at evaluating the capacity of the territorial approach to contribute to poverty issues and Brazilian social inequalities, representing an alternative of employment and income generation in depressed rural territories. Through Consórcios de Segurança Alimentar e Desenvolvimento Local-CONSADs (Food Safety Consortia and Local Development we analyzed the potentialities and difficulties the strategy is facing to establish the cooperation between public power and civil society regarding fomentation, logistic support and canalization of resources for territorial initiatives, projects and structuring actions that seek employment and income generation with food safety warranty and local development.

  4. Assessing pharmacists' readiness to prescribe oral antibiotics for limited infections using a case-vignette technique.

    Science.gov (United States)

    Ung, Elizabeth; Czarniak, Petra; Sunderland, Bruce; Parsons, Richard; Hoti, Kreshnik

    2017-02-01

    Background Pharmacist's skills are underutilized whilst they are directly involved with antibiotic supply to the community. Addressing this issue could lead to better use of antibiotics and hence decreased resistance. Objective Explore how pharmacists can prescribe oral antibiotics to treat a limited range of infections whilst focusing on their confidence and appropriateness of prescribing. Setting Community pharmacies, Western Australia. Method Data were collected using a self-administered questionnaire also containing case vignettes. These were distributed to a random sample of metropolitan and rural community pharmacies in Western Australia. A Generalised Estimating Equation was used to compare respondents' level of confidence in treating various infections and to assess appropriateness of prescribing. Main outcome measure Appropriateness and confidence of antibiotic prescribing. Results A response rate of 34.2% (i.e. 425 responses to case vignettes) was achieved from 240 pharmacies. There were high levels of confidence to treat simple infections such as uncomplicated UTIs (n = 73; 89.0%), impetigo (n = 65; 79.3%), mild bacterial skin infections (n = 62; 75.6%) and moderate acne (n = 61; 72.4%). Over 80% of respondents were confident to prescribe amoxicillin (n = 73; 89%), trimethoprim (n = 72; 87.8%), amoxicillin and clavulanic acid (n = 70; 85.4%), flucloxacillin (n = 70; 85.4%) and cephalexin (n = 68; 82.9%). High levels of appropriate antibiotic prescribing were shown for uncomplicated UTI (97.2%), cellulitis (98.2%) and adolescent acne (100.0%). Conclusion This study identified key limited infections and antibiotics for which pharmacists were supportive and confident to prescribe. This role could lead to better use of antibiotics in the community and minimisation of resistance.

  5. A importância dos limites no desenvolvimento de crianças com necessidades especiais

    OpenAIRE

    Jussara Iensen Pedroso; Carlos Décimo Martins

    2008-01-01

    O atual trabalho de pesquisa tem como proposta refletir sobre a importância do estabelecimento, por parte de pais e professores, de normas e regras de comportamento no desenvolvimento das crianças, no seu processo educativo e na sua constituição como sujeitos. Discutir sobre limites na formação das crianças, especificamente de crianças especiais, é de extrema importância principalmente no momento em que se procura efetivar a sua inclusão nos ambientes sociais. A partir da análise de dados, po...

  6. An Optimization-Based Impedance Approach for Robot Force Regulation with Prescribed Force Limits

    Directory of Open Access Journals (Sweden)

    R. de J. Portillo-Vélez

    2015-01-01

    Full Text Available An optimization based approach for the regulation of excessive or insufficient forces at the end-effector level is introduced. The objective is to minimize the interaction force error at the robot end effector, while constraining undesired interaction forces. To that end, a dynamic optimization problem (DOP is formulated considering a dynamic robot impedance model. Penalty functions are considered in the DOP to handle the constraints on the interaction force. The optimization problem is online solved through the gradient flow approach. Convergence properties are presented and the stability is drawn when the force limits are considered in the analysis. The effectiveness of our proposal is validated via experimental results for a robotic grasping task.

  7. Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patients

    DEFF Research Database (Denmark)

    Baandrup, Lone; Allerup, Peter; Lublin, H

    2010-01-01

    OBJECTIVE: To evaluate the effect of a multifaceted educational intervention on the frequency of antipsychotic co-prescribing in adult schizophrenia out-patients. METHOD: Controlled quasi-experimental study performed in two Danish municipalities matched for baseline prevalence of antipsychotic po...... for differences in case-mix (P = 0.07). CONCLUSION: This multifaceted educational intervention failed to reduce the frequency of antipsychotic co-prescribing, but it suggested that future efforts to improve prescribing practice should address organizational barriers to implementation....

  8. Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patients

    DEFF Research Database (Denmark)

    Baandrup, Lone; Allerup, Peter; Lublin, H

    2010-01-01

    polypharmacy, socioeconomic status and functional level of patients. The intervention was aimed at psychiatric healthcare providers and consisted of 1 day of didactic lectures, six 3-h educational outreach visits and an electronic reminder during drug prescribing. RESULTS: Between-group use of antipsychotic...

  9. 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...

  10. Para onde nos guia a mão invisível? Considerações sobre os paradoxos do modelo econômico hegemônico e sobre os limites ecológicos do desenvolvimento

    Directory of Open Access Journals (Sweden)

    Carolina Lopes Araujo

    2014-08-01

    Full Text Available A dinâmica do crescimento econômico contínuo vigente no capitalismo financeiro tem se mostrado incompatível com os limites planetários. A humanidade se encontra em um impasse ético, econômico e tecnológico. O modelo de produção e consumo vigente se mostra insuficiente para assegurar condições de vida digna para toda a humanidade no presente e aponta para uma deterioração dessas condições em um futuro próximo. Este artigo realiza uma revisão bibliográfica de trabalhos clássicos na teoria do desenvolvimento sustentável e, por meio da abordagem crítica da economia capitalista, coloca em xeque o conceito hegemônico do progresso e aponta a insuficiência do paradigma do crescimento para assegurar o desenvolvimento sustentável. Mesclando e conjugando as ideias dos principais autores dessas áreas, o artigo conclui que a sustentabilidade do desenvolvimento requer condicionantes que, ao longo do tempo, se tornam mais difíceis de serem alcançados. A dinâmica atual do sistema econômico leva a desgastes ambientais com efeitos cada vez mais severos, que serão sentidos especialmente a partir de 2030, podendo chegar a um colapso antes de 2100, comprometendo a capacidade de sobrevivência humana no planeta. A sustentabilidade, a suficiência e a equidade do desenvolvimento exigem uma mudança estrutural no paradigma de produção e de consumo. Para tanto, se fazem necessários mecanismos sociais, institucionais e informacionais, além da adequação e da coordenação dos avanços tecnológicos.

  11. Bens culturais acessíveis às crianças: limites e possibilidades para o desenvolvimento cultural na educação infantil

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    Muriane Sirlene Silva de Assis

    2012-10-01

    Full Text Available Este trabalho é parte de uma tese de doutorado que investigou o processo de desenvolvimento cultural da criança na Educação Infantil a partir das concepções de diferentes sujeitos. O presente trabalho focalizou as concepções das crianças, das professoras e dos pais sobre o acesso das crianças aos bens culturais. A pesquisa utilizou procedimentos metodológicos fundamentados em abordagem qualitativa e coletou dados por meio de entrevistas semiestruturadas e questionários. A Teoria Histórico-Cultural serviu de fundamentação teórica para o estudo. A análise dos dados enunciou que a escola e a família contribuíam para o desenvolvimento cultural das crianças, todavia, essa contribuição ocorria de forma pouco intencional e sistematizada. A pesquisa demonstrou que o acesso das crianças e dos adultos aos bens culturais era restrito e limitado, em especial à televisão, e isso empobrecia as possibilidades de desenvolvimento cultural deles. As atividades artísticas e culturais eram interpretadas como recurso didático-pedagógico e raramente se vinculavam ao lazer, ao divertimento, a ampliação da visão de mundo e consequentemente ao desenvolvimento cultural. O estudo ressaltou que não basta ter acesso aos bens culturais, há que se buscar por meio da apropriação do patrimônio cultural da humanidade, uma atuação mais consciente na prática social.

  12. 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

  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. Repensando a relação entre Estado, direito e desenvolvimento: os limites do paradigma rule of law e a relevância das alternativas institucionais Rethinking the relation between state, law and development

    Directory of Open Access Journals (Sweden)

    Mario Gomes Schapiro

    2010-06-01

    Full Text Available Assumindo a primazia da abordagem institucionalista na agenda contemporânea do desenvolvimento, este artigo procurará discutir alguns de seus limites, descritivos e normativos, no que tange, em especial, ao sistema financeiro. particularmente, procurar-se-á sugerir que os programas de difusão do rule of law têm se constituído em um paradigma estreito do papel exercido pelo direito, segundo a qual cabe ao ambiente jurídico cumprir, apenas e tão somente, a função de garantidor dos interesses de investidores privados, entendidos como atores centrais de um modelo de financiamento baseado em transações de mercado. o texto sugere que o paradigma rule of law, como estratégia de promoção do desenvolvimento, tem dificuldade em lidar com a existência de alternativas institucionais de organização econômica e financeira, para além de um modelo de mercado baseado em atores atomizados e carentes de segurança jurídica. um exemplo disso, que escapa do instrumental tradicional, é o modelo brasileiro de financiamento, que, apesar de ter vivenciado inúmeras reformas institucionais, dedicadas a elevar o nível de proteção de investidores, ainda concentra em um banco de desenvolvimento - o BNDES - grande parte do financiamento de longo prazo do país. o artigo assume, portanto, que, sim, o direito e as instituições, de fato, importam para o desenvolvimento, mas há uma variedade de possibilidades e funções a serem exercidas pelos arranjos institucionais e ferramentas jurídicas - muito além do que supõem os programas de Rule of Law. uma bem sucedida organização institucional baseada em um banco de desenvolvimento é um exemplo disso.Taken the prevalence of institutionalist and Rule of Law approach in the contemporary debate on economic development, this paper intends to discuss some theoretical limits of this literature, either positive or normative, mainly in its application to discussions related to the financial sector. this

  15. MEIO AMBIENTE E DESENVOLVIMENTO

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    Suely Salgueiro Chacon

    2009-12-01

    Full Text Available O objetivo deste artigo é resgatar elementos para subsidiar uma reflexão crítica sobre o modelo de desenvolvimento econômico prevalente na sociedade e as relações com o meio ambiente, sob a ameaça que ronda o destino da espécie humana, conforme afirmação de Lovelock (2006, p. 20 sobre o conceito de desenvolvimento sustentável: “uma ideia adorável se a tivéssemos aplicado 200 anos atrás, quando havia um bilhão de pessoas no mundo. Agora é tarde demais. Não há mais espaço para nenhum tipo de desenvolvimento. A humanidade tem que regredir”. Este artigo apresenta a evolução do conceito de desenvolvimento econômico sob a ótica da sustentabilidade, e interliga temas como: o ambientalismo, aglutinador de distintos pensamentos sobre as relações entre a sociedade e a natureza; o movimento ambiental, a fundamentar a disseminação do conceito de desenvolvimento sustentável, e a gestão ambiental, abordada como prática orientada pelo conceito de desenvolvimento sustentável.

  16. Valores e Desenvolvimento Humano

    NARCIS (Netherlands)

    F. Comim (Flavio); A. Macedo de Jesus (Anderson); R.C.B Oliveira (Raissa); A. Davison (Anna); S. Galeno (Sabrina); A.C.V. Ribeiro (Ana)

    2010-01-01

    markdownabstractA primeira parte desse Relatório de Desenvolvimento Humano do Brasil 2009/2010 começa com a descrição de um amplo processo de consulta aberta à sociedade, denominada Brasil Ponto a Ponto, para a escolha do tema do relatório. A Campanha Brasil Ponto a Ponto teve por objetivo

  17. Limites de Regionalizações para Elaboração de Estratégias para o Desenvolvimento Regional

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    José Elmar Feger

    2010-12-01

    Full Text Available In the debate on the regional strategic planning, little is questioned about what criteria shouldguide the regionalization. It seems that there is aconsideration of the geographical area defined apriori, and the plan consists of deepening knowledge on various aspects circumscribed here,becoming an obstacle to knowledge as an instrumentof action. The main objective of the article is,from an illustrative case; discuss the limits of the strategic planning when it adopts a pre-defined region, without proper questioning of its validityfor such a venture. As a methodology for surveyand tabulation of data, The Location Quotients (LQ were used, which are a indicative of thepotential for endogenous development of cities or regions. After calculating the LQs of the regionsand towns, they were allocated on a map of the regions to facilitate spatial analysis. Because this isan exploratory study, it does not provide conclusive results. However evidence shows that theregionalization adopted for strategic planning, tobe defined a priori, may be limiting the seizure ofreality, and therefore becoming an obstacle to theaction desired.

  18. OS LIMITES DO ‘DESENVOLVIMENTO LOCAL’ E AS POSSIBILIDADES ABERTAS PELA ABORDAGEM DIALÉTICA PROPOSTA POR DAVID HARVEY PARA COMPREENDER UMA REGIÃO

    Directory of Open Access Journals (Sweden)

    Rogério Faé

    2012-12-01

    Full Text Available O objetivo deste artigo é fundamentar a escolha pela perspectiva teórica do materialismo histórico-geográfico, desenvolvida pelo geógrafo David Harvey para compreender uma região. Para tanto, apresentamos e discutimos também os referenciais predominantes nas análises sobre regiões, com o intuito de demonstrar os limites desses referenciais e as possibilidades abertas pela perspectiva de Harvey. Assim, apresentamos alguns dos principais conceitos que têm orientado as ações de governos dos mais diversos matizes; a abordagem de David Harvey bem como seus pressupostos teóricos e históricos; e uma análise comparativa em que demonstramos as limitações dos referenciais predominantes e as possibilidades da perspectiva do último autor. Ao final, conclui-se que o materialismo histórico-geográfico permite compreender que as dinâmicas sociais e econômicas de uma região se caracterizam em processos conflituosos e contraditórios e resultam em uma configuração regional específica e transitória.

  19. Meios e fins do desenvolvimento para Celso Furtado

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    Fabio Antonio de Campos

    2014-10-01

    Full Text Available O objetivo desse artigo é expor o conceito de desenvolvimento para Celso Furtado. Para tanto, nos interessa apresentar o desenvolvimento nacional como um fim em sua abordagem sobre a formação social brasileira Para atingir tal estágio, os meios para o autor seriam assegurados por um típico desenvolvimento capitalista. Dentro dessa problemática, mostraremos também o alcance e os limites dessa concepção para o caráter dependente e subdesenvolvido do capitalismo brasileiro.

  20. 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.

  1. 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 ...

  2. Learning from prescribing errors

    OpenAIRE

    Dean, B

    2002-01-01

    

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

  3. Nacionalismo e desenvolvimento

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    Paulo Nogueira Batista Jr.

    2007-03-01

    Full Text Available Este texto discute o nacionalismo, tomando emprestadas algumas proposições de um filósofo declarada e radicalmente antinacionalista, Friedrich Nietzsche. Procura-se argumentar que, ressalvados os raros casos de integração regional profunda, o nacionalismo é, na prática, o único caminho para o desenvolvimento econômico e a melhoria das condições de vida das populações na periferia da economia internacional.This paper discusses nationalism, borrowing some propositions from a philosopher who was openly and radically antinationalist, Friedrich Nietzsche. It argues that, with the exception of the rare cases of deep regional integration, nationalism is, in practice, the only route to economic development and the improvement of the standards of living of populations in the periphery of the international economy.

  4. 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

  5. Self: um conceito em desenvolvimento

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    Lídia Suzana Rocha de Macedo

    2012-08-01

    Full Text Available Diversas definições de self coexistem nas teorias e práticas psicológicas. Essa variedade é resultante de bases epistemológicas a partir das quais se adotam estratégias diferentes para abordar e demarcar os limites do objeto em questão e descrevê-lo. Este estudo teve como objetivo oferecer uma revisão dos conceitos de self e uma reflexão sobre como esse conceito se articula nas diferentes abordagens teóricas da psicologia. Destaca-se que dilemas centrais à psicologia do desenvolvimento atravessam o conceito de self. Por essa razão, apresenta-se a tese de que, ao analisar cada definição de self, deve-se buscar responder como cada teoria colocou-se diante das dicotomias estabilidade versus transformação, específico versus universal e mundo interno versus mundo externo.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Amenidades ambientais e desenvolvimento rural

    OpenAIRE

    Dentinho, Tomaz; Rodrigues, Orlando

    2007-01-01

    Este texto sobre amenidades ambientais e desenvolvimento rural trata, fundamentalmente, da incerteza resultante da reacção das pessoas e das instituições face aos recursos naturais que exploram e quanto ao efeito das políticas que são implementadas.

  11. 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.

  12. Saúde e desenvolvimento

    Directory of Open Access Journals (Sweden)

    Ana Luiza D'Ávila Viana

    Full Text Available Considerando que os modernos sistemas de saúde são o resultado da complexa interação de processos econômicos, políticos e sociais, o objetivo do trabalho é discutir a relação entre saúde e desenvolvimento no Brasil, mostrando que o esgotamento do modelo liberal de política econômica abre nova perspectiva para a retomada do desenvolvimento, entendido como combinação entre crescimento da economia, mudanças na estrutura produtiva e melhora das condições de vida da população. O complexo produtivo da saúde joga papel decisivo nesse processo, pois constitui um campo em que inovação tecnológica e acumulação de capital geram oportunidades de investimento, trabalho e renda, além de produzir avanços importantes para melhorar o estado de saúde das pessoas. A recente adoção de políticas públicas voltadas para articular, de forma positiva, aspectos da política econômica e da política social revela que a questão do desenvolvimento nacional ganhou nova centralidade na agenda governamental, o que abre a perspectiva de maior integração entre a lógica econômica e a lógica sanitária. Entretanto, é preciso reconhecer que o Brasil ainda não logrou alcançar uma associação virtuosa entre saúde e desenvolvimento.

  13. 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.

  14. 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.

  15. 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…

  16. 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...

  17. 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...

  18. 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

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. ESTRATÉGIA DO DESENVOLVIMENTO URBANO COMO FATOR DETERMINANTE PARA O DESENVOLVIMENTO INDUSTRIAL SUSTENTÁVEL

    Directory of Open Access Journals (Sweden)

    Rúbia Tânia Welter

    2016-11-01

    Full Text Available Este artigo tem por objetivo identificar a estratégia do desenvolvimento urbano como fator do desenvolvimento industrial sustentável. Para alcançar este objetivo, foi realizada uma pesquisa documental e uma revisão histórico-bibliográfica de uma cidade, neste caso, a cidade de Joinville-SC. Foi realizado, também, um estudo sobre a evolução dos acontecimentos históricos da cidade pesquisada, como forma de estabelecer que estratégias adotadas interferiram neste processo de desenvolvimento. Como resultado, foram identificados os fatores estratégicos inerentes ou determinantes para o desenvolvimento industrial da cidade. Palavras-chave: Desenvolvimento urbano. Desenvolvimento industrial. Fatores estratégicos.

  5. 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.

  6. 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

  7. 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

  8. 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...

  9. Nutrição e desenvolvimento Nutrition and development

    Directory of Open Access Journals (Sweden)

    Ilma K. G. de Arruda

    1994-09-01

    Full Text Available As discussões sobre desenvolvimento e nutrição freqüentemente se realizam sob um duplo enfoque: aqueles que consideram o estado nutricional como reflexo do desenvolvimento, e os que admitem que a nutrição influencia fortemente no nível e ritmo desse desenvolvimento. Os autores focalizam o tema visualizando a nutrição como um fator decisivo para um bom desenvolvimento social e econômico, particularizando o fato de que as intervenções nutricionais podem contribuir para melhorias significativas nos resultados escolares, na produtividade do trabalho e na resistência às infecções. Assim, os reflexos da desnutrição na economia seriam evidentes: quer pelas limitações na expectativa de renda, quer pelo aumento dos custos dos compromissos que a população assume para proteger-se, quer pelos avultados custos ocultos de origem social - absenteísmo, acidentes do trabalho e rotatividade de pessoal. Em face dos propósitos de modernização e competitividade da economia, é inquestionável a necessidade da nutrição figurar bem alto na lista de prioridades nacionais. Com isso, promover-se-ia o desenvolvimento dos recursos humanos e a preservação desse capital, que é o ideário de uma economia socialmente responsável.Discussions on development and nutrition frequently have a double focus: one that considers nutritional status as a reflection of development, and another that admits that nutrition strongly influences the level and rhythm of development. The authors view nutrition as a decisive factor for adequate social and economic development, specifying the fact that nutritional interventions might contribute to significant improvements in individual classroom performance, productivity at the workplace, and resistance to infections. The implications of malnutrition for the economy are thus evident: either by limitations in income expectations, increased costs deriving from burdens assumed by the population to protect themselves, or

  10. CERVEJA ARTESANAL E DESENVOLVIMENTO REGIONAL EM SANTA CATARINA (BRASIL

    Directory of Open Access Journals (Sweden)

    Valdinho Pellin

    2016-12-01

    Full Text Available Discussões relacionadas ao fortalecimento do desenvolvimento regional tem estimulado um debate em relação a contribuições que Indicações Geográficas (IGs podem oferecer ao desenvolvimento. IGs se constituem em elemento de identificação de produtos ou serviços com seus territórios e podem oferecer contribuições importantes para o desenvolvimento regional, agregando valor aos produtos, facilitando o acesso a novos mercados e valorizando tradições locais. Este artigo procura discutir a importância da cerveja artesanal no contexto do desenvolvimento regional em Santa Catarina. Para tanto explora como objetivos específicos: (i caracterizar as discussões que estão ocorrendo em torno do reconhecimento da IG para chope e cerveja artesanal na região de Blumenau (SC; (ii identificar contribuições e desafios para o Desenvolvimento Regional de um possível reconhecimento da IG; e (iii caracterizar limites e potencialidades sinalizados pela iniciativa em curso. Metodologicamente trata-se de pesquisa analítica e descritiva baseada em estudo de caso de natureza exploratória. Como instrumento de coleta de dados se realizou entrevistas semiestruturadas com gestores de micro cervejarias artesanais da região e atores públicos e privados envolvidos diretamente nas discussões. Além destas fontes primárias o estudo fundamentou-se em fontes consubstanciadas pelos documentos produzidos nas reuniões de trabalho realizadas até o presente. Os principais resultados de análise destacam que um possível reconhecimento da IG poderia contribuir para o fortalecimento do setor, aumentando a competitividade, além de fortalecer a atividade turística na região. Entretanto para isso, alguns conflitos, surgidos no âmbito das discussões, precisam ser assumidos, superados ou mitigados

  11. A teoria do “desenvolvimento fragmentador”

    Directory of Open Access Journals (Sweden)

    Fred Scholz

    2010-04-01

    Full Text Available O pensamento desenvolvimentista do passado era dominado pela ideia de que o subdesenvolvimento do Terceiro Mundo poderia ser superado mediante ajuda técnica, financeira e pessoal dos países do Norte. A meta era alcançar o nível de desenvolvimento dos países ocidentais industrializados por meio de um desenvolvimento retardatário. Na base dessa ideia estava, por um lado, o consenso de valores ocidental-humanitários, que, o mais tardar desde a época do Esclarecimento, determinou o pensar e o devir social. Por outro lado, a ideia baseou-se na responsabilidade histórica (surgida das condições da Guerra Fria, aceita política e socialmente do "Ocidente" para com os chamados países em desenvolvimento, na sua maioria ex-colônias. Argumenta-se, neste artigo, que a ideia de um desenvolvimento retardatário deve, na era da globalização, ser substituída pelo fato de um desenvolvimento fragmentador.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. Gerenciamento de Projetos em Pesquisa e Desenvolvimento

    Directory of Open Access Journals (Sweden)

    Mauro Maia Laruccia

    2013-01-01

    Full Text Available Este trabalho tem por objetivo estudar o gerenciamento de projetos na área de Pesquisa e Desenvolvimento, em um cenário onde os avanços da tecnologia têm influenciado nas mais diversas áreas do conhecimento humano e passaram a exigir abordagens diferenciadas na forma de planejar, executar e controlar os projetos, para assegurar os resultados almejados pelas organizações. Avaliar as formas de conhecimento aplicadas ao gerenciamento de projetos e as interações de suas disciplinas apresenta-se como uma condição oportuna para compreensão e melhoria do processo de gerenciamento de projetos. Considerando que a interdisciplinaridade destaca-se na crítica e na busca de respostas aos limites do conhecimento e que rompe com o paradigma disciplinar de produção do conhecimento particionado, a análise da forma de conhecimento do gerenciamento de projetos pode contribuir para desvelar oportunidades e engendrar melhorias neste processo. Verifica-se que o gerenciamento de projeto tem evoluído continuamente e congrega diversas disciplinas do conhecimento nos modelos praticados. Atualmente, um dos modelos mais consagrados de gerenciamento de projetos é o Project Management Body of Knowledge (PMBOK, publicado pelo Project Management Institute (PMI, que é utilizado em mais de 185 países. Vale ressaltar, que a simples comunicação entre as disciplinas do gerenciamento de projetos não significa que estejamos aplicando necessariamente uma abordagem interdisciplinar. Analisar o gerenciamento de projetos na ótica da interdisciplinaridade pode contribuir para o aperfeiçoamento dos modelos de gerenciamento de projetos e consequentemente para a geração de melhores resultados para as organizações.DOI:10.5585/gep.v3i3.82

  17. Os limites e possibilidades de desenvolvimento humano nas teorias organizacionais

    Directory of Open Access Journals (Sweden)

    Daniela Giareta Durante

    2008-01-01

    Full Text Available This text analyse how the human development the his broached in the Administrative Theories (Scientific Administration, School of Human Relationships, Motivation and leadership Theories, Structuralist Theory and System Theory. The theories studied promote the human being development very little due to the fact that the worry and the politics were usually concerning the organizational effectiveness, relegating the social aspect to the economical one. The participative administration, the knowledge administration, the development of the emancipatory logic, the theory of the communicative action, among others, represent alternatives to conciliate the organizational and individual interests in the perspective of the development. However, these alternatives implicate in the change of paradigms, in a critical view of the reality which goes beyond the functionalist rationality still predominant in the organizational environment.

  18. Os limites e possibilidades de desenvolvimento humano nas teorias organizacionais

    OpenAIRE

    Daniela Giareta Durante; Enise Barth Teixeira

    2008-01-01

    This text analyse how the human development the his broached in the Administrative Theories (Scientific Administration, School of Human Relationships, Motivation and leadership Theories, Structuralist Theory and System Theory). The theories studied promote the human being development very little due to the fact that the worry and the politics were usually concerning the organizational effectiveness, relegating the social aspect to the economical one. The participative administration, the know...

  19. 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.

  20. Hackers e sua relação com o surgimento e desenvolvimento da chipmusic

    Directory of Open Access Journals (Sweden)

    Camila Schäfer

    2015-07-01

    Full Text Available O presente artigo tem como objetivo relacionar as características da microcultura hacker com o surgimento e desenvolvimento da cena musical chipmusic. Para isso, utilizam-se dados divulgados amplamente sobre a cena chipmusic internacional, além de entrevistas com um grupo de músicos brasileiros. Por fim, conclui-se que, tanto a microcultura hacker, como o desenvolvimento da tecnocultura atual, têm criado nas pessoas um desejo de explorar os limites de hardwares e softwares, que, por sua vez, acaba dando origem a cenas como a chipmusic, objeto deste trabalho. 

  1. Antipsychotic prescribing in older people.

    Science.gov (United States)

    Neil, Wendy; Curran, Stephen; Wattis, John

    2003-09-01

    Antipsychotic medications have made a significant contribution to the care of the mentally ill people over the past 50 years, with good evidence that both typical and atypical agents are effective in the treatment of schizophrenia and related conditions. In addition they are widely used to good effect in other disorders including psychotic depression, dementia and delirium. Both typical and atypical agents may cause severe side-effects and, in the elderly in particular, there is an increased propensity for drug interactions. If used with care, antipsychotics are usually well tolerated, especially the atypical drugs. Although antipsychotics are effective at reducing psychotic symptoms their limitations should be recognised. They do not 'cure' the underlying illness, and the management of psychotic and behavioural symptoms must take into consideration treatment of physical illness as well as psychosocial interventions. In addition, the antipsychotic effect may take one to two weeks to be evident so doses should not be increased too rapidly. Often small doses are effective in the elderly if they are given sufficient time to work. As our understanding of the mechanisms of psychosis improves it is hoped that new drugs will be developed with novel mechanisms of action with improved efficacy and reduced side-effects. There are several drugs in development, some sharing similarities to currently available agents whilst others have novel mechanisms of actions involving glutamate and nicotinic receptors. Pharmacogenetics is also likely to be increasingly important over the next few years. As the genetic basis of many psychiatric disorders becomes more clearly established it is likely that drugs specifically designed for particular sub-groups of receptors will be developed. Finally, although the pharmacological treatment of psychotic disorders in younger people has been given considerable attention, there is a paucity of good quality research on antipsychotic drug use in

  2. CONHECIMENTO: UM FATOR DE DESENVOLVIMENTO ORGANIZACIONAL

    Directory of Open Access Journals (Sweden)

    Adilson dos Santos Morais

    2017-09-01

    Full Text Available Cada vez mais, criar conhecimento útil para atuar em uma posição de vantagem competitiva, orientado para o desenvolvimento organizacional e valorizando o capital humano tem-se demonstrato uma estratégia eficaz. O presente artigo busca apresentar a importância do conhecimento para o desenvolvimento das organizações em âmbito geral com destaque para as comunidades de prática. Esse conhecimento é derivado das interações desenvolvidas em processos de aprendizagem que ocorrem no ambiente organizacional. Para este, realizou-se um estudo teórico, descritivo, que tem como procedimento a pesquisa bibliográfica. Deste modo, apresenta como resultado deste trabalho a evidência de que existem poucos resultados divulgados sobre retorno financeiro e os benefícios dos investimentos realizados no capital intelectual humano pelas organizações. Porém, o conhecimento agrega valor à organização aumentando o valor do capital intelectual e as literaturas sobre o conhecimento e desenvolvimento organizacional consideram o capital intelectual o fator chave para a melhoria nos sistemas estratégicos. Destaca-se que esta contribuição poderá instigar cada vez mais a criação de conhecimento como fator de reconhecimento humano e de desenvolvimento das organizações.

  3. 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...

  4. 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?

  5. Desenvolvimento econômico, desigualdade e saúde Economic development, inequality, and health

    Directory of Open Access Journals (Sweden)

    Pedro Reginaldo Prata

    1994-09-01

    Full Text Available O autor se refere a dimensão socioeconômica, individual e coletiva do fenômeno saúde-doença. Refere-se também ao fato das populações estarem sobre a influência desigual de fatores de risco e de proteção à saúde. Discute as desigualdades no desenvolvimento e a relação entre desenvolvimento, riqueza, saúde e justiça social. Questiona as teorias de desenvolvimento econômico, diferenciando desenvolvimento de crescimento. Cunha os conceitos de armadilha do desenvolvimento e refugiados sociais. Define uma comunidade saudável. Propõe a necessidade de mudança no modelo de desenvolvimento. Baliza o papel e as limitações do setor saúde no que diz respeito a iniqüidade social.The author refers to the social, economic, individual, and collective dimensions of the relationship between health and disease. He considers that individuals and populations are not equally exposed to protective and risk factors. He highlights the uneven development between nations and Brazilian regions, and communities, as well as discussing the relationship between development, wealth, health, and social justice. The article analyzes development theories and makes a distinction between economic development and growth. The concepts of development trap and social refugees are coined. The author defines a healthy community, points to the need for a shift in the current development model, and delineates the health sector's role and limitations in dealing with social inequality.

  6. 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...

  7. 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.

  8. 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.

  9. 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...

  10. 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.

  11. Desenvolvimento econômico, desigualdade e saúde

    Directory of Open Access Journals (Sweden)

    Prata Pedro Reginaldo

    1994-01-01

    Full Text Available O autor se refere a dimensão socioeconômica, individual e coletiva do fenômeno saúde-doença. Refere-se também ao fato das populações estarem sobre a influência desigual de fatores de risco e de proteção à saúde. Discute as desigualdades no desenvolvimento e a relação entre desenvolvimento, riqueza, saúde e justiça social. Questiona as teorias de desenvolvimento econômico, diferenciando desenvolvimento de crescimento. Cunha os conceitos de armadilha do desenvolvimento e refugiados sociais. Define uma comunidade saudável. Propõe a necessidade de mudança no modelo de desenvolvimento. Baliza o papel e as limitações do setor saúde no que diz respeito a iniqüidade social.

  12. A mesoeconomia do desenvolvimento econômico: o papel das instituições

    Directory of Open Access Journals (Sweden)

    Huáscar Pessali

    2011-01-01

    Full Text Available O desenvolvimento econômico depende das instituições e as instituições, ao mesmo tempo, são uma medida do desenvolvimento econômico. Assim, correlação e causalidade se confundem num processo cumulativo e circular - uma espiral de mudanças que condiciona a ampliação das liberdades dos indivíduos. A contribuição pretendida por este ensaio é reunir e propor uma organização de várias idéias dispersas no tema "instituições e desenvolvimento econômico". Nossa releitura adiciona um breve exemplo da relação entre mercados, firmas e estado no âmbito do desenvolvimento. Isto permite defender o retorno a uma análise econômica que não se limite às falhas de mercado, mas que encare a responsabilidade de lidar com um emaranhado mais complexo de interações.

  13. 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...

  14. 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

  15. 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....

  16. 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.

  17. 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.

  18. 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 ...

  19. 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 ...

  20. 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.

  1. 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.

  2. 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/.

  3. Charles Darwin: um observador do desenvolvimento humano

    Directory of Open Access Journals (Sweden)

    Eloisa Helena Rubello Valler Celeri

    2010-12-01

    Full Text Available Os autores traduzem, pela primeira vez para o português, o artigo de Charles Darwin "A Biographical Sketch of an Infant", publicado no periódico Mind em julho de 1877. Utilizando anotações de observações do desenvolvimento de seus filhos, especialmente de seu filho mais velho William Erasmus (Doddy, Darwin descreve e estuda, a partir de seu enfoque naturalista, o filhote humano, narrando os primeiros indicativos comportamentais de emoções tais como raiva e medo, curiosidade e senso moral, o brincar e o prazer envolvido nesta atividade, a capacidade de imitação e os primeiros indícios daquilo que hoje conhecemos como "teoria da mente". Colocando-se questões sobre as capacidades do bebê, como eles aprendem e como se comunicam e levantando hipóteses sobre possíveis significados de certos comportamentos, questões ainda hoje fundamentais para o estudo do desenvolvimento humano, Darwin mostra-se também um pioneiro no estudo do bebê e da criança pequena, numa época na qual as capacidades dos bebês eram extremamente subestimadas e desconsideradas.

  4. Desenvolvimento puberal em meninas tratadas de LLA

    Directory of Open Access Journals (Sweden)

    Monteiro I.M.M.

    1998-01-01

    Full Text Available OBJETIVO: Com o objetivo de avaliar o desenvolvimento puberal após o tratamento de leucemia linfóide aguda (LLA na infância, foi realizado um estudo retrospectivo, em meninas tratadas de janeiro de 1980 a janeiro de 1991, no Centro de Investigações Hematológicas "Dr. Domingos A. Boldrini", em Campinas-SP. CASUÍSTICA E MÉTODO: Foram selecionadas 42 meninas, tratadas antes da puberdade com quimioterapia sistêmica e intratecal e radioterapia cranial, utilizando doses de 18 ou 24 Grays (Gy. RESULTADOS: As idades médias da telarca, pubarca e menarca foram inferiores às do grupo-controle, embora com significância estatística apenas para a idade da telarca. Não houve diferenças entre os grupos tratados com 18 ou 24Gy. As meninas tratadas antes dos cinco anos de idade apresentaram idade média da menarca estatisticamente inferior àquelas tratadas após cinco anos e em relação ao grupo-controle. CONCLUSÃO: Os resultados mostraram que o desenvolvimento puberal em meninas tratadas de LLA na infância foi mais precoce que o de meninas saudáveis.

  5. Robust test limits

    NARCIS (Netherlands)

    Albers, Willem/Wim; Kallenberg, W.C.M.; Otten, G.D.

    1997-01-01

    Because of inaccuracies of the measurement process inspection of manufactured parts requires test limits which are more strict than the given specification limits. Test limits derived under the assumption of normality for product characteristics turn out to violate the prescribed bound on the

  6. 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.

  7. 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

  8. Herbicides as an alternative to prescribed burning for achieving wildlife management objectives

    Science.gov (United States)

    T. Bently Wigley; Karl V. Miller; David S. deCalesta; Mark W. Thomas

    2002-01-01

    Prescribed burning is used for many silvicultural and wildlife management objectives. However, the use of prescribed burning can be constrained due to difficulties in obtaining burning permits, concerns about liability, potential effects of scorch on growth and survival of crop trees, its sometimes ineffective results, limited burning days, and the costs of applying,...

  9. Prescribed burning in the interior ponderosa pine type of northeastern California . . . a preliminary study

    Science.gov (United States)

    Donald T. Gordon

    1967-01-01

    Three prescribed burns, made in 1959-62, in the interior ponderosa pine type of northeastern California are described in terms of meteorological factors, fire behavior, and effects of burning. Results were generally unsatisfactory. Factors that limit the usefulness of prescribed burning for reducing fuel hazard or for thinning in young-growth stands include stand...

  10. 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.

  11. 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...

  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. DIREITOS HUMANOS, DESENVOLVIMENTO SUSTENTÁVEL E SUSTENTABILIDADE

    OpenAIRE

    Carvalho, Sonia Aparecida de; Silva, Denival Francisco da; Adolfo, Luiz Gonzaga Silva

    2015-01-01

    Este artigo trata da relação intrínseca entre os direitos humanos, o desenvolvimento sustentável e a sustentabilidade. Seu objetivo geral consiste em analisar o modelo de desenvolvimento implementado e a necessária proteção e preservação do meio ambiente ligado à defesa dos direitos humanos. Os objetivos específicos pretendem investigar a distinção dos termos sustentabilidade e desenvolvimento sustentável, como a concretização do direito à sustentabilidade, os critérios e as dimensões da sust...

  14. O DIREITO FUNDAMENTAL AO DESENVOLVIMENTO SUSTENTÁVEL

    OpenAIRE

    Fernandes, Jeferson Nogueira

    2012-01-01

    Este artigo jurídico trata do direito fundamental do ser humano ter um desenvolvimento sustentável, e tem como objetivo identificar o desenvolvimento sustentável como sendo um direito fundamental consagrado universalmente. Em sua elaboração foi utilizado o seguinte material: textos doutrinários, legislação nacional pertinente e documentos internacionais. A conclusão indica que: o desenvolvimento sustentável é um direito fundamental do homem e que devemos manter equilibrada a relação ambiente ...

  15. O desafio político do desenvolvimento sustentado

    OpenAIRE

    Guimarães,Roberto P.

    1995-01-01

    A unanimidade que hoje parece haver em favor do desenvolvimento sustentado contrasta com a ausência de iniciativas políticas significativas para transformar as instituições econômicas, sociais e políticas que estão comprometidas com o estilo vigente de desenvolvimento. Em particular, há uma patente contradição entre o discurso antiestatista hegemônico e as exigências do desenvolvimento sustentado, que incluem um Estado ainda mais forte, em suas capacidades reguladoras e de planificação, que o...

  16. CERVEJA ARTESANAL E DESENVOLVIMENTO REGIONAL EM SANTA CATARINA (BRASIL)

    OpenAIRE

    Valdinho Pellin; Oklinger Mantovaneli Jr.

    2016-01-01

    Discussões relacionadas ao fortalecimento do desenvolvimento regional tem estimulado um debate em relação a contribuições que Indicações Geográficas (IGs) podem oferecer ao desenvolvimento. IGs se constituem em elemento de identificação de produtos ou serviços com seus territórios e podem oferecer contribuições importantes para o desenvolvimento regional, agregando valor aos produtos, facilitando o acesso a novos mercados e valorizando tradições locais. Este artigo procura discutir a importân...

  17. Emissions from Combustion of Open Area Sources: Prescribed Forest and Agricultural Burns

    Science.gov (United States)

    Emissions from wildfires and prescribed forest and agricultural burns generate a variety of emissions that can cause adverse health effects for humans, contribute to climate change, and decrease visibility. Only limited pollutant data are available for these sources, particularly...

  18. 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, ...

  19. 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.

  20. 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.

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    Anuja Damani

    2016-01-01

    Full Text Available Introduction: There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging specialty. Prescribing pain and symptom control drugs in children with cancer requires knowledge of palliative care formulary, dosing schedules, and prescription guidelines. This study is a retrospective audit of prescribing practices of a specialist palliative care service situated in a tertiary cancer center. Methods: A total of 1135 medication records of children receiving specialist pediatric palliative care services were audited for 5 years (2010-2014 to evaluate prescribing practices in children with advanced cancer. Results: A total of 51 types of drugs were prescribed with an average of 4.2 drugs per prescription. 66.9% of the prescriptions had paracetamol, and 33.9% of the prescriptions had morphine. Most common nonsteroidal anti-inflammatory drugs prescribed was ibuprofen (23.9%, and more than 50% of the prescriptions had aperients. The most commonly prescribed aperient was a combination of liquid paraffin and sodium-picosulfate. Dexamethasone was prescribed in 51.9% of patients and in most cases this was part of oral chemotherapy regimen. Generic names in prescription were used only in 33% of cases, and adverse effects of the drugs were documented in only 9% of cases. In 25% of cases, noncompliance to the WHO prescription guidelines was seen, and patient compliance to prescription was seen in 40% of cases. Conclusions: Audit of the prescribing practices in specialist pediatric palliative care service shows that knowledge of pediatric palliative care formulary, rational drug use, dosing, and prescribing guidelines is essential for symptom control in children with advanced life-limiting illness. Noncompliance to WHO prescribing guidelines in one fourth of cases and using nongeneric names in two-thirds of prescription indicates poor prescribing practices and warrants prescriber education. Prescription

  3. 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.

  4. Rede de Protagonismo Local para o Desenvolvimento Global

    DEFF Research Database (Denmark)

    Weber, Ángela; Hermann, Roberto Rivas

    Este artigo pretende fazer uma reflexão sobre metodologia a ser desenvolvida e utilizada num projeto de desenvolvimento local, através das ações protagonizadas pela própria comunidade. Para isso parte de uma discussão sobre o conceito de desenvolvimento sustentável, e a seguir propõe a busca de f...

  5. 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

  6. Biotecnologia e desenvolvimento sustentável

    Directory of Open Access Journals (Sweden)

    Ana Clara Guerrini Schenberg

    2010-01-01

    Full Text Available A biotecnologia pode desempenhar um papel importante para atingir as metas da sustentabilidade. No presente trabalho, são descritos diferentes exemplos bem-sucedidos de micro-organismos especialmente desenhados para otimizar a produção de etanol, a produção de plásticos biodegradáveis a partir de recursos renováveis e a biorremediação de metais tóxicos. Esses processos biotecnológicos contribuem significantemente para promover o desenvolvimento sustentável, embora possam, por enquanto, não ser ainda competitivos em relação às tecnologias convencionais.Biotechnology can play an important role to reach the goals of sustainability. In the present work, we describe successful examples of microorganisms especially designed for optimizing ethanol production, biodegradable plastics production from renewable resources, and toxic metals bioremediation. These biotechnological processes significantly contribute to promote sustainable development, although they may, at present, not be competitive with the conventional technologies.

  7. 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

  8. 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.

  9. Drug formularies--good or evil? A view using prescribing analyses and cost trends data.

    Science.gov (United States)

    Chapman, S

    1994-01-01

    In the UK, the drugs bill has almost trebled in the last 10 years and is consuming an increasing proportion of the total National Health Service spend. If the drugs bill can be limited, greater funds will be available for other areas of the health service. Therefore, cost containment measures which include prescribing from a formulary or generic prescribing are now widely encouraged. Prescribing analyses and cost trends data generated from pharmacists sending dispensed general practitioners' prescriptions to a central point for reimbursement are a valuable tool in the assessment of prescribing habits and can be used by general practitioners when preparing a formulary. In the West Midlands, such data have been used to identify areas of growth in cardiovascular drugs and problem areas where prescribing an expensive formulation has led to a dramatic increase in costs.

  10. Nurse practitioner prescribing: an international perspective

    Directory of Open Access Journals (Sweden)

    Fong J

    2015-10-01

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

  11. Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia.

    Science.gov (United States)

    Ab Rahman, Norazida; Teng, Cheong Lieng; Sivasampu, Sheamini

    2016-05-17

    Antibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia. We used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014. NMCS contained demographic, diagnoses and prescribing from 129 public clinics and 416 private clinics. We identified all encounters who were prescribed antibiotic and analyse the prescribing rate, types of antibiotics, and diagnoses that resulted in antibiotic. Five thousand eight hundred ten encounters were prescribed antibiotics; antibiotic prescribing rate was 21.1 % (public clinics 6.8 %, private clinics 30.8 %). Antibiotic prescribing was higher in private clinics where they contributed almost 87 % of antibiotics prescribed in primary care. Upper respiratory tract infection (URTI) was the most frequent diagnosis in patients receiving antibiotic therapy and accounted for 49.2 % of prescriptions. Of the patients diagnosed with URTI, 46.2 % received antibiotic treatment (public 16.8 %, private 57.7 %). Penicillins, cephalosporins and macrolides were the most commonly prescribed antibiotics and accounted for 30.7, 23.6 and 16.0 % of all antibiotics, respectively. More recently available broad-spectrum antibiotics such as azithromycin and quinolones were more frequently prescribed in private clinics. Antibiotic prescribing rates are high in both public and private primary care settings in Malaysia, especially in the latter. This study provides evidence of excessive and inappropriate antibiotic prescribing for self-limiting conditions. These data highlights the needs for more concerted interventions targeting both prescribers and public. Improvement strategies should focus on reducing

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. 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....

  17. 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.

  18. Antibiotic prescribing for acute bronchitis

    DEFF Research Database (Denmark)

    Llor, Carl; Bjerrum, Lars

    2016-01-01

    INTRODUCTION: Acute bronchitis is a self-limiting infectious disease characterized by acute cough with or without sputum but without signs of pneumonia. About 90% of cases are caused by viruses. AREAS COVERED: Antibiotics for acute bronchitis have been associated with an approximately half......-day reduction in duration of cough. However, at follow-up there are no significant differences in overall clinical improvement inpatients treated with antibiotics compared with those receiving placebo. Despite this, antibiotics are administered to approximately two thirds of these patients. This review...... discusses the reason for this antibiotic overprescription. Other therapies targeted to control symptoms have also demonstrated a marginal or no effect. EXPERT COMMENTARY: Clinicians should be aware of the marginal effectiveness of antibiotic therapy. Some strategies like the use of rapid tests, delayed...

  19. Os eventos programados, como alternativo do desenvolvimento do turismo

    Directory of Open Access Journals (Sweden)

    Andrés Pinassi

    2014-10-01

    Full Text Available Turismo e lazer são vistos como uma alternativa para o desenvolvimento econômico, social e cultural de uma comunidade. Ambas práticas de lazer são consolidadas como processos sócio-espaciais que podem trazer muitos impactos benéficos para os moradores de uma determinada localidade. Assim, a dinâmica de eventos programados em aldeias visa proporcionar uma alternativa oportunidades de desenvolvimento local para comunidades carentes. Nesse contexto, a pesquisa desenvolvida, em seguida, analisa o desenvolvimento de um festival especial, realizada na Provincia de Buenos Aires (Argentina. Este festival, iniciado a partir da esfera pública municipal, mostrou benefícios económicos significativos e definir um entretenimento alternativa valiosa para a população local e da área de influência.

  20. Preparando um ambiente de desenvolvimento para a plataforma android

    Directory of Open Access Journals (Sweden)

    Felipe Pires de Oliveira

    2015-11-01

    Full Text Available Este artigo descreve as etapas para a criação de um ambiente de desenvolvimento para a plataforma Android. O artigo foi dividido em quatro partes: Primeiro uma introdução sobre o assunto. Na segunda seção são mostrados os passos necessários para a configuração do ambiente de desenvolvimento. Na terceira seção, é demonstrado como criar uma aplicação para dispositivo Android que calculo Índice de Massa Corporal (IMC. A quarta seção apresenta as considerações finais. A solução abordada tem como base a IDE Eclipse e o SDK do Android, bem como o Kit de Desenvolvimento Java da Oracle (JDK.

  1. Preparando um ambiente de desenvolvimento para a plataforma android

    Directory of Open Access Journals (Sweden)

    Felipe Pires de Oliveira

    2015-12-01

    Full Text Available Este artigo descreve as etapas para a criação de um ambiente de desenvolvimento para a plataforma Android. O artigo foi dividido em quatro partes: Primeiro uma introdução sobre o assunto. Na segunda seção são mostrados os passos necessários para a configuração do ambiente de desenvolvimento. Na terceira seção, é demonstrado como criar uma aplicação para dispositivo Android que calculo Índice de Massa Corporal (IMC. A quarta seção apresenta as considerações finais. A solução abordada tem como base a IDE Eclipse e o SDK do Android, bem como o Kit de Desenvolvimento Java da Oracle (JDK.

  2. What do providers want to know about opioid prescribing? A qualitative analysis of their questions.

    Science.gov (United States)

    Cushman, Phoebe A; Liebschutz, Jane M; Hodgkin, Joseph G; Shanahan, Christopher W; White, Julie L; Hardesty, Ilana; Alford, Daniel P

    2017-01-01

    In 2012, the US Food and Drug Administration (FDA) responded to the opioid crisis with a Risk Evaluation and Mitigation Strategy, requiring manufacturers of extended-release/long-acting opioids to fund continuing medical education based on the "FDA Blueprint for Prescriber Education." Topics in the Blueprint are "Assessing Patients for Treatment," "Initiating Therapy, Modifying Dosing, and Discontinuing Use," "Managing Therapy," "Counseling Patients and Caregivers about Safe Use," "General Drug Information," and "Specific Drug Information." Based on the FDA Blueprint, Boston University School of Medicine's "Safe and Competent Opioid Prescribing Education" (SCOPE of Pain) offers live trainings for physicians and other prescribers. During trainings, participants submit written questions about the curriculum and/or their clinical experiences. The objective was to compare themes that arose from questions asked by SCOPE of Pain participants with content of the FDA Blueprint in order to evaluate how well the Blueprint answers prescribers' concerns. The authors conducted qualitative analyses of all 1309 questions submitted by participants in 29 trainings across 16 states from May 2013 to May 2015, using conventional content analysis to code the questions. Themes that emerged from participants' questions were then compared with the Blueprint. Most themes fell into the topic categories of the Blueprint. Five main themes diverged: Participants sought information on (1) safe alternatives to opioids, (2) overcoming barriers to safe opioid prescribing, (3) government regulations of opioid prescribing, (4) the role of marijuana in opioid prescribing, and (5) maintaining a positive provider-patient relationship while prescribing opioids. In addition to learning the mechanics of safe opioid prescribing, providers want to understand government regulations and effective patient communication skills. Aware of the limitations of opioids in managing chronic pain, providers seek advice

  3. Desenvolvimento de um monitor de apneia pediátrico

    OpenAIRE

    Caldeira, Gonçalo José Martins

    2009-01-01

    O trabalho apresentado tem por base o desenvolvimento de um monitor de apneia do sono pediátrico. Aborda questões ao nível da fisiologia respiratória e da mecânica pulmonar de um indivíduo. Apresenta uma proposta de desenvolvimento de um monitor de aquisição e identificação de sinais respiratórios, a fim de efectuar a detecção da apneia do sono.

  4. 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

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

    NARCIS (Netherlands)

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

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

  6. 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.

  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. 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.

  10. 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.

  11. 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.

  12. 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 ...

  13. 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: ...

  14. O desenvolvimento sustentável: uma palavra e as coisas

    Directory of Open Access Journals (Sweden)

    Wolf-Dietrich SAHR

    1998-12-01

    Full Text Available A discussão sobre o desenvolvimento sustentável é um exercício interessante para se entender as novas formas do relacionamento entre a ciência e a política que surgiram durante os trinta anos passados. Originalmente vindo do âmbito da economia e modificado por abordagens ecológicas, o conceito se transformou, durante os anos 80, em palavra-chave nas discussões internacionais e interdisciplinares sobre o desenvolvimento em sua relação com a natureza. Percebe-se que várias qualidades clássicas da metodologia científica, como exatidão das definições e termos técnicos, epistemologias disciplinares e rígidas formulações de teorias, perderam gradativamente sua relevância durante esse processo. Isso colocou os limites da própria ciência acadêmica em questão. Através de uma crítica do economicismo ecológico, que até hoje domina no discurso, abre-se um espaço para a incorporação de abordagens epistemológicas diferentes da ciência pura como atividades sociais, métodos psico-analíticos e até mesmo atividades da arte e da religião. O discurso do desenvolvimento sustentável apresenta-se, deste modo, como uma modificação cultural do próprio meio académico nas condições da pós-modernidade.

  15. Perspectives on Trends, Effectiveness, and Impediments to Prescribed Burning in the Southern U.S.

    Directory of Open Access Journals (Sweden)

    Leda N. Kobziar

    2015-02-01

    Full Text Available The southern region of the U.S. uses prescribed fire as a management tool on more of its burnable land than anywhere in the U.S., with ecosystem restoration, wildlife habitat enhancement, and reduction of hazardous fuel loads as typical goals. Although the region performs more than 50,000 prescribed fire treatments each year, evaluation of their effects on wildfire suppression resources or behavior/effects is limited. To better understand trends in the use and effectiveness of prescribed fire, we conducted a region-wide survey of 523 fire use practitioners, working on both public and private lands. A 1–2 year prescribed fire interval was consistently viewed as effective in decreasing wildfire ignitions, behavior, and severity, as well as reducing suppression resources needed where wildfire occurred. Yet fewer than 15% of practitioners viewed burn intervals of 3–4 years as effective in reducing ignitions, underscoring the importance of high-frequency burning in vegetation communities where fuel recovery is rapid. Public lands managers identified limited budget and staffing as major institutional impediments to prescribed fire, in contrast to private individuals, more of whom chose liability as a key challenge. Differences in responses across ownership type, state, and vegetation type call for a broader perspective on how fire managers in the southern U.S. view prescribed fire.

  16. 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...

  17. 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

  18. 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 ...

  19. 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 ...

  20. 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 ...

  1. 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 ...

  2. 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 ...

  3. 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.

  4. [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.

  5. 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.

  6. The Value of Electronically Extracted Data for Auditing Outpatient Antimicrobial Prescribing.

    Science.gov (United States)

    Livorsi, Daniel J; Linn, Carrie M; Alexander, Bruce; Heintz, Brett H; Tubbs, Traviss A; Perencevich, Eli N

    2018-01-01

    OBJECTIVE The optimal approach to auditing outpatient antimicrobial prescribing has not been established. We assessed how different types of electronic data-including prescriptions, patient-visits, and International Classification of Disease, Tenth Revision (ICD-10) codes-could inform automated antimicrobial audits. DESIGN Outpatient visits during 2016 were retrospectively reviewed, including chart abstraction, if an antimicrobial was prescribed (cohort 1) or if the visit was associated with an infection-related ICD-10 code (cohort 2). Findings from cohorts 1 and 2 were compared. SETTING Primary care clinics and the emergency department (ED) at the Iowa City Veterans Affairs Medical Center. RESULTS In cohort 1, we reviewed 2,353 antimicrobial prescriptions across 52 providers. ICD-10 codes had limited sensitivity and positive predictive value (PPV) for validated cases of cystitis and pneumonia (sensitivity, 65.8%, 56.3%, respectively; PPV, 74.4%, 52.5%, respectively). The volume-adjusted antimicrobial prescribing rate was 13.6 per 100 ED visits and 7.5 per 100 primary care visits. In cohort 2, antimicrobials were not indicated in 474 of 851 visits (55.7%). The antimicrobial overtreatment rate was 48.8% for the ED and 59.7% for primary care. At the level of the individual prescriber, there was a positive correlation between a provider's volume-adjusted antimicrobial prescribing rate and the individualized rates of overtreatment in both the ED (r=0.72; P<.01) and the primary care setting (r=0.82; P=0.03). CONCLUSIONS In this single-center study, ICD-10 codes had limited sensitivity and PPV for 2 infections that typically require antimicrobials. Electronically extracted data on a provider's rate of volume-adjusted antimicrobial prescribing correlated with the frequency at which unnecessary antimicrobials were prescribed, but this may have been driven by outlier prescribers. Infect Control Hosp Epidemiol 2018;39:64-70.

  7. 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.

  8. Improving antimicrobial prescribing in Irish primary care through electronic data collection and surveillance: a feasibility study.

    Science.gov (United States)

    Galvin, Sandra; Callan, Aoife; Cormican, Martin; Duane, Sinead; Bennett, Kathleen; Murphy, Andrew W; Vellinga, Akke

    2015-07-02

    The increase in the spread of antimicrobial resistance (AMR) in bacterial pathogens and limited availability of new antimicrobials places immense pressure on general practitioners (GPs) to prescribe appropriately. Currently, electronic antimicrobial prescribing data is not routinely collected from GPs in Ireland for surveillance purposes to assess regional specific fluctuations or trends in antimicrobial prescribing. The current study aimed to address this issue by assessing the feasibility of remotely extracting antimicrobial prescribing data from primary care practices in Ireland, for the purpose of assessing prescribing quality using the European Surveillance of Antimicrobial Consumption (ESAC) drug specific quality indicators. Participating practices (n = 30) uploaded data to the Irish Primary Care Research Network (IPCRN). The IPCRN data extraction facility is integrated within the practice patient management software system and permitted the extraction of anonymised patient prescriptions for a one year period, from October 2012 to October 2013. The quality of antimicrobial prescribing was evaluated using the twelve ESAC drug specific quality indicators using the defined daily dose (DDD) per 1,000 inhabitants per day (DID) methodology. National and European prescribing surveillance data (based on total pharmacy sales) was obtained for a comparative analysis. Antimicrobial prescriptions (n = 57,079) for 27,043 patients were obtained from the thirty study practices for a one year period. On average, study practices prescribed a greater proportion of quinolones (37 % increase), in summer compared with winter months, a variation which was not observed in national and European data. In comparison with national data, study practices prescribed higher proportions of β-lactamase-sensitive penicillins (4.98 % vs. 4.3 %) and a greater use of broad spectrum compared to narrow-spectrum antimicrobials (ratio = 9.98 vs. 6.26) was observed. Study practices exceeded the

  9. 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

  10. A ranking system for prescribed burn prioritization in Table Mountain National Park, South Africa.

    Science.gov (United States)

    Cowell, Carly Ruth; Cheney, Chad

    2017-04-01

    To aid prescribed burn decision making in Table Mountain National Park, in South Africa a priority ranking system was tested. Historically a wildfire suppression strategy was adopted due to wildfires threatening urban areas close to the park, with few prescribed burns conducted. A large percentage of vegetation across the park exceeded the ecological threshold of 15 years. We held a multidisciplinary workshop, to prioritize areas for prescribed burning. Fire Management Blocks were mapped and assessed using the following seven categories: (1) ecological, (2) management, (3) tourism, (4) infrastructure, (5) invasive alien vegetation, (6) wildland-urban interface and (7) heritage. A priority ranking system was used to score each block. The oldest or most threatened vegetation types were not necessarily the top priority blocks. Selected blocks were burnt and burning fewer large blocks proved more effective economically, ecologically and practically due to the limited burning days permitted. The prioritization process was efficient as it could be updated annually following prescribed burns and wildfire incidents. Integration of prescribed burn planning and wildfire suppression strategies resulted in a reduction in operational costs. We recommend protected areas make use of a priority ranking system developed with expert knowledge and stakeholder engagement to determine objective prescribed burn plans. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Pharmacy clients' attitudes to expanded pharmacist prescribing and the role of agency theory on involved stakeholders.

    Science.gov (United States)

    Hoti, Kreshnik; Hughes, Jeffery; Sunderland, Bruce

    2011-02-01

    To examine the views of regular pharmacy clients on pharmacist prescribing and employ agency theory in considering the relationship between the stakeholders involved. Computer assisted telephone interviews were conducted with 400 pharmacy clients recruited around Australia. Potential respondents were identified using a random number generation function in Microsoft Excel. Data were analysed with SPSS version 17 using one-way analysis of variance, principal component analysis and linear regression. The relationships between the main stakeholders involved were explored using agency theory. A total of 1153 answered calls recruited 400 consenting pharmacy clients. Most respondents (71%) trusted pharmacists adopting an expanded role in prescribing, however the majority (66%) supported this only after a diagnosis had been made by a doctor. Those who accepted pharmacist diagnosing and prescribing preferred that this was limited to pain management and antibiotics. Most respondents (64%) considered that expanded pharmacist prescribing would improve their access to prescription medicines, although those over 65 years of age were less supportive than younger respondents. Factors which contributed positively to clients' perception of trust in an expanded prescribing role for pharmacists were identified, and improved access to medicines was found to be the strongest predictor (P Agency theory would conceptualize the introduction of pharmacist prescribers, as disrupting the principal (patient) agent (doctor) relationship. Its introduction would best be facilitated by careful change management. © 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.

  12. 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.

  13. 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

  14. Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature.

    Science.gov (United States)

    Kroezen, Marieke; van Dijk, Liset; Groenewegen, Peter P; Francke, Anneke L

    2011-05-27

    A growing number of countries are introducing some form of nurse prescribing. However, international reviews concerning nurse prescribing are scarce and lack a systematic and theoretical approach. The aim of this review was twofold: firstly, to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; secondly, to identify possible mechanisms underlying the introduction and organisation of nurse prescribing on the basis of Abbott's theory on the division of professional labor. A comprehensive search of six literature databases and seven websites was performed without any limitation as to date of publication, language or country. Additionally, experts in the field of nurse prescribing were consulted. A three stage inclusion process, consisting of initial sifting, more detailed selection and checking full-text publications, was performed independently by pairs of reviewers. Data were synthesized using narrative and tabular methods. One hundred and twenty-four publications met the inclusion criteria. So far, seven Western European and Anglo-Saxon countries have implemented nurse prescribing of medicines, viz., Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA. The Netherlands and Spain are in the process of introducing nurse prescribing. A diversity of external and internal forces has led to the introduction of nurse prescribing internationally. The legal, educational and organizational conditions under which nurses prescribe medicines vary considerably between countries; from situations where nurses prescribe independently to situations in which prescribing by nurses is only allowed under strict conditions and supervision of physicians. Differences between countries are reflected in the jurisdictional settlements between the nursing and medical professions concerning prescribing. In some

  15. 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

  16. Rational use of medicine in dentistry: do dentists prescribe antibiotics in appropriate indications?

    Science.gov (United States)

    Koyuncuoglu, Cenker Z; Aydin, Mehtap; Kirmizi, N Ipek; Aydin, Volkan; Aksoy, Mesil; Isli, Fatma; Akici, Ahmet

    2017-08-01

    There are concerns regarding appropriate use of antibiotics in dentistry practice. Data on dental antibiotic prescribing patterns by dentists is relatively limited. This nationwide study aimed to examine dentists' antibiotic prescriptions in a diagnosis-based manner in Turkey. This retrospective study on utilization of systemic antibiotics for dental problems was based on the national health data of the dentists obtained from Prescription Information System between January 2013 and August 2015. Only those prescriptions containing single diagnosis and at least one systemic antibiotic were included in the study. Antibiotic prescribing was compared by diagnoses and expertise of dentists. A total of 9,293,410 antibiotics were detected in 9,214,956 prescriptions that contained "single diagnosis and at least one antibiotic." The number of antibiotics per prescription was 1.01. "Periapical abscess without sinus" (28.1%), "dental examination" (20.7%), and "dental caries" (16.2%) were the three most common indications in which antibiotics were prescribed by dentists. While only 3.4% of antibiotics were prescribed upon the single and appropriate "cellulitis and abscess of mouth" diagnosis, the remaining 96.6% was prescribed for irrational/uncertain indications. Consistent in all diagnoses, "amoxicillin + enzyme inhibitor" (58.6%) was the mainly prescribed antibiotic. Analysis of the most preferred "amoxicillin + enzyme inhibitor" prescriptions by expertise of dentists showed significantly much higher prescription rates among Group A specialists and Group B specialists (67.0 and 67.8%, respectively) than those in unidentified dental practitioners (58.2%, p < 0.0001). This study showed that dentists prescribed antibiotics in an arbitrary and mostly unnecessary manner. In general, their antibiotic choices for examined diagnoses could be regarded as irrational. These results indicate the urgent need for improvement of rational antibiotic prescribing habits of dentists.

  17. Measuring the relationship between interruptions, multitasking and prescribing errors in an emergency department: a study protocol.

    Science.gov (United States)

    Raban, Magdalena Z; Walter, Scott R; Douglas, Heather E; Strumpman, Dana; Mackenzie, John; Westbrook, Johanna I

    2015-10-13

    Interruptions and multitasking are frequent in clinical settings, and have been shown in the cognitive psychology literature to affect performance, increasing the risk of error. However, comparatively less is known about their impact on errors in clinical work. This study will assess the relationship between prescribing errors, interruptions and multitasking in an emergency department (ED) using direct observations and chart review. The study will be conducted in an ED of a 440-bed teaching hospital in Sydney, Australia. Doctors will be shadowed at proximity by observers for 2 h time intervals while they are working on day shift (between 0800 and 1800). Time stamped data on tasks, interruptions and multitasking will be recorded on a handheld computer using the validated Work Observation Method by Activity Timing (WOMBAT) tool. The prompts leading to interruptions and multitasking will also be recorded. When doctors prescribe medication, type of chart and chart sections written on, along with the patient's medical record number (MRN) will be recorded. A clinical pharmacist will access patient records and assess the medication orders for prescribing errors. The prescribing error rate will be calculated per prescribing task and is defined as the number of errors divided by the number of medication orders written during the prescribing task. The association between prescribing error rates, and rates of prompts, interruptions and multitasking will be assessed using statistical modelling. Ethics approval has been obtained from the hospital research ethics committee. Eligible doctors will be provided with written information sheets and written consent will be obtained if they agree to participate. Doctor details and MRNs will be kept separate from the data on prescribing errors, and will not appear in the final data set for analysis. Study results will be disseminated in publications and feedback to the ED. Published by the BMJ Publishing Group Limited. For permission

  18. Prescribed Burning and Erosion Potential in Mixed Hardwood Forests of Southern Illinois

    Directory of Open Access Journals (Sweden)

    Gurbir Singh

    2017-04-01

    Full Text Available Prescribed fire has several benefits for managing forest ecosystems including reduction of fuel loading and invasive species and enhanced regeneration of desirable tree species. Along with these benefits there are some limitations like nutrient and sediment loss which have not been studied extensively in mixed hardwood forests. The objective of our research was to quantify the amount of sediment movement occurring on a watershed scale due to prescribed fire in a southern Illinois mixed hardwood ecosystem. The research site was located at Trail of Tears State Forest in western Union county, IL, USA and included five watershed pairs. One watershed in each pair was randomly assigned the prescribed burn treatment and the other remained as control (i.e., unburned. The prescribed burn treatment significantly reduced the litter depth with 12.6%–31.5% litter remaining in the prescribed burn treatment watersheds. When data were combined across all watersheds, no significant differences were obtained between burn treatment and control watershed for total suspended solids and sediment concentrations or loads. The annual sediment losses varied from 1.41 to 90.54 kg·ha−1·year−1 in the four prescribed burn watersheds and 0.81 to 2.54 kg·ha−1·year−1 in the four control watersheds. Prescribed burn watershed 7 showed an average soil sediment loss of 4.2 mm, whereas control watershed 8 showed an average accumulation of sediments (9.9 mm, possibly due to steeper slopes. Prescribed burning did not cause a significant increase in soil erosion and sediment loss and can be considered acceptable in managing mixed hardwood forests of Ozark uplands and the Shawnee Hills physiographic regions of southern Illinois.

  19. Exploração e desenvolvimento vocacional de jovens

    OpenAIRE

    Taveira, Maria do Céu

    2000-01-01

    Livro que apresenta de modo reduzido o trabalho de dissertação de Doutoramento em Psicologia da Educação, realizado pela autora em 1997, sob o titulo: Exploração e Desenvolvimento Vocacional de Jovens: Estudo sobre as relações entre a Exploração, a Identidade e a Indecisão Vocacional Fundação para a Ciência e a Tecnologia (FCT)

  20. Desenvolvimento humano: contribuições da psicologia moral

    Directory of Open Access Journals (Sweden)

    Yves de La Taille

    2007-03-01

    Full Text Available Procuramos avaliar as contribuições do conhecimento acumulado pela Psicologia Moral para a compreensão do desenvolvimento humano, para sustentar a tese segundo a qual a fonte energética do dever moral precisa ser procurada não só em sentimentos exclusivamente morais, mas também em sentimentos que desempenham um papel para o próprio desenvolvimento humano no seu conjunto. Três são os passos da análise deste artigo. Em primeiro lugar, verifi car se há possibilidade de articulação entre teorias psicológicas que enfatizam a dimensão afetiva da moralidade (Freud e Durkheim e outras que enfatizam a dimensão intelectual (Piaget e Kohlberg. Em segundo lugar, uma vez constatada a impossibilidade dessa articulação, sustentar que o sentimento de vergonha, presente na moralidade mas também em outras dimensões do desenvolvimento humano, é condição necessária ao sentimento de obrigatoriedade. Finalmente, analisar se tal sentimento é passível de ser evocado como fonte energética essencial nas abordagens que enfatizam a dimensão intelectual da moralidade.

  1. 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.

  2. 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 ...

  3. 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 ...

  4. 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...

  5. 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.

  6. Effect of season and interval of prescribed burn on ponderosa pine butterfly defoliation patterns

    Science.gov (United States)

    Becky K. Kerns; Douglas J. Westlind

    2013-01-01

    Current knowledge concerning the interactions between forest disturbances such as fire and insect defoliation is limited. Wildfires and prescribed burns may influence the intensity and severity of insect outbreaks by affecting the vigor of residual trees, altering aspects of stand structure and abundance of preferred hosts, and by changing the physical environment...

  7. Age-specific antibiotic prescribing and adherence to guidelines in pediatric patients in primary care.

    NARCIS (Netherlands)

    Ivanovska, V.; Hek, K.; Mantel-Teeuwisse, A.K.; Leufkens, H.G.M.; Dijk, L. van

    2018-01-01

    Background: Most antibiotics in children are used to treat viral and self-limiting conditions. This study aims to compare physicians' adherence to guidelines on antibiotic prescribing in fever and in ear and respiratory infections to children in different age groups in the Netherlands. Methods: Data

  8. [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.

  9. 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.

  10. 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.

  11. Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.

    Directory of Open Access Journals (Sweden)

    Geoffrey K Spurling

    2010-10-01

    analyses. Data were extracted independently by two authors and a narrative synthesis performed following the MOOSE guidelines. Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four found no association, and one found an association with lower costs. The narrative synthesis finding of variable results was supported by a meta-analysis of studies of prescribing frequency that found significant heterogeneity. The observational nature of most included studies is the main limitation of this review. CONCLUSIONS: With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. We did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies. Please see later in the article for the Editors' Summary.

  12. “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.

  13. 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.

  14. Facilitators and barriers to non-medical prescribing - A systematic review and thematic synthesis.

    Science.gov (United States)

    Graham-Clarke, Emma; Rushton, Alison; Noblet, Timothy; Marriott, John

    2018-01-01

    Non-medical prescribing has the potential to deliver innovative healthcare within limited finances. However, uptake has been slow, and a proportion of non-medical prescribers do not use the qualification. This systematic review aimed to describe the facilitators and barriers to non-medical prescribing in the United Kingdom. The systematic review and thematic analysis included qualitative and mixed methods papers reporting facilitators and barriers to independent non-medical prescribing in the United Kingdom. The following databases were searched to identify relevant papers: AMED, ASSIA, BNI, CINAHL, EMBASE, ERIC, MEDLINE, Open Grey, Open access theses and dissertations, and Web of Science. Papers published between 2006 and March 2017 were included. Studies were quality assessed using a validated tool (QATSDD), then underwent thematic analysis. The protocol was registered with PROSPERO (CRD42015019786). Of 3991 potentially relevant identified studies, 42 were eligible for inclusion. The studies were generally of moderate quality (83%), and most (71%) were published 2007-2012. The nursing profession dominated the studies (30/42). Thematic analysis identified three overarching themes: non-medical prescriber, human factors, and organisational aspects. Each theme consisted of several sub-themes; the four most highly mentioned were 'medical professionals', 'area of competence', 'impact on time' and 'service'. Sub-themes were frequently interdependent on each other, having the potential to act as a barrier or facilitator depending on circumstances. Addressing the identified themes and subthemes enables strategies to be developed to support and optimise non-medical prescribing. Further research is required to identify if similar themes are encountered by other non-medical prescribing groups than nurses and pharmacists.

  15. What drives the prescribing of growth hormone preparations in England? Prices versus patient preferences.

    Science.gov (United States)

    Chapman, Stephen R; Fitzpatrick, Raymond W; Aladul, Mohammed I

    2017-04-11

    The patent expiry of a number of biological medicines and the advent of biosimilars raised the expectations of healthcare commissioners that biosimilars would reduce the high cost of these medicines and produce potential savings to the NHS. We aimed to examine the prescribing pattern of different growth hormone preparations (ready to use and reconstitution requiring) in primary and secondary care in England to determine relative rates of decrease or increase and identify the possible factors influencing prescribing following the introduction of biosimilar growth hormone in 2008. Longitudinal observational study. Primary care prescribing cost and volume data was derived from the NHS business services authority website, and for secondary care from the DEFINE database, between April 2011 and December 2015. Quarterly prescribing analysis to examine trends and measure the relationship between usage and price. Expenditure and usage of growth hormone in primary care decreased by 17.91% and 7.29%, respectively, whereas expenditure and usage in secondary care increased by 68.41% and 100%, respectively, between April 2011 and December 2015. The usage of reconstitution requiring products significantly declined in primary care (R²=0.9292) and slightly increased in use in secondary care (R²=0.139). In contrast, the usage of ready-to-use products significantly increased in use in primary (R²=0.7526) and secondary care (R²=0.9633), respectively. Weak or no correlation existed between the usage and price of growth hormone preparations in primary and secondary care. The price of growth hormone products was not the key factor influencing the prescribing of the biological medicines. The main driver for specific product selection was the ease of use and the number of steps in dose preparation. Prescribers appear to be taking into account patient preferences rather than cost in their prescribing decisions. Published by the BMJ Publishing Group Limited. For permission to use (where

  16. Facilitators and barriers of implementing and delivering social prescribing services: a systematic review.

    Science.gov (United States)

    Pescheny, Julia Vera; Pappas, Yannis; Randhawa, Gurch

    2018-02-07

    Social Prescribing is a service in primary care that involves the referral of patients with non-clinical needs to local services and activities provided by the third sector (community, voluntary, and social enterprise sector). Social Prescribing aims to promote partnership working between the health and the social sector to address the wider determinants of health. To date, there is a weak evidence base for Social Prescribing services. The objective of the review was to identify factors that facilitate and hinder the implementation and delivery of SP services based in general practice involving a navigator. We searched eleven databases, the grey literature, and the reference lists of relevant studies to identify the barriers and facilitators to the implementation and delivery of Social Prescribing services in June and July 2016. Searches were limited to literature written in English. No date restrictions were applied. Findings were synthesised narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. Eight studies were included in the review. The synthesis identified a range of factors that facilitate and hinder the implementation and delivery of SP services. Facilitators and barriers were related to: the implementation approach, legal agreements, leadership, management and organisation, staff turnover, staff engagement, relationships and communication between partners and stakeholders, characteristics of general practices, and the local infrastructure. The quality of most included studies was poor and the review identified a lack of published literature on factors that facilitate and hinder the implementation and delivery of Social Prescribing services. The review identified a range of factors that facilitate and hinder the implementation and delivery of Social Prescribing services. Findings of this review provide an insight for commissioners, managers, and providers

  17. First Approximations of Prescribed Fire Risks Relative to Other Management Techniques Used on Private Lands.

    Directory of Open Access Journals (Sweden)

    Dirac Twidwell

    Full Text Available Fire is widely recognized as a critical ecological and evolutionary driver that needs to be at the forefront of land management actions if conservation targets are to be met. However, the prevailing view is that prescribed fire is riskier than other land management techniques. Perceived risks associated with the application of fire limits its use and reduces agency support for prescribed burning in the private sector. As a result, considerably less cost-share support is given for prescribed fire compared to mechanical techniques. This study tests the general perception that fire is a riskier technique relative to other land management options. Due to the lack of data available to directly test this notion, we use a combination of approaches including 1 a comparison of fatalities resulting from different occupations that are proxies for techniques employed in land management, 2 a comparison of fatalities resulting from wildland fire versus prescribed fire, and 3 an exploration of causal factors responsible for wildland fire-related fatalities. This approach establishes a first approximation of the relative risk of fatality to private citizens using prescribed fire compared to other management techniques that are readily used in ecosystem management. Our data do not support using risks of landowner fatalities as justification for the use of alternative land management techniques, such as mechanical (machine-related equipment, over prescribed fire. Vehicles and heavy machinery are consistently leading reasons for fatalities within occupations selected as proxies for management techniques employed by ranchers and agricultural producers, and also constitute a large proportion of fatalities among firefighters. Our study provides the foundation for agencies to establish data-driven decisions regarding the degree of support they provide for prescribed burning on private lands.

  18. The safety of meperidine prescribing in older adults: A longitudinal population-based study.

    Science.gov (United States)

    Friesen, Kevin J; Falk, Jamie; Bugden, Shawn

    2016-05-11

    Meperidine (pethidine) is an opioid analgesic that offers little advantage relative to other opioids and several disadvantages including limited potency, short duration of action, and the production of a neurotoxic metabolite (normeperidine) with a long half-life. Older adults are more sensitive to meperidine's side effects and may have diminished renal function which leads to the accumulation of normeperidine. The Institute for Safe Medication Practices has suggested avoiding meperidine in older adults, limiting its dose (≤600 mg/day) and duration of use (≤48 h). The objective of this study was to determine the level of meperidine use in older adults and assess the dosage and duration of meperidine with reference to these safety recommendations. A longitudinal study using administrative healthcare data was conducted to examine meperidine utilization and levels of high dose and extended duration prescribing among persons ≥65 years of age between April 1, 2001, and March 31, 2014 in Manitoba, Canada. The number of meperidine prescriptions, users, duration of treatment, defined daily doses (DDD) dispensed and number of prescribers were determined over the study period. In the Manitoba older adult population there was a marked decline in meperidine users and prescriptions from 2001 to 2014. There was an average use of 26.4 (95 % CI 24.0-28.8) DDDs of meperidine per user per year. While only 3.7 % of the prescriptions exceeded the 600 mg maximum daily dose, 96.7 % of prescriptions exceeded the recommended 2 days of therapy. For the remaining users of meperidine, the amount of meperidine used per person rose from 18.98 to 56.14 DDDs/user/year over the study period. The number of prescribers of meperidine declined throughout the study, but low DDD prescribers declined more quickly than high DDD prescribers. While meperidine use has declined, the remaining use appears to be decreasing in safety, with more meperidine prescribed per user. This seems to be driven by

  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. 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.

  2. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis.

    Science.gov (United States)

    Anderson, Kristen; Stowasser, Danielle; Freeman, Christopher; Scott, Ian

    2014-12-08

    To synthesise qualitative studies that explore prescribers' perceived barriers and enablers to minimising potentially inappropriate medications (PIMs) chronically prescribed in adults. A qualitative systematic review was undertaken by searching PubMed, EMBASE, Scopus, PsycINFO, CINAHL and INFORMIT from inception to March 2014, combined with an extensive manual search of reference lists and related citations. A quality checklist was used to assess the transparency of the reporting of included studies and the potential for bias. Thematic synthesis identified common subthemes and descriptive themes across studies from which an analytical construct was developed. Study characteristics were examined to explain differences in findings. All healthcare settings. Medical and non-medical prescribers of medicines to adults. Prescribers' perspectives on factors which shape their behaviour towards continuing or discontinuing PIMs in adults. 21 studies were included; most explored primary care physicians' perspectives on managing older, community-based adults. Barriers and enablers to minimising PIMs emerged within four analytical themes: problem awareness; inertia secondary to lower perceived value proposition for ceasing versus continuing PIMs; self-efficacy in regard to personal ability to alter prescribing; and feasibility of altering prescribing in routine care environments given external constraints. The first three themes are intrinsic to the prescriber (eg, beliefs, attitudes, knowledge, skills, behaviour) and the fourth is extrinsic (eg, patient, work setting, health system and cultural factors). The PIMs examined and practice setting influenced the themes reported. A multitude of highly interdependent factors shape prescribers' behaviour towards continuing or discontinuing PIMs. A full understanding of prescriber barriers and enablers to changing prescribing behaviour is critical to the development of targeted interventions aimed at deprescribing PIMs and reducing the

  3. Effects of MHRA drug safety advice on time trends in prescribing volume and indices of clinical toxicity for quinine

    Science.gov (United States)

    Acheampong, Paul; Cooper, Gill; Khazaeli, Behshad; Lupton, David J; White, Sue; May, Margaret T; Thomas, Simon H L

    2013-01-01

    Aims To ascertain the effects of the Medicines and Healthcare products Regulatory Agency's (MHRA) safety update in June 2010 on the volume of prescribing of quinine and on indices of quinine toxicity. Methods We analysed quarterly primary care total and quinine prescribing data for England and quinine prescribing volume for individual Primary Care Trusts in the North East of England from 2007/8 to 2011/12 obtained from the ePACT.net database. We also analysed quinine toxicity enquiries to the National Poisons Information Service (NPIS) via Toxbase® and by telephone between 2004/5 and 2011/12. Joinpoint regression and Pearson's correlation tests were used to ascertain changes in trends in prescribing and indices of toxicity and associations between prescribing and indices of toxicity, respectively. Results Total prescribing continued to increase, but annual growth in quinine prescribing in England declined from 6.0 to −0.6% following the MHRA update [difference −0.04 (95% confidence interval −0.07 to −0.01) quinine prescriptions per 100 patients per quarter, P = 0.0111]. Much larger reductions were observed in Primary Care Trusts that introduced comprehensive prescribing reviews. The previously increasing trend in Toxbase® quinine searches was reversed [difference −19.76 (95% confidence interval −39.28 to −9.20) user sessions per quarter, P = 0.0575]. Telephone enquiries to NPIS for quinine have declined, with stabilization of the proportion of moderate to severe cases of quinine poisoning since the update. Conclusions The MHRA advice was followed by limited reductions in the growth in quinine prescribing and in indicators of quinine overdose and toxicity. Quinine prescribing, however, remains common, and further efforts are needed to reduce availability and use. PMID:23594200

  4. Biblioteca Digital do Supremo Tribunal Federal: uma proposta em desenvolvimento

    Directory of Open Access Journals (Sweden)

    Maria Tereza Machado Teles Walter

    2017-12-01

    Full Text Available As t e c n o l o g i as d e i nf o rm a ç ã o e d e c om u n i c a ç ã o revolucionaram as formas de organização e de mediação de informação em todas as instituições prestadoras de serviço, sejam elas bibliotecas ou centros de documentação. Seu desenvolvimento passou a ser uma questão estratégica de planejamento para as instituições que desejem manter-se em consonância com demandas cada vez mais especializadas e atender usuários que têm modelos mentais e conhecimentos de uso de informação em ambientes digitais. Reconhecendo esse cenário, foi elaborado, pela Coordenadoria de Biblioteca do Supremo Tribunal Federal, o projeto de desenvolvimento de sua Biblioteca Digital, cuja definição foi a de se tratava de um ambiente em meio eletrônico, para prestação de serviços e oferta de produtos, que incluem textos integrais e que independem da presença física dos usuários. O histórico desse projeto é apresentado incluindo as etapas e os perfis profissionais que atuaram no desenvolvimento do trabalho. Em função das características das propostas, todo o projeto foi modularizado visando facilitar sua implantação, de forma que independesse de mudanças na alta gestão do órgão. Alguns resultados dessa proposição são relacionados ao final.

  5. Predicted effects of prescribed burning and harvesting on forest recovery and sustainability in southwest Georgia, USA.

    Science.gov (United States)

    Garten, Charles T

    2006-12-01

    A model-based analysis of the effect of prescribed burning and forest thinning or clear-cutting on stand recovery and sustainability was conducted at Fort Benning, GA, in the southeastern USA. Two experiments were performed with the model. In the first experiment, forest recovery from degraded soils was predicted for 100 years with or without prescribed burning. In the second experiment simulations began with 100 years of predicted stand growth, then forest sustainability was predicted for an additional 100 years under different combinations of prescribed burning and forest harvesting. Three levels of fire intensity (low, medium, and high), that corresponded to 17%, 33%, and 50% consumption of the forest floor C stock by fire, were evaluated at 1-, 2-, and 3-year fire return intervals. Relative to the control (no fire), prescribed burning with a 2- or 3-year return interval caused only a small reduction in predicted steady state soil C stocks (burns did adversely impact forest recovery and sustainability (after harvesting) on less sandy soils, but not on more sandy soils that had greater N availability. Higher intensity and frequency of ground fires increased the chance that tree biomass would not return to pre-harvest levels. Soil N limitation was indicated as the cause of unsustainable forests when prescribed burns were too frequent or too intense to permit stand recovery.

  6. 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)

  7. Perfil do desenvolvimento motor em escolares com excesso de peso

    Directory of Open Access Journals (Sweden)

    Mayara Moura Alves da Cruz

    2017-12-01

    Full Text Available Introdução: Diferenças relacionadas ao peso e as habilidades motoras em crianças em idade escolar ainda apresentam controversias. Objetivo: Analisar a relação entre desenvolvimento motor e nível de atividade física com o índice de massa corporal (IMC de escolares com excesso de peso. Métodos: Foram avaliados 85 escolares de ambos os sexos, de 6 a 10 anos, de Presidente Prudente, São Paulo, Brasil. Os instrumentos utilizados foram a classificação do IMC/idade, a Escala de Desenvolvimento Motor e o Questionário do Nível de Atividade Física Modificado e Adaptado. A amostra foi dividida em dois grupos: grupo com excesso de peso (GEP, com 50 escolares com diagnostico nutricional de sobrepeso e obesidade; e grupo com normopeso (GNP, com 35 escolares eutroficos. Para analise dos dados obtidos foram utilizados: Shapiro Wilk (normalidade, teste t de Student não pareado ou Mann Whitney (amostras independentes, teste de Spearman (correlação e teste do χ2 (proporção, com nível de significância p<0,05. Resultados: O GEP apresentou resultados inferiores significantes no desenvolvimento motor geral (91,32±10,68 versus 97,14±9,06; p=0,010, nas áreas de motricidade fina – QM1 (93,21±21,59 versus 103,1±13,12; p=0,0138 e motricidade global – QM2 (90,31±23,54 versus 112,6±16,07; p<0,0001. Observou-se correlação positiva significativa entre o nível de atividade física e o desenvolvimento motor no GEP, nas áreas de equilibrio – QM3 (0,35080; p=0,0125 e organização espacial – QM5 (0,41820; p=0,0025. Conclusão: O GEP, quando comparado com o GNP, demonstrou resultados inferiores no quociente motor geral (QMG, QM1 e QM2.

  8. Lazer como pratica educativa : as possibilidades para o desenvolvimento humano

    OpenAIRE

    Maira Ivone Lombardi

    2005-01-01

    Resumo: Os objetivos principais deste trabalho consistem em conhecer as inter-relações existentes entre lazer, educação, animação sociocultural e desenvolvimento humano integral e quais as possibilidades de se contribuir para a emancipação do indivíduo na sociedade, utilizando o lazer como prática educativa. Já os objetivos mais específicos são fundamentais à proposição de que o lazer como prática educativa, com base nos seis conteúdos culturais do lazer, pode contribuir para a formação de um...

  9. 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

    policy on drug costs and healthcare utilisation have not been measured. Effects of the reimbursement rate reduction policy on drug use and drug costs are uncertain, as the certainty of such evidence has been assessed as very low. No included study assessed the effects of this policy on healthcare utilisation or health outcomes. Administration costs of the policies were not reported in any of the included studies. Although financial incentives are considered an important element in strategies to change prescribing patterns, limited evidence of their effects can be found. Effects of policies, including pay for performance policies, in improving quality of care and health outcomes remain uncertain. Because pharmaceutical policies have uncertain effects, and because they might cause harm as well as benefit, proper evaluation of these policies is needed. Future studies should consider the impact of these policies on health outcomes, drug use and overall healthcare expenditures, as well as on drug expenditures.

  10. Teoria da reciprocidade e sócio-antropologiado desenvolvimento Theory of reciprocity and social anthropology of development

    Directory of Open Access Journals (Sweden)

    Eric Sabourin

    2011-08-01

    Full Text Available No momento em que o ensino da sociologia do desenvolvimento está declinando nas universidades européias e, em menor grau, nas latino-americanas, afirma-se uma renovação da teoria da reciprocidade, precisamente nesse campo e no da economia social, a partir da antropologia e da sociologia econômica. O artigo trata, portanto, da contribuição da teoria da reciprocidade para a sócioantropologia do desenvolvimento. Divide-se em duas partes. A primeira apresenta brevemente os precursores e os fundamentos da teoria da reciprocidade. A segunda ilustra, a partir de alguns exemplos contemporâneos, a aplicação dessa teoria à sócio-antropologia do desenvolvimento rural. As considerações finais tratam dos limites e novas perspectivas heurísticas dessa teoria.At a time when the teaching of sociology of development is fading from European universities, and to a lesser extent in Latin America, appears a renewal of the theory of reciprocity in this field of social economy, coming from anthropology and sociological economics. The article presents the contribution of the theory of reciprocity to a socio-anthropology of development. It is divided into two parts. The first briefly presents the forerunners and foundations of the theory of reciprocity. The second illustrates, from some contemporary examples, applying this theory to socio-anthropology of rural development. The conclusion presents the limits and some new heuristic perspectives of this theory.

  11. [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.

  12. 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.’

  13. PATRIMÔNIO CULTURAL ARQUEOLÓGICO: INSTRUMENTO DE DESENVOLVIMENTO TURÍSTICO

    OpenAIRE

    Rossano Bastos

    2012-01-01

    O presente trabalho trata das perspectivas de aproveitamento do Patrimônio Cultural Arqueológico como instrumento de desenvolvimento turístico.PALAVRAS-CHAVE: Arqueologia; Turismo;Desenvolvimento.ABSTRACT: This work considers some improvement perspectives ofthe archaeological cultural heritage as an instrument of tourism development.KEY-WORDS: Archaeology; Tourism; Development. 

  14. Desenvolvimento Policêntrico na Europa : Uma reflexao critica sobre um conceito de politicas normativas

    NARCIS (Netherlands)

    Meijers, E.J.

    Durante a última década, o desenvolvimento policêntrico tornou-se um conceito-chave no desenvolvimento territorial europeu. Em muitos aspectos, é um conceito difuso que significa diferentes coisas para diferentes pessoas em diferentes escalas espaciais. Neste artigo, analisamos as variadas

  15. Desenvolvimento regional sob o enfoque pós-keynesiano

    Directory of Open Access Journals (Sweden)

    Júlia Elisabete Barden

    2007-01-01

    Full Text Available Este trabalho tem como objetivo fazer uma revisão bibliográfica acerca de estudosque analisam o desenvolvimento regional sob a perspectiva da teoria pós-keynesiana. Osresultados destes demonstram que o sistema financeiro, em especial os bancos,influenciam no grau de desenvolvimento das regiões, sobretudo, porque o comportamentodestes agentes segue um conceito importante utilizado pela teoria, a preferência pelaliquidez. Assim, a disponibilidade de crédito para investimento no sistema produtivosofrerá impactos importantes conforme a preferência pela liquidez dos bancos.Abstract This paper has as objective to bring a bibliographical review about the studies thatanalyze the regional development on the Post-Keynesian theory perspective. The resultsobtained show that the financial system especially the banks, however these agentsbehavior follow an important concept used by the theory, the preference to the liquidity.Yet, the credit responsibility for the investment in the productive system will sufferimportant impacts due to the preference for the liquidity from the banks.

  16. Investimentos diretos estrangeiros e políticas de desenvolvimento

    Directory of Open Access Journals (Sweden)

    Antônio Corrêa de Lacerda

    2008-05-01

    Full Text Available O artigo discute alternativas para a inserção internacional da economia brasileira, especialmente no que se refere ao papel dos investimentos diretos estrangeiros, da geração de valor agregado local e do desempenho das exportações, a partir do cenário da globalização e suas transformações. Na primeira parte analisa-se a competitividade dos países em desenvolvimento e, na segunda parte, discutem-se estratégias de política econômica para uma inserção internacional mais ativa na economia brasileira. Palavras-chave: investimentos diretos estrangeiros; globalização; inserção externa; políticas de desenvolvimento. Abstract The article discusses alternatives for the international insertion of Brazilian economy especially considering the role of foreign direct investments, the creation of local aggregated value and the exportations performance from the scene of the globalization and its transformations. In the first part, the competitiveness of developing countries is analyzed and in the second part, strategies of economic policy for a more active international of Brazilian economy are discussed. Keywords: foreign direct investments, globalization, international insertion, development policies.

  17. COPA DO MUNDO 2014: TURISMO, DESENVOLVIMENTO E SUSTENTABILIDADE NA CONTEMPORANEIDADE

    Directory of Open Access Journals (Sweden)

    Luciana Hoppe

    2015-08-01

    Full Text Available A atividade turística é um dos fenômenos mais significativos da contemporaneidade e cada vez mais tem se tornado objeto de pesquisas e estudos tanto no âmbito das ciências sociais aplicadas quanto das ciências humanas. Atenção essa que ganha vulto em função da complexa estrutura de serviços que envolve e, também, em razão do impacto que o turismo tem no cotidiano daquelas populações que habitam as cidades receptoras. Neste sentido, um dos modos pelos quais o turismo toma forma é aquele ligado aos eventos, em especial aos denominados megaeventos. Diante disso, este estudo busca refletir sobre a Copa do Mundo de 2014 realizada no Brasil no sentido de colaborar com a discussão acadêmica sobre megaeventos, seus impactos e desdobramentos no âmbito de uma perspectiva sinérgica entre desenvolvimento e sustentabilidade. Assim, defende-se no texto o argumento de que muitas são as formas como o turismo impacta na vida das pessoas e no interior das relações cotidianas daqueles que vivem nas cidades receptoras ganhando, assim, tangibilidade e concretude. Palavras-chave: Turismo. Desenvolvimento. Sustentabilidade. Megaevento. Copa do Mundo.

  18. 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

  19. 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....

  20. 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.

  1. 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

  2. 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....

  3. 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.

  4. 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

  5. Off-label psychotropic prescribing for young persons in medium security.

    Science.gov (United States)

    Haw, C; Stubbs, J

    2010-10-01

    Psychotropic drug prescribing for children and adolescents is frequently off-label and has increased over time and can be controversial. Psychotropic prescribing in two large UK medium secure units for young people has been studied. A total of 89 patients were included, 64% being aged less than 18 years. A total of 137 of 202 (67.8%) of prescriptions were off-label. The most common reasons for a prescription being off-label were the indication (N = 103) and the patient's age (N = 41). The main classes of drugs involved were antipsychotics (N = 59), antiepileptics as mood stabilisers (N = 22), anticholinergics and hyoscine (N = 15) and antidepressants (N = 11). Aggression (N = 48) and post-traumatic stress disorder (N = 30) were the most common off-label indications. Some antidepressant prescriptions were contrary to advice of the Committee on Safety of Medicines (CSM). Meta-analyses or randomised controlled trials supported 27% of off-label prescriptions, with lesser quality studies supporting a further 29.2% and expert opinion 38.7%, whereas for 5.1% no evidence could be found. Prescribers tended to over-estimate the level of evidence from clinical trials or extrapolated from findings in adults. They often quoted their own experience rather than expert sources to justify their prescribing practice. It is important that prescribers are fully aware of the quality of experimental data and the risk-benefit ratio when prescribing off-label for young persons. If the evidence base is limited, it is particularly important to provide information about the risks and benefits of the treatment to the patient/relatives. A second opinion may be helpful. Both target symptoms and side effects should be monitored and regularly reviewed.

  6. Meio ambiente, capitalismo e desenvolvimento sustentável: a arquitetura de um matrimônio duvidoso

    Directory of Open Access Journals (Sweden)

    François M. P. Gavard

    2009-01-01

    Full Text Available http://dx.doi.org/10.5007/1806-5023.2009v6n3p25 A revolução no pensamento e na relação do homem com o meio ambiente advinda do Iluminismo desencadeou durante a Modernidade um processo de desenvolvimento econômico e tecnológico que ao alcançar o século XX demonstrou-se problemático trazendo a perspectiva da finitude e do limite de volta às consciências. Movimentos sociais se organizaram reivindicando a conservação do meio ambiente e a ciência e o capitalismo foram apontados com responsáveis pela destruição do ambiente natural. O debate em torno da problemática ambiental era pautado pelo impasse entre as posições antagônicas de “ambientalistas” e “desenvolvimentistas”. Na busca da superação deste impasse foram articulados os conceitos de “Ecodesenvolvimento” e posteriormente o de Desenvolvimento Sustentável. O primeiro foi rejeitado devido ao seu conteúdo excessivamente político e de partir de premissas que contrariavam os interesses da economia mundial. O segundo ganhou proeminência no discurso ambiental e teve ampla aceitação nos mais diversos setores devido ao seu caráter conciliador que afirmava a possibilidade de se alcançar um tipo de desenvolvimento capaz de contemplar os aspectos sociais, econômicos e ecológicos. Ainda que elaborado de maneira vaga e alvo de suspeita de mera estratégia discursiva.

  7. O desenvolvimento corporal na educação infantil

    Directory of Open Access Journals (Sweden)

    Adriana Pacheco da Silva Santos

    2011-12-01

    Full Text Available Este artigo é resultado de um estudo realizado em uma creche pública pertencente à rede municipal de educação de Sinop - MT. Objetivamos compreender o movimento corporal das crianças como parte do desenvolvimento integral das crianças. E também entender como os profissionais trabalham a especificidade do corpo infantil, dos movimentos das crianças durante a rotina da instituição de uma turma de crianças de dois a três anos de idade. Optamos em focalizar a pesquisa na área da Educação Infantil por entender que as crianças desta faixa etária apresentam características importantes no desenvolvimento corporal, visto que muitas vezes na educação infantil o movimento é considerado como ‘indisciplina’, fazendo com que a criança, na maioria das vezes permanece quietas e sentadas em suas cadeiras. Diante de tal propósito, buscamos uma metodologia que nos possibilitasse apreender o movimento corporal da criança e encontramos na pesquisa qualitativa, através da ‘observação participante’, trilhas que nos conduziram à construção de conhecimentos. Como pesquisadora, permanecemos na instituição investigada por quase três meses, em horários intercalados, utilizando o caderno de campo, no qual registramos as observações realizadas, bem como as entrevistas com as professoras da referida turma. Os principais referenciais utilizados para o estudo foram: Vygotsky, Piaget, Vitor Fonseca e Henri Wallon. De acordo com o observado em campo e leituras teóricas, ressaltamos com este estudo a importância do movimento para as crianças e sua contribuição no desenvolvimento infantil pleno.Palavras-chave: educação; educação infantil; maternal II; movimento; sociointeracionismo.

  8. CARTOGRAFIAS DO PIAUÍ: RELACIONANDO INFRAESTRUTURA E DESENVOLVIMENTO SOCIAL

    Directory of Open Access Journals (Sweden)

    Paulo Antônio Barbosa Júnior

    2016-08-01

    Full Text Available Durante as décadas de 50 a 90, o Piauí foi o Estado mais pobre do Brasil. Recentemente, o Piauí tem apresentado acelerado crescimento econômico, devido em parte ao fortalecimento dos setores de comércio e construção, e a implantação da agricultura moderna na porção do Cerrado piauiense da região MAPITOBA. Apesar do recente incremento econômico, percebe-se que no Piauí, assim como em outros estados do Brasil, o desenvolvimento se dá de forma irregular com relação aos aspectos sociais e seus padrões de distribuição no território. Neste sentido, o presente trabalho busca mostrar que no Piauí a concentração de bens e pessoas está em parte condicionada a infraestrutura de transporte, com exceção da mesorregião Sudoeste Piauiense, onde o modelo de desenvolvimento adotado é essencialmente diferente do modelo das demais regiões. Desta forma, a baixa integração regional no Piauí tem contribuído para o surgimento de duas porções territoriais distintas e isoladas: uma ao norte, com características predominantemente urbanas e relativa concentração de bens e pessoas; e outra ao sul, onde se estabeleceu a última fronteira agrícola do país, com a implantação da agricultura moderna em áreas de vazios demográficos e baixos índices de desenvolvimento social. Assim, partindo-se da demanda por estudos que melhor descrevam as especificidades do território e que contribuam para a elaboração de políticas públicas adjetivadas ao local, o trabalho faz uso da Cartografia Temática e da Análise Espacial para descrever a situação atual do estado do Piauí com relação a Renda e Educação.

  9. Prescribed Travel Schedules for Fatigue Management

    Science.gov (United States)

    Whitmire, Alexandra; Johnston, Smith; Lockley, Steven

    2011-01-01

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

  10. 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.

  11. 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.

  12. 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

  13. Saúde e desenvolvimento Healthcare and development

    Directory of Open Access Journals (Sweden)

    Ana Luiza D'Ávila Viana

    2007-11-01

    Full Text Available Considerando que os modernos sistemas de saúde são o resultado da complexa interação de processos econômicos, políticos e sociais, o objetivo do trabalho é discutir a relação entre saúde e desenvolvimento no Brasil, mostrando que o esgotamento do modelo liberal de política econômica abre nova perspectiva para a retomada do desenvolvimento, entendido como combinação entre crescimento da economia, mudanças na estrutura produtiva e melhora das condições de vida da população. O complexo produtivo da saúde joga papel decisivo nesse processo, pois constitui um campo em que inovação tecnológica e acumulação de capital geram oportunidades de investimento, trabalho e renda, além de produzir avanços importantes para melhorar o estado de saúde das pessoas. A recente adoção de políticas públicas voltadas para articular, de forma positiva, aspectos da política econômica e da política social revela que a questão do desenvolvimento nacional ganhou nova centralidade na agenda governamental, o que abre a perspectiva de maior integração entre a lógica econômica e a lógica sanitária. Entretanto, é preciso reconhecer que o Brasil ainda não logrou alcançar uma associação virtuosa entre saúde e desenvolvimento.As modern healthcare systems are the outcome of complex interactions among economic, political and social processes, the purpose of this paper is to discuss the links between health and development in Brazil, showing that the depletion of the liberal economic policy model paves the way for a return to development, understood as a blend of economic growth, changes in the production structure and better living standards. The healthcare production complex plays a crucial role in this process, as a field where technological innovation and capital build-up generate opportunities for investment, work and income, in addition to spurring major steps forward in terms of upgrading individual health. The recent adoption of

  14. UMA METODOLOGIA VOLTADA PARA O DESENVOLVIMENTO DE LÍDERES

    OpenAIRE

    Carvalho, Leila de Moura

    2003-01-01

    Este trabalho aborda uma metodologia voltada para o desenvolvimento do grupo de líderes da Divisão Logística de uma empresa do setor de varejo. Em uma pesquisa realizada pela empresa, detectou-se uma deficiência no estilo de supervisão atual adotada pelo grupo de líderes e as conseqüências negativas geradas para a organização. A proposta deste trabalho é promover a educação e o treinamento do grupo de líderes para uma mudança de estilo de supervisão. Para isso, propõe-se a utilizar como base ...

  15. Perspectivas de desenvolvimento e meio ambiente: o caso do Brasil

    OpenAIRE

    Cardoso, Fernando Henrique

    2014-01-01

    Introdução Nos últimos dez anos o desenvolvimento econômico do Brasil é frequentemente apontado como um caso êxito de industrialização e de mudança social ocorrido na periferia do sistema capitalista internacional. Não terá sido este o único caso. México, Argentina, Africa do Sul, Singapura, Coréia, índia etc, em graus variáveis e com padrões diversos de integração na economia mundial, são outros tantos exemplos. É certo que existe, nesta matéria, muitos equívocos. Mesmo considerando-se que e...

  16. Desenvolvimento neuropsicomotor de lactentes desnutridos Neuropsychomotor development of malnourished babies

    Directory of Open Access Journals (Sweden)

    SS Mansur

    2006-01-01

    Full Text Available OBJETIVOS: O objetivo deste estudo foi analisar o desenvolvimento neuropsicomotor de lactentes com desnutrição leve e caracterizar seu perfil nutricional. MÉTODOS: A pesquisa foi do tipo transversal, numa população de 374 lactentes e amostra de 31 desnutridos leve, entre 7 e 24 meses de idade, matriculados em creches municipais. O estado nutricional foi identificado pelo critério de Gómez e caracterizado por um questionário. Para a avaliação neuropsicomotora utilizou-se a Escala de Desenvolvimento Psicomotor da Primeira Infância de Brunet e Lézine. RESULTADOS: Os principais resultados do questionário mostraram: infecções respiratórias (48,4%; diarréias (71,0%; pais em união estável (61,3%; pais com ensino fundamental incompleto (74,2% das mães, 83,8% dos pais; renda familiar de 1 a 3 salários-mínimos (80,6%; aleitamento materno satisfatório (67,7%; reação adversa a algum alimento (41,9%. Entre os dados neuropsicomotores, as médias das Idades de Desenvolvimento da Linguagem (14,45 meses e da Sociabilidade (14,74 meses foram as que obtiveram os valores mais abaixo da média da Idade Cronológica (16,41 meses. Todas as áreas avaliadas obtiveram Quocientes de Desenvolvimento dentro da normalidade, porém, as áreas da Linguagem e da Sociabilidade foram classificadas em nível "normal baixo" e as outras em nível "normal médio". CONCLUSÕES: A avaliação neuropsicomotora é instrumento fundamental na assistência ao lactente desnutrido, que tende a apresentar deficiências nas áreas da Linguagem e Sociabilidade, fornecendo subsídios para observar sua atuação exploratória, efeito de seu pensamento, e planejar o trabalho intervencionista.OBJECTIVE: The purpose of this study was to analyze the neuropsychomotor development of babies with slight malnutrition and to characterize their nutritional profile. METHOD: This was a cross-sectional survey on a population of 374 babies and a sample of 31 babies with slight

  17. Leptospirose animal: estudos para o desenvolvimento de vacinas recombinantes

    OpenAIRE

    Felix, Samuel Rodrigues

    2013-01-01

    A leptospirose é uma doença causada por espiroquetas do gênero Leptospira. É uma zoonose de ampla distribuição geográfica, sendo um problema de saúde pública e veterinária, principalmente em países subdesenvolvidos e em desenvolvimento de clima tropical e subtropical. Em medicina veterinária, a leptospirose é uma doença importante tanto para a clínica quanto para a produção, devido ao risco à saúde pública, perdas reprodutivas e óbitos. A vacinação animal é realizada como medida de prevenção ...

  18. As sementes geneticamente modificadas e o direito ao desenvolvimento

    Directory of Open Access Journals (Sweden)

    Milena Barbosa Melo

    2017-12-01

    Full Text Available O presente artigo apresenta como objeto de investigação a ligação entre os direitos da propriedade intelectual no contexto dos organismos geneticamente modificados (OGM´S. Objetivou-se, especificamente, responder inquietações acerca dos danos reais para os consumidores, bem como o lucro para as empresas multinacionais, sem desconsiderar, ainda, os efetivos danos ao meio ambiente e à saúde. Utilizou metodologia pautada em pesquisa bibliográfica e documental a partir do método hermenêutico fazendo uso da interpretação judicial-histórica. Conclui pela relevância da temática para efetivação do direito ao desenvolvimento, bem como pela urgência de uma regulamentação da biossegurança, de forma a permitir melhor sustentação aos OGM´s.

  19. Asthma medication prescribing before, during and after pregnancy: a study in seven European regions.

    Science.gov (United States)

    Charlton, Rachel A; Pierini, Anna; Klungsøyr, Kari; Neville, Amanda J; Jordan, Susan; de Jong-van den Berg, Lolkje T W; Thayer, Daniel; Bos, H Jens; Puccini, Aurora; Hansen, Anne V; Gini, Rosa; Engeland, Anders; Nybo Andersen, Anne-Marie; Dolk, Helen; Garne, Ester

    2016-01-19

    To explore utilisation patterns of asthma medication before, during and after pregnancy as recorded in seven European population-based databases. A descriptive drug utilisation study. 7 electronic healthcare databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna and Tuscany), Wales, and the Clinical Practice Research Datalink representing the rest of the UK. All women with a pregnancy ending in a delivery that started and ended between 2004 and 2010, who had been present in the database for the year before, throughout and the year following pregnancy. The percentage of deliveries where the woman received an asthma medicine prescription, based on prescriptions issued (UK) or dispensed (non-UK), during the year before, throughout or during the year following pregnancy. Asthma medicine prescribing patterns were described for 3-month time periods and the choice of asthma medicine and changes in prescribing over the study period were evaluated in each database. In total, 1,165,435 deliveries were identified. The prevalence of asthma medication prescribing during pregnancy was highest in the UK and Wales databases (9.4% (CI95 9.3% to 9.6%) and 9.4% (CI95 9.1% to 9.6%), respectively) and lowest in the Norwegian database (3.7% (CI95 3.7% to 3.8%)). In the year before pregnancy, the prevalence of asthma medication prescribing remained constant in all regions. Prescribing levels peaked during the second trimester of pregnancy and were at their lowest during the 3-month period following delivery. A decline was observed, in all regions except the UK, in the prescribing of long-acting β-2-agonists during pregnancy. During the 7-year study period, there were only small changes in prescribing patterns. Differences were found in the prevalence of prescribing of asthma medications during and surrounding pregnancy in Europe. Inhaled β-2 agonists and inhaled corticosteroids were, however, the most popular therapeutic regimens in all databases. Published by the BMJ

  20. 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.

  1. 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.

  2. 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...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...

  4. 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.

  5. 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...

  6. 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, ...

  7. 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...

  8. 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...

  9. Desenvolvimento, globalização e trabalho decente

    Directory of Open Access Journals (Sweden)

    Ronaldo Baltar

    Full Text Available O objetivo do artigo é discutir alguns desafios para o projeto brasileiro de desenvolvimento, baseado no consumo de massas dos três últimos Planos Plurianuais, que consiste na busca de equacionamento entre a ampliação da renda nacional através do trabalho, com aumento da empregabilidade e eliminação da precarização do trabalho. A pesquisa procura avaliar e comparar alguns indicadores sobre qualidade no emprego formal, tal como definido pela proposta da Organização Internacional do Trabalho (OIT para a Agenda do Trabalho Decente, em conjunto com dados que mostram a trajetória de inserção do Brasil no comércio internacional. O estudo levanta questões sobre as possibilidades de se garantir uma política de maior inserção no processo de globalização e, ao mesmo tempo, rever as consequências diretas da internacionalização da produção e do comércio sobre a qualidade do trabalho e a geração de renda. O texto conclui apontando que a formação de uma política de desenvolvimento centrada na ampliação do mercado interno, com propostas de expansão do consumo de massas, requer a definição de metas, não apenas de empregabilidade, mas voltadas à formação de empregos que atendam aos direitos fundamentais dos trabalhadores, seguindo os parâmetros da Agenda do Trabalho Decente.

  10. O desenvolvimento das competências coletivas no terceiro setor

    Directory of Open Access Journals (Sweden)

    Lorena Tello‐Gamarra

    2015-11-01

    Full Text Available Dentro da abordagem de competências que se focam na gestão de recursos humanos, a abordagem de competências coletivas é uma área de pesquisa emergente. O objetivo da presente pesquisa é compreender as competências coletivas em um projeto voluntário do terceiro setor. O método utilizado foi o estudo de caso, tendo como objeto de estudo o terceiro setor, mais especificamente um projeto social. Para isto, se fez a escolha da Organização Não Governamental Parceiros Voluntários (PV com o projeto «Desenvolvimento de Princípios de Transparência e Prestação de Contas em Organizações da Sociedade Civil». Entre os resultados teóricos se identificaram 7 dimensões das competências coletivas. No que tange aos resultados empíricos referidos ao entendimento das competências coletivas no projeto voluntário do terceiro setor, observaram‐se 4 resultados: (1 todas as dimensões das competências coletivas foram comprovadas no projeto; (2 essas dimensões conseguiram ser determinantes para o desempenho do projeto, (3 as 7 dimensões influenciaram também o desempenho de toda a ONG, (4 as dimensões das competências coletivas do projeto contribuíram para que as organizações sociais pratiquem os princípios da transparência e da prestação de contas em suas atividades. Finalmente, o fato da confirmação das dimensões das competências coletivas como elemento‐chave do desenvolvimento abre a possiblidade de avançar na operacionalização deste construto.

  11. Desenvolvimento e sociologia: uma aproximação necessária

    Directory of Open Access Journals (Sweden)

    Alessandro André Leme

    2015-08-01

    Full Text Available ResumoO debate acerca do desenvolvimento na América Latina e no Brasil em particular revelou-se como um dos temas proeminentes do pensamento sociopolítico e econômico brasileiro. As interpretações do Brasil a partir da temática do desenvolvimento ganham força a partir da década de 1930, porém, será após a Segunda Guerra Mundial, com a intensificação da industrialização e a modernização da sociedade capitalista brasileira, que o tema adquire centralidade na sociologia/ciência política. Por outro lado, as discussões acerca do Estado e do desenvolvimento estão intimamente ligadas ao desenvolvimento do capitalismo brasileiro, ou seja, configura uma tríade que simultaneamente evidencia tanto um tipo historicamente determinado de Estado como um tipo particular de desenvolvimento econômico e social do país. O desenvolvimento do Brasil caracteriza-se por um embate entre o mercado e o Estado, sendo a influência desse último fundante para o padrão de desenvolvimento pretendido no país. Propomos a análise do processo de desenvolvimento como forma de revisitar o debate teórico e conceitual produzido sobre a temática no país, assim como investigar o movimento histórico, econômico e político adotado pelo Brasil como estratégia para o desenvolvimento nos anos 1990.

  12. 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.

  13. 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...

  14. Benzodiazepines - Their role in aggression and why GPs should prescribe with caution.

    Science.gov (United States)

    Jones, Katy A; Nielsen, Suzanne; Bruno, Raimondo; Frei, Matthew; Lubman, Dan I

    2011-11-01

    Benzodiazepines are widely prescribed in Australia, despite concerns about their potential for abuse and dependence. Paradoxical reactions, disinhibition and amnesia are all associated with benzodiazepine use, misuse and intoxication. While violent and aggressive behaviour may be a consequence of such disinhibition, there is limited information available regarding the links between benzodiazepine use and violence. This article aims to examine the existing evidence on the relationship between benzodiazepines, violence and aggression. While current evidence suggests that benzodiazepines rarely induce violence, it is important to note that the available literature is limited in its scope and that benzodiazepine related violence is often severe and of potential concern to frontline workers. Mediating risk factors for benzodiazepine related violence include concurrent alcohol use, benzodiazepine dose, a history of aggression and underlying impulsivity. Comprehensive assessment and alternate nonpharmacological treatment options should be considered before prescribing benzodiazepines within primary care.

  15. 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

  16. Tutorial para o Desenvolvimento de Jogos 2D usando a Linguagem Java

    Directory of Open Access Journals (Sweden)

    Soraia Teixeira Barbosa

    2015-07-01

    Full Text Available Atualmente é grande o estudo e desenvolvimento de jogos eletrônicos tanto no meio acadêmico como fora dele. Entretanto o desenvolvimento do mesmo não é uma tarefa trivial. Este artigo mostra o desenvolvimento de um jogo computacional através de uma versão do conhecido jogo de arcade Space Invaders. O artigo proposto tem como objetivo mostrar os passos básicos para a construção de um jogo computacional em duas dimensões utilizando a linguagem de programação Java.

  17. Prescribing Clinicians’ Perspectives on Evidence-Based Psychotherapy for Posttraumatic Stress Disorder

    Science.gov (United States)

    Barnett, Erin R.; Bernardy, Nancy C.; Jenkyn, Aaron B.; Parker, Louise E.; Lund, Brian C.; Alexander, Bruce; Friedman, Matthew J.

    2014-01-01

    Evidence-based psychotherapies (EBP) for Posttraumatic Stress Disorder are not utilized to their full extent within the Department of Veterans Affairs (VA). VA provides care to many persons with PTSD and has been in the forefront of clinical practice guidelines and EBP training and dissemination. Yet VA continues to find EBP implementation difficult. Veterans with PTSD often initially present to prescribing clinicians, who then help make care decisions. It is therefore critical that these clinicians correctly screen and triage appropriate mental health care. The purpose of this study was to assess VA prescribing clinicians’ knowledge, perceptions, and referral behaviors related to EBPs for PTSD and to identify facilitators and barriers to implementing EBPs within VA. We conducted qualitative interviews with 26 VA prescribing clinicians. Limited access to EBPs was the most commonly noted barrier. The clinicians we interviewed also held specific beliefs and behaviors that may delay or deter EBPs. Strategies to improve utilization also emerged. Findings suggest the need for increased access to EBPs, training to optimize the role of prescribing clinicians in helping Veterans with PTSD make appropriate care decisions, and specific organizational changes to facilitate access and effective referral systems for EBPs. PMID:25431445

  18. The impact of the government health funding on prescribing behaviors in community health institutions in China.

    Science.gov (United States)

    Sun, Gang; Lu, Zuxun; Gan, Yong; Dong, Xiaoxin; Li, Yongbin; Wang, Yunxia; Li, Liqing

    2017-11-01

    Government health funding (GHF) is a cosmopolitan problem. It is especially conspicuous in China, where drug sales become a main source of medical institutions' incomes due to limited GHF. This is well known as China's "drug maintain medical institutions (DMMIs)" system which results directly in very high use of antibiotics, injections, and corticosteroids. However, few statistical data existed in China on the association between the GHF and the prevalence of inappropriate drug prescribing, despite widespread acknowledgment of its existence.A multistage sampling strategy was employed to select 442,100 prescriptions written between 2007 and 2011 by urban community health (CH) institutions and check the GHF in 36 key cities (districts) across China. This study examined the association between the GHF and the prevalence of inappropriate drug prescribing, which differs somewhat from previous studies.The data suggested that from 2007 to 2011, with the increase of GHF, prescribing behaviors (PB) gradually improved on the whole although doctors still prescribed a few more drugs than the recommendations from World Health Organization (WHO). This study found that there is significant negative association between GHF and main indicators of PB (correlation coefficients more than 0.5).The findings implied that government should further perfect the compensation mechanism to medical institutions for gradually weakening the compensation function of drug sales in medical institutions.

  19. Occupational Exposure to Polycyclic Aromatic Hydrocarbon of Wildland Firefighters at Prescribed and Wildland Fires.

    Science.gov (United States)

    Navarro, Kathleen M; Cisneros, Ricardo; Noth, Elizabeth M; Balmes, John R; Hammond, S Katharine

    2017-06-06

    Wildland firefighters suppressing wildland fires or conducting prescribed fires work long shifts during which they are exposed to high levels of wood smoke with no respiratory protection. Polycyclic aromatic hydrocarbons (PAHs) are hazardous air pollutants formed during incomplete combustion. Exposure to PAHs was measured for 21 wildland firefighters suppressing two wildland fires and 4 wildland firefighters conducting prescribed burns in California. Personal air samples were actively collected using XAD4-coated quartz fiber filters and XAD2 sorbent tubes. Samples were analyzed for 17 individual PAHs through extraction with dichloromethane and gas chromatograph-mass spectrometer analysis. Naphthalene, retene, and phenanthrene were consistently the highest measured PAHs. PAH concentrations were higher at wildland fires compared to prescribed fires and were highest for firefighters during job tasks that involve the most direct contact with smoke near an actively burning wildland fire. Although concentrations did not exceed current occupational exposure limits, wildland firefighters are exposed to PAHs not only on the fire line at wildland fires, but also while working prescribed burns and while off-duty. Characterization of occupational exposures from wildland firefighting is important to understand better any potential long-term health effects.

  20. 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

  1. 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.

  2. 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.

  3. DANÇA E O DESENVOLVIMENTO MOTOR DE PORTADORES DE NECESSIDADES EDUCATIVAS ESPECIAIS - PNEEs

    Directory of Open Access Journals (Sweden)

    Liliane de Oliveira

    2012-04-01

    Full Text Available O estudo objetivou verificar as modificações nos padrões de desenvolvimento motor de PNEEs mediante prática da dança. Participaram 14 PNEEs do CIEP/Cruz Alta. O instrumento foi a Escala de Desenvolvimento Motor (Rosa Neto, 1996. Utilizou-se a estatística descritiva e teste “t” para análise dos dados. Observou-se diferenças estatisticamente significativas (p<0,05 entre pré e pós-testes nas variáveis idade cronológica, motora geral, motricidade ampla e equilíbrio. Concluiu-se que o programa de dança contribuiu significativamente para o desenvolvimento motor de PNEEs. Palavras chave: dança, motor, desenvolvimento, especial, educação.

  4. 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

  5. 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.

  6. Gestões do desenvolvimento e desenvolvimentos da gestão: da unilateralidade reificada à dialogicidade da simbiose homem/natureza

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Justen

    Full Text Available Este artigo, ao situar culturalmente os fenômenos da gestão e do desenvolvimento, em sua concepção tradicional, no projeto da modernidade e ao identificar o predomínio da unilateralidade reificada na interface entre gestão e desenvolvimento - a primeira vista como instrumento técnico submisso à via clássica do segundo - almeja evidenciar as potencialidades da compreensão e da construção de alternativas, tanto para a gestão como para o desenvolvimento, a partir da ressignificação dessa interface. Para tanto, o esforço foi direcionado ao resgate do que é comum aos fenômenos da gestão e do desenvolvimento - os substratos antropológico e ecológico -, nucleados nos princípios da reciprocidade dialógica, concretizadora da condição antropológica, e da finitude, caracterizadora da condição ecológica. Ao final, são apresentadas oito potenciais contribuições advindas da exploração renovada da interface entre a gestão e o desenvolvimento. Propôs-se, ainda, a substituição da lógica instrumental da eficiência financeira, comum à concepção tradicional dos fenômenos estudados, pela lógica da simbiose dialógica homem/natureza, uma vez que, como fenômenos sociais, desenvolvimento e gestão, mediados pelo meio, também são ecológicos em sua essência.

  7. Prescription drug abuse communication: A qualitative analysis of prescriber and pharmacist perceptions and behaviors.

    Science.gov (United States)

    Hagemeier, Nicholas E; Tudiver, Fred; Brewster, Scott; Hagy, Elizabeth J; Hagaman, Angela; Pack, Robert P

    Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and pharmacist health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research on HCP PDA communication behavioral engagement and factors that influence it is limited. This study quantitatively examined communication behaviors and trait-level communication metrics, and qualitatively described prescription drug abuse-related communication perceptions and behaviors among primary care prescribers and community pharmacists. Five focus groups (N = 35) were conducted within the Appalachian Research Network (AppNET), a rural primary care practice-based research network (PBRN) in South Central Appalachia between February and October, 2014. Focus groups were structured around the administration of three previously validated trait-level communication survey instruments, and one instrument developed by the investigators to gauge HCP prescription drug abuse communication engagement and perceived communication importance. Using a grounded theory approach, focus group themes were inductively derived and coded independently by study investigators. Member-checking interviews were conducted to validate derived themes. Respondents' trait-level communication self-perceptions indicated low communication apprehension, high self-perceived communication competence, and average willingness to communicate as compared to instrument specific criteria and norms. Significant variation in HCP communication behavior engagement was noted specific to PDA. Two overarching themes were noted for HCP-patient communication: 1) influencers of HCP communication and prescribing/dispensing behaviors, and 2) communication behaviors. Multiple sub-themes were identified within each theme. Similarities were noted in perceptions and behaviors across both prescribers and pharmacists. Despite the perceived importance of engaging in PDA communication, HCPs reported

  8. Deciding Where to Burn: Stakeholder Priorities for Prescribed Burning of a Fire-Dependent Ecosystem

    Directory of Open Access Journals (Sweden)

    Jennifer K. Costanza

    2011-03-01

    Full Text Available Multiagency partnerships increasingly work cooperatively to plan and implement fire management. The stakeholders that comprise such partnerships differ in their perceptions of the benefits and risks of fire use or nonuse. These differences inform how different stakeholders prioritize sites for burning, constrain prescribed burning, and how they rationalize these priorities and constraints. Using a survey of individuals involved in the planning and implementation of prescribed fire in the Onslow Bight region of North Carolina, we examined how the constraints and priorities for burning in the longleaf pine (Pinus palustris ecosystem differed among three stakeholder groups: prescribed burn practitioners from agencies, practitioners from private companies, and nonpractitioners. Stakeholder groups did not differ in their perceptions of constraints to burning, and development near potentially burned sites was the most important constraint identified. The top criteria used by stakeholders to decide where to burn were the time since a site was last burned, and a site's ecosystem health, with preference given to recently burned sites in good health. Differences among stakeholder groups almost always pertained to perceptions of the nonecological impacts of burning. Prescribed burning priorities of the two groups of practitioners, and particularly practitioners from private companies, tended to be most influenced by nonecological impacts, especially through deprioritization of sites that have not been burned recently or are in the wildland-urban interface (WUI. Our results highlight the difficulty of burning these sites, despite widespread laws in the southeast U.S. that limit liability of prescribed burn practitioners. To avoid ecosystem degradation on sites that are challenging to burn, particularly those in the WUI, conservation partnerships can facilitate demonstration projects involving public and private burn practitioners on those sites. In summary

  9. Impacts of prescribed burning on soil greenhouse gas fluxes in a suburban native forest of south-eastern Queensland, Australia

    Science.gov (United States)

    Zhao, Y.; Wang, Y. Z.; Xu, Z. H.; Fu, L.

    2015-11-01

    Prescribed burning is a forest management practice that is widely used in Australia to reduce the risk of damaging wildfires. Prescribed burning can affect both carbon (C) and nitrogen (N) cycling in the forest and thereby influence the soil-atmosphere exchange of major greenhouse gases, i.e. carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O). To quantify the impact of a prescribed burning (conducted on 27 May 2014) on greenhouse gas exchange and the potential controlling mechanisms, we carried out a series of field measurements before (August 2013) and after (August 2014 and November 2014) the fire. Gas exchange rates were determined in four replicate plots which were burned during the combustion and in another four adjacent unburned plots located in green islands, using a set of static chambers. Surface soil properties including temperature, pH, moisture, soil C and N pools were also determined either by in situ measurement or by analysing surface 10 cm soil samples. All of the chamber measurements indicated a net sink of atmospheric CH4, with mean CH4 uptake ranging from 1.15 to 1.99 mg m-2 d-1. Prescribed burning significantly enhanced CH4 uptake as indicated by the significant higher CH4 uptake rates in the burned plots measured in August 2014. In the following 3 months, the CH4 uptake rate was recovered to the pre-burning level. Mean CO2 emission from the forest soils ranged from 2721.76 to 7113.49 mg m-2 d-1. The effect of prescribed burning on CO2 emission was limited within the first 3 months, as no significant difference was observed between the burned and the adjacent unburned plots in both August and November 2014. The CO2 emissions showed more seasonal variations, rather than the effects of prescribed burning. The N2O emission in the plots was quite low, and no significant impact of prescribed burning was observed. The changes in understory plants and litter layers, surface soil temperature, C and N substrate availability and microbial

  10. A COMPLEXIDADE ECONÔMICA DOS DIREITOS HUMANOS: UMA DIMENSÃO ESCONDIDA DO DESENVOLVIMENTO HUMANO

    Directory of Open Access Journals (Sweden)

    Leilane Serratine Grubba

    2012-10-01

    Full Text Available Este artigo tem por objeto a complexidade econômica dos direitos humanos, mais precisamente, a investigação da relação entre a complexidade econômica e o desenvolvimento humano. Nesse sentido, objetivou demonstrar a intrínseca relação e dependência do desenvolvimento humano à complexidade econômica dos direitos humanos, que influi na positivação dos direitos, assim como na luta pelo acesso aos bens necessários a uma vida digna. Por meio do método dedutivo, o artigo problematizou a relação entre o ser humano e seu contexto econômico-social para o desenvolvimento da vida em dignidade. Diante disso, em primeiro lugar, foi apresentada a noção de complexidade dos direitos humanos, isto é, as suas múltiplas dimensões. No segundo momento, foi analisada a questão econômica do desenvolvimento humano, ou seja, a relação entre o desenvolvimento da vida digna e a dimensão econômica da sociedade, e, finalmente, foi apresentada a complexidade econômica dos direitos humanos. O desenvolvimento humano não está apenas vinculado à dimensão econômica, mas compreende todas as dimensões (complexidade que perfazem uma vida digna de ser vivida. A vida se desenvolve em dignidade mediante o acesso aos bens materiais e imateriais. As políticas do desenvolvimento humano, nesse sentido, devem se integrar a uma estrutura que apoie um crescimento com equidade e sustentabilidade. Palavras-chave: Pensamento complexo. Complexidade econômica. Direitos humanos. Desenvolvimento humano. Dignidade humana.

  11. By Default: The Effect of Prepopulated Prescription Quantities on Opioid Prescribing in the Emergency Department.

    Science.gov (United States)

    Santistevan, Jamie R; Sharp, Brian R; Hamedani, Azita G; Fruhan, Scott; Lee, Andrew W; Patterson, Brian W

    2018-03-01

    Opioid prescribing patterns have come under increasing scrutiny with the recent rise in opioid prescriptions, opioid misuse and abuse, and opioid-related adverse events. To date, there have been limited studies on the effect of default tablet quantities as part of emergency department (ED) electronic order entry. Our goal was to evaluate opioid prescribing patterns before and after the removal of a default quantity of 20 tablets from ED electronic order entry. We performed a retrospective observational study at a single academic, urban ED with 58,000 annual visits. We identified all adult patients (18 years or older) seen in the ED and discharged home with prescriptions for tablet forms of hydrocodone and oxycodone (including mixed formulations with acetaminophen). We compared the quantity of tablets prescribed per opioid prescription 12 months before and 10 months after the electronic order-entry prescription default quantity of 20 tablets was removed and replaced with no default quantity. No specific messaging was given to providers, to avoid influencing prescribing patterns. We used two-sample Wilcoxon rank-sum test, two-sample test of proportions, and Pearson's chi-squared tests where appropriate for statistical analysis. A total of 4,104 adult patients received discharge prescriptions for opioids in the pre-intervention period (151.6 prescriptions per 1,000 discharged adult patients), and 2,464 post-intervention (106.69 prescriptions per 1,000 discharged adult patients). The median quantity of opioid tablets prescribed decreased from 20 (interquartile ration [IQR] 10-20) to 15 (IQR 10-20) (pdefault quantity. While the most frequent quantity of tablets received in both groups was 20 tablets, the proportion of patients who received prescriptions on discharge that contained 20 tablets decreased from 0.5 (95% confidence interval [CI] [0.48-0.52]) to 0.23 (95% CI [0.21-0.24]) (pdefault quantity removal. Although the median number of tablets differed significantly

  12. Investimento parental e desenvolvimento da criança Parental investment and child development

    Directory of Open Access Journals (Sweden)

    Eulina Rocha Lordelo

    2006-12-01

    Full Text Available Segundo a teoria do investimento parental, seria esperada uma relação entre condições de criação da mãe e sua carreira reprodutiva e, por conseqüência, seus padrões de cuidado aos filhos, com repercussões no desenvolvimento das crianças. Esta pesquisa buscou verificar essas relações, em amostra de 37 mães e seus filhos entre um e quatro anos, de um bairro pobre de Salvador, Bahia. Foi investigada a história familiar e reprodutiva das mães, associada a resultados desenvolvimentais das crianças, medidos através das escalas Bayley e WIPPSI-R, em quatro avaliações realizadas ao longo de três anos. Foram encontradas correlações entre condições de criação da mãe e sua carreira reprodutiva subseqüente. Por sua vez, esses padrões mostraram-se modestamente relacionados ao desenvolvimento cognitivo de seus filhos, favorecendo as crianças cujas mães iniciaram sua vida reprodutiva mais tarde. Os resultados são, em geral, compatíveis com a teoria do investimento parental. Limitações do estudo e perspectivas futuras são discutidas.According to the parental investment theory, it would be expected an association between maternal family environment and her reproductive behavior and, as a consequence, her patterns of parental investment on her children, with effects on their development. This study aimed to verify that association, in a sample of 37 mothers and their children (one to four years old, in a poor neighborhood of Salvador, in the state of Bahia, Brazil. We studied the family and reproductive history of the mothers and assessed the cognitive development of children, through Bayley and WIPPSI-R scales, in four assessments during three years. We found correlation between the raising environment of the mother and her subsequent reproductive patterns. These patterns were related to cognitive development of children, favoring children whose mothers started their reproductive life later. The results are, in general

  13. PROPOSTA TEÓRICO-CONCEITUAL DE DESENVOLVIMENTO EM ARRANJOS PRODUTIVOS LOCAIS

    Directory of Open Access Journals (Sweden)

    Adriana Valélia Saraceni

    2013-04-01

    Full Text Available O objetivo central deste trabalho foi evidenciar algumas ferramentas para o desenvolvimento da inovação e verificar a relação com a configuração do desenvolvimento em Arranjos Produtivos Locais (APLs. Esta pesquisa pode ser considerada como exploratória e descritiva, pois envolve levantamento bibliográfico e análise de exemplos que estimulem a compreensão. Estudos sobre ferramentas de inovação tecnológica e referencias do desenvolvimento de ecossistemas industriais, foram utilizados buscando demonstrar uma proposta teórico-conceitual de integração das ferramentas. Por meio do resultado obtido com a aplicação da metodologia e do referencial teórico, verificou-se que aplicação das ferramentas de inovação tecnológica e a operacionalização com a implantação de métodos e ações cooperadas, tende a fortalecer o desempenho do processo de inovação do arranjo produtivo. A aplicação do conceito de ecologia industrial no desenvolvimento ambientalmente sustentável do aglomerado tende a fortalecer não só o desenvolvimento do APL, como também o desenvolvimento econômico e regional.

  14. 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 ...

  15. 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

  16. 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 ...

  17. 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

  18. 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.

  19. Medicare Part D Prescriber Look-up Tool

    Data.gov (United States)

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

  20. 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.

  1. 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 ...

  2. 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

  3. 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)

  4. 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.

  5. 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.

  6. 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

  7. 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

  8. 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.

  9. DESENVOLVIMENTO DE MUDAS DE REPOLHO EM DIFERENTES TIPOS SUBSTRATOS

    Directory of Open Access Journals (Sweden)

    Rebyson Bissaco Guidinelle

    2017-05-01

    Full Text Available Resumo: O objetivo deste trabalho foi avaliar o crescimento vegetativo de mudas de repolho, em diferentes tipos de substrato orgânicos. O experimento foi conduzido em uma casa de vegetação utilizando três substratos, S1 - Comercial; S2 - Vermicomposto; S3 - Serapilheira. Os parâmetros morfoagronômicos avaliados foram o comprimento das mudas, sendo: altura parte aérea (APA, comprimento da maior raiz (CMR e altura total das plântulas (AT que é o somatório da APA e CMR. Os substratos apresentaram diferenças significativas entre si, sendo que a Serapilheira apresentou os melhores resultados de desenvolvimento vegetativo juntamente com o vermicomposto. Concluindo-se que a produção de mudas de repolho pode ser feita a partir de substratos orgânicos alternativos, recomendando a substituição total dos substratos comerciais, visando menor custo na produção das mudas, garantindo boa produtividade e qualidade das mudas de repolho das cultivares estudadas.

  10. ROBÓTICA: DESENVOLVIMENTO E APLICAÇÕES

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Silveira Junior

    2011-02-01

    Full Text Available A robótica é um campo de interesse que a cada dia possui mais adeptos devido principalmente a gama de possibilidades de aplicações vistas atualmente: robôs que orientam pessoas cegas em aeroportos, robôs que aspiram sujeira em casa, robôs que desbravam marte. No entanto tem-se a idéia de que o desenvolvimento de robôs é difícil, seja pelos custos envolvidos, seja pela complexidade de programação. Essa palestra tem como objetivo apresentar como é possível desenvolver robótica por conta própria através do uso de componentes de baixo custo aliados ao uso de controladores de codificação de alto nível. Além disso, serão apresentadas formas de programar a autonomia e inteligência em robôs para realização de tarefas sem interferência externa. Ao final serão apresentados alguns robôs possíveis de serem desenvolvidos para uso em ambiente de pesquisa e competição no meio acadêmico e robôs que estão sendo desenvolvidos no Instituto.

  11. DESENVOLVIMENTO DE ROBÔ DE SUMÔ MICROCONTROLADO POR MSP430

    Directory of Open Access Journals (Sweden)

    Magno Melo

    2017-02-01

    Full Text Available Este artigo apresenta a pesquisa e definição dos componentes necessários ao desenvolvimento de um robô autônomo a ser utilizado em competição de sumô de robôs. Este tipo de equipamento, também conhecido como robô segue faixa, será desenvolvido com o objetivo de introdução à robótica, bem como do estudo do funcionamento e aplicabilidade do microcontrolador MSP430, o qual será o componente responsável pela automação deste robô. Assim, a partir desta definição, faz-se necessária a especificação dos demais componentes integrantes do equipamento (chassi, meio de locomoção, motores, sensores e alimentação de tal forma que o robô possa desempenhar adequadamente as tarefas para os quais o mesmo foi idealizado.

  12. LEVEL UP! DESENVOLVIMENTO COGNITIVO, APRENDIZAGEM ENATIVA E VIDEOGAMES

    Directory of Open Access Journals (Sweden)

    Carlos Baum

    Full Text Available Resumo Os videogames são frequentemente acusados de serem prejudiciais à saúde. Sua operatividade colocaria o jogador em uma série de rotinas irracionais, muito próximas a uma relação estímulo-resposta. Sugerimos que tal posição limita as possibilidades de relação entre o videogame e a aprendizagem e está baseada em uma imagem teleológica do desenvolvimento da cognição que toma o aprender como uma caminhada em direção à racionalidade lógica. O presente artigo parte da descrição do aprendizado de um dos autores analisada a partir da retórica procedural com um jogo eletrônico para propor um modo de compreender a ação com o videogame, que convoca a uma constante recomposição do sujeito que joga e do jogo. A teoria da enação, por sua vez, apresenta proposições que sustentam uma modalidade de conhecimento operativo e incorporado, mais próximo da experiência com os videogames.

  13. [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.

  14. 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.

  15. 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 ...

  16. Determinantes do desenvolvimento do setor agropecuário nos municípios

    Directory of Open Access Journals (Sweden)

    Caio César de Medeiros Costa

    2013-06-01

    Full Text Available Dada a importância do setor agropecuário para a economia brasileira, é fundamental conhecer os fatores determinantes do desenvolvimento agropecuário em seus municípios. Sob a luz de referencial teórico que aborda questões relacionadas aos fatores determinantes do desenvolvimento agropecuário e do desenvolvimento econômico local, neste estudo fez-se uso das metodologias de análise multivariada conhecidas como análise fatorial e análise de cluster. Utilizou-se o estado de Minas Gerais como recorte analítico. Foram selecionadas 22 variáveis para cada município, representando diferentes dimensões do desenvolvimento, visando verificar quais os fatores determinantes do desenvolvimento agropecuário. Após a análise fatorial, optou-se pela extração de seis fatores com raiz característica maior do que um e que respondem, em conjunto, por 62,25% da variância total dos dados: desenvolvimento econômico, investimento público, qualidade de vida, condições da atividade agropecuária, condições de meio ambiente e consumo, e condições de financiamento. Pela análise de cluster, foram criados cinco grupos, de acordo com o desempenho dos membros nos fatores. Os resultados corroboram os apontamentos literários em quase sua totalidade e, além disso, destaca-se e discute-se a existência de um ciclo positivo gerado pelo incremento dos fatores determinantes do desenvolvimento agropecuário e pelas vantagens competitivas. Neste estudo, aponta-se a importância do investimento público na promoção do desenvolvimento, reforçando o proposto por trabalhos anteriores de que o Estado desempenha papel fundamental para garantir condições que propiciem o desenvolvimento do setor agropecuário. Outra constatação factível é a de que fatores isolados, tais como as boas condições da agricultura e do meio ambiente, não são capazes de propiciar desenvolvimento para o setor nos municípios mineiros.

  17. 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

  18. Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial.

    Science.gov (United States)

    Guthrie, Bruce; Kavanagh, Kimberley; Robertson, Chris; Barnett, Karen; Treweek, Shaun; Petrie, Dennis; Ritchie, Lewis; Bennie, Marion

    2016-08-18

    was effective at reducing high risk prescribing. The intervention would be feasible to implement at scale in contexts where electronic health records are in general use.Trial registration Clinical trials NCT01602705. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. "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.

  20. Desenvolvimento e Gestão Pública: das ideias às práticas

    Directory of Open Access Journals (Sweden)

    Jackeline Amantino de Andrade

    2010-11-01

    Full Text Available Este artigo tem como objetivo tratar dos modelos de desenvolvimento no contexto brasileiro e introduzir uma discussão sobre políticas de desenvolvimento e sua gestão. Para tanto, faz-se necessário resgatar a discussão sobre desenvolvimento tanto em suas bases desenvolvimentistas como a atual proposição de desenvolvimento endógeno. Entende-se que o desenvolvimento depende de uma capacidade organizacional na articulação de vários fatores, tangíveis e intangíveis, quantitativos e qualitativos e envolve várias dimensões: econômica, social, cultural, ambiental e físico-territorial, político-institucional e científico-tecnológica e é construído através de estratégias processuais potencializadas por coletivos. A primeira parte apresenta uma discussão conceitual sobre o desenvolvimento e os processos de organizacionais e de gestão neles implicados. A segunda parte apresenta um estudo empírico de caráter exploratório de modo a ampliar a discussão sobre modelos de desenvolvimento a partir da relação entre teoria e prática. Finalmente, são tecidas algumas considerações sobre o por vir, principalmente, quando se considera que nesses tempos de globalização e de acirramento das desigualdades urge encontrar alternativas justas e solidárias para as sociedades.

  1. 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.

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. 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.

  7. O capital humano e o desenvolvimento econômico

    Directory of Open Access Journals (Sweden)

    Beatriz Maria Witkowski

    2007-07-01

    Full Text Available Um ambiente competitivo de negócios é decorrência cada vez maior de uma administração eficaz do capital humano. Estrutura, tecnologia, recursos financeiros e materiais são aspectos meramente físicos e inertes que precisam ser administrados inteligentemente por meio das pessoas que constituem a organização. A Teoria do Capital Humano é uma derivação da Teoria Econômica Neoclássica e, ao mesmo tempo, uma atualização, do axioma liberal do indivíduo livre, soberano e racional. Ressurgiu com a crise do modelo tayloris ta-fordis ta, associada à redefinição das relações de trabalho na empresa e do papel do sistema educacional. A qualidade dos funcionários de uma organização, seus conhecimentos e habilidades, entusiasmo e satisfação com seus cargos, seu senso de iniciativa para gerar riqueza, tudo isso tem forte impacto na produtividade da organização, no nível de serviço ao cliente, na reputação e na competitividade. Para qualquer que seja a área empresarial escolhida, o futuro administrador necessita ter uma visão sobre como lidar com assuntos relacionados com pessoas para alcançar o seu sucesso profissional e levar a sua organização rumo à excelência e à competitividade. Em seu conjunto, as pessoas constituem o capital humano da organização. Esse capital pode valer mais ou valer menos, na medida em que contenha talentos capazes de agregar valor à organização e torná-la mais ágil e competitiva. Portanto, esse capital vale mais na medida em que consiga influenciar as ações e os destinos da organização. A era da informação torna o trabalho menos físico e mais mental, pois as pessoas deixaram de ser fornecedoras de mão-de-obra para serem alçadas à categoria de fornecedoras de conhecimento e de competências. Do mesmo modo que o capital humano é relevante para a sociedade e para as organizações, observa-se que o desenvolvimento econômico também possui um papel de suma importância. Define

  8. Health Alliance for prudent antibiotic prescribing in patients with Respiratory Tract Infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme

    DEFF Research Database (Denmark)

    Bjerrum, Lars; Munck, Anders; Gahrn-Hansen, Bente

    2011-01-01

    ABSTRACT: BACKGROUND: Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence...... with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention....

  9. Desenvolvimento produtivo de colmeias de abelhas Melipona scutellaris

    Directory of Open Access Journals (Sweden)

    Adriana Evangelista Rodrigues

    2008-01-01

    Full Text Available http://dx.doi.org/10.5007/2175-7925.2008v21n1p59 A criação de espécies nativas de abelhas, também conhecidas como abelhas sem ferrão, têm despertado interesse geral na área, em função da facilidade de manejo e da qualidade dos produtos. No entanto, pouco se sabe sobre sua produção e sua biologia e por isto o presente trabalho acompanhou o desenvolvimento de colmeias de Melipona scutellaris, avaliando os seus parâmetros produtivos em ambiente de criação. Como o crescimento de uma colmeia tem como parâmetro o armazenamento de alimento, e como no caso da abelha M.scutellaris este armazenamento é feito em potes construídos com cera, foram feitas contagens dos potes nas colmeias classificando-os como: potes abertos, potes fechados e potes vazios, separando-os de acordo com o conteúdo (mel ou pólen. Foram medidas as suas dimensões e anotadas para posterior avaliação dos dados. Com os resultados pôde-se averiguar que as colmeias apresentam quantidades de potes diferentes, variando em função do número de indivíduos que colaboram para este fator. Confirmou-se que, quando o alimento é escasso no pasto apícola, as abelhas usam o alimento armazenado nos potes, em função da diminuição de matéria-prima na entressafra.

  10. Desenvolvimento de modelo experimental de endometriose em ratas

    Directory of Open Access Journals (Sweden)

    Vivian Ferreira do Amaral

    Full Text Available OBJETIVO: Desenvolver um modelo de endometriose experimental em ratas. MÉTODOS: Foram utilizadas 30 ratas adultas da linhagem Wistar. A técnica cirúrgica consistiu em laparotomia mediana com identificação do útero bicorno e ressecção de um segmento de 2 cm do corno uterino direito. Um retalho de 0,25 cm² foi retirado dessa estrutura e suturado na parede abdominal com a face endometrial voltada para a cavidade peritoneal. As ratas foram divididas aleatoriamente em dois grupos de acordo com o tempo para a reoperação: grupo 1 (n=15, reoperado em 30 dias, e grupo 2 (n=15, em 60 dias. No momento da segunda laparotomia os implantes foram avaliados macroscopicamente, ressecados e encaminhados para análise microscópica com coloração hematoxilina-eosina e imunohistoquímica (HEMA, AE1 e AE2. RESULTADOS: Os implantes se desenvolveram em 83,3 % do Grupo 1 e 71,4% no Grupo 2. Não houve diferença estatisticamente significativa entre o peso dos animals dos dois grupos. Também não houve diferença estatisticamente significativa no tamanho da área das lesões induzidas: no Grupo 1 a média foi 0,37 cm² e no Grupo 2, de 0,25 cm². Segundo a classificação histológica semi-quantitativa de Keenan (de acordo com a preservação da camada epitelial de endométrio, o Grupo 1 teve média de 1,9 e o Grupo 2, de 2,4. CONCLUSÃO: A técnica utilizada para o desenvolvimento de endometriose em ratas foi satisfatória.

  11. Estratégia de desenvolvimento e combate à pobreza

    Directory of Open Access Journals (Sweden)

    Roberto Cavalcanti de Albuquerque

    1995-08-01

    Full Text Available Neste estudo, partindo-se de concepção do desenvolvimento como processo global (econômico, social e político, propõe-se formular modelos de intervenção pública em situações de pobreza, com o objetivo de superar o que se considera um dos maiores desafios para a modernização dos países menos avançados. Os modelos propostos são concebidos a partir da análise e interpretação detalhadas de três diferenciadas situações de pobreza no Brasil: o Nordeste rural (área considerada de baixa renda, ou subdesenvolvida, o Sudeste metropolitano (de nível médio-alto de desenvolvimento e o Nordeste urbano (nível médio-baixo. Pretendem, porém, ter validade mais geral como enquadramentos a partir dos quais programas de combate à pobreza específicos, inseridos em estratégias de desenvolvimento, podem ser formulados e executados. O núcleo dos modelos é integrado por três variáveis básicas, às quais correspondem três ações estratégicas: o crescimento, com a indentificação dos mecanismos pelos quais os pobres podem dele se beneficiar; o conhecimento, representado pelo capital humano, de que decorre esforço de educação básica e de qualificação da pobreza; e o trabalho, considerado como variável-enlace entre o crescimento e o conhecimento, pelo qual se dá a inserção produtiva dos pobres e sua autopromoção social. São consideradas ainda ações complementares, envolvendo a extensão aos pobres das políticas sociais públicas; o planejamento familiar; a intensificação do uso do trabalho como forma de suplementação de renda; a assistência aos pobres considerados mais vulneráveis; e a extensão, a eles, dos direitos da cidadania, assegurados pela presença do Estado nas áreas de concentração de pobreza.The paper initially considers development a global process (at the same time an economic, social and political phenomenon and discusses its implications for the modernization paths adopted by the less

  12. Relatório brasileiro sobre desenvolvimento social

    Directory of Open Access Journals (Sweden)

    Luiz Felipe Lampreia

    1995-08-01

    Full Text Available O relatório nacional brasileiro, elaborado como parte do processo de preparação da participação brasileira na Cúpula Mundial para o Desenvolvimento Social, busca traçar um quadro da situação do Brasil em relação aos três temas centrais do evento: alívio e redução da pobreza, expansão do emprego produtivo e integração social. Com o objetivo de qualificar a peculiaridade dos desafios sociais com os quais o Brasil se defronta, a primeira parte consiste de um quadro abrangente, onde estão expostos os dados gerais mais relevantes. A segunda parte, de caráter conceituai, explora a relação à dicotomia desenvolvimento econômico/desenvolvimento social, políticas econômicas/políticas sociais. Passa-se, então, à parte do relatório mais diretamente ligada aos temas centrais da Cúpula. O capítulo sobre pobreza busca sistematizar algumas das principais características desse fenômeno no Brasil; em "Emprego e mercado de trabalho" examinam-se questões como a baixa taxa de desemprego aberto do mercado brasileiro e sua relação com a má qualidade dos postos de trabalho existentes; finalmente, "Integração social e políticas sociais" salienta a necessidade de novas formas de solidariedade social, o que implicaria a reformulação da lógica de financiamento das políticas sociais e sua integração num conjunto coeso, ao lado de novas parcerias do Estado com a sociedade e do setor público com o setor privado. À guisa de conclusão, alinham-se as principais diretrizes do Governo Federal para o período 1995-1999. Depois de enfatizar a necessidade de que quatro condições prévias - fortalecimento da democracia, manutenção da estabilidade econômica, recuperação do crescimento sustentado e reforma do Estado - sejam alcançadas, identificam-se cinco metas prioritárias na área social: agricultura, educação, emprego, saúde e segurança. O relatório termina com breve esboço da estrutura do Programa Comunidade Solid

  13. 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.

  14. 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.

  15. 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.

  16. Paradox of Prescribing Late Chemotherapy: Oncologists Explain.

    Science.gov (United States)

    Bluhm, Minnie; Connell, Cathleen M; De Vries, Raymond G; Janz, Nancy K; Bickel, Kathleen E; Silveira, Maria J

    2016-12-01

    The value of chemotherapy for patients with cancer in the last weeks of life warrants examination. Late chemotherapy may not improve survival or quality of life but typically precludes hospice enrollment and may result in additional symptoms, increased use of other aggressive treatments, and worsening quality of life. Few studies have explored oncologists' rationales for administering chemotherapy near death. This study examines the self-reported factors that influence oncologists' decisions about late chemotherapy. In-depth individual interviews were conducted with 17 oncologists through a semistructured interview guide. Interviews were audio recorded and transcribed verbatim. Transcripts were coded and analyzed using conventional content analysis, a qualitative method that allows the detection and analysis of patterns in the data. Clinical factors take priority in determining late chemotherapy decisions when clear treatment choices exist. When clinical factors are ambiguous, emotion becomes a highly salient influence. Oncologists view late chemotherapy to be patient driven and use it to palliate emotional distress and maintain patient hope even when physical benefit is unexpected. Oncologists experience unique and difficult challenges when caring for dying patients, including emotionally draining communication, overwhelming responsibility for life/death, limitations of oncology to heal, and prognostic uncertainty. These challenges are also eased by offering late chemotherapy. The findings reveal a nuanced understanding of why oncologists find it difficult to refuse chemotherapy treatment for patients near death. Optimal end-of-life treatment decisions require supportive interventions and system change, both of which must take into account the challenges oncologists face.

  17. 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.

  18. A família e a escola como contextos de desenvolvimento humano

    Directory of Open Access Journals (Sweden)

    Maria Auxiliadora Dessen

    2007-04-01

    Full Text Available Escola e família constituem dois contextos de desenvolvimento fundamentais para a trajetória de vida das pessoas. Neste artigo, são destacadas as contribuições destes contextos para a promoção do desenvolvimento humano, enfatizando suas implicações nos processos evolutivos. Questões sobre configurações, vínculos familiares e a importância da rede social de apoio para o desenvolvimento da família são discutidas. Focalizam-se as funções da escola, considerando sua influência nas pessoas em desenvolvimento. Apontam-se algumas considerações sobre a necessidade de compreender as inter-relações entre escola e família, visando facilitar a aprendizagem e desenvolvimento humano. A integração entre esses dois contextos é destacada como desafio para a prática profissional e pesquisa empírica.

  19. 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.

  20. Democracia e cultura no planejamento do desenvolvimento urbano Democracy and culture in the planning of the urban development

    Directory of Open Access Journals (Sweden)

    Aline Virgínia Medeiros Nelson

    2012-12-01

    Full Text Available A cultura e o regime democrático interferem no planejamento de políticas de desenvolvimento das cidades. Em busca de legitimação das ações públicas para melhoria da qualidade de vida da população, o Estado deve compartilhar a decisão sobre prioridades, mediando interesses dos atores sociais. Para isso, a Constituição Federal condiciona a modernização e a democratização da gestão pública, com abertura de novos espaços de deliberação participativa nas cidades. A partir desses pressupostos e através de uma pesquisa bibliográfica e dedutiva, o presente artigo se propõe a analisar como o Estado pode intervir de forma planejada, a fim de apaziguar conflitos, envolvendo a interseção entre expectativas de desenvolvimento, democracia e cultura, para ao final, concluir que esses elementos estão intrinsecamente relacionados. Isso significa que o desenvolvimento urbano vai além do fenômeno econômico e aqualidade de vida, almejada pela sociedade, exige uma atuação conjunta desta com o Estado.The culture and the democratic regime are elements that interfere in planning policies for development of cities. In search of legitimacy of public actions to improve the quality of life of the population, the state should listen to people about priorities, through the mediation of interest of social actors. For this, the Constitution limits the modernization and democratization of public administration, with the opening of new spaces for participatory deliberation in the cities. Of these assumptions, through a literature search and deductive, This study proposes to analyze how the state can intervene, in a planned manner, in the urban order, to appease conflicts, involving the intersection between expectations of development, democracy and culture, so that, ultimately, to conclude that these elements are closely related, which means that urban development goes beyond economic phenomenon and that the quality of life, desired by society

  1. Concern about the Expanding Prescription Drug Epidemic: A Survey of Licensed Prescribers and Dispensers.

    Science.gov (United States)

    Wright, R Eric; Reed, Nia; Carnes, Neal; Kooreman, Harold E

    2016-01-01

    Prescription drug misuse and abuse has reached epidemic levels in the U.S., and stands as a leading cause of death. As the primary gatekeepers to the medications contributing to this epidemic, it is critical to understand the views of licensed health care professionals. In this study, we examine health care professionals' concern regarding prescription drug abuse in their communities and the impact their concern has had on their prescribing and dispensing practices. An online survey of licensed health care providers. Conducted in Indiana. This study was a state-wide evaluation of Indiana's prescription drug monitoring program. The questionnaire asked respondents how concerned they were about prescription drug abuse in their community. Variation in the level of concern was examined using ordinary least squares regression and information about the respondents' demographic background and clinical experience. In addition, we used logistic regression to examine whether concern was associated with changing prescribing and/or dispensing behavior. The majority of providers indicated they were "moderately" or "extremely concerned" about prescription drug abuse in their communities. The level of concern, however, varied significantly by profession, with pharmacists, physicians, nurse practitioners/physician assistants being more concerned than dentists. Additional analyses indicate that providers with higher levels of concern were those who also reported recently changing their prescribing and/or dispensing behavior. The voluntary nature and geographical focus of the study limits the generalizability of the findings. Concern about prescription drug abuse is generally high across the major health care professions; however, a significant minority of providers, particularly among dentists, expressed little or no concern about the epidemic. Increasing health care providers' general level of concern about prescription drug abuse may be an effective public health tool for

  2. General practitioner attitudes towards prescribing aspirin to carriers of Lynch Syndrome: findings from a national survey.

    Science.gov (United States)

    Smith, Samuel G; Foy, Robbie; McGowan, Jennifer; Kobayashi, Lindsay C; Burn, John; Brown, Karen; Side, Lucy; Cuzick, Jack

    2017-10-01

    A dose non-inferiority study comparing 100 mg, 300 mg and 600 mg of aspirin for cancer prevention among Lynch Syndrome carriers is underway (Colorectal Adenoma/Carcinoma Prevention Programme trial 3, CaPP3). To guide implementation of the findings, we investigated general practitioner (GP) attitudes towards aspirin prescribing for Lynch Syndrome carriers. We surveyed 1007 UK GPs (9.6% response rate). Using a within-subjects design, GPs read a statement on harms and benefits of aspirin and indicated their willingness to prescribe aspirin at three doses (100 mg, 300 mg, 600 mg). Approximately two-thirds (70.8%) of GPs had heard of Lynch Syndrome or its associated names, and among those 46.7% were aware of the cancer preventive effects of aspirin among carriers. Two-thirds (68.1%) of GPs reported feeling comfortable discussing harms and benefits of aspirin with a Lynch Syndrome patient. Willingness to prescribe was 91.3% at 100 mg, and declined to 81.8% at 300 mg and 62.3% at 600 mg (p Lynch Syndrome patient in practice (OR 1.44, 95% CI 1.01-2.05, p = 0.045). GPs report limited awareness of Lynch Syndrome and the preventive effects of aspirin among carriers. To ensure the optimal dose identified in the CaPP3 trial is readily available to patients, prescribing guidance and strategies to educate GPs should be developed.

  3. Prescribing Habits for Androgenic Alopecia Among Dermatologists in Spain in 2017: A Cross-Sectional Study.

    Science.gov (United States)

    Pindado-Ortega, C; Saceda-Corralo, D; Buendía-Castaño, D; Fernández-González, P; Moreno-Arrones, Ó M; Fonda-Pascual, P; Alegre-Sánchez, A; Rodrigues-Barata, A R; Vañó-Galván, S

    2018-04-12

    Topical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA). Descriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain. The responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%). A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy. The most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA. Copyright © 2018 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Impacts of prescribed fire on Pinus rigida Mill. in upland forests of the Atlantic Coastal Plain.

    Science.gov (United States)

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

    2016-08-01

    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, one experiencing prescribed fire and one control (unburned) plot for comparison before and after the fire. We found that photosynthetic capacity in terms of Rubisco-limited carboxylation rate and intrinsic water-use efficiency was unaffected, while light compensation point and dark respiration rate were significantly lower in the burned vs control plots post-fire. Furthermore, quantum yield in pines in the pine-dominated stands was less affected than pines in the mixed oak/pine stand, as there was an increase in quantum yield in the oak/pine stand post-fire compared with the control (unburned) plot. We attribute this to an effect of forest type but not fire per se. Average daily sap-flux rates of the pine trees increased compared with control (unburned) plots in pine-dominated stands and decreased in the oak/pine stand compared with control (unburned) plots, potentially due to differences in fuel consumption and pre-fire sap-flux rates. Finally, when reference canopy stomatal conductance was analyzed, pines in the pine-dominated stands were more sensitive to changes in vapor pressure deficit (VPD), while stomatal responses of pines in the oak/pine stand were less affected by VPD. Therefore, prescribed fire affects physiological functioning and water use of pines, but the effects may be modulated by forest stand type and fuel consumption pattern, which suggests that these factors may need to be taken into account for forest management in fire-dominated systems. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. 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.

  6. 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.

  7. [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.

  8. 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.

  9. 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...

  10. 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

  11. [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.

  12. Elaboração e avaliação de um website sobre o desenvolvimento da linguagem infantil: portal dos bebês - desenvolvimento da linguagem

    Directory of Open Access Journals (Sweden)

    Aline Martins

    2015-02-01

    Full Text Available OBJETIVO: criar e desenvolver um website na área de fonoaudiologia com enfoque no desenvolvimento da linguagem de bebês de 0 a 48 meses, além de avaliar a qualidade do conteúdo apresentado e os recursos tecnológicos utilizados. MÉTODOS: na primeira fase do projeto foi realizado um levantamento de dados por meio de revisão de literatura sobre o desenvolvimento e aquisição da linguagem infantil. Em seguida esse conteúdo foi inserido no website e avaliado por 20 pais e/ou cuidadores. RESULTADO: o website Portal dos Bebês - Desenvolvimento da Linguagem foi desenvolvido com linguagem voltada a pais e/ou cuidadores, e seu conteúdo foi dividido em três temas: "Desenvolvimento da Linguagem", "Fala e Linguagem" e "Linguagem e o Ambiente". No que se refere à qualidade do conteúdo e da apresentação, o website foi avaliado como "excelente" por todos os participantes da amostra. Quanto à avaliação sobre o vocabulário utilizado e a forma de apresentação do conteúdo, 70% e 75% respectivamente, consideraram o website como "excelente". Em relação à apresentação visual, 85% dos participantes classificaram como "excelentes", já o tipo de navegação foi classificado como "satisfatório" por 50% dos participantes. Quanto à importância que os pais e/ou cuidadores julgam sobre o site a maioria classificou como "excelente" o auxilio que o mesmo dá no desenvolvimento da linguagem da criança. CONCLUSÃO: o website Portal dos Bebês - Desenvolvimento da Linguagem pode ser acessado pelo endereço online http://portaldosbebes.fob.usp.br, e seu conteúdo e recursos tecnológicos utilizados foram avaliados como satisfatório a excelente pelos pais e/ou cuidadores participantes.

  13. O conceito histórico de desenvolvimento econômico

    OpenAIRE

    Pereira, Luiz C. Bresser

    2006-01-01

    Uma Análise do Conceito de Desenvolvimento Econômico. o Crescimento Econômico, ou Desenvolvimento Econômico, é Visto como um Fenômeno Histórico como Resultado da Revolução Capitalista, E, Consequentemente, da Revolução Comercial, da Industrial E, no Meio Delas, da Revolução Nacional. Assim, é Necessário um Conceito Histórico de Crescimento Econômico, e não um Conceito Normativo. Visto sob este Aspecto, o Desenvolvimento Econômico é Intrinsecamente Relacionado ao Surgimento do Estado-Nação M...

  14. Desenvolvimento e Sustentabilidade na América Latina: Velha História, Novos Caminhos

    Directory of Open Access Journals (Sweden)

    Tayso Silva

    2014-06-01

    Full Text Available O desenvolvimento, considerado durante muito tempo um valor universalmente aceito, e meta de toda sociedade moderna, hoje é questionado, inclusive sobre a forma como é produzido. É demonstrada a importância do desenvolvimento sustentável em direção à conquista de melhores condições de vida. Determinou-se como objetivo principal deste estudo apresentar insights para a maximização da sustentabilidade enquanto dinamizadora da trajetória de desenvolvimento na América Latina. Foram considerados o Painel Intergovernamental sobre Mudanças Climáticas, a Organização das Nações Unidas, o Protocolo de Quioto, entre outros estudos de validade e aceitabilidade internacional para propor parâmetros estratégicos aos negócios da AL. DOI:10.5585/riae.v13i2.2095

  15. Promessa e desafios do desenvolvimento Promises and challenges of development

    Directory of Open Access Journals (Sweden)

    Gary Gereffi

    2007-06-01

    Full Text Available A economia global tem mudado rapidamente. China, Índia e México representam casos particularmente interessantes por seus distintos modelos de desenvolvimento. O processo de consolidação global ampliou-se na década passada na esteira do rápido crescimento da China nos setores de manufatura para exportação e da entrada em cena da Índia na exportação de serviços no ramo da tecnologia de informação. A indústria do vestuário também ilustra tal tendência à consolidação, dadas as mudanças na regulação internacional com a gradual retração, a partir de 2005, do sistema de quotas estabelecido pelo Acordo Multifibras. As trajetórias de aprimoramento industrial manifestadas pela China e México são comparadas neste texto; com base em dados do comércio internacional, faz-se uma análise mais detida da composição das suas exportações destinadas ao mercado norte-americano no que respeita a ramos e produtos-chave. A experiência chinesa das chamadas "cidades-cadeias-de-suprimento" é também analisada; trata-se de uma nova forma de organização econômica, voltada a integrar geograficamente a produção para exportação e outros segmentos de alto valor agregado das cadeias globais de valor.The global economy is changing rapidly, and China, India, and Mexico represent particularly interesting cases because of their divergent development models. Global consolidation is increasing in the past decade because of the rapid growth of China in manufacturing export industries, and India's surge in the offshoring of information technology services. The apparel industry also illustrates the consolidation trend because of a shift in international regulation with the phase out in 2005 of the quotas associated with the Multi-Fiber Arrangement. Industrial upgrading trajectories in China and Mexico are compared, using international trade data to look closely at export profiles in key industries and products destined for the U.S. market. China

  16. DESENVOLVIMENTO DE BALAS MASTIGÁVEIS ADICIONADAS DE INULINA

    Directory of Open Access Journals (Sweden)

    ALEX AUGUSTO GONÇALVES

    2010-03-01

    Full Text Available

    O segmento de confeitos em geral, onde se destacam as balas, está muito presente no cenário brasileiro e mundial. As indústrias vêm constantemente aprimorando seus produtos com a incorporação de novos ingredientes e tecnologias, para atender principalmente as necessidades exigidas pelos consumidores, que estão cada vez mais exigentes em relação à qualidade do produto a ser consumido. Com base nesta premissa e vislumbrando atender esta nova tendência de mercado a proposta deste trabalho foi o desenvolvimento de uma bala mastigável adicionada de inulina. A inulina é um carboidrato (frutano que não é digerido no trato gastro-intestinal superior do ser humano, e exerce efeito bifidogênico, estimulando o crescimento e/ou a atividade das bactérias benéficas do cólon, ajudando na manutenção da fl ora intestinal e prevenção do câncer (prebiótico. Foram desenvolvidas duas formulações de balas mastigáveis, com e sem inulina na composição. Realizaram- se análises microbiológicas, físico-químicas e análise sensorial. As amostras analisadas adequaram-se à legislação brasileira nos parâmetros físico-químicos e microbiológicos avaliados e, quanto à análise sensorial, observou-se boa aceitação do produto. A adição de inulina à formulação trouxe uma variação significativa no atributo textura, tendo um aumento na maciez do produto final.

  17. Profundidade de semeadura no desenvolvimento inicial de pseudocereais

    Directory of Open Access Journals (Sweden)

    Daniele Brandstetter Rodrigues

    2016-08-01

    Full Text Available O objetivo deste trabalho foi avaliar a influência da profundidade de semeadura na emergência de plântulas de sementes de  amaranto e quinoa. Foram avaliados os efeitos das profundidades de 0; 0,5; 1,0; 1,5 e 2,5 cm para amaranto e de 0; 1,5; 2,5; 3,5; e 4,5 cm para quinoa, obtidas por meio de anéis de pvc, com espessura equivalente a estes valores, que foram imersos no substrato para simular as profundidades de semeadura. O delineamento experimental foi inteiramente casualizado, com quatro repetições. Os dados foram submetidos à análise de variância e as médias, comparadas pelo teste de Tukey com 5% de probabilidade de erro. Foram realizados os testes de germinação, primeira contagem de germinação, emergência de plântulas em bandejas, massa de matéria seca e peso de mil sementes. A profundidade de semeadura para o melhor desenvolvimento inicial indicada para amaranto é de até 1,5 cm, e para quinoa até 2,5 cm.Seeding depth in the initial development of pseudocerealsAbstract: The objective of this study was to evaluate the influence of sowing depth on emergence of amaranth and quinoa seeds seedlings. The effects of the depths of 0; 0.5; 1.0; 1.5 and 2.5 cm and amaranth 0; 1.5; 2.5; 3.5; quinoa and 4.5 cm, obtained from PVC rings with a thickness equivalent to these values, which were immersed in the substrate to simulate the sowing depths. The experimental design was completely randomized, with four replications. The data were submitted to analysis of variance and the means were compared by Tukey test at 5% probability of error. The germination tests were carried out, first count, seedling emergence on trays, dry mass and weight of a thousand seeds. The seeding depth for the initial development best suited for Amaranthus is up to 1.5 cm, and quinoa to 2.5 cm.  

  18. Current limiters

    Energy Technology Data Exchange (ETDEWEB)

    Loescher, D.H. [Sandia National Labs., Albuquerque, NM (United States). Systems Surety Assessment Dept.; Noren, K. [Univ. of Idaho, Moscow, ID (United States). Dept. of Electrical Engineering

    1996-09-01

    The current that flows between the electrical test equipment and the nuclear explosive must be limited to safe levels during electrical tests conducted on nuclear explosives at the DOE Pantex facility. The safest way to limit the current is to use batteries that can provide only acceptably low current into a short circuit; unfortunately this is not always possible. When it is not possible, current limiters, along with other design features, are used to limit the current. Three types of current limiters, the fuse blower, the resistor limiter, and the MOSFET-pass-transistor limiters, are used extensively in Pantex test equipment. Detailed failure mode and effects analyses were conducted on these limiters. Two other types of limiters were also analyzed. It was found that there is no best type of limiter that should be used in all applications. The fuse blower has advantages when many circuits must be monitored, a low insertion voltage drop is important, and size and weight must be kept low. However, this limiter has many failure modes that can lead to the loss of over current protection. The resistor limiter is simple and inexpensive, but is normally usable only on circuits for which the nominal current is less than a few tens of milliamperes. The MOSFET limiter can be used on high current circuits, but it has a number of single point failure modes that can lead to a loss of protective action. Because bad component placement or poor wire routing can defeat any limiter, placement and routing must be designed carefully and documented thoroughly.

  19. 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

    The U.S. opioid epidemic has been driven by the high volume of opioids prescribed by healthcare providers. U.S. states have recently enacted four types of laws designed to curb high-risk prescribing practices, such as high-dose and long-term opioid prescribing, associated with opioid-related mortality: (1) mandatory Prescription Drug Monitoring Program (PDMP) enrollment laws, which require prescribers to enroll in their state's PDMP, an electronic database of patients' controlled substance prescriptions, (2) mandatory PDMP query laws, which require prescribers to query the PDMP prior to prescribing an opioid, (3) opioid prescribing cap laws, which limit the dose and/or duration of opioid prescriptions, and (4) pill mill laws, which strictly regulate pain clinics to prevent nonmedical opioid prescribing. Some pain experts have expressed concern that these laws could negatively affect pain management among patients with chronic non-cancer pain. This paper describes the protocol for a mixed-methods study analyzing the independent effects of these four types of laws on opioid prescribing patterns and chronic non-cancer pain treatment, accounting for variation in implementation and enforcement of laws across states. Many states have enacted multiple opioid prescribing laws at or around the same time. To overcome this issue, our study focuses on 18 treatment states that each enacted a single law of interest, and no other potentially confounding laws, over a 4-year period (2 years pre-/post-law). Qualitative interviews with key leaders in each of the 18 treatment states will characterize the timing, scope, and strength of each state law's implementation and enforcement. This information will inform the design and interpretation of synthetic control models analyzing the effects of each of the two types of laws on two sets of outcomes: measures of (1) high-risk opioid prescribing and (2) non-opioid treatments for chronic non-cancer pain. Study of mandatory PDMP enrollment

  20. 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.

  1. 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.

  2. 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.

  3. TECNOLOGIAS DIGITAIS: PROMOVENDO O DESENVOLVIMENTO SUSTENTÁVEL PARA O JOVEM DO CAMPO

    OpenAIRE

    Zarpelon, Mirian Cátia; Kolcenti, Cassiane; Balestrin, Deisi; Tortelli, Luana; Blazszack, Vinicíus; Guedes, Anibal Lopes

    2015-01-01

    O desenvolvimento sustentável é hoje em dia, um dos principais desafios a ser enfrentado na atualidade. Inclui-se neste universo a agricultura, através da consolidação das atividades produtivas a fim de desenvolver de forma sustentável, a gestão da propriedade rural, bem como sua condição ambiental e social, sem degradar o capital natural e mantendo o bem estar da sociedade. Dentro desse processo, as novas tecnologias proporcionam o desenvolvimento de soluções criativas simples que visam melh...

  4. The development and treatment of impulsivity = O desenvolvimento e tratamento da impulsividade

    Directory of Open Access Journals (Sweden)

    Amorim Neto, Roque do Carmo

    2011-01-01

    Full Text Available Impulsividade é um fator presente em várias desordens psicológicas, incluindo ADHD, drogadição, comportamentos agressivos e automutiladores, e obesidade infantil. Impulsividade também é um fator de risco para o abandono de tratamento. Este artigo tem por objetivo apresentar as raízes da impulsividade do ponto de vista biológico, sociológico e do desenvolvimento humano, bem como as formas de tratamento mais comuns para pessoas com extrema impulsividade. Aqui também se inclui pesquisas das áreas de desenvolvimento neuronal e regulação emocional

  5. Desenvolvimento do feijoeiro sob o uso de biofertilizante e adubação mineral.

    OpenAIRE

    Galbiatti, João A.; Silva, Flávia G. da; Franco, Claudenir F.; Caramelo, Anaira D.

    2011-01-01

    A produção intensiva de alimentos exige manejo adequado do solo para garantir a produtividade e a sustentabilidade ambiental. Uma das alternativas é a utilização de resíduos orgânicos no desenvolvimento das culturas, diminuindo a dependência de adubos minerais. Com o objetivo de avaliar o desenvolvimento da cultura de feijão (Phaseolus vulgaris L.), utilizando biofertilizante e adubação mineral, conduziu-se o experimento com seis tratamentos dispostos ao acaso, em esquema fatorial, em quatro ...

  6. O coaching enquanto prática de desenvolvimento de recursos humanos

    OpenAIRE

    Soares, Luciana Rocha

    2013-01-01

    A presente investigação visa identificar os benefícios do coaching para o desenvolvimento de recursos humanos, procurando entender como esta prática contribui para o desenvolvimento de competências, para a melhoria de desempenhos e resultados organizacionais. Sendo uma pesquisa de natureza qualitativa, foram realizadas entrevistas semiestruturadas a 10 coaches profissionais, as quais foram submetidas a análise de conteúdo. Não representativos da população, os resultados obti...

  7. Resistindo ao desenvolvimento neocolonial: a luta do povo de Andalgalá contra projetos megamineiros

    OpenAIRE

    Misoczky,Maria Ceci; Böhm,Steffen

    2013-01-01

    A América Latina vem experimentando uma nova era de declarada fé dos governos no mito do desenvolvimento, em articulação com a expansão de políticas extrativistas exportadoras em um contexto de renovada dependência. A face mais dramática do extrativismo na região tem sido a crescente presença de corporações mineiras transnacionais apoiadas por governos nacionais e regionais e por instituições internacionais financeiras e de apoio ao desenvolvimento, e intensamente resistidas por movimentos so...

  8. Estudo longitudinal do desenvolvimento da comunicação em diversas economias mundiais

    OpenAIRE

    Arruda Filho, Emílio José Montero

    2012-01-01

    O desenvolvimento do setor de comunicação de um país possui relações com o seu desenvolvimento econômico e é possível demonstrar essa conexão estatisticamente, como tem sido feito por pesquisadores de instituições como a ITU (International Telecommunications Union). Como esses dados estão apenas apresentados na forma simples e não levam em conta fatores de interconexão, é importante desenvolver pesquisas que avaliem a conexão entre variáveis relevantes no campo. Este trabalho visa analisar o...

  9. Um metodo para modelagem de exceções em desenvolvimento baseado em componentes

    OpenAIRE

    Patrick Henrique da Silva Brito

    2005-01-01

    Resumo: Devido a grande popularização do Desenvolvimento Baseado em Componentes (DBC), ele vem sendo empregado inclusive no desenvolvimento de sistemas computacionais críticos. O emprego do DBC na construção de sistemas confiáveis evidencia a necessidade de se desenvolver componentes de software que sejam robustos e que possuam uma garantia maior do seu funcionamento correto. Tratamento de exceções é uma técnica bastante conhecida para a verificação e tratamento de erros em sistemas de softwa...

  10. Estilos parentais e personalidade: competências sociais e o desenvolvimento do processo resiliente

    OpenAIRE

    Ferreira, Sara Patrícia Duarte

    2016-01-01

    Dissertação de Mestrado em Psicologia Clínica De acordo com a literatura, as vivências afetivas e relacionais experienciadas no seio familiar, nomeadamente na relação entre pais-filhos, têm um papel privilegiado no desenvolvimento dos jovens. Nesta medida, postula-se que um estilo parental baseado na assertividade e responsividade assuma um papel significativo e protetor face ao desenvolvimento de características e competências adaptativas dos adolescentes e jovens adultos. A presente inve...

  11. The viability of prescribed fire for mitigating the soil degradational impacts of wildfire

    Science.gov (United States)

    Shakesby, R. A.; Bento, C. P. M.; Ferreira, C. S. S.; Ferreira, A. J. D.; Stoof, C. R.; Urbanek, E.; Walsh, R. P. D.

    2012-04-01

    Prescribed (controlled) fire has become an important strategy primarily to limit the likelihood of more devastating wildfire. The considerable increase in wildfire activity in recent decades throughout the Mediterranean, and in Portugal in particular, has meant that this strategy has become increasingly popular despite inherent fears of people about fire of any sort. Despite many studies of the impact of wildfire on soil erosion and degradation, relatively little research has assessed impacts of prescribed fire on soil in Portugal or elsewhere in the Mediterranean. As part of the DESIRE research programme, this paper addresses this research gap by investigating hillslope-scale losses of soil, soil organic matter and selected nutrients before and after an experimental fire (representing a 'worst case-scenario' prescribed fire) in a shrub-vegetated catchment in central Portugal. Comparison is provided by post-fire monitoring of a nearby hillslope affected by a wildfire of moderate severity. Hillslope-scale measurements were carried out over c. 3 years using sediment fences with contributing areas of up to c. 0.5 ha. Eroded sediment was periodically removed from the fences both before and after the fire at intervals ranging from a few weeks to several months depending on rainfall characteristics and logistics. Erosion expressed as g/m2 and g/m2/mm of rainfall was determined. Figures for long-term (c. 10 years) erosion under unburnt conditions for this vegetation type were obtained from a small bounded plot and from sediment accumulating in a weir pool draining a sub-catchment within the prescribed-fire catchment. In addition, soil organic matter and selected nutrients, including K2O, P2O5 and Total N, were measured in the eroded sediment and in the pre-burn and post-burn in situ soil. The results indicate that both the wildfire and prescribed fire caused erosion that was orders of magnitude higher than for long-term plot-scale and hillslope-scale erosion recorded

  12. O desenvolvimento do conhecimento na Pesquisa e Desenvolvimento e o registro através de patentes no Brasil – uma experiência profissional

    Directory of Open Access Journals (Sweden)

    Cynthia Helena Soares Bouças Teixeira

    2017-11-01

    Full Text Available Este trabalho tem como objetivo fornecer um detalhamento sobre o processo de busca do conhecimento, partindo de uma ferramenta básica que é a informação. No contexto que envolve Pesquisa & Desenvolvimento, o conhecimento pode ser estruturado para o desenvolvimento de novas tecnologias, produtos ou processos, em que o registro do conhecimento pode ocorrer  através das patentes. Dado que é preciso conhecer a legislação do país de depósito,trataremos mais especificamente do sistema de registro de patentes brasileiro denominado Instituto Nacional da Propriedade Intelectual – INPI. As reflexões apresentadas são provenientes de uma experiência profissional.

  13. 48 CFR 352.231-70 - Salary rate limitation.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Salary rate limitation... Salary rate limitation. As prescribed in 331.101-70, the Contracting Officer shall insert the following clause: Salary Rate Limitation (January 2010) (a) Pursuant to the current and applicable prior HHS...

  14. Differential impact of two risk communications on antipsychotic prescribing to people with dementia in Scotland: segmented regression time series analysis 2001-2011.

    Science.gov (United States)

    Guthrie, Bruce; Clark, Stella A; Reynish, Emma L; McCowan, Colin; Morales, Daniel R

    2013-01-01

    Regulatory risk communications are an important method for disseminating drug safety information, but their impact varies. Two significant UK risk communications about antipsychotic use in older people with dementia were issued in 2004 and 2009. These varied considerably in their content and dissemination, allowing examination of their differential impact. Segmented regression time-series analysis 2001-2011 for people aged ≥65 years with dementia in 87 Scottish general practices, examining the impact of two pre-specified risk communications in 2004 and 2009 on antipsychotic and other psychotropic prescribing. The percentage of people with dementia prescribed an antipsychotic was 15.9% in quarter 1 2001 and was rising by an estimated 0.6%/quarter before the 2004 risk communication. The 2004 risk communication was sent directly to all prescribers, and specifically recommended review of all patients prescribed relevant drugs. It was associated with an immediate absolute reduction in antipsychotic prescribing of 5.9% (95% CI -6.6 to -5.2) and a change to a stable level of prescribing subsequently. The 2009 risk communication was disseminated in a limited circulation bulletin, and only specifically recommended avoiding initiation if possible. There was no immediate associated impact, but it was associated with a significant decline in prescribing subsequently which appeared driven by a decline in initiation, with the percentage prescribed an antipsychotic falling from 18.4% in Q1 2009 to 13.5% in Q1 2011. There was no widespread substitution of antipsychotics with other psychotropic drugs. The two risk communications were associated with reductions in antipsychotic use, in ways which were compatible with marked differences in their content and dissemination. Further research is needed to ensure that the content and dissemination of regulatory risk communications is optimal, and to track their impact on intended and unintended outcomes. Although rates are falling

  15. Differential Impact of Two Risk Communications on Antipsychotic Prescribing to People with Dementia in Scotland: Segmented Regression Time Series Analysis 2001–2011

    Science.gov (United States)

    Guthrie, Bruce; Clark, Stella A.; Reynish, Emma L.; McCowan, Colin; Morales, Daniel R.

    2013-01-01

    Background Regulatory risk communications are an important method for disseminating drug safety information, but their impact varies. Two significant UK risk communications about antipsychotic use in older people with dementia were issued in 2004 and 2009. These varied considerably in their content and dissemination, allowing examination of their differential impact. Methods Segmented regression time-series analysis 2001–2011 for people aged ≥65 years with dementia in 87 Scottish general practices, examining the impact of two pre-specified risk communications in 2004 and 2009 on antipsychotic and other psychotropic prescribing. Results The percentage of people with dementia prescribed an antipsychotic was 15.9% in quarter 1 2001 and was rising by an estimated 0.6%/quarter before the 2004 risk communication. The 2004 risk communication was sent directly to all prescribers, and specifically recommended review of all patients prescribed relevant drugs. It was associated with an immediate absolute reduction in antipsychotic prescribing of 5.9% (95% CI −6.6 to −5.2) and a change to a stable level of prescribing subsequently. The 2009 risk communication was disseminated in a limited circulation bulletin, and only specifically recommended avoiding initiation if possible. There was no immediate associated impact, but it was associated with a significant decline in prescribing subsequently which appeared driven by a decline in initiation, with the percentage prescribed an antipsychotic falling from 18.4% in Q1 2009 to 13.5% in Q1 2011. There was no widespread substitution of antipsychotics with other psychotropic drugs. Conclusions The two risk communications were associated with reductions in antipsychotic use, in ways which were compatible with marked differences in their content and dissemination. Further research is needed to ensure that the content and dissemination of regulatory risk communications is optimal, and to track their impact on intended and

  16. Differential impact of two risk communications on antipsychotic prescribing to people with dementia in Scotland: segmented regression time series analysis 2001-2011.

    Directory of Open Access Journals (Sweden)

    Bruce Guthrie

    Full Text Available Regulatory risk communications are an important method for disseminating drug safety information, but their impact varies. Two significant UK risk communications about antipsychotic use in older people with dementia were issued in 2004 and 2009. These varied considerably in their content and dissemination, allowing examination of their differential impact.Segmented regression time-series analysis 2001-2011 for people aged ≥65 years with dementia in 87 Scottish general practices, examining the impact of two pre-specified risk communications in 2004 and 2009 on antipsychotic and other psychotropic prescribing.The percentage of people with dementia prescribed an antipsychotic was 15.9% in quarter 1 2001 and was rising by an estimated 0.6%/quarter before the 2004 risk communication. The 2004 risk communication was sent directly to all prescribers, and specifically recommended review of all patients prescribed relevant drugs. It was associated with an immediate absolute reduction in antipsychotic prescribing of 5.9% (95% CI -6.6 to -5.2 and a change to a stable level of prescribing subsequently. The 2009 risk communication was disseminated in a limited circulation bulletin, and only specifically recommended avoiding initiation if possible. There was no immediate associated impact, but it was associated with a significant decline in prescribing subsequently which appeared driven by a decline in initiation, with the percentage prescribed an antipsychotic falling from 18.4% in Q1 2009 to 13.5% in Q1 2011. There was no widespread substitution of antipsychotics with other psychotropic drugs.The two risk communications were associated with reductions in antipsychotic use, in ways which were compatible with marked differences in their content and dissemination. Further research is needed to ensure that the content and dissemination of regulatory risk communications is optimal, and to track their impact on intended and unintended outcomes. Although rates

  17. Quench limits

    International Nuclear Information System (INIS)

    Sapinski, M.

    2012-01-01

    With thirteen beam induced quenches and numerous Machine Development tests, the current knowledge of LHC magnets quench limits still contains a lot of unknowns. Various approaches to determine the quench limits are reviewed and results of the tests are presented. Attempt to reconstruct a coherent picture emerging from these results is taken. The available methods of computation of the quench levels are presented together with dedicated particle shower simulations which are necessary to understand the tests. The future experiments, needed to reach better understanding of quench limits as well as limits for the machine operation are investigated. The possible strategies to set BLM (Beam Loss Monitor) thresholds are discussed. (author)

  18. Health Canada Warning on Citalopram and Escitalopram--Its Effects on Prescribing in Consultation-Liaison Psychiatry.

    Science.gov (United States)

    Do, André; Noohi, Saeid; Elie, Dominique; Mahdanian, Artin A; Yu, Ching; Segal, Marilyn; Looper, Karl J; Rej, Soham

    2016-01-01

    Reports have suggested that citalopram and escitalopram may prolong the QTc interval, leading Health Canada to issue a warning to limit their dosages in 2012. Little is known about the effects of this warning and similar ones (e.g., by the Food and Drug Administration) on antidepressant prescribing in inpatients with acute medical illness, who are theoretically at high risk of QTc prolongation. The main objective of our study is to examine the effect of the Health Canada warning on citalopram/escitalopram prescribing patterns in the consultation-liaison (C-L) psychiatry setting. We performed a retrospective cohort study including 275 randomly selected inpatients with medical illness assessed by the psychiatric C-L team of a large Canadian academic hospital between 2008 and 2014. We grouped patients based on whether they were assessed by the C-L team before or after the citalopram Health Canada warning. Our primary outcome was change in citalopram/escitalopram prescribing patterns. We found that of patients seen before the Health Canada warning, a significantly higher number were prescribed citalopram/escitalopram (44.1% vs. 22.3%, χ(2) = 14.835, p Canada warning was similar in both groups (8.9% vs. 12.1%, χ(2) = 0.233, p = 0.63). Overall, C-L psychiatrists were less likely to prescribe citalopram/escitalopram following the Health Canada warning, which did not translate into safer dosing. Clinicians should not avoid prescribing citalopram/escitalopram appropriately in medically vulnerable inpatients when benefits outweigh disadvantages. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  19. 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 ...

  20. 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.

  1. 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%), ...

  2. 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 ...

  3. Practices in prescribing protein substitutes for PKU in Europe

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  4. 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...

  5. 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...

  6. 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 ...

  7. 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.

  8. 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...

  9. 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.

  10. 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.

  11. 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....

  12. 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 ...

  13. 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 ...

  14. 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

  15. 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...

  16. [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.

  17. 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.

  18. 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...

  19. 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 ...

  20. 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.

  1. 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

  2. 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,...

  3. 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...

  4. 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

  5. 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 ...

  6. 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 ...

  7. 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 ...

  8. 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.

  9. 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...

  10. 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.

  11. 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...

  12. 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...

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. Saúde e territorialização na perspectiva do desenvolvimento Health and territorialization from the perpective of development

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Grabois Gadelha

    2011-06-01

    Full Text Available A relação entre saúde e desenvolvimento é complexa e remete ao campo da economia política, dado que envolve diferentes interesses sociais, políticos e econômicos. No caso brasileiro, esta associação é particularmente relevante no que diz respeito à dimensão territorial, tendo em vista o papel central dos serviços de saúde para organização da rede urbana e delimitação de escalas e limites territoriais. No campo teórico-conceitual, o artigo explora vertentes analíticas das relações entre saúde e desenvolvimento, bem como entre a saúde e a questão territorial. A seguir, analisa a trajetória da política de descentralização e regionalização do Sistema Único de Saúde (SUS e dos investimentos federais, que constituem a base de sua evolução espacial. A partir da revisão conceitual e dos dados empíricos, procuram-se estabelecer os nexos teóricos e político-institucionais entre saúde e desenvolvimento, buscando subsidiar a discussão dos desafios para uma nova inserção da saúde no modelo de desenvolvimento brasileiro, historicamente marcado por desigualdades econômicas e sociais com forte expressão territorial.The relationship between health and development is complex and lies in the field of political economy, given that it involves different social, political, and economic interests. In the Brazilian case, this association is particularly relevant in terms of the territorial dimension, in light of the central role of healthcare services in the organization of the urban network and the demarcation of territorial schedules and limits. In the theoretical-conceptual field, this study explores analytical areas that approach the relations between health and development, as well as between health and the territorial issue; and analyzes the history of the decentralization and regionalization policy in the Unified National Health System (SUS and Federal investments that constitute the basis for its spatial evolution

  18. Dose limits

    International Nuclear Information System (INIS)

    Fitoussi, L.

    1987-12-01

    The dose limit is defined to be the level of harmfulness which must not be exceeded, so that an activity can be exercised in a regular manner without running a risk unacceptable to man and the society. The paper examines the effects of radiation categorised into stochastic and non-stochastic. Dose limits for workers and the public are discussed

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

    Science.gov (United States)

    Lennan, Elaine

    2014-01-01

    This study report examines the views and experiences of professional stakeholders about non-medical prescribing (NMP) of chemotherapy. The introduction of open formulary NMP has created opportunities to radically change health-care delivery. For chemotherapy services, the most recent advice from the National Chemotherapy Advisory Group [Department of Health (2009) Chemotherapy Services in England, ensuring quality and safety: a report from the National Chemotherapy Advisory Group, London Her Majesty's Stationary Office] clearly endorses the development of nurse- or pharmacist-led chemotherapy clinics. This is very much welcomed but is based on very limited evidence as to their effectiveness. A fourth-generation evaluation study. A purposeful sample of 23 stakeholders connected with the chemotherapy service was used. A serial data collection technique with individual interviews followed by uni-professional focus groups was adopted. Finally, a multi-professional focus group was held to determine the strategic way forward. Data were collected in 2009-2010. The study illuminated the key features necessary to maximise success of NMP in chemotherapy clinics and captures the importance of good working relationships. Whilst different practice models will emerge, fundamental and core to services is the need for good team working, established and effective communication strategies, and most importantly avoiding isolation in practice. This study additionally reinforced any evaluation takes place within preexisting political contexts and in particular medical dominance. Not all medical colleagues agreed with or wanted NMP for their patients, highlighting difficulties of developing new models of working within a resisting culture. No objections to NMP of chemotherapy were found, but, clearly, the context of practice needs to be agreed and supportedby all professional stakeholders. What is already known about this topicOpen formulary non-medical prescribing has been rapidly

  20. GPs' decision-making when prescribing medicines for breastfeeding women: Content analysis of a survey

    Directory of Open Access Journals (Sweden)

    Amir Lisa H

    2010-03-01

    Full Text Available Abstract Background Many breastfeeding women seek medical care from general practitioners (GPs for various health problems and GPs may consider prescribing medicines in these consultations. Prescribing medicines to a breastfeeding mother may lead to untimely cessation of breastfeeding or a breastfeeding mother may be denied medicines due to the possible risk to her infant, both of which may lead to unwanted consequences. Information on factors governing GPs' decision-making and their views in such situations is limited. Methods GPs providing shared maternity care at the Royal Women's Hospital, Melbourne were surveyed using an anonymous postal survey to determine their knowledge, attitudes and practices on medicines and breastfeeding, in 2007/2008 (n = 640. Content analysis of their response to a question concerning decision-making about the use of medicine for a breastfeeding woman was conducted. A thematic network was constructed with basic, organising and global themes. Results 335 (52% GPs responded to the survey, and 253 (76% provided information on the last time they had to decide about the use of medicine for a breastfeeding woman. Conditions reported were mastitis (24%, other infections (24% and depressive disorders (21%. The global theme that emerged was "complexity of managing risk in prescribing for breastfeeding women". The organising themes were: certainty around decision-making; uncertainty around decision-making; need for drug information to be available, consistent and reliable; joint decision-making; the vulnerable "third party" and infant feeding decision. Decision-making is a spectrum from a straight forward decision, such as treatment of mastitis, to a complicated one requiring multiple inputs and consideration. GPs use more information seeking and collaboration in decision-making when they perceive the problem to be more complex, for example, in postnatal depression. Conclusion GPs feel that prescribing medicines for

  1. Prescribing of Electronic Activity Monitors in Cardiometabolic Diseases: Qualitative Interview-Based Study.

    Science.gov (United States)

    Bellicha, Alice; Macé, Sandrine; Oppert, Jean-Michel

    2017-09-23

    The prevalence of noncommunicable diseases, including those such as type 2 diabetes, obesity, dyslipidemia, and hypertension, so-called cardiometabolic diseases, is high and is increasing worldwide. Strong evidence supports the role of physical activity in management of these diseases. There is general consensus that mHealth technology, including electronic activity monitors, can potentially increase physical activity in patients, but their use in clinical settings remains limited. Practitioners' requirements when prescribing electronic activity monitors have been poorly described. The aims of this qualitative study were (1) to explore how specialist physicians prescribe electronic activity monitors to patients presenting with cardiometabolic conditions, and (2) to better understand their motivation for and barriers to prescribing such monitors. We conducted qualitative semistructured interviews in March to May 2016 with 11 senior physicians from a public university hospital in France with expertise in management of cardiometabolic diseases (type 1 and type 2 diabetes, obesity, hypertension, and dyslipidemia). Interviews lasted 45 to 60 minutes and were audiotaped, transcribed verbatim, and analyzed using directed content analysis. We report our findings following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Most physicians we interviewed had never prescribed electronic activity monitors, whereas they frequently prescribed blood glucose or blood pressure self-monitoring devices. Reasons for nonprescription included lack of interest in the data collected, lack of evidence for data accuracy, concern about work overload possibly resulting from automatic data transfer, and risk of patients becoming addicted to data. Physicians expected future marketing of easy-to-use monitors that will accurately measure physical activity duration and intensity and provide understandable motivating feedback. Features of electronic activity monitors

  2. 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

  3. 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

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

    Directory of Open Access Journals (Sweden)

    LASZLO-ZOLTAN SZTANKOVSZKY

    2015-11-01

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

  5. Pediatricians' ideas about child development and education Concepções dos pediatras acerca da educação e do desenvolvimento infantil

    Directory of Open Access Journals (Sweden)

    Cristina Nunes

    2011-01-01

    Full Text Available In Andalusia (Spain, pediatricians are the main formal counseling source about children's development and education. Unfortunately, there is a limited knowledge about their ideas, practices and skills to guide parents. In this study, through the content analysis of 26 pediatrician interviews, we describe their ideas and goals about anticipatory guidance. We also analyze their perceptions about parental practices and the educative messages given to parents. The results show that pediatrician agenda focus mainly on bio-medical issues, such as nutrition, accident prevention and growth monitoring. Child development and education are not priorities and issues like psychomotor development and language are only approached to fill out medical records.Na Andaluzia (Espanha, os pediatras são a principal fonte técnica de aconselhamento sobre o desenvolvimento e a educação infantil. No entanto existe um conhecimento limitado sobre as suas ideias, práticas e habilidades para orientar os pais. Neste estudo, através da análise de conteúdo das entrevistas realizadas a vinte e seis pediatras, descrevem-se os objectivos da agenda pediátrica, as percepções sobre as práticas parentais e as mensagens educativas transmitidas aos pais. Os resultados mostram que a agenda pediátrica é centrada sobretudo nos temas biomédicos, como alimentação, prevenção de acidentes e crescimento. O desenvolvimento e a educação da criança não são prioridades e os temas relacionados com o desenvolvimento psicomotor e linguagem são abordados sobretudo para preencher a história clínica.

  6. 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

  7. Inverse Limits

    CERN Document Server

    Ingram, WT

    2012-01-01

    Inverse limits provide a powerful tool for constructing complicated spaces from simple ones. They also turn the study of a dynamical system consisting of a space and a self-map into a study of a (likely more complicated) space and a self-homeomorphism. In four chapters along with an appendix containing background material the authors develop the theory of inverse limits. The book begins with an introduction through inverse limits on [0,1] before moving to a general treatment of the subject. Special topics in continuum theory complete the book. Although it is not a book on dynamics, the influen

  8. A aplicação do QFD no desenvolvimento de software: um estudo de caso

    Directory of Open Access Journals (Sweden)

    Fernando Antônio Sonda

    2000-06-01

    Full Text Available Este trabalho tem como objetivo apresentar a aplicação do QFD como ferramenta de suporte para o planejamento e desenvolvimento de um software de custos, visando um melhor atendimento das características demandadas pelo cliente, bem como a determinação de indicadores para controlar o processo de desenvolvimento do produto. O trabalho foi desenvolvido a partir de uma pesquisa de mercado realizada com usuários de softwares de custos e demais pessoas envolvidas com o gerenciamento de custos. Com a aplicação do QFD, observou-se que a definição antecipada das características principais do sistema é fundamental para o desenvolvimento de um software. O QFD vem se somar as demais ferramentas de análise de sistemas proporcionando, simultaneamente, um desenvolvimento mais rápido e mais qualificado.This paper presents an application of QFD for planning and development of a cost software. The QFD was chosen aiming a better assessment of the user desires as well as the indication of the parameters for process control. The work was initiated from a market survey conducted on users of cost software and other people involved in cost management. The use of the QFD shows that the early definition of the key characteristics of the system is essential in software development. The QFD complements the use of other system analysis techniques and contributes for a faster and more qualified software development.

  9. Planos diretores: o caminho para o desenvolvimento sustentável das cidades

    Directory of Open Access Journals (Sweden)

    Alexsandro da Miranda

    2013-11-01

    Full Text Available Os Planos Diretores efetivam a existência de uma legislação geral estabelecendo as normas necessárias à implementação de políticas urbanas, previstas na Constituição Federal e no Estatuto da Cidade (Lei Federal 10.257/2001 e que em seu foco principal está o desenvolvimento e a expansão urbana.  Assim, o presente artigo aborda uma breve discussão teórica do tema, suas problemáticas e contextualizações na perspectiva de fundamentá-las à luz das teorias existentes. Três principais diretrizes devem ser destacadas: o desenvolvimento sustentável, a gestão democrática da cidade e o planejamento do desenvolvimento das cidades, onde os municípios, devem, portanto, utilizar as diretrizes e instrumentos do Estatuto da Cidade com o objetivo de estabelecer as regras que propiciem o pleno desenvolvimento econômico, social, ambiental e sustentável, com vistas a garantir o direito à cidade para todos os que nela vivem.

  10. Desenvolvimento da Coordenação Motora Fina: Sugestões Estratégicas

    Directory of Open Access Journals (Sweden)

    Berenice Crestana Guardia

    2007-06-01

    Full Text Available Este artigo tem como objetivo de sugerir atividades para a fase inicial da aprendizagem da escrita, partindo de uma visão geral dos aspectos que o desenvolvimento da coordenção motora fina apresenta na prática pedagógica.

  11. Avaliação do crescimento e desenvolvimento de crianças institucionalizadas

    Directory of Open Access Journals (Sweden)

    Caroline Magna Pessoa Chaves

    2013-10-01

    Full Text Available O estudo objetivou avaliar o crescimento e desenvolvimento de crianças de 0 a 6 anos institucionalizadas. Abordagem descritiva, transversal e de natureza quantitativa. Foi realizado em um abrigo da Secretaria do Trabalho e Desenvolvimento Social do Governo do Estado do Ceará, nos meses de março e abril de 2011. A amostra foi composta por 44 crianças. Prevaleceram crianças de sexo masculino (59,1%; faixa etária entre 24 a 72 meses (56,8%, e tempo de abrigamento superior a um ano (72,7%. Verificou-se que as crianças estavam na faixa de normalidade nutricional. Porém, 65,9% das crianças não alcançaram pelo menos um dos marcos do desenvolvimento propostos pelo Ministério da Saúde. O estudo possibilitou uma reflexão sobre como as crianças residentes em abrigos estão sendo assistidas pela equipe de saúde, tornando-se necessário realizar o acompanhamento de seu crescimento e desenvolvimento, a fim de intervir sobre as alterações encontradas.

  12. Biopolítica e Desenvolvimento? Foucault e Agamben sobre Estado, Governo e Violência

    Directory of Open Access Journals (Sweden)

    Guilherme F. W. Radomsky

    2015-06-01

    Full Text Available Este artigo analisa as relações entre biopolítica e desenvolvimento sob o ângulo das noções de Estado, governo e violência. O objetivo consiste em examinar elementos analíticos que gravitam em torno de perspectivas críticas do desenvolvimento buscando um eixo interpretativo sobre a ambivalência das ações do Estado a partir de duas possibilidades teóricas que convergem no pensamento de Giorgio Agamben: a análise do biopoder e do governo em Foucault e as articulações entre violência e lei que remetem a Walter Benjamin. A reflexão sobre os argumentos teóricos é realizada examinando-se dados oriundos de pesquisa de abordagem qualitativa sobre políticas para a agricultura ecológica no sul do Brasil. As conclusões mostram que o desenvolvimento e seus benefícios podem ser problematizados pelo olhar do biopoder e da violência, que reconfiguram o que seja desenvolvimento, menos como expansão do bem-estar e mais como impulso modernizante de mudança que se ampara em administrar a vida.

  13. O uso de múltiplas escalas geográficas no planejamento do desenvolvimento regional

    Directory of Open Access Journals (Sweden)

    Vivian Costa Brito

    2017-01-01

    Full Text Available O uso de múltiplas escalas geográficas aplicadas ao planejamento de políticas públicas de desenvolvimento regional é recente no Brasil. Remete à criação da Política Nacional de Desenvolvimento Regional (PNDR em 2003. A ênfase dada na categoria socioespacial reflete uma abordagem de caráter territorialista, que se contrapõe ao planejamento com enfoque estritamente macrorregional e com viés econômico. Este artigo analisa a conformação de estruturação e implementação desse arranjo multiescalar, para compreender a dimensão do planejamento na PNDR I e II. Como eixo central de articulação da política tem-se a relação intergovernamental e extragovernamental com inserção de todos os setores, abarcando estratégias de ação multiescalares. A abordagem multiescalar precisa avançar sobre a questão do ritmo e direção do desenvolvimento. As ferramentas da transversalidade e da intersetorialidade devem refletir em mudança social. Sem isso, o desenvolvimento regional torna-se contraditório, longe de representar uma oportunidade para regiões deprimidas tanto econômica quanto socialmente.

  14. O TRABALHO COMO ATIVIDADE PRINCIPAL NO DESENVOLVIMENTO PSÍQUICO DO INDIVÍDUO ADULTO

    Directory of Open Access Journals (Sweden)

    Camila Fernanda Moro Rios

    2017-12-01

    Full Text Available Este artigo visa analisar, por meio da revisão teórica de autores clássicos e contemporâneos da psicologia histórico-cultural, o trabalho como atividade principal na vida adulta, isto é, como a atividade que orienta as principais mudanças no psiquismo humano e na personalidade nessa idade. Para tanto, abstrai e generaliza elementos constantes nos estudos sobre periodização do desenvolvimento psíquico humano. Por um lado, identifica os conteúdos e processos psicológicos que, produzidos pelo trabalho, evidenciam sua relevância para o desenvolvimento do indivíduo adulto. Por outro, aborda os processos de alienação inerentes à sociedade capitalista, que alienam o trabalho como atividade principal. Assim, o trabalho se apresenta, dialeticamente, como atividade humanizadora e alienada. Entende-se que este estudo contribui para o avanço teórico-metodológico da psicologia histórico-cultural por abordar a questão do trabalho como atividade principal, uma discussão que se encontra ainda incipiente e pouco sistematizada. Além disso, supera o enfoque dos estudos sobre o desenvolvimento centrados na infância e reitera o rompimento com a perspectiva maturacionista de que a vida adulta é um período de estagnação do desenvolvimento. Pela análise do trabalho como atividade principal conclui-se que o desenvolvimento psicológico, produzido na vida adulta, se expressa, principalmente, por uma série de aquisições de habilidades e capacidades, pelo exercício da criatividade, por uma complexa reestruturação da esfera afetivo-motivacional da personalidade, pelo desenvolvimento da autoconsciência e pelo movimento dialético da consciência de classe, que tensiona a contradição entre o polo humanizador e o polo alienado/alienante do trabalho numa sociedade que limita e empobrece esse mesmo desenvolvimento.

  15. 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.

  16. Argumentação e desenvolvimento do pensamento reflexivo Argumentation and development of reflective thinking

    Directory of Open Access Journals (Sweden)

    Selma Leitão

    2007-01-01

    Full Text Available O objetivo central do presente artigo é oferecer uma perspectiva a partir da qual as relações entre argumentação e reflexão podem ser investigadas. O argumento central proposto é que os mesmos mecanismos semiótico-dialógicos que constituem a argumentação (justificação de pontos de vista, consideração de objeções e reação a elementos contrários são igualmente efetivos em deslocar o pensamento do indivíduo para um plano reflexivo (metacognitivo. A produção destas ações discursivas reorienta o pensamento do indivíduo do objeto sobre o qual argumenta para o exame das bases e limites de suas próprias concepções sobre aquele objeto. Tal reorientação institui o pensamento do próprio indivíduo como objeto de reflexão. Na segunda parte do artigo, uma análise de fragmentos de argumentação produzida por crianças em sala de aula ilustra a forma como a perspective proposta pode ser utilizada na investigação do desenvolvimento de processos auto-regulados de reflexão.The main goal of this article is to offer a perspective from which the relations between argumentation and reflection can be investigated. The main argument proposed is that the same semiotic-dialogic mechanism that constitutes argumentation (supporting a view with reasons, considering objections and responding to opposition has a built-in capacity to place the arguer's thinking in a metacognitive framework. Together, they are effective in orienting the thinking a person does towards examining the bases and limits of his/her own thoughts. They do so by introducing into the person's psychological field a new object for reflection the arguer's own thoughts. At the second section of the article, the analysis of some fragments of children's argumentation produced in classroom illustrates how the framework proposed can be used in investigating the development of self-regulated reflection.

  17. 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.

  18. Taking Less Than Prescribed: Medication Nonadherence and Provider-Patient Relationships in Lower-Income, Rural Minority Adults With Hypertension

    OpenAIRE

    Martin, Michelle Y.; Kohler, Connie; Kim, Young-il; Kratt, Polly; Schoenberger, Yu-Mei; Litaker, Mark S.; Prayor-Patterson, Heather M.; Clarke, Stephen J.; Andrews, Shiquina; Pisu, Maria

    2010-01-01

    Control of hypertension remains poor, and lack of adherence to medication is considered a primary reason. Few studies have examined the reasons for medication nonadherence in African American, lower-income, rural adults receiving medications at no personal cost. Moreover, our understanding of how the provider-patient relationship influences adherence in this population is limited. In this study, the authors (1) examined reasons for taking less medication than prescribed and (2) examined the a...

  19. 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...

  20. 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...

  1. 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.

  2. 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.

  3. 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...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-01-01

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

  5. 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.

  6. 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.

  7. 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.

  8. 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. 

  9. 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.

  10. 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.

  11. 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.

  12. Comparing the Influence of Wildfire and Prescribed Burns on Watershed Nitrogen Biogeochemistry Using 15N Natural Abundance in Terrestrial and Aquatic Ecosystem Components

    Science.gov (United States)

    Stephan, Kirsten; Kavanagh, Kathleen L.; Koyama, Akihiro

    2015-01-01

    We evaluated differences in the effects of three low-severity spring prescribed burns and four wildfires on nitrogen (N) biogeochemistry in Rocky Mountain headwater watersheds. We compared paired (burned/unburned) watersheds of four wildfires and three spring prescribed burns for three growing seasons post-fire. To better understand fire effects on the entire watershed ecosystem, we measured N concentrations and δ15N in both the terrestrial and aquatic ecosystems components, i.e., soil, understory plants in upland and riparian areas, streamwater, and in-stream moss. In addition, we measured nitrate reductase activity in foliage of Spiraea betulifolia, a dominant understory species. We found increases of δ15N and N concentrations in both terrestrial and aquatic ecosystem N pools after wildfire, but responses were limited to terrestrial N pools after prescribed burns indicating that N transfer from terrestrial to aquatic ecosystem components did not occur in low-severity prescribed burns. Foliar δ15N differed between wildfire and prescribed burn sites; the δ15N of foliage of upland plants was enriched by 2.9 ‰ (difference between burned and unburned watersheds) in the first two years after wildfire, but only 1.3 ‰ after prescribed burns. In-stream moss δ15N in wildfire-burned watersheds was enriched by 1.3 ‰, but there was no response by moss in prescription-burned watersheds, mirroring patterns of streamwater nitrate concentrations. S. betulifolia showed significantly higher nitrate reductase activity two years after wildfires relative to corresponding unburned watersheds, but no such difference was found after prescribed burns. These responses are consistent with less altered N biogeochemistry after prescribed burns relative to wildfire. We concluded that δ15N values in terrestrial and aquatic plants and streamwater nitrate concentrations after fire can be useful indicators of the magnitude and duration of fire effects and the fate of post

  13. Determining the Uncertainties in Prescribed Burn Emissions Through Comparison of Satellite Estimates to Ground-based Estimates and Air Quality Model Evaluations in Southeastern US

    Science.gov (United States)

    Odman, M. T.; Hu, Y.; Russell, A. G.

    2016-12-01

    Prescribed burning is practiced throughout the US, and most widely in the Southeast, for the purpose of maintaining and improving the ecosystem, and reducing the wildfire risk. However, prescribed burn emissions contribute significantly to the of trace gas and particulate matter loads in the atmosphere. In places where air quality is already stressed by other anthropogenic emissions, prescribed burns can lead to major health and environmental problems. Air quality modeling efforts are under way to assess the impacts of prescribed burn emissions. Operational forecasts of the impacts are also emerging for use in dynamic management of air quality as well as the burns. Unfortunately, large uncertainties exist in the process of estimating prescribed burn emissions and these uncertainties limit the accuracy of the burn impact predictions. Prescribed burn emissions are estimated by using either ground-based information or satellite observations. When there is sufficient local information about the burn area, the types of fuels, their consumption amounts, and the progression of the fire, ground-based estimates are more accurate. In the absence of such information satellites remain as the only reliable source for emission estimation. To determine the level of uncertainty in prescribed burn emissions, we compared estimates derived from a burn permit database and other ground-based information to the estimates by the Biomass Burning Emissions Product derived from a constellation of NOAA and NASA satellites. Using these emissions estimates we conducted simulations with the Community Multiscale Air Quality (CMAQ) model and predicted trace gas and particulate matter concentrations throughout the Southeast for two consecutive burn seasons (2015 and 2016). In this presentation, we will compare model predicted concentrations to measurements at monitoring stations and evaluate if the differences are commensurate with our emission uncertainty estimates. We will also investigate if

  14. OS MODELOS DE CRESCIMENTO E DE DESENVOLVIMENTO ECONÔMICO E SUA APLICABILIDADE NAS ECONOMIAS REGIONAIS NÃO DESENVOLVIDAS

    OpenAIRE

    Adelmo M. França

    2012-01-01

    Neste artigo serão apresentadas as definições de crescimento e desenvolvimento econômico e as algumas discussões propostas pelos principais modelos econômicos voltados ao crescimento e desenvolvimento econômicos, questionando o fato deles terem suas origens nas economias desenvolvidas e, portanto, distantes das realidades sociais, políticas e econômicas dos países e das regiões pobres ou em fase de desenvolvimento. As abordagens sobre o tema estarão focadas na realidade econômica brasileira d...

  15. Método Ágil aplicado ao desenvolvimento de software confiável baseado em componentes

    OpenAIRE

    Alan Braz

    2013-01-01

    Resumo: Os Métodos Ágeis, ou Desenvolvimento Ágil de Software (DAS), tem se popularizado, na última década, por meio de métodos como Extreme Programming (XP) e Scrum e isso fez com que fossem aplicadas no desenvolvimento de sistemas computacionais de diversos tamanhos, complexidades técnica e de domínio, e de rigor quanto à confiabilidade. Esse fato evidencia a necessidade de processos de desenvolvimento de software que sejam mais rigorosos e que possuam uma quantidade adequada de modelagem e...

  16. O papel das Forças Armadas na I&D da Defesa como vector de desenvolvimento nacional

    OpenAIRE

    Simões, Luís

    2010-01-01

    A humanidade sempre se preocupou com o seu bem-estar, de alguma forma. Neste âmbito, o desenvolvimento económico tem vindo a desempenhar um papel fundamental. Após a revolução industrial, mas particularmente depois da II Guerra Mundial, os Estados têm-se preocupado com o respectivo desenvolvimento económico sustentável, entre outras questões, como garante de bem-estar das suas populações. A investigação e desenvolvimento (I&D), no seu conjunto, têm sido apontados como um possível vector de de...

  17. 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.

  18. Adherence of pharmaceutical advertisements in medical journals to FDA guidelines and content for safe prescribing.

    Science.gov (United States)

    Korenstein, Deborah; Keyhani, Salomeh; Mendelson, Ali; Ross, Joseph S

    2011-01-01

    Physician-directed pharmaceutical advertising is regulated in the United States by the Food and Drug Administration (FDA); adherence to current FDA guidelines is unknown. Our objective was to determine adherence rates of physician-directed print advertisements in biomedical journals to FDA guidelines and describe content important for safe prescribing. Cross-sectional analysis of November 2008 pharmaceutical advertisements within top U.S.-based biomedical journals publishing original research. We excluded advertisements for devices, over the counter medications, and disease awareness. We utilized FDA guideline items identifying unique forms of advertisement bias to categorize advertisements as adherent to FDA guidelines, possibly non-adherent to at least 1 item, or non-adherent to at least 1 item. We also evaluated advertisement content important for safe prescribing, including benefit quantification, risk information and verifiable references. All advertisements were evaluated by 2 or more investigators, with differences resolved by discussion. Twelve journals met inclusion criteria. Nine contained pharmaceutical advertisements, including 192 advertisements for 82 unique products; median 2 per product (range 1-14). Six "teaser" advertisements presented only drug names, leaving 83 full unique advertisements. Fifteen advertisements (18.1%) adhered to all FDA guidelines, 41 (49.4%) were non-adherent with at least one form of FDA-described bias, and 27 (32.5%) were possibly non-adherent due to incomplete information. Content important for safe prescribing was often incomplete; 57.8% of advertisements did not quantify serious risks, 48.2% lacked verifiable references and 28.9% failed to present adequate efficacy quantification. Study limitations included its focus on advertisements from a single month, the subjectivity of FDA guidelines themselves, and the necessary subjectivity of determinations of adherence. Few physician-directed print pharmaceutical advertisements

  19. Prescribing for Children With Rheumatic Disease: Perceived Treatment Approaches Between Pediatric and Adult Rheumatologists.

    Science.gov (United States)

    van Mater, Heather; Balevic, Stephen J; Freed, Gary L; Clark, Sarah J

    2018-02-01

    To compare practice patterns and prescribing differences for juvenile idiopathic arthritis (JIA) between adult rheumatologists (ARs) and pediatric rheumatologists (PRs), the perceived educational needs, and factors that enhance or impede co-management. Two parallel, cross-sectional surveys focusing on JIA were administered in 2009 to a random sample of 193 PRs and 500 ARs using the American College of Rheumatology membership file. Bivariate analysis was conducted for common items. The response rate was 62.1% for ARs (n = 306) and 72.3% for PRs (n = 138). Only 23% of responding ARs (n = 69) reported caring for children with JIA. Of these, 94% strongly agreed/agreed feeling comfortable diagnosing JIA; however, only 76% felt comfortable treating JIA. Clinical vignettes highlighted several prescribing differences. Forty-eight percent of ARs and 31% of PRs felt medications to treat JIA did not have clear dosing guidelines. Though PRs initiated disease-modifying antirheumatic drugs and biologic agents earlier, treatments were similar after 3 months. To enhance co-management, 74% of pediatric respondents endorsed shared medical records. Nearly one-quarter of surveyed ARs care for children with JIA, with most limiting their practice to older children. There was more discomfort in treating JIA than diagnosing it, and there were significant prescribing differences. Both provider types identified the need for better dosing and treatment resources. Updated management guidelines along with exposure to pediatric rheumatology in fellowship could reduce treatment differences and enhance the care of children with JIA. Shared medical records and improvement in reimbursement may optimize co-management. © 2017, American College of Rheumatology.

  20. Workarounds to hospital electronic prescribing systems: a qualitative study in English hospitals.

    Science.gov (United States)

    Cresswell, Kathrin M; Mozaffar, Hajar; Lee, Lisa; Williams, Robin; Sheikh, Aziz

    2017-07-01

    Concerns with the usability of electronic prescribing (ePrescribing) systems can lead to the development of workarounds by users. To investigate the types of workarounds users employed, the underlying reasons offered and implications for care provision and patient safety. We collected a large qualitative data set, comprising interviews, observations and project documents, as part of an evaluation of ePrescribing systems in five English hospitals, which we conceptualised as case studies. Data were collected at up to three different time points throughout implementation and adoption. Thematic analysis involving deductive and inductive approaches was facilitated by NVivo 10. Our data set consisted of 173 interviews, 24 rounds of observation and 17 documents. Participating hospitals were at various stages of implementing a range of systems with differing functionalities. We identified two types of workarounds: informal and formal. The former were informal practices employed by users not approved by management, which were introduced because of perceived changes to professional roles, issues with system usability and performance and challenges relating to the inaccessibility of hardware. The latter were formalised practices that were promoted by management and occurred when systems posed threats to patient safety and organisational functioning. Both types of workarounds involved using paper and other software systems as intermediaries, which often created new risks relating to a lack of efficient transfer of real-time information between different users. Assessing formal and informal workarounds employed by users should be part of routine organisational implementation strategies of major health information technology initiatives. Workarounds can create new risks and present new opportunities for improvement in system design and integration. 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/.

  1. Adherence of pharmaceutical advertisements in medical journals to FDA guidelines and content for safe prescribing.

    Directory of Open Access Journals (Sweden)

    Deborah Korenstein

    Full Text Available Physician-directed pharmaceutical advertising is regulated in the United States by the Food and Drug Administration (FDA; adherence to current FDA guidelines is unknown. Our objective was to determine adherence rates of physician-directed print advertisements in biomedical journals to FDA guidelines and describe content important for safe prescribing.Cross-sectional analysis of November 2008 pharmaceutical advertisements within top U.S.-based biomedical journals publishing original research. We excluded advertisements for devices, over the counter medications, and disease awareness. We utilized FDA guideline items identifying unique forms of advertisement bias to categorize advertisements as adherent to FDA guidelines, possibly non-adherent to at least 1 item, or non-adherent to at least 1 item. We also evaluated advertisement content important for safe prescribing, including benefit quantification, risk information and verifiable references. All advertisements were evaluated by 2 or more investigators, with differences resolved by discussion. Twelve journals met inclusion criteria. Nine contained pharmaceutical advertisements, including 192 advertisements for 82 unique products; median 2 per product (range 1-14. Six "teaser" advertisements presented only drug names, leaving 83 full unique advertisements. Fifteen advertisements (18.1% adhered to all FDA guidelines, 41 (49.4% were non-adherent with at least one form of FDA-described bias, and 27 (32.5% were possibly non-adherent due to incomplete information. Content important for safe prescribing was often incomplete; 57.8% of advertisements did not quantify serious risks, 48.2% lacked verifiable references and 28.9% failed to present adequate efficacy quantification. Study limitations included its focus on advertisements from a single month, the subjectivity of FDA guidelines themselves, and the necessary subjectivity of determinations of adherence.Few physician-directed print pharmaceutical

  2. Improving antibiotic prescribing skills in medical students: the effect of e-learning after 6 months.

    Science.gov (United States)

    Sikkens, Jonne J; Caris, Martine G; Schutte, Tim; Kramer, Mark H H; Tichelaar, Jelle; van Agtmael, Michiel A

    2018-05-09

    Antimicrobial prescribing behaviour is first established during medical study, but teachers often cite lack of time as an important problem in the implementation of antimicrobial stewardship in the medical curriculum. The use of electronic learning (e-learning) is a potentially time-efficient solution, but its effectiveness in changing long-term prescribing behaviour in medical students is as yet unknown. We performed a prospective controlled intervention study of the long-term effects of a short interactive e-learning course among fourth year medical students in a Dutch university. The e-learning was temporarily implemented as a non-compulsory course during a 6 week period. Six months later, all students underwent an infectious disease-based objective structured clinical examination (OSCE) aimed at simulating postgraduate prescribing. If they passed, each student did the OSCE only once. We created a control group of students from a period when the e-learning was not implemented. Main outcomes were the OSCE pass percentage and knowledge, drug choice and overall scores. We used propensity scores to create equal comparisons. We included 71 students in the intervention group and 285 students in the control group. E-learning participation in the intervention group was 81%. The OSCE pass percentage was 86% in the control group versus 97% in the intervention group (+11%, OR 5.9, 95% CI 1.7-20.0). OSCE overall, knowledge and drug choice grades (1-10) were also significantly higher in the intervention group (differences +0.31, +0.31 and +0.51, respectively). E-learning during a limited period can significantly improve medical students' performance of an antimicrobial therapeutic consultation in a situation simulating clinical practice 6 months later.

  3. Restoration of mountain big sagebrush steppe following prescribed burning to control western juniper.

    Science.gov (United States)

    Davies, K W; Bates, J D; Madsen, M D; Nafus, A M

    2014-05-01

    Western juniper (Juniperus occidentalis ssp. occidentalis Hook) encroachment into mountain big sagebrush (Artemisia tridentata spp. vaseyana (Rydb.) Beetle) steppe has reduced livestock forage production, increased erosion risk, and degraded sagebrush-associated wildlife habitat. Western juniper has been successfully controlled with partial cutting followed by prescribed burning the next fall, but the herbaceous understory and sagebrush may be slow to recover. We evaluated the effectiveness of seeding perennial herbaceous vegetation and sagebrush at five sites where juniper was controlled by partially cutting and prescribed burning. Treatments tested at each site included an unseeded control, herbaceous seed mix (aerially seeded), and the herbaceous seed mix plus sagebrush seed. In the third year post-treatment, perennial grass cover and density were twice as high in plots receiving the herbaceous seed mix compared to the control plots. Sagebrush cover and density in the sagebrush seeded plots were between 74- and 290-fold and 62- and 155-fold greater than the other treatments. By the third year after treatment, sagebrush cover was as high as 12 % in the sagebrush seeded plots and between 0 % and 0.4 % where it was not seeded. These results indicate that aerial seeding perennial herbaceous vegetation can accelerate the recovery of perennial grasses which likely stabilize the site. Our results also suggest that seeding mountain big sagebrush after prescribed burning encroaching juniper can rapidly recover sagebrush cover and density. In areas where sagebrush habitat is limited, seeding sagebrush after juniper control may increase sagebrush habitat and decrease the risks to sagebrush-associated species.

  4. 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...

  5. 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

  6. 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

  7. 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

  8. 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.

  9. 12 CFR 308.13 - Change of time limits.

    Science.gov (United States)

    2010-01-01

    ... PRACTICE AND PROCEDURE Uniform Rules of Practice and Procedure § 308.13 Change of time limits. Except as otherwise provided by law, the administrative law judge may, for good cause shown, extend the time limits prescribed by the Uniform Rules or by any notice or order issued in the proceedings. After the referral of...

  10. 12 CFR 263.13 - Change of time limits.

    Science.gov (United States)

    2010-01-01

    ... RULES OF PRACTICE FOR HEARINGS Uniform Rules of Practice and Procedure § 263.13 Change of time limits. Except as otherwise provided by law, the administrative law judge may, for good cause shown, extend the time limits prescribed by the Uniform Rules or by any notice or order issued in the proceedings. After...

  11. 12 CFR 747.13 - Change of time limits.

    Science.gov (United States)

    2010-01-01

    ... ADMINISTRATIVE ACTIONS, ADJUDICATIVE HEARINGS, RULES OF PRACTICE AND PROCEDURE, AND INVESTIGATIONS Uniform Rules of Practice and Procedure § 747.13 Change of time limits. Except as otherwise provided by law, the administrative law judge may, for good cause shown, extend the time limits prescribed by the Uniform Rules or by...

  12. 12 CFR 509.13 - Change of time limits.

    Science.gov (United States)

    2010-01-01

    ... PROCEDURE IN ADJUDICATORY PROCEEDINGS Uniform Rules of Practice and Procedure § 509.13 Change of time limits. Except as otherwise provided by law, the administrative law judge may, for good cause shown, extend the time limits prescribed by the Uniform Rules or any notice or order issued in the proceedings. After the...

  13. 12 CFR 19.13 - Change of time limits.

    Science.gov (United States)

    2010-01-01

    ... PROCEDURE Uniform Rules of Practice and Procedure § 19.13 Change of time limits. Except as otherwise provided by law, the administrative law judge may, for good cause shown, extend the time limits prescribed by the Uniform Rules or by any notice or order issued in the proceedings. After the referral of the...

  14. Da revolução verde ao discurso do PRONAF: a representação do desenvolvimento nas políticas públicas de desenvolvimento rural no Brasil

    Directory of Open Access Journals (Sweden)

    Michell Leonard Duarte de Lima Tolentino

    2016-12-01

    Full Text Available Este trabalho procura refletir acerca das várias representações de desenvolvimento que embasam algumas das políticas públicas de desenvolvimento rural no Brasil, partindo das representações de desenvolvimento subjacentes à Revolução Verde e focando, posteriormente, no discurso do Programa Nacional de Fortalecimento da Agricultura Familiar (PRONAF. O trabalho se embasa em uma ampla pesquisa bibliográfica e documental. De início abordamos o discurso do desenvolvimento de forma crítica, para logo depois atentarmos para a maneira como este coloca o espaço rural. Para tanto utilizamos autores como Esteva (2000, Escobar (2000, Santos (1979 e Montenegro Gómez (2006. Posteriormente analisamos a Revolução Verde “brasileira” compreendendo o fordismo enquanto seu principal modelo de desenvolvimento. Em seguida, partimos para uma reflexão mais profunda sobre o PRONAF. O PRONAF assume fundamental importância nesse trabalho, pois o entendemos enquanto uma política de extrema relevância para se ler esse momento de inflexão das políticas públicas para o campo, de mudança nas representações sobre o espaço rural e o desenvolvimento rural brasileiro. Ao nos determos no PRONAF, discutimos a mudança de um modelo de desenvolvimento fordista para um modelo de desenvolvimento flexível.

  15. 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

  16. 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

  17. 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 ...

  18. 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.

  19. Resiliência e Justiça Organizacional como Antecedentes da Percepção de Desenvolvimento Profissional

    Directory of Open Access Journals (Sweden)

    Ana Claudia Monteiro

    Full Text Available RESUMO O mercado competitivo da atualidade tem exigido mais qualificação dos trabalhadores, o que aumenta a relevância do construto desenvolvimento profissional. O objetivo deste estudo foi testar um modelo de predição da percepção do desenvolvimento profissional. Participaram da pesquisa 320 trabalhadores de diferentes categorias profissionais de organizações públicas e privadas. O questionário continha três escalas, todas com bons indicadores psicométricos. Os resultados apontados a partir da regressão múltipla confirmaram que percepção de justiça organizacional e resiliência predizem positivamente a percepção de desenvolvimento profissional, sendo que esta demonstra maior poder preditivo. Os resultados foram discutidos de acordo com a teoria do desenvolvimento profissional.

  20. The radiological safety in the use of nuclear technique -activities developed by Centro de Desenvolvimento da Tecnologia Nuclear - CNEN

    International Nuclear Information System (INIS)

    Wakabayashi, T.; Pereira, E.G.; Hirayama, T.

    1991-01-01

    The activities developed by the Centro de Desenvolvimento da Tecnologia Nuclear - CDTN supporting the users of nuclear techniques are described. The methodology used and future plans for the group are shown. (E.G.)

  1. Desenvolvimento moral: considerações teóricas a partir de uma abordagem sociocultural construtivista

    Directory of Open Access Journals (Sweden)

    Martins Lincoln Coimbra

    2001-01-01

    Full Text Available Partindo da análise de trabalhos tradicionalmente realizados na área de desenvolvimento moral, o artigo sinaliza a necessidade de desenvolver uma abordagem teórica que trate o tema dentro de um enfoque que considere os aspectos socioculturais, cognitivos e afetivos. A questão central reside em abordar de forma sistêmica e integrada a dinâmica do desenvolvimento moral do indivíduo, resgatando a dimensão interativa e contextual envolvida na resolução dos conflitos morais e no desenvolvimento de crenças e valores. O trabalho parte dos pressupostos da perspectiva histórica socio-cultural construtivista do desenvolvimento humano, explicitando as exigências metodológicas implicadas na adoção dos conceitos e categorias utilizados no âmbito de tal perspectiva.

  2. Desenvolvimento moral: considerações teóricas a partir de uma abordagem sociocultural construtivista

    Directory of Open Access Journals (Sweden)

    Lincoln Coimbra Martins

    Full Text Available Partindo da análise de trabalhos tradicionalmente realizados na área de desenvolvimento moral, o artigo sinaliza a necessidade de desenvolver uma abordagem teórica que trate o tema dentro de um enfoque que considere os aspectos socioculturais, cognitivos e afetivos. A questão central reside em abordar de forma sistêmica e integrada a dinâmica do desenvolvimento moral do indivíduo, resgatando a dimensão interativa e contextual envolvida na resolução dos conflitos morais e no desenvolvimento de crenças e valores. O trabalho parte dos pressupostos da perspectiva histórica socio-cultural construtivista do desenvolvimento humano, explicitando as exigências metodológicas implicadas na adoção dos conceitos e categorias utilizados no âmbito de tal perspectiva.

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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,...

  8. 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...

  9. Otimização de alternativas para o desenvolvimento de campos de petróleo Selection of alternatives for the development of oil fields

    Directory of Open Access Journals (Sweden)

    Luciana Faletti Almeida

    2007-12-01

    Full Text Available Este artigo apresenta um sistema de suporte à decisão para a otimização de alternativas de desenvolvimento de campos de petróleo. O desenvolvimento de um campo de petróleo consiste na escolha de uma alternativa para a explotação de um reservatório petrolífero, conhecido e delimitado, que permita produzir a maior quantidade de hidrocarboneto possível, dentro dos limites físicos e econômicos existentes, isto é, maximizar o valor presente líquido (VPL. O VPL é calculado a partir da produção de óleo, a qual é obtida com o uso de um simulador de reservatório. Cada execução do simulador pode demorar desde alguns segundos até várias horas, dependendo da complexidade do reservatório modelado. Isto reduz o número de alternativas que podem ser geradas e avaliadas pelo especialista na busca da melhor solução. Deste modo, o objetivo deste trabalho é propor e avaliar um sistema inteligente de otimização que emprega: algoritmos genéticos (AGs, algoritmos culturais (ACs e coevolução para a busca de uma alternativa de desenvolvimento ótima; e um ambiente de computação paralela para a simulação de reservatório e cálculo do VPL das alternativas. O sistema resultante permite que o especialista obtenha, em tempo hábil, a alternativa ótima (ou quase-ótima para o desenvolvimento de um campo de petróleo conhecido. Os resultados obtidos nos estudos de casos apresentados demonstram que o sistema proposto, baseado em técnicas inteligentes, obtém boas alternativas de desenvolvimento de campos petrolíferos com uma grande redução do tempo computacional, redução esta obtida a partir do aproveitamento do poder computacional de um ambiente de computação paralela e do aproveitamento de conhecimento do especialista, por meio das sementes iniciais.This paper presents an optimization system for the development of petroleum fields. Developing a petroleum field consists of choosing an alternative exploitation of an already known

  10. Desenvolvimento de hardware reconfigurável de criptografia assimétrica

    Directory of Open Access Journals (Sweden)

    Otávio Souza Martins Gomes

    2015-01-01

    Full Text Available Este artigo apresenta o resultado parcial do desenvolvimento de uma interface de hardware reconfigurável para criptografia assimétrica que permite a troca segura de dados. Hardwares reconfiguráveis permitem o desenvolvimento deste tipo de dispositivo com segurança e flexibilidade e possibilitam a mudança de características no projeto com baixo custo e de forma rápida.Palavras-chave: Criptografia. Hardware. ElGamal. FPGA. Segurança. Development of an asymmetric cryptography reconfigurable harwadre ABSTRACTThis paper presents some conclusions and choices about the development of an asymmetric cryptography reconfigurable hardware interface to allow a safe data communication. Reconfigurable hardwares allows the development of this kind of device with safety and flexibility, and offer the possibility to change some features with low cost and in a fast way.Keywords: Cryptography. Hardware. ElGamal. FPGAs. Security.

  11. Relação entre saúde e saneamento na perspectiva do desenvolvimento

    OpenAIRE

    Heller,Léo

    1998-01-01

    Discute-se a relação entre saúde e saneamento, situando-a no contexto do processo de desenvolvimento social. É defendida inicialmente a inserção dessa relação no atual enfoque saúde e ambiente, reconhecendo que esta nova área não elimina a pertinência da abordagem saúde-saneamento, na verdade sua precursora. Apresenta-se a conceituação de saneamento e sua atual situação no país, além dos marcos conceituais da relação saúde-saneamento. Indicadores de desenvolvimento dos países, enfatizando os ...

  12. Disponibilidades e auto-implicação: desenvolvimento profissional e plurilinguismo

    Directory of Open Access Journals (Sweden)

    Gonçalves, Maria de Lurdes

    2007-01-01

    Full Text Available A crescente importância e o relevo que o plurilinguismo vem adquirindo, alargou o âmbito do trabalho dos docentes de línguas. Assim, a educação plurilingue e intelectual constitui um importante desafio para o crescimento profissional de um educador em línguas, sendo os programas de formação, enquanto mecanismos de desenvolvimento profissional, uma condição necessária para responder a esse desafio. Este texto apresenta um programa de formação para o desenvolvimento do plurilinguismo e analisa as disponibilidades e auto-implicação que esta proposta de formação encontrou no seio do grupo de professores de línguas de uma escola secundária em Portugal

  13. A organização confessional e o desenvolvimento humano frente à pedagogia Montessori

    OpenAIRE

    Guilhon, Edite Maria Barbosa

    2002-01-01

    Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Engenharia de Produção. Os fenômenos associados ao contexto das organizações e sua relação com o desenvolvimento humano dos profissionais nela envolvidos têm sido alvo de várias pesquisas e reflexões. Embora muito se fale em mudanças organizacionais, com ênfase na inclusão total e no desenvolvimento do ser humano, de concreto, muito pouco se tem praticado. Num cenário em que...

  14. Rastreio do desenvolvimento psicomotor: influência dos fatores de risco e contributo da psicomotricidade

    OpenAIRE

    Afonso, Carla Sandra Carneiro

    2015-01-01

    Tese de Doutoramento em Ciências do Desporto O desenvolvimento psicomotor é um processo dinâmico e contínuo que resulta das transformações que vão ocorrendo no ser humano ao longo da sua vida, e que depende da inter-relação entre os fatores genéticos e ambientais. Para se proceder à verificação e avaliação do desenvolvimento, é necessária a utilização de testes válidos, práticos e precisos que nos permitam obter resultados fidedignos, essenciais para que a criança cumpra em ...

  15. O desenvolvimento econômico da Venezuela, 1950/2006

    OpenAIRE

    Romina Batista de Lucena de Souza

    2008-01-01

    O objetivo desta tese é avaliar a contribuição do petróleo no desenvolvimento econômico da Venezuela, entre 1950/2006. Investiga-se por que uma economia rica em petróleo ainda não conseguiu industrializar-se. Seguindo os diferentes períodos governamentais, examinam-se a contribuição das políticas macroeconômicas sobre o desenvolvimento e a questão da doença holandesa e do capitalismo rentístico. Segundo a teoria da base econômica, as regiões crescem em torno de uma base exportadora, exercendo...

  16. A Importância da Criatividade no Desenvolvimento do Indivíduo

    Directory of Open Access Journals (Sweden)

    Débora Martins

    2012-09-01

    Full Text Available Construído com o propósito de enfatizar a importância da criatividade para o desenvolvimento do indivíduo, este trabalho reflete sobre os diversos ambientes criativos (casa, escola e trabalho e sobre as influências dos seus intervenientes. Assim, é abordada neste estudo a criatividade, enquanto definição e conceito, o papel da família e da sua influência no percurso educativo e o ambiente criativo na escola e no mundo profissional. Posteriormente são apresentados estudos sobre a importância da criatividade na educação, e sobre o papel das disciplinas artísticas para o desenvolvimento criativo do indivíduo. Por último, são apresentados alguns casos de sucesso e empreendedorismo, que fundamentam a importância deste tema para o percurso profissional.

  17. A PERCEPÇÃO DO DESENVOLVIMENTO REGIONAL NA GRANDE FRONTEIRA DO MERCOSUL

    Directory of Open Access Journals (Sweden)

    Jandir Ferrera de Lima

    2012-09-01

    Full Text Available Este artigo analisa a percepção do desenvolvimento regional na opinião das lideranças do Fórum da região Grande Fronteira do Mercosul (GFM no Sul do Brasil. A região GFM enfrenta dificuldades em manter seu dinamismo econômico frente ao contexto de globalização, da competitividade dos mercados, das dificuldades das pequenas propriedades rurais e as precárias condições sociais de parcela significativa da sua população. Para as lideranças do Fórum da GFM, o desenvolvimento regional implica na melhoria dos indicadores econômicos e sociais e na ação coordenada da sociedade civil organizada através dos órgãos de governança local.

  18. Diretrizes para o desenvolvimento e a avaliação de blogs de biblioteca

    Directory of Open Access Journals (Sweden)

    Laura Akie Saito Inafuko

    2012-01-01

    Full Text Available Os blogs se popularizam pela facilidade de uso e publicação, influenciando no aumento de ambientes informacionais digitais. Considera-se necessário estudos que otimizem a organização das informações contidas em blogs, para contribuir no seu desenvolvimento. A partir de observação direta não-participativa, analisou-se em 6 blogs de bibliotecas universitárias elementos de AI (MORVILLE; ROSENFELD, 2006 e diretrizes de Usabilidade (NIELSEN, 2005, identificando-se os elementos fundamentais e opcionais para o desenvolvimento estrutural de um blog. Além disso, foram elaboradas diretrizes de planejamento, um modelo de avaliação, e foram propostos elementos de AI específicos para blogs, contribuindo para os estudos da AI Digital.

  19. Desenvolvimento floral de Sinningia leucotricha (Hohne Moore, Gesneriaceae (rainha-do-abismo.

    Directory of Open Access Journals (Sweden)

    Lúcia Iuchi

    1997-05-01

    Full Text Available Flores de rainha-do-abismo, Sinni'ngi'a leucotricha (Hoehne Moore, em vários estádios de desenvolvimento, foram utilizadas para medição, descrição e documentação fotográfica, com o objetivo de estudar o desenvolvimento floral e verificar como ocorre naturalmente a polinização dessa espécie. Em trabalhos de cruzamentos, as flores de Rainha-do-abismo devem ser emasculadas com 3 cm de comprimento (estádio 3, quando as anteras ainda se encontram fechadas, para não correr o risco de uma autofecundação. As flores dessa espécie apresentaram uma dicogamia protândrica numa extensão tal que dificultou a autofecundação, mas não a impediu totalmente.

  20. Metodologia de avaliação e desenvolvimento de grupos de alto desempenho

    Directory of Open Access Journals (Sweden)

    Ana Cristina Carneiro

    2008-11-01

    Full Text Available Este artigo discute a fundamentação teórica do Projeto de Avaliação e Desenvolvimento de Grupos de Alto Desempenho, concebido com base na metodologia da Meta-aprendizagem, e no Modelo Evolutivo, estendido à luz da Teoria da Complexidade. Visa ao desenvolvimento e aplicação de uma metodologia de avaliação/constituição de grupos de alto desempenho no ambiente de pesquisa e pós-graduação. A metodologia proposta validada empiricamente teve base no aproveitamento das virtudes e potencialidades das teorias que lhe deram origem. É destinado aos docentes e pesquisadores de vários campos do conhecimento, bem como aos dirigentes de instituições de educação superior e de pesquisa.

  1. Aprimorando a Gerência e o Desenvolvimento de Software com Metodologias Ágeis

    Directory of Open Access Journals (Sweden)

    Mauricio Andreazza Sganderla

    2016-07-01

    Full Text Available Este artigo aborda a melhoria da gerência e construção de software utilizando as metodologias ágeis eXtreme Programming e Scrum. São aplicadas as melhores práticas de ambas as metodologias em uma equipe de desenvolvimento de software, em um ambiente em que não havia nenhum processo bem definido de desenvolvimento de software. A escolha pelo uso das metodologias ágeis foi definida, pois atende ao dinamismo do cenário atual, requisitos voláteis, ambiente mais colaborativo e menos burocrático, tendo como objetivo principal o software em funcionamento e que realmente traga retorno ao cliente.

  2. 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.

  3. 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)

  4. [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.

  5. 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....

  6. 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

  7. 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.

  8. 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...

  9. 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.

    1991-01-01

    Smoke aerosol and background aerosol particles were collected from the controlled burning of boreal forest where vegetation species and relative mass distributions are known. Chemical mass balances were constructed for the total mass of carbonaceous aerosol particles emitted during the prescribed burn. In addition, a carbonaceous species inventory was developed for aerosol particles presnt under background, smoldering, and full-fire conditions; the production of organic carbon and elemental carbon particles is noted for these two fire regimes. Distributions of the solvent-soluble organic components of the sampled aerosols were generated to identify molecular properties that can be traced to unburned and pyrolyzed materials present in the boreal forest fuels

  10. Economia e Desenvolvimento Social: A Possibilidade da Utilização de Indicadores Sociais na Avaliação do Desenvolvimento Paranaense

    Directory of Open Access Journals (Sweden)

    Daniel Vitor Vicente

    2013-12-01

    Full Text Available Este trabalho pretende analisar a progressão de indicadores sociais no Paraná a partir dos anos 1990, utilizando como base de dados os indicadores sociais de Educação, Emprego e Renda, Saúde e Saneamento, disponibilizados pelo Instituto Paranaense de Desenvolvimento Econômico e Social - IPARDES. Para o desdobramento de tal reflexão, será resgatado brevemente o desenvolvimento econômico Brasileiro, cujo projeto de Estado está embasado no que se conhece por novo desenvolvimentismo. Do mesmo modo, também será abordada a possibilidade de serem utilizados indicadores sociais públicos e gratuitos, a fim de que os mesmos auxiliem nos procedimentos de análise e problematização de questões sociais que interessam às Ciências Sociais, utilizando-se como exemplo os dados que serão apresentados.

  11. Ação coletiva e coprodução para o desenvolvimento rural: um estudo de caso do Colegiado de Desenvolvimento Territorial da Serra Catarinense

    Directory of Open Access Journals (Sweden)

    Alexandre Coimbra Ribeiro

    2015-02-01

    Full Text Available Este artigo analisa a ação coletiva promovida pelo Colegiado de Desenvolvimento Territorial (Codeter da Serra Catarinense, buscando verificar se essa ação colaborou para mobilizar um processo de coprodução do bem público no planejamento e gestão do desenvolvimento rural no território. Foi empregada uma estratégia de investigação de estudo de caso que combinou a utilização de diversas técnicas qualitativas de coleta de dados, análise e interpretação dos resultados. Diferentes paradigmas que tratam da ação coletiva foram considerados, no intuito de examinar a ação concertada promovida no Codeter e suas características principais. Com base no conceito de coprodução e suas variáveis, verificamos que essa ação coletiva engendrou um novo tipo de ação pública, ampliando a participação e a colaboração entre os atores sociais na coconstrução de soluções para os problemas públicos do território.

  12. A CRISE DO PLANEJAMENTO DE TRANSPORTES NOS PAÍSES EM DESENVOLVIMENTO: REAVALIANDO PRESSUPOSTOS E ALTERNATIVAS

    Directory of Open Access Journals (Sweden)

    Eduardo A. Vasconcellos

    2010-04-01

    Full Text Available O artigo faz inicialmente uma sistematização dos problemas verificados nos países em desenvolvimento, como contribuição ao entendimento da crise urbana e seus efeitos sobre as condições de transporte, são sugeridos novos pressupostos e novos objetivos de orientação do processo de planejamento de transportes.

  13. Desenvolvimento vegetativo de pinhão-manso em diferentes arranjos de plantio em sistemas agrossilvipastoris

    Directory of Open Access Journals (Sweden)

    Marcelo Dias Müller

    2014-07-01

    Full Text Available O objetivo deste trabalho foi avaliar o efeito de diferentes arranjos de plantio no desenvolvimento vegetativo de plantas de pinhão-manso estabelecidas em dois tipos de consórcio agrossilvipastoril. O experimento foi realizado no Município de Coronel Pacheco, MG, em delineamento de blocos ao acaso, em arranjo de parcelas subdivididas. A parcela foi representada por cinco espaçamentos: 6x3 m (555 plantas por hectare, 12x(2x2 m (714 plantas por hectare, 10x(2x2 m (833 plantas por hectare, 8x(2x2 m (1.000 plantas por hectare e 6x1,5 m (1.111 plantas por hectare; e a subparcela, por dois tipos de consórcio: agrossilvipastoril (integração lavoura-pecuária-pinhão-manso e silvipastoril (integração pecuária-pinhão-manso. As avalições foram realizadas nas safras 2010/2011 e 2011/2012. O espaçamento de plantio de 6x3 m proporcionou maior desenvolvimento em diâmetro de copa e número de brotações das plantas de pinhão-manso, na safra 2010/2011. Na safra 2011/2012, foi observado maior desenvolvimento em altura com o espaçamento de plantio de 8x(2x2 m. O consórcio de pinhão-manso x milho x pastagem proporciona maior desenvolvimento das plantas de pinhão-manso para todas as variáveis estudadas nas duas safras.

  14. A CONTRIBUIÇÃO DO GERENCIAMENTO DE PROJETOS NO PROCESSO DE DESENVOLVIMENTO DE PRODUTOS

    Directory of Open Access Journals (Sweden)

    Paulo Fernando Pinto Barcellos

    2014-09-01

    Full Text Available Em um ambiente complexo, caracterizado por uma demanda crescente de produtos customizados e personalizados, a diminuição do tempo de ciclo para o lançamento de novos produtos torna-se um ponto importante para obtenção de um maior retorno do investimento nos projetos de desenvolvimento. Assim, o objetivo proposto neste artigo foi investigar a contribuição das metodologias de gerenciamento de projetos para a diminuição do tempo de desenvolvimento de produtos. Para a realização deste estudo, e tendo em vista o objetivo proposto, foi utilizada metodologia qualitativa bibliográfica. As análises, realizadas no sentido de entender qual o tipo de processo de gerenciamento de projetos pode melhor contribuir para o desenvolvimento de produtos, trouxeram resultados contraditórios no sentido da utilização de métodos prescritivos e adaptativos. Este fato levou a reflexão de que a contribuição apresentada pelas práticas de gerenciamento de projetos para o desenvolvimento de produtos se dá com a verificação do cenário e o grau de inovação do projeto de produto que está sendo desenvolvido e com a utilização de metodologias adaptativas para projetos inovadores em ambientes complexos e metodologias prescritivas para projetos de concepção de rotina em ambientes simples.

  15. Resistindo ao desenvolvimento neocolonial: a luta do povo de Andalgalá contra projetos megamineiros

    Directory of Open Access Journals (Sweden)

    Maria Ceci Misoczky

    Full Text Available A América Latina vem experimentando uma nova era de declarada fé dos governos no mito do desenvolvimento, em articulação com a expansão de políticas extrativistas exportadoras em um contexto de renovada dependência. A face mais dramática do extrativismo na região tem sido a crescente presença de corporações mineiras transnacionais apoiadas por governos nacionais e regionais e por instituições internacionais financeiras e de apoio ao desenvolvimento, e intensamente resistidas por movimentos sociais populares. Neste artigo apresentamos o caso de Andalgalá (uma pequena cidade na Província de Catamarca, na Argentina e as lutas do povo contra corporações mineiras transnacionais e seus aliados. Na tradição da Filosofia da Libertação e do método ana-dialético de Dussel, nos engajamos com o que tem sido denominado "comunidades argentinas do NÃO", expressando sua oposição a formas neocoloniais de desenvolvimento e gestão. Neste artigo estamos especificamente interessados em compreender como dois dispositivos gerencialistas usados pelas corporações mineiras, responsabilidade social corporativa (RSC e pactos de governança, impactam a luta do povo. Acima de tudo, este artigo oferece instantâneos de batalhas na linha de frente do extrativismo. Esperamos ter dado voz àquelas pessoas que normalmente não são ouvidas, criando um espaço para suas visões sobre um tipo diferente de desenvolvimento.

  16. Desenvolvimento da linguagem na clínica fonoaudiológica em uma perspectiva multimodal

    Directory of Open Access Journals (Sweden)

    Ivonaldo Leidson Barbosa Lima

    2015-12-01

    Full Text Available A aquisição da linguagem contempla um processo dialógico contínuo de desenvolvimento mútuo da fala, dos gestos, do olhar que se (interrelacionam e constituem um único conjunto de produção e de significação. Essa concepção de linguagem multimodal começa a penetrar, atualmente, na prática fonoaudiológica, que busca promover atenção à saúde da comunicação humana. Desse modo, este trabalho buscou analisar o desenvolvimento linguístico, em uma perspectiva multimodal, de uma criança com atraso nesse processo de apropriação da linguagem. Para isso, foram realizadas filmagens de três encontros terapêuticos entre uma díade criança-fonoaudiólogo e foi analisada uma atividade comum nessas sessões: uma brincadeira com um jogo de animais. Constatou-se que há uma integração entre o uso de gestos e da fala, principalmente em partes que atraem mais a atenção da criança. Além disso, houve um desenvolvimento das produções verbais característica da trajetória infantil: na avaliação fonoaudiológica, foi observado que o menino só balbuciava, mais, durante o processo terapêutico, verificou-se o surgimento do uso de jargões e das primeiras palavras reconhecíveis e interpretáveis pelo adulto. Acredita-se que esse desenvolvimento tenha sido favorecido pela terapia fonoaudiológica em parceria à estimulação familiar.

  17. O ensino da escrita e o desenvolvimento das pessoas com deficiência intelectual

    Directory of Open Access Journals (Sweden)

    Solange Marques Rossato

    2013-12-01

    Full Text Available O presente artigo propõe uma reflexão teórica acerca do desenvolvimento das crianças com deficiência intelectual no que tange à importância e à necessidade de aprender a linguagem escrita, do ponto de vista da Teoria Histórico-Cultural. Para essa abordagem, o curso de desenvolvimento de uma criança, considerada deficiente ou não, ocorrerá conforme as condições culturais e sociais em que ela estiver inserida. Assim, no tocante à criança com deficiência intelectual, a sua condição cultural, em relação dinâmica com os entraves colocados por sua condição especial, será a fonte de seu desenvolvimento. Se o desenvolvimento das funções psicológicas superiores se realiza mediante o uso de ferramentas e se as pessoas com deficiência intelectual apresentam inaptidão para o uso dessas ferramentas, será necessário criar meios auxiliares para elas poderem aprender a utilizá-las, como meio de formar e desenvolver as suas funções psíquicas. Nesse processo, o ensino e a apropriação da linguagem escrita são vias fundamentais de acesso ao mundo cultural, numa mais ampla significação da comunicação, do mundo e de si mesmo. Em suma, os educadores compreenderem a relevância do ensino intencional da linguagem escrita e do processo histórico que a constitui representa uma contribuição fundamental para o processo de humanização das crianças com deficiência.

  18. A politica nuclear da Argentina e do Brasil : Desenvolvimento, nao-proliferacao e democratizacao

    OpenAIRE

    澤田, 眞治

    1994-01-01

    Este artigo e uma tentativa de analisar o desenvolvimento da politica da energia nuclear da Argentina e do Brasil, com relacao ao regime internacional de naoproliferacao das armas nucleares. Dado o fato de que ambos os paises da America do Sul recusaram a assinatura do TNP(Tratad0 sobre Nao-Proliferacao das Armas Nucleares), em razao do carater discriminatorio de inspecao, a Argentina e o Brasil estavam sendo considerado os estados duvidossos que potencialmente teriam a bomba atomica. A despe...

  19. Desenvolvimento de equações para estimativa do VO2PICO pelo teste de 9 minutos

    Directory of Open Access Journals (Sweden)

    Ana Carolina Paludo

    2014-06-01

    Full Text Available OBJETIVO: Desenvolver e validar modelos matemáticos para predição do VO2pico em crianças e adolescentes, por meio da utilização do teste de campo de corrida/caminhada de 9 minutos. MÉTODOS: Foram avaliados 211 escolares, de sete a 12 anos de idade, de ambos os sexos, regularmente matriculados em duas escolas do Município de Londrina - PR, sendo 141 escolares separados para amostra de desenvolvimento e 70 para validação das equações desenvolvidas. As medidas avaliadas foram: massa corporal, estatura, espessuras de dobras cutâneas (tricipital e subescapular, além da maturação biológica. Os testes de corrida/caminha de 9 minutos foram realizados em pista de atletismo e a análise direta do VO2pico (mL/kg/min realizada em laboratório, com analisador de gás portátil, através um teste incremental em esteira rolante. O desenvolvimento das equações foi realizado através da análise de regressão linear pelo método stepwise e a validação foi realizada pelos testes matemáticos específicos levando em consideração uma significância de 5% para todas as análises. RESULTADOS: A equação geral para a amostra total foi VO2pico= 24,506+16,672 (maturação, 0=pré e 1=púbere e pós - 0,346 (Σ DC + 5,187 (sexo, 0=F e 1=M + 0,009 (distância com um r=0,742 e EPE=9,149 mL/kg/min e sua validação apresentou r=0,570, CCI= 0,68, limites de concordância de -1,4 mL/kg/min, EPE=8,39 mL/kg/min e CV= 21,94%. CONCLUSÃO: Conclui-se que a equação generalizada desenvolvida fornece uma estimativa válida do VO2pico em crianças e adolescentes de sete a 12 anos de idade.

  20. Intervenção fonoaudiologica baseada na perspectiva comportamental em transtorno global do desenvolvimento (tgd: relato de caso

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    Ana Paola Nicolielo

    2014-08-01

    Full Text Available O objetivo deste trabalho foi descrever um processo de intervenção fonoaudiológica focado na adequação das habilidades linguísticas, sociais e cognitivas de uma criança com Distúrbio de Linguagem como parte de um Transtorno Global do Desenvolvimento (TGD, sob a perspectiva comportamental. A criança em questão era do gênero feminino e foi diagnosticada numa clínica-escola de Fonoaudiologia e encaminhada ao diagnóstico neurológico aos 2 anos de idade. Logo após o diagnóstico iniciou-se a intervenção fonoaudiológica individual, com base numa perspectiva comportamentalista de base mais tradicional; no entanto, ao longo do processo, houve mudanças no direcionamento da intervenção, sendo aqui relatados os dois primeiros anos de intervenção e apresentados dados da reavaliação fonoaudiológica no início do terceiro ano de intervenção. Como resultado da intervenção, houve melhora da linguagem receptiva e expressiva, sendo que a criança apresentou evolução quanto ao aspecto comportamental e aquisição de habilidades comunicativas, associando respostas verbais à ações. Além disso, houve aumento do contato ocular e do tempo de atenção e de aspectos relacionados ao simbolismo. O caso foi descrito com a preocupação de deixar claro que nem sempre é fácil a identificação da melhor abordagem terapêutica para essas crianças logo no início do processo, sendo que as decisões acerca da abordagem adequada devem ser repensadas constantemente não somente em decorrência do diagnóstico em si, mas também das manifestações da sintomatologia geral e específica – que variam conforme o desenvolvimento da criança e a evolução do processo de intervenção. Essas decisões devem ser pautadas na experiência do profissional, mas também na expectativa e no limite de cada família.

  1. Issues with prescribed medications in Aboriginal communities: Aboriginal health workers' perspectives.

    Science.gov (United States)

    Hamrosi, Kim; Taylor, Susan J; Aslani, Parisa

    2006-01-01

    The health of Indigenous Australians remains appalling. The causes of this situation are multi-factorial, however one contributing factor is poor medication compliance within Aboriginal populations. Anecdotal evidence provided by Aboriginal health workers in western New South Wales (NSW), Australia, has suggested that there are problems associated with the use of prescribed medications within the Aboriginal community. Aboriginal health workers form a core component of the Aboriginal health service sector and they have an in-depth knowledge of the community and its healthcare provision, as well as a familiarity with clinic patients and families. As such they are an important group whose opinions and beliefs about medication use in the Aboriginal population should be investigated. While there have been studies on the issues of prescribing in Aboriginal communities and access to medications, limited investigation into the use of prescribed medicines in Aboriginal communities and the role of the pharmacist in that process, has taken place. Therefore, this research aimed to identify the type of and reasons for inappropriate use of prescribed medications within Aboriginal communities serviced by the Mid Western Area Health Service (since incorporated into the Greater West Area Health Service) as perceived by the Aboriginal health workers in the area, and to explore strategies in conjunction with those Aboriginal health workers to address identified issues. Qualitative, in-depth interviews were held with 11 Aboriginal health workers employed in Community Health Centres and hospitals in the Mid Western Area Health service of NSW. The interviews were audiotaped and transcribed verbatim. The transcripts were content analysed for emerging themes. The interviews explored the beliefs, perceptions and experiences of the Aboriginal health workers regarding prescribed medication use, the role of the pharmacist, and identification of future strategies to improve medication use in

  2. Sensibilizar professores para o desenvolvimento de carreira dos alunos: relato de uma experiência

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    Íris M. Oliveira

    Full Text Available A literatura destaca a importância de realizar sessões de sensibilização dos professores para promover a sua influência positiva e intencional, enquanto docentes, nas trajetórias de carreira dos alunos. Este artigo relata uma experiência de realização de uma sessão de sensibilização junto a professores da educação básica de um agrupamento de escolas no noroeste de Portugal. Procurou-se esclarecer o conceito de desenvolvimento de carreira junto dos professores, conscientizá-los para o papel da escola no desenvolvimento de carreira dos alunos e estimular a dinamização de atividades promotoras desse processo. Apresenta-se a estrutura da sessão, as estratégias adotadas para alcançar os objetivos propostos e as reflexões partilhadas e debatidas pelos professores. As apreciações dos intervenientes quanto à sessão de sensibilização mostraram-se favoráveis. Esta experiência ilustra a importância de realizar sessões de sensibilização dos professores nesse domínio, as quais podem sustentar a promoção do desenvolvimento de carreira dos alunos, ao longo da escolaridade.

  3. AGROECOLOGIA: UMA ALTERNATIVA DE DESENVOLVIMENTO RURAL SUSTENTÁVEL PARA OS ASSENTAMENTOS RURAIS

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    Nivea Massaretto Verges

    2013-03-01

    Full Text Available Atualmente, observa-se o aumento das discussões, dentro das dimensões acadêmica, econômica, política e social, em relação à agricultura do país e do mundo, dentre as discussões está a questão do desenvolvimento rural sustentável, que existe em documentos, porém está ausente na prática. Um exemplo da ausência do desenvolvimento rural sustentável pode ser encontrado nas famílias de produtores assentadas que, em meio a muitas pressões, acabam se rendendo ao capital, deixando de produzir e desenvolver em seus lotes. Diante disso, este trabalho buscou analisar as características dos assentamentos rurais do Pontal do Paranapanema, identificando seus potenciais e impasses a fim de apresentar as práticas agroecológicas como alternativa para o desenvolvimento rural sustentável dos assentamentos, destacando alguns esboços para um projeto a fim de proporcionar embasamento para que o processo de integração econômica e social dos assentados seja efetivado de forma autônoma pelos mesmos. Para a realização desse trabalho foi utilizado levantamentos bibliográficos e dados obtidos junto ao IBGE e DATALUTA.

  4. Mesorregião Grande Fronteira do Mercosul: perfil locacional do desenvolvimento regional

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    Jandir Ferrera de Lima

    2010-05-01

    Full Text Available O objetivo deste artigo é analisar o perfil das desigualdades regionais na área de abrangência na região Grande Fronteira do Mercosul (GFM, através da mensuração do coeficiente de desenvolvimento regional e do padrão de localização do emprego formal. No âmbito dessa análise ficaram demonstrados dois fenômenos espaciais: um processo de reestruturação espacial e a forte desigualdade das mesorregiões Sudoeste PR, Noroeste RS e Fronteira Oeste RS em relação às outras mesorregiões do Sul do Brasil. Esse resultado fortalece a identificação de particularidades espaciais capazes de esclarecer um padrão de desenvolvimento econômico regional diferenciado nas fronteiras, em particular na Região Sul do Brasil. Os resultados deste estudo forneceram elementos para a intervenção regional, pois é possível, via políticas públicas adequadas, buscar a retomada do dinamismo econômico e o desenvolvimento socioeconômico na GFM.

  5. POLITIZAÇÃO, AMBIENTALIZAÇÃO E DESENVOLVIMENTO TERRITORIAL EM RESERVAS EXTRATIVISTAS

    Directory of Open Access Journals (Sweden)

    Maria José da S. A. Teisserenc

    Full Text Available Esse artigo, resultante de pesquisas no contexto de duas Resex marinhas do estado do Pará, Mãe Grande do Curuçá e São João da Ponta, trata de mudanças que vêm ocorrendo no poder local, relacionadas à criação de áreas protegidas na Amazônia brasileira. Observa-se, então, uma politização dos desafios locais, manifesta como resultado do trabalho realizado nos Conselhos Deliberativos, nos quais a mobilização das comunidades e o engajamento de seus representantes possibilitam debates que dizem respeito ao desenvolvimento de seu território conforme exigências ambientais. Trata-se de uma dinâmica significativa de um desenvolvimento territorial que se beneficia de uma ambientalização geral gerada com a criação das Reservas e do valor deliberativo dos compromissos de membros conselheiros como uma instância política. Essa situação constitui interessante oportunidade de análise das relações entre práticas de democracia local de tipo deliberativo e uma orientação de desenvolvimento que inspira o engajamento dos atores locais em instituições novas, como os Conselhos Deliberativos.

  6. ATIVIDADES CORPORAIS AQUÁTICAS EM ESPECIAL O MERGULHO E O DESENVOLVIMENTO DO PSIQUISMO

    Directory of Open Access Journals (Sweden)

    Celi Taffarel

    2015-04-01

    Full Text Available O presente estudo situa-se entre os que investigam o desenvolvimento do psiquismo ressaltando o papel da educação escolar e o acesso ao conhecimento clássico sobre as atividades corporais aquáticas, e dentre elas o mergulho, no desenvolvimento dos processos funcionais, através do ensino e da aprendizagem de conteúdos nucleares na escola. Objetivo:Analisar o desenvolvimento do psiquismo à luz da psicologia histórico-cultural e propor o trato com o conhecimento clássico sobre atividades aquáticas, em especial o mergulho, a luz da pedagogia histórico-critica, defendendo este conhecimento como nuclear no currículo escolar, nos estudos sobre a relação “ser humano-água”, para a elevação da capacidade teórica dos estudantes, através da metodologia do ensino critico-suparadora.

  7. Inglês como língua franca: desenvolvimentos recentes

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    Telma Gimenez

    Full Text Available Em face da atual posição do inglês como uma língua franca global, este artigo tem como principal objetivo discutir os desenvolvimentos recentes dessa área, tomando como base os trabalhos apresentados durante a 7th International Conference on English as a Lingua Franca, realizada em Atenas, Grécia, em setembro de 2014. As reflexões, aprofundadas nos tópicos i Teorizações sobre ILF; ii ILF e formação de professores; iii Desenvolvimentos futuros, trazem um olhar analítico sobre os temas discutidos no evento. Espera-se que as informações e reflexões aqui contempladas possam contribuir para o desenvolvimento de uma "curiosidade acadêmica" a respeito do paradigma ILF (inglês como língua franca e para o engajamento com suas questões e implicações.

  8. Considerações sobre o desenvolvimento de jogos por meio do framework Scrum

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    Olívia Hamada

    2016-02-01

    Full Text Available Os jogos (games se configuram como a contemporânea maneira das pessoas se relacionarem com as soluções tecnológicas e com os aplicativos. As expansões nas vendas dos dispositivos, dos aplicativos e os números de usuários, ano a ano, aumentam em proporções interessantes em termos de negócios e de consolidação de tendências nos hábitos. Desta forma, o desenvolvimento rápido, eficaz e de qualidade para os jogos se torna essencial para as empresas e para os parceiros que participam das suas elaborações, comercialização, suporte e disseminação. Utilizam-se metodologias diversas para esse desenvolvimento, tendo as metodologias ágeis as maiores possibilidades de sucesso. Este artigo trata do desenvolvimento dos jogos, as metodologias aplicadas e, em particular, do framework Scrum. Conclui-se que o Scrum é efetivamente uma boa opção para a construção de jogos, em função de suas características próprias.

  9. Alinhando objetivos estratégicos e processo de desenvolvimento em empresas de software

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    André Leme Fleury

    2014-06-01

    Full Text Available Sistemas de software são atualmente responsáveis por parte significativa das inovações tecnológicas viabilizadas em produtos e serviços. A história do software é recente, assim como são recentes as pesquisas sobre o tema, que tem como foco principal o aprimoramento dos seus processos de desenvolvimento. Apesar das contribuições trazidas por essas teorias, a questão do alinhamento entre objetivos estratégicos e o processo de desenvolvimento nas empresas de software considerando as suas principais capacidades produtivas permanece um tema inexplorado. Como consequência, técnicas da engenharia de software são aplicadas sem incorporar considerações de valor nos processos de análise e na tomada de decisões. Este artigo analisa e apresenta soluções para duas questões: como diferenciar as empresas de software de acordo com seus processos produtivos mais relevantes e como garantir que esses processos de desenvolvimento encontram-se alinhados com os objetivos do negócio. A abordagem resultante inclui um referencial para classificação de empresas de software e uma técnica de planejamento tecnológico para essas empresas. O projeto de pesquisa incluiu a realização de surveys, pesquisa-ação e estudos de caso.

  10. O desafio político do desenvolvimento sustentado The political challenge of sustainable development

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    Roberto P. Guimarães

    1995-01-01

    Full Text Available A unanimidade que hoje parece haver em favor do desenvolvimento sustentado contrasta com a ausência de iniciativas políticas significativas para transformar as instituições econômicas, sociais e políticas que estão comprometidas com o estilo vigente de desenvolvimento. Em particular, há uma patente contradição entre o discurso antiestatista hegemônico e as exigências do desenvolvimento sustentado, que incluem um Estado ainda mais forte, em suas capacidades reguladoras e de planificação, que o Estado intervencionista do passado.The seeming unanimity in favour of sustainable development stands in contrast to the absence of meaningful political initiatives in order to change the economic, social and political intitutions linked to the ongoing style of development In particular there is a patent contradiction between the hegemonic antistatist discourse and the requirements for sustainable development, including a state with even more regulatory and planning powers than the interventionist state of the past.

  11. Desdobramento da qualidade no desenvolvimento de filmes flexíveis para embalagens

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    Miguel Paulo A. Cauchick

    2003-01-01

    Full Text Available Um dos métodos atuais importantes para o desenvolvimento de produtos é o QFD (Quality Function Deployment ou Desdobramento da Função Qualidade. O QFD consiste em um processo sistemático para traduzir a opinião do cliente em requisitos técnicos e operacionais, mostrando e documentando as informações na forma de matrizes. O método objetiva enfocar os itens mais importantes, proporcionando um mecanismo para alcançar vantagens competitivas no processo de desenvolvimento. Este trabalho destaca o conceito do QFD, citando uma aplicação em uma empresa que produz filmes flexíveis de polipropileno (BOPP. O trabalho apresenta alguns aspectos da introdução do método na empresa, apontando as dificuldades encontradas, resultados e benefícios decorrentes da implantação. Dentre os benefícios gerados, destacam-se a importância do papel do QFD como um método para sistematizar o processo de desenvolvimento, bem como outros benefícios para a equipe, tais como melhoria nas habilidades de planejamento, disseminação do conhecimento e melhoria de comunicação entre as áreas funcionais.

  12. Utilization of a clinical microbiology service at a Cambodian paediatric hospital and its impact on appropriate antimicrobial prescribing.

    Science.gov (United States)

    Fox-Lewis, Shivani; Pol, Sreymom; Miliya, Thyl; Day, Nicholas P J; Turner, Paul; Turner, Claudia

    2018-02-01

    Antimicrobial resistance threatens human health worldwide. Antimicrobial misuse is a major driver of resistance. Promoting appropriate antimicrobial use requires an understanding of how clinical microbiology services are utilized, particularly in resource-limited settings. To assess the appropriateness of antimicrobial prescribing and the factors affecting utilization of the established clinical microbiology service (CMS). The CMS comprises the microbiology laboratory, clinical microbiologists (infection doctors) and antimicrobial treatment guidelines. This mixed-methods study was conducted at a non-governmental Cambodian paediatric hospital. Empirical and post-culture antimicrobial prescriptions were reviewed from medical records. The random sample included 10 outpatients per week in 2016 (retrospective) and 20 inpatients per week for 4 weeks in the medical, neonatal and intensive care wards (prospective). Post-culture prescriptions were assessed in patients with positive blood and cerebrospinal fluid cultures from 1 January 2014 to 31 December 2016. Focus group discussions and semi-structured interviews with clinicians explored barriers and facilitators to use of the CMS. Only 31% of outpatients were prescribed empirical antimicrobials. Post-culture prescriptions (394/443, 89%) were more likely to be appropriate than empirical prescriptions (447/535, 84%), based on treatment guidelines, microbiology advice and antimicrobial susceptibility test results (P = 0.015). Being comprehensive, accessible and trusted enabled CMS utilization. Clinical microbiologists provided a crucial human interface between the CMS and physicians. The main barriers were a strong clinical hierarchy and occasional communication difficulties. Antimicrobial prescribing in this hospital was largely appropriate. A culturally appropriate human interface linking the laboratory and physicians is essential in providing effective microbiology services and ensuring appropriate antimicrobial

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

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    Courtenay Molly

    2012-06-01

    Full Text Available Abstract Background Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP has been implemented within organisations across a strategic health authority (SHA. The aim of the study was to provide an overview of NMP across one SHA. Methods NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7% participants responded. Data was collected between November 2010 and February 2011. Results The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6% compared to community practitioner prescribers (198 or 22.4%, pharmacist independent supplementary prescribers (35 or 4%, and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%. Nearly all (over 90% of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p  Conclusion NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and

  14. 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

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

    LENUS (Irish Health Repository)

    Ryan, Cristín

    2009-12-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers\\' criteria, Screening Tool of Older Persons\\' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.

  16. Poverty and the Millennium Development Goals Pobreza e Metas de Desenvolvimento para o Milênio

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    G. J. Ebrahim

    2007-12-01

    apresentada como um desafio para muitos países em desenvolvimento. Em um ambiente físico de privação se desenvolve a cultura da pobreza com sua prevalência de doença, desagregação social, violência dentro e fora dos lares e dependência de álcool e drogas. No meio urbano pobre a inserção no comportamento de risco é comum. As principais vítimas de privações são as mulheres, as crianças, os idosos e os fracos. Evidências mostram os efeitos deletérios de a criança crescer em meio à pobreza. Ação corretiva consiste em uma tarefa árdua, cara e nem sempre bem sucedida. O despertar da consciência social global provocado pela dura realidade do pobre urbano vivendo lado a lado em íntimo contato com o consumo opulento e evidente tem persuadido líderes mundiais e economistas a mobilizar a opinião pública. Um encontro de lideres mundiais ocorrido nas Nações Unidas, no ano 2000, propôs e acordou Metas de Desenvolvimento para o Milênio. As metas são dirigidas não apenas para a pobreza per se mas também os seus efeitos. A data limite para a conquista das metas de desenvolvimento do milênio foi estabelecida para o ano 2015. Os progressos em torno dessas metas têm sido toscos e dependem da maturidade política nacional.

  17. Cough mixtures: rational or irrational prescribing in Hong Kong?

    Science.gov (United States)

    Wong, William C W; Dickinson, James; Chan, Cynthia

    2005-08-01

    To investigate the extent and how cough mixtures are prescribed, and what conditions or specific groups of people would contribute to its prescription in Hong Kong. Using diagnosis and drug data obtained from logbooks submitted by participants in the diploma in family medicine course between 1999 and 2003, we selected and analysed all patients with a diagnosis of cough or cough-related illnesses as well as cough mixtures that were used to treat them. This study confirmed that cough-related illnesses were common in the Hong Kong primary care setting and cough mixtures were used quite liberally irrespective of the patients' age and sex. Combination preparations accounted for over half of the prescriptions and cough mixture was used less in severe cases when antibiotics were given. Private doctors working in the public sector. Given the current health care system, inappropriate and over-prescribing of cough mixtures can be improved by promoting health education and awareness among patients seeking medical help for this common medical condition.

  18. Planning a prescribed burn at Tectonagrandis Linn F. plantation

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    Marcos Pedro Ramos Rodríguez

    2018-05-01

    Full Text Available During the last decades, the frequency and severity of forest fires in the tropical region and in other parts of the world, have increased. The accumulation of forest fuel on the forest floor over the years dramatically increases the risk of fire. One of the alternatives to reduce this risk or the potential for damages is to reduce the amount of forest fuel using prescribed burns. This work had the objective of planning a prescribed burning at a Tectonagrandis plantation in Jipijapa, Manabí, Ecuador. The amount of woody dead fuel was determined using the planar intersections method. The amount of miscellaneous and green fuels was evaluated by collecting the material in boxes of 30 x 30 cm and in a plot of 1 m2, respectively, placing samples in stoves to remove moisture. Fire behavior was estimated by calculating parameters such as fire intensity, flame length and lethal scorch height. The total amount of forest fuel estimated was 11.17 t ha-1. The prescriptions obtained for the optimal intervals of the fire behavior parameters presented values of fire intensity between 16.43 and 33.89 kcal m-1 s-1; flame length between 0.54 and 0.76 m and lethal scorch height between 1.38 and 4.20 m. These values sufficiently argue the application of fire in the stand of T. grandis without danger to the trees.

  19. Searching online to buy commonly prescribed psychiatric drugs.

    Science.gov (United States)

    Monteith, Scott; Glenn, Tasha

    2018-02-01

    The use of online pharmacies to purchase prescription drugs is increasing. The patient experience when searching to buy commonly prescribed psychiatric drugs was investigated. Using the search term "buy [drug name] online" in Google, 38 frequently prescribed drugs, including 13 with a high potential for abuse, were searched by brand and generic names. The first page of results were analyzed, including with pharmacy certification checkers and ICANN WHOIS. Search results for all drugs yielded 167 pharmacies, of which 147 (88%) did not require a prescription. Considering all searches, the average number of pharmacies requiring a prescription was 2.7 for a brand name drug and 2.4 for a generic name. A phrase like "buy without a prescription" usually appeared on the search results page. All results for drugs with a high potential for abuse were for illegal pharmacies. Information from certification agencies was often conflicting. Most pharmacies were registered internationally. Patients searching online to purchase prescription psychiatric drugs are presented predominantly with illegal pharmacies, and find conflicting certification data. Patient education should address typical search results. Societal pressures may increase the use of online pharmacies including prescription drug costs, stigma, loss of trust in expert opinion, and the changing patient role. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. The Role of Theory in Increasing Adherence to Prescribed Practice

    Science.gov (United States)

    Richardson, Julie; Wishart, Laurie; Hanna, Steven

    2009-01-01

    ABSTRACT Purpose: The purpose of this article is to apply theoretical frameworks to adherence behaviour and to guide the development of an intervention to increase adherence to prescribed home programmes. Summary of Key Points: Delivering an effective intervention requires establishing one that is evidence based and of adequate dosage. Two-thirds of patients who receive home exercise prescriptions do not adhere to their home programme, which may contribute to their physiotherapy's being ineffective. The mediating concepts of self-efficacy (SE) and outcome expectations (OE) are common to the five relevant theories used to explain adherence to exercise: the health belief model, protection motivation theory, theory of reasoned action, theory of planned behaviour, and social cognitive theory. Conclusion/Recommendations: Few intervention studies with any theoretical underpinning have examined adherence to exercise. Even fewer have been designed to affect and measure change in the theoretical mediators of SE and OE in patient populations. Physiotherapists must consider increasing adherence as a component of effective physiotherapy. Ongoing research is needed to increase our understanding of adherence to prescribed home programmes and to design interventions to affect theoretical mediators for increasing adherence. PMID:20190989