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Sample records for psychiatric resident prescription

  1. [Prescription drug abuse in elderly psychiatric patients].

    Science.gov (United States)

    Wetterling, Tilman; Schneider, Barbara

    2012-08-01

    Due to demographic changes there will be a fraction of elderly patients with substance use disorders. However, only a few data have been published about elderly abusers of prescription drugs. Since substance abuse is frequently comorbid with psychiatric disorders, treatment in a psychiatric hospital is often needed. In this explorative study elderly people with prescription drug abuse who required psychiatric inpatient treatment should be characterized. This study was part of the gerontopsychiatry study Berlin (Gepsy-B), an investigation of the data of all older inpatients (≥ 65 years) admitted to a psychiatric hospital within a period of 3 years. Among 1266 documented admissions in 110 cases (8.7 %) (mean age: 75.7 ± 7.1 years) prescription drug abuse, mostly of benzodiazepines was diagnosed. Females showed benzodiazepine abuse more often than males. In only a small proportion of the cases the reason for admission was withdrawal of prescribed drugs. 85.5 % suffered from psychiatric comorbidity, mostly depression. As risk factors for abuse depressive symptoms (OR: 3.32) as well as concurrent nicotine (OR: 2.69) or alcohol abuse (OR: 2.14) were calculated. Psychiatric inpatient treatment was primarily not necessary because of prescription drug abuse but because of other psychopathological symptoms. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Psychosomatic Medicine for Non-Psychiatric Residents: Video Education and Incorporation of Technology.

    Science.gov (United States)

    Saunders, J; Gopalan, P; Puri, N; Azzam, P N; Zhou, L; Ghinassi, F; Jain, A; Travis, M; Ryan, N D

    2015-12-01

    Psychiatric education for non-psychiatric residents varies between training programs, and may affect resident comfort with psychiatric topics. This study's goals were to identify non-psychiatric residents' comfort with psychiatric topics and to test the effectiveness of a video intervention. Residents in various departments were given a survey. They were asked to rank their comfort level with multiple psychiatric topics, answer questions about medical decision making capacity (MDMC), watch a 15-min video about MDMC, and answer a post-test section. In total, 91 Internal Medicine, General Surgery, and Obstetrics and Gynecology residents responded to the study. Of the 91 residents, 55 completed the pre- and post-test assessments. There was no significant difference in correct responses. Residents' comfort levels were assessed, and a significant improvement in comfort level with MDMC was found. This study highlights potential opportunities for psychiatric education, and suggests brief video interventions can increase resident physicians' comfort with a psychiatric topic.

  3. Sexual Health Education: A Psychiatric Resident's Perspective

    Science.gov (United States)

    Waineo, Eva; Arfken, Cynthia L.; Morreale, Mary K.

    2010-01-01

    Objective: This report discusses psychiatric residents' perceptions of sexual health education and their opinions regarding curricular improvements. Methods: An anonymous, web-based survey was sent to residents in one general psychiatry program (N = 33). The response rate was 69.7%. Results: Residents reported inadequate experience in multiple…

  4. Reintegrating Family Therapy Training in Psychiatric Residency Programs: Making the Case

    Science.gov (United States)

    Rait, Douglas; Glick, Ira

    2008-01-01

    Objective: Given the marginalization of couples and family therapy in psychiatric residency programs over the past two decades, the authors propose a rationale for the reintegration of these important psychosocial treatments into the mainstream of general psychiatric residency education. Methods: After reviewing recent trends in the field that…

  5. Intravenous fluid prescription practices among pediatric residents in Korea

    OpenAIRE

    Lee, Jiwon M.; Jung, Younghwa; Lee, Se Eun; Lee, Jun Ho; Kim, Kee Hyuck; Koo, Ja Wook; Park, Young Seo; Cheong, Hae Il; Ha, Il-Soo; Choi, Yong; Kang, Hee Gyung

    2013-01-01

    Purpose: Recent studies have established the association between hypotonic fluids administration and hospital-acquired hyponatremia in children, and have contended that hypotonic fluids be removed from routine practice. To assess current intravenous fluid prescription practices among Korean pediatric residents and to call for updated clinical-practice education Methods: A survey-based analysis was carried out. Pediatric residents at six university hospitals in Korea completed a survey consist...

  6. Intravenous fluid prescription practices among pediatric residents in Korea.

    Science.gov (United States)

    Lee, Jiwon M; Jung, Younghwa; Lee, Se Eun; Lee, Jun Ho; Kim, Kee Hyuck; Koo, Ja Wook; Park, Young Seo; Cheong, Hae Il; Ha, Il-Soo; Choi, Yong; Kang, Hee Gyung

    2013-07-01

    Recent studies have established the association between hypotonic fluids administration and hospital-acquired hyponatremia in children. The present paper investigated the pattern of current practice in intravenous fluid prescription among Korean pediatric residents, to underscore the need for updated education. A survey-based analysis was carried out. Pediatric residents at six university hospitals in Korea completed a survey consisting of four questions. Each question proposed a unique scenario in which the respondents had to prescribe either a hypotonic or an isotonic fluid for the patient. Ninety-one responses were collected and analyzed. In three of the four scenarios, a significant majority prescribed the hypotonic fluids (98.9%, 85.7%, and 69.2%, respectively). Notably, 69.2% of the respondents selected the hypotonic fluids for postoperative management. Almost all (96.7%) selected the isotonic fluids for hydration therapy. In the given scenarios, the majority of Korean pediatric residents would prescribe a hypotonic fluid, except for initial hydration. The current state of pediatric fluid management, notably, heightens the risk of hospital-acquired hyponatremia. Updated clinical practice education on intravenous fluid prescription, therefore, is urgently required.

  7. Psychotropic Drug Prescription in Adolescents: A Retrospective Study in a Swiss Psychiatric University Hospital.

    Science.gov (United States)

    Ansermot, Nicolas; Jordanov, Véronique; Smogur, Michal; Holzer, Laurent; Eap, Chin B

    2018-04-01

    This retrospective study aims to evaluate off-label prescriptions and administrations of psychotropic medications in adolescents in a university psychiatric hospital in Switzerland. Data were collected during the entire stays from the electronic database for 76 inpatients in 2008 and 76 inpatients in 2014. Data collected included gender, age, psychiatric diagnosis, duration of hospitalization, and psychotropic drug prescriptions and administrations. A total of 224 psychotropic drugs (mean 2.9 drugs/patient) were prescribed in 2008 and 268 (mean 3.5 drugs/patient) in 2014. Due to the prescriptions of some drugs as required, only 76% of the prescriptions were actually administered in 2008 (mean 2.3 drugs/patient) and 55% in 2014 (mean 1.9 drugs/patient). Antipsychotics were the most frequently prescribed drugs in 2008 (74% of patients) and 2014 (86% of patients). Anxiolytics were also highly prescribed in 2008 (54% of patients) and 2014 (66% of patients), as well as antidepressants in 2008 (30% of patients), but less in 2014 (13% of patients). Overall, 69% of prescriptions were found to be off label in 2008 and 68% in 2014, according to age, diagnosis, dose, or formulation as approved by Swissmedic. The medication classes with the highest rate of off-label prescriptions were antidepressants (100% for both years), antipsychotics (94% in 2008 and 92% in 2014), and hypnotics (67% in 2008 and 100% in 2014). For both study periods, at least one off-label psychotropic drug prescription and administration was recorded in 96% and 79% of the patients, respectively. The high rate of off-label psychotropic drug use strengthens the need for clinical trials to better evaluate the efficacy and safety of these treatments in adolescents.

  8. End-of-Life Care Education for Psychiatric Residents: Attitudes, Preparedness, and Conceptualizations of Dignity

    Science.gov (United States)

    Tait, Glendon R.; Hodges, Brian D.

    2009-01-01

    Objective: The authors examined psychiatric residents' attitudes, perceived preparedness, experiences, and needs in end-of-life care education. They also examined how residents conceptualized good end-of-life care and dignity. Methods: The authors conducted an electronic survey of 116 psychiatric residents at the University of Toronto. The survey…

  9. Intravenous fluid prescription practices among pediatric residents in Korea

    Directory of Open Access Journals (Sweden)

    Jiwon M. Lee

    2013-07-01

    Full Text Available Purpose: Recent studies have established the association between hypotonic fluids administration and hospital-acquired hyponatremia in children, and have contended that hypotonic fluids be removed from routine practice. To assess current intravenous fluid prescription practices among Korean pediatric residents and to call for updated clinical-practice education Methods: A survey-based analysis was carried out. Pediatric residents at six university hospitals in Korea completed a survey consisting of four questions. Each question supposed a unique scenario in which the respondents were to prescribe either a hypotonic or an isotonic fluid for the patient. Results: Ninety-one responses were collected and analyzed. In three of the four scenarios, a significant majority prescribed the hypotonic fluids (98.9%, 85.7%, and 69.2%, respectively. Notably, 69.2% of the respondents selected the hypotonic fluids for postoperative management. Almost all (96.7% selected the isotonic fluids for hydration therapy. Conclusion: In the given scenarios, the majority of Korean pediatric residents would prescribe a hypotonic fluid, except for initial hydration. The current state of pediatric fluid management, notably, heightens the risk of hospital-acquired hyponatremia. Updated clinical practice education on intravenous fluid prescription, therefore, is urgently required.

  10. [Psychiatric consultations for nursing-home residents: aspects and course of such consultations].

    Science.gov (United States)

    Steenbeek, M; van Baarsen, C; Koekkoek, B

    2012-01-01

    Psychiatric symptoms occur frequently in nursing-home residents. The psychiatric expertise and support available to residents vary from one nursing home to another. International studies show that psychiatric consultations can be effective, but in the Netherlands very little research has been done on this topic. To list the types of psychiatric problems and symptoms for which consultations are requested and to determine whether a psychiatric consultation can have positive results for nursing-home residents and staff. The psychiatric consultations requested were tabulated and were analysed. Details of 71 psychiatric consultations were recorded. The percentage of women (average age 74 years) was slightly higher than the percentage of men. More than 75% of the patients suffered from agitation/aggression or irritability, 65% suffered from depression, 63% from anxiety and 56% from dysinhibition. A post-intervention assessment was performed in 54 patients (76%). In this group psychiatric symptoms were found to be greatly reduced, with regard to both frequency and severity. In addition, nursing staff seemed to suffer less of the stress and strain in their work. The patients for whom a consultation was requested seemed to suffer from serious psychiatric symptoms and were often aggressive. It was possible to achieve substantial progress as a result of a simple intervention. A possible explanation for this effect is probably the nature of the psychiatric consultation used; it was structured, multi-disciplinary and time-consuming. However, since no control group was involved, it is impossible to say with certainty that the reduction in symptoms can be attributed solely to the consultation.

  11. Cross-cultural psychiatric residency training: the Oregon experience.

    Science.gov (United States)

    Boehnlein, James K; Leung, Paul K; Kinzie, John David

    2008-01-01

    The purpose of this article is to describe the goals and structure of cross-cultural psychiatric training at Oregon Health and Science University (OHSU). This training in core knowledge, skills, and attitudes of cultural psychiatry over the past three decades has included medical students, residents, and fellows, along with allied mental health personnel. The curriculum includes both didactic sessions devoted to core topics in the field and varied clinical experiences in community settings and the Intercultural Psychiatric Program under the supervision of experienced academic faculty. The authors review the central elements of the training experiences and include a detailed description of the core clinical settings and experiences. At the conclusion of their clinical experiences, trainees have specialized cross-cultural psychiatric knowledge and skills, including treatment of refugees and immigrants, sociocultural variables that influence the assessment and treatment of a wide range of psychiatric conditions, and comfort with cultural dynamics that influence both the doctor/patient relationship and collaboration with a wide range of mental health professionals. Because of rapid demographic changes in the U.S. population, providing cross-cultural training for students, residents, and fellows is an essential foundation for the education of the next generation of clinicians and health care leaders. OHSU has provided a long-term model for this training in a busy clinical and academic setting that places an emphasis on multidisciplinary and multicultural collaboration.

  12. Neighborhood linking social capital as a predictor of psychiatric medication prescription in the elderly: a Swedish national cohort study.

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    Sundquist, Jan; Hamano, Tsuyoshi; Li, Xinjun; Kawakami, Naomi; Shiwaku, Kuninori; Sundquist, Kristina

    2014-08-01

    Little is known about the association between neighborhood linking social capital and psychiatric medication in the elderly. The present study analyzes whether there is an association between linking social capital (a theoretical concept describing the amount of trust between individuals and societal institutions) and prescription of antipsychotics, anxiolytics, hypnotics/sedatives, antidepressants, or anti-dementia drugs. The entire Swedish population aged 65+, a total of 1,292,816 individuals, were followed from 1 July 2005 until first prescription of psychiatric medication, death, emigration, or the end of the study on 31 December 2010. Small geographic units were used to define neighborhoods. The definition of linking social capital was based on mean voting participation in each neighborhood unit, categorized in three groups. Multilevel logistic regression was used to estimate odds ratios (ORs) and between-neighborhood variance in three different models. There was an inverse association between the level of linking social capital and prescription of psychiatric medications (except for anti-dementia drugs). The associations decreased, but remained significant, after accounting for age, sex, family income, marital status, country of birth, and education level (except for antidepressants). The OR for prescription of antipsychotics in the crude model was 1.65 (95% CI 1.53-1.78) and decreased, but remained significant (OR = 1.26; 95% CI 1.17-1.35), after adjustment for the individual-level sociodemographic variables. Decision-makers should take into account the potentially negative effect of linking social capital on psychiatric disorders when planning sites of primary care centers and psychiatric clinics, as well as other kinds of community support for elderly patients with such disorders. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Changes in communication skills of clinical residents through psychiatric training.

    Science.gov (United States)

    Yutani, Motoki; Takahashi, Megumi; Miyaoka, Hitoshi

    2011-10-01

    The objective of this study was to clarify whether the communication skills (CS) of clinical residents change before and after psychiatric training and, if so, what factors are related to the change. The 44 clinical residents who agreed to participate in this study were provided with an originally developed self-accomplished questionnaire survey on CS (communication skills questionnaire [CSQ]) and a generally used questionnaire on self-esteem, anxiety, and depressive mood considered to be related to CS at the start and end of a 2-month psychiatric training session. Statistical analysis was conducted for the 34 residents who completed both questionnaires. The CSQ score (t[32]: -2.17, P self-esteem and negatively with anxiety and depressive tendency. The amount of change in assertive CS score showed a weakly positive correlation with self-esteem. The results suggested that CS, including assertive CS and cooperative CS, were improved by the psychiatric training. Increasing self-esteem and reducing the tendency toward depression and anxiety are considered to be useful for further improving CS. © 2011 The Authors. Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology.

  14. Burden and Stress among Psychiatry Residents and Psychiatric Healthcare Providers

    Science.gov (United States)

    Zuardi, Antonio Waldo; Ishara, Sergio; Bandeira, Marina

    2011-01-01

    Purpose: The authors compared the levels of job burden and stress in psychiatry residents with those of other healthcare professionals at inpatient and outpatient psychiatric hospitals in a medium-sized Brazilian city. Method: In this study, the levels of job burden and stress of 136 healthcare workers and 36 psychiatry residents from six various…

  15. A Psychiatric Residency Curriculum on the Care of African American Patients

    Science.gov (United States)

    Harris, Herbert W.; Felder, Diane; Clark, Michelle O.

    2004-01-01

    Training psychiatric residents to address cross-cultural issues in their practice of psychiatry is a necessary objective of contemporary psychiatric education. Cultural issues play a critical role in the formation and expression of a patient's personality. In addition, they are a major determinant of the context in which mental illness develops.…

  16. Benzodiazepine prescription in relation to psychiatric diagnosis and patient characteristics: A pilot study

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    Marić Nađa P.

    2015-01-01

    Full Text Available Introduction: Benzodiazepines are widely used drugs which are often misused. Analysis of psychotropic drugs prescription in Serbia showed high prescription rate of benzodiazepines in the psychiatric patient population, with an increasing trend. Potential association between psychiatric diagnostic categories (organic brain syndrome, psychotic disorders, bipolar disorder, unipolar depression, anxiety disorder, personality disorder, or the sociodemographic characteristics of patients (gender, age, education, marital state and benzodiazepine prescribing practice was not thoroughly tested. Aim: By analyzing routine practice of the university clinic, the aim of this study was to examine whether there is an association between clinical or socio-demographic characteristics of the patients and benzodiazepine prescribing practice. Material and methods: This study was carried out by retrospective analysis of the patient's medical charts after hospital discharge (n=102. Data analysis included descriptive statistics, testing the difference between groups and correlation analysis. Results: At the discharge, 94.1% of patients had benzodiazepines prescribed, with an average dose of 4.6 ± 3.2mg lorazepam dose equivalents. It is shown that female patients were prescribed with higher doses of benzodiazepines than male patients (p=0.018, that the average dose was higher for patients treated with an overall larger number of psychiatric drugs (p = 0.013, as well as that hospital inpatients had higher doses compared to day hospital-treated patients (p = 0.011. Patients with a diagnosis of personality disorder had a slight upward trend of benzodiazepine dose (p=0.078. Conclusion: Current research provided a clear insight into the actual practice of benzodiazepine prescription at local university center. Similarly to our region, indications for prescribing benzodiazepines appear to be quite broad and not specific enough worldwide. This is why it is important to

  17. Psychiatric Residents as Teachers: Development and Evaluation of a Teaching Manual

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    Swainson, Jennifer; Marsh, Melanie; Tibbo, Philip G.

    2010-01-01

    Objective: Psychiatric residents spend much time as teachers and mentors to medical students. Recently, the Canadian Medical Education Directions for Specialists (CanMEDS) roles identified the importance of this role as a scholar. Residents are now expected to develop skills to fulfill this role, one of which involves the ability to teach.…

  18. Reproductive Psychiatry Residency Training: A Survey of Psychiatric Residency Program Directors.

    Science.gov (United States)

    Osborne, Lauren M; MacLean, Joanna V; Barzilay, Erin Murphy; Meltzer-Brody, Samantha; Miller, Laura; Yang, Sarah Nagle

    2018-04-01

    The reproductive life cycle has unique influences on the phenotypic expression of mental illness in women. Didactic and clinical training focused on these sex-specific influences should be a vital component of the education of future psychiatrists. The authors sought to determine the current state of and attitudes toward reproductive psychiatry in resident education. The authors administered a web-based survey to psychiatry residency training directors. They assessed the availability of both mandated and optional didactic and clinical training experiences in reproductive psychiatry. Fifty residency program directors answered the survey, for a response rate of 28%. More than half of residency program directors (59%) reported requiring some training in reproductive psychiatry. Both the breadth and depth of topics covered varied greatly among programs. Lack of time (48%) and lack of qualified faculty (26%) were the most frequently cited barriers to more training. Only 40% of residency directors surveyed agreed that all residents should be competent in reproductive psychiatry. These findings suggest that specific training in reproductive psychiatry is inconsistent in US residency programs, and that training that does exist varies considerably in clinical time and content. Given that women comprise more than 50% of all psychiatric patients and most women will menstruate, give birth, and undergo menopause, future psychiatrists would benefit from more systematic instruction in this area. The authors propose the development of a national, standardized reproductive psychiatry curriculum to address this gap and aid in producing psychiatrists competent to treat women at all stages of life.

  19. Knowledge and Attitude Towards Pharmacological Management of Acute Agitation: A Survey of Psychiatrists, Psychiatry Residents, and Psychiatric Nurses.

    Science.gov (United States)

    Tangu, KeumbÔh; Ifeanyi, Adaora; Velusamy, Mayurapriya; Dar, Sara; Shah, Nurun; Ezeobele, Ifeoma E; Okusaga, Olaoluwa O

    2017-06-01

    The authors compared the current knowledge and attitude of psychiatrists, psychiatry residents, and psychiatric nurses towards the pharmacological management of acute agitation. Questionnaires were electronically distributed to all attending psychiatrists, psychiatry residents, and psychiatric nurses who were either employed by the University Department of Psychiatry and Behavioral Sciences or were staff at a 250-bed affiliated Psychiatric Hospital. Where possible, Fisher's exact test was used to compare responses to questions based on designation. Of the 250 questionnaires distributed, 112 were returned (response rate of 44.8%), of which 64 (57.1%) were psychiatric nurses, 27 (24.1%) were attending psychiatrists, and 21 (18.8%) were psychiatry residents. A significantly higher percentage of attending psychiatrists and psychiatric nurses compared to psychiatry residents thought that newer second- generation antipsychotics (SGAs) are not as effective as older first-generation antipsychotics (FGAs) for managing acute agitation (55.6, 48.4, and 9.5% respectively, p = 0.008). The combination of intramuscular haloperidol, lorazepam, and diphenhydramine was the most preferred option chosen by all designations for the psychopharmacological management of severe agitation. Furthermore, a larger percentage of the psychiatric nurses, in comparison to attending psychiatrists, also chose the combination of intramuscular chlorpromazine, lorazepam, and diphenhydramine as an option for managing severe agitation; no psychiatry resident chose this option. Knowledge of evidence-based psychopharmacological management of agitation differs among attending psychiatrists, psychiatry residents and psychiatric nurses. Although the management of agitation should be individualized and context specific, monotherapy should be considered first where applicable.

  20. The Dubai Community Psychiatric Survey: acculturation and the prevalence of psychiatric disorder.

    Science.gov (United States)

    Ghubash, R; Hamdi, E; Bebbington, P

    1994-02-01

    Dubai, an Emirate in the Gulf region, has experienced spectacular social change as a result of the exploitation of its oil reserves. The Dubai Community Psychiatric Survey was designed to study the effects of this social change on the mental health of female nationals. In this paper, we approach the problem by quantifying social change in two main ways: the first focused on social change at the individual level as measured by the Socio-cultural Change Questionnaire (Bebbington et al. 1993). The second examined the effect of social change at the community level by identifying areas of residence at different levels of development. We hypothesized that attitudes and behaviours markedly at odds with traditional prescriptions would be associated with high rates of psychiatric morbidity. On the individual level, the association between psychiatric morbidity and the amount of social change reflected in the behaviours and views of the subjects was not significant. However, there was a significant association between morbidity and between social attitudes and behaviours. At the community level, in contrast, the relationship between psychiatric morbidity and social change was significant: there was more psychiatric morbidity in areas at the extremes of the social change continuum. The hypothesis put forward in this study must be modified accordingly.

  1. Using Motivational Interviewing to Meet Core Competencies in Psychiatric Resident Training

    Science.gov (United States)

    Kaplan, Sebastian; Elliott, Harold

    2011-01-01

    Objective: The authors propose that motivational interviewing (MI), a brief intervention designed to manage ambivalence regarding complex behavior change, is well suited for integration into psychiatric residency training programs. Methods: The authors provide a brief description of MI. In addition, based on a review of the literature the authors…

  2. Psychiatric Resident and Faculty Views on and Interactions with the Pharmaceutical Industry

    Science.gov (United States)

    Misra, Sahana; Ganzini, Linda; Keepers, George

    2010-01-01

    Objective: Sales visits, or detailing, by pharmaceutical industry representatives at academic institutions has been increasingly criticized. The authors surveyed psychiatric residents and faculty members on their views and interactions with representatives of the pharmaceutical industry. Methods: In 2007, a 46-item online survey measuring…

  3. Factors Related to Psychotropic Drug Prescription for Neuropsychiatric Symptoms in Nursing Home Residents With Dementia

    NARCIS (Netherlands)

    Smeets, Claudia H. W.; Smalbrugge, Martin; Zuidema, Sytse U.; Derksen, Els; de Vries, Erica; van der Spek, Klaas; Koopmans, Raymond T. C. M.; Gerritsen, Debby L.

    2014-01-01

    Objectives: The objective of this study is to explore factors that elucidate reasons for psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home (NH) residents with dementia. Design: A qualitative study using a grounded theory approach. Setting: Twelve NHs in The

  4. Competency of Psychiatric Residents in the Treatment of People with Severe Mental Illness before and after a Community Psychiatry Rotation

    Science.gov (United States)

    Randall, Melinda; Romero-Gonzalez, Mauricio; Gonzalez, Gerardo; Klee, Anne; Kirwin, Paul

    2011-01-01

    Objective: Psychiatric rehabilitation is an evidence-based service with the goal of recovery for people with severe mental illness. Psychiatric residents should understand the services and learn the principles of psychiatric rehabilitation. This study assessed whether a 3-month rotation in a psychiatric rehabilitation center changes the competency…

  5. Assessment of prevalence of tobacco consumption among psychiatric inmates residing in Central Jail, Bhopal, Madhya Pradesh, India: A cross-sectional survey

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    Nilesh Arjun Torwane

    2013-01-01

    Full Text Available Aim: The aim of the current cross-sectional study was to assess the prevalence of tobacco consumption among psychiatric jail patients residing in Central Jail, Bhopal, Madhya Pradesh, India. Materials and Methods: The study subjects consisted of prediagnosed psychiatric patients residing in Central Jail, Bhopal, Madhya Pradesh, India. A matched control consisting of cross-section of the population, that is, jail inmates residing in the same Central Jail locality was also assessed to compare the psychiatric subjects. An 18 item questionnaire was used to assess the prevalence of tobacco consumption among study subjects. Results: The total number of subjects examined was 244, which comprised of 122 psychiatric inmates and 122 nonpsychiatric inmates. Among all psychiatric inmates, about 57.4% of inmates had a diagnosis of depression, 14.8% had psychotic disorders (such as schizophrenia, and 12.3% had anxiety disorder. A total of 77% study inmates, which comprised of 87.7% psychiatrics and 66.4% nonpsychiatrics had a habit of tobacco consumption (smokeless or smoking. Conclusion: The information presented in this study adds to our understanding of the common tobacco related practices among psychiatric inmate population. Efforts to increase patient awareness of the hazards of tobacco consumption and to eliminate the habit are needed to improve oral and general health of the prison population.

  6. Residents' numeric inputting error in computerized physician order entry prescription.

    Science.gov (United States)

    Wu, Xue; Wu, Changxu; Zhang, Kan; Wei, Dong

    2016-04-01

    Computerized physician order entry (CPOE) system with embedded clinical decision support (CDS) can significantly reduce certain types of prescription error. However, prescription errors still occur. Various factors such as the numeric inputting methods in human computer interaction (HCI) produce different error rates and types, but has received relatively little attention. This study aimed to examine the effects of numeric inputting methods and urgency levels on numeric inputting errors of prescription, as well as categorize the types of errors. Thirty residents participated in four prescribing tasks in which two factors were manipulated: numeric inputting methods (numeric row in the main keyboard vs. numeric keypad) and urgency levels (urgent situation vs. non-urgent situation). Multiple aspects of participants' prescribing behavior were measured in sober prescribing situations. The results revealed that in urgent situations, participants were prone to make mistakes when using the numeric row in the main keyboard. With control of performance in the sober prescribing situation, the effects of the input methods disappeared, and urgency was found to play a significant role in the generalized linear model. Most errors were either omission or substitution types, but the proportion of transposition and intrusion error types were significantly higher than that of the previous research. Among numbers 3, 8, and 9, which were the less common digits used in prescription, the error rate was higher, which was a great risk to patient safety. Urgency played a more important role in CPOE numeric typing error-making than typing skills and typing habits. It was recommended that inputting with the numeric keypad had lower error rates in urgent situation. An alternative design could consider increasing the sensitivity of the keys with lower frequency of occurrence and decimals. To improve the usability of CPOE, numeric keyboard design and error detection could benefit from spatial

  7. Psychiatric Emergency Services - Can Duty-Hour Changes Help Residents and Patients?

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    Brainch, Navjot; Schule, Patrick; Laurel, Faith; Bodic, Maria; Jacob, Theresa

    2018-04-14

    Limitations on resident duty hours have been widely introduced with the intention of decreasing resident fatigue and improving patient outcomes. While there is evidence of improvement in resident well-being and education following such initiatives, they have inadvertently resulted in increased number of hand-offs between clinicians leading to potential errors in patient care. Current literature emphasizes need for more specialty/setting-specific scheduling, while considering residents' opinions when implementing duty-hour reforms. There are no reports examining the impact of duty-hour changes on residents or patients in psychiatric emergency service (PES) settings. Our purpose was to assess the impact of a recent scheduling change and decrease in overall duty hours, on resident well-being and sense of burnout, while also evaluating changes to patient wait-time and length of stay (LOS) in PES. Residents completed Maslach Burnout Inventory and anonymous surveys focusing on: fatigue, sleep, life outside work for shifts - regular (8 am-8 pm) and swing shifts (12 pm-10 pm). Data from the electronic medical records were collected for 6 months pre- and post-schedule change (January 2016-February 2017), for LOS and patient wait-time. Residents' preference for shifts was split. However, 86% reported getting enough sleep during swing shifts, while 83% reported lack of sleep during regular shifts. The average patient wait-time and LOS significantly decreased from 169 to 147 and 690 to 515 min, respectively. The change to swing shifts significantly impacts LOS and patient wait-time. The short shifts demonstrated an improvement in well-being for residents, but were not the singular factor for overall resident satisfaction.

  8. Determinants for the use of psychotropics among nursing home residents

    DEFF Research Database (Denmark)

    Sørensen, Lisbeth Uhrskov; Foldspang, A; Gulmann, N C

    2001-01-01

    's Activities of Daily Living (ADL), behavioural problems (Nursing Home Behavior Problem Scale), orientation, communication skills and if the resident had any psychiatric disorder. Multiple logistic regression was used to select the items that determined the use of psychotropics. Results Fifty-six percent......Purpose To characterise the prescription pattern of psychotropics in Danish nursing homes and to identify diagnostic, behavioural, cognitive and performance characteristics associated with prevalent psychotropic drug use. Methods Prescribed daily medication was recorded from nurses' files. Based...

  9. Psychiatric patients' satisfaction in the therapeutic residence services: A positive experience of psychiatric deinstitutionalization

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    Rafael Gustavo Maluf

    Full Text Available This study investigated the satisfaction level of psychiatric patients in the therapeutic residential services of Barbacena-MG. Total population comprised 154 individuals, of which 45 were sampled. Subjects were interviewed with the SATIS-BR scale and a sociodemographic questionnaire. Results showed a high degree of satisfaction with the service for the global score and its three dimensions staff competence and understanding, help received, infrastructure. Results were not related to sociodemographic and clinical variables analyzed individually. Multivariate analysis indicated higher satisfaction for literate patients and for those that underwent some other form of treatment (e.g., hydrogymnastics and fitness activities besides medications or occupational therapy. We conclude that the therapeutic residence services appear to be a viable alternative for mental health public policy, from the patients' perspective.

  10. Prescription headache medication in OEF/OIF veterans: results from the Women Veterans Cohort Study.

    Science.gov (United States)

    Seng, Elizabeth K; Driscoll, Mary A; Brandt, Cynthia A; Bathulapalli, Harini; Goulet, Joseph; Silliker, Norman; Kerns, Robert D; Haskell, Sally G

    2013-09-01

    To examine differences in male and female veterans of Operations Enduring Freedom/Iraqi Freedom (OEF/OIF) period of service in taking prescription headache medication, and associations between taking prescription headache medication and mental health status, psychiatric symptoms, and rates of traumatic events. Headaches are common among active service members and are associated with impairment in quality of life. Little is known about headaches in OEF/OIF veterans. Veterans participating in the Women Veterans Cohort Study responded to a cross-sectional survey to assess taking prescription headache medication, mental health status (Post Deployment Health Assessment), psychiatric symptoms (portions of the Brief Patient Health Questionnaire and the Posttraumatic Stress Disorder Checklist), and traumatic events (the Traumatic Life Events Questionnaire and queries regarding military trauma). Gender differences among taking prescription headache medication, health status, psychiatric symptoms, and traumatic events were examined. Regression analyses were used to examine the influence of gender on the associations between taking prescription headache medication and health status, psychiatric symptoms, and traumatic events. 139/551 (25.2%) participants reported taking prescription headache medication in the past year. A higher proportion of women veterans (29.1%) reported taking prescription medication for headache in the last year compared with men (19.7%). Taking prescription headache medication was associated with poorer perceived mental health status, higher anxiety and posttraumatic stress disorder symptoms, and higher rates of traumatic events. The association between prescription headache medication use and perceived mental health status, and with the association between prescription headache medication use and posttraumatic stress disorder symptoms, was stronger for men than for women. Among OEF/OIF veterans, the prevalence of clinically relevant headache is high

  11. Resident Workflow and Psychiatric Emergency Consultation: Identifying Factors for Quality Improvement in a Training Environment.

    Science.gov (United States)

    Blair, Thomas; Wiener, Zev; Seroussi, Ariel; Tang, Lingqi; O'Hora, Jennifer; Cheung, Erick

    2017-06-01

    Quality improvement to optimize workflow has the potential to mitigate resident burnout and enhance patient care. This study applied mixed methods to identify factors that enhance or impede workflow for residents performing emergency psychiatric consultations. The study population consisted of all psychiatry program residents (55 eligible, 42 participating) at the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles. The authors developed a survey through iterative piloting, surveyed all residents, and then conducted a focus group. The survey included elements hypothesized to enhance or impede workflow, and measures pertaining to self-rated efficiency and stress. Distributional and bivariate analyses were performed. Survey findings were clarified in focus group discussion. This study identified several factors subjectively associated with enhanced or impeded workflow, including difficulty with documentation, the value of personal organization systems, and struggles to communicate with patients' families. Implications for resident education are discussed.

  12. Study of psychiatric morbidity among residents of government old age homes in Delhi

    Directory of Open Access Journals (Sweden)

    Raj Kumar

    2017-01-01

    Full Text Available Context: The increased demand on long-term old age care homes in urban India is a result of demographic transition together with the disintegration of joint family system and changing social values which make them increasingly vulnerable to mental health problems. Aims: This study attempted to find out an array of mental health problems and associated morbidity among inhabitant of government old age homes. Settings and Design: This was a cross-sectional study which included government run old age homes (OAHs in Delhi. Subjects and Methods: The sample comprised a total of 148 elderly in four OAHs with a mean age of 72.81 years. The World Health Organization Quality of Life-BREF Scale (QOL, Mini-Mental State Examination, Geriatric Depression Scale, Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, and Kesseler-10 Scale were administered. Statistical Analysis: Data were analyzed through SPSS version 20.0 version. Frequency distribution and cross-tabulation used to create summary tables and compare items. Results: Female constituted two-third of study population whereas one-third of subjects were illiterate and two-third without income. The study demonstrated psychiatric morbidity profile among OAH inhabitants and exhibited mild-moderate anxiety symptoms in almost 95% followed by mild-severe depression reported by 85%, mild-moderate psychotic illnesses, psychological distress, cognitive impairments, and poor QOL. Low income and education, low social connections and loss of spouse were key risk factors. Conclusions and Recommendation: Psychiatric morbidity profile and QOL among OAH residents is influenced by various psychological, social, and economic factors. This emphasized the need for better management of the government-run OAHs to ensure better overall mental health of the residents.

  13. Training in Good Psychiatric Management for Borderline Personality Disorder in Residency: An Aide to Learning Supportive Psychotherapy for Challenging-to-Treat Patients.

    Science.gov (United States)

    Bernanke, Joel; McCommon, Benjamin

    2018-01-01

    Given many competing demands, psychotherapy training to competency is difficult during psychiatric residency. Good Psychiatric Management for borderline personality disorder (GPM) offers an evidence-based, simplified, psychodynamically informed framework for the outpatient management of patients with borderline personality disorder, one of the most challenging disorders psychiatric residents must learn to treat. In this article, we provide an overview of GPM, and show that training in GPM meets a requirement for training in supportive psychotherapy; builds on psychodynamic psychotherapy training; and applies to other severe personality disorders, especially narcissistic personality disorder. We describe the interpersonal hypersensitivity model used in GPM as a straightforward way for clinicians to collaborate with patients in organizing approaches to psychoeducation, treatment goals, case management, use of multiple treatment modalities, and safety. A modification of the interpersonal hypersensitivity model that includes intra-personal hypersensitivity can be used to address narcissistic problems often present in borderline personality disorder. We argue that these features make GPM ideally suited for psychiatry residents in treating their most challenging patients, provide clinical examples to illustrate these points, and report the key lessons learned by a psychiatry resident after a year of GPM supervision.

  14. Antipsychotic Prescriptions for Children Aged 5 Years or Younger

    Directory of Open Access Journals (Sweden)

    Ana Lòpez-De Fede

    2014-10-01

    Full Text Available The use of antipsychotics in very young children is of concern given the lack of empirical evidence in their efficacy and long-term impact on children’s health. This study examined the prescription of antipsychotics among children aged ≤5 years enrolled in a state Medicaid program. Secondary data analysis was conducted using the Medicaid administrative data of a southeastern state. Using SAS 9.3, descriptive statistics were performed to examine socio-demographic characteristics, psychiatric diagnoses, off-label use, receipt of medications from multiple psychotropic drug classes, and receipt of non-pharmacologic psychiatric services among children aged ≤5 years who received antipsychotic prescriptions in calendar year (CY 2011. A total of 112 children in the target age group received antipsychotics in CY 2011, the most common prescription being risperidone. The most common listed psychiatric diagnosis was attention deficit hyperactivity disorder. Two in five children received antipsychotics for off-label use. Three in four children also received medications from at least one other psychotropic drug class. More than half did not receive adjunct psychiatric services. State-level policies offering specific guidance and recommendations for antipsychotic use among very young children are urgently needed. Future research is warranted to examine long-term impact of such practices on children’s growth and development.

  15. Psychiatric emergencies (part II): psychiatric disorders coexisting with organic diseases.

    Science.gov (United States)

    Testa, A; Giannuzzi, R; Sollazzo, F; Petrongolo, L; Bernardini, L; Dain, S

    2013-02-01

    In this Part II psychiatric disorders coexisting with organic diseases are discussed. "Comorbidity phenomenon" defines the not univocal interrelation between medical illnesses and psychiatric disorders, each other negatively influencing morbidity and mortality. Most severe psychiatric disorders, such as schizophrenia, bipolar disorder and depression, show increased prevalence of cardiovascular disease, related to poverty, use of psychotropic medication, and higher rate of preventable risk factors such as smoking, addiction, poor diet and lack of exercise. Moreover, psychiatric and organic disorders can develop together in different conditions of toxic substance and prescription drug use or abuse, especially in the emergency setting population. Different combinations with mutual interaction of psychiatric disorders and substance use disorders are defined by the so called "dual diagnosis". The hypotheses that attempt to explain the psychiatric disorders and substance abuse relationship are examined: (1) common risk factors; (2) psychiatric disorders precipitated by substance use; (3) psychiatric disorders precipitating substance use (self-medication hypothesis); and (4) synergistic interaction. Diagnostic and therapeutic difficulty concerning the problem of dual diagnosis, and legal implications, are also discussed. Substance induced psychiatric and organic symptoms can occur both in the intoxication and withdrawal state. Since ancient history, humans selected indigene psychotropic plants for recreational, medicinal, doping or spiritual purpose. After the isolation of active principles or their chemical synthesis, higher blood concentrations reached predispose to substance use, abuse and dependence. Abuse substances have specific molecular targets and very different acute mechanisms of action, mainly involving dopaminergic and serotoninergic systems, but finally converging on the brain's reward pathways, increasing dopamine in nucleus accumbens. The most common

  16. The anticholinergic impregnation scale: Towards the elaboration of a scale adapted to prescriptions in French psychiatric settings.

    Science.gov (United States)

    Briet, Jeanne; Javelot, Hervé; Heitzmann, Edwige; Weiner, Luisa; Lameira, Catherine; D'Athis, Philippe; Corneloup, Marie; Vailleau, Jean-Louis

    2017-09-01

    Some drugs have anticholinergic activity and can cause peripheral or central side effects. Several scales exist to evaluate the potential anticholinergic effect of prescribed drugs but: (i) they are validated in the elderly and mainly assess the cognitive side effect of treatments; (ii) they do not concern some of the drugs frequently used in clinical psychiatry in France. The aim of our study is to develop a new scale, the anticholinergic impregnation scale (AIS), with drugs used in France and based on an assessment of the drugs used against peripheral anticholinergic adverse effects. We assigned a score, ranging from 1 to 3, to a list of 128 drugs with a consensus approach obtained via literature data and expert opinions. We collected data from 7278 prescriptions in 34 French psychiatric facilities: age, sex, atropinic drugs, laxatives and treatments of xerophthalmia and xerostomia, in order to evaluate the association between AIS score and the prescription of drugs aiming to reduce peripheral anticholinergic side effects. The most frequently prescribed drugs were cyamemazine (n=1429; 20%) and tropatepine (n=1403; 19%), two drugs marketed almost exclusively in France and with a score of 3. The frequency of patients with a high AIS score, greater than 5, was significantly higher in patients who received laxatives and treatments of xerostomia. AIS score represents the first validated solution to evaluate anticholinergic load in psychiatry settings in France. The anticholinergic problem remains underevaluated in mental health settings. In order to rule out the confounding factor of mental disease, assessment of peripheral side effects can be considered more objective than the evaluation of cognitive function in psychiatric patients. Building scales appropriate for each state also appear essential to obtain an useful and effective tool in clinical practice. Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS

  17. 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.

  18. Psychiatric morbidity and non-participation in breast cancer screening.

    Science.gov (United States)

    Jensen, Line Flytkjær; Pedersen, Anette Fischer; Bech, Bodil Hammer; Andersen, Berit; Vedsted, Peter

    2016-02-01

    Organised breast cancer screening is currently one of the best strategies for early-stage breast cancer detection. However, early detection has proven challenging for women with psychiatric disease. This study aims to investigate psychiatric morbidity and non-participation in breast cancer screening. We conducted an observational cohort study including women invited to the first organised screening round in the Central Denmark Region. Data on psychiatric diagnosis, psychoactive prescription medicine and consultation with private psychiatrists were obtained from Danish registries and assessed for a period of up to 10 years before the screening date. The cohort comprised 144,264 women whereof 33.0% were registered with an indication of psychiatric morbidity. We found elevated non-participation propensity among women with a psychiatric diagnosis especially for women with schizophrenia and substance abuse. Also milder psychiatric morbidity was associated with higher non-participation likelihood as women who had redeemed psychoactive prescription medicine or have had minimum one consultation with a private psychiatrist were more likely not to participate. Finally, we found that the chronicity of psychiatric morbidity was associated with non-participation and that woman who had a psychiatric morbidity defined as 'persistent' had higher likelihood of non-participation than women with recently active morbidity or inactive psychiatric morbidity. This study showed a strong association between psychiatric morbidity and an increased likelihood of non-participation in breast cancer screening in a health care system with universal and tax-funded health services. This knowledge may inform interventions targeting women with psychiatric morbidity as they have poorer breast cancer prognosis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Manipulation of prescriptions by patients - what must a doctor do?

    Science.gov (United States)

    DeSousa, Avinash

    2016-01-01

    Over-the-counter use of medication via chemists, including the use of psychiatric medication, has always been a cause of worry in the Indian subcontinent. Over the last two years, the rules on dispensing psychiatric medication have become stringent and chemists have to dispense the exact amount of medicine written on the prescription for the time duration mentioned. The chemist also stamps the prescription with the amount of medicine dispensed so that the patient does not use the prescription at another chemist's or counter to obtain more than the amount prescribed. This means that patients must follow up with the psychiatrist regularly, have themselves evaluated, and get a fresh prescription that must be signed by the doctor and also carry his seal. There are many patients who do not adhere to this rule. Many a time, chemists who have known a patient over the years tend to continue dispensing medication to the patient for durations which far exceed that prescribed by the doctor. This is rather dangerous as the patient may end up taking antidepressants, antipsychotics and sedatives for months or at times, years, without a valid prescription. They may also develop side-effects that could ensue under unsupervised consumption.

  20. Thinking outside the medicine cabinet: a comparative content analysis of direct-to-consumer advertisements for prescription drug treatments.

    Science.gov (United States)

    McKeever, Robert

    2014-01-01

    This study content analyzed online direct-to-consumer advertisements (DTCA) for prescription drug treatments to explore whether ads for prescription treatments for psychiatric conditions, which are commonly untreated, differ from other drug advertisements. Coded variables included the presence of interactive technological components, use of promotional incentives, and the social contexts portrayed in images shown on each site. Statistical analysis revealed ads for psychiatric medications contained fewer interactive website features, financial incentives, and calls to action than other types of prescription drug advertisements. Implications for health communication researchers are discussed.

  1. Multidisciplinary, Nurse-Led Psychiatric Consultation in Nursing Homes: A Pilot Study in Clinical Practice.

    Science.gov (United States)

    Koekkoek, Bauke; van Baarsen, Carlijn; Steenbeek, Mirella

    2016-07-01

    To determine the effects of multidisciplinary, nurse-led psychiatric consultation on behavioral problems of nursing home residents. Residents often suffer from psychiatric symptoms, while staff psychiatric expertise varies. A pre-post study was conducted in seven homes using the Neuropsychiatric Inventory Nursing Home version (NPI-NH). In 71 consultations during 18 months, 56-75% of residents suffered from agitation/aggression, depression, anxiety, and disinhibition. Post-intervention (n = 54), frequency, and severity of psychiatric symptoms were significantly and clinically meaningfully reduced. Also, staff suffered from less work stress. Nurse-led psychiatric consultation is valuable to both nursing home residents and staff. © 2015 Wiley Periodicals, Inc.

  2. 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.

  3. Increasing access to emergency contraception through online prescription requests.

    Science.gov (United States)

    Averbach, Sarah; Wendt, Jacqueline Moro; Levine, Deborah K; Philip, Susan S; Klausner, Jeffrey D

    2010-01-01

    To describe a pilot program, Plan B Online Prescription Access, to provide easy access to prescriptions for emergency contraception via the Internet. We measured electronic prescriptions for Plan B (Duramed Pharmaceuticals, Cincinnati, Ohio) by month over time. Pharmacists faxed patient-generated prescriptions back to the Department of Public Health for confirmation. Despite no marketing, within the first 18 months of the program, 152 electronic prescriptions for Plan B were requested by 128 female San Francisco residents. Seventy-eight prescriptions were filled (51%) by pharmacists. If correctly marketed, online prescriptions for Plan B have the potential to be an effective means of increasing emergency contraception access in both urban and rural settings across the United States. Further user-acceptability studies are warranted.

  4. Attitudes of college students toward mental illness stigma and the misuse of psychiatric medications.

    Science.gov (United States)

    Stone, Amanda M; Merlo, Lisa J

    2011-02-01

    Mental illness stigma remains a significant barrier to treatment. However, the recent increase in the medical and nonmedical use of prescription psychiatric medications among college students seems to contradict this phenomenon. This study explored students' attitudes and experiences related to psychiatric medications, as well as correlates of psychiatric medication misuse (ie, attitudes toward mental illness and beliefs about the efficacy of psychiatric medications). Data were collected anonymously via self-report questionnaires from April 2008 to February 2009. Measures included the Michigan Alcoholism Screening Test, the Drug Abuse Screening Test, Day's Mental Illness Stigma Scale, the Attitudes Toward Psychiatric Medication scale, and the Psychiatric Medication Attitudes Scale. Participants included 383 university students (59.2% female), recruited on the campus of a large state university or through online classes offered through the same university. High rates of psychiatric medication misuse were shown (13.8%) when compared to rates of medical use (6.8%), and students with prescriptions for psychiatric drugs were also more likely to be misusers (χ(2) = 20.60, P mental illness, including lower anxiety around the mentally ill (t = 3.26, P mental illness (t = -2.11, P mental illness, the appropriate use of psychiatric medications, and the potential consequences associated with abuse of these potent drugs. © Copyright 2011 Physicians Postgraduate Press, Inc.

  5. Psychiatric diagnoses and psychoactive medication use among nonsurgical critically ill patients receiving mechanical ventilation

    DEFF Research Database (Denmark)

    Wunsch, Hannah; Christiansen, Christian Fynbo; Johansen, Martin B

    2014-01-01

    IMPORTANCE: The relationship between critical illness and psychiatric illness is unclear. OBJECTIVE: To assess psychiatric diagnoses and medication prescriptions before and after critical illness. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study in Denmark of critically ill patien...

  6. Errors and omissions in hospital prescriptions: a survey of prescription writing in a hospital.

    Science.gov (United States)

    Calligaris, Laura; Panzera, Angela; Arnoldo, Luca; Londero, Carla; Quattrin, Rosanna; Troncon, Maria G; Brusaferro, Silvio

    2009-05-13

    The frequency of drug prescription errors is high. Excluding errors in decision making, the remaining are mainly due to order ambiguity, non standard nomenclature and writing illegibility. The aim of this study is to analyse, as a part of a continuous quality improvement program, the quality of prescriptions writing for antibiotics, in an Italian University Hospital as a risk factor for prescription errors. The point prevalence survey, carried out in May 26-30 2008, involved 41 inpatient Units. Every parenteral or oral antibiotic prescription was analysed for legibility (generic or brand drug name, dose, frequency of administration) and completeness (generic or brand name, dose, frequency of administration, route of administration, date of prescription and signature of the prescriber). Eight doctors (residents in Hygiene and Preventive Medicine) and two pharmacists performed the survey by reviewing the clinical records of medical, surgical or intensive care section inpatients. The antibiotics drug category was chosen because its use is widespread in the setting considered. Out of 756 inpatients included in the study, 408 antibiotic prescriptions were found in 298 patients (mean prescriptions per patient 1.4; SD +/- 0.6). Overall 92.7% (38/41) of the Units had at least one patient with antibiotic prescription. Legibility was in compliance with 78.9% of generic or brand names, 69.4% of doses, 80.1% of frequency of administration, whereas completeness was fulfilled for 95.6% of generic or brand names, 76.7% of doses, 83.6% of frequency of administration, 87% of routes of administration, 43.9% of dates of prescription and 33.3% of physician's signature. Overall 23.9% of prescriptions were illegible and 29.9% of prescriptions were incomplete. Legibility and completeness are higher in unusual drugs prescriptions. The Intensive Care Section performed best as far as quality of prescription writing was concerned when compared with the Medical and Surgical Sections

  7. Prescription Program Provides Significant Savings

    Science.gov (United States)

    Rowan, James M.

    2010-01-01

    Most school districts today are looking for ways to save money without decreasing services to its staff. Retired pharmacist Tim Sylvester, a lifelong resident of Alpena Public Schools in Alpena, Michigan, presented the district with a pharmaceuticals plan that would save the district money without raising employee co-pays for prescriptions. The…

  8. Off-Label Prescription of Psychopharmacological Drugs in Child and Adolescent Psychiatry

    DEFF Research Database (Denmark)

    Braüner, Julie Vestergaard; Johansen, Lily Manzello; Roesbjerg, Troels M I

    2016-01-01

    This study aimed to describe the frequency of off-label prescriptions of psychopharmacological drugs in a child and adolescent psychiatric setting. A cross-sectional study was conducted on November 1, 2014, including all inpatients and outpatients at the Mental Health Centre for Child...

  9. Wellbeing, activity and housing satisfaction - comparing residents with psychiatric disabilities in supported housing and ordinary housing with support.

    Science.gov (United States)

    Eklund, Mona; Argentzell, Elisabeth; Bejerholm, Ulrika; Tjörnstrand, Carina; Brunt, David

    2017-08-30

    The home is imperative for the possibilities for meaningful everyday activities among people with psychiatric disabilities. Knowledge of whether such possibilities vary with type of housing and housing support might reveal areas for improved support. We aimed to compare people with psychiatric disabilities living in supported housing (SH) and ordinary housing with support (OHS) regarding perceived well-being, engaging and satisfying everyday activities, and perceived meaning of activity in one's accommodation. The importance of these factors and socio-demographics for satisfaction with housing was also explored. This naturalistic cross-sectional study was conducted in municipalities and city districts (n = 21) in Sweden, and 155 SH residents and 111 OHS residents participated in an interview that included both self-reports and interviewer ratings. T-test and linear regression analysis were used. The SH group expressed more psychological problems, but better health, quality of life and personal recovery compared to the OHS residents. The latter were rated as having less symptom severity, and higher levels of functioning and activity engagement. Both groups rated themselves as under-occupied in the domains of work, leisure, home management and self-care, but the SH residents less so regarding home management and self-care chores. Although the groups reported similar levels of activity, the SH group were more satisfied with everyday activities and rated their housing higher on possibilities for social interaction and personal development. The groups did not differ on access to activity in their homes. The participants generally reported sufficient access to activity, social interaction and personal development, but those who wanted more personal development in the OHS group outnumbered those who stated they received enough. Higher scores on satisfaction with daily occupations, access to organization and information, wanting more social interaction, and personal

  10. Detection and correction of prescription errors by an emergency department pharmacy service.

    Science.gov (United States)

    Stasiak, Philip; Afilalo, Marc; Castelino, Tanya; Xue, Xiaoqing; Colacone, Antoinette; Soucy, Nathalie; Dankoff, Jerrald

    2014-05-01

    Emergency departments (EDs) are recognized as a high-risk setting for prescription errors. Pharmacist involvement may be important in reviewing prescriptions to identify and correct errors. The objectives of this study were to describe the frequency and type of prescription errors detected by pharmacists in EDs, determine the proportion of errors that could be corrected, and identify factors associated with prescription errors. This prospective observational study was conducted in a tertiary care teaching ED on 25 consecutive weekdays. Pharmacists reviewed all documented prescriptions and flagged and corrected errors for patients in the ED. We collected information on patient demographics, details on prescription errors, and the pharmacists' recommendations. A total of 3,136 ED prescriptions were reviewed. The proportion of prescriptions in which a pharmacist identified an error was 3.2% (99 of 3,136; 95% confidence interval [CI] 2.5-3.8). The types of identified errors were wrong dose (28 of 99, 28.3%), incomplete prescription (27 of 99, 27.3%), wrong frequency (15 of 99, 15.2%), wrong drug (11 of 99, 11.1%), wrong route (1 of 99, 1.0%), and other (17 of 99, 17.2%). The pharmacy service intervened and corrected 78 (78 of 99, 78.8%) errors. Factors associated with prescription errors were patient age over 65 (odds ratio [OR] 2.34; 95% CI 1.32-4.13), prescriptions with more than one medication (OR 5.03; 95% CI 2.54-9.96), and those written by emergency medicine residents compared to attending emergency physicians (OR 2.21, 95% CI 1.18-4.14). Pharmacists in a tertiary ED are able to correct the majority of prescriptions in which they find errors. Errors are more likely to be identified in prescriptions written for older patients, those containing multiple medication orders, and those prescribed by emergency residents.

  11. 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.

  12. Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training.

    Science.gov (United States)

    Shweiki, Ehyal; Martin, Niels D; Beekley, Alec C; Jenoff, Jay S; Koenig, George J; Kaulback, Kris R; Lindenbaum, Gary A; Patel, Pankaj H; Rosen, Matthew M; Weinstein, Michael S; Zubair, Muhammad H; Cohen, Murray J

    2015-01-01

    Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education.

  13. Validation of the Verbal and Social Interaction questionnaire: carers' focus in the carer-resident relationship in supported housing facilities for persons with psychiatric disabilities (VSI-SH).

    Science.gov (United States)

    Brunt, D; Rask, M

    2013-04-01

    A questionnaire to measure the verbal and social interactions between carers and residents in supported housing facilities for persons with psychiatric disabilities has been developed. It is an adaptation of a questionnaire originally used in a forensic psychiatric setting. The aim of the present study was thus to investigate the construct validity and the reliability of this new version of the Verbal and Social Interactions questionnaire for use in supported housing facilities (VSI-SH). Two hundred and twenty-three carers from municipal and privately run housing facilities completed the questionnaire. A factor analysis was performed, which resulted in six factors. The number of items was reduced from the original 47 to 30 in order to minimize factorial complexity and multiple loadings. The reliability was tested with Cronbach's alpha and good internal consistency for the questionnaire and five of the six factors was found. The resulting six factors and the items were compared to the conceptual model and four of the six factors corresponded well with the categories in this original theoretical model. The questionnaire can be a useful contribution to the study of interactions between carers and residents in supported housing facilities for persons with psychiatric disabilities. © 2012 Blackwell Publishing.

  14. Are we adequately preparing the next generation of physicians to prescribe exercise as prevention and treatment? Residents express the desire for more training in exercise prescription

    OpenAIRE

    Solmundson, Kara; Koehle, Michael; McKenzie, Donald

    2016-01-01

    Background: Physical activity (PA) is a key intervention for chronic disease, yet few physicians provide exercise prescription (EP). EP is an important component in larger strategies of reducing non-communicable disease (NCD). Our objective was to assess Family Medicine Residents (FMR) knowledge, competence, and perspectives of EP to help inform future curriculum development. Methods: A 49-item cross-sectional survey was administered to 396 University of British Columbia FMR. Residents’ EP...

  15. Potentially inappropriate prescriptions in patients admitted to a psychiatric hospital

    DEFF Research Database (Denmark)

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

    2016-01-01

    university hospital during a 3-month period (September 2013–November 2013). Patients medication lists (n = 207) were reviewed at the time of admission and all identified PIPs were assessed for potential consequences by clinical pharmacologists. Results There were 349 PIP identified in 1291 prescriptions...... with the probability of PIP. Improving the quality of prescribing might benefit from an interprofessional approach and thus better training of physicians and nurses is needed in order to minimize PIP....

  16. Assessment of clinical residents' needs for ten educational subjects

    Directory of Open Access Journals (Sweden)

    Mansour Razavi

    2002-04-01

    Full Text Available Background Fulfilling the learners' "real needs" will improve medical education. There are subjects that are necessary for any clinical residents not considering their field of specialty. Among the subjects ten seems to be the most important: research methodology and data analysis, computer-based programs, medical recording, cardiopulmonary and cerebral resuscitation, clinical teaching programs, communication skills, clinical ethics, laboratory examinations, reporting special diseases and death certification, and prescription. Purpose This cross-sectional study assessed educational needs of clinical residents for ten educational subjects. Methods A questionnaire prepared by board faculty members consisted of 10 close-ended questions, and one open­ ended question was distributed among 1307 residents from 22 clinical disciplines, who registered for preboard or promotion exam in June 2000. Results Among the subjects three were the most needed: computer-based programs 149 (60%, data collecting system 606 (49%, and clinical ethics 643 (46%. The prescription standard was the least required 177(13%. Conclusion Complementary training courses on these subjects can be an answer to the clinical residents needs. Keywords : research methodology, computer in medicine, cpr, clinical teaching methods, communication in medicine, medical ethics, laboratory ordering, disease coding system, death certificate, prescription writing

  17. Co-creating a psychiatric resident program with Ethiopians, for Ethiopians, in Ethiopia: the Toronto Addis Ababa Psychiatry Project (TAAPP).

    Science.gov (United States)

    Alem, Atalay; Pain, Clare; Araya, Mesfin; Hodges, Brian D

    2010-01-01

    Globalization in medical education often means a "brain drain" of desperately needed health professionals from low- to high-income countries. Despite the best intentions, partnerships that simply transport students to Western medical schools for training have shockingly low return rates. Ethiopia, for example, has sent hundreds of physicians abroad for specialty training over the past 30 years, the vast majority of whom have not returned. This represents a highly problematic net transfer of financial and human resources from the Ethiopian people to Western countries that have failed to develop their own adequate health human resource plans. With this background in mind, in 2003 Addis Ababa University invited the University of Toronto to collaborate on the first Ethiopian psychiatric residency program to be run entirely in Ethiopia. Called the Toronto Addis Ababa Psychiatry Project (TAAPP), it was established on the principle of supplementing the ability of the small Addis Ababa University Department of Psychiatry to teach, provide clinical supervision, and to help develop educational capacity. Over the last 6 years the model has involved a large number of University of Toronto faculty and residents who have spent blocks of 1 month each in Addis Ababa. This article describes the first three phases of TAAPP (I) Development of a model residency program; (II) Enhancing clinical, educational and leadership capacity; and (III) Sustainability, faculty development, and continuing education. Between 2003 and 2009, the number of psychiatrists in Ethiopia increased from 11 to 34; the Addis Ababa University Department of Psychiatry faculty increased members from three to nine. There are new departments of psychiatry established in four other university hospitals in Ethiopia outside the capital city. Mental health services are now being integrated within the national system of primary care. An important issue that underscores such a partnership is the risk of simply exporting

  18. Global health training in US graduate psychiatric education.

    Science.gov (United States)

    Tsai, Alexander C; Fricchione, Gregory L; Walensky, Rochelle P; Ng, Courtney; Bangsberg, David R; Kerry, Vanessa B

    2014-08-01

    Global health training opportunities have figured prominently into medical students' residency program choices across a range of clinical specialties. To date, however, the national scope of global mental health education has not heretofore been systematically assessed. We therefore sought to characterize the distribution of global health training opportunities in US graduate psychiatric education. We examined the web pages of all US psychiatry residency training programs, along with search results from a systematic Google query designed to identify global health training opportunities. Of the 183 accredited US psychiatry residency programs, we identified 17 programs (9.3%) offering 28 global health training opportunities in 64 countries. Ten psychiatry residency programs offered their residents opportunities to participate in one or more elective-based rotations, eight offered research activities, and six offered extended field-based training. Most global health training opportunities occurred within the context of externally administered, institution-wide initiatives generally available to residents from a range of clinical specialties, rather than within internally administered departmental initiatives specifically tailored for psychiatry residents. There are relatively few global health training opportunities in US graduate psychiatric education. These activities have a clear role in enhancing mastery of Accreditation Council for Graduate Medical Education core competencies, but important challenges related to program funding and evaluation remain.

  19. Underestimation of substance abuse in psychiatric patients by conventional hospital screening.

    Science.gov (United States)

    Reidy, Lisa J; Junquera, Patricia; Van Dijck, Karolien; Steele, Bernard W; Nemeroff, Charles B

    2014-12-01

    Psychiatric diagnosis mainly relies on behavioral signs and symptoms. Substance abuse can mimic the clinical presentation of primary psychiatric disorders and can also complicate the management of psychiatric patients. The reliability and accuracy of urine toxicology is a vital tool in the optimal treatment of these patients. Current demographics of substance abuse suggest that in addition to the most conventional drugs of abuse (e.g. cocaine, cannabis) that are of concern to treating physicians, prescription medications and new designer drugs also should be when evaluating patients who present with symptoms of psychosis/drug addiction or altered mental status. Urine samples from 220 psychiatric inpatients admitted to either an acute drug and alcohol unit or acute psychiatric unit were analyzed for drugs by the standard hospital assay (KIMS) and by a more sensitive ELISA and GC-MS basic drug screening protocol. The standard hospital toxicology (KIMS) was inferior to the ELISA and GC-MS methods in terms of both assay sensitivity and in detecting a broader number of drugs. The KIMS tests failed to identify opiates and amphetamine/methamphetamine in 50% of the patients. The KIMS screen did not identify zolpidem, buprenorphine and a number of synthetic drugs of abuse including cathinone and tryptamines. In order to reliably identify substance abuse in patients with altered mental status in inpatient settings, analytical methodologies with adequate assay sensitivity and range to detect the vast majority of commonly abused illicit drugs and prescription medications are required for optimal clinical assessment and treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Sociodemographic profile and psychiatric diagnosis of patients referred to consultation-liaison psychiatric services of general hospital psychiatric unit at a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Shri Gopal Goyal

    2017-01-01

    Full Text Available Context: Previous studies have reported high psychiatric comorbidity with physical illness. However, referral rate to consultation-liaison (C-L psychiatry from other departments is very low. There is a paucity of literature from India in this subspecialty of psychiatry. Aims: This study was conducted to assess the sociodemographic profile and psychiatric diagnosis of patients referred to C-L psychiatric services at a tertiary care center. Settings and Design: This was a descriptive cross-sectional study conducted in a tertiary care multispecialty teaching institution. Patients and Methods: The study population comprised all the patients who were referred for psychiatric consultation from other departments to C-L services of psychiatry department for 2 months. Information was collected using semi-structured pro forma, and diagnosis was made based on the International Classification of Diseases-10 criteria. Results: A total of 160 patients were referred for C-L psychiatric services. Majority of the patients were in the age group of 31–45 years, married, educated matriculation or beyond, belonged to Hindu religion, nuclear family, and residing in urban area. The maximum referrals were from internal medicine department (17.5 followed by nephrology (15.0% and neurology (10.6%. The most common psychiatric diagnosis was depression (12% followed by delirium (8%. The most common reason for seeking psychiatric consultation was psychiatric clearance of prospective kidney donor and bone marrow transplant/stem cell transplant recipient. Conclusions: Psychiatric comorbidity may present with chronic physical illness. The C-L psychiatry would play a major role in the management of psychiatric comorbidity.

  1. Psychiatric disease in late adolescence and young adulthood. Foetal programming by maternal hypothyroidism?

    Science.gov (United States)

    Andersen, Stine Linding; Olsen, Jørn; Wu, Chun Sen; Laurberg, Peter

    2014-07-01

    Lack of maternal thyroid hormones during foetal brain development may lead to structural abnormalities in the brain. We hypothesized that maternal hypothyroidism during the pregnancy could programme the foetus to development of psychiatric disease later in life. Danish nationwide register study. Singletons live-born 1980-1990. Cox proportional hazards model was used to estimate adjusted hazard ratio (aHR) with 95% confidence interval for offspring redemption of ≥2 prescriptions of a psychiatric drug from age 15 to 31 years. Among 542 100 adolescents and young adults included, altogether 3979 (0·7%) were born to mothers with hypothyroidism registered before 1996. In crude analyses, the use of a psychiatric drug was more frequent in late adolescence and young adulthood when the mother had hypothyroidism (P hypothyroidism often also had a psychiatric registration (38·5% vs 27·7%, P hypothyroidism was associated with an increased risk of having redeemed prescriptions of anxiolytics [aHR 1·23 (1·03-1·48)] and antipsychotics [aHR 1·22 (1·03-1·44)] in late adolescence and young adulthood. For antidepressants, aHR was 1·07 (0·98-1·17). The association between maternal hypothyroidism and the use of a psychiatric drug in late adolescence and young adulthood was partly confounded by maternal psychiatric history, but foetal programming by maternal hypothyroidism may be part of the mechanisms leading to the use of anxiolytics and antipsychotics. © 2014 John Wiley & Sons Ltd.

  2. Depression and cognitive impairment among newly admitted nursing home residents in the USA.

    Science.gov (United States)

    Ulbricht, Christine M; Rothschild, Anthony J; Hunnicutt, Jacob N; Lapane, Kate L

    2017-11-01

    The objective of this study is to describe the prevalence of depression and cognitive impairment among newly admitted nursing home residents in the USA and to describe the treatment of depression by level of cognitive impairment. We identified 1,088,619 newly admitted older residents between 2011 and 2013 with an active diagnosis of depression documented on the Minimum Data Set 3.0. The prevalence of receiving psychiatric treatment was estimated by cognitive impairment status and depression symptoms. Binary logistic regression using generalized estimating equations provided adjusted odds ratios and 95% confidence intervals for the association between level of cognitive impairment and receipt of psychiatric treatment, adjusted for clustering of residents within nursing homes and resident characteristics. Twenty-six percent of newly admitted residents had depression; 47% of these residents also had cognitive impairment. Of those who had staff assessments of depression, anhedonia, impaired concentration, psychomotor disturbances, and irritability were more commonly experienced by residents with cognitive impairment than residents without cognitive impairment. Forty-eight percent of all residents with depression did not receive any psychiatric treatment. Approximately one-fifth of residents received a combination of treatment. Residents with severe cognitive impairment were less likely than those with intact cognition to receive psychiatric treatment (adjusted odds ratio = 0.95; 95% confidence interval: 0.93-0.98). Many newly admitted residents with an active diagnosis of depression are untreated, potentially missing an important window to improve symptoms. The extent of comorbid cognitive impairment and depression and lack of treatment suggest opportunities for improved quality of care in this increasingly important healthcare setting. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  3. Violence prevention education program for psychiatric outpatient departments.

    Science.gov (United States)

    Feinstein, Robert E

    2014-10-01

    Approximately 40 % of psychiatrists and up to 64 % of psychiatric residents have been physically assaulted. Ranges of 72-96 % of psychiatric residents in various studies have been verbally threatened. As violence risk occurs in outpatient settings, our department developed a quality and safety curriculum designed to prepare psychiatric residents and staff to optimally respond to aggressive outpatients and violence threats or events. In 2011 and 2012, we offered an 8-part violence prevention performance improvement curriculum/program including (1) situational awareness/creating a safe environment; (2) violence de-escalation training; (3) violence risk assessment training, use of risk assessment tools, and medical record documentation; (4) violence safety discharge planning; (5) legal issues and violence; (6) "shots fired on campus" video/discussion; (7) "2011 violence threat simulation" video/discussion; and (8) violence threat simulation exercise. This program was offered to approximately 60 psychiatric residents/staff in each year. We obtained qualitative comments about the entire program and data from 2 years of post-event surveys on the usefulness of the "violence threat simulation exercise." The large majority of comments about program elements 1 to 7 were positive. In 2011 and 2012, respectively, 76 and 86 % of participants responded to a post-event survey of the violence threat simulation exercise; 90 and 88 % of participants, respectively, reported the simulation to be very helpful/somewhat helpful; and 86 and 82 % of participants, respectively, reported feeling much better/better prepared to deal with a violent event. Although some participants experienced anxiety, sleep disturbances, increase in work safety concerns, and/or traumatic memories, the majority reported no post-simulation symptoms (72 and 80 %, respectively). Although we are unable to demonstrate that this program effectively prevents violence, the overall positive response from participants

  4. Racial disparities in prescription drug use for mental illness among population in US.

    Science.gov (United States)

    Han, Euna; Liu, Gordon G

    2005-09-01

    Racial minorities are a rapidly growing portion of the US population. Research suggests that racial minorities are more vulnerable to mental illness due to risk factors, such as higher rates of poverty. Given that the burden of mental illnesses is significant, equal likelihood of mental health services utilization is important to reduce such burden. Racial minorities have been known to use mental health services less than Whites. However, it is unclear whether racial disparity in prescription drug use for mental illnesses exists in a nationally representative sample. For a valid estimation of prescription drug use patterns, the characteristic in the distribution of prescription drug use should be accounted for in the estimation model. This study is intended to document whether there was a disparity in psychiatric drug use in both extensive and intensive margins between Whites and three racial minorities: Blacks, Hispanics, and Asian-Indians. The study looked at several specified mental illnesses, controlling for underlying health status and other confounding factors. Secondary data analysis was conducted using the multiyear Medical Expenditure Panel Survey (MEPS), a nationally representative panel sample from 1996 through 2000. This analysis provides estimates of the actual expenditure on prescription drug use for people with specified mental illnesses for this study, based on comparison of Whites and other racial minorities. We derived the estimates from the two-part model, a framework that adjusts the likelihood of using prescription drugs for the specified mental illnesses while estimating the total actual expenditures on prescription drugs among the users. This study found that Blacks, Hispanics, and Asian-Indians were less likely than Whites to use prescription drugs by 8.3, 6.1 and 23.6 percentage points, respectively, holding other factors constant in the sample, with at least one of the specified mental illnesses. The expenditure on prescription drugs for

  5. Antihypertensive treatment and control according to gender, education, country of birth and psychiatric disorder: the Swedish Primary Care Cardiovascular Database (SPCCD).

    Science.gov (United States)

    Ljungman, C; Kahan, T; Schiöler, L; Hjerpe, P; Wettermark, B; Boström, K B; Manhem, K

    2015-06-01

    The reasons why women and men are treated with different antihypertensive drugs are not clear. Whether socioeconomic factors influence prescription patterns and blood pressure control differently in women and men has not been investigated. This cross-sectional study performed in a cohort of hypertensive patients from the Swedish Primary Care Cardiovascular Database (SPCCD) examined the influence of educational level, country of birth, gender and concomitant psychiatric disorder on prescription pattern and blood pressure control in 40,825 hypertensive patients. Men were more often than women treated with calcium channel blocker and angiotensin-converting enzyme inhibitor (ACEI), irrespective of education, country of birth and psychiatric disorder. Educational level influenced the prescription pattern to some extent, where the gender differences were reduced in patients with a higher educational level. In women, but not in men, high educational level and concomitant psychiatric disorder were associated with a higher proportion reaching target blood pressure. The predominant use of ACEI and calcium channel blockers in men is not influenced by educational level, country of birth or psychiatric disorder. Thus other explanations must be considered such as gender differences in side effects. Educational level seems to have a greater impact on reaching target blood pressure in women compared with men.

  6. Prevalence and Correlates of Psychiatric Disorders among ...

    African Journals Online (AJOL)

    Prevalence and Correlates of Psychiatric Disorders among Residents of a ... mental healthcare resources, availability of data on mental health needs of children ... gender-matched school going adolescents were evaluated for the presence of ...

  7. Collaborative Care in Ambulatory Psychiatry: Content Analysis of Consultations to a Psychiatric Pharmacist

    Science.gov (United States)

    Gotlib, Dorothy; Bostwick, Jolene R.; Calip, Seema; Perelstein, Elizabeth; Kurlander, Jacob E.; Fluent, Thomas

    2017-01-01

    Objectives To determine the volume and nature (or topic) of consultations submitted to a psychiatric pharmacist embedded in an ambulatory psychiatry clinic, within a tertiary care academic medical center and to increase our understanding about the ways in which providers consult with an available psychiatric pharmacist. Experimental Design Authors analyze and describe the ambulatory psychiatric pharmacist consultation log at an academic ambulatory clinic. All consultation questions were submitted between July 2012 and October 2014. Principal Observations Psychiatry residents, attending physicians, and advanced practice nurse practitioners submitted 280 primary questions. The most common consultation questions from providers consulted were related to drug-drug interactions (n =70), drug formulations/dosing (n =48), adverse effects (n =43), and pharmacokinetics/lab monitoring/cross-tapering (n =36). Conclusions This is a preliminary analysis that provides information about how psychiatry residents, attending physicians, and advanced practice nurse practitioners at our health system utilize a psychiatric pharmacist. This collaborative relationship may have implications for the future of psychiatric care delivery. PMID:28936009

  8. Collaborative Care in Ambulatory Psychiatry: Content Analysis of Consultations to a Psychiatric Pharmacist.

    Science.gov (United States)

    Gotlib, Dorothy; Bostwick, Jolene R; Calip, Seema; Perelstein, Elizabeth; Kurlander, Jacob E; Fluent, Thomas

    2017-09-15

    To determine the volume and nature (or topic) of consultations submitted to a psychiatric pharmacist embedded in an ambulatory psychiatry clinic, within a tertiary care academic medical center and to increase our understanding about the ways in which providers consult with an available psychiatric pharmacist. Authors analyze and describe the ambulatory psychiatric pharmacist consultation log at an academic ambulatory clinic. All consultation questions were submitted between July 2012 and October 2014. Psychiatry residents, attending physicians, and advanced practice nurse practitioners submitted 280 primary questions. The most common consultation questions from providers consulted were related to drug-drug interactions (n =70), drug formulations/dosing (n =48), adverse effects (n =43), and pharmacokinetics/lab monitoring/cross-tapering (n =36). This is a preliminary analysis that provides information about how psychiatry residents, attending physicians, and advanced practice nurse practitioners at our health system utilize a psychiatric pharmacist. This collaborative relationship may have implications for the future of psychiatric care delivery.

  9. Evaluation of Branched-Narrative Virtual Patients for Interprofessional Education of Psychiatry Residents.

    Science.gov (United States)

    Wilkening, G Lucy; Gannon, Jessica M; Ross, Clint; Brennan, Jessica L; Fabian, Tanya J; Marcsisin, Michael J; Benedict, Neal J

    2017-02-01

    This pilot study evaluated the utility of branched-narrative virtual patients in an interprofessional education series for psychiatry residents. Third-year psychiatry residents attended four interprofessional education advanced psychopharmacology sessions that involved completion of a branched-narrative virtual patient and a debriefing session with a psychiatric pharmacist. Pre- and post-assessments analyzed resident learning and were administered around each virtual patient. Simulation 4 served as a comprehensive review. The primary outcome was differences in pre- and post-assessment scores. Secondary outcomes included resident satisfaction with the virtual patient format and psychiatric pharmacist involvement. Post-test scores for simulations 1, 2, and 3 demonstrated significant improvement (p education series for advanced learners.

  10. Psychotropic medicine prescriptions in Italian youths: a multiregional study.

    Science.gov (United States)

    Piovani, Daniele; Clavenna, Antonio; Cartabia, Massimo; Bonati, Maurizio

    2016-03-01

    The aim of the study was to evaluate the trend of paediatric psychotropic drug prescriptions in Italy. Data sources were regional, outpatient prescription databases. Seven Italian regions, covering 50 % of the Italian population, provided data from 2006 to 2011. Prevalence and incidence of prescriptions by age and gender were evaluated for psychotropic, antidepressant, antipsychotic, and attention-deficit/hyperactivity disorders (ADHD) medications. The hospital admission rate for psychiatric conditions was calculated, also at the local health unit (LHU) level. The presence of trends in prescription prevalence and incidence during the 6 year period was assessed. Finally, the correlation between prevalence, prescription, hospital admission rates, latitude, longitude, and average annual income at the LHU level was also investigated. In 2011, 8834 youths received at least one psychotropic drug prescription, with a prevalence of 1.76 ‰ (95 % CI 1.72-1.80). The incidence of new psychotropic drug users was 1.03 ‰ (1.00-1.06). The prevalence of antidepressants was 1.02 ‰ (0.99-1.04), while that of antipsychotics was 0.70 ‰ (0.68-0.72), and that of ADHD medications 0.19 ‰ (0.18-0.21). The psychotropic drug prevalence increased with increasing age. Males were more exposed to psychotropic drugs than females (AUC0-17 male/female = 1.23). Antipsychotics were the most prescribed psychotropic drugs in males, while antidepressants were in females. Between-region prevalence ranged from 1.56 to 2.17 ‰. The overall prevalence of psychotropic drug from 2006 to 2011 was stable (χ(t)2 ≤ 0.001, p = 0.97). No correlation was found between prevalence and the variables investigated. Psychotropic drug prescription was very limited and stable. No geographical patterns were found.

  11. Psychiatric morbidity among inmates of center for destitutes: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Raghavendra B Nayak

    2015-01-01

    Full Text Available Context: One percent of the population in India is homeless (destitutes which include beggars, commercial sex workers, homeless mentally ill, elderly women with dependent children, street children, and persons with disability. Psychiatric disorders are generally seen to be common among homeless individuals. The data are limited regarding psychiatric morbidity and its prevalence in this populace in Indian context. Aim: The aim was to study the prevalence of psychiatric morbidity among the inmates of a center for destitutes. Settings and Design: Cross-sectional study. Materials and Methods: The study included all the residents (n = 50 of a center of destitutes. Psychiatric evaluation was done by qualified practicing psychiatrist. Brief Psychiatric Rating Scale and Global Assessment of Functioning instruments were used to assess the severity of psychiatric symptoms and general functioning of the individuals with mental disorders. Statistical Analysis Used: SPSS version 13 was used for statistical analysis. Results: All residents (n = 50 of center of destitutes were evaluated for psychiatric co-morbidity. 42 (84% inmates were suffering from psychiatric disorders. Most common psychiatric disorder among them was psychotic disorders in 19 (38%, followed by affective disorders, mainly depression in 16 (32%, somatoform disorders in 5 (10%, and anxiety disorders in 2 (4%. No significant gender differences were noted (P = 0.335. Substance abuse was present in 22 (44% of the inmates. A significant negative correlation between psychiatric symptoms and functioning of the subject was seen, (P < 0.001. Conclusion: Psychiatric disorders and in particular substance abuse, are common among the homeless people who stay in the center of destitutes. Psychiatric disorders are likely to be the cause significant functional impairment.

  12. [The attitudes nurses working at psychiatric hospitals in Turkey have towards forensic psychiatric patients and the associated factors].

    Science.gov (United States)

    Baysan Arabacı, Leyla; Çam, M Olcay

    2013-01-01

    To determine the attitudes nurses working at psychiatric hospitals in Turkey have towards forensic psychiatric patients and the associated factors. This cross-sectional study included 620 nurses working at 8 psychiatric hospitals in Turkey that completed ≥80% of the Nurses' Attitudes Towards Forensic Psychiatric Patients Scale (NAFPPS). Data were evaluated based on number-percentage distribution, and the relationship between variables was examined via t-test, variance analysis, and correlation analysis. Mean age of the nurses was 34.37 ± 7.48 years and 79.4% were female. Mean NAFPPS total and subscale scores were as follows: Xtotal = 69.07 ± 12.46 (max: 125); Xfeelingthreatened = 15.98 ± 3.61 (max: 30); Xtrust = 20.49 ± 5.24 (max: 20); Xsocialdistance = 10.45 ± 3.33 (max: 20); Xwillingnesstoprovidecare = 22.31 ± 4.25 (max: 40). Gender, place of employment, method of obtaining current position, employment status, level of satisfaction working as a psychiatric nurse, history of providing treatment to forensic psychiatric patients, having knowledge of Turkish laws regarding the treatment of forensic psychiatric patients, and thinking that nurses should treat forensic psychiatric patients were correlated with the nurses' attitudes towards forensic psychiatric patients, whereas age, marital status, place of longest residence, level of education, duration of working in the profession, and duration at current hospital were not. Despite the fact that the nurses working at 8 psychiatric hospitals in Turkey considered forensic psychiatric patients threatening, didn't trust them, and had a tendency to be socially distant with them, they had a moderate level of willingness to provide them proper care.

  13. Systems-Based Aspects in the Training of IMG or Previously Trained Residents: Comparison of Psychiatry Residency Training in the United States, Canada, the United Kingdom, India, and Nigeria

    Science.gov (United States)

    Jain, Gaurav; Mazhar, Mir Nadeem; Uga, Aghaegbulam; Punwani, Manisha; Broquet, Karen E.

    2012-01-01

    Objectives: International medical graduates (IMGs) account for a significant proportion of residents in psychiatric training in the United States. Many IMGs may have previously completed psychiatry residency training in other countries. Their experiences may improve our system. Authors compared and contrasted psychiatry residency training in the…

  14. Pharmaceutical development of diacetylmorphine preparations for prescription to opioid dependent patients

    OpenAIRE

    Klous, Marjolein Gabriëlle

    2004-01-01

    Addiction to heroin is a common problem in many countries around the world. Nowadays, addiction has been accepted as a chronic, relapsing psychiatric disorder. Pharmacological treatments have been developed, but stabilisation of drug use and harm reduction have become the focus of therapy for a subgroup of chronic addicts, for whom treatment options are limited. Presently, there is considerable interest in heroin-assisted treatment (HAT): (co-)prescription of heroin to chronic, treatment-refr...

  15. [Views on the new psychiatric specialist certification system from the perspective of those experiencing the postgraduate psychiatric training system in Japan].

    Science.gov (United States)

    Umene-Nakano, Wakako; Uchida, Naoki; Kato, Takahiro; Tateno, Masaru; Matsumoto, Ryohei; Nakamura, Jun

    2011-01-01

    The psychiatric specialist certification system of the Japanese Society of Psychiatry and Neurology was established in 2005, with a transitional period that ran until 2008. A three-year postgraduate training scheme was started in connection with the new psychiatric specialist certification system, and the first formal examination under the new system was held in 2010. A resident desiring certification as a psychiatric specialist must purchase a psychiatric specialist certification handbook and present it when taking the examination. There are many differences between the new examination and the transitional period examination, in terms of both the handbook and the number of case reports to be submitted. Results of a survey conducted on 360 psychiatrists belonging to either university or national hospitals, all of whom had undergone psychiatric training within the past eight years, revealed that there was currently a lack of knowledge, and low rate of utilization, of the handbook. The primary author was in the first cohort of those who began postgraduate psychiatric training in a university hospital and subsequently took the first examination administered after the transition period. The author has maintained that, based on personal experience, a number of issues need improvement, such as the large number of grading items to be signed off on by supervising psychiatrists, and complications involving the outline of cases to be experienced. Additionally, it was thought to be difficult for supervisors who had obtained their specialist certification via the transitional period examination to have an adequate understanding of the outline of the new examination. Therefore, it is important that residents themselves take a more assertive attitude to becoming specialists. In the future, in order to establish a sound specialist certification system, the results of this survey of physicians who took the new examination should be taken into account.

  16. Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training

    Directory of Open Access Journals (Sweden)

    Shweiki E

    2015-04-01

    Full Text Available Ehyal Shweiki,1 Niels D Martin,2 Alec C Beekley,1 Jay S Jenoff,1 George J Koenig,1 Kris R Kaulback,1 Gary A Lindenbaum,1 Pankaj H Patel,1 Matthew M Rosen,1 Michael S Weinstein,1 Muhammad H Zubair,2 Murray J Cohen1 1Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA; 2Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Abstract: Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education. Keywords: learning, education, achievement

  17. Improving the quality of the order-writing process for inpatient orders and outpatient prescriptions.

    Science.gov (United States)

    Meyer, T A

    2000-12-15

    Because many preventable medication errors occur at the ordering stage, a program for improving the quality of writing inpatient orders and outpatient prescriptions at one institution was developed. To determine whether potential problems existed in the order-writing process for inpatients, all physician orders for a seven-day period in 1997 were reviewed (n = 3740). More than 10% of all orders had illegible handwriting or were written with a felt-tip pen, which makes NCR copies difficult to read. Other potential errors were also identified. Following educational programs for physicians and residents focusing on the importance of writing orders clearly, physician orders were reviewed for a 24-hour period (n = 654). The use of felt-tip pens decreased to 1.37% of all orders, and no orders had illegible handwriting. A similar quality improvement approach was used to evaluate the outpatient prescription-writing process. A review of all new prescriptions for a consecutive seven-day period at a local hospital-owned community pharmacy (n = 1425) revealed that about 15% of the prescriptions had illegible handwriting and roughly 10% were incomplete. Additional data were gathered through a survey sent to 71 outside provider pharmacies requesting information on problems related to prescriptions written by physicians from the institution; 66% responded. Failure to print prescriber name (96%), illegible signature (94%), failure to include DEA number (89%), and illegible handwriting other than signature (69%) were reported as the main problems. Each physician was given a self-inking name stamp to use when writing prescriptions. In addition, educational programs covering examples of poorly written prescriptions and the legal requirements of a prescription were held for physicians and residents. A follow-up survey showed that 72% of pharmacies saw stamps being used; when stamps were not used, however, illegible signatures continued to be a problem. Follow-up reviews of outpatient

  18. Teaching Residents Practice-Management Knowledge and Skills: An "in Vivo" Experience

    Science.gov (United States)

    Williams, Laurel Lyn

    2009-01-01

    Objective: This article explores the relevant data regarding teaching psychiatric residents practice management knowledge and skills. This article also introduces a unique program for teaching practice management to residents. Methods: A literature search was conducted through PubMed and "Academic Psychiatry". Additionally residents…

  19. A comprehensive payment model for short- and long-stay psychiatric patients.

    Science.gov (United States)

    Fries, B E; Durance, P W; Nerenz, D R; Ashcraft, M L

    1993-01-01

    In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. "Transition pricing" provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated.

  20. Teaching psychiatric residents about women and leadership.

    Science.gov (United States)

    Steiner, Jeanne L; Mazure, Carolyn; Siggins, Lorraine D; Waxman, Merle; Jacobs, Selby C

    2004-01-01

    The purpose of this project was to develop a seminar on women as leaders within an academic department of psychiatry and to evaluate its effectiveness. A seminar was offered as an elective to all residents within the Yale University Department of Psychiatry. Didactic presentations and open discussion were structured around the following topics: 1) exploration of leadership roles in various areas, including research, clinical practice, teaching, and administration; 2) organizational dynamics and gender; 3) negotiation skills and conflict resolution strategies; 4) role of consultation, seminars, peer support and mentoring by both men and women in the development of leadership skills; and 5) "keeping the balance: work, relationships, and personal health." The 13 participants were queried at the completion of the seminar, and a follow-up survey was performed 18 months later. The initial and follow-up evaluations were quite positive, with average ratings in the "excellent" range at both points. The 10 respondents at 18 months were unanimous that there had been a positive and lasting effect on their professional lives. A seminar on women as leaders was a successful venture within an academic department of psychiatry. The structure of the course, which incorporated specific teaching materials plus "local" expertise, could serve as a model for such seminars in other programs or could be integrated into an existing course for all residents.

  1. Views of practitioners of alternative medicine toward psychiatric illness and psychiatric care: a study from Solapur, India.

    Science.gov (United States)

    Holikatti, Prabhakar C; Kar, Nilamadhab

    2015-01-01

    It is common knowledge that patients seek treatment for psychiatric illnesses from various sources including the alternative medicine. Views and attitudes of clinicians often influence the provision of appropriate mental health care for these patients. In this context, it was intended to study the views of the practitioners of alternative medicine toward psychiatric disorders, patients and interventions. The study was conducted as a questionnaire-based survey among a sample of practitioners of alternative medicine specifically Ayurveda and Homeopathy, who were practicing in Solapur and adjoining areas of Maharashtra and Karnataka states in India. A semi-structured Attitudinal Inventory for Psychiatry questionnaire was used. Demographic and professional data were collected. Out of 62 practitioners approached, 50 responded (80.6%). There were no significant differences in the views of practitioners toward psychiatry and psychiatrists based on respondents' gender, place of residence, location of practice, type of alternative medicine, exposure to psychiatric patients, or if they knew someone with psychiatric illness. Attitudes were generally positive, but variable. Among negative observations were that approximately 60% of respondents felt that a patient can be disadvantaged by being given a psychiatric label and 58% believed that emotions are difficult to handle. A considerable proportion (40%) of the respondents felt doctors other than psychiatrists were unable to identify psychiatric disorders. This study's findings suggest that practitioners of alternative medicine have mixed views about mental illness, patients and treatment. Some of their negative views and perceived inability to identify psychiatric disorders may be addressed through further training, information sharing and collaborative work.

  2. [Clinical audit on drug prescriptions for elderly patients hospitalized in a unit of psychiatry].

    Science.gov (United States)

    Humaraut, C; Caron, J; Bayonne, L; Moalic, Y

    2016-02-01

    The elderly are particularly vulnerable to the iatrogenic effects of drugs that are a major public health problem. In a geriatric care unit of a psychiatric hospital, the pharmacist, in close cooperation with the various health professionals, takes part in the optimization of drug therapy of these patients during cross-professional consultation meetings. From 2009 to 2011, an evaluation of professional practices was run through a targeted clinical audit on the theme of "prescription drugs at the age of 75 and over". The main objective of this study is to measure the differences between the practices and the guidelines for prescription drugs concerning the elderly, and then to analyze and amend these differences. The secondary objective is to gather data on the prescription drugs for the elderly in the particular context of a psychiatric unit. The evaluation was performed using two standards: the evaluation chart of prescriptions of the Professional College of French Geriatrics (CPGF) and the French National Authority for Health and the list of Laroche et al. In the first round, after analyzing the prescriptions of 105 patients, the gap between practice and accepted standards led to the definition of three areas of improvement on the associations of neuroleptics, on the use of anticholinergic drugs and on the prescription of benzodiazepines, the latter being subject of another communication. After reassessment, the prescriptions of 101 patients were thereafter analyzed in relation to the identified areas of improvement. Patient samples of both phases were statistically homogeneous. Between the two evaluations, the percentage of prescriptions with at least two neuroleptics remained stable, the decline was not significant (18.1% to 13.9%, P≥0.05). However, it was observed that the second suggested a "conditional" decline with dosages less than or equal to those recommended for the elderly dosages. The proportion of patients who did not take anticholinergic drugs

  3. Psychiatric disorders among the Mapuche in Chile.

    Science.gov (United States)

    Vicente, Benjamin; Kohn, Robert; Rioseco, Pedro; Saldivia, Sandra; Torres, Silverio

    2005-06-01

    The Mapuche are the largest indigenous group in Chile; yet almost all data on the mental health of indigenous populations are from North America. The study examines the differential DSM-III-R prevalence rates of psychiatric disorders and service utilization among indigenous and non-indigenous community residence. The Composite International Diagnostic Interview (CIDI) was administered to a stratified random sample of 75 Mapuche and 434 non-Mapuche residents of the province of Cautín. Lifetime prevalence and 12-month prevalence rates were estimated. Approximately 28.4% of the Mapuche population had a lifetime, and 15.7% a 12-month, prevalent psychiatric disorder compared to 38.0% and 25.7%, respectively, of the non-Mapuche. Few significant differences were noted between the two groups; however, generalized anxiety disorder, simple phobia, and drug dependence were less prevalent among the Mapuche. Service utilization among the Mapuche with mental illness was low. This is a preliminary study based on a small sample size. Further research on the mental health of indigenous populations of South America is needed.

  4. Prescription stimulant use is associated with earlier onset of psychosis.

    Science.gov (United States)

    Moran, Lauren V; Masters, Grace A; Pingali, Samira; Cohen, Bruce M; Liebson, Elizabeth; Rajarethinam, R P; Ongur, Dost

    2015-12-01

    A childhood history of attention deficit hyperactivity disorder (ADHD) is common in psychotic disorders, yet prescription stimulants may interact adversely with the physiology of these disorders. Specifically, exposure to stimulants leads to long-term increases in dopamine release. We therefore hypothesized that individuals with psychotic disorders previously exposed to prescription stimulants will have an earlier onset of psychosis. Age of onset of psychosis (AOP) was compared in individuals with and without prior exposure to prescription stimulants while controlling for potential confounding factors. In a sample of 205 patients recruited from an inpatient psychiatric unit, 40% (n = 82) reported use of stimulants prior to the onset of psychosis. Most participants were prescribed stimulants during childhood or adolescence for a diagnosis of ADHD. AOP was significantly earlier in those exposed to stimulants (20.5 vs. 24.6 years stimulants vs. no stimulants, p drugs of abuse, and family history of a first-degree relative with psychosis, the association between stimulant exposure and earlier AOP remained significant. There was a significant gender × stimulant interaction with a greater reduction in AOP for females, whereas the smaller effect of stimulant use on AOP in males did not reach statistical significance. In conclusion, individuals with psychotic disorders exposed to prescription stimulants had an earlier onset of psychosis, and this relationship did not appear to be mediated by IQ or cannabis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Increase in the prescription rate of antidepressants after the Sewol Ferry disaster in Ansan, South Korea.

    Science.gov (United States)

    Han, Kyu-Man; Kim, Kyoung-Hoon; Lee, Mikyung; Lee, Sang-Min; Ko, Young-Hoon; Paik, Jong-Woo

    2017-09-01

    Previous pharmaco-epidemiological studies have reported increases in the prescription of psychotropic medications after a disaster, reflecting post-disaster changes in psychiatric conditions and mental health service utilization. We investigated changes in the prescription of psychotropic medications in the Danwon district of Ansan city (Ansan Danwon) compared to a control community before and after the Sewol Ferry disaster on April 16, 2014. Data was collected from the Korean Health Insurance Review and Assessment Service database. We analyzed the prescription rates of psychotropic medications including antidepressants, anxiolytics, and sedatives/hypnotics, and investigated whether the time-series pattern of monthly prescriptions per 100,000 people was different in Ansan Danwon compared to that in Cheonan city after the Sewol Ferry disaster through difference-in-differences regression analysis. Ansan Danwon showed a significantly greater increase (5.6%) in the prescription rate of antidepressants compared to Cheonan city following the Sewol Ferry disaster. There were no significant differences in changes in the prescription rates of anxiolytics or sedatives/hypnotics. In the secondary analysis, a significantly greater increase in the prescription rate of antipsychotics was observed in Ansan Danwon compared to a control community after the disaster. We could not exclude the possibility that other events influenced changes in the prescription rates of psychotropic medications during the study period. Pharmaco-epidemiological studies on psychotropic medication prescription after a disaster provide important information about population-level mental health. Our results suggest that the Sewol Ferry disaster exerted a harmful effect on the mental health status of the affected community. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Prescription drugs in nursing homes: managing costs and quality in a complex environment.

    Science.gov (United States)

    Mendelson, Dan; Ramchand, Rajeev; Abramson, Richard; Tumlinson, Anne

    2002-11-12

    This brief provides a description of prescription drug use in nursing homes and a summary of current policy issues in this area. The brief first profiles the nursing home pharmaceutical market, outlining the major trends in demographics and drug utilization, the supply chain by which drugs go from manufacturers to pharmacies to nursing home residents, and the alternative arrangements by which prescription drugs in nursing homes are financed. The brief then provides a synopsis of current policy issues, focusing in turn on cost containment and quality improvement initiatives.

  7. Beta-Blockers for Exams Identify Students at High Risk of Psychiatric Morbidity.

    Science.gov (United States)

    Butt, Jawad H; Dalsgaard, Søren; Torp-Pedersen, Christian; Køber, Lars; Gislason, Gunnar H; Kruuse, Christina; Fosbøl, Emil L

    2017-04-01

    Beta-blockers relieve the autonomic symptoms of exam-related anxiety and may be beneficial in exam-related and performance anxiety, but knowledge on related psychiatric outcomes is unknown. We hypothesized that beta-blocker therapy for exam-related anxiety identifies young students at risk of later psychiatric events. Using Danish nationwide administrative registries, we studied healthy students aged 14-30 years (1996-2012) with a first-time claimed prescription for a beta-blocker during the exam period (May-June); students who were prescribed a beta-blocker for medical reasons were excluded. We matched these students on age, sex, and time of year to healthy and study active controls with no use of beta-blockers. Risk of incident use of antidepressants, incident use of other psychotropic medications, and suicide attempts was examined by cumulative incidence curves for unadjusted associations and multivariable cause-specific Cox proportional hazard analyses for adjusted hazard ratios (HRs). We identified 12,147 healthy students with exam-related beta-blocker use and 12,147 matched healthy students with no current or prior use of beta-blockers (median age, 19 years; 80.3% women). Among all healthy students, 0.14% had a first-time prescription for a beta-blocker during the exam period with the highest proportion among students aged 19 years (0.39%). Eighty-one percent of the students filled only that single prescription for a beta-blocker during follow-up. During follow-up, 2225 (18.3%) beta-blocker users and 1400 (11.5%) nonbeta-blocker users were prescribed an antidepressant (p beta-blocker users and 658 (5.4%) nonbeta-blocker users were prescribed a psychotropic drug (p beta-blocker users and 6 (0.05%) nonbeta-blocker users attempted suicide (p = 0.03). Exam-related beta-blocker use was associated with an increased risk of antidepressant use (adjusted HRs, 1.68 [95% confidence intervals (CIs), 1.57-1.79], p beta-blockers during the exam period was

  8. Differences between youth with a single suicide attempt and repeaters regarding their and their parents history of psychiatric illness

    DEFF Research Database (Denmark)

    Jakobsen, Ida Skytte; Christiansen, Erik; Juul Larsen, Kim

    2011-01-01

    , psychiatric diagnoses, and psychopharmacological medications prescribed to youth before and after the index attempt were risk factors for repeated suicide attempts. Parental diagnoses and drug prescriptions following a child's first suicide attempt moderated the risk of repeated attempts. Psychiatric illness......The objective of this study was to determine predictors of repeated suicide attempts in young people, focusing on psychiatric illness. A longitudinal population-based register study of all adolescents born in Denmark between 1984 and 2006 was conducted. Greater numbers of hospitalizations...... is a strong predictor of repeated suicide attempts in young people, and those with co-morbid diagnoses are at increased risk of repeated suicide attempts. Treatment of psychiatric illness in the parents after their child's first suicide attempt is a potential protective factor....

  9. Preparing Psychiatric Residents for the "Real World": A Practice Management Curriculum

    Science.gov (United States)

    Wichman, Christina L.; Netzel, Pamela J.; Menaker, Ronald

    2009-01-01

    Objective: The authors describe a course designed for residents to develop the knowledge and skills necessary to collaborate and successfully compete in today's complex health care environment and to achieve competency in systems-based practice. Methods: Postgraduation surveys demonstrated a need for improvement in preparing residents for practice…

  10. Pain treatment for nursing home residents differs according to cognitive state - a cross-sectional study.

    Science.gov (United States)

    Bauer, Ulrike; Pitzer, Stefan; Schreier, Maria Magdalena; Osterbrink, Jürgen; Alzner, Reinhard; Iglseder, Bernhard

    2016-06-17

    Communication skills are known to decrease with advancing cognitive impairment. Analgesic treatment in long-term care may be deficient due to the residents' impaired ability to communicate their pain and needs. Undertreated pain frequently leads to rising BPSD in residents with cognitive impairment, resulting in a treatment with antipsychotics. Aim of this study was the analysis of differences in assessment and pharmacological treatment of pain in nursing home residents relative to their cognitive state and ability to articulate pain. Data stems from the baseline of a non-experimental pre-post-study in 12 Austrian nursing homes. Residents' pain prevalence in relation to pain assessment and cognitive decline was assessed, data on medical diagnoses and prescriptions were retrieved from the nursing homes' documentation (n = 425). Residents were first divided into two groups: Residents with MMSE ≥ 18 were selected into group CUS (cognitively unimpaired/slightly impaired), residents with MMSE ≤ 17 were selected into group CI (cognitively moderately to severely impaired). CI residents were then sub-grouped according to their ability to communicate pain via the Verbal Rating Scale (VRS) (i.e. group CI-V, group CI-NV). Pain behavior of CI residents was assessed with a modified German version of PAINAD. Group differences were tested with ANOVA and H-test, 95 % confidence intervals were calculated and associations were tested with log-binomial regression. Pain prevalence in CI residents irrespective of their ability to communicate pain was 80 % and exceeded the CUS group prevalence significantly by 14 %. CI residents had significantly less analgesic prescriptions. Furthermore, CI residents have a significantly higher risk of getting no analgesics when in pain than CUS residents (CI-V: RR =2.6, CI-NV: RR =3.4). Use of antipsychotics was high in all groups (49 - 65 %) with more prescriptions in the cognitively impaired group. Results point toward an

  11. Antipsychotic Medication Prescription Patterns in Adults with Developmental Disabilities Who Have Experienced Psychiatric Crisis

    Science.gov (United States)

    Lunsky, Yona; Elserafi, Jonny

    2012-01-01

    Antipsychotic medication rates are high in adults with developmental disability. This study considered rates of antipsychotic use in 743 adults with developmental disability who had experienced a psychiatric crisis. Nearly half (49%) of these adults were prescribed antipsychotics. Polypharmacy was common with 22% of those prescribed antipsychotics…

  12. Ethical Challenges in Psychiatric Administration and Leadership.

    Science.gov (United States)

    Moffic, H Steven; Saeed, Sy Atezaz; Silver, Stuart; Koh, Steve

    2015-09-01

    As with all professional ethical principles, those in psychiatry have to evolve over time and societal changes. The current ethical challenges for psychiatric administration and leadership, especially regarding for-profit managed care, need updated solutions. One solution resides in the development by the American Association of Psychiatric Administrators (AAPA) of the first set of ethical principles designed specifically for psychiatric administrators. These principles build on prior Psychological Theories of leadership, such as those of Freud, Kernberg, and Kohut. Supplementing these theories are the actual real life models of psychiatrist leadership as depicted in the memoirs of various psychiatrists. Appreciating these principles, theories, and models may help emerging leaders to better recognize the importance of ethical challenges. A conclusion is that psychiatrists should have the potential to assume more successful leadership positions once again. In such positions, making the skills and well-being of all in the organization seems now to be the foremost ethical priority.

  13. Economics and psychiatric education: the irresistible force meets the moveable object.

    Science.gov (United States)

    Borus, J F

    1994-01-01

    Recent changes in health care delivery and financing threaten the traditional funding base for psychiatric education. These changes are disrupting the often-tenuous "critical balances" in psychiatry residency, weighting them toward greater provision of services and less training, education, autonomy of practice, and time for personal needs. Three strategies for adapting creatively to the new fiscal and organizational realities in health care are described: decreasing the number of residents and residency-training programs, rethinking the content of residency so that it provides training for the practice realities of the twenty-first century, and marketing the quality and cost-effectiveness of academic psychiatry systems better in a managed care environment.

  14. The prescription of addiction medications after implementation of chronic care management for substance dependence in primary care

    Science.gov (United States)

    Park, Tae Woo; Samet, Jeffrey H.; Cheng, Debbie M.; Winter, Michael R.; Kim, Theresa W.; Fitzgerald, Anna; Saitz, Richard

    2014-01-01

    People with addictive disorders commonly do not receive efficacious medications. Chronic care management (CCM) is designed to facilitate delivery of effective therapies. Using data from the CCM group in a trial testing its effectiveness for addiction (n=282), we examined factors associated with the prescription of addiction medications. Among participants with alcohol dependence, 17% (95%CI 12.0–22.1%) were prescribed alcohol dependence medications. Among those with drug dependence, 9% (95%CI 5.5–12.6%) were prescribed drug dependence medications. Among those with opioids as a substance of choice, 15% (95%CI 9.3–20.9%) were prescribed opioid agonist therapy. In contrast, psychiatric medications were prescribed to 64% (95%CI 58.2–69.4%). Absence of co-morbid drug dependence was associated with prescription of alcohol dependence medications. Lower alcohol addiction severity and recent opioid use were associated with prescription of drug dependence medications. Better understanding of infrequent prescription of addiction medications, despite a supportive clinical setting, might inform optimal approaches to delivering addiction medications. PMID:25524751

  15. Development of a Web-Based Clinical Decision Support System for Drug Prescription: Non-Interventional Naturalistic Description of the Antipsychotic Prescription Patterns in 4345 Outpatients and Future Applications.

    Science.gov (United States)

    Berrouiguet, Sofian; Barrigón, Maria Luisa; Brandt, Sara A; Ovejero-García, Santiago; Álvarez-García, Raquel; Carballo, Juan Jose; Lenca, Philippe; Courtet, Philippe; Baca-García, Enrique

    2016-01-01

    The emergence of electronic prescribing devices with clinical decision support systems (CDSS) is able to significantly improve management pharmacological treatments. We developed a web application available on smartphones in order to help clinicians monitor prescription and further propose CDSS. A web application (www.MEmind.net) was developed to assess patients and collect data regarding gender, age, diagnosis and treatment. We analyzed antipsychotic prescriptions in 4345 patients attended in five Psychiatric Community Mental Health Centers from June 2014 to October 2014. The web-application reported average daily dose prescribed for antipsychotics, prescribed daily dose (PDD), and the PDD to defined daily dose (DDD) ratio. The MEmind web-application reported that antipsychotics were used in 1116 patients out of the total sample, mostly in 486 (44%) patients with schizophrenia related disorders but also in other diagnoses. Second generation antipsychotics (quetiapine, aripiprazole and long-acting paliperidone) were preferably employed. Low doses were more frequently used than high doses. Long acting paliperidone and ziprasidone however, were the only two antipsychotics used at excessive dosing. Antipsychotic polypharmacy was used in 287 (26%) patients with classic depot drugs, clotiapine, amisulpride and clozapine. In this study we describe the first step of the development of a web application that is able to make polypharmacy, high dose usage and off label usage of antipsychotics visible to clinicians. Current development of the MEmind web application may help to improve prescription security via momentary feedback of prescription and clinical decision support system.

  16. From Leros asylum to community-based facilities: levels of functioning and quality of life among hostel residents in Greece.

    Science.gov (United States)

    Zissi, A; Barry, M M

    1997-01-01

    The pattern of mental health care in Greece is undergoing a major transformation. The Leros Projects I and II supported the development of 13 community hostels located throughout the Greek mainland. These hostels provide residential care to more than 100 former psychiatric inpatients, mainly from Leros asylum. The present study evaluates the impact of the resettlement process on the residents' perceived quality of life (QoL) together with an examination of the residents' psychiatric and behavioural functioning four years after the move from hospital. The target sample (n = 99) comprised of individuals who may be considered 'chronic' psychiatric patients with a long history of institutionalisation and many are socially deprived with few family ties. The residents' functioning profile indicates a range of different levels of abilities. The QoL findings show that the majority of residents (70%) perceived the movement from the traditional hospital regime to the community hostels as being a positive change and expressed their satisfaction (74%) with the new living situation. This study demonstrates that even the most dependent, chronic psychiatric patients in Greece can be maintained in community settings and are able to articulate generally reliable and valid responses concerning the impact of service changes.

  17. The Competencies, Roles and Scope of Practice of Advanced Psychiatric Nursing in Indonesia

    Directory of Open Access Journals (Sweden)

    Yulia Wardani

    2014-01-01

    Full Text Available The graduate advanced psychiatric nursing (psychiatric nursing specialist from master degree in Indonesia are about 70 nurses, 67 nurses were graduated from University of Indonesia. They are working at mental health services and educational setting around Indonesia and yet seem not ready to perform some specific advanced competencies in clinical area. The mastery on mental health assessment, neurochemical perspectives, medical management and psychotherapy have not yet performed by the psychiatric nurse specialist in the clinical area or community.To have those competencies and its performances, therefore the curriculum in a psychiatric nursing graduate program must include advanced courses in physiopsychology, psychopathology, advanced psychopharmacology, neurobehavioral science, advanced mental health assessment, and advanced treatment interventions such as psychotherapy and prescription and management of psychotropic medications as their core and major courses in the curriculum. Those courses should be performed in their clinical practice courses or other related learning experiences. When those qualifications are met, then they are competent to be called advanced psychiatric nurse.As advanced practice registered nurses, the advanced psychiatric nurses should be able to demonstrate their direct expertise and roles in advanced mental health assessment, diagnostic evaluation, psychopharmacology management, psychotherapy with individuals, group and families, case management, millieu management, liason and counselling from prevention, promotion until psychiatric rehabilitation. Meanwhile the skill such as psycho-education, teaching, unit management, research and staff development can be added as their indirect roles.

  18. Association of Socio-Demographic Factors, Sick-Leave and Health Care Patterns with the Risk of Being Granted a Disability Pension among Psychiatric Outpatients with Depression

    Science.gov (United States)

    Mittendorfer-Rutz, Ellenor; Härkänen, Tommi; Tiihonen, Jari; Haukka, Jari

    2014-01-01

    Background Depression ranges among the leading causes of early exit from the labor market worldwide. We aimed to investigate the associations of socio-demographic factors, sickness absence, health care and prescription patterns with the risk of being granted a disability pension in psychiatric outpatients with depression. Methods All non-retired patients aged 18–60 years and living in Sweden 31.12.2005 with at least one psychiatric outpatient care visit due to a depressive episode during 2006 (N = 18034): were followed from 01.01.2007 to 31.12.2010 with regard to granting of all-cause and diagnosis-specific disability pension. Uni- and multivariate Rate Ratios (RR) and 95% Confidence Intervals (CI) were estimated for the various risk markers by Poisson Regression. Results During the four years of follow-up, 3044 patients (16.8%) were granted a disability pension, the majority due to mental disorders (2558, 84%). In the multivariate analyses, being female, below 25 or above 45 years of age, with low educational level, living alone, residing outside big cities and being born outside Europe were predictive of a granted disability pension. Frequent in- and outpatient care due to mental disorders, prescription of antidepressants and long sickness absence spells were also associated with an increased risk of disability pension (range of RRs 1.10 to 5.26). Somatic health care was only predictive of disability pension due to somatic disorders. The risk of being granted a disability pension remained at the same level as at the start of follow-up for about 1.5 years, when it started to decrease and to level off at about 20% of the risk at the end of follow-up. Conclusions Identified risk markers should be considered when monitoring individuals with depression and when designing intervention programs. PMID:24963812

  19. Association of socio-demographic factors, sick-leave and health care patterns with the risk of being granted a disability pension among psychiatric outpatients with depression.

    Directory of Open Access Journals (Sweden)

    Ellenor Mittendorfer-Rutz

    Full Text Available Depression ranges among the leading causes of early exit from the labor market worldwide. We aimed to investigate the associations of socio-demographic factors, sickness absence, health care and prescription patterns with the risk of being granted a disability pension in psychiatric outpatients with depression.All non-retired patients aged 18-60 years and living in Sweden 31.12.2005 with at least one psychiatric outpatient care visit due to a depressive episode during 2006 (N = 18,034: were followed from 01.01.2007 to 31.12.2010 with regard to granting of all-cause and diagnosis-specific disability pension. Uni- and multivariate Rate Ratios (RR and 95% Confidence Intervals (CI were estimated for the various risk markers by Poisson Regression.During the four years of follow-up, 3044 patients (16.8% were granted a disability pension, the majority due to mental disorders (2558, 84%. In the multivariate analyses, being female, below 25 or above 45 years of age, with low educational level, living alone, residing outside big cities and being born outside Europe were predictive of a granted disability pension. Frequent in- and outpatient care due to mental disorders, prescription of antidepressants and long sickness absence spells were also associated with an increased risk of disability pension (range of RRs 1.10 to 5.26. Somatic health care was only predictive of disability pension due to somatic disorders. The risk of being granted a disability pension remained at the same level as at the start of follow-up for about 1.5 years, when it started to decrease and to level off at about 20% of the risk at the end of follow-up.Identified risk markers should be considered when monitoring individuals with depression and when designing intervention programs.

  20. The Use of Prescription Drugs, Recreational Drugs, and "Soft Enhancers" for Cognitive Enhancement among Swiss Secondary School Students.

    Directory of Open Access Journals (Sweden)

    Evangelia Liakoni

    Full Text Available The use of prescription or recreational drugs for cognitive enhancement (CE is prevalent among students. However, the prevalence of CE among Swiss school students is unknown. We therefore performed a cross-sectional online survey including ≥ 16-year-old students from bridge-year schools (10th grade, vocational schools, and upper secondary schools (10th-12th grade in the Canton of Zurich to investigate the prevalence of and motives for the use of prescription drugs, recreational drugs, and/or freely available soft enhancers for CE. A total of 1,139 students were included. Of these, 54.5% reported the use of prescription drugs (9.2%, recreational drugs including alcohol (6.2%, or soft enhancers (51.3% explicitly for CE at least once in their lives. The last-year and last-month prevalence for CE considering all substances was 45.5% and 39.5%, respectively. Soft enhancers were the substances that were most commonly used (ever, last-year, and last-month, respectively, including energy drinks (33.3%, 28.4%, and 24.6%, coffee (29.8%, 25.1%, and 21.9%, and tobacco (12.6%, 9.3%, and 8.3%. CE with methylphenidate was less prevalent (4.0%, 2.8%, and 2.0%. However, the use of prescription drugs, alcohol, or illegal drugs for CE was reported by 13.3% of the participants. The most common motives for use were to stay awake and improve concentration. CE was more prevalent among students who reported higher levels of stress or performance pressure and students with psychiatric disorders. In conclusion, half of the school students had used a substance at least once in their lives to improve school performance. Soft enhancers were most commonly used. Prevalence rates were similar to those reported by Swiss university students, indicating that the use of prescription or recreational drugs for CE already occurs before starting higher education. Performance pressure, stress, and psychiatric disorders may be associated with CE.

  1. Death of Dementia Patients in Psychiatric Hospitals and Regional Supply of Psychiatric Services: Study of the National Data from 1996 to 2014 in Japan.

    Science.gov (United States)

    Nakanishi, Miharu; Niimura, Junko; Yamasaki, Syudo; Nishida, Atsushi

    2017-01-01

    Japan designates psychiatric inpatient care for behavior management of individuals with dementia and for helping dementia patients discharge to home. However, there has been no examination of the effectiveness of this strategy. The present study investigated the association between dementia and the discharge destination of patients in psychiatric hospitals. Data from the National Patient Survey, which is a nationally representative cross-sectional survey of inpatient care, were used. The 96,420 patients with dementia or other mental illness who were discharged from psychiatric hospitals in September of every 3 years from 1996 to 2014 were included in analyses. Of the 96,420 discharged patients, 13,823 had dementia as the primary disease. Of the 13,823 dementia patients, 3,865 (28.0%) were discharged to home, 3,870 (28.0%) were admitted to a facility or other care settings, 3,574 (25.9%) were admitted to another hospital, and 2,514 (18.2%) died. Patients were more likely to die in psychiatric hospital if their primary disease was dementia, and they had resided in a region that provided fewer home visits for psychiatric nursing care or had available a larger number of psychiatric hospital beds per capita. Psychiatric inpatient care may be ineffective as a treatment for the challenging behaviors of dementia. A community mental health system for behavior management should be constructed in parallel with a reduction in the number of hospital beds allotted for psychiatric care.

  2. Prescription pattern of medication in the elderly residing in nursing homes in Tehran

    Directory of Open Access Journals (Sweden)

    Sabour Malihe

    2014-01-01

    Full Text Available Objective: This study aimed to investigate prescription patterns for older people in nursing homes of Tehran. Methods: In this cross-sectional study, the data of 170 older people, sampled random cluster gathering method, using medical records, questionnaires and interview with nurses and physicians. Results: The mean average age of the sample was 79.75. 64.7% of them were female. 62.4% received more than 5 types of medicines. The mean number of medicines was 7.55 with the ranging of 1-19 drugs. The most medicine forms used by older people were: tablets 98.2%, injection medicines 20.6 %, drops 13.5%, syrup 8.8%, sprays 6.5%, ointments and suppositories 2.9%. There was not a significant relationship between participating in geriatric educational course And the mean numbers of the prescribed medications (P>0.05., as well as between covering by health insurance specialty in medicine and the mean of the numbers of mediations (P>0.05. There was a significant relationship between having insurance and the mean number of prescribed medicine (P<0.05. Conclusion: Developing educational programs on geriatric pharmacology general practitioners and more supervision on residential care homes practices may have affects on prescription pattern.

  3. Substance use - prescription drugs

    Science.gov (United States)

    Substance use disorder - prescription drugs; Substance abuse - prescription drugs; Drug abuse - prescription drugs; Drug use - prescription drugs; Narcotics - substance use; Opioid - substance use; Sedative - substance ...

  4. Personal Therapy in Psychiatry Residency Training: A National Survey of Canadian Psychiatry Residents.

    Science.gov (United States)

    Hadjipavlou, George; Halli, Priyanka; Hernandez, Carlos A Sierra; Ogrodniczuk, John S

    2016-02-01

    The authors collected nationally representative data on Canadian residents' experiences with and perspectives on personal psychotherapy in their psychiatric training. A 43-item questionnaire was distributed electronically to all current psychiatry residents in Canada (N = 839). Four hundred residents from every program across Canada returned the survey (response rate 47.7%). The prevalence of personal therapy at any time was 55.3%, with 42.8% receiving personal therapy during residency. Of residents who undertook personal psychotherapy, 59.3% engaged in weekly therapy, 74.1% received psychodynamic psychotherapy, and 81.5% participated in long-term therapy (>1 year). Personal growth, self-understanding, and professional development were the most common reasons for engaging in personal therapy; however, one-third of residents did so to alleviate symptoms of depression, anxiety, or other mental health concerns. Time was the most important factor impeding residents from personal therapy; only 8.8% found stigma to act as a barrier. The vast majority of residents rated their experience with personal therapy as having a positive or very positive impact on their personal life (84.8%) and overall development as psychiatrists (81.8%). For 64% of respondents, personal therapy had an important or very important role in psychiatry residency training. Residents who received personal therapy rated themselves as better able to understand what happens moment by moment during therapy sessions, detect and deal with patients' emotional reactions, and constructively use their personal reactions to patients. Interest in personal therapy remains strong among psychiatry trainees in Canada. Residents who engaged in psychotherapy endorsed greater confidence in psychotherapy and rated their psychotherapy skills more favorably than those who had never been in the patient role, supporting the view of personal therapy as an important adjunct to psychotherapy training during residency.

  5. Evaluation of potentially inappropriate medications among older residents of Malaysian nursing homes.

    Science.gov (United States)

    Chen, Li Li; Tangiisuran, Balamurugan; Shafie, Asrul Akmal; Hassali, Mohamed Azmi Ahmad

    2012-08-01

    There is an increasing evidence of medicines related issues such as inappropriate prescribing among older people. Inappropriate prescribing is an important risk factor for adverse drug reactions and hospitalizations in the older people. To assess and characterize the prevalence of Potentially Inappropriate Medications (PIMs) in nursing home care in Malaysia as defined by Screening Tool of Older Peoples Prescriptions (STOPP) and Beers criteria. Four Nursing Homes situated in Penang, Malaysia. A multicenter and cross-sectional study was conducted over 2 months period at four large non-governmental organizations nursing homes in Penang, Malaysia. The study population included older residents (≥65 years old) taking at least one medication. Residents who had been diagnosed with dementia or taking anti dementia drugs, delirium, too frail or refused to give consent were excluded. Demographic, clinical data and concurrent medications were collected through direct interview and also by reviewing medical records. STOPP and Beers criteria were applied in the medical review to screen for PIMs. Potentially Inappropriate Medication using STOPP and Beers criteria. Two hundred eleven residents were included in the study with the median age of 77 (inter quartile range (IQR) 72-82) years. Median number of prescription medicines was 4 (IQR 1-14). STOPP identified less residents (50 residents, 23.7 %) being prescribed on PIMs compared with Beers criteria (69 residents, 32.7 %) (p older residents living in the nursing homes and are associated with number of medications and longer nursing home stay. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

  6. [Challenges for the future of psychiatry and psychiatric medical care].

    Science.gov (United States)

    Higuchi, Teruhiko

    2013-01-01

    In addition to the prolonged economic recession and global financial crisis, the Great East Japan Earthquake of March 2011 has caused great fear and devastation in Japan. In the midst of these, Japanese people have felt to lose the traditional values and common sense they used to share, and it has become necessary to build a new consciousness. Engaged in psychiatry and psychiatric care under these circumstances, we have to analyze the challenges we face and to brainstorm on appropriate prescriptions that can be applied to solve the problems. Five points in particular were brought up: [1] The persistently high number of suicides. [2] The increase in depression and overflowing numbers of patients visiting clinics and outpatient departments at hospitals. [3] The absolute shortage of child psychiatrists. [4] Little progress with the transition from hospitalization-centered to community-centered medical care. [5] The disappearance of beds for psychiatry patients from general hospitals. The situations surrounding these five issues were briefly analyzed and problems were pointed out. The following are five problems that psychiatry is facing: 1) A lack of large clinical trials compared to the rest of the world. 2) The drug lag and handling of global trials. 3) The lack of staff involved in education and research (in the field of psychiatry). 4) Following the DSM diagnostic criteria dogmatically, without differentiating therapeutics. 5) Other medical departments, the industry, patients, and their families are demanding objective diagnostic techniques. After analyzing the problems, and discussing to some extent what kind of prescription may be considered to solve the problems, I gave my opinion. (1) The first problem is the deep-rooted prejudice and discrimination against psychiatric disorders that continue to be present among Japanese people. The second problem is the government's policy of low remuneration (fees) for psychiatric services. The third problem, symbolic of the

  7. Characteristics associated with family money management for persons with psychiatric disorders.

    Science.gov (United States)

    Labrum, Travis

    2018-05-11

    Persons with psychiatric disorders (PD) commonly have their money officially or unofficially managed by others, with money managers most commonly being family members. (i) Identify characteristics of persons with PD, adult family members, and interactions with each other significantly associated with family money management (FMM). (ii) Identify significant differences in aforementioned characteristics between official versus unofficial FMM. Five hundred and seventy-three adults residing in USA with an adult relative with PD completed a survey. Among persons with PD, FMM was positively associated with lower income, diagnosis of schizophrenia/schizoaffective or bipolar disorder, psychiatric hospitalization, and arrest history. FMM was negatively associated with family members having a mental health diagnosis. FMM was positively associated with interaction characteristics of co-residence, financial assistance, caregiving, and use of limit-setting practices. Compared to official FMM, when unofficial FMM was present, persons with PD were less likely to have been psychiatrically hospitalized or to have regularly attended mental health treatment. When unofficial FMM was present, adult family members were less likely to be a parent of the person with PD. Practitioners should assess the level of burden experienced by family money managers and assess and address with family money managers the use of limit-setting practices.

  8. Population prevalence of high dose paracetamol in dispensed paracetamol/opioid prescription combinations: an observational study

    Science.gov (United States)

    2012-01-01

    Background Paracetamol (acetaminophen) is generally considered a safe medication, but is associated with hepatotoxicity at doses above doses of 4.0 g/day, and even below this daily dose in certain populations. Methods The Nova Scotia Prescription Monitoring Program (NSPMP) in the Canadian province of Nova Scotia is a legislated organization that collects dispensing information on all out-of-hospital prescription controlled drugs dispensed for all Nova Scotia residents. The NSPMP provided data to track all paracetamol/opioids redeemed by adults in Nova Scotia, from July 1, 2005 to June 30, 2010. Trends in the number of adults dispensed these prescriptions and the numbers of prescriptions and tablets dispensed over this period were determined. The numbers and proportions of adults who filled prescriptions exceeding 4.0 g/day and 3.25 g/day were determined for the one-year period July 1, 2009 to June 30, 2010. Data were stratified by sex and age (paracetamol/opioid prescription was lower in each successive one-year period. From July 2009 to June 2010, one in 12 adults (n = 59,197) filled prescriptions for over 13 million paracetamol/opioid tablets. Six percent (n = 3,786) filled prescriptions that exceeded 4.0 g/day and 18.6% (n = 11,008) exceeded 3.25 g/day of paracetamol at least once. These findings exclude non-prescription paracetamol and paracetamol–only prescribed medications. Conclusions A substantial number of individuals who redeem prescriptions for paracetamol/opioid combinations may be at risk of paracetamol-related hepatotoxicity. Healthcare professionals must be vigilant when prescribing and dispensing these medications in order to reduce the associated risks. PMID:22709372

  9. Prescription Drug Abuse

    Science.gov (United States)

    ... drug abuse. And it's illegal, just like taking street drugs. Why Do People Abuse Prescription Drugs? Some people abuse prescription drugs ... common risk of prescription drug abuse is addiction . People who abuse ... as if they were taking street drugs. That's one reason most doctors won't ...

  10. Beta-blockers for exams identify students at high risk of psychiatric morbidity

    DEFF Research Database (Denmark)

    Butt, Jawad H.; Dalsgaard, Søren; Torp-Pedersen, Christian

    2017-01-01

    Objectives: Beta-blockers relieve the autonomic symptoms of exam-related anxiety and may be beneficial in exam-related and performance anxiety, but knowledge on related psychiatric outcomes is unknown. We hypothesized that beta-blocker therapy for exam-related anxiety identifies young students...... at risk of later psychiatric events. Methods: Using Danish nationwide administrative registries, we studied healthy students aged 14-30 years (1996-2012) with a first-time claimed prescription for a beta-blocker during the exam period (May-June); students who were prescribed a beta-blocker for medical...... reasons were excluded. We matched these students on age, sex, and time of year to healthy and study active controls with no use of beta-blockers. Risk of incident use of antidepressants, incident use of other psychotropic medications, and suicide attempts was examined by cumulative incidence curves...

  11. Clinical features and therapeutic management of patients admitted to Italian acute hospital psychiatric units: the PERSEO (psychiatric emergency study and epidemiology survey

    Directory of Open Access Journals (Sweden)

    Russo Federico

    2007-11-01

    -reported compliance increased during hospital stay. Conclusion Results confirm the widespread use of antipsychotics and the increasing trend in atypical drugs prescription, in both psychiatric in- and outpatients.

  12. Incidence of psychiatric disorders among accompanied and unaccompanied asylum-seeking children in Denmark

    DEFF Research Database (Denmark)

    Norredam, Marie; Nellums, Laura; Nielsen, Runa Schmidt

    2018-01-01

    linked a cohort of refugee children who obtained right of residency in Denmark between 01 January 1993 and 31 December 2010 to the Danish Psychiatric Central Register, and calculated incidence rates per 100,000 person years and incidence rate ratios of overall psychiatric disorder, psychotic disorders...... psychiatric disorder (aIRR: 1.38, 95% CI 1.14-1.68) and neurotic disorders (aIRR: 1.67, 95% CI 1.32-2.13) than accompanied minors. Among children from Afghanistan, unaccompanied minors had significantly higher rates of any psychiatric disorder (aIRR: 2.23, 95% CI 1.26-3.93) and neurotic disorders (aIRR: 3.......50, 95% CI 1.72-7.11). Among children from Iraq, unaccompanied minors had higher rates of any psychiatric disorder (aIRR: 2.02, 95% CI 1.18-3.45), affective disorders (aIRR: 6.04, 95% CI 2.17-16.8), and neurotic disorders (aIRR: 3.04, 95% CI 1.62-5.70). Unaccompanied children were found to experience...

  13. Psychopathology and resident status - comparing asylum seekers, refugees, illegal migrants, labor migrants, and residents.

    Science.gov (United States)

    Heeren, Martina; Wittmann, Lutz; Ehlert, Ulrike; Schnyder, Ulrich; Maier, Thomas; Müller, Julia

    2014-05-01

    This study aimed to describe, compare, and predict mental health outcomes of different migrant groups and native residents in Switzerland. Asylum seekers (n=65); refugees holding permanent protection visas (n=34); illegal migrants (n=21); labor migrants (n=26); and residents (n=56) completed an assessment by questionnaire. Main outcome variables were symptoms of posttraumatic stress, anxiety and depression. It was tested whether resident status predicted psychopathology over and above the influence of control variables including social desirability, traumatic event types and post-migration resources. Asylum seekers (54.0%) and refugees (41.4%) fulfilled criteria of PTSD most frequently. Clinically relevant symptoms of anxiety and depression were most frequently reported by asylum seekers (84.6% and 63.1%, resp.) and illegal migrants (both 47.6%). Resident status contributed to psychopathology over and above the influence of control variables. Overall, asylum seekers, refugees, and illegal migrants showed high psychiatric morbidity. Differences in resident status appear to be specifically associated with mental health outcomes. This association persists even when controlling for social desirability, post-migration resources and traumatic events. This emphasizes the importance of current socio-political living conditions for mental health, even with respect to the psychopathological sequelae of past traumatic experiences. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. The impact of trauma exposure characteristics on post-traumatic stress disorder and psychiatric co-morbidity among Syrian refugees.

    Science.gov (United States)

    Cheung Chung, Man; AlQarni, Nowf; AlMazrouei, Mariam; Al Muhairi, Shamsa; Shakra, Mudar; Mitchell, Britt; Al Mazrouei, Sara; Al Hashimi, Shurooq

    2018-01-01

    This study investigated the impact of trauma exposure characteristics on post-traumatic stress disorder (PTSD) and psychiatric co-morbidity among Syrian refugees. One thousand one hundred and ninety-seven refugees residing in Turkey and Sweden participated in the research. They completed the Harvard Trauma Questionnaire and the General Health Questionnaire-28. Forty-three percent of refugees met the cutoff for PTSD. After adjusting for location of residence, witnessing horror and exposure to life threat and assault were significantly correlated with PTSD and psychiatric co-morbidity respectively. Death of, or life threat to family members or friends were significantly correlated with both distress outcomes. Refugees residing in Turkey had significantly higher levels of PTSD, psychiatric co-morbidity and trauma characteristics than those living in Sweden. To conclude, Syrian refugees who witnessed horror, life threat or had family or friends die, tended to have elevated psychological distress. Levels of distress among resettled refugees can vary depending on country of resettlement. We recommend systematic mental health screening and implementation of psychotherapeutic interventions to address issues pertaining to subjective experience of resettlement and trauma exposure for Syrian refugees. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Hyperthyroidism and psychiatric morbidity: evidence from a Danish nationwide register study.

    Science.gov (United States)

    Brandt, Frans; Thvilum, Marianne; Almind, Dorthe; Christensen, Kaare; Green, Anders; Hegedüs, Laszlo; Brix, Thomas Heiberg

    2014-02-01

    Thyroid hormones are essential for the normal development of the fetal brain, while hyperthyroidism in adults is associated with mood symptoms and reduced quality of life. In this study, we aimed to investigate the association and temporal relationship between hyperthyroidism and psychiatric morbidity. Register-based nationwide cohort study. Data on hyperthyroidism and psychiatric morbidity were obtained by record linkage of the Danish National Patient Registry and the Danish National Prescription Registry. A total of 2631 hyperthyroid individuals were identified and matched 1:4 with non-hyperthyroid controls and followed for a mean duration of 6 years (range 0-13). Logistic and Cox regression models were used to assess the risk of psychiatric morbidity before and after the diagnosis of hyperthyroidism respectively. BEFORE THE DIAGNOSIS OF HYPERTHYROIDISM, SUCH INDIVIDUALS HAD AN INCREASED RISK OF BEING HOSPITALIZED WITH PSYCHIATRIC DIAGNOSES (ODDS RATIO (OR): 1.33; 95% CI: 0.98-1.80) and an increased risk of being treated with antipsychotics (OR: 1.17; 95% CI: 1.00-1.38), antidepressants (OR: 1.13; 95% CI: 1.01-1.27), or anxiolytics (OR: 1.28; 95% CI: 1.16-1.42). After the diagnosis of hyperthyroidism, there was a higher risk of being hospitalized with psychiatric diagnoses (hazard ratio (HR): 1.51; 95% CI: 1.11-2.05) and an increased risk of being treated with antipsychotics (HR: 1.46; 95% CI: 1.20-1.79), antidepressants (HR: 1.54; 95% CI: 1.36-1.74), or anxiolytics (HR: 1.47; 95% CI: 1.27-1.69). Hyperthyroid individuals have an increased risk of being hospitalized with psychiatric diagnoses and being treated with antipsychotics, antidepressants, and anxiolytics, both before and after the diagnosis of hyperthyroidism.

  16. Precipitants of elderly psychiatric patient assaults on staff: preliminary empirical inquiry.

    Science.gov (United States)

    Flannery, Raymond B; Peterson, Brenda; Walker, Andrew P

    2005-01-01

    Although there have been several studies of the characteristics of psychiatric patient assailants, there have been only six comprehensive, empirical assessments of precipitants to these assaults and no precipitant study has focused solely on elderly psychiatric patient assailants. This one and one-half year, retrospective study continued the inquiry into the nature of patient assault precipitants and focused only on elderly assailants. Older, male patients with a diagnosis of schizophrenia and histories of violence toward others and substance use disorder physically assaulted primarily male, mental health workers. These staff victims experienced disruptions in the domains of mastery, attachment, and meaning as well as the symptomatology associated with psychological trauma. The most common precipitants to these assaults were denial of services and acute psychosis. The findings and implications for health care providers in long-term care settings where elderly psychiatric patients reside are discussed.

  17. Stress and coping among orthopaedic surgery residents and faculty.

    Science.gov (United States)

    Sargent, M Catherine; Sotile, Wayne; Sotile, Mary O; Rubash, Harry; Barrack, Robert L

    2004-07-01

    Evaluations of physicians and residents have revealed concerning levels of psychosocial dysfunction. The purposes of this study were to determine the quality of life of orthopaedic residents and faculty and to identify the risk factors for decompensation. Twenty-one orthopaedic residents and twenty-five full-time orthopaedic faculty completed a 102-question voluntary, anonymous survey. The survey consisted of three validated instruments, i.e., the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale; and three novel question sets addressing background and demographic information, stress reaction and management, and the balance between work and home life. Descriptive statistics, pairwise correlations, simple t tests, and Pearson and nonparametric Spearman correlations were calculated. The simple correlation coefficient was used to assess bivariate relationships. The mean overall quality-of-life score, on a scale of 0 to 4 points, was 2.5 points for residents compared with 3.6 points for faculty members. Residents reported considerable burnout, showing a high level of emotional exhaustion and depersonalization and an average level of personal achievement, whereas faculty reported minimal burnout, showing a low level of emotional exhaustion (p burnout and psychiatric morbidity correlated with weekly work hours; conflict between the commitments of work and home life; discord with faculty, nursing staff, and senior residents; debt load; and work-related stress. Protective factors included being a parent, spending time with a spouse, having a physician father, and deriving satisfaction from discussing concerns with colleagues, friends, and family. In pursuit of our goal of determining the quality of life of orthopaedic residents and faculty, we identified a large disparity between the two groups. The resident group reported much greater levels of dysfunction particularly with regard to burnout and psychiatric morbidity

  18. Does a hostel's managing agency determine the access to psychiatric services of its residents?

    Science.gov (United States)

    Lucas, B; Audini, B; Chisholm, D; Knapp, M; Lelliott, P

    1998-10-01

    This study examines the effect of managing agency (local authority, private or voluntary) on the use of other health and social care services by residents in mental health hostels and group homes with different levels of staffing in England and Wales. The sample comprised 1323 residents in 275 facilities in eight districts. The measures of service use were number of days in hospital and number of other service contacts. There were highly significant differences between facilities with similar levels of staffing managed by different agencies. Residents in the voluntary sector used fewer community services overall; residents in low-staffed local authority facilities used more services than those in similar facilities managed by other agencies. These differences were not easily explained by differences in the social or clinical characteristics of residents. This suggests that there may be organisational factors, e.g. hostel staff, knowledge of services, which influence access to and use of community services.

  19. Training the "assertive practitioner of behavioral science": advancing a behavioral medicine track in a family medicine residency.

    Science.gov (United States)

    Butler, Dennis J; Holloway, Richard L; Fons, Dominique

    2013-01-01

    This article describes the development of a Behavioral Medicine track in a family medicine residency designed to train physicians to proactively and consistently apply advanced skills in psychosocial medicine, psychiatric care, and behavioral medicine. The Behavioral Medicine track emerged from a behavioral science visioning retreat, an opportunity to restructure residency training, a comparative family medicine-psychiatry model, and qualified residents with high interest in behavioral science. Training was restructured to increase rotational opportunities in core behavioral science areas and track residents were provided an intensive longitudinal counseling seminar and received advanced training in psychopharmacology, case supervision, and mindfulness. The availability of a Behavioral Medicine track increased medical student interest in the residency program and four residents have completed the track. All track residents have presented medical Grand Rounds on behavioral science topics and have lead multiple workshops or research sessions at national meetings. Graduate responses indicate effective integration of behavioral medicine skills and abilities in practice, consistent use of brief counseling skills, and good confidence in treating common psychiatric disorders. As developed and structured, the Behavioral Medicine track has achieved the goal of producing "assertive practitioners of behavioral science in family medicine" residents with advanced behavioral science skills and abilities who globally integrate behavioral science into primary care.

  20. A Novel Approach to Medicine Training for Psychiatry Residents

    Science.gov (United States)

    Onate, John; Hales, Robert; McCarron, Robert; Han, Jaesu; Pitman, Dorothy

    2008-01-01

    Objective: A unique rotation was developed to address limited outpatient internal medicine training in psychiatric residency by the University of California, Davis, Department of Psychiatry and Behavioral Sciences, which provides medical care to patients with mental illness. Methods: The number of patients seen by the service and the number of…

  1. Partnership for Prescription Assistance

    Science.gov (United States)

    ... may use our name without our permission. The Partnership for Prescription Assistance will help you find the ... Events Blog Facebook Twitter Start living better. The Partnership for Prescription Assistance helps qualifying patients without prescription ...

  2. [Prescription annotations in Welfare Pharmacy].

    Science.gov (United States)

    Han, Yi

    2018-03-01

    Welfare Pharmacy contains medical formulas documented by the government and official prescriptions used by the official pharmacy in the pharmaceutical process. In the last years of Southern Song Dynasty, anonyms gave a lot of prescription annotations, made textual researches for the name, source, composition and origin of the prescriptions, and supplemented important historical data of medical cases and researched historical facts. The annotations of Welfare Pharmacy gathered the essence of medical theory, and can be used as precious materials to correctly understand the syndrome differentiation, compatibility regularity and clinical application of prescriptions. This article deeply investigated the style and form of the prescription annotations in Welfare Pharmacy, the name of prescriptions and the evolution of terminology, the major functions of the prescriptions, processing methods, instructions for taking medicine and taboos of prescriptions, the medical cases and clinical efficacy of prescriptions, the backgrounds, sources, composition and cultural meanings of prescriptions, proposed that the prescription annotations played an active role in the textual dissemination, patent medicine production and clinical diagnosis and treatment of Welfare Pharmacy. This not only helps understand the changes in the names and terms of traditional Chinese medicines in Welfare Pharmacy, but also provides the basis for understanding the knowledge sources, compatibility regularity, important drug innovations and clinical medications of prescriptions in Welfare Pharmacy. Copyright© by the Chinese Pharmaceutical Association.

  3. [Significance of cross-cultural experience for young psychiatrists--learning from "The Joint Workshop for Psychiatric Residents of Korea and Japan"].

    Science.gov (United States)

    kato, Takahiro

    2006-01-01

    Korea and Japan are geographically very close, and a variety of cultural exchanges have taken place in recorded history. However, Korea and Japan have been enriched by the influence of Western cultures along with modernization, and mutual exchanges between the two countries have thus decreased in numerous fields including mental health and psychiatry. Prof. Masahisa Nishizono and Prof. Byun-Kun Min, who are leaders in the field of psychiatry in both Japan and Korea, have established "The Joint Workshop for Psychiatric Residents of Korea and Japan", which has been held alternately in Fukuoka or Seoul every summer since 2000. This Joint Workshop provides young psychiatrists with real experiences and many opportunities to learn about transcultural psychiatry regarding both countries. The participants are able to obtain a better mutual understanding of psychiatric epidemiology, recent developments in biological psychiatry while also learning about different concepts regarding the stigma of mental disorders. All participants could also increase their knowledge about the traditional culture and social changes related to the field of psychiatry in both countries. The workshop has helped to build friendship and mutual cooperation between both nations. Contemporary societies are continually becoming more and more diversified and complicated. For young psychiatrists who have to treat patients with modern difficulties and various complicated problems, such cross-cultural experiences may be useful for establishing potentially new and effective treatments for such patients. Psychiatrists and mental health experts have tried to reduce of stigma and discrimination against people with mental disorders, but even today such stigma and discrimination continues to strongly exist. The author thinks that such cross-cultural experiences by the psychiatrists themselves may help to reduce such notions. The author would like to explore the role of cross-cultural experiences in the field of

  4. Outpatient prescription practices in rural township health centers in Sichuan Province, China

    Directory of Open Access Journals (Sweden)

    Jiang Qian

    2012-09-01

    lack of medical devices for disease diagnosis in those township health centers. The policy implication from this study is to enhance professional training in rational medication uses for rural doctors, improve hardware facilities for township health centers, promote health education to rural residents and establish a public reporting system to monitor prescription practices in rural township health centers, etc.

  5. Exercise Dosing and Prescription-Playing It Safe: Dangers and Prescription.

    Science.gov (United States)

    Wang, Lei; Ai, Dongmei; Zhang, Ning

    2017-01-01

    Cardiac rehabilitation is a comprehensive and multidisciplinary program, and exercise training is extremely crucial in the whole program. In the past decades, many researches have shown the beneficial effects of exercise for cardiovascular disease (CVD) is indisputable Nevertheless, only a well-designed exercise prescription may achieve the ideal benefits. In this chapter, we will have a discussion of what is exercise prescription and how to establish a scientific and appropriate exercise prescription for CVD patients depending on the current scientific evidence and recommendations.

  6. Social Support Influences on Substance Abuse Outcomes among Sober Living House Residents with Low and Moderate Psychiatric Severity

    Science.gov (United States)

    Polcin, Douglas L.; Korcha, Rachael

    2017-01-01

    Social support and psychiatric severity are known to influence substance abuse. However, little is known about how their influences vary under different conditions. We aimed to study how different types of social support were associated with substance abuse outcomes among persons with low and moderate psychiatric severity who entered Sober Living…

  7. Marked reduction in length of stay for patients with psychiatric emergencies after implementation of a comanagement model.

    Science.gov (United States)

    Polevoi, Steven K; Jewel Shim, J; McCulloch, Charles E; Grimes, Barbara; Govindarajan, Prasanthi

    2013-04-01

    Patients with psychiatric emergencies often spend excessive time in an emergency department (ED) due to limited inpatient psychiatric bed capacity. The objective was to compare traditional resident consultation with a new model (comanagement) to reduce length of stay (LOS) for patients with psychiatric emergencies. The costs of this model were compared to those of standard care. This was a before-and-after study conducted in the ED of an urban academic medical center without an inpatient psychiatry unit from January 1, 2007, through December 31, 2009. Subjects were all adult patients seen by ED clinicians and determined to be a danger to self or others or gravely disabled. At baseline, psychiatry residents evaluated patients and made therapeutic recommendations after consultation with faculty. The comanagement model was fully implemented in September 2008. In this model, psychiatrists directly ordered pharmacotherapy, regularly monitored effects, and intensified efforts toward appropriate disposition. Additionally, increased attending-level involvement expedited focused evaluation and disposition of patients. An interrupted time series analysis was used to study the effects of this intervention on LOS for all psychiatric patients transferred for inpatient psychiatric care. Secondary outcomes included mean number of hours on ambulance diversion per month and the mean number of patients who left without being seen (LWBS) from the ED. A total of 1,884 patient visits were considered. Compared to the preintervention phase, median LOS for patients transferred for inpatient psychiatric care decreased by about 22% (p model was associated with a marked reduction in the LOS for this patient population. © 2013 by the Society for Academic Emergency Medicine.

  8. [Driving under the influence of benzodiazepines and antidepressants: prescription and abuse].

    Science.gov (United States)

    Coutinho, Daniel; Vieira, Duarte Nuno; Teixeira, Helena M

    2011-01-01

    Benzodiazepines are drugs usually used in anxiety disorders, dyssomnias, convulsions, muscle disorders, alcohol and other drugs detoxification, as well as in preoperative sedation/amnesia. Moreover, antidepressants are mainly indicated in depression and as co-therapeutic drugs in other psychiatric disorders. The use of benzodiazepines and antidepressants is associated with some health and public safety problems. Decreased of attention, concentration, reflexes, visual capacity, motor coordination and reasoning, associated with increased reaction time and lack of awareness of driving impairment among these drug users, contributes to the increased risk on traffic safety linked with these drugs. This risk may further increase with non-compliance of medical prescription, drug abuse or concomitant use of alcohol. The relationship between the use of psychoactive drugs and road traffic safety is, however, an extremely complex subject and has a primordial importance in the clarification of the role of benzodiazepine and antidepressant effects on driving skills. The prevention of driving under the influence of these drugs depends on the awareness, among doctors, of the risks associated with their use. Thus, the consciousness of medical prescription, as well as providing clear information to patients is extremely important.

  9. Assessment of prescription opioid intentional exposures across the rural-urban continuum in the United States using both population and drug availability rates.

    Science.gov (United States)

    Le Lait, Marie-Claire; Martinez, Erin M; Severtson, Stevan G; Lavery, Sarah A; Bucher-Bartelson, Becki; Dart, Richard C

    2014-12-01

    Prescription opioid abuse and misuse are a serious problem in the U.S. today. Several studies have shown that the epidemic disproportionately affects rural areas. This paper uses three different rates to gain a more complete picture of opioid abuse in rural areas. This study examines prescription opioid intentional exposures using opioid classes tracked in the RADARS(®) System Poison Center Program. Intentional exposure rates were calculated adjusting for population and unique recipients of dispensed drug (URDD). These rates were analyzed using time (quarter) and the proportion of a three-digit zip code residing in a rural area as covariates. Additionally, the URDD per population rate was calculated to examine the proportion of the population filling prescriptions for opioids. After adjusting for population, intentional exposure cases significantly increased as the proportion of the population residing in a rural area increased. However, when adjusting for URDD, intentional exposure cases decreased with increasing rural population. The URDD per population increased as the proportion of people residing in a rural area increased. Using both population and URDD adjusted intentional exposure rates gives a more complete picture of opioid abuse in rural areas. Considering product availability can be used to develop opioid abuse prevention strategies and further the education of physicians serving rural areas about this epidemic. Copyright © 2014 John Wiley & Sons, Ltd.

  10. The use of potentially inappropriate medications and changes in quality of life among older nursing home residents.

    Science.gov (United States)

    Al Aqqad, Saná M H; Chen, Li Li; Shafie, Asrul Akmal; Hassali, Mohamed Azmi; Tangiisuran, Balamurugan

    2014-01-01

    Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL) have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs) and the changes observed in the HRQoL among older nursing home residents. A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old) taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP) criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D) and EuroQol-visual analog scale (EQ-VAS) at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test. The median age of the 211 participants was 77 years (interquartile range 72-82 years) and the median number of prescription medicines was four (interquartile range three to six). The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months also showed no statistically significant differences. PIMs were found to be relatively common among older nursing home residents. However, no significant changes were observed in HRQoL among these residents. Further studies with a bigger sample size and

  11. Prescription Opioid Usage and Abuse Relationships: An Evaluation of State Prescription Drug Monitoring Program Efficacy

    Directory of Open Access Journals (Sweden)

    Richard M. Reisman

    2009-01-01

    Full Text Available Context The dramatic rise in the use of prescription opioids to treat non-cancer pain has been paralleled by increasing prescription opioid abuse. However, detailed analyses of these trends and programs to address them are lacking. Objective To study the association between state shipments of prescription opioids for medical use and prescription opioid abuse admissions and to assess the effects of state prescription drug monitoring programs (PDMPs on prescription opioid abuse admissions. Design and Setting A retrospective ecological cohort study comparing state prescription opioid shipments (source: Automation of Reports and Consolidated Orders Systems database and inpatient admissions for prescription opioid abuse (source: Treatment Episode Data Set in 14 states with PDMPs (intervention group and 36 states without PDMPs (control group for the period 1997–2003. Results From 1997 to 2003, oxycodone, morphine, and hydrocodone shipments increased by 479%, 100%, and 148% respectively. Increasing prescription oxycodone shipments were significantly associated with increasing prescription opioid admission rates (p < 0.001. PDMP states had significantly lower oxycodone shipments than the control group. PDMP states had less increase in prescription opioid admissions per year (p = 0.063. A patient admitted to an inpatient drug abuse rehabilitation program in a PDMP state was less likely to be admitted for prescription opioid drug abuse (Odds ratio = 0.775, 95% Confidence Interval 0.764–0.785. Conclusions PDMPs appear to decrease the quantity of oxycodone shipments and the prescription opioid admission rate for states with these programs. Overall, opioid shipments rose significantly in PDMP states during the study period indicating a negligible “chilling effect” on physician prescribing.

  12. Route of administration for illicit prescription opioids: a comparison of rural and urban drug users

    Directory of Open Access Journals (Sweden)

    Havens Jennifer R

    2010-10-01

    Full Text Available Abstract Background Nonmedical prescription opioid use has emerged as a major public health concern in recent years, particularly in rural Appalachia. Little is known about the routes of administration (ROA involved in nonmedical prescription opioid use among rural and urban drug users. The purpose of this study was to describe rural-urban differences in ROA for nonmedical prescription opioid use. Methods A purposive sample of 212 prescription drug users was recruited from a rural Appalachian county (n = 101 and a major metropolitan area (n = 111 in Kentucky. Consenting participants were given an interviewer-administered questionnaire examining sociodemographics, psychiatric disorders, and self-reported nonmedical use and ROA (swallowing, snorting, injecting for the following prescription drugs: buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, OxyContin® and other oxycodone. Results Among urban participants, swallowing was the most common ROA, contrasting sharply with substance-specific variation in ROA among rural participants. Among rural participants, snorting was the most frequent ROA for hydrocodone, methadone, OxyContin®, and oxycodone, while injection was most common for hydromorphone and morphine. In age-, gender-, and race-adjusted analyses, rural participants had significantly higher odds of snorting hydrocodone, OxyContin®, and oxycodone than urban participants. Urban participants had significantly higher odds of swallowing hydrocodone and oxycodone than did rural participants. Notably, among rural participants, 67% of hydromorphone users and 63% of morphine users had injected the drugs. Conclusions Alternative ROA are common among rural drug users. This finding has implications for rural substance abuse treatment and harm reduction, in which interventions should incorporate methods to prevent and reduce route-specific health complications of drug use.

  13. Administration of medication to use when needed and the care of psychiatric nursing

    Directory of Open Access Journals (Sweden)

    Kelly da Silva Rocha Estrela

    2014-07-01

    Full Text Available This qualitative study aimed to analyze the clinical criteria used for the administration of prescribed medications for use when needed (SOS; and discuss the implication of the findings in this research to clinical psychiatric nursing. The records of female patients admitted to a psychiatric institution in the city of Rio de Janeiro, in the time frame from May to June 2009, were analyzed. In the 38 patient records, 16 prescriptions for medications SOS were found. The mean age of patients was around 45-55 years with a clinical diagnosis of Bipolar Mood Disorder. The medication category most prescribed as SOS was of benzodiazepines, followed by antipsychotics. It was noticed a tendency to not valuing the administration of medication in SOS notes. The study points out the importance to establish clinical criteria to indicate the need, or not, to administer prescribed SOS medications.

  14. A 4-Year Curriculum on Substance Use Disorders for Psychiatry Residents

    Science.gov (United States)

    Iannucci, Rocco; Sanders, Kathy; Greenfield, Shelly F.

    2009-01-01

    Objective: The authors describe an addiction psychiatry curriculum integrated in a general psychiatry training program to demonstrate comprehensive and practical approaches to educating general psychiatric residents on the recognition and treatment of substance use disorders. Methods: The Massachusetts General Hospital/McLean Hospital adult…

  15. Problem neurology residents: a national survey.

    Science.gov (United States)

    Tabby, David S; Majeed, Muhammed H; Schwartzman, Robert J

    2011-06-14

    Problem residents are found across most medical specialties at a prevalence of about 10%. This study was designed to explore the prevalence and causes of problem neurology residents and to compare neurology programs' responses and outcomes. Directors of 126 US neurology residency programs were sent an electronic survey. We collected data on demographics, first and all "identifiers" of problem residents, and year of training in which the problem was found. We asked about observable signs, etiology, and who performed remediation. We asked what resources were used and what outcomes occurred. Ninety-five program directors completed surveys (75% response rate). Almost all neurology programs have problem residents (81%). Age, sex, marital status, being a US native, or attending a US medical school had no effect on problem status. Being a parent carried a lower likelihood of problems (32%). Most commonly the problem is acted on during the first year of training. Faculty members without defined educational roles were the most frequent first identifiers. Program directors were the most common remediators. The most common remediation techniques were increasing supervision and assigning a faculty mentor. Graduate medical education office and psychiatric or psychological counseling services were most often used. Eleven percent of problem residents required a program for impaired physicians and 14% required a leave of absence. Sixteen percent were dismissed from their programs. The prevalence of problem residents in neurology is similar to other disciplines, and various resources are available to remediate them.

  16. Antipsychotic drug prescription rates among Dutch nursing homes : the influence of patient characteristics and the dementia special care unit

    NARCIS (Netherlands)

    van der Putten, M. J. G.; Wetzels, R. B.; Bor, H.; Zuidema, S. U.; Koopmans, R. T. C. M.

    2014-01-01

    Objectives: To assess the differences in antipsychotic drug prescription rates in residents with dementia in dementia special care units (SCUs) of Dutch nursing homes, considering the differences in patient characteristics. Method: As part of the Waalbed-II study, the data on antipsychotic drug use

  17. Prescription Drug Abuse

    Science.gov (United States)

    ... what the doctor prescribed, it is called prescription drug abuse. It could be Taking a medicine that ... purpose, such as getting high Abusing some prescription drugs can lead to addiction. These include opioids, sedatives, ...

  18. Residents as teachers: psychiatry and family medicine residents' self-assessment of teaching knowledge, skills, and attitudes.

    Science.gov (United States)

    Brand, Michael W; Ekambaram, Vijayabharathi; Tucker, Phebe; Aggarwal, Ruchi

    2013-09-01

    understanding of teaching techniques, and report spending less time educating patients than do family medicine residents. The differences might be due to different patient populations and treatment settings. The study suggests that psychiatry residents may have difficulty adapting the One-Minute Preceptor technique in psychiatric settings. Results serve as a benchmarking study in a performance-improvement program to enhance psychiatry residents' teaching skills.

  19. Perspective of ophthalmology residents in the United States about residency programs and competency in relation to the International Council of Ophthalmology guidelines.

    Science.gov (United States)

    Abdelfattah, Nizar Saleh; Radwan, Ahmed E; Sadda, Srinivas R

    2016-09-01

    To evaluate the perspective of ophthalmology residents in the US about their residency programs and compare the competency of residency programs to international competency levels set by the International Council of Ophthalmology (ICO). A cross-sectional web-based survey extracted from the ICO published competency standards was sent to program directors of ophthalmology residency programs in the US to forward it to current PGY-3, 4 residents, and residency graduates from 2011 to 2014. Eighty-seven responses were received, comprising 61 residents and 26 graduates. Most respondents were highly satisfied with their programs (93.6%). Clinic-based training was rated satisfactorily. Insufficient exposure to low-vision rehabilitation (38.5%), refraction and contact lenses prescription (38.5%), and vitreo-retinal surgeries (38.5%) was reported. Respondents were satisfied with their overall surgical experiences, with the vast majority (>83%) rating case volume, complexity, and variety as satisfactory or better. A significant group stated they had insufficient exposure to extra-capsular cataract extraction (26.3%), refractive surgery (19.7%), and orbital surgery (64.5%). All graduates surveyed passed their Ophthalmic Knowledge Assessment Program (OKAP) examinations, and 72% felt their residency programs adequately prepared them for the examinations. All respondents reported insufficient training in certain nonclinical areas, such as practice management, staffing, and administration skills. Ophthalmology residents in the US express high levels of satisfaction with their residency training programs. While most programs adequately address most ICO core objectives, certain curriculum modifications should be considered.

  20. Prescriptions for uncomplicated malaria treatment among pregnant women in the Brazilian Amazon: evidences from the Mafalda Project.

    Science.gov (United States)

    Luz, Tatiana Chama Borges; Miranda, Elaine Silva; Freitas, Letícia Figueira; Osório-de-Castro, Claudia Garcia Serpa

    2013-06-01

    To evaluate antimalarial prescriptions according to quality indicators and to describe adverse events reports among pregnant women with uncomplicated malaria. Descriptive study of medical files of pregnant women 15 years and older, residents in high-risk municipalities in the Brazilian Amazon. Antimalarial medicines were characterized by frequency of prescription, type of plasmodium and health care facilities where prescribing took place, and by possible adverse events. Variables were compared by Pearson's chi-square. A total of 262 medical files were evaluated. Most patients were diagnosed for Plasmodium vivax 71,2%. Chloroquine was the commonest prescribed antimalarial (65.6%). Of P. vivax prescriptions, 9.0%, and 16.2% of P. falciparum prescriptions presented antimalarials not recommended in the official protocol. Prescriptions for P. falciparum , in significantly higher proportion, did not adhere to the official protocol in regard to type of antimalarial and dose/duration of treatment (p = 0,001). They also lacked information on dose and dosing interval (p = 0,004). There were no significant differences among reference centers and basic health care units in respect to the prescribed antimalarials, to prescriptions containing antimalarials not recommended in the official protocol or in respect to lack of dosing information. Chloroquine was the antimalarial most related to the occurrence of adverse events. THE findings indicate that there are flaws in antimalarial prescribing for pregnant women, especially in respect to their adequacy to the official protocol.

  1. Psychiatric Residents' Views of Quality of Psychotherapy Training and Psychotherapy Competencies: A Multisite Survey

    Science.gov (United States)

    Calabrese, Christina; Sciolla, Andres; Zisook, Sidney; Bitner, Robin; Tuttle, Jeffrey; Dunn, Laura B.

    2010-01-01

    Objective: Few studies of residents' attitudes toward psychotherapy training exist. The authors examined residents' perceptions of the quality of their training, support for training, their own competence levels, and associations between self-perceived competence and perceptions of the training environment. Methods: An anonymous, web-based…

  2. Looking at prescription quality in Ayurveda: Developing, validating and pilot testing a prescription quality index for Ayurveda.

    Science.gov (United States)

    Rastogi, Sanjeev

    2017-11-06

    Prescription quality can be a direct predictor of the net outcome of a health care delivery effort. Quality of prescription may be considered as a cumulative matrix of multiple components of a prescription on the basis of their relative importance. Prescription quality index is a recognized tool in clinical medicine for multiple purposes including the prediction of health care intervention outcome. Considering the importance of prescription quality among every system of medicine, an attempt was made to design a prescription quality index for Ayurveda. The Prescription Quality Index for Ayurveda was designed through item selection following a thorough literature search and was validated through multiple peer group discussions. Final draft of index containing 38 individual items carrying different scores as per their importance in the prescription was subjected to a pilot test upon 1576 indoor prescriptions generated in 2015 at State Ayurvedic College Hospital, Lucknow. The study revealed large information gaps in the components of the prescription where it was supposed to be noted by the prescribers. These gaps in the Ayurvedic prescriptions were most significant in the areas pertaining to Ayurvedic fundamentals of clinical examination, disease diagnosis and Ayurvedic drug intake methods. Prescription Quality Index for Ayurveda was found useful in underlining the gaps between the ideal and generated prescriptions. This can be utilized as a useful tool to evaluate the quality of Ayurvedic prescriptions by seeing their adherence to the standard prescription template. Copyright © 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Published by Elsevier B.V. All rights reserved.

  3. Conditions of life and death of psychiatric patients in France during World War II: euthanasia or collateral casualties?

    Science.gov (United States)

    Lemoine, Patrick; Stahl, Stephen M

    2018-04-01

    Between 1940 and 1944, an estimated 48,588 patients resident in French psychiatric hospitals died of starvation. Standard prisons, while facing similar problems, did not experience the same number of deaths by starvation, partly due to their ability to develop a black market for food and rations. Patients in psychiatric hospitals, on the other hand, were completely at the mercy of their doctors and the personnel in charge. At Hôpital du Vinatier, a psychiatric facility in Lyon, the mortality rate increased sharply from 1940 to 1944. In 1942, the worst year, 42% of patients died of hunger and exposure. In the end, more than 2,000 patients died at Vinatier. Was this due to a supposed lack of rations, or was it something more sinister? In Germany at the same time, tens of thousands of psychiatric patients died of purposeful starvation in psychiatric hospitals as part of the Nazi program of psychiatric euthanasia. Was the same thing occurring in Lyon?

  4. [Changes in prescription patterns for peripheral and cerebral vasoactive drugs before and after establishing prescription standards in France].

    Science.gov (United States)

    Vuittenez, F; Guignard, E; Comte, S

    1999-01-23

    Assess changes in the number of prescriptions for peripheral and cerebral vasoactive drugs for the treatment of lower limb arteritis and cerebrovascular disease since the promulgation in 1995 of prescription standards for the treatment of lower limb arteritis. Assess compliance to prescription standards with a detailed analysis of patient features, prescriptions written for lower limb arteritis, cerebrovascular disease and concomitant diseases and evaluate changes in treatment costs for lower limb arteritis and cerebrovascular disease as well as cost of the full prescription, including treatments for associated diseases. This study was based on data recorded during the Permanent Study of Medical Prescriptions conducted from March 1994 to February 1995 and from March 1995 to February 1996 by the IMS. Prescription costs were established from the National Description Files of the IMS. Treatment costs were expressed as public price (FF) tax included. Prescriptions meeting the following criteria were selected for each period: prescriptions written by general practitioners for drugs with peripheral and cerebral vasoactivity (excepting calcium antagonists with a cerebral target) belonging to the Anatomic Therapeutic Classes C4A1 of the European Pharmaceutical Marketing Research Association, Bromly 1996; prescriptions for diagnoses 447.6 (arteritis) and 437.9 (cerebrovascular disease) according to the 9th WHO classification. A random sample of 500 prescriptions was selected to calculate costs. Since the advent of the prescription standards in 1995, prescriptions have dropped off by 6.3% for lower limb arteritis and by 14.8% for cerebrovascular disease. There was a 3.7 point decline in the percentage of multiple prescriptions of vasoactive drugs for lower limb arteritis (21.7% prior to March 1995 versus 18% after promulgation of the prescription standards, p > 0.1) and a 1.8 increase in the percentage of multiple prescriptions for cerebrovascular disease (14% prior to March

  5. Familiality of Psychiatric Disorders and Risk of Postpartum Psychiatric Episodes

    DEFF Research Database (Denmark)

    Bauer, Anna E; Maegbaek, Merete L; Liu, Xiaoqin

    2018-01-01

    OBJECTIVE: Postpartum psychiatric disorders are common and morbid complications of pregnancy. The authors sought to evaluate how family history of psychiatric disorders is associated with postpartum psychiatric disorders in proband mothers with and without a prior psychiatric history by assessing...

  6. Prescriptive or Interpretive Regulation at the Frontlines of Care Work in the “Three Worlds” of Canada, Germany and Norway

    Science.gov (United States)

    Daly, Tamara; Struthers, Jim; Müller, Beatrice; Taylor, Deanne; Goldmann, Monika; Doupe, Malcolm; Jacobsen, Frode F.

    2018-01-01

    This paper examines the tension between macro level regulation and the rule breaking and rule following that happens at the workplace level. Using a comparative study of Canada, Norway, and Germany, the paper documents how long-term residential care work is regulated and organized differently depending on country, regional, and organizational contexts. We ask where each jurisdiction’s staffing regulations fall on a prescription-interpretation continuum; we define prescription as a regulatory tendency to identify what to do and when and how to do it, and interpretation as a tendency to delineate what to do but not when and how to do it. In examining frontline care workers’ strategies for accomplishing everyday social, health, and dining care tasks we explore how a policy-level prescriptive or interpretive regulatory approach affects the potential for promising practices to emerge on the frontlines of care work. Overall, we note the following associations: prescriptive regulatory environments tend to be accompanied by a lower ratio of professional to non-professional staff, a higher concentration of for-profit providers, a lower ratio of staff to residents and a sharper division of labour. Interpretive regulatory environments tend to have higher numbers of professionals relative to non-professionals, more limited for-profit provision, a higher ratio of staff to residents, and a more relational division of labour that enables the work to be more fluid and responsive. The implication of a prescriptive environment, such as is found in Ontario, Canada, is that frontline care workers possess less autonomy to be creative in meeting residents’ needs, a tendency towards more task-oriented care and less job autonomy. The paper reveals that what matters is the type of regulation as well as the regulatory tendency towards controlling frontline care workers decision-making and decision-latitude. PMID:29467547

  7. Prescriptions for schedule II opioids and benzodiazepines increase after the introduction of computer-generated prescriptions.

    Science.gov (United States)

    McGerald, Genevieve; Dvorkin, Ronald; Levy, David; Lovell-Rose, Stephanie; Sharma, Adhi

    2009-06-01

    Prescriptions for controlled substances decrease when regulatory barriers are put in place. The converse has not been studied. The objective was to determine whether a less complicated prescription writing process is associated with a change in the prescribing patterns of controlled substances in the emergency department (ED). The authors conducted a retrospective nonconcurrent cohort study of all patients seen in an adult ED between April 19, 2005, and April 18, 2007, who were discharged with a prescription. Prior to April 19, 2006, a specialized prescription form stored in a locked cabinet was obtained from the nursing staff to write a prescription for benzodiazepines or Schedule II opioids. After April 19, 2006, New York State mandated that all prescriptions, regardless of schedule classification, be generated on a specialized bar-coded prescription form. The main outcome of the study was to compare the proportion of Schedule III-V opioids to Schedule II opioids and benzodiazepines prescribed in the ED before and after the introduction of a less cumbersome prescription writing process. Of the 26,638 charts reviewed, 2.1% of the total number of prescriptions generated were for a Schedule II controlled opioid before the new system was implemented compared to 13.6% after (odds ratio [OR] = 7.3, 95% confidence interval [CI] = 6.4 to 8.4). The corresponding percentages for Schedule III-V opioids were 29.9% to 18.1% (OR = 0.52, 95% CI = 0.49 to 0.55) and for benzodiazepines 1.4% to 3.9% (OR = 2.8, 95% CI = 2.4 to 3.4). Patients were more likely to receive a prescription for a Schedule II opioid or a benzodiazepine after a more streamlined computer-generated prescription writing process was introduced in this ED. (c) 2009 by the Society for Academic Emergency Medicine.

  8. Perception of the risk of adverse reactions to analgesics: differences between medical students and residents

    Directory of Open Access Journals (Sweden)

    Sandra Castillo-Guzman

    2016-07-01

    Full Text Available Background. Medications are not exempt from adverse drug reactions (ADR and how the physician perceives the risk of prescription drugs could influence their availability to report ADR and their prescription behavior. Methods. We assess the perception of risk and the perception of ADR associated with COX2-Inbitors, paracetamol, NSAIDs, and morphine in medical students and residents of northeast of Mexico. Results. The analgesic with the highest risk perception in both group of students was morphine, while the drug with the least risk perceived was paracetamol. Addiction and gastrointestinal bleeding were the ADR with the highest score for morphine and NSAIDs respectively. Discussion. Our findings show that medical students give higher risk scores than residents toward risk due to analgesics. Continuing training and informing physicians about ADRs is necessary since the lack of training is known to induce inadequate use of drugs.

  9. Relationship between occupational stress and depressive mood among interns and residents in a tertiary hospital, Seoul, Korea.

    Science.gov (United States)

    Kim, Keon; Lee, Sunhwa; Choi, Yoon Hee

    2015-06-01

    Occupational stress can have a harmful effect on the individual both physically and psychologically. In Korea, occupational stress of physician is rarely demonstrated. Although it is well reported that physicians tend to have a high incidence of minor psychiatric disorders, the magnitude of the problem remains unclear. Interns and residents are thought to be under substantial amount of stress, and tend to have psychiatric disorder. In this paper, we aimed to evaluate the relationship between the occupational stress and depression of residents. The participants of this study were surgical and medical residents in a tertiary hospital in Korea. For measurement of occupational stress, we used an occupational stress scale. In addition, to evaluate the prevalence of depression, we used the Beck Depression Inventory. Female doctors showed higher degree of occupational stress than the males. The interns and chief residents showed higher degree of occupational stress than the other residents. Interestingly, in this study, most of the participants experienced a depressive mood. Compared with the general population, job demand and culture of workplace were high. Occupational stress was the only significant predictor of a depressive mood. Hospital residents experience a high degree of occupational stress leading to a depressed mood due to various risk factors. Therefore, it is essential to recognize the occupational stress of residents early, to encourage positive competition and peer and social support, and to help improve the residents' ability to cope with stress.

  10. The association of consumer cost-sharing and direct-to-consumer advertising with prescription drug use.

    Science.gov (United States)

    Hansen, Richard A; Schommer, Jon C; Cline, Richard R; Hadsall, Ronald S; Schondelmeyer, Stephen W; Nyman, John A

    2005-06-01

    Previous research on the impact of various cost-sharing strategies on prescription drug use has not considered the impact of direct-to-consumer (DTC) advertising. To explore the association of cost-containment strategies with prescription drug use and to determine if the association is moderated by DTC prescription drug advertising. The study population included 288 280 employees and dependents aged 18 to 65 years with employer-sponsored health insurance contributing to the MEDSTAT MarketScan administrative data set. Person-level enrollment and claims data were obtained for beneficiaries enrolled continuously during July 1997 through December 1998. Direct-to-consumer advertising data were obtained from Competitive Media Reporting and linked to the MEDSTAT enrollment files. Localized DTC advertising expenditures for one class of medication were evaluated and matched with prescription claims for eligible MEDSTAT contributors. The association of various types and levels of cost-sharing incentives with incident product use was evaluated, controlling for the level of DTC advertising, health status, and other demographic covariates. The relationship of cost-sharing amounts with drug use was modified by the level of DTC advertising in a geographic market. This relationship was dependent on the type of cost-sharing, distinguishing between co-payments for provider visits and co-payments for prescription drugs. Compared with low-advertising markets, individuals residing in markets with high levels of advertising and paying provider co-payments of $10.00 or more were more likely to use the advertised product. In the same markets, higher prescription drug co-payments were associated with a decreased likelihood of using the advertised product. A similar relationship was not observed for the nonadvertised competitor. Among insured individuals, response to cost-sharing strategies is moderated by DTC prescription drug advertising. The relative ability of cost-sharing strategies to

  11. A prescription fraud detection model.

    Science.gov (United States)

    Aral, Karca Duru; Güvenir, Halil Altay; Sabuncuoğlu, Ihsan; Akar, Ahmet Ruchan

    2012-04-01

    Prescription fraud is a main problem that causes substantial monetary loss in health care systems. We aimed to develop a model for detecting cases of prescription fraud and test it on real world data from a large multi-center medical prescription database. Conventionally, prescription fraud detection is conducted on random samples by human experts. However, the samples might be misleading and manual detection is costly. We propose a novel distance based on data-mining approach for assessing the fraudulent risk of prescriptions regarding cross-features. Final tests have been conducted on adult cardiac surgery database. The results obtained from experiments reveal that the proposed model works considerably well with a true positive rate of 77.4% and a false positive rate of 6% for the fraudulent medical prescriptions. The proposed model has the potential advantages including on-line risk prediction for prescription fraud, off-line analysis of high-risk prescriptions by human experts, and self-learning ability by regular updates of the integrative data sets. We conclude that incorporating such a system in health authorities, social security agencies and insurance companies would improve efficiency of internal review to ensure compliance with the law, and radically decrease human-expert auditing costs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  12. Workplace Violence and Harassment Against Emergency Medicine Residents.

    Science.gov (United States)

    Schnapp, Benjamin H; Slovis, Benjamin H; Shah, Anar D; Fant, Abra L; Gisondi, Michael A; Shah, Kaushal H; Lech, Christie A

    2016-09-01

    Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety. This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe "Occasionally," "Seldom" or "Never" while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.

  13. The use of potentially inappropriate medications and changes in quality of life among older nursing home residents

    Directory of Open Access Journals (Sweden)

    Al Aqqad S MH

    2014-01-01

    Full Text Available Sana’ MH Al Aqqad, Li Li Chen, Asrul Akmal Shafie, Mohamed Azmi Hassali, Balamurugan Tangiisuran Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia Background: Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs and the changes observed in the HRQoL among older nursing home residents. Methods: A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D and EuroQol-visual analog scale (EQ-VAS at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test. Results: The median age of the 211 participants was 77 years (interquartile range 72–82 years and the median number of prescription medicines was four (interquartile range three to six. The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months

  14. Non-medical use of psychoactive prescription drugs is associated with fatal poisoning.

    Science.gov (United States)

    Haukka, Jari; Kriikku, Pirkko; Mariottini, Claudia; Partonen, Timo; Ojanperä, Ilkka

    2018-03-01

    The aims of this study were to estimate the prevalence and predictors of non-medical substance use, and to assess the association between non-medical substance use and fatal poisoning or history of drug abuse in Finland. Retrospective cohort study of all medico-legally investigated death cases in Finland. The postmortem toxicology database was linked together with the register on reimbursed prescription medicines. All postmortem cases between 2011 and 2013 positive for one or more of the following drugs: oxycodone, fentanyl, tramadol, clonazepam, gabapentin, pregabalin, tizanidine, olanzapine, quetiapine, risperidone, alprazolam, zolpidem, mirtazapine and bupropion, n = 2974. Non-medical use of substance was the outcome variable. Predictors were the following: gender, residence at the time of death, place of death, blood alcohol concentration, age, drug abuse, number of prescriptions of any psychoactive drugs in last year and proportion of prescriptions issued by psychiatrist in last year. In 50.4% of the studied cases, at least one drug was detected without a prescription. Clonazepam, alprazolam and tramadol were the most prevalent non-medical findings in these cases (6.6, 6.1 and 5.6%, respectively). The risk of non-medical use of prescription drugs was especially high in cases with history of drug abuse (88.5%) and in fatal poisonings (71.0%). The proportion of non-medical use of the studied substances varied between 5.9% [95% confidence interval (CI) = 3.1-10.1%)] for risperidone and 55.7% for fentanyl (95% CI = 44.1-66.9%). Valid prescription for one or more of any psychoactive drug was associated with lower odds for non-medical use of the studied substances. Additionally, the higher the proportion of psychoactive drugs prescribed by a psychiatrist, the lower the probability of non-medical use. Non-prescribed psychoactive drugs are found commonly at postmortem in drug poisoning deaths in Finland, with history of drug abuse being a major contributing

  15. Does Targeted Education of Emergency Physicians Improve Their Comfort Level in Treating Psychiatric Patients?

    Directory of Open Access Journals (Sweden)

    Brenda J Walker

    2012-12-01

    Full Text Available Introduction: We determined if targeted education of emergency physicians (EPsregarding the treatment of mental illness will improve their comfort level in treatingpsychiatric patients boarding in the emergency department (ED awaiting admission.Methods: We performed a pilot study examining whether an educational interventionwould change an EP’s comfort level in treating psychiatric boarder patients (PBPs. Weidentified a set of psychiatric emergencies that typically require admission or treatmentbeyond the scope of practice of emergency medicine. Diagnoses included majordepression, schizophrenia, schizoaffective disorder, bipolar affective disorder, generalanxiety disorder, suicidal ideation, and criminal behavior. We designed equivalentsurveys to be used before and after an educational intervention. Each survey consistedof 10 scenarios of typical psychiatric patients. EPs were asked to rate their comfort levelsin treating the described patients on a visual analogue scale. We calculated summaryscores for the non intervention survey group (NINT and intervention survey group (INTand compared them using Student’s t-test.Results: Seventy-nine percent (33/42 of eligible participants completed the preinterventionsurvey (21 attendings, 12 residents and comprised the NINT group. Fiftyfivepercent (23/42 completed the post-intervention survey (16 attendings, 7 residentscomprising the INT group. A comparison of summary scores between ‘NINT’ and ‘INT’groups showed a highly significant improvement in comfort levels with treating thepatients described in the scenarios (P = 0.003. Improvements were noted on separateanalysis for faculty (P = 0.039 and for residents (P = 0.012. Results of a sensitivityanalysis excluding one highly significant scenario showed decreased, but still importantdifferences between the NINT and INT groups for all participants and for residents, butnot for faculty (all: P = 0.05; faculty: P = 0.25; residents: P = 0

  16. Benefits of a telepsychiatry consultation service for rural nursing home residents.

    Science.gov (United States)

    Rabinowitz, Terry; Murphy, Katharine M; Amour, Judith L; Ricci, Michael A; Caputo, Michael P; Newhouse, Paul A

    2010-01-01

    Psychiatric care for nursing home residents is difficult to obtain, especially in rural areas, and this deficiency may lead to significant morbidity or death. Providing this service by videoconference may be a helpful, cost-effective, and acceptable alternative to face-to-face treatment. We analyzed data for 278 telepsychiatry encounters for 106 nursing home residents to estimate potential cost and time savings associated with this modality compared to in-person care. A total of 843.5 hours (105.4 8-hour work days) of travel time was saved compared to in-person consultation for each of the 278 encounters if they had occurred separately. If four resident visits were possible for each trip, the time saved would decrease to 26.4 workdays. Travel distance saved was 43,000 miles; 10,750 miles if four visits per trip occurred. More than $3,700 would be spent on gasoline for 278 separate encounters; decreased to $925 for four visits per roundtrip. Personnel cost savings estimates ranged from $33,739 to $67,477. Physician costs associated with additional travel time ranged from $84,347 to $253,040 for 278 encounters, or from $21,087 to $63,260 for four encounters per visit. The telepsychiatry approach was enthusiastically accepted by virtually all residents, family members, and nursing home personnel, and led to successful patient management. Providing psychiatric care to rural nursing home residents by videoconference is cost effective and appears to be a medically acceptable alternative to face-to-face care. In addition, this approach will allow many nursing homes to provide essential care that would not otherwise be available.

  17. Relationships between self-reported unfair treatment and prescription medication use, illicit drug use, and alcohol dependence among Filipino Americans.

    Science.gov (United States)

    Gee, Gilbert C; Delva, Jorge; Takeuchi, David T

    2007-05-01

    We examined associations between self-reported unfair treatment and prescription medication use, illicit drug use, and alcohol dependence. We used data from the Filipino American Community Epidemiological Survey, a cross-sectional investigation involving 2217 Filipino Americans interviewed in 1998-1999. Multinomial logistic and negative binomial regression analyses were used in assessing associations between unfair treatment and the substance use categories. Reports of unfair treatment were associated with prescription drug use, illicit drug use, and alcohol dependence after control for age, gender, location of residence, employment status, educational level, ethnic identity level, nativity, language spoken, marital status, and several health conditions. Unfair treatment may contribute to illness and subsequent use of prescription medications. Furthermore, some individuals may use illicit drugs and alcohol to cope with the stress associated with such treatment. Addressing the antecedents of unfair treatment may be a potential intervention route.

  18. Visualization of medicine prescription behavior

    NARCIS (Netherlands)

    Corput, van der P.N.A.; Arends, J.B.A.M.; Wijk, van J.J.

    2014-01-01

    Medicine prescriptions play an important role in medical treatments. More insight in medicine prescription behavior can lead to more efficient and effective treatments, as well as reflection on prescription behavior for specific physicians, types of medicines, or classes of patients. Most current

  19. Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders

    Directory of Open Access Journals (Sweden)

    Chiriac A

    2014-03-01

    Full Text Available Anca Chiriac,1 Liliana Foia,2 Cristina Birsan,1 Ancuta Goriuc,2 Caius Solovan3 1Department of Dermatology, Nicolina Medical Center, Iaşi, Romania; 2Surgical Department, Grigore T Popa University of Medicine and Pharmacy, Iaşi, Romania; 3Department of Dermatology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania Background: The factitious disorders, more commonly known in daily practice as pathomimia, are expressed in dermatology units by skin lesions induced voluntarily by the patient, in order to draw attention of the medical staff and/or the family members. The disorder is often challenging to diagnose and even more difficult to document in front of the patient or relatives. It represents a challenge for the physician, and any attempt at treatment may be followed by recurrence of the self-mutilation. This paper describes two cases of pathomimia diagnosed by dermatologists and treated in a psychiatry unit, highlighting the importance of collaboration in these situations. Patients and methods: Two case reports, describing old female patients with pathomimia, hospitalized in a department of dermatology for bizarre skin lesions. Results: The first case was a 77-year-old female with unknown psychiatric problems and atrophic skin lesions on the face, self-induced for many months, with multiple hospitalizations in dermatology units, with no response to different therapeutic patterns, and full recovery after psychiatric treatment for a major depressive syndrome. The second case was a 61-year-old female patient with disseminated atrophic scars on the face, trunk, and limbs. She raised our interest because of possible psychiatric issues, as she had attempted to commit suicide. The prescription of antidepressants led to a significant clinical improvement. Conclusion: These cases indicate that a real psychiatric disease may be recorded in patients suffering from pathomimia. Therefore, complete psychiatric evaluation in order to

  20. Transitioning Children from Psychiatric Hospitals to Schools: The Role of the Special Educator

    Science.gov (United States)

    Simon, Joan B.; Savina, Elena A.

    2010-01-01

    Over a quarter of a million U.S. students each year reside for a period of time in a psychiatric inpatient hospital setting to receive mental health treatment. Following inpatient treatment, most children are transitioned from the hospital into a regular school setting. Little is known about how these transitions are managed by hospital or school…

  1. Associate Residency Training Directors in Psychiatry: Demographics, Professional Activities, and Job Satisfaction

    Science.gov (United States)

    Arbuckle, Melissa R.; DeGolia, Sallie G.; Esposito, Karin; Miller, Deborah A.; Weinberg, Michael; Brenner, Adam M.

    2012-01-01

    Objective: The purpose of this study was to characterize associate training director (ATD) positions in psychiatry. Method: An on-line survey was e-mailed in 2009 to all ATDs identified through the American Association of Directors of Psychiatric Residency Training (AADPRT). Survey questions elicited information regarding demographics,…

  2. Prescription Monitoring Program Trends Among Individuals Arrested in Maine for Trafficking Prescription Drugs in 2014.

    Science.gov (United States)

    McCall, Kenneth; Nichols, Stephanie D; Holt, Christina; Ochs, Leslie; Cattabriga, Gary; Tu, Chunhao

    2016-06-01

    To evaluate controlled substance prescribing trends available in the Maine Prescription Monitoring Program (PMP) among individuals arrested for prescription drug "trafficking." The demographic characteristics of the individuals who had matching prescription records in the PMP within 90 days of the arrest were identified. A population-based, retrospective cohort study using data from the Maine Diversion Alert Program (DAP) and the Maine PMP. The study population consisted of persons arrested for trafficking prescription drugs in Maine during the 2014 calendar year from January 1 to December 31. There were 594 trafficking arrests reported by the Maine DAP in 2014. The study population consisted of the 235 persons (40%) with arrests involving controlled prescription medications. The mean age of these persons was 33 years (range 18-77 yrs), and 156 (66%) were male. Arrests involved 154 prescription opioids (65%), seven stimulants (3%), seven benzodiazepines (3%), and 77 unspecified controlled prescription drugs (33%). A minority of individuals (n=57, 24%) had a prescription record in the PMP that matched the substance involved in the arrest. Only one person with matching PMP and arrest records utilized ≥ 5 prescribers, while none used ≥ 5 pharmacies within 90 days before the arrest. Payment methods for matching prescriptions were commercial insurance (n=28, 49%), Medicaid (n=19, 33%), Medicare (n=5, 9%), and cash (n=5, 9%). The majority (76%) of persons arrested for prescription drug trafficking did not have PMP records and did not directly obtain the diverted medication from a licensed pharmacy. Traditional red flags, like cash payment and using multiple prescribers or pharmacies, were uncommon. Therefore, arrest records for diversion and PMPs are distinct and complementary tools for identifying individuals at risk for substance misuse. © 2016 Pharmacotherapy Publications, Inc.

  3. A resident's rotation in consultation psychiatry. A maturational experience.

    Science.gov (United States)

    Granet, R B; Perry, S W; Talbott, J A

    1980-12-01

    The authors emphasize the importance of a consultation psychiatry experience in the maturation of the young psychiatrist by examining some of the processes operational in both community and hospital consultation work, performed by the senior author during his fourth year of residency. Such experiences can provide opportunities for developing psychiatric skills not emphasized elsewhere, including the adoption of an active therapeutic stance, the application of the psychodynamic theory to the consultation system itself, and teaching without the use of jargon. In addition the experience as consultant facilitates the transition from residency to the outside world, not only through attitudinal changes achieved by exposure to less structured settings, a change in the supervisory model, and a solidification of identity as a physician and psychiatrist, but also by providing the resident the opportunity to begin de-cathecting from the training program.

  4. Perceived Educational Needs of the Integrated Care Psychiatric Consultant.

    Science.gov (United States)

    Ratzliff, Anna; Norfleet, Kathryn; Chan, Ya-Fen; Raney, Lori; Unützer, Jurgen

    2015-08-01

    With the increased implementation of models that integrate behavioral health with other medical care, there is a need for a workforce of integrated care providers, including psychiatrists, who are trained to deliver mental health care in new ways and meet the needs of a primary care population. However, little is known about the educational needs of psychiatrists in practice delivering integrated care to inform the development of integrated care training experiences. The educational needs of the integrated care team were assessed by surveying psychiatric consultants who work in integrated care. A convenience sample of 52 psychiatrists working in integrated care responded to the survey. The majority of the topics included in the survey were considered educational priorities (>50% of the psychiatrists rated them as essential) for the psychiatric consultant role. Psychiatrists' perspectives on educational priorities for behavioral health providers (BHPs) and primary care providers (PCPs) were also identified. Almost all psychiatrists reported that they provide educational support for PCPs and BHPs (for PCP 92%; for BHP 96%). The information provided in this report suggests likely educational needs of the integrated care psychiatric consultant and provides insight into the learning needs of other integrated care team members. Defining clear priorities related to the three roles of the integrated care psychiatric consultant (clinical consultant, clinical educator, and clinical team leader) will be helpful to inform residency training programs to prepare psychiatrists for work in this emerging field of psychiatry.

  5. Radiopharmaceutical prescription in nuclear medicine departments

    International Nuclear Information System (INIS)

    Biechlin-Chassel, M.L.; Lao, S.; Bolot, C.; Francois-Joubert, A.

    2010-01-01

    In France, radiopharmaceutical prescription is often discussed depending to which juridical structure the nuclear medicine department is belonging. According to current regulation, this prescription is an obligation in a department linked to hospital with a pharmacy department inside. But situation remains unclear for independent nuclear medicine departments where physicians are not constrained to prescribe radiopharmaceuticals. However, as radiographers and nurses are only authorized to realize theirs acts in front of a medical prescription, one prescription must be realized. Nowadays, computerized prescription tools have been developed but only for radiopharmaceutical drugs and not for medical acts. In the aim to achieve a safer patient care, the prescription regulation may be applied whatever differences between nuclear medicines departments. (authors)

  6. [Survey among academic teachers about psychiatric training in France].

    Science.gov (United States)

    van Effenterre, A; Hanon, C; Llorca, P-M

    2014-06-01

    Given the results of resident psychiatrists' surveys conducted in France over the past 3 years, it has become essential to also examine the opinion of the academic psychiatrists in charge of psychiatry education. To study the teachers point of view on psychiatric training in France, the weaknesses and strengths of the training, recent improvements and problems, and to compare their opinion with that of the residents. A survey was conducted in April 2012 among 125 academic teachers professors hospital practitioners (PU-PH), in child & adolescent psychiatry and adult psychiatry. An anonymous online questionnaire including seven parts and three open questions was sent to the PU-PH. The questionnaire was answered by 79/125 psychiatric PU-PH (63%). Results show that a majority of PU-PH (78%) were willing to maintain a single training pathway including adult psychiatry and child psychiatry with a single diploma, with the addition of a DESC (specific and additional Diploma) in forensic psychiatry (72%) and old age psychiatry (62%). Almost all respondents suggested the implementation of an assessment of teaching and a formal mentorship program. Some aspects of training included more controversial issues: such as the length of the training, the opening of training to private practice physicians, or the European harmonization. The survey stressed some areas of improvement: such training in psychotherapy and research, access to supervision as well as barriers to improved training including an insufficient number of academic practitioners. Compared with other surveys, it emphasized that in addition to the need of diversifying the theoretical (thematic, interactive media and teaching, teachers, etc.) and the practical aspect (training sites), it is essential according to trainees and PU-PH, to implement an efficient supervision during residency. Copyright © 2013 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  7. Prescription Drug Profiles PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Prescription Drug Profiles Public Use Files (PUFs) drawn from Medicare prescription drug claims for the year of the date on which the...

  8. Women who abuse prescription opioids: findings from the Addiction Severity Index-Multimedia Version Connect prescription opioid database.

    Science.gov (United States)

    Green, Traci C; Grimes Serrano, Jill M; Licari, Andrea; Budman, Simon H; Butler, Stephen F

    2009-07-01

    Evidence suggests gender differences in abuse of prescription opioids. This study aimed to describe characteristics of women who abuse prescription opioids in a treatment-seeking sample and to contrast gender differences among prescription opioid abusers. Data collected November 2005 to April 2008 derived from the Addiction Severity Index Multimedia Version Connect (ASI-MV Connect) database. Bivariate and multivariable logistic regression examined correlates of prescription opioid abuse stratified by gender. 29,906 assessments from 220 treatment centers were included, of which 12.8% (N=3821) reported past month prescription opioid abuse. Women were more likely than men to report use of any prescription opioid (29.8% females vs. 21.1% males, phistory of drug overdose. Men-specific correlates were age screen and identify those at highest risk of prescription opioid abuse. Prevention and intervention efforts with a gender-specific approach are warranted.

  9. Psychiatric education in the correctional setting: challenges and opportunities.

    Science.gov (United States)

    Holoyda, Brian J; Scott, Charles L

    2017-02-01

    As the need for mental healthcare services within correctional settings in the US increases, so does the need for a mental health workforce that is motivated to work within such systems. One potentially effective method by which to increase the number of psychiatrists working in jails, prisons, and parole clinics is to provide exposure to these environments during their training. Correctional settings can serve as unique training sites for medical students and psychiatric residents and fellows. Such training experiences can provide a host of benefits to both trainees and staff within the correctional mental health system. Alongside many potential benefits exist substantial potential barriers to coordinating correctional training experiences, including both programme directors' and residents' concerns regarding safety and enjoyment and negative perceptions of inmate and prisoner patients. The establishment of academic affiliations with correctional institutions and didactic instruction on commonly encountered clinical issues with inmate populations may be methods of diffusing these concerns. Improving residents' and fellows' training experiences offers a hope for increasing the attractiveness of a career in correctional psychiatry.

  10. Workplace Violence and Harassment Against Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Benjamin H. Schnapp

    2016-09-01

    Full Text Available Introduction: Several studies have shown that workplace violence in the emergency department (ED is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM residents by patients and visitors and to identify perceived barriers to safety. Methods: This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. Results: A majority of residents (66%, 78/119 reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119 experienced verbal harassment, 78% (93/119 had experienced verbal threats, and 52% (62/119 reported sexual harassment. Almost a quarter of residents felt safe “Occasionally,” “Seldom” or “Never” while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Conclusion: Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.

  11. Workplace Violence and Harassment Against Emergency Medicine Residents

    Science.gov (United States)

    Schnapp, Benjamin H.; Slovis, Benjamin H.; Shah, Anar D.; Fant, Abra L.; Gisondi, Michael A.; Shah, Kaushal H.; Lech, Christie A.

    2016-01-01

    Introduction Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety. Methods This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. Results A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe “Occasionally,” “Seldom” or “Never” while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Conclusion Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts. PMID:27625721

  12. Holes in the safety net: a case study of access to prescription drugs and specialty care.

    Science.gov (United States)

    Stanley, Ava; Cantor, Joel C; Guarnaccia, Peter

    2008-07-01

    The health care safety net in the United States is intended to fill gaps in health care services for uninsured and other vulnerable populations. This paper presents a case study of New Brunswick, NJ, a small city rich in safety net resources, to examine the adequacy of the American model of safety net care. We find substantial gaps in access to care despite the presence of a medical school, an abundance of primary care and specialty physicians, two major teaching hospitals, a large federally qualified health center and other safety net resources in this community of about 50,000 residents. Using a blend of random-digit-dial and area probability sampling, a survey of 595 households was conducted in 2001 generating detailed information about the health, access to care, demographic and other characteristics of 1,572 individuals. Confirming the great depth of the New Brunswick health care safety net, the survey showed that more than one quarter of local residents reported a hospital or community clinic as their usual source of care. Still, barriers to prescription drugs were reported for 11.0% of the area population and more than two in five (42.8%) local residents who perceived a need for specialty care reported difficulty getting those services. Bivariate analyses show significantly elevated risk of access problems among Hispanic and black residents, those in poor health, those relying on hospital and community clinics or with no usual source of care, and those living at or below poverty. In multivariate analysis, lack of health insurance was the greatest risk factor associated with both prescription drug and specialty access problems. Few local areas can claim the depth of safety net resources as New Brunswick, NJ, raising serious concerns about the adequacy of the American safety net model, especially for people with complex and chronic health care needs.

  13. The Effect of Sociocultural Factors on Maternal Short Psychiatric Status and Hyperemesis Gravidarum

    Directory of Open Access Journals (Sweden)

    Mehmet Baki Şentürk

    2016-01-01

    Full Text Available OBJECTIVE: This study sought to investigate the associations between Hyperemesis Gravidarum and both sociocultural factors and psychiatric status. STUDY DESIGN: A prospective non-randomized cohort design was employed. A total of 79 patients with Hyperemesis Gravidarum and 71 healthy pregnant women were enrolled. The study and control groups were compared according to results on the Brief Psychiatric Rating Scale and sociocultural factors specific to the region. RESULTS: Anxiety, somatic concern, tension, depressive mood, hostility, motor retardation, uncooperativeness and blunted effect were found to be statistically significantly higher in patients with Hyperemesis Gravidarum(p<0.01 and p<0.05. Furthermore, pregnant women living in extended families had statistically higher anxiety scores than those residing in nuclear families (p<0.05. CONCLUSION: Psychiatric status as well as sociocultural factors specific to the society in which the individuals live should be taken into account in assessments of patients with Hyperemesis Gravidarum.

  14. [Analysis on composition principles of prescriptions for stranguria in dictionary of traditional Chinese medicine prescription].

    Science.gov (United States)

    Sun, Jing-Chang; Wang, Miao-Miao

    2014-03-01

    By using traditional Chinese medicine inheritance support system to analyze the dominant experience and recessive principles of the prescriptions for stranguria in the dictionary of traditional Chinese medicine prescription (DCMP), we aim to define the medication pattern and rule and to acquire new prescriptions. In dominant experience analysis, we were able to find 22 drugs used over 50 times, including drugs of clearing heat, diuresis and relieving stranguria which are the most used and drugs of clearing heat, cooling blood, benefiting Qi and nourishing Yin. In addition, drugs of activating Qi and Xue, eliminating phlegm and removing toxic are often used, including 34 herb pairs and 5 combinations of three-taste drugs are used more than 35 times. These results fully reflect the composition principles and compatibility characteristic of prescriptions for treating stranguria in DCMP. Thirteen new prescriptions by way of recessive principle excavating were acquired. These new prescriptions might be suitable to clinical treatments of variable syndromes. This article provides an useful clue to research and produce new drugs.

  15. Decision Factors Nurses Use to Assess Pain in Nursing Home Residents With Dementia.

    Science.gov (United States)

    Monroe, Todd B; Parish, Abby; Mion, Lorraine C

    2015-10-01

    Nurses caring for older people with various psychiatric illnesses face many obstacles when treating pain. One setting with a high percentage of psychiatric conditions is long-term care where more than half of residents have some form of dementia, and behavioral symptoms of dementia (BSDs) may mimic behavioral displays of pain. Furthermore, two-thirds of nursing home residents have pain. Thus, many nursing home residents with dementia have pain that may be confounded by BSDs. Since many people with dementia are at risk for poor pain management, determining current methods in which nurses assess and manage pain in nursing home residents will aid in recognizing potential barriers to using current pain management guidelines and help develop strategies to enhance nurses' assessment and management of pain in this vulnerable population. The aim of this study was to explore nursing home nurses' cues and practices to identify and alleviate pain in nursing home residents with dementia. Nurses use the constructs of 'comfort' and 'quality of life' as key components in their overall pain assessment strategy in people with dementia. Indeed, the extensive process they use involving frequent reassessment and application of interventions is geared towards "appearance of comfort." Nurses reported difficulty in ascertaining whether a person with dementia was in pain, and they expressed further difficulty determining the intensity associated with resident pain. Nurses further reported that residents with dementia who are not well know by the staff were are greater risk of poor pain management. It was not unusual for nurses to discuss the importance of conflict resolution among family members as well as allowing for open expression of family's concerns. Nurses had to focus not only on the resident's comfort, but also the families' level of comfort with pain management, especially at the end-of-life. Findings support further use and development of discomfort behavior scales to help

  16. Research Experience in Psychiatry Residency Programs Across Canada: Current Status

    Science.gov (United States)

    Shanmugalingam, Arany; Ferreria, Sharon G; Norman, Ross M G; Vasudev, Kamini

    2014-01-01

    Objective: To determine the current status of research experience in psychiatry residency programs across Canada. Method: Coordinators of Psychiatric Education (COPE) resident representatives from all 17 psychiatry residency programs in Canada were asked to complete a survey regarding research training requirements in their programs. Results: Among the 17 COPE representatives, 15 completed the survey, representing 88% of the Canadian medical schools that have a psychiatry residency program. Among the 15 programs, 11 (73%) require residents to conduct a scholarly activity to complete residency. Some of these programs incorporated such a requirement in the past 5 years. Ten respondents (67%) reported availability of official policy and (or) guidelines on resident research requirements. Among the 11 programs that have a research requirement, 10 (91%) require residents to complete 1 scholarly activity; 1 requires completion of 2 scholarly activities. Eight (53%) residency programs reported having a separate research track. All of the programs have a research coordinator and 14 (93%) programs provide protected time to residents for conducting research. The 3 most common types of scholarly activities that qualify for the mandatory research requirement are a full independent project (10 programs), a quality improvement project (8 programs), and assisting in a faculty project (8 programs). Six programs expect their residents to present their final work in a departmental forum. None of the residency programs require publication of residents’ final work. Conclusions: The current status of the research experience during psychiatry residency in Canada is encouraging but there is heterogeneity across the programs. PMID:25565474

  17. Use of Non-Prescription Remedies by Ghanaian Human Immunodeficiency Virus-Positive Persons on Antiretroviral Therapy.

    Science.gov (United States)

    Laar, Amos K; Kwara, Awewura; Nortey, Priscillia A; Ankomah, Augustine K; Okyerefo, Michael P K; Lartey, Margaret Y

    2017-01-01

    Inappropriate use of non-prescription remedies by persons living with human immunodeficiency virus (PLHIV) may result in adverse events or potentiate non-adherence to prescribed medications. This study investigated the use of non-prescription remedies among PLHIV receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. A mixed method design using quantitative and qualitative methods was used. This article focuses on the quantitative survey of 540 respondents. Univariate analysis was used to generate descriptive tabulations of key variables. Bivariate analysis and logistic regression modeling, respectively, produced unadjusted and adjusted associations between background attributes of PLHIV and the use of non-prescription remedies. A p -value of antiretroviral medications (ARVs)-46% or administered with ARVs but at different times during the day (43%). Some of the remedies were reportedly prescribed by health workers, or self-initiated during periods of ARVs shortage. Others took them based on their perception of their efficacy. Bivariate level analysis identified ART clinic site, place of residence, and ARV adherence monitoring to be significantly associated with the use of non-prescription remedies ( p  < 0.05). Multiple logistic regression analysis controlling for covariates confirmed the location of ART clinic as the only predictor of the use of non-prescription remedies. Compared to clients at the large urban teaching hospital (Korle-Bu Fevers Unit ART center), those at the district level (Atua ART center) were ninefold more likely to use non-prescription remedies [adjusted odds ratio (AOR) = 8.84; 95% confidence interval (CI) 2.83-33.72]. Those from a district level mission hospital (St. Martin's ART center) were threefold as likely to use these remedies (AOR = 2.610; 95% CI 1.074-9.120). The use of non-prescription remedies by PLHIV on ART is common in southern Ghana. Usage is mostly self-initiated because of perceived

  18. Improving the physical health in long-term psychiatric inpatients

    DEFF Research Database (Denmark)

    Hjorth, Peter; Davidsen, A.S.; Killian, R.

    2014-01-01

    programme to improve physical health is effective. METHODS: An extension of the European Network for Promoting the Health of Residents in Psychiatric and Social Care Institutions (HELPS) project further developed as a 12-month controlled cluster-randomized intervention study in the Danish centre. Waist......, but not significant, reduction in waist circumference, while participants in the control group showed a significant increase in waist circumference. CONCLUSIONS: The intervention had a positive effect on the physical health of the patients measured by a reduction in the increase of waist circumference....

  19. Exposure to non-ionizing electromagnetic radiation from mobile telephony and the association with psychiatric symptoms.

    Science.gov (United States)

    Silva, Denize Francisca da; Barros, Warley Rocha; Almeida, Maria da Conceição Chagas de; Rêgo, Marco Antônio Vasconcelos

    2015-10-01

    The aim of this study was to investigate the association between exposure to non-ionizing electromagnetic radiation from mobile phone base stations and psychiatric symptoms. In a cross-sectional study in Salvador, Bahia State, Brazil, 440 individuals were interviewed. Psychiatric complaints and diagnoses were the dependent variables and distance from the individual's residence to the base station was considered the main independent variable. Hierarchical logistic regression analysis was conducted to assess confounding. An association was observed between psychiatric symptoms and residential proximity to the base station and different forms of mobile phone use (making calls with weak signal coverage, keeping the mobile phone close to the body, having two or more chips, and never turning off the phone while sleeping), and with the use of other electronic devices. The study concluded that exposure to electromagnetic radiation from mobile phone base stations and other electronic devices was associated with psychiatric symptoms, independently of gender, schooling, and smoking status. The adoption of precautionary measures to reduce such exposure is recommended.

  20. The relationship between quality of life and psychiatric impairment for a Taiwanese community post-earthquake.

    Science.gov (United States)

    Choul, F H-C; Chou, P; Lin, C; Su, Tom T-P; Ou-Yang, W-C; Chien, I C; Su, C-Y; Lui, M-K; Chen, M-C

    2004-08-01

    This purpose of this study was to investigate the relationship between quality of life and psychiatric impairment in a Taiwanese community located near the epicenter of the 1999 earthquake, as assessed four to six months after the natural catastrophe. Trained assistants interviewed the 4223 respondents using the disaster-related psychological screening test (DRPST), an instrument specifically designed and validated by senior psychiatrists for assessment of psychiatric impairment after natural catastrophe. Additionally, the 36-Item Short-Form Health Survey (SF-36) was used to evaluate quality of life. The collected results were analyzed using Windows SPSS 10.0 software. Psychiatric impairment rated moderate to severe was assessed for 1448 (34.3%) of the responding residents. The 4223 respondents were divided into 4 psychiatric-impairment groups based on DPRST score: healthy (n = 952); mild impairment (n = 1823); moderate impairment (n = 1126); and, severe impairment (n = 322). The four groups were compared for a number of salient factors, including gender, age, current marital status and psychiatric-impairment score, to determine impact on quality of life. Respondents assessed as psychiatrically impaired tended to be older, female, divorced/widowed, and less educated, and they were more likely to have experienced major familial financial loss as an immediate consequence of the earthquake. Further, the greater the severity of the psychiatric impairment, the lower the scores for quality of life, for both the physical and mental aspects of this important general indicator.

  1. Comprehensive Psychiatric Evaluation

    Science.gov (United States)

    ... Facts for Families Guide Facts for Families - Vietnamese Comprehensive Psychiatric Evaluation No. 52; Updated October 2017 Evaluation ... with serious emotional and behavioral problems need a comprehensive psychiatric evaluation. Comprehensive psychiatric evaluations usually require a ...

  2. Joint crisis plans and psychiatric advance directives in German psychiatric practice.

    Science.gov (United States)

    Radenbach, Katrin; Falkai, Peter; Weber-Reich, Traudel; Simon, Alfred

    2014-05-01

    This study explores the attitude of German psychiatrists in leading positions towards joint crisis plans and psychiatric advance directives. This topic was examined by contacting 473 medical directors of German psychiatric hospitals and departments. They were asked to complete a questionnaire developed by us. That form contained questions about the incidence and acceptance of joint crisis plans and psychiatric advance directives and previous experiences with them. 108 medical directors of psychiatric hospitals and departments responded (response rate: 22.8%). Their answers demonstrate that in their hospitals these documents are rarely used. Among the respondents, joint crisis plans are more accepted than psychiatric advance directives. There is a certain uncertainty when dealing with these instruments. Our main conclusion is that German psychiatry needs an intensified discussion on the use of instruments for patients to constitute procedures for future critical psychiatric events. For this purpose it will be helpful to collect more empirical data. Furthermore, the proposal of joint crisis plans in psychiatric hospitals and departments should be discussed as well as the possibility of consulting an expert during the preparation of a psychiatric advance directive.

  3. Individual Psychotherapy ("Talking Therapy"): A Survey of Attitudes among Residents & Specialists in Psychiatry, Israel 2010-2011.

    Science.gov (United States)

    Levi Shachar, Orit; Mendlovic, Shlomo; Hertzberg, Libi; Baruch, Yehuda; Lurie, Ido

    2016-01-01

    Individual psychotherapy is an efficient tool and an integral part of psychiatric treatment. However, its status among psychiatrists in Israel has never been explored. To explore and map the attitudes of psychiatrists in Israel regarding psychotherapy and psychotherapy training during residency, with comparisons between residents vs. specialists, peripheral vs. central institutions and mental health vs. medical centers. We conducted a cross-sectional survey to examine the attitudes toward individual psychotherapy. The questionnaire was delivered via email and direct approach to psychiatrists in Israel. The survey was completed by 229 of 1,502 registered psychiatrists (15.3%). While 96% (n=218) had positive attitudes towards psychotherapy, 93.1% (n=215) thought psychotherapy was less available than pharmacotherapy. Psychiatrists from peripheral institutions prefer cognitive behavioral therapy, while psychiatrists from central institutions prefer dynamic psychotherapy. Psychiatrists from mental health centers use more dynamic psychotherapy compared to psychiatrists from medical centers. The number of dynamic psychotherapy treatments psychiatrists delivered during their residencies has been decreasing over time, meaning residents today deliver fewer dynamic psychotherapy treatments compared to the number of treatments specialists delivered during their residencies. Additionally, 97.4% (n=225) believed psychotherapy training should be included in the psychiatric residency and 87.3% thought that the training should be improved to a great extent. The survey demonstrates mixed but overall positive attitudes towards psychotherapy among psychiatrists in Israel. The findings should be taken into consideration by psychiatrists who design the residency program and by policy makers who are in charge of the mental health reform in Israel, or the psychotherapy usage and therapeutic potential may diminish, as has happened in other countries.

  4. [Fifty years of residency in Psychiatry at the University of Montreal: relevance and necessity of the Residents' Association].

    Science.gov (United States)

    Thibault, Alexis

    2015-01-01

    In the context of the fiftieth anniversary celebrations of the Département de psychiatrie de l'Université de Montréal, the present article offers to retrace the history of the Psychiatry Resident's Association (ARPUM). Since the Association's activities and demands reflected the concerns of the time, a depiction of the Residency Program and exploration of the historical and administrative context, in each key period, is also undertaken. Multiple psychiatrists from every decade, who were once active members of the Association, were interviewed and asked to describe the Residency Program at their time, with its positive and negative aspects, based on their own personal experience as a resident, but also as a member of the organization. The interviewees were also invited to share their recollections of the various Association's demands, representations, activities and functioning, depending on the issues and periods. Various private and public archives were also used, in order to contextualize the residents' experiences and the Association's work. A brief exploration of the historical and political context that led to the creation of the organization is explained. Training and working conditions of residents at that time are reported, enabling the understanding of the first demands when the group was born. Historical jumps are then proposed, from decades to decades, in order to depict key issues, whether they were academic, clinical or organizational, through which the Association worked, over the evolution of the Residency Program. The internal functioning and its occasional problems throughout the years are also described, as is the role in organizing social and educational events. The Residency Program is in constant mutation, and the Association has played its part in shaping the psychiatric training at the Université de Montréal. Multiple positive and tangible impacts were and are still made possible from the collaborative work between the Département de

  5. Social Stigma Toward Persons With Prescription Opioid Use Disorder: Associations With Public Support for Punitive and Public Health-Oriented Policies.

    Science.gov (United States)

    Kennedy-Hendricks, Alene; Barry, Colleen L; Gollust, Sarah E; Ensminger, Margaret E; Chisolm, Margaret S; McGinty, Emma E

    2017-05-01

    Prescription opioid use disorder and overdose have emerged as significant public health challenges in the past 15 years. Little is known about public attitudes toward individuals who have developed a prescription opioid use disorder and whether these attitudes affect support for policy interventions. This study examined social stigma toward individuals with prescription opioid use disorder and tested whether stigma was associated with support for various policy interventions. A nationally representative Web-based survey was conducted from January 31 to February 28, 2014. The 1,071 respondents reported on their beliefs about and attitudes toward persons affected by prescription opioid use disorder and rated their support for various policy interventions. Ordered logistic regression models estimated the association between stigma and public support for punitive and public health-oriented policies. Most respondents viewed this disorder as affecting all groups-racial and ethnic, income, and geographic area of residence groups-fairly equally, despite epidemiological data demonstrating that certain populations have been disproportionately burdened. Respondents expressed high levels of stigma toward individuals with prescription opioid use disorder. Levels of stigma were generally similar among those with and without experience with prescription opioid use disorder, either one's own or that of a relative or close friend. Higher levels of stigma were associated with greater support for punitive policies and lower support for public health-oriented policies. Reframing the issue to emphasize the structural factors contributing to prescription opioid use disorder and the barriers to accessing evidence-based treatment might improve support for policies that benefit affected individuals.

  6. The Tarrytown Chief Residents Leadership Conference: a long-term follow-up.

    Science.gov (United States)

    Schwartz, Bruce J; Blackmore, Michelle A; Weiss, Andrea

    2014-02-01

    Creating training opportunities for the development of effective leaders is an increasingly important goal in psychiatry residency training programs. This article examines the long-term perceived impact of the Tarrytown Chief Residents Leadership Conference on preparing psychiatric residents for future leadership positions. Self-report surveys from attendees who participated in the conference between 1998 and 2011 were examined. Five hundred and forty-one completed surveys were returned (43 % response rate). Eighty-six percent of respondents reported moderate to extreme improvement in leadership confidence post-conference. Most respondents indicated at least moderate improvement in self-awareness (93 %), understanding of group process (92 %), and willingness to address conflict (89 %). Ninety percent felt the conference was important to their residency training, and 80 % indicated increased interest in leadership post-conference. Responders reported lasting improvements in their confidence in and perceived ability to utilize skills necessary for effective leadership, demonstrating the value of this experiential learning opportunity.

  7. Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial.

    Science.gov (United States)

    Ofori-Atta, A; Attafuah, J; Jack, H; Baning, F; Rosenheck, R

    2018-01-01

    Care of people with serious mental illness in prayer camps in low-income countries generates human rights concerns and ethical challenges for outcome researchers. Aims To ethically evaluate joining traditional faith healing with psychiatric care including medications (Clinical trials.gov identifier NCT02593734). Residents of a Ghana prayer camp were randomly assigned to receive either indicated medication for schizophrenia or mood disorders along with usual prayer camp activities (prayers, chain restraints and fasting) (n = 71); or the prayer camp activities alone (n = 68). Masked psychologists assessed Brief Psychiatric Rating Scale (BPRS) outcomes at 2, 4 and 6 weeks. Researchers discouraged use of chaining, but chaining decisions remained under the control of prayer camp staff. Total BPRS symptoms were significantly lower in the experimental group (P = 0.003, effect size -0.48). There was no significant difference in days in chains. Joining psychiatric and prayer camp care brought symptom benefits but, in the short-run, did not significantly reduce days spent in chains. Declaration of interest None.

  8. Diagnosis-Prescription in the Context of Instructional Management.

    Science.gov (United States)

    Besel, Ronald

    The usage of the terms "diagnosis" and "prescription" in the fields of medicine and electronic troubleshooting is reviewed, and a common structure for diagnosis-prescription is proposed. The diagnosis-prescription decision sequence is outlined. Prescription-without-diagnosis and diagnosis-without-prescription in education is discussed. The…

  9. Usefulness of traditionally defined herbal properties for distinguishing prescriptions of traditional Chinese medicine from non-prescription recipes.

    Science.gov (United States)

    Ung, C Y; Li, H; Kong, C Y; Wang, J F; Chen, Y Z

    2007-01-03

    Traditional Chinese medicine (TCM) has been widely practiced and is considered as an attractive to conventional medicine. Multi-herb recipes have been routinely used in TCM. These have been formulated by using TCM-defined herbal properties (TCM-HPs), the scientific basis of which is unclear. The usefulness of TCM-HPs was evaluated by analyzing the distribution pattern of TCM-HPs of the constituent herbs in 1161 classical TCM prescriptions, which shows patterns of multi-herb correlation. Two artificial intelligence (AI) methods were used to examine whether TCM-HPs are capable of distinguishing TCM prescriptions from non-TCM recipes. Two AI systems were trained and tested by using 1161 TCM prescriptions, 11,202 non-TCM recipes, and two separate evaluation methods. These systems correctly classified 83.1-97.3% of the TCM prescriptions, 90.8-92.3% of the non-TCM recipes. These results suggest that TCM-HPs are capable of separating TCM prescriptions from non-TCM recipes, which are useful for formulating TCM prescriptions and consistent with the expected correlation between TCM-HPs and the physicochemical properties of herbal ingredients responsible for producing the collective pharmacological and other effects of specific TCM prescriptions.

  10. Care systematization in psychiatric nursing within the psychiatric reform context.

    Science.gov (United States)

    Hirdes, A; Kantorski, L P

    2002-02-01

    The aim of this study was to approach care systematization in psychiatric nursing in two psychiatric disorder patients who attended 'Nossa Casa', São Lourenço do Sul, RS, Brazil. Nossa Casa services psychiatric patients in the community, focussing on: (i) permanence in their environment, allowing patients to remain close to their families and social spheres; (ii) integral attendance to meet individual needs; (iii) respecting individual differences; (iv) rehabilitation practices; and (v) social reinsertion. Concepts and assumptions of the psychiatric reform and the Irving's nursing process were used as theoretical-methodological references to elaborate this systematization. A therapeutic project for the psychiatric patient was elaborated, in accordance with the interdisciplinary proposal accepted by Nossa Casa. Interdisciplinary team intervention, guided by a previously discussed common orientation and defined through an individualized therapeutic project, allowed for an effective process of psychosocial rehabilitation. The authors concluded that a therapeutic project based on the mentioned premises leads to consistent, comprehensive, dialectical and ethical assistance in mental health, thereby reinstating the citizenship of psychiatric patients.

  11. Attitudes toward neuroscience education among psychiatry residents and fellows.

    Science.gov (United States)

    Fung, Lawrence K; Akil, Mayada; Widge, Alik; Roberts, Laura Weiss; Etkin, Amit

    2014-04-01

    The purpose of this study is to assess the attitudes of psychiatry trainees toward neuroscience education in psychiatry residency and subsequent training in order to inform neuroscience education approaches in the future. This online survey was designed to capture demographic information, self-assessed neuroscience knowledge, attitudes toward neuroscience education, preferences in learning modalities, and interest in specific neuroscience topics. Volunteers were identified through the American Psychiatric Association, which invited 2,563 psychiatry trainees among their members. Four hundred thirty-six trainees completed the survey. Nearly all agreed that there is a need for more neuroscience education in psychiatry residency training (94%) and that neuroscience education could help destigmatize mental illness (91%). Nearly all (94%) expressed interest in attending a 3-day course on neuroscience. Many neuroscience topics and modes of learning were viewed favorably by participants. Residents in their first 2 years of training expressed attitudes similar to those of more advanced residents and fellows. Some differences were found based on the level of interest in a future academic role. This web-based study demonstrates that psychiatry residents see neuroscience education as important in their training and worthy of greater attention. Our results suggest potential opportunities for advancing neuroscience education.

  12. A new prescription for soft gluon resummation

    International Nuclear Information System (INIS)

    Abbate, Riccardo; Forte, Stefano; Ridolfi, Giovanni

    2007-01-01

    We present a new prescription for the resummation of the divergent series of perturbative corrections, due to soft gluon emission, to hard processes near threshold in perturbative QCD (threshold resummation). This prescription is based on Borel resummation, and contrary to the commonly used minimal prescription, it does not introduce a dependence of resummed physical observables on the kinematically unaccessible x→0 region of parton distributions. We compare results for resummed deep-inelastic scattering obtained using the Borel prescription and the minimal prescription and exploit the comparison to discuss the ambiguities related to the resummation procedure

  13. Correlates of lifetime alcohol misuse among older community residents in Brazil

    Science.gov (United States)

    Blay, Sergio Luis; Fillenbaum, Gerda G.; Andreoli, Sergio Baxter; Gastal, Fabio Leite

    2009-01-01

    Background Little is known about the sociodemographic correlates and health effects associated with lifetime alcohol misuse in community resident elderly in Brazil. Method Data came from a representative sample of 6961 residents aged 60+ in the State of Rio Grande do Sul, Brazil. The structured interview included a five-item lifetime alcohol use questionnaire addressing abuse and dependence, and enquiry regarding sociodemographic characteristics, lifestyle and social support, and health conditions. Results Of the sample, 10.6% (25.3% men, 2.9% women) endorsed at least one lifetime alcohol misuse question. Controlled analyses comparing a gradient of alcohol misuse (none, one, more than one item endorsed), found that men, people age 60–69 (compared to older persons), and tobacco users were more likely to endorse alcohol misuse items. Persons reporting lower income, and of nonWhite race/ethnicity did not differ from their comparison groups with respect to endorsing one item, but they were more likely to endorse two or more items. Endorsing more than one item was associated with impaired activities of daily living, the presence of respiratory problems and psychiatric disorder, but was protective against vascular conditions. Conclusions Major lifetime alcohol misuse (defined as endorsing more than one of five items reflecting alcohol abuse or dependence) is more common in certain sociodemographic groups (men, younger elderly, lower income, nonWhites). With the exception of vascular conditions, it is associated with smoking, poorer functional status, respiratory problems, and psychiatric disorder. Endorsing only one item has a reduced association, significant only for male gender, smoking, and psychiatric disorder. PMID:19141169

  14. Quality of life in boarding houses and hostels: a residents' perspective.

    Science.gov (United States)

    Horan, M E; Muller, J J; Winocur, S; Barling, N

    2001-08-01

    In the last forty years deinstitutionalization has transferred the care of people with a serious mental illness from the psychiatric hospitals to community based facilities. More recently it has been questioned whether these new facilities offer the anticipated benefits of quality of life. This study examines the Quality of Life (QOL) of people diagnosed with schizophrenia living in two different accommodation facilities, hostels and boarding houses. QOL is examined from the resident's perspective. Lehman's (1988b) QOL Interview was used to measure objective, subjective, and global QOL of 60 participants in three hostels and two boarding house clusters. Hostel and boarding house data were compared and results showed that residents preferred boarding house accommodation. Overall, residents of both accommodation facilities reported satisfaction with QOL, and indicated that they regard them as asylum or sanctuary from the outside world.

  15. The Danish National Prescription Registry

    DEFF Research Database (Denmark)

    Kildemoes, Helle Wallach; Toft Sørensen, Henrik; Hallas, Jesper

    2011-01-01

    Introduction: Individual-level data on all prescription drugs sold in Danish community pharmacies has since 1994 been recorded in the Register of Medicinal Products Statistics of the Danish Medicines Agency. Content: The register subset, termed the Danish National Prescription Registry (DNPR......), contains information on dispensed prescriptions, including variables at the level of the drug user, the prescriber, and the pharmacy. Validity and coverage: Reimbursement-driven record keeping, with automated bar-code-based data entry provides data of high quality, including detailed information...

  16. Prescription drug abuse: problem, policies, and implications.

    Science.gov (United States)

    Phillips, Janice

    2013-01-01

    This article provides an overview on prescription drug abuse and highlights a number of related legislative bills introduced during the 112th Congress in response to this growing epidemic. Prescription drug abuse has emerged as the nation's fastest growing drug problem. Although prescription drugs have been used effectively and appropriately for decades, deaths from prescription pain medicine in particular have reached epidemic proportions. Bills related to prescription drug abuse introduced during the 112th Congress focus on strengthening provider and consumer education, tracking and monitoring prescription drug abuse, improving data collection on drug overdose fatalities, combating fraud and abuse in Medicare and Medicaid programs, reclassifying drugs to make them more difficult to prescribe and obtain, and enforcing stricter penalties for individuals who operate scam pain clinics and sell pain pills illegitimately. This article underscores the importance of a multifaceted approach to combating prescription drug abuse and concludes with implications for nursing. Copyright © 2013. Published by Mosby, Inc.

  17. Adolescents' utilisation of psychiatric care, neighbourhoods and neighbourhood socioeconomic deprivation: a multilevel analysis.

    Directory of Open Access Journals (Sweden)

    Anna-Karin Ivert

    Full Text Available Mental health problems among adolescents have become a major public health issue, and it is therefore important to increase knowledge on the contextual determinants of adolescent mental health. One such determinant is the socioeconomic structure of the neighbourhood. The present study has two central objectives, (i to examine if neighbourhood socioeconomic deprivation is associated to individual variations in utilisation of psychiatric care in a Swedish context, and (ii to investigate if neighbourhood boundaries are a valid construct for identifying contexts that influence individual variations in psychiatric care utilization. Data were obtained from the Longitudinal Multilevel Analysis in Scania (LOMAS database. The study population consists of all boys and girls aged 13-18 years (N=18,417, who were living in the city of Malmö, Sweden, in 2005. Multilevel logistic regression analysis was applied to estimate the probability of psychiatric care utilisation. The results from the study indicate that the neighbourhood of residence had little influence on psychiatric care utilisation. Although we initially found a variation between neighbourhoods, this general contextual effect was very small (i.e. 1.6%. The initial conclusive association between the neighbourhood level of disadvantage and psychiatric care utilisation (specific contextual effect disappeared following adjustment for individual and family level variables. Our results suggest the neighbourhoods in Malmö (at least measured in terms of SAMS-areas, do not provide accurate information for discriminating adolescents utilisation of psychiatric care. The SAMS-areas appears to be an inappropriate construct of the social environment that influences adolescent utilisation of psychiatric care. Therefore, public health interventions should be directed to the whole city rather than to specific neighbourhoods. However, since geographical, social or cultural contexts may be important for our

  18. Understanding psychiatric nursing care with nonsuicidal self-harming patients in acute psychiatric admission units: the views of psychiatric nurses.

    Science.gov (United States)

    O'Donovan, Aine; Gijbels, Harry

    2006-08-01

    Self-harm in the absence of suicidal intent is an underexplored area in psychiatric nursing research. This article reports on findings of a study undertaken in two acute psychiatric admission units in Ireland. The purpose of this study was to gain an understanding of the practices of psychiatric nurses in relation to people who self-harm but who are not considered suicidal. Semistructured interviews were held with eight psychiatric nurses. Content analysis revealed several themes, some of which will be presented and discussed in this article, namely, the participants' understanding of self-harm, their approach to care, and factors in the acute psychiatric admission setting, which impacted on their care. Recommendations for further research are offered.

  19. An Epidemiological Study of Psychiatric Disorders in Hamadan Province , 2001

    Directory of Open Access Journals (Sweden)

    M.R. Mohammadi

    2004-10-01

    Full Text Available The burden of psychiatric disorders in the developed countries has been identified by the screening questionnaires and standard clinical interviews at a high level, but the epidemiological studies of psychiatric disorders in our country are brief and their numbers are few. Planning for providing essential mental health services to the people requires us to be knowledgeable about the present status of psychiatric disorders in the society. The objective of this research was to carry out the epidemiological study of the psychiatric disorders in the individuals 18 years and above in urban and rural areas of Hamadan province. 664 individuals selected through randomized clustered and systematic sampling methods among the existing families of Hamadan province and the Schedule for Affective Disorders and Schizophrenia (SADS questionnaires completed by the clinical psychologist. The diagnosis of the disorders was based on DSM-IV classification criteria.The results of the study showed that the overall prevalence of psychiatric disorders in the province was 11.28% (17.2% in women , 5.8% in men. The anxiety and mood disorders with 5.87 and 2.71% respectively had the highest prevalence in the province. The prevalence of psychotic disorders in this study was 0.60% , neuro- cognitive disorders 1.35% and dissociative disorders 0.75%. In the group of mood disorders, major depression with 2.56% and in the group of anxiety disorders, phobia with 2.56% had the higher prevalence. This study showed that 8.13% of studied individuals suffered from at least one of the psychiatric disorders. The prevalence of psychiatric disorders in the province among the individuals in the age group of 66 years and above was 13.33%, individuals whose spouses had passed away 18.75%, urban residents of province 9.81%, illiterate individuals 12.80% and housewife individuals 12.31% was more than other individuals in the sample. Being aware of this matter reveals the responsibility of the

  20. A psychiatric dialogue on the mind-body problem.

    Science.gov (United States)

    Kendler, K S

    2001-07-01

    Of all the human professions, psychiatry is most centrally concerned with the relationship of mind and brain. In many clinical interactions, psychiatrists need to consider both subjective mental experiences and objective aspects of brain function. This article attempts to summarize, in the form of a dialogue between a philosophically informed attending psychiatrist and three residents, the major philosophical positions on the mind-body problem. The positions reviewed include the following: substance dualism, property dualism, type identity, token identity, functionalism, eliminative materialism, and explanatory dualism. This essay seeks to provide a brief user-friendly introduction, from a psychiatric perspective, to current thinking about the mind-body problem.

  1. Environmental factors predict the severity of delirium symptoms in long-term care residents with and without delirium.

    Science.gov (United States)

    McCusker, Jane; Cole, Martin G; Voyer, Philippe; Vu, Minh; Ciampi, Antonio; Monette, Johanne; Champoux, Nathalie; Belzile, Eric; Dyachenko, Alina

    2013-04-01

    To identify potentially modifiable environmental factors (including number of medications) associated with changes over time in the severity of delirium symptoms and to explore the interactions between these factors and resident baseline vulnerability. Prospective, observational cohort study. Seven long-term care (LTC) facilities. Two hundred seventy-two LTC residents aged 65 and older with and without delirium. Weekly assessments (for up to 6 months) of the severity of delirium symptoms using the Delirium Index (DI), environmental risk factors, and number of medications. Baseline vulnerability measures included a diagnosis of dementia and a delirium risk score. Associations between environmental factors, medications, and weekly changes in DI were analyzed using a general linear model with correlated errors. Six potentially modifiable environmental factors predicted weekly changes in DI (absence of reading glasses, aids to orientation, family member, and glass of water and presence of bed rails and other restraints) as did the prescription of two or more new medications. Residents with dementia appeared to be more sensitive to the effects of these factors. Six environmental factors and prescription of two or more new medications predicted changes in the severity of delirium symptoms. These risk factors are potentially modifiable through improved LTC clinical practices. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  2. Alcohol and prescription drug safety in older adults

    Directory of Open Access Journals (Sweden)

    Zanjani F

    2013-02-01

    Full Text Available Faika Zanjani,1,2 Aasha I Hoogland,1 Brian G Downer11Department of Gerontology, 2Building Interdisciplinary Research Careers in Women's Health University of Kentucky, Lexington, KY, USABackground: The objectives of this study were to investigate older adults' knowledge of prescription drug safety and interactions with alcohol, and to identify pharmacists' willingness to disseminate prescription drug safety information to older adults.Methods: The convenience sample consisted of 48 older adults aged 54–89 years who were recruited from a local pharmacy and who completed surveys addressing their alcohol consumption, understanding of alcohol and prescription drug interactions, and willingness to change habits regarding alcohol consumption and prescription drugs. To address pharmacist willingness, 90 pharmacists from local pharmacies volunteered and answered questions regarding their willingness to convey prescription drug safety information to older adults.Results: Older adults reported low knowledge of alcohol and prescription drug safety, with women tending to be slightly more knowledgeable. More importantly, those who drank in the previous few months were less willing to talk to family and friends about how alcohol can have harmful interactions with prescription drugs, or to be an advocate for safe alcohol and prescription drug use than those who had not had a drink recently. Pharmacists reported that they were willing to convey prescription drug safety information to older adults via a variety of formats, including displaying or distributing a flyer, and directly administering a brief intervention.Conclusion: In this study, older adults were found to have inadequate knowledge of prescription drug safety and interactions with alcohol, but pharmacists who regularly come in contact with older adults indicated that they were ready and willing to talk to older adults about prescription drug safety. Future research should focus on interventions

  3. The Optimizing Strategies for Prescription of Sleeping Pills for Insomnia Patients

    Directory of Open Access Journals (Sweden)

    Seockhoon Chung

    2017-06-01

    Full Text Available Many patients claim that they cannot sleep well despite ingestion of sleeping pills. In such cases, the physician should explore the reason why sleep disturbance persisted in patients despite administration of sleeping pills. We should consider patients’ age, gender, medical or psychiatric diseases, workplace, or sleep environment that may influence patients’ sleep and satisfaction with their hypnotics. However, prior to prescribing a hypnotic agent for patients with sleep disturbance, good sleep hygiene education should be provided first. Cognitive-behavioral therapy for insomnia is an important and effective treatment modality to improve patients’ sleep quality and reduce dosage of sleeping pills, but it is not easy for most general practitioners to learn and practice this modality. Therefore, we need to consider how to optimize the prescription of hypnotics for treating insomnia in order to prescribe hypnotics safely and appropriately at the lowest dosage. Physician should consider the mechanism of action of each hypnotic agent and prescribe proper hypnotics according to patients’ comorbid illness, insomnia types, or other underlying sleep disorders. Also, we should instruct the patients about when they should take their sleeping pills and we should monitor whether they have followed the instructions or not. Hospitalized patients are in a different sleep environment compared to outpatients, and therefore, we should also prepare modified management strategies for inpatients. In this review, strategies for optimizing the prescription of sleeping pills for insomnia patients will be discussed.

  4. Assessment of parental understanding of paediatric medical prescriptions

    Directory of Open Access Journals (Sweden)

    Sadiqua Anjum, Nasir Mohiuddin M, Narayan Reddy U, Narsing Rao J, Sana Afreen, Mir S Adil, Javeedullah M

    2014-07-01

    Full Text Available Introduction: Medical prescriptions are bound to be misinterpreted by patients and pharmacists if not properly conveyed. Pediatric prescriptions differ from adult prescriptions having wide variation in doses and formulations. There is a need to evaluate the lacunae in the parental understanding of pediatric prescriptions. Aims and objective: To evaluate the parental understanding of pediatric prescription and to evaluate the adequacy of communication with the physician and pharmacist regarding the same. Material and methods: 550 parents were enrolled and their literacy level was noted. They were subjected to modify MUSE questionnaire. Physician’s prescription was analyzed in terms of ease of understanding by parents. These parents were followed up till the pharmacies and the pharmacist understanding of prescription was analyzed and their communication with parents regarding drug usage was noted. Finally, ease of usage of drugs by parents was noted. Results: MUSE scale was modified to suit pediatric prescription understanding by parents and also additional questions were asked to include complete parental understanding of doctor’s prescription. Majority of parents failed to completely understand the written prescription. Though around 80% of pharmacist could understand the prescription, their communication with parents was poor resulting in difficulty for parents to even enquire about medicines from them. Parental overall understanding of prescription increased with their literacy levels. Conclusion: Not all prescriptions are completely understood by parents as well as a pharmacist. This can lead to misuse of drugs. Efforts to explain the drug usage are not adequate enough from the doctor or the pharmacist. While communicating literacy levels of parents is not being considered which may further worsen the understanding ability

  5. Neuroscience and humanistic psychiatry: a residency curriculum.

    Science.gov (United States)

    Griffith, James L

    2014-04-01

    Psychiatry residencies with a commitment to humanism commonly prioritize training in psychotherapy, cultural psychiatry, mental health policy, promotion of human rights, and similar areas reliant upon dialogue and collaborative therapeutic relationships. The advent of neuroscience as a defining paradigm for psychiatry has challenged residencies with a humanistic focus due to common perceptions that it would entail constriction of psychiatric practice to diagnostic and psychopharmacology roles. The author describes a neuroscience curriculum that has taught psychopharmacology effectively, while also advancing effectiveness of language-based and relationship-based therapeutics. In 2000, the George Washington University psychiatry residency initiated a neuroscience curriculum consisting of (1) a foundational postgraduate year 2 seminar teaching cognitive and social neuroscience and its integration into clinical psychopharmacology, (2) advanced seminars that utilized a neuroscience perspective in teaching specific psychotherapeutic skill sets, and (3) case-based teaching in outpatient clinical supervisions that incorporated a neuroscience perspective into traditional psychotherapy supervisions. Curricular assessment was conducted by (1) RRC reaccreditation site visit feedback, (2) examining career trajectories of residency graduates, (3) comparing PRITE exam Somatic Treatments subscale scores for 2010-2012 residents with pre-implementation residents, and (4) postresidency survey assessment by 2010-2012 graduates. The 2011 RRC site visit report recommended a "notable practice" citation for "innovative neurosciences curriculum." Three of twenty 2010-2012 graduates entered neuroscience research fellowships, as compared to none before the new curriculum. PRITE Somatic Treatments subscale scores improved from the 23rd percentile to the 62nd percentile in pre- to post-implementation of curriculum (p neuroscience curriculum for a residency committed to humanistic psychiatry

  6. Direct-to-consumer prescription drug advertising and the public.

    Science.gov (United States)

    Bell, R A; Kravitz, R L; Wilkes, M S

    1999-11-01

    Drug manufacturers are intensely promoting their products directly to consumers, but the impact has not been widely studied. Consumers' awareness and understanding of, attitudes toward, and susceptibility to direct-to-consumer (DTC) drug advertising were examined. Random-digit dialing telephone survey with a random household member selection procedure (completion and response rates, 58% and 69%, respectively). Respondents were interviewed while they were at their residences. Complete data were obtained from 329 adults in Sacramento County, California. Outcome measures included awareness of advertisements for 10 selected drugs, misconceptions about DTC advertising, attitudes toward DTC ads, and behavioral responses to such promotions. The influence of demographic characteristics, health status, attitudes, beliefs, and media exposure on awareness and behaviors was examined. On average, respondents were aware of advertisements for 3.7 of the 10 drugs; awareness varied from 8% for Buspar (buspirone) to 72% for Claritin (loratadine). Awareness was associated with prescription drug use, media exposure, positive attitudes toward DTC advertising, poorer health, and insurance status. Substantial misconceptions were revealed; e.g., 43% thought that only "completely safe" drugs could be advertised. Direct-to-consumer advertisements had led one third of respondents to ask their physicians for drug information and one fifth to request a prescription. Direct-to-consumer advertisements are reaching the public, but selectively so, and affecting their behaviors. Implications for public policy are examined.

  7. Psychiatry chief resident opinions toward basic and clinical neuroscience training and practice.

    Science.gov (United States)

    Bennett, Jeffrey I; Handa, Kamna; Mahajan, Aman; Deotale, Pravesh

    2014-04-01

    The authors queried attendees to a chief resident conference on whether program education and training in neuroscience or in translating neuroscience research into practice is sufficient and what changes are needed. The authors developed and administered a 26-item voluntary questionnaire to each attendee at the Chief Residents' Leadership Conference at the American Psychiatric Association 2013 annual meeting in San Francisco, CA. Out of 94 attendees, 55 completed and returned questionnaires (58.5%). A majority of respondents stated that their program provided adequate training in neuroscience (61.8%); opportunities for neuroscience research existed for them (78.2%), but that their program did not prepare them for translating future neuroscience research findings into clinical practice (78.9%) or educate them on the NIMH Research Domain Criteria (83.3%). A majority of respondents stated that the ACGME should require a specific neuroscience curriculum (79.6%). Chief residents believe that curricular and cultural change is needed in psychiatry residency neuroscience education.

  8. [Drug interactions in chronic prescription].

    Science.gov (United States)

    Comet, D; Casajuana, J; Bordas, J M; Fuentes, M A; Arnáiz, J A; Núñez, B; Pou, R

    1997-06-30

    Application of computerized program for detection of potential drug interactions (PDI) in chronic prescriptions in four primary care centers. To evaluate the clinical significance of PDI identified according to clinical criterions. An observational crossover study. Clutat Vella health district (City of Barcelona). Using information of Consejo General de Colegios Oficiales de Farmaceuticos databases and the chronic prescriptions database of the primary care centers, computerized drug-interaction system have been developed for detection of PDI in patients. A panel of primary care physicians and clinical pharmacists developed criteria that were used to evaluate the clinical significance of PDI. 9840 Cards of Authorized Prescription (CAP) were analyzed, 36108 medicaments and 42877 drugs. A total of 2140 patients were involved for a total of 3406 PDI, 21.75% of patients with CAP. Clinical signification for the panel was found in 40.07% of these 3406 PIF; 3.78% were suggest to avoid the association drugs. The incidence of PDI with clinical signification are lower than other studies of the literature; it suggest a appropriate knowledge of drug prescription. The application of computerized program make much more easy the detection of adverse drug interactions in chronic prescription.

  9. Increasing Direct Care Staff Compliance to Individualized Physical Therapy Body Positioning Prescriptions: Prescriptive Checklists.

    Science.gov (United States)

    Lattimore, Jennifer; And Others

    1984-01-01

    The study confirmed previous research indicating that workshop training by itself is an ineffective method of increasing direct care staff compliance to treatment prescriptions, and that providing direct staff supervisors with a training and management tool (prescriptive checklists) may be an effective alternative for serving multihandicapped…

  10. [Hospital fluoroquinolone prescription habits in northern France].

    Science.gov (United States)

    Levent, T; Cabaret, P

    2010-09-01

    The aim of the study was to assess the good use organization and fluoroquinolone prescription habits in cases of bone and joint, urinary, pulmonary, and digestive infections. A declarative survey was made (questionnaire for the hospital and for the prescriber). Thirty percent (44/145) of hospitals participated with 274 prescribers. Eighty percent had prescription protocols, 71 % of clinicians had access to epidemiologic data. A percentage of 30.7 (853/2,771) of prescriptions included a fluoroquinolone, 44.5 % (380/853) among these had not been recommended. The excessive prescription reached 24.4 % (116/474) in case of bone and joint infection, 14.6 % (107/731), and 20 % (157/779) in cases of digestive and respiratory infection respectively. Prescriptions for urinary infection were adequate in 47.6 % (375/787) of cases. Inadequate prescriptions were made because of bad knowledge of bacteria resistance epidemiology and pharmacology (insufficient dose, monotherapy at risk of selection), and non-application of good practice recommendations. This study justifies the rationalization of antibiotic prescription. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  11. [Analysis on traditional Chinese medicine prescriptions treating cancer based on traditional Chinese medicine inheritance assistance system and discovery of new prescriptions].

    Science.gov (United States)

    Yu, Ming; Cao, Qi-chen; Su, Yu-xi; Sui, Xin; Yang, Hong-jun; Huang, Lu-qi; Wang, Wen-ping

    2015-08-01

    Malignant tumor is one of the main causes for death in the world at present as well as a major disease seriously harming human health and life and restricting the social and economic development. There are many kinds of reports about traditional Chinese medicine patent prescriptions, empirical prescriptions and self-made prescriptions treating cancer, and prescription rules were often analyzed based on medication frequency. Such methods were applicable for discovering dominant experience but hard to have an innovative discovery and knowledge. In this paper, based on the traditional Chinese medicine inheritance assistance system, the software integration of mutual information improvement method, complex system entropy clustering and unsupervised entropy-level clustering data mining methods was adopted to analyze the rules of traditional Chinese medicine prescriptions for cancer. Totally 114 prescriptions were selected, the frequency of herbs in prescription was determined, and 85 core combinations and 13 new prescriptions were indentified. The traditional Chinese medicine inheritance assistance system, as a valuable traditional Chinese medicine research-supporting tool, can be used to record, manage, inquire and analyze prescription data.

  12. Radiopharmaceutical prescription in nuclear medicine departments; La prescription medicale des radiopharmaceutiques au sein d'un service de medecine nucleaire

    Energy Technology Data Exchange (ETDEWEB)

    Biechlin-Chassel, M.L. [Radiopharmacie, service de pharmacie, Centre hospitalier de Chambery, 73 - Chambery (France); Lao, S. [Service de medecine nucleaire, CHU-Hopital de l' Archet, 06 - Nice (France); Bolot, C. [Service de pharmacie, hospices civiles de Lyon, groupement hospitalier Est, 69 - Bron (France); Francois-Joubert, A. [Service de medecine nucleaire, centre hospitalier de Chambery, 73 - Chambery (France)

    2010-11-15

    In France, radiopharmaceutical prescription is often discussed depending to which juridical structure the nuclear medicine department is belonging. According to current regulation, this prescription is an obligation in a department linked to hospital with a pharmacy department inside. But situation remains unclear for independent nuclear medicine departments where physicians are not constrained to prescribe radiopharmaceuticals. However, as radiographers and nurses are only authorized to realize theirs acts in front of a medical prescription, one prescription must be realized. Nowadays, computerized prescription tools have been developed but only for radiopharmaceutical drugs and not for medical acts. In the aim to achieve a safer patient care, the prescription regulation may be applied whatever differences between nuclear medicines departments. (authors)

  13. Use of Non-Prescription Remedies by Ghanaian Human Immunodeficiency Virus-Positive Persons on Antiretroviral Therapy

    Directory of Open Access Journals (Sweden)

    Amos K. Laar

    2017-05-01

    Full Text Available BackgroundInappropriate use of non-prescription remedies by persons living with human immunodeficiency virus (PLHIV may result in adverse events or potentiate non-adherence to prescribed medications. This study investigated the use of non-prescription remedies among PLHIV receiving antiretroviral therapy (ART from four treatment centers in southern Ghana.MethodsA mixed method design using quantitative and qualitative methods was used. This article focuses on the quantitative survey of 540 respondents. Univariate analysis was used to generate descriptive tabulations of key variables. Bivariate analysis and logistic regression modeling, respectively, produced unadjusted and adjusted associations between background attributes of PLHIV and the use of non-prescription remedies. A p-value of < 0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics for Windows, Version 20.0.ResultsOne out of three respondents reported the use of non-prescription remedies at least once within 3 months of the survey. Most of these were locally made and included “Angel natural bitters, concoctions from the Christian prayer centers, garlic, and mahogany syrups.” These remedies were used concomitantly with antiretroviral medications (ARVs—46% or administered with ARVs but at different times during the day (43%. Some of the remedies were reportedly prescribed by health workers, or self-initiated during periods of ARVs shortage. Others took them based on their perception of their efficacy. Bivariate level analysis identified ART clinic site, place of residence, and ARV adherence monitoring to be significantly associated with the use of non-prescription remedies (p < 0.05. Multiple logistic regression analysis controlling for covariates confirmed the location of ART clinic as the only predictor of the use of non-prescription remedies. Compared to clients at the large urban teaching hospital (Korle-Bu Fevers Unit ART

  14. Prescription drugs: issues of cost, coverage, and quality.

    Science.gov (United States)

    Copeland, C

    1999-04-01

    This Issue Brief closely examines expenditures on prescription drugs, and discusses their potential to substitute for other types of health care services. In addition, it describes employer coverage of prescription drugs, direct-to-consumer advertising of prescription drugs, and potential legislation affecting the prescription drug market. Prescription drug expenditures grew at double-digit rates during almost every year since 1980, accelerating to 14.1 percent in 1997. In contrast, total national health expenditures, hospital service expenditures, and physician service expenditures growth rates decreased from approximately 13 percent in 1980 to less than 5 percent in 1997. Private insurance payments for prescription drugs increased 17.7 percent in 1997, after growing 22.1 percent in 1995 and 18.3 percent in 1996. This growth in prescription drug payments compares with 4 percent or less overall annual growth in private insurance payments for each of those three years. From 1993 to 1997, the overwhelming majority of the increases in expenditures on prescription drugs were attributable to increased volume, mix, and availability of pharmaceutical products. In 1997, these factors accounted for more than 80 percent of the growth in prescription drug expenditures. A leading explanation for the sharp growth in drug expenditures is that prescription drugs are a substitute for other forms of health care. While it is difficult to determine the extent to which this substitution occurs, various studies have associated cost savings with the use of pharmaceutical products in treating specific diseases. Evidence suggests that more appropriate utilization of prescription drugs has the potential to lower total expenditures and improve the quality of care. Also, some studies indicate the U.S. health care system needs to improve the way patients use and physicians prescribe current medications. Prescription drug plans offered by employers are likely to undergo changes to ensure that

  15. 75 FR 16235 - Electronic Prescriptions for Controlled Substances

    Science.gov (United States)

    2010-03-31

    ... mature standard for the formatting of prescription data, most electronic prescriptions are routed from... prescriptions prior to granting access to sign such prescriptions, two-factor authentication including a hard... practitioner can retain control of a biometric or hard token. Authentication based only on knowledge factors is...

  16. [Medical prescription and informed consent for the use of physical restraints in nursing homes in the Canary Islands (Spain)].

    Science.gov (United States)

    Estévez-Guerra, Gabriel J; Fariña-López, Emilio; Penelo, Eva

    To identify the frequency of completion of informed consent and medical prescription in the clinical records of older patients subject to physical restraint, and to analyse the association between patient characteristics and the absence of such documentation. A cross-sectional and descriptive multicentre study with direct observation and review of clinical records was conducted in nine public nursing homes, comprising 1,058 beds. 274 residents were physically restrained. Informed consent was not included in 82.5% of cases and was incomplete in a further 13.9%. There was no medical prescription in 68.3% of cases and it was incomplete in a further 12.0%. The only statistical association found was between the lack of prescription and the patients' advanced age (PR=1.03; p <0.005). Failure to produce this documentation contravenes the law. Organisational characteristics, ignorance of the legal requirements or the fact that some professionals may consider physical restraint to be a risk-free procedure may explain these results. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. [Standardization of names in prescriptions of traditional Chinese medicines].

    Science.gov (United States)

    Li, Chao-Feng; Zhang, Yu-Jun; Fan, Dong-He; Zhang, Meng-Jie; Bai, Xue; Yang, Wen-Hua; Qi, Shu-Ya; Zhang, Zhi-Jie; Xue, Chun-Miao; Mao, Liu-Ying; Cao, Jun-Ling

    2017-01-01

    Chinese medicine prescriptions are a type of medical documents written by doctors after they understand the patients' conditions for syndrome differentiation. Chinese medicine prescriptions are also the basis for pharmacy personnel to dispense medicines and guide patients to use drugs. It has the legal, technical and economic significances. Chinese medicine prescriptions contain such information of names, quantity and usage. Whether the names of drugs in Chinese medicine prescriptions are standardized or not is directly related to the safety and efficacy of the drugs. At present, nonstandard clinical prescriptions are frequently seen. With "Chinese medicine prescription", "names of drug in Chinese medicine prescription" and "standards of Chinese medicine prescription" as key words, the author searched CNKI, Wanfang and other databases, and consulted nearly 100 literatures, so as to summarize current names of drugs in traditional Chinese medicine prescription, analyze the reasons, and give suggestions, in the expectation of standardizing the names of drugs used in traditional Chinese medicine prescriptions. Copyright© by the Chinese Pharmaceutical Association.

  18. Abuse of prescription medicines in southwestern France.

    Science.gov (United States)

    Baumevieille, M; Haramburu, F; Bégaud, B

    1997-01-01

    Few quantitative data are available concerning abuse of medicine in the general population, although dependence on prescription medicines involves a significant proportion of the population. Falsified prescription forms can be used as an indicator of abuse. Community pharmacists in a representative network were asked to report any falsified prescription form presented over a 1-year period. Sales data were used to express results as abuse rate and abuse rate ratio. Two-thirds of the 130 pharmacies in the network reported at least 1 falsified prescription. The reported incidence of falsified prescriptions was 2.3 per 10 000 inhabitants. A total of 392 falsified prescription forms was collected. The abuse rate ratios were 171 (95% CI 140 to 210) for dextroamphetamine-phenobarbital in combination, 168 (95% CI 131 to 216) for fenozolone, 67 (95% CI 53 to 84) for buprenorphine, and 40.5 (95% CI 33 to 50) for clobenzorex. These results show the efficiency of a method for detecting falsified prescriptions forms using community pharmacists. The abuse of medicines already known for their addictive potential can be estimated and alerts can also be detected.

  19. Psychiatric Disorders and Predictors Hereof Among Refugee Children in Early Adulthood

    DEFF Research Database (Denmark)

    Barghadouch, Amina; Carlsson, Jessica; Norredam, Marie

    2018-01-01

    Studies show a high level of mental health problems among refugee children and adults. This study aimed to examine psychiatric disorders among refugee children in early adulthood. A total of 15,264 young adult refugees, who obtained residence permission January 1, 1993 to December 31, 2010, were...... matched 1:6 on age and sex with 99,313 Danish-born children. Rate ratios (RR) of having a first-time in- or outpatient hospital diagnosis with an affective (F30-39), psychotic (F29-30), neurotic (F40-48), or any psychiatric disorder (F00-99) according to ICD-10 were computed. Refugees had higher RRs...... of psychotic (RR: 1.81, 95%CI: 1.41-2.32) and nervous (RR: 1.28, 95% CI: 1.14-1.43) disorders compared with Danish-born children. The RRs of having an affective disorder among refugees was 0.74 (95% CI: 0.60-0.90) compared with Danish-born children. Sex, geographical origin, migrant status, household income...

  20. Cannabis as a substitute for prescription drugs – a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Corroon Jr JM

    2017-05-01

    Full Text Available James M Corroon Jr,1 Laurie K Mischley,2 Michelle Sexton3 1Center for Medical Cannabis Education, Del Mar, CA, 2Bastyr University Research Institute, Kenmore, WA, 3Department of Medical Research, Center for the Study of Cannabis and Social Policy, Seattle, WA, USA Background: The use of medical cannabis is increasing, most commonly for pain, anxiety and depression. Emerging data suggest that use and abuse of prescription drugs may be decreasing in states where medical cannabis is legal. The aim of this study was to survey cannabis users to determine whether they had intentionally substituted cannabis for prescription drugs.Methods: A total of 2,774 individuals were a self-selected convenience sample who reported having used cannabis at least once in the previous 90 days. Subjects were surveyed via an online anonymous questionnaire on cannabis substitution effects. Participants were recruited through social media and cannabis dispensaries in Washington State.Results: A total of 1,248 (46% respondents reported using cannabis as a substitute for prescription drugs. The most common classes of drugs substituted were narcotics/opioids (35.8%, anxiolytics/benzodiazepines (13.6% and antidepressants (12.7%. A total of 2,473 substitutions were reported or approximately two drug substitutions per affirmative respondent. The odds of reporting substituting were 4.59 (95% confidence interval [CI], 3.87–5.43 greater among medical cannabis users compared with non-medical users and 1.66 (95% CI, 1.27–2.16 greater among those reporting use for managing the comorbidities of pain, anxiety and depression. A slightly higher percentage of those who reported substituting resided in states where medical cannabis was legal at the time of the survey (47% vs. 45%, p=0.58, but this difference was not statistically significant.Discussion: These patient-reported outcomes support prior research that individuals are using cannabis as a substitute for prescription drugs

  1. The Gap in Knowledge of Clinical Practice Guidelines by Mental Health Residents in Buenos Aires (Argentina

    Directory of Open Access Journals (Sweden)

    Javier Fabrissin

    2014-05-01

    Full Text Available The aim of this pilot study was to evaluate if the residents of psychiatry and clinical psychology from the city of Buenos Aires knew any of the existing mental health Clinical Practice and Treatment Guidelines (CPTGs. We asked residents their opinion about CPTGs and, also, if they followed their recommendations in clinical practice. We asked 59 mental health residents (28 physicians and 29 psychologists with different years of clinical training to fill a questionnaire to know their opinion about CPTGs and also if they follow the CPTG recommendations in their clinical practice. We found that 79.31% of residents did not know any CPTG. Eighty percent of the residents who did know any CPTG have a positive opinion about CPTGs. Finally, the American Psychiatric Association Guidelines were the most known CPTGs. The authors emphasize the need for a clinical guidelines diffusion policy in Buenos Aires city and particularly as a clinical and training resource for mental health residents.

  2. Prescription History of Emergency Department Patients Prescribed Opioids

    Directory of Open Access Journals (Sweden)

    Jason A Hoppe

    2013-05-01

    Full Text Available Introduction: To use Colorado’s prescription drug monitoring program (PDMP to describe the recent opioid prescription history of patients discharged from our emergency department (ED with a prescription for opioid pain medications.Methods: Retrospective cohort study of 300 adult ED patients who received an opioid prescription. We abstracted prescription histories for the six months prior to the ED visit from the PDMP, and abstracted clinical and demographic variables from the chart.Results: There were 5,379 ED visits during the study month, 3,732 of which were discharged. Providers wrote 1,165 prescriptions for opioid analgesics to 1,124/3,732 (30% of the patients. Median age was 36 years. Thirty-nine percent were male. Patients were 46% Caucasian, 26% African American, 22% Hispanic, 2% Asian and 4% other. These were similar to our overall ED population. There was substantial variability in the number of prescriptions, prescribers and total number of pills. A majority (205/296 of patients had zero or one prescription. The 90th percentile for number of prescriptions was seven, while the 10th percentile was zero. Patients in the highest decile tended to be older, with a higher proportion of Caucasians and females. Patients in the lowest decile resembled the general ED population. The most common diagnoses associated with opioid prescriptions were abdominal pain (11.5%, cold/flu symptoms (9.5%, back pain (5.4%, flank pain (5.0% and motor vehicle crash (4.7%.Conclusion: Substantial variability exists in the opioid prescription histories of ED patients, but a majority received zero or one prescription in the preceding six months. The top decile of patients averaged more than two prescriptions per month over the six months prior to ED visit, written by more than 6 different prescribers. There was a trend toward these patients being older, Caucasian and female. [West J Emerg Med. 2013;14(3:247–252.

  3. Prescription Drug Abuse and Youth. Information Brief.

    Science.gov (United States)

    Department of Justice, Washington, DC. National Drug Intelligence Center.

    Prescription drugs, a category of psychotherapeutics that comprises prescription-type pain relievers, tranquilizers, stimulants, and sedatives, are among the substances most commonly abused by young people in the United States. Prescription drugs are readily available and can easily be obtained by teenagers who abuse these drugs to experience a…

  4. Assessment of legibility and completeness of handwritten and electronic prescriptions.

    Science.gov (United States)

    Albarrak, Ahmed I; Al Rashidi, Eman Abdulrahman; Fatani, Rwaa Kamil; Al Ageel, Shoog Ibrahim; Mohammed, Rafiuddin

    2014-12-01

    To assess the legibility and completeness of handwritten prescriptions and compare with electronic prescription system for medication errors. Prospective study. King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. Handwritten prescriptions were received from clinical units of Medicine Outpatient Department (MOPD), Primary Care Clinic (PCC) and Surgery Outpatient Department (SOPD) whereas electronic prescriptions were collected from the pediatric ward. The handwritten prescription was assessed for completeness by the checklist designed according to the hospital prescription and evaluated for legibility by two pharmacists. The comparison between handwritten and electronic prescription errors was evaluated based on the validated checklist adopted from previous studies. Legibility and completeness of prescriptions. 398 prescriptions (199 handwritten and 199 e-prescriptions) were assessed. About 71 (35.7%) of handwritten and 5 (2.5%) of electronic prescription errors were identified. A significant statistical difference (P prescriptions in omitted dose and omitted route of administration category of error distribution. The rate of completeness in patient identification in handwritten prescriptions was 80.97% in MOPD, 76.36% in PCC and 85.93% in SOPD clinic units. Assessment of medication prescription completeness was 91.48% in MOPD, 88.48% in PCC, and 89.28% in SOPD. This study revealed a high incidence of prescribing errors in handwritten prescriptions. The use of e-prescription system showed a significant decline in the incidence of errors. The legibility of handwritten prescriptions was relatively good whereas the level of completeness was very low.

  5. [Prescription patterns for antilipidemic drugs in a group of Colombian patients].

    Science.gov (United States)

    Machado, Jorge Enrique; Moncada, Juan Carlos; Mesa, Giovanny

    2008-03-01

    To determine patterns in antilipidemic drug prescriptions among a group of patients covered by the General Social Security System (Sistema General de Seguridad Social) in Colombia. A descriptive, observational study was conducted of 41 580 hyperlipidemics of both sexes, who were over 20 years of age, undergoing treatment from at least April to June 2006, and were residents of one of 19 cities in Colombia. A database was created to track prescription data collected by the pharmaceutical company that dispenses medications to the patients. The mean age was 58.4+/-13.5 years; 58.9% of the participants were women. Of the total number of patients, 95.6% were receiving monotherapy, while 4.4% were receiving two or more antilipidemics. Prescriptions were ranked as follows: statins (70.9%), fibrates (27.5%), bile acid sequestrant resins (0.9%), and others (0.7%), all at low dosage levels. The most common therapy combinations were lovastatin + gemfibrozil (n = 1 568), cholestyramine + gemfibrozil (n = 92), and cholestyramine + lovastatin (n = 78). Comedications most frequently prescribed were: antihypertensive (60.9%), antiinflammatory (56.5%), antiulcer (22.9%), and antidiabetes drugs (20.6%), and acetylsalicylic acid (ASA, 3.8%). Antianginals and ASA were being underused, while antiinflamatories and antiulcer drugs were being overused. Dyslipidemia is a primary risk factor for developing coronary heart disease and stroke, frequent causes of morbidity and mortality in Colombia and the world. All of the antilipidemics are being used at lower-than-recommended dosage levels. Clearly there is a need for creating educational strategies to address these prescribing habits and for exploring clinical results of the pharmaceuticals studied.

  6. Using prescription registries to define continuous drug use: how to fill gaps between prescriptions

    DEFF Research Database (Denmark)

    Nielsen, Lars Hougaard; Løkkegaard, Ellen; Andreasen, Anne Helms

    2008-01-01

    Pharmacoepidemiological studies often use prescription registries to assess patients' drug episodes. The databases usually provide information on the date of the redemption of the prescription as well as on the dispensed amount, and this allows us to define episodes of drug use. However, when...... that the retrospective exposure definition introduces an artificially protective effect of HT....

  7. Mental health care in Italy: organisational structure, routine clinical activity and costs of a community psychiatric service in Lombardy region.

    Science.gov (United States)

    Fattore, G; Percudani, M; Pugnoli, C; Contini, A; Beecham, J

    2000-01-01

    The Magenta Community Mental Health Centre (CMHC) is the public agency responsible for providing adult psychiatric care to about 85,000 adult residents. In 1995, it had 1,145 clients and incurred costs of Euro 1.9 millions. Average cost per patient and per adult resident were Euro 1,661 and Euro 22.2, respectively. These values mask large variation across diagnosis: while patients with schizophrenia and related disorders had an average cost of Euro 3,771, those with neurotic and related disorders had an average cost of Euro 439. Patients with schizophrenia and related disorders (28% of the patients) absorbed about 60% of total costs and made extensive use of several types of services (hospital, outpatient, domiciliary, social and rehabilitative care). Since integrating different types of services is the key element of Italian psychiatric care, the new fee-for-service system adopted by the NHS to fund providers does not appear appropriate, particularly for schizophrenic patients.

  8. Opioid Prescriptions by Specialty in Ohio, 2010-2014.

    Science.gov (United States)

    Weiner, Scott G; Baker, Olesya; Rodgers, Ann F; Garner, Chad; Nelson, Lewis S; Kreiner, Peter W; Schuur, Jeremiah D

    2018-05-01

    The current US opioid epidemic is attributed to the large volume of prescribed opioids. This study analyzed the contribution of different medical specialties to overall opioids by evaluating the pill counts and morphine milligram equivalents (MMEs) of opioid prescriptions, stratified by provider specialty, and determined temporal trends. This was an analysis of the Ohio prescription drug monitoring program database, which captures scheduled medication prescriptions filled in the state as well as prescriber specialty. We extracted prescriptions for pill versions of opioids written in the calendar years 2010 to 2014. The main outcomes were the number of filled prescriptions, pill counts, MMEs, and extended-released opioids written by physicians in each specialty, and annual prescribing trends. There were 56,873,719 prescriptions for the studied opioids dispensed, for which 41,959,581 (73.8%) had prescriber specialty type available. Mean number of pills per prescription and MMEs were highest for physical medicine/rehabilitation (PM&R; 91.2 pills, 1,532 mg, N = 1,680,579), anesthesiology/pain (89.3 pills, 1,484 mg, N = 3,261,449), hematology/oncology (88.2 pills, 1,534 mg, N = 516,596), and neurology (84.4 pills, 1,230 mg, N = 573,389). Family medicine (21.8%) and internal medicine (17.6%) wrote the most opioid prescriptions overall. Time trends in the average number of pills and MMEs per prescription also varied depending on specialty. The numbers of pills and MMEs per opioid prescription vary markedly by prescriber specialty, as do trends in prescribing characteristics. Pill count and MME values define each specialty's contribution to overall opioid prescribing more accurately than the number of prescriptions alone.

  9. Abuse of prescription drugs.

    Science.gov (United States)

    Wilford, B B

    1990-01-01

    An estimated 3% of the United States population deliberately misuse or abuse psychoactive medications, with severe consequences. According to the National Institute on Drug Abuse, more than half of patients who sought treatment or died of drug-related medical problems in 1989 were abusing prescription drugs. Physicians who contribute to this problem have been described by the American Medical Association as dishonest--willfully misprescribing for purposes of abuse, usually for profit; disabled by personal problems with drugs or alcohol; dated in their knowledge of current pharmacology or therapeutics; or deceived by various patient-initiated fraudulent approaches. Even physicians who do not meet any of these descriptions must guard against contributing to prescription drug abuse through injudicious prescribing, inadequate safeguarding of prescription forms or drug supplies, or acquiescing to the demands or ruses used to obtain drugs for other than medical purposes. PMID:2349801

  10. [Extension of psychotherapeutic activities within a psychiatric ward and the team's occupational background].

    Science.gov (United States)

    Antikainen, R

    1991-01-01

    The importance of democratizing the therapeutic process in a psychiatric ward has been emphasized by Hägglund and Pylkkänen (1980). In spite of different levels of training extensive participating of the team members in performing individual psychotherapy promotes the unity of the therapeutic views of the staff. It prevents the formation of antitherapeutic staff groups. The subjective outcome of the treatment on a psychiatric open ward was examined using a questionnaire to patients. All those patients (N = 55) were selected who during a two years' research period stayed at least three weeks on the ward. Three subsamples were formed according to the therapist's occupation: a. patients of registered psychiatric nurses, b. patients of assistant psychiatric nurses and c. patients of residents, psychologists and social workers. There were no significant differences in the evaluations of the general treatment outcome between these three groups. Instead, the occupational background correlated with the patient's evaluation of the importance of the personal therapeutic relationship. The therapeutic relationship with a registered psychiatric nurse or with an assistant psychiatric nurse was significantly more often evaluated to be very or rather important at the end of the treatment than a relationship with a member of the group c. It was concluded that the goal to delegate the psychotherapeutic activities to the whole staff had been achieved quite well. The patients did not devaluate therapeutic relationships with staff members from a lower level of occupational training, on the contrary. The "non academic" personnel had established good contact with their patients. These observations support the views proposed by Hägglund and Pylkkänen (1980). Individual therapy should not be separated from the therapeutic community and the staff should not be divided into therapists and non-therapists.

  11. Urinalysis requests on the elderly residing in the Auckland community: tick box requesting?

    Science.gov (United States)

    Upton, Arlo; McEwan, M; Williamson, Deborah

    2016-01-29

    Urinalysis for microscopy and culture is one of the most frequently requested tests for microbiology laboratories, particularly from elderly patients. This study sought to describe the clinical appropriateness of urinalysis from community-dwelling elderly patients and subsequent antibiotic prescription. Demographic, laboratory, and antibiotic prescription data were collected on all samples submitted from patients ≥ 70 years during August 2014 to Labtests Auckland. In addition, clinical data were collected by questionnaire from a subgroup of 200 patients. During August 2014, approximately 7% of the Auckland population aged ≥ 70 years had urinalysis submitted. Urine dipstick was not routinely performed before specimen submission, particularly from patients living at home rather than a long-term care facility, and nearly 50% of samples were not cultured due to absence of pyuria. Escherichia coli was isolated from 23% of female and 7% of male specimens. E. coli isolates from our cohort were less susceptible to all antibiotics tested against compared with all E. coli isolated from all urines in 2014. Clinical indications were absent in 40% of the subgroup of patients. Antibiotic prescription within 7 days of urinalysis was common (36%). This study highlights the frequency of urinalysis testing among the elderly residing in the community. Clinical indications are often absent, and treatment of asymptomatic bacteriuria is likely to be contributing to excessive antibiotic prescription in this group of patients.

  12. 21 CFR 886.5844 - Prescription spectacle lens.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Prescription spectacle lens. 886.5844 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Therapeutic Devices § 886.5844 Prescription spectacle lens. (a) Identification. A prescription spectacle lens is a glass or plastic device that is a lens intended to be worn by...

  13. 21 CFR 202.1 - Prescription-drug advertisements.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Prescription-drug advertisements. 202.1 Section 202.1 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL PRESCRIPTION DRUG ADVERTISING § 202.1 Prescription-drug advertisements. (e) * * * (6) * * * (ii) Represents or suggests that a...

  14. Assessment of prescription sales in Ukraine

    Directory of Open Access Journals (Sweden)

    N. V. Teterich

    2013-10-01

    Full Text Available Currently, the state of the national health system (health is characterized by a low level of funding for medical and pharmaceutical care and the lack of effective methods of free and preferential dispensing of medicines (drugs and compensation of their value. Thus the most urgent problem arises is unregulated drugs prescription, which is one of the main negative factors behind the rapid spread of self-medication and polypragmasy. Thus, improving drugs prescription dispensing is one of the current challenges of medicine and pharmacy management which should be solved to provide a safe, rational and effective drug therapy. The results of the questionnaire survey of doctors and pharmaceutical workers identified and explored key factors that contribute to a violation of drugs prescription. The authors analyzed the literature on the current state of drugs prescription in Ukraine, which resulted in selected priority issues that need resolution as soon as possible. Established that the main disadvantages of the national health care system is unreasonable approach to state regulation of the relevant system and the low level of funding. This situation prevents rational regulation of free and preferential delivery of drugs, the introduction of obligatory medical insurance and the reimbursement cost of drugs and other modern approaches that are effective in developed countries. Тhe main motive of view of legislative acts to implement strict drugs prescription in Ukraine is a link to international experience, guided by the standards of European and international practices that do not comply with the Law of Ukraine issued on 18.03.2004 № 1629-IV «On the National Program for Adaptation of Ukraine to the European Union, "and points to the disparity modern domestic rule-making European practice. The fundamental problem here is the comparison of the legal, social, financial and economic status of the counter in Ukraine with the countries in which the system

  15. Psychiatric specialty training in Greece.

    Science.gov (United States)

    Margariti, M; Kontaxakis, V; Ploumpidis, D

    2017-01-01

    specialty, the European Board of Psychiatry. In the US, the supervising bodies are the Accreditation Council on Graduate Medical Education (ACGME) and the American Board of Psychiatry and Neurology, in the United Kingdom the Royal College of Psychiatrists, in Canada the Royal College of Physicians and Surgeons, etc. In our country, the debate on the need to reform the institutional framework for Psychiatric training has been underway since the mid-90s, with initiatives especially by the Hellenic Psychiatric Association, aiming to raise awareness and concern among psychiatrists while responding to requests from competent central bodies of the state, as well as establishing Panhellenic training programs for psychiatric trainees and continuing education programs. But what is the situation of the educational map in the country today, what would be the objectives, and how might we proceed? These questions we will try to answer in an effort initiated by Hellenic Psychiatric Association (HPA) and the journal "Psychiatriki" with the publication of thematic articles starting by presenting in the next issue of "Psychiatriki"a comparative study of the training in the specialty of psychiatry at two distinct periods of time (2000 and 2014). These time-frames are of great importance, since the first is a period that in retrospect can be considered as wealthier yet missing robust priorities, while the second, at the peak of the economic crisis, constitutes a difficult environment with limited resources. Already in the year 2000, psychiatric residency training in our country had major difficulties due to its outdated framework and its fragmentation. All areas in which training is assessed (clinical experience, theoretical training and training in psychotherapy exhibited inadequacies and limited convergence with European golden standards, in the absence of a plan and the implementation of a national education curriculum. Certain university clinics constituted an important exception, though

  16. Mobbing Exposure of Anaesthesiology Residents in Turkey.

    Science.gov (United States)

    Aykut, Gülnihal; Efe, Esra Mercanoğlu; Bayraktar, Selcan; Şentürk, Sinem; Başeğmez, İrem; Özkumit, Özlem; Kabak, Elmas; Yavaşçaoğlu, Belgin; Bilgin, Hülya

    2016-08-01

    In recent years, psychological problems that are caused by working conditions, like burn out syndrome, are more commonly observed. In our study, we aimed to evaluate mobbing exposure, factors causing mobbing and precautions for mobbing in residency students who are educated in anaesthesiology and reanimation clinics in Turkey. After obtaining consent from the ethics committee, we sent our questionnaires to the secretariats of the departments by postal mail. Completed questionnaires were collected in our department's secretariat blindly and randomly mixed. One hundred and one participants were returned the questionnaires. Data was statistically analysed in SPSS 21.0 software programme. During residency programme, sated to have experienced mobbing one or more time. Interestingly, 5.9% participants complained of physical mobbing. Mobbing exposure was more common in females. The most serious new onset psychosomatic symptoms stated during residency were committing suicide (2%), addiction (16%), severe depression (18%), panic attack (8%), more accidents (7%) and tendency of violence (15%). In mobbing group there was statistically significant dissatisfaction rate. In professions where mobbing is common, incidences of psychiatric diseases and suicide attempts are high are increased. Who are under risk for experiencing mobbing should be noticed carefully to ensure good judgement and problems should be inspected objectively in a detailed manner. Anesthesiology societies and other medical professional societies should establish mobbing committees. Thus, mobbing problems can be resolved and healthy career oppurtunities can be presented to residents.

  17. Drug prescriptions in Danish out-of-hours primary care

    DEFF Research Database (Denmark)

    Christensen, Morten Bondo; Nørøxe, Karen Busk; Moth, Grete

    2016-01-01

    of prescriptions per 100 contacts. RESULTS: Of 644,777 contacts, 154,668 (24.0%) involved medication prescriptions; 21.9% of telephone consultations, 32.9% of clinic consultations and 14.3% of home visits. Around 53% of all drug prescriptions were made in telephone consultations. Anti-infective medications...... for systemic use accounted for 45.5% of all prescriptions and were the most frequently prescribed drug group for all contact types, although accounting for less than 1/3 of telephone prescriptions. Other frequently prescribed drugs were ophthalmological anti-infectives (10.5%), NSAIDs (6.4%), opioids (3......) primary care services cover more than 75% of all hours during a normal week, insight into the extent and type of OOH drug prescription is important. General practitioners (GPs) are responsible for more than 80% of all drug prescriptions in Denmark. Of all contacts 24.0% involved medication prescriptions...

  18. Prescription Stimulants Are "A Okay": Applying Neutralization Theory to College Students' Nonmedical Prescription Stimulant Use

    Science.gov (United States)

    Cutler, Kristin A.

    2014-01-01

    Objective: National college health data indicate that prescription stimulants are the most widely misused prescription drugs among college students, with 9% admitting to nonmedical use within the past year. Although motivations for the nonmedical use of these drugs have been explored, scant attention has been paid to justifications for nonmedical…

  19. Overcoming Recruitment Barriers in Urban Older Adults Residing in Congregate Living Facilities

    Directory of Open Access Journals (Sweden)

    Adam Simning

    2015-01-01

    Full Text Available Background. Participation of minority older adults in mental health research has been limited by mistrust, transportation difficulties, lack of knowledge, and insufficient community partnership. We describe strategies utilized to overcome these recruitment barriers. Methods. Our target population included 553 public housing residents of older adult high-rise buildings in Rochester, NY. We had a two-stage cross-sectional study: Stage 1 was a health survey for all residents and Stage 2 was a psychiatric interview of English-speaking residents aged 60 years and older. Recruitment occurred through mailings, onsite activities, and resident referrals. Results. Stage 1 had 358 participants (64.7% response and Stage 2 had 190 (61.6% target population response, with higher participation among African Americans. We found some strategies effective for overcoming recruitment barriers. First, we partnered with a community agency and organized onsite educational activities to improve residents’ trust. Second, the study occurred entirely onsite, which facilitated participation of functionally impaired residents. Third, onsite activities allowed the residents to learn about the study and complete surveys in person. Fourth, we provided immediate incentives that resulted in many study referrals. Conclusions. Although recruitment of minority older adults presents unique challenges, a multifaceted community-tailored approach mitigated several recruitment barriers in this mental health study.

  20. Direct-to-Consumer Prescription Drug Advertising and the Public

    Science.gov (United States)

    Bell, Robert A; Kravitz, Richard L; Wilkes, Michael S

    1999-01-01

    OBJECTIVE Drug manufacturers are intensely promoting their products directly to consumers, but the impact has not been widely studied. Consumers' awareness and understanding of, attitudes toward, and susceptibility to direct-to-consumer (DTC) drug advertising were examined. DESIGN Random-digit dialing telephone survey with a random household member selection procedure (completion and response rates, 58% and 69%, respectively). SETTING Respondents were interviewed while they were at their residences. PARTICIPANTS Complete data were obtained from 329 adults in Sacramento County, California. MEASUREMENTS AND MAIN RESULTS Outcome measures included awareness of advertisements for 10 selected drugs, misconceptions about DTC advertising, attitudes toward DTC ads, and behavioral responses to such promotions. The influence of demographic characteristics, health status, attitudes, beliefs, and media exposure on awareness and behaviors was examined. On average, respondents were aware of advertisements for 3.7 of the 10 drugs; awareness varied from 8% for Buspar (buspirone) to 72% for Claritin (loratadine). Awareness was associated with prescription drug use, media exposure, positive attitudes toward DTC advertising, poorer health, and insurance status. Substantial misconceptions were revealed; e.g., 43% thought that only “completely safe” drugs could be advertised. Direct-to-consumer advertisements had led one third of respondents to ask their physicians for drug information and one fifth to request a prescription. CONCLUSIONS Direct-to-consumer advertisements are reaching the public, but selectively so, and affecting their behaviors. Implications for public policy are examined. PMID:10571712

  1. Effect of Promotional Strategies of Pharmaceutical Companies on Doctors' Prescription Pattern in South East Nigeria

    Directory of Open Access Journals (Sweden)

    Linus Onah

    2010-02-01

    Full Text Available AIM: Drug promotions use multifaceted approaches incorporating hospital and office detailing by marketing representatives. Very few studies exist on their influence on doctors’ prescription pattern in Nigeria. We examined the scope and effects of marketing strategies on the prescription habits of doctors in Enugu, South East Nigeria. METHOD: This was a cross-sectional study; 210 self-administered structured questionnaires were distributed among doctors in six major hospitals in Enugu. Ethical approval was obtained from the University of Nigeria Teaching Hospital Ethics Committee, Enugu. RESULTS: There was 88% response rate, with more males than females (M:F= 2.2: 1. Most were residents-in-training/ house officers (69% while consultants were 7.1% of the group. Stickers, drug presentations/ launches and personal souvenirs were most commonly employed marketing strategies. Most doctors (60% attending a drug presentation felt influenced. While 87.5% appreciated the benefits of marketing strategies, about 70% would consider patients’ socioeconomic status before prescribing. Continuing medical education and stiff competition were reasons adduced for the marketing strategies. CONCLUSION: Pharmaceutical companies in Nigeria adopt varied strategies to influence doctors’ prescriptions. Often this aim is achieved. The practice is accepted by most who nevertheless will consider other factors when deciding on what to prescribe. [TAF Prev Med Bull 2010; 9(1.000: 1-6

  2. Migraine and its psychiatric comorbidities.

    Science.gov (United States)

    Minen, Mia Tova; Begasse De Dhaem, Olivia; Kroon Van Diest, Ashley; Powers, Scott; Schwedt, Todd J; Lipton, Richard; Silbersweig, David

    2016-07-01

    Migraine is a highly prevalent and disabling neurological disorder associated with a wide range of psychiatric comorbidities. In this manuscript, we provide an overview of the link between migraine and several comorbid psychiatric disorders, including depression, anxiety and post-traumatic stress disorder. We present data on psychiatric risk factors for migraine chronification. We discuss the evidence, theories and methods, such as brain functional imaging, to explain the pathophysiological links between migraine and psychiatric disorders. Finally, we provide an overview of the treatment considerations for treating migraine with psychiatric comorbidities. In conclusion, a review of the literature demonstrates the wide variety of psychiatric comorbidities with migraine. However, more research is needed to elucidate the neurocircuitry underlying the association between migraine and the comorbid psychiatric conditions and to determine the most effective treatment for migraine with psychiatric comorbidity. 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. Alcohol and Nonmedical Prescription Drug Use to Cope With Posttraumatic Stress Disorder Symptoms: An Analysis of Hurricane Sandy Survivors.

    Science.gov (United States)

    Lowe, Sarah R; Sampson, Laura; Young, Megan N; Galea, Sandro

    2017-08-24

    Postdisaster increases in substance use have been attributed to use of substances to cope with emotional reactions. However, no study to our knowledge has explored disaster survivors' substance use to cope with posttraumatic stress disorder (PTSD) symptoms. We investigated the prevalence and correlates of alcohol use and nonmedical prescription drug use (NMPDU) to cope with PTSD symptoms in two population-based samples of adult residents of New York City neighborhoods affected by Hurricane Sandy. Participants completed structured interviews at either 13-16 or 25-28 months postdisaster (combined N = 914). Participants with PTSD symptoms, assessed via the Posttraumatic Stress Checklist for DSM-5, indicated whether they coped with their symptoms through alcohol use or NMPDU, via items adapted from the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression models explored correlates of substance use coping, including demographic characteristics, lifetime and hurricane-related exposures, and psychiatric symptoms in the combined sample. Over a third of participants in the combined sample (n = 311, 34.0%) reported PTSD symptoms, and of these, 12.8% used alcohol to cope and 9.2% endorsed NMPDU to cope. Older age and being a parent living with a child under 18 years old at the time of the hurricane were associated with a lower likelihood, and more severe depression symptoms with a higher likelihood, of alcohol use coping. Conclusions/Importance: Although preliminary, the results provide evidence for the use of substances to cope with postdisaster PTSD symptoms, and that age, parent status, and depression symptoms are associated with alcohol use coping.

  4. A Prescription Survey from Sri Lanka

    African Journals Online (AJOL)

    adherence to standard guidelines on the layout and content of prescriptions. Method: A ... Conclusion: Prescription errors are common in outpatient settings of Aluthgama and Kandy areas in .... qualification of the prescriber was present, it was.

  5. Unintentional prescription opioid-related overdose deaths: description of decedents by next of kin or best contact, Utah, 2008-2009.

    Science.gov (United States)

    Johnson, Erin M; Lanier, William A; Merrill, Ray M; Crook, Jacob; Porucznik, Christina A; Rolfs, Robert T; Sauer, Brian

    2013-04-01

    Little is known about the characteristics that may predispose an individual to being at risk for fatal overdose from prescription opioids. To identify characteristics related to unintentional prescription opioid overdose deaths in Utah. Interviews were conducted (October 2008-October 2009) with a relative or friend most knowledgeable about the decedent's life. Analyses involved 254 decedents aged 18 or older, where cause of death included overdose on at least one prescription opioid. Decedents were more likely to be middle-aged, Caucasian, non-Hispanic/Latino, less educated, not married, or reside in rural areas than the general adult population in Utah. In the year prior to death, 87.4 % were prescribed prescription pain medication. Reported potential misuse prescription pain medication in the year prior to their death was high (e.g., taken more often than prescribed [52.9 %], obtained from more than one doctor during the previous year [31.6 %], and used for reasons other than treating pain [29.8 %, almost half of which "to get high"]). Compared with the general population, decedents were more likely to experience financial problems, unemployment, physical disability, mental illness (primarily depression), and to smoke cigarettes, drink alcohol, and use illicit drugs. The primary source of prescription pain medication was from a healthcare provider (91.8 %), but other sources (not mutually exclusive) included: for free from a friend or relative (24 %); from someone without their knowledge (18.2 %); purchase from a friend, relative, or acquaintance (16.4 %); and purchase from a dealer (not a pharmacy) (11.6 %). The large majority of decedents were prescribed opioids for management of chronic pain and many exhibited behaviors indicative of prescribed medication misuse. Financial problems, unemployment, physical disability, depression, and substance use (including illegal drugs) were also common.

  6. Cannabis as a substitute for prescription drugs – a cross-sectional study

    Science.gov (United States)

    Corroon, James M; Mischley, Laurie K; Sexton, Michelle

    2017-01-01

    Background The use of medical cannabis is increasing, most commonly for pain, anxiety and depression. Emerging data suggest that use and abuse of prescription drugs may be decreasing in states where medical cannabis is legal. The aim of this study was to survey cannabis users to determine whether they had intentionally substituted cannabis for prescription drugs. Methods A total of 2,774 individuals were a self-selected convenience sample who reported having used cannabis at least once in the previous 90 days. Subjects were surveyed via an online anonymous questionnaire on cannabis substitution effects. Participants were recruited through social media and cannabis dispensaries in Washington State. Results A total of 1,248 (46%) respondents reported using cannabis as a substitute for prescription drugs. The most common classes of drugs substituted were narcotics/opioids (35.8%), anxiolytics/benzodiazepines (13.6%) and antidepressants (12.7%). A total of 2,473 substitutions were reported or approximately two drug substitutions per affirmative respondent. The odds of reporting substituting were 4.59 (95% confidence interval [CI], 3.87–5.43) greater among medical cannabis users compared with non-medical users and 1.66 (95% CI, 1.27–2.16) greater among those reporting use for managing the comorbidities of pain, anxiety and depression. A slightly higher percentage of those who reported substituting resided in states where medical cannabis was legal at the time of the survey (47% vs. 45%, p=0.58), but this difference was not statistically significant. Discussion These patient-reported outcomes support prior research that individuals are using cannabis as a substitute for prescription drugs, particularly, narcotics/opioids, and independent of whether they identify themselves as medical or non-medical users. This is especially true if they suffer from pain, anxiety and depression. Additionally, this study suggests that state laws allowing access to, and use of, medical

  7. Reasons for job separations in a cohort of workers with psychiatric disabilities.

    Science.gov (United States)

    Cook, Judith A; Burke-Miller, Jane K

    2015-01-01

    We explored the relative effects of adverse working conditions, job satisfaction, wages, worker characteristics, and local labor markets in explaining voluntary job separations (quits) among employed workers with psychiatric disabilities. Data come from the Employment Intervention Demonstration Program in which 2,086 jobs were ended by 892 workers during a 24 mo observation period. Stepped multivariable logistic regression analysis examined the effect of variables on the likelihood of quitting. Over half (59%) of all job separations were voluntary while 41% were involuntary, including firings (17%), temporary job endings (14%), and layoffs (10%). In multivariable analysis, workers were more likely to quit positions at which they were employed for 20 h/wk or less, those with which they were dissatisfied, low-wage jobs, non-temporary positions, and jobs in the structural (construction) occupations. Voluntary separation was less likely for older workers, members of racial and ethnic minority groups, and those residing in regions with lower unemployment rates. Patterns of job separations for workers with psychiatric disabilities mirrored some findings regarding job leaving in the general labor force but contradicted others. Job separation antecedents reflect the concentration of jobs for workers with psychiatric disabilities in the secondary labor market, characterized by low-salaried, temporary, and part-time employment.

  8. Clinical Use of Mood Stabilizers With Antidepressants in Asia: Report From the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) Projects in 2004 and 2013.

    Science.gov (United States)

    Rajaratnam, Kamini; Xiang, Yu-Tao; Tripathi, Adarsh; Chiu, Helen F K; Si, Tian-Mei; Chee, Kok-Yoon; Avasthi, Ajit; Grover, Sandeep; Chong, Mian-Yoon; Kuga, Hironori; Kanba, Shigenobu; He, Yan-Ling; Lee, Min-Soo; Yang, Shu-Yu; Udomratn, Pichet; Kallivayalil, Roy A; Tanra, Andi J; Maramis, Margarita M; Shen, Winston W; Sartorius, Norman; Kua, Ee-Heok; Tan, Chay-Hoon; Mahendran, Rathi; Shinfuku, Naotaka; Sum, Min Yi; Baldessarini, Ross J; Sim, Kang

    2017-04-01

    As most reports concerning treatment with combinations of mood stabilizer (MS) with antidepressant (AD) drugs are based in the West, we surveyed characteristics of such cotreatment in 42 sites caring for the mentally ill in 10 Asian countries. This cross-sectional, pharmacoepidemiologic study used 2004 and 2013 data from the REAP-AD (Research Study on Asian Psychotropic Prescription Patterns for Antidepressants) to evaluate the rates and doses of MSs given with ADs and associated factors in 4164 psychiatric patients, using standard bivariate methods followed by multivariable logistic regression modeling. Use of MS + AD increased by 104% (5.5% to 11.2%) between 2004 and 2013 and was much more associated with diagnosis of bipolar disorder than major depression or anxiety disorder, as well as with hospitalization > outpatient care, psychiatric > general-medical programs, and young age (all P contemporary use of MSs with ADs in Asia, support predictions that such treatment increased in recent years, and was associated with diagnosis of bipolar disorder, treatment in inpatient and psychiatric settings, and younger age.

  9. Reasons for psychiatric consultation referrals in Dutch nursing home patients with dementia: a comparison with normative data on prevalence of neuropsychiatric symptoms.

    NARCIS (Netherlands)

    Kat, M.G.; Zuidema, S.U.; Ploeg, T. van der; Kalisvaart, K.J.; Gool, W.A. van; Eikelenboom, P.; Jonghe, J.F. de

    2008-01-01

    OBJECTIVE: To study psychiatric consultation referrals of nursing home patients with dementia and to compare referral reasons with normative data on prevalence of neuropsychiatric symptoms. METHODS: This is part of a cross-sectional study of 787 patients residing in 14 nursing homes in the

  10. Reasons for psychiatric consultation referrals in Dutch nursing home patients with dementia: a comparison with normative data on prevalence of neuropsychiatric symptoms

    NARCIS (Netherlands)

    Kat, Martin G.; Zuidema, Sytse U.; van der Ploeg, Tjeerd; Kalisvaart, Kees J.; van Gool, Willem A.; Eikelenboom, Piet; de Jonghe, Jos F. M.

    2008-01-01

    Objective To study psychiatric consultation referrals of nursing home patients with dementia and to compare referral reasons with normative data on prevalence of neuropsychiatric symptoms. Methods This is part of a cross-sectional study of 787 patients residing in 14 nursing homes in the

  11. Reasons for psychiatric consultation referrals in Dutch nursing home patients with dementia: a comparison with normative data on prevalence of neuropsychiatric symptoms

    NARCIS (Netherlands)

    Kat, M.G.; Zuidema, S.U.; van der Ploeg, T.; Kalisvaart, K.J.; van Gool, W.A.; Eikelenboom, P.; de Jonghe, J.F.M.

    2008-01-01

    Objective: To study psychiatric consultation referrals of nursing home patients with dementia and to compare referral reasons with normative data on prevalence of neuropsychiatric symptoms. Methods: This is part of a cross-sectional study of 787 patients residing in 14 nursing homes in the

  12. Psychological Factors Associated with Emotional Distress among Palestinian Arabs from East Jerusalem Accessing Psychiatric Care in Israel.

    Science.gov (United States)

    Nakash, Ora; Nagar, Maayan; Levav, Itzhak; Danilovich, Eli; Abu-Tair, Mamoun; Podolsky, Grigory

    2016-01-01

    The Palestinian population residing in East Jerusalem is characterized by high rates of poverty and unemployment and is subject to discrimination in various forms, including infrastructure of mental health services. Little is known about the help seeking needs and practices of East Jerusalem residents. We examined socio-demographic and clinical characteristics of a consecutive sample Palestinian residents from East Jerusalem (N=50) who accessed a specially assigned psychiatric clinic in Israel. In addition, we examined the psychological factors associated with emotional distress among these service-users upon entry to care. Participants completed a survey in Arabic that included a socio-demographic questionnaire and measures assessing emotional distress, perceived exposure to discrimination and social support, and mental health stigma. Participants reported high levels of emotional distress. Female gender, low socioeconomic status, higher perceived exposure to discrimination and higher perceived social support were associated with increased emotional distress. Findings add to the scarce body of knowledge on specific mental health characteristics of East Jerusalem Palestinian residents.

  13. A smart-card-enabled privacy preserving E-prescription system.

    Science.gov (United States)

    Yang, Yanjiang; Han, Xiaoxi; Bao, Feng; Deng, Robert H

    2004-03-01

    Within the overall context of protection of health care information, privacy of prescription data needs special treatment. First, the involvement of diverse parties, especially nonmedical parties in the process of drug prescription complicates the protection of prescription data. Second, both patients and doctors have privacy stakes in prescription, and their privacy should be equally protected. Third, the following facts determine that prescription should not be processed in a truly anonymous manner: certain involved parties conduct useful research on the basis of aggregation of prescription data that are linkable with respect to either the patients or the doctors; prescription data has to be identifiable in some extreme circumstances, e.g., under the court order for inspection and assign liability. In this paper, we propose an e-prescription system to address issues pertaining to the privacy protection in the process of drug prescription. In our system, patients' smart cards play an important role. For one thing, the smart cards are implemented to be portable repositories carrying up-to-date personal medical records and insurance information, providing doctors instant data access crucial to the process of diagnosis and prescription. For the other, with the secret signing key being stored inside, the smart card enables the patient to sign electronically the prescription pad, declaring his acceptance of the prescription. To make the system more realistic, we identify the needs for a patient to delegate his signing capability to other people so as to protect the privacy of information housed on his card. A strong proxy signature scheme achieving technologically mutual agreements on the delegation is proposed to implement the delegation functionality.

  14. Prosthesis Prescription Protocol of the Arm (PPP-Arm) : The implementation of a national prosthesis prescription protocol

    NARCIS (Netherlands)

    Wijdenes, Paula; Brouwers, Michael; van der Sluis, Corry K

    BACKGROUND AND AIM: In order to create more uniformity in the prescription of upper limb prostheses by Dutch rehabilitation teams, the development and implementation of a Prosthesis Prescription Protocol of the upper limb (PPP-Arm) was initiated. The aim was to create a national digital protocol to

  15. An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions

    OpenAIRE

    Islam, M Mofizul; McRae, Ian S

    2014-01-01

    Background In an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriat...

  16. An Epidemiological Study of Psychiatric Disorders in Lorestan Province (Year 2001

    Directory of Open Access Journals (Sweden)

    mohammad reza Mohammadi

    2004-01-01

    Findings: The results of the study showed that the prevalence of psychiatric disorders in the province was 19.05 percent, which was 23.81 percent in the women, and 14.29 percent in the men. The anxiety and mood disorders with 12.46 and 3.48 percent had the higher prevalence in the province respectively. The prevalence of psychotic disorders in this study was 1.48 percent, neuro-cognitive disorders were 1.47 percent and dissociative disorders 0.18 percent. In the group of mood disorders, major depression with 2.20 percent and in the group of anxiety disorders, generalized anxiety disorder with 5.68 percent had the higher prevalence. Conclusion: This study showed that 11.36 percent of individuals that studied suffered from minimum one of the psychiatric disorders. The prevalence of psychiatric disorders in the province among the individuals in the age group of 26-40 with 14.57 percent, divorced or separated individuals with 25 percent, residents of Khorramabad city 14.85 percent, higher educated individuals 19.51 percent and retired individuals 18.75 percent was more than other individuals in the sample. Being aware of this matter reveals the responsibility of the health policy makers and programmers, prevention, treatment and medical education more than before in relation to preparing application and executive plans in Lorestan province for mental health.

  17. Getting to know the person behind the illness - the significance of interacting with patients hospitalised in forensic psychiatric settings.

    Science.gov (United States)

    Salzmann-Erikson, Martin; Rydlo, Cecilia; Wiklund Gustin, Lena

    2016-05-01

    To describe what nurses want to accomplish in relationships with patients who are hospitalised in forensic psychiatric settings. Relationships between staff and patients in forensic psychiatric settings should be grounded in trust and confidence, and the patients need opportunities for emotional reconciliation. However, relationships can be challenging for nurses, who sometimes distance themselves from patients' expressions of suffering. The role of forensic mental health nurses is nebulous, as are the prescriptives and the implementation of nursing practices. Qualitative descriptive design. In-depth interviews with five nurses who all work in forensic psychiatric settings. We present a descriptive analysis of what nurses want to accomplish in relationships with patients who are hospitalised in forensic psychiatric settings. The results are presented in two main categories: (1) getting to know the person behind the illness and (2) making a difference. Care in forensic psychiatry needs to shift towards a more long-term view of the role of nursing, focusing less on the traditional and stereotypical identity of the productive nurse and more on the care given when nurses slow down and take the time to see the patients as individuals. Establishing trusting relationships with patients in forensic psychiatric settings is viewed as a less oppressive way to control patients and guide them in directions that are preferable for the nurses and for the society. Nurses may use simple strategies in their daily practice such as sitting on the sofa with patients to establish trust. We stress that nurses should abandon policing roles and custodial activities in favour of guiding principles that promote individual recovery, treatment and health-promoting care. © 2016 John Wiley & Sons Ltd.

  18. New possibility of traditional Chinese and Japanese medicine as treatment for behavioral and psychiatric symptoms in dementia

    Directory of Open Access Journals (Sweden)

    Kung FC

    2012-10-01

    Full Text Available Fan-Chin Kung,1 Ryouhei Ishii,2 Hsing-Cheng Liu,3 Masatoshi Takeda21Yuli Hospital, DOH, Hualien, Taiwan; 2Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan; 3Department of General Psychiatry, Taipei City Psychiatric Center, Taipei, TaiwanAbstract: Yokukansan, one of the Kampo prescriptions, is composed of seven herbaceous plants and was developed in China in the 16th century as a cure for restlessness and agitation in children. Yokukansan has also become a popular drug combination in Japan, especially for the behavioral and psychiatric symptoms of dementia (BPSD. Recent studies have shown that yokukansan might also be quite effective against BPSD occurring in association with other types of dementia, such as Alzheimer's disease, Lewy body disease, Parkinson's disease with dementia, frontotemporal dementia, and vascular dementia. Researchers have intensively investigated yokukansan, focusing on the pharmacological mechanisms against glutamate-mediated excitotoxicity. This traditional Chinese and Japanese medicine holds potential promise for improving BPSD in elderly patients suffering from dementia.Keywords: yokukansan, dementia, Alzheimer's disease, behavioral and psychological symptoms of dementia, Kampo, glutamate

  19. Community child psychiatric medication experiences measured by an internet-based, prospective parent survey of retail pharmacy customers.

    Science.gov (United States)

    Hilt, Robert; Wolf, Christine; Koprowicz, Kent; Thomas, Elizabeth; Chandler, Mary; Hao, Xiao Lei; Russell, Matthew; Le, Tung; Hooks, Lee; King, Bryan

    2014-02-01

    One thousand five hundred parents filling a psychiatric prescription for their 6-18 year old child with a multi-state retail pharmacy chain received a single mailed invitation to complete a detailed online survey. 276 parents responded (18.4%). 60% of children on medications had a parent rated CBCL scale score in the clinically significant range at enrollment (T score ≥65), with a similar frequency of clinically significant CBCL scores through 15 months of survey followup. 47% of medication regimens were noted to be causing persistent side effects. This simple community based data collection method can offer a unique way to investigate naturalistic treatment outcomes.

  20. The use of psychoactive prescription drugs among DUI suspects.

    Science.gov (United States)

    Karjalainen, Karoliina; Haukka, Jari; Lintonen, Tomi; Joukamaa, Matti; Lillsunde, Pirjo

    2015-10-01

    The study seeks to increase understanding of the use of psychoactive prescription drugs among persons suspected of driving under the influence (DUI). We studied whether the use of prescribed psychoactive medication was associated with DUI, and examined the difference in the use of prescription drugs between DUI recidivists and those arrested only once. In this register-based study, persons suspected of DUI (n=29470) were drawn from the Register of DUI suspects, and an age- and gender-matched reference population (n=30043) was drawn from the Finnish general population. Data on prescription drug use was obtained by linkage to the National Prescription Register. The associations of DUI arrest and use of psychoactive prescription drugs in different DUI groups (findings for alcohol only, prescription drugs, prescription drugs and alcohol, illicit drugs) were estimated by using mixed-effect logistic regression. The use of psychoactive prescription drugs and DUI appeared to be strongly associated, with DUI suspects significantly more likely to use psychoactive prescription drugs compared to the reference population. Gender differences existed, with the use of benzodiazepines being more common among female DUI suspects. Moreover, DUI recidivists were more likely to use psychoactive prescription drugs compared to those arrested only once. In addition to alcohol and/or illicit drug use, a significant proportion of DUI suspects were using psychoactive prescription drugs. When prescribing psychoactive medication, especially benzodiazepines, physicians are challenged to screen for possible substance use problems and also to monitor for patients' alcohol or illicit drug use while being medicated. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Implementation of an antimicrobial stewardship program targeting residents with urinary tract infections in three community long-term care facilities: a quasi-experimental study using time-series analysis.

    Science.gov (United States)

    Doernberg, Sarah B; Dudas, Victoria; Trivedi, Kavita K

    2015-01-01

    Asymptomatic bacteriuria in the elderly commonly results in antibiotic administration and, in turn, contributes to antimicrobial resistance, adverse drug events, and increased costs. This is a major problem in the long-term care facility (LTCF) setting, where residents frequently transition to and from the acute-care setting, often transporting drug-resistant organisms across the continuum of care. The goal of this study was to assess the feasibility and efficacy of antimicrobial stewardship programs (ASPs) targeting urinary tract infections (UTIs) at community LTCFs. This was a quasi-experimental study targeting antibiotic prescriptions for UTI using time-series analysis with 6-month retrospective pre-intervention and 6-month intervention period at three community LTCFs. The ASP team (infectious diseases (ID) pharmacist and ID physician) performed weekly prospective audit and feedback of consecutive prescriptions for UTI. Loeb clinical consensus criteria were used to assess appropriateness of antibiotics; recommendations were communicated to the primary treating provider by the ID pharmacist. Resident outcomes were recorded at subsequent visits. Generalized estimating equations using segmented regression were used to evaluate the impact of the ASP intervention on rates of antibiotic prescribing and antibiotic resistance. One-hundred and four antibiotic prescriptions for UTI were evaluated during the intervention, and recommendations were made for change in therapy in 40 (38 %), out of which 10 (25 %) were implemented. Only eight (8 %) residents started on antibiotics for UTI met clinical criteria for antibiotic initiation. An immediate 26 % decrease in antibiotic prescriptions for UTI during the ASP was identified with a 6 % reduction continuing through the intervention period (95 % Confidence Interval ([CI)] for the difference: -8 to -3 %). Similarly, a 25 % immediate decrease in all antibiotic prescriptions was noted after introduction of the ASP with a

  2. [Psychiatric manifestations of lupus erythematosus systemic and Sjogren's syndrome].

    Science.gov (United States)

    Ampélas, J F; Wattiaux, M J; Van Amerongen, A P

    2001-01-01

    undiagnosed SLE and SS in psychiatric departments. Two studies report systematic search for SLE in psychiatric patients. In 1992, Hopkinson et al. (39) searched for several autoantibodies in serum samples of nearly 300 hospitalized psychiatric patients. In 1993, Van Dam et al. (65) did the same with more than 2,000 patients admitted to a psychiatric hospital. Hopkinson et al. found 1% undiagnosed SLE, which is much higher than in general population, and recommended to search SLE in every patient with a high erythrocyte sedimentation rate in psychiatric services. Results of the Van Dam et al. study suggest on the contrary, that SLE is not a common cause of admission to psychiatric hospitals. There is no study which report systematic search of Sjögren's syndrome in a psychiatric department. This is probably because most of patients receive or have recently received psychotropics with anticholinergic side-effects which is an exclusion criteria of SS. Psychiatrists should keep in mind that SLE and primary SS are potential causes of psychiatric manifestations when examining patients with multiple unexplained somatic complaints and psychiatric symptoms. They should then search for autoantibodies in the serum after careful physical examination. Diagnosis of SLE or SS could lead to a better adapted prescription of corticosteroids and/or immunosuppressive drugs and specific psychotropic drugs, making sure to avoid lupus-inducing drugs in SLE and drugs with anticholinergic effects in SS. The existence of psychiatric manifestations in SLE and SS constitutes an indisputable clinical reality that each practitioner must be able to recognize and treat.

  3. Methadone for the treatment of Prescription Opioids Dependence. A retrospective chart review.

    Science.gov (United States)

    Barrio, Pablo; Ezzeldin, Mohamed; Bruguera, Pol; Pérez, Ana; Mansilla, Sara; Fàbrega, Marina; Lligoña, Anna; Mondón, Sílvia; Balcells, Mercè

    2016-06-14

    Prescription opioids (PO) addiction is increasing to an epidemic level. Few studies exist regarding its treatment. Although buprenorphine has been the mainstay so far, other treatment options might be considered, such as methadone. We conducted a retrospective assessment of all patients admitted to a psychiatry ward for PO detoxification using methadone between 2010 and 2013. The assessment and description was carried out during a 3-month follow-up period after their discharge. Although this is a retrospective chart review, our exploration included sociodemographic and treatment variables in addition to the abstinence rates for the whole sample. Eleven patients were included, mostly women (81.8%), with a median age of 50 years. The median duration of dependence was 8 years. Dependence on other substances and psychiatric comorbidities were high. Eight patients were monitored during three months. Of these, 7 (87.5%) were abstinent after that period. The results suggest that methadone deserves further exploration as a potentially efficacious treatment option for PO dependence.

  4. Influence of pharmacists expertise on physicians prescription ...

    African Journals Online (AJOL)

    the prescribing behaviour of physicians. ... Keywords: Physician prescription behaviour, Pharmacist factor, Collaboration, Trustworthiness ... provide information relating to drug prescription, ... processing [22], which takes into consideration.

  5. Prescription-induced jump distributions in multiplicative Poisson processes.

    Science.gov (United States)

    Suweis, Samir; Porporato, Amilcare; Rinaldo, Andrea; Maritan, Amos

    2011-06-01

    Generalized Langevin equations (GLE) with multiplicative white Poisson noise pose the usual prescription dilemma leading to different evolution equations (master equations) for the probability distribution. Contrary to the case of multiplicative Gaussian white noise, the Stratonovich prescription does not correspond to the well-known midpoint (or any other intermediate) prescription. By introducing an inertial term in the GLE, we show that the Itô and Stratonovich prescriptions naturally arise depending on two time scales, one induced by the inertial term and the other determined by the jump event. We also show that, when the multiplicative noise is linear in the random variable, one prescription can be made equivalent to the other by a suitable transformation in the jump probability distribution. We apply these results to a recently proposed stochastic model describing the dynamics of primary soil salinization, in which the salt mass balance within the soil root zone requires the analysis of different prescriptions arising from the resulting stochastic differential equation forced by multiplicative white Poisson noise, the features of which are tailored to the characters of the daily precipitation. A method is finally suggested to infer the most appropriate prescription from the data.

  6. Prescription-induced jump distributions in multiplicative Poisson processes

    Science.gov (United States)

    Suweis, Samir; Porporato, Amilcare; Rinaldo, Andrea; Maritan, Amos

    2011-06-01

    Generalized Langevin equations (GLE) with multiplicative white Poisson noise pose the usual prescription dilemma leading to different evolution equations (master equations) for the probability distribution. Contrary to the case of multiplicative Gaussian white noise, the Stratonovich prescription does not correspond to the well-known midpoint (or any other intermediate) prescription. By introducing an inertial term in the GLE, we show that the Itô and Stratonovich prescriptions naturally arise depending on two time scales, one induced by the inertial term and the other determined by the jump event. We also show that, when the multiplicative noise is linear in the random variable, one prescription can be made equivalent to the other by a suitable transformation in the jump probability distribution. We apply these results to a recently proposed stochastic model describing the dynamics of primary soil salinization, in which the salt mass balance within the soil root zone requires the analysis of different prescriptions arising from the resulting stochastic differential equation forced by multiplicative white Poisson noise, the features of which are tailored to the characters of the daily precipitation. A method is finally suggested to infer the most appropriate prescription from the data.

  7. Past-year Prescription Drug Monitoring Program Opioid Prescriptions and Self-reported Opioid Use in an Emergency Department Population With Opioid Use Disorder.

    Science.gov (United States)

    Hawk, Kathryn; D'Onofrio, Gail; Fiellin, David A; Chawarski, Marek C; O'Connor, Patrick G; Owens, Patricia H; Pantalon, Michael V; Bernstein, Steven L

    2017-11-22

    Despite increasing reliance on prescription drug monitoring programs (PDMPs) as a response to the opioid epidemic, the relationship between aberrant drug-related behaviors captured by the PDMP and opioid use disorder is incompletely understood. How PDMP data should guide emergency department (ED) assessment has not been studied. The objective was to evaluate a relationship between PDMP opioid prescription records and self-reported nonmedical opioid use of prescription opioids in a cohort of opioid-dependent ED patients enrolled in a treatment trial. PDMP opioid prescription records during 1 year prior to study enrollment on 329 adults meeting Diagnostic and Statistical Manual IV criteria for opioid dependence entering a randomized clinical trial in a large, urban ED were cross-tabulated with data on 30-day nonmedical prescription opioid use self-report. The association among these two types of data was assessed by the Goodman and Kruskal's gamma; a logistic regression was used to explore characteristics of participants who had PDMP record of opioid prescriptions. During 1 year prior to study enrollment, 118 of 329 (36%) patients had at least one opioid prescription (range = 1-51) in our states' PDMP. Patients who reported ≥15 of 30 days of nonmedical prescription opioid use were more likely to have at least four PDMP opioid prescriptions (20/38; 53%) than patients reporting 1 to 14 days (14/38, 37%) or zero days of nonmedical prescription opioid use (4/38, 11%; p = 0.002). Female sex and having health insurance were significantly more represented in the PDMP (p Medicine.

  8. Satisfaction with housing and housing support for people with psychiatric disabilities.

    Science.gov (United States)

    Brolin, Rosita; Rask, Mikael; Syrén, Susanne; Baigi, Amir; Brunt, David Arthur

    2015-01-01

    The aim of this study was to investigate the degree of satisfaction with housing and housing support for people with psychiatric disabilities in Sweden. A total of 370 residents, in supported housing and in ordinary housing with housing support, completed a new questionnaire and reported a high degree of overall satisfaction, but many of them wanted to move somewhere else. Differences were found between the two different types of housing concerning satisfaction with housing support, social life and available choices. Security and privacy, as well as other's influence on the choice of residential area and dwelling proved to be important predictors for satisfaction.

  9. An integrative approach to cultural competence in the psychiatric curriculum.

    Science.gov (United States)

    Fung, Kenneth; Andermann, Lisa; Zaretsky, Ari; Lo, Hung-Tat

    2008-01-01

    As it is increasingly recognized that cultural competence is an essential quality for any practicing psychiatrist, postgraduate psychiatry training programs need to incorporate cultural competence training into their curricula. This article documents the unique approach to resident cultural competence training being developed in the Department of Psychiatry at the University of Toronto, which has the largest residency training program in North America and is situated in an ethnically diverse city and country. The authors conducted a systematic review of cultural competence by searching databases including PubMed, PsycINFO, PsycArticles, CINAHL, Social Science Abstracts, and Sociological Abstracts; by searching government and professional association publications; and through on-site visits to local cross-cultural training programs. Based on the results of the review, a resident survey, and a staff retreat, the authors developed a deliberate "integrative" approach with a mindful, balanced emphasis on both generic and specific cultural competencies. Learning objectives were derived from integrating the seven core competencies of a physician as defined by the Canadian Medical Education Directions for Specialists (CanMEDS) roles framework with the tripartite model of attitudes, knowledge, and skills. The learning objectives and teaching program were further integrated across different psychiatric subspecialties and across the successive years of residency. Another unique strategy used to foster curricular and institutional change was the program's emphasis on evaluation, making use of insights from modern educational theories such as formative feedback and blueprinting. Course evaluations of the core curriculum from the first group of residents were positive. The authors propose that these changes to the curriculum may lead to enhanced cultural competence and clinical effectiveness in health care.

  10. Morbidity and medicine prescriptions in a nationwide Danish population of patients diagnosed with polycystic ovary syndrome.

    Science.gov (United States)

    Glintborg, Dorte; Hass Rubin, Katrine; Nybo, Mads; Abrahamsen, Bo; Andersen, Marianne

    2015-05-01

    The prevalence of type 2 diabetes is increased in polycystic ovary syndrome (PCOS), but the prevalence of other diseases is not clarified. We aimed to investigate morbidity and medicine prescriptions in PCOS. A National Register-based study. Patients with PCOS (PCOS Denmark and an embedded cohort; PCOS Odense University Hospital (OUH)) and one control population. Premenopausal women with PCOS underwent clinical and biochemical examination (PCOS OUH, n=1217). PCOS Denmark (n=19 199) included women with PCOS in the Danish National Patient Register. Three age-matched controls were included per patient (n=57 483). Diagnosis codes and filled prescriptions. The mean (range) age of the PCOS Denmark group and controls was 30.6 (12-60) years. Patients in PCOS Denmark had higher Charlson index, higher prevalence of diabetes, dyslipidemia, and hypertension than controls. PCOS was associated with a two times increased risk of stroke and thrombosis, whereas the risk of other cardiovascular diseases was not increased. Thyroid disease, asthma, migraine, and depression were more prevalent in PCOS Denmark vs controls, whereas fractures were rarer. Infertility was increased in patients compared with controls, but the mean number of births was higher in PCOS. Medicine prescriptions within all diagnosis areas were significantly higher in PCOS patients than in controls.In PCOS OUH, polycystic ovaries (PCO) and irregular menses were associated with a more adverse metabolic risk profile, but individual Rotterdam criteria were not associated with cardiometabolic diagnoses. Cardiometabolic and psychiatric morbidity were significantly increased in a Danish population with PCOS. Medical diseases are frequent also in young patients with PCOS. © 2015 European Society of Endocrinology.

  11. [Alcohol consumption in patients with psychiatric disorders: assessment and treatment].

    Science.gov (United States)

    Lang, J-P; Bonnewitz, M-L; Kusterer, M; Lalanne-Tongio, L

    2014-09-01

    Alcohol consumption in France exceeds the European average (12.7L of pure alcohol/habitant/year in 2009 for an average of 12.5 L). This consumption has a major professional, social and health impact on the individuals and their families. The cost of such, estimated in Europe to be of 155.8 billion Euros in 2010, is the highest among the central nervous system diseases in Europe, far higher than that of depression or dementia. Patients suffering from psychiatric disorders are more frequently affected by problems related to alcohol use than the general population. They are also more vulnerable to the immediate and subsequent consequences of their consumption. The alcohol related disorders that are often accompanied by risk taking and other addictive behaviour require a global assessment of the addiction, with and without substance, and of the complications. These have a strong impact on risk taking, compliance with care, and the morbidity of somatic and psychiatric disorders, as well as access to optimal care and the life span of patients suffering from psychiatric disorders. The development of addictology care, with integrative treatment programs, is recommended in response to these public health issues. Nevertheless, specific addictology practices and partners with addictology care structures are still scarcely developed in psychiatry. Firstly, it would be necessary to set up such integrated treatments through the systematisation of an "addictology" checkup on admission, a global assessment of addictive behaviour and cognitive disorders, using pragmatic tools that are user-friendly for the care teams, maintain the reduction in risk taking, and apply prescriptions for addiction to psychotropic treatments, in liaison with the referring general practitioner. As early as possible, accompanied by specific training in addictology for the psychiatrists and the mental health nursing teams, such care could be enhanced by the development of liaison and advanced psychiatric

  12. ASD, a Psychiatric Disorder, or Both? Psychiatric Diagnoses in Adolescents with High-Functioning ASD

    Science.gov (United States)

    Mazefsky, Carla A.; Oswald, Donald P.; Day, Taylor N.; Eack, Shaun M.; Minshew, Nancy J.; Lainhart, Janet E.

    2012-01-01

    Varied presentations of emotion dysregulation in autism complicate diagnostic decision making and may lead to inaccurate psychiatric diagnoses or delayed autism diagnosis for high-functioning children. This pilot study aimed to determine the concordance between prior psychiatric diagnoses and the results of an autism-specific psychiatric interview…

  13. The Effects of Bairesi Complex Prescription (a Uyghur Medicine Prescription and Its Five Crude Herbal Extracts on Melanogenesis in G-361 Cells

    Directory of Open Access Journals (Sweden)

    Xuedan Huang

    2016-01-01

    Full Text Available Vitiligo is considered a preimmune stage of a disease that is not well clarified. This condition is difficult to treat because there is no definite cure. Uyghur medicine is an important part of traditional Chinese medicine. There are many types of prescriptions that are used for the treatment of vitiligo. Bairesi complex prescription is one of the active prescriptions for vitiligo that is used in the clinic. However, the intensities of melanogenesis due to uses of Bairesi complex prescription and its five constituent crude herbs have not been reported yet. In the present study, we found that the hot water extracts of Bairesi complex prescription and the crude herbs were more effective in eliciting melanin production in G-361 cells than the EtOH extracts. Furthermore, the Bairesi complex prescription exhibited less cytotoxicity and was more effective in melanin formation than the five crude herbal extracts. In the present study, we also discuss the mechanisms of melanogenesis due to the use of the Bairesi complex prescription and its single crude herbal extracts.

  14. Interkulturelle Kompetenz in der Facharztausbildung von Psychiatern in Deutschland: Ergebnisse einer Umfrage [Intercultural competence in the psychiatric training curriculum in Germany: Results of a survey

    Directory of Open Access Journals (Sweden)

    Machleidt, Wielant

    2008-08-01

    Full Text Available [english] Background: This study was carried out to assess the situation of and the demand for specific training in transcultural psychiatry as part of the residency program in Germany. Method: A semistructured questionnaire with 30 questions (28 structured, 2 open was developed, for which the “Local Survey of Realities in Transcultural Psychiatry” of the (APA served as a model and was modified accordingly. This questionnaire was sent out to all directors of psychiatric training institutions in Germany (N = 450. The directors of official psychiatric training institutions are authorized for residency training by the state medical associations. The responses were not anonymous. Results: The return rate was 25.5% (N = 114. In 71.7% of the training institutions (81 out of 113 valid cases, specific training in transcultural psychiatry occurred only rarely or not at all. 83.3% of the directors of psychiatric training institutions (70 out of 84 valid cases reported a demand for training in transcultural psychiatry in their training institutions; in 94.5% of the cases, the directors of psychiatric training institutions (69 out of 73 valid cases reported a need for transcultural issues as part of the official curriculum of the psychiatric residency program in Germany. The most frequently reported aspects were teaching of general cultural competence and of culture-specific issues in mental disorders. Implications: Cultural aspects currently are not a mandatory part of the official training curriculum of the psychiatric residency training in Germany. With respect to the reported need for training in cultural issues of mental disorders, the implementation of transcultural psychiatry within the official curriculum of the psychiatric residency training in Germany should be discussed. [german] Zielsetzung: Ziel der vorliegenden Studie ist die Erhebung des Status quo der Weiterbildungssituation in transkultureller Psychiatrie für den Facharzt in

  15. High Rates of Tramadol Use among Treatment-Seeking Adolescents in Malmö, Sweden: A Study of Hair Analysis of Nonmedical Prescription Opioid Use

    Directory of Open Access Journals (Sweden)

    Martin O. Olsson

    2017-01-01

    Full Text Available Background. Nonmedical prescription opioid use (NMPOU is a growing problem and tramadol has been suggested as an emerging problem in young treatment-seeking individuals. The aim of the present study was to investigate, through hair analysis, NMPOU in this group and, specifically, tramadol use. Methods. In a study including 73 treatment-seeking adolescents and young adults at an outpatient facility for young substance users, hair specimens could be obtained from 59 subjects. Data were extracted on sociodemographic background variables and psychiatric diagnoses through MINI interviews. Results. In hair analysis, tramadol was by far the most prevalent opioid detected. Thirty-two percent screened positive for opioids, and of those, all but one were positive for tramadol. Ninety-eight percent reported problematic cannabis use. Significantly more opioid-positive patients also screened positive for other (noncannabis drugs, compared to nonopioid users. Sixty-four percent fulfilled criteria of DSM-IV psychiatric disorders, other than substance use disorders according to MINI. Fifty-three percent met the symptom criteria count of ADHD above cut-off level. Conclusion. In the present setting, tramadol, along with high rates of cannabis use, may represent a novel pattern of substance use among young treatment-seeking subjects with problematic substance use and high rates of concurrent psychiatric problems.

  16. Investigating the relationship between neighborhood experiences and psychiatric distress for individuals with serious mental illness.

    Science.gov (United States)

    Kloos, Bret; Townley, Greg

    2011-03-01

    The present study examined the relationships between how research participants experienced their neighborhood, their neighborhood social climate, and psychological well-being. Participants (n = 525) were residents of supported housing programs who used mental health services at one of 17 community mental health centers in South Carolina. Hierarchical regression and mediation analyses were employed to answer research questions. Results suggest that neighbor relations, perceptions of neighborhood safety, and neighborhood satisfaction were significantly associated with perceptions of neighborhood social climate; and neighborhood social climate accounted for a significant amount of the variance in psychiatric distress. Of particular interest, perceptions of neighborhood social climate fully mediated the relationship between the specific reported neighborhood experiences and psychiatric distress. These findings have implications for interventions and policy aimed at promoting integration of individuals with serious mental illness into community settings.

  17. Description, prescription and the choice of discount rates

    International Nuclear Information System (INIS)

    Baum, Seth D.

    2009-01-01

    The choice of discount rates is a key issue in the analysis of long-term societal issues, in particular environmental issues such as climate change. Approaches to choosing discount rates are generally placed into two categories: the descriptive approach and the prescriptive approach. The descriptive approach is often justified on grounds that it uses a description of how society discounts instead of having analysts impose their own discounting views on society. This paper analyzes the common forms of the descriptive and prescriptive approaches and finds that, in contrast with customary thinking, both forms are equally descriptive and prescriptive. The prescriptions concern who has standing (i.e. who is included) in society, how the views of these individuals are measured, and how the measurements are aggregated. Such prescriptions are necessary to choose from among the many possible descriptions of how society discounts. The descriptions are the measurements made given a choice of measurement technique. Thus, the labels 'descriptive approach' and 'prescriptive approach' are deeply misleading, as analysts cannot avoid imposing their own views on society. (author)

  18. Resident Evaluation of a Required Telepsychiatry Clinical Experience.

    Science.gov (United States)

    Teshima, John; Hodgins, Michael; Boydell, Katherine M; Pignatiello, Antonio

    2016-04-01

    The authors explored resident experiences of telepsychiatry clinical training. This paper describes an analysis of evaluation forms completed by psychiatry residents following a required training experience in telepsychiatry. Retrospective numeric and narrative data were collected from 2005 to 2012. Using a five-point Likert-type scale (1 = strongly disagree and 5 = strongly agree), residents ranked the session based on the following characteristics: the overall experience, interest in participating in telepsychiatry in the future, understanding service provision to underserved areas, telepsychiatry as mode of service delivery, and the unique aspects of telepsychiatry work. The authors also conducted a content analysis of narrative comments in response to open-ended questions about the positive and negative aspects of the training experience. In all, 88% of residents completed (n = 335) an anonymous evaluation following their participation in telepsychiatry consultation sessions. Numeric results were mostly positive and indicated that the experience was interesting and enjoyable, enhanced interest in participating in telepsychiatry in the future, and increased understanding of providing psychiatric services to underserved communities. Narrative data demonstrated that the most valuable aspects of training included the knowledge acquired in terms of establishing rapport and engaging with patients, using the technology, working collaboratively, identifying different approaches used, and awareness of the complexity of cases. Resident desire for more training of this nature was prevalent, specifically a wish for more detail, additional time for discussion and debriefing, and further explanation of the unique aspects of telepsychiatry as mode of delivery. More evaluation of telepsychiatry training, elective or required, is needed. The context of this training offered potential side benefits of learning about interprofessional and collaborative care for the

  19. Effect of EHR user interface changes on internal prescription discrepancies.

    Science.gov (United States)

    Turchin, A; Sawarkar, A; Dementieva, Y A; Breydo, E; Ramelson, H

    2014-01-01

    To determine whether specific design interventions (changes in the user interface (UI)) of an electronic health record (EHR) medication module are associated with an increase or decrease in the incidence of contradictions between the structured and narrative components of electronic prescriptions (internal prescription discrepancies). We performed a retrospective analysis of 960,000 randomly selected electronic prescriptions generated in a single EHR between 01/2004 and 12/2011. Internal prescription discrepancies were identified using a validated natural language processing tool with recall of 76% and precision of 84%. A multivariable autoregressive integrated moving average (ARIMA) model was used to evaluate the effect of five UI changes in the EHR medication module on incidence of internal prescription discrepancies. Over the study period 175,725 (18.4%) prescriptions were found to have internal discrepancies. The highest rate of prescription discrepancies was observed in March 2006 (22.5%) and the lowest in March 2009 (15.0%). Addition of "as directed" option to the dropdown decreased prescription discrepancies by 195 / month (p = 0.0004). An non-interruptive alert that reminded providers to ensure that structured and narrative components did not contradict each other decreased prescription discrepancies by 145 / month (p = 0.03). Addition of a "Renew / Sign" button to the Medication module (a negative control) did not have an effect in prescription discrepancies. Several UI changes in the electronic medication module were effective in reducing the incidence of internal prescription discrepancies. Further research is needed to identify interventions that can completely eliminate this type of prescription error and their effects on patient outcomes.

  20. Audit of carbapenem prescriptions comparing 2 assessment periods.

    Science.gov (United States)

    Lefébure, A; Papy, E; Rioux, C; Diamantis, S; Armand-Lefèvre, L; Longuet, P; Lescure, F X; Wolff, M; Arnaud, P; Lucet, J C

    2015-07-01

    The emergence of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae has resulted in the increase of carbapenem prescriptions. The objective of our study was to determine the appropriateness of carbapenem prescriptions from initiation to reassessment of treatment, between 2009 and 2011. A questionnaire drafted by infectious diseases specialists (IDS) and microbiologists was used to collect clinical and microbiological data concerning carbapenem prescriptions in 2009 and 2011. An IDS then compared the results to assess carbapenem prescription compliance with our hospital's local recommendations. Seventy-one prescriptions were included in 2009 and 32 in 2011. The carbapenem treatment had been most frequently probabilistic to treat nosocomial infections. The microbiological data revealed that the number of multidrug-resistant (MDR) infections had increased between 2009 and 2011, especially infections involving ESBL-producing Enterobacteriaceae. At treatment reassessment, in 2009 and 2011, 15 (21%) and 12 (38%) carbapenem prescriptions were appropriate and continued. Overall, when comparing the 2 periods, prescriptions complied with local guidelines from initiation to reassessment of treatment without any statistically significant difference (68% in 2009 and 75% in 2011). Our study results showed that MDR infections had increased and especially infections due to ESBL-producing Enterobacteriaceae; this was consistent with epidemiological data. We also proved that most carbapenem prescriptions were compliant with recommendations. The increased mobile IDS interventions in medical and surgical departments helped reach this rate of compliance. Carbapenem stewardship may be promoted even in a difficult epidemiological context, especially with IDS interventions for the duration of treatment or at treatment reassessment. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. Subtypes of nonmedical prescription drug misuse

    Science.gov (United States)

    McCabe, Sean Esteban; Boyd, Carol J.; Teter, Christian J.

    2010-01-01

    This study used three characteristics (i.e., motive, route of administration, and co-ingestion with alcohol) of nonmedical prescription drug misuse across four separate classes (i.e., pain, sedative/anxiety, sleeping and stimulant medications) to examine subtypes and drug related problems. A Web survey was self-administered by a randomly selected sample of 3,639 undergraduate students attending a large Midwestern 4-year U.S. university. Self-treatment subtypes were characterized by motives consistent with the prescription drug's pharmaceutical main indication, oral only routes of administration, and no co-ingestion with alcohol. Recreational subtypes were characterized by recreational motives, oral or non-oral routes, and co-ingestion. Mixed subtypes consisted of other combinations of motives, routes, and co-ingestion. Among those who reported nonmedical prescription drug misuse, approximately 13% were classified into the recreational subtype, while 39% were in the self-treatment subtype, and 48% were in the mixed subtype. There were significant differences in the subtypes in terms of gender, race and prescription drug class. Approximately 50% of those in subtypes other than self-treatment screened positive for drug abuse. The odds of substance use and abuse were generally lower among self-treatment subtypes than other subtypes. The findings indicate subtypes should be considered when examining nonmedical prescription drug misuse, especially for pain medication. PMID:19278795

  2. Education as prescription for patients with type 2 diabetes mellitus: compliance and efficacy in clinical practice.

    Science.gov (United States)

    Kim, Mi Yeon; Suh, Sunghwan; Jin, Sang-Man; Kim, Se Won; Bae, Ji Cheol; Hur, Kyu Yeon; Kim, Sung Hye; Rha, Mi Yong; Cho, Young Yun; Lee, Myung-Shik; Lee, Moon Kyu; Kim, Kwang-Won; Kim, Jae Hyeon

    2012-12-01

    Diabetes self-management education has an important role in diabetes management. The efficacy of education has been proven in several randomized trials. However, the status of diabetes education programs in real Korean clinical practice has not yet been evaluated in terms of patient compliance with the education prescription. We retrospectively analyzed clinical and laboratory data from all patients who were ordered to undergo diabetes education during 2009 at Samsung Medical Center, Seoul, Korea (n=2,291). After excluding ineligible subjects, 588 patients were included in the analysis. Among the 588 patients, 433 received education. The overall compliance rate was 73.6%, which was significantly higher in the subjects with a short duration or living in a rural area compared to those with a long duration (85.0% vs. 65.1%, respectively; Ppatients refuse to get education despite having a prescription from their physician. This refusal rate was higher in the patients with long-standing diabetes or in urban residence. Furthermore, education was more effective in patients with a short duration of diabetes in clinical practice.

  3. Effects of a dedicated regional psychiatric emergency service on boarding of psychiatric patients in area emergency departments.

    Science.gov (United States)

    Zeller, Scott; Calma, Nicole; Stone, Ashley

    2014-02-01

    Mental health patients boarding for long hours, even days, in United States emergency departments (EDs) awaiting transfer for psychiatric services has become a considerable and widespread problem. Past studies have shown average boarding times ranging from 6.8 hours to 34 hours. Most proposed solutions to this issue have focused solely on increasing available inpatient psychiatric hospital beds, rather than considering alternative emergency care designs that could provide prompt access to treatment and might reduce the need for many hospitalizations. One suggested option has been the "regional dedicated emergency psychiatric facility," which serves to evaluate and treat all mental health patients for a given area, and can accept direct transfers from other EDs. This study sought to assess the effects of a regional dedicated emergency psychiatric facility design known at the "Alameda Model" on boarding times and hospitalization rates for psychiatric patients in area EDs. Over a 30-day period beginning in January 2013, 5 community hospitals in Alameda County, California, tracked all ED patients on involuntary mental health holds to determine boarding time, defined as the difference between when they were deemed stable for psychiatric disposition and the time they were discharged from the ED for transfer to the regional psychiatric emergency service. Patients were also followed to determine the percentage admitted to inpatient psychiatric units after evaluation and treatment in the psychiatric emergency service. In a total sample of 144 patients, the average boarding time was approximately 1 hour and 48 minutes. Only 24.8% were admitted for inpatient psychiatric hospitalization from the psychiatric emergency service. The results of this study indicate that the Alameda Model of transferring patients from general hospital EDs to a regional psychiatric emergency service reduced the length of boarding times for patients awaiting psychiatric care by over 80% versus

  4. Brand Name Statin Prescribing in a Resident Ambulatory Practice: Implications for Teaching Cost-Conscious Medicine.

    Science.gov (United States)

    Ryskina, Kira L; Pesko, Michael F; Gossey, J Travis; Caesar, Erica Phillips; Bishop, Tara F

    2014-09-01

    Several national initiatives aim to teach high-value care to residents. While there is a growing body of literature on cost impact of physicians' therapeutic decisions, few studies have assessed factors that influence residents' prescribing practices. We studied factors associated with intensive health care utilization among internal medicine residents, using brand name statin prescribing as a proxy for higher-cost care. We conducted a retrospective, cross-sectional analysis of statin prescriptions by residents at an urban academic internal medicine program, using electronic health record data between July 1, 2010, and June 30, 2011. For 319 encounters by 90 residents, patients were given a brand name statin in 50% of cases. When categorized into quintiles, the bottom quintile of residents prescribed brand name statins in 2% of encounters, while the top quintile prescribed brand name statins in 98% of encounters. After adjusting for potential confounders, including patient characteristics and supervising attending, being in the primary care track was associated with lower odds (odds ratio [OR], 0.38; P  =  .02; 95% confidence interval [CI], 0.16-0.86), and graduating from a medical school with an above-average hospital care intensity index was associated with higher odds of prescribing brand name statins (OR, 1.70; P  =  .049; 95% CI, 1.003-2.88). We found considerable variation in brand name statin prescribing by residents. Medical school attended and residency program type were associated with resident prescribing behavior. Future interventions should raise awareness of these patterns in an effort to teach high-value, cost-conscious care to all residents.

  5. Overdosed prescription of paracetamol (acetaminophen) in a teaching hospital.

    Science.gov (United States)

    Charpiat, B; Henry, A; Leboucher, G; Tod, M; Allenet, B

    2012-07-01

    Paracetamol is the most commonly used analgesic and antipyretic. Reviews of hospital use of paracetamol are scarce. Little is known about the appropriateness of the dose of paracetamol prescribed for hospitalized adults. The aim of this study was to report on the nature and the frequency of the overdosed prescription of paracetamol observed in adult patients over a 4.5-year period in a teaching hospital. Prescription analysis by pharmacists was performed once a week in six medical and three surgical departments and daily in a post-emergency unit. In cases of prescription error, the pharmacist notified the physician through an electronic alert when a computerized prescription order entry system was available or otherwise by face-to-face discussion. For each drug-related problem detected, the pharmacists recorded relevant details in a database. From October 2006 to April 2011, 44,404 prescriptions were reviewed and 480 alerts related to the overdosed prescription of paracetamol were made (1% of analyzed prescriptions). The extent of errors of dosage was within the intervals [90-120 mg/kg/d] and greater than 120 mg/kg/d for 87 and 11 patients respectively, who were prescribed a single non-combination paracetamol containing product. Sixty alerts concerned co-prescription of at least two paracetamol containing products with similar frequency for computerized (1.4/1000) or handwritten (1.2/1000) prescriptions. Prescriptions of paracetamol for hospitalized adults frequently exceed the recommended dosage. These results highlight the need for increased awareness of unintentional paracetamol overdose and support the initiation of an educational program aimed at physicians and nurses. Copyright © 2012. Published by Elsevier Masson SAS.

  6. Prescription analysis of pediatric outpatient practice in Nagpur city

    Directory of Open Access Journals (Sweden)

    Pandey Anuja

    2010-01-01

    Full Text Available Background: Medication errors are probably one of the most common types of medical errors, as medication is the most common health-care intervention. Knowing where and when errors are most likely to occur is generally felt to be the first step in trying to prevent these errors. Objective: To study prescribing patterns and errors in pediatric OPD prescriptions presenting to four community pharmacies across Nagpur city and to compare the prescription error rates across prescriber profiles. Materials and Methods: The study sample included 1376 valid pediatric OPD prescriptions presenting to four randomly selected community pharmacies in Nagpur, collected over a period of 2 months. Confirmed errors in the prescriptions were reviewed and analyzed. The core indicators for drug utilization studies, mentioned by WHO, were used to define errors. Results: The 1376 prescriptions included in the study were for a total of 3435 drugs, prescribed by 41 doctors. Fixed dose formulations dominated the prescribing pattern, many of which were irrational. Prescribing by market name was almost universal and generic prescriptions were for merely 254 (7.4% drugs. The prescribing pattern also indicated polypharmacy with the average number of drugs per encounter of 2.5. Antibiotics were included in 1087 (79% prescriptions, while injectable drugs were prescribed in 22 (1.6% prescriptions. The prescription error score varied significantly across prescriber profiles. Conclusion: The findings of our study highlight the continuing crisis of the irrational drug prescribing in the country.

  7. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Psychiatric Emergencies Small Group Module

    Directory of Open Access Journals (Sweden)

    Andrew King

    2017-07-01

    Full Text Available Audience: This curriculum created and implemented at The Ohio State University Wexner Medical Center was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction: In 2007, there were 12 million adult Emergency Department visits for mental health and substance abuse complaints. This represents 12.5% of all adult emergency department visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of psychiatric emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of psychiatric emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group

  8. The feasibility of QR-code prescription in Taiwan.

    Science.gov (United States)

    Lin, C-H; Tsai, F-Y; Tsai, W-L; Wen, H-W; Hu, M-L

    2012-12-01

    An ideal Health Care Service is a service system that focuses on patients. Patients in Taiwan have the freedom to fill their prescriptions at any pharmacies contracted with National Health Insurance. Each of these pharmacies uses its own computer system. So far, there are at least ten different systems on the market in Taiwan. To transmit the prescription information from the hospital to the pharmacy accurately and efficiently presents a great issue. This study consisted of two-dimensional applications using a QR-code to capture Patient's identification and prescription information from the hospitals as well as using a webcam to read the QR-code and transfer all data to the pharmacy computer system. Two hospitals and 85 community pharmacies participated in the study. During the trial, all participant pharmacies appraised highly of the accurate transmission of the prescription information. The contents in QR-code prescriptions from Taipei area were picked up efficiently and accurately in pharmacies at Taichung area (middle Taiwan) without software system limit and area limitation. The QR-code device received a patent (No. M376844, March 2010) from Intellectual Property Office Ministry of Economic Affair, China. Our trial has proven that QR-code prescription can provide community pharmacists an efficient, accurate and inexpensive device to digitalize the prescription contents. Consequently, pharmacists can offer better quality of pharmacy service to patients. © 2012 Blackwell Publishing Ltd.

  9. Time Trends in Antipsychotic Drug Use in Patients with Dementia

    DEFF Research Database (Denmark)

    Nørgaard, Ane; Jensen-Dahm, Christina; Gasse, Christiane

    2015-01-01

    : To investigate time trends in use of antipsychotics and other psychotropic drugs in dementia care. METHODS: The study included longitudinal data on all Danish residents ≥65 years. The study population was defined on January 1 of each year from 2000-2012. Data included prescriptions, discharge diagnoses......, and somatic and psychiatric comorbidities. Multivariate time trend analyses of psychotropic drug use in patients with dementia within 4-year age bands were performed. RESULTS: Overall, among patients with dementia the prevalence of antipsychotic drug use decreased from 31.3% in 2000 to 20.4% in 2012...

  10. Subtypes of adolescent sedative/anxiolytic misusers: A latent profile analysis.

    Science.gov (United States)

    Hall, Martin T; Howard, Matthew O; McCabe, Sean Esteban

    2010-10-01

    Few empirically-based taxonomies of nonmedical prescription drug misusers have been published. This study used latent profile analysis (LPA) to identify classes of adolescent sedative/anxiolytic misusers. Interviews assessing substance use, psychiatric symptoms, antisocial traits/behavior, and traumatic life experiences were conducted with 723 Missouri youth in residential care for antisocial behavior. Sedative/anxiolytic misusers (N=247) averaged 15.8 (S.D.=1.1) years of age; a majority were male (83.8%), White (70.0%), and resided in rural/small town areas (53.8%). LPA yielded a three-class solution. Class 1 (59.1%) was comprised of youth with significantly lower levels of currently distressing psychiatric symptoms, fewer lifetime traumatic experiences, less problematic substance use histories, less frequent antisocial behavior, and less impulsivity than youth in Classes 2 and 3. Class 2 (11.3%) youth had high levels of currently distressing psychiatric symptoms and more frequent antisocial behavior compared to youth in Classes 1 and 3. Class 3 (29.5%) youth evidenced levels of psychiatric and behavioral problems that were intermediate to those of Class 1 and 2 youth. Frequency of sedative/anxiolytic misuse was significantly higher in Classes 2 and 3 compared to Class 1. Members of Class 2 and Class 3 also had the highest levels of psychiatric symptoms for which sedatives/anxiolytics are commonly prescribed. Significant differences between classes were observed across a range of health, mental health, personality, and behavioral variables. Adolescents who misused prescription sedatives/anxiolytics evidenced significant heterogeneity across measures of psychiatric and behavioral dysfunction. Youth with comparatively high levels of anxiety and depression reported significantly more intensive sedative/anxiolytic misuse than their counterparts and may be at high risk for sedative/anxiolytic abuse and dependence. 2010 Elsevier Ltd. All rights reserved.

  11. Understanding migraine and psychiatric comorbidity.

    Science.gov (United States)

    Seng, Elizabeth K; Seng, Cynthia D

    2016-06-01

    This article describes recent trends in our understanding of the role of psychiatric disorders in the experience and treatment of migraine, and the role of migraine in the experience and treatment of psychiatric disorders. Although the majority of studies evaluating psychiatric comorbidity in migraine have focused on depression, anxiety, and bipolar disorders are highly associated with migraine and relevant for prognosis and treatment planning. Comorbid psychiatric disorders may be associated with poorer treatment response for some acute pharmacotherapies; however, people with comorbid migraine and mood or anxiety disorders can achieve large responses to preventive pharmacologic and behavioral therapies. Emerging research is developing and evaluating behavioral treatments designed to manage cooccurring migraine and mood or anxiety disorders. Stigma related to psychiatric disorders has been well characterized, and could exacerbate extant migraine-related stigma. Anxiety and mood disorders are prevalent in people with migraine, although not ubiquitous. Psychiatric comorbidity is associated with greater migraine symptoms and disability; however, people with comorbid depression or anxiety are amenable to preventive migraine treatment. Research regarding migraine treatment strategies optimized for people with comorbid psychiatric disorders is critical to advancing care and reducing stigma for this important subpopulation of people with migraine.

  12. Effect of EHR User Interface Changes on Internal Prescription Discrepancies

    Science.gov (United States)

    Sawarkar, A.; Dementieva, Y.A.; Breydo, E.; Ramelson, H.

    2014-01-01

    Summary Objective To determine whether specific design interventions (changes in the user interface (UI)) of an electronic health record (EHR) medication module are associated with an increase or decrease in the incidence of contradictions between the structured and narrative components of electronic prescriptions (internal prescription discrepancies). Materials and Methods We performed a retrospective analysis of 960,000 randomly selected electronic prescriptions generated in a single EHR between 01/2004 and 12/2011. Internal prescription discrepancies were identified using a validated natural language processing tool with recall of 76% and precision of 84%. A multivariable autoregressive integrated moving average (ARIMA) model was used to evaluate the effect of five UI changes in the EHR medication module on incidence of internal prescription discrepancies. Results Over the study period 175,725 (18.4%) prescriptions were found to have internal discrepancies. The highest rate of prescription discrepancies was observed in March 2006 (22.5%) and the lowest in March 2009 (15.0%). Addition of „as directed“ option to the dropdown decreased prescription discrepancies by 195 / month (p = 0.0004). An non-interruptive alert that reminded providers to ensure that structured and narrative components did not contradict each other decreased prescription discrepancies by 145 / month (p = 0.03). Addition of a „Renew / Sign“ button to the Medication module (a negative control) did not have an effect in prescription discrepancies. Conclusions Several UI changes in the electronic medication module were effective in reducing the incidence of internal prescription discrepancies. Further research is needed to identify interventions that can completely eliminate this type of prescription error and their effects on patient outcomes. PMID:25298811

  13. Factors influencing psychotropic prescription by non-psychiatrist physicians in a nursing home for the elderly in Brazil

    Directory of Open Access Journals (Sweden)

    Florindo Stella

    Full Text Available CONTEXT AND OBJECTIVE: Although psychotropics are one of the classes of medications most prescribed in nursing homes for the elderly, studies examining prescribing patterns are limited in both number and scope. The present study was undertaken to investigate factors associated with general psychotropic use in a nursing home in Brazil. DESIGN AND SETTING: Retrospective observational study at the Nursing Home for the Elderly, Institute of Biosciences, Universidade Estadual Paulista. METHODS: Information on prescriptions was retrieved from the medical records of 108 elderly residents in a nursing home. Sixty-five of these patients, with mean age 74.5 years (± standard deviation 9.4 years, who were taking medications on a regular basis, comprised the sample. The effects of demographic and clinical variables on the psychotropic prescription pattern were examined. RESULTS: Females were more likely to receive psychotropics (p = 0.038. Individuals on medicines for cardiovascular diseases received psychotropics less frequently (p = 0.001. The number of prescribed psychotropics correlated negatively with both age (p = 0.009 and number of non-psychotropic drugs (p = 0.009. CONCLUSIONS: Although preliminary, the present results indicated that cardiovascular disease was the clinical variable that most influenced psychotropic prescription. Physicians' overconcern regarding drug interactions might at least partially explain this result. Further investigations involving larger sample sizes from different regions are warranted to confirm these findings.

  14. Psychiatric Adverse Effects of Dermatological Drugs

    Directory of Open Access Journals (Sweden)

    Mine Özmen

    2010-07-01

    Full Text Available Dermatological drugs, mostly corticosteroids and isotretinoin, cause different psychiatric adverse effects. During steroid therapy, a wide range of psychiatric conditions, from minor clinical symptoms like insomnia and anxiety to serious psychiatric syndromes like psychosis and delirium might be seen. In medical literature, a causal connection is usually suggested between “isotretinoin”, which is used for treatment of acne vulgaris and depression and suicide attempts. However, there are no statistically significant double-blind randomized studies that support this connection. Clinicians must know patient’s psychiatric history before using any dermatological treatment known as causing psychiatric adverse effects, and psychiatric consultation should be established whenever necessary.

  15. Price elasticity of demand for psychiatric consultation in a Nigerian psychiatric service.

    Science.gov (United States)

    Esan, Oluyomi

    2016-12-01

    This paper addresses price elasticity of demand (PED) in a region where most patients make payments for consultations out of pocket. PED is a measure of the responsiveness of the quantity demanded of goods or services to changes in price. The study was done in the context of an outpatient psychiatric clinic in a sub -Saharan African country. The study was performed at the University College Hospital (UCH), Ibadan, Nigeria. Aggregate data were collected on weekly clinic attendance over a 24-month period October 2008 - September 2010 representing 12 months before, to 12months after a 67% increase in price of outpatient psychiatric consultation. The average weekly clinic attendance prior to the increase was compared to the average clinic attendance after the price increase. Arc-PED for consultation was also estimated. Clinic attendance dropped immediately and significantly in the weeks following the price increase. There was a 34.4% reduction in average weekly clinic attendance. Arc-PED for psychiatric consultation was -0.85. In comparison to reported PED on health care goods and services, this study finds a relatively high PED in psychiatric consultation following an increase in price of user fees of psychiatric consultation.

  16. Rationality of Antimicrobial Prescriptions in Community Pharmacy Users.

    Directory of Open Access Journals (Sweden)

    Sara I V C Lima

    Full Text Available Although there is a conflict between the treatment benefits for a single individual and society, restrictions on antibiotic use are needed to reduce the prevalence of resistance to these drugs, which is the main result of irrational use. Brazil, cataloged as a pharmemerging market, has implemented restrictive measures for the consumption of antibiotics. The objective of this study was to investigate the quality of antimicrobial prescriptions and user knowledge of their treatment with these drugs.A two-stage cross-sectional, combined and stratified survey of pharmacy users holding an antimicrobial prescription was conducted in the community between May and November 2014. A pharmacist analyzed each prescription for legibility and completeness, and applied a structured questionnaire to the users or their caregivers on their knowledge regarding treatment and user sociodemographic data. An estimated 29.3% of prescriptions had one or more illegible items, 91.3% had one or more missing items, and 29.0% had both illegible and missing items. Dosing schedule and patient identification were the most commonly unreadable items in prescriptions, 18.81% and 12.14%, respectively. The lack of complete patient identification occurred in 90.53% of the prescriptions. It is estimated that 40.3% of users have used antimicrobials without prescription and that 46.49% did not receive any guidance on the administration of the drug.Despite the measures taken by health authorities to restrict the misuse of antimicrobials, it was observed that prescribers still do not follow the criteria of current legislation, particularly relating to items needed for completion of the prescription. Moreover, users receive little information about their antimicrobial treatment.

  17. The appropriateness of a proton pump inhibitor prescription.

    LENUS (Irish Health Repository)

    Moran, N

    2014-11-01

    Proton pump inhibitors (PPIs) are one of the most commonly prescribed groups of drug in Ireland, at great expense to the Irish healthcare executive. This study aims to evaluate the appropriateness of PPI prescriptions on admission and discharge in a tertiary referral hospital. All non-elective admissions in the Emergency Department in one week were included in the study. 102 patients in total were included, with 36 (35.4%) treated with a PPI on admission. Of these, only 3 (8.3%) had a clear indication noted as per current NICE guidelines. 18 new in-hospital PPI prescriptions were documented. 11 (61%) of which were present on discharge prescriptions. Continuing PPI prescription on discharge into the community may be inappropriate, costly and potentially harmful. Brief interventions aimed at reducing inappropriate PPI prescriptions have been shown to be effective at reducing the cost and potential harm of unnecessary treatment.

  18. Evaluation of social disablement, psychiatric symptoms and autonomy in long-stay psychiatric patients Avaliação do comportamento social, sintomas psiquiátricos e autonomia em pacientes psiquiátricos de longa permanência

    Directory of Open Access Journals (Sweden)

    Lúcia Abelha

    2006-01-01

    Full Text Available BACKGROUND: Data on prevalence of social disablement, psychiatric symptoms and independent living skills in long-stay psychiatric patients are scarce in Brazil. Therefore, a cross-sectional study was carried out on a population of 881 long-stay psychiatric patients. METHOD: Data were collected from all the patients living in the Municipal Mental Health Institute from Rio de Janeiro city, using 3 instruments: Social Behaviour Schedule (SBS-BR, Brief Psychiatric Rating Scale (BPRS, and Independent Living Skills Survey (ILSS-BR. RESULTS: 75% of total patients presented poor independent living skills, and high rates of social disablement, specially in the items: poor self care (50,9%, little spontaneous communication (46,2% and underactivity (37,5%. 15.1% of schizophrenic patients showed severe symptoms of hallucinations, delusions and conceptual disorganization.11.5% did not present psychiatric symptoms in the last month, and 16% showed no social disablement CONCLUSION: 50% of patients are older than 65 years and have been living in the institution for more than 38 years. They present high rates of problem behaviours and poor autonomy. Our data should suggest the adoption of treatment programs or interventions for those patients. Also, there is a group without psychiatric symptoms, good autonomy degree and no social disablement that could live in therapeutic residences in the community.INTRODUÇÃO: No Brasil ainda são escassos os dados sobre limitações no comportamento social, sintomas psiquiátricos e habilidades de vida independente. Nesse sentido foi realizado um estudo seccional em uma população de 881 pacientes psiquiátricos de longa permanência. METODOLOGIA: Foram coletados dados de todos os pacientes residentes no Instituto Municipal Juliano Moreira, utilizando três instrumentos: Avaliação das Limitações no Comportamento Social (SBS-BR, Brief Psychiatric Rating Scale (BPRS e o Inventário de Habilidades de Vida Independente para

  19. Patient Aggression and the Wellbeing of Nurses: A Cross-Sectional Survey Study in Psychiatric and Non-Psychiatric Settings.

    Science.gov (United States)

    Pekurinen, Virve; Willman, Laura; Virtanen, Marianna; Kivimäki, Mika; Vahtera, Jussi; Välimäki, Maritta

    2017-10-18

    Wellbeing of nurses is associated with patient aggression. Little is known about the differences in these associations between nurses working in different specialties. We aimed to estimate and compare the prevalence of patient aggression and the associations between patient aggression and the wellbeing of nurses in psychiatric and non-psychiatric specialties (medical and surgical, and emergency medicine). A sample of 5288 nurses (923 psychiatric nurses, 4070 medical and surgical nurses, 295 emergency nurses) participated in the study. Subjective measures were used to assess both the occurrence of patient aggression and the wellbeing of nurses (self-rated health, sleep disturbances, psychological distress and perceived work ability). Binary logistic regression with interaction terms was used to compare the associations between patient aggression and the wellbeing of nurses. Psychiatric nurses reported all types of patient aggression more frequently than medical and surgical nurses, whereas nurses working in emergency settings reported physical violence and verbal aggression more frequently than psychiatric nurses. Psychiatric nurses reported poor self-rated health and reduced work ability more frequently than both of the non-psychiatric nursing groups, whereas medical and surgical nurses reported psychological distress and sleep disturbances more often. Psychiatric nurses who had experienced at least one type of patient aggression or mental abuse in the previous year, were less likely to suffer from psychological distress and sleep disturbances compared to medical and surgical nurses. Psychiatric nurses who had experienced physical assaults and armed threats were less likely to suffer from sleep disturbances compared to nurses working in emergency settings. Compared to medical and surgical nurses, psychiatric nurses face patient aggression more often, but certain types of aggression are more common in emergency settings. Psychiatric nurses have worse subjective

  20. Psychiatric morbidity in prisoners

    Science.gov (United States)

    Kumar, Vinod; Daria, Usha

    2013-01-01

    Background: Prisoners are having high percentage of psychiatric disorders. Majority of studies done so far on prisoners are from Western countries and very limited studies from India. Aim: Study socio-demographic profile of prisoners of a central jail and to find out current prevalence of psychiatric disorders in them. Materials and Methods: 118 prisoners were selected by random sampling and interviewed to obtain socio-demographic data and assessed on Indian Psychiatric Interview Schedule (IPIS) with additional required questions to diagnose psychiatric disorders in prisoners. Results: Mean age of prisoners was 33.7 years with 97.5% males, 57.6% from rural areas and 65.3% were married. Average education in studied years was 6.6 years and 50.8% were unskilled workers. 47.4% were murderers while 20.3% of drugs related crimes. 47.5% were convicted and history of criminal behavior in family was in 32.2% prisoners. Current prevalence of psychiatric disorders was 33%. Psychotic, depressive, and anxiety disorders were seen in 6.7%, 16.1%, and 8.5% prisoners respectively. 58.8% had history of drug abuse/dependence prior to imprisonment. Conclusion: One prison of Hadoti region of Rajasthan is full of people with mental-health problems who collectively generate significant levels of unmet psychiatric treatment need. Prisons are detrimental to mental-health. Beginning of reforms is the immediate need. PMID:24459308

  1. [Failure mode and effects analysis on computerized drug prescriptions].

    Science.gov (United States)

    Paredes-Atenciano, J A; Roldán-Aviña, J P; González-García, Mercedes; Blanco-Sánchez, M C; Pinto-Melero, M A; Pérez-Ramírez, C; Calvo Rubio-Burgos, Miguel; Osuna-Navarro, F J; Jurado-Carmona, A M

    2015-01-01

    To identify and analyze errors in drug prescriptions of patients treated in a "high resolution" hospital by applying a Failure mode and effects analysis (FMEA).Material and methods A multidisciplinary group of medical specialties and nursing analyzed medical records where drug prescriptions were held in free text format. An FMEA was developed in which the risk priority index (RPI) was obtained from a cross-sectional observational study using an audit of the medical records, carried out in 2 phases: 1) Pre-intervention testing, and (2) evaluation of improvement actions after the first analysis. An audit sample size of 679 medical records from a total of 2,096 patients was calculated using stratified sampling and random selection of clinical events. Prescription errors decreased by 22.2% in the second phase. FMEA showed a greater RPI in "unspecified route of administration" and "dosage unspecified", with no significant decreases observed in the second phase, although it did detect, "incorrect dosing time", "contraindication due to drug allergy", "wrong patient" or "duplicate prescription", which resulted in the improvement of prescriptions. Drug prescription errors have been identified and analyzed by FMEA methodology, improving the clinical safety of these prescriptions. This tool allows updates of electronic prescribing to be monitored. To avoid such errors would require the mandatory completion of all sections of a prescription. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  2. Prescriptions, Nonmedical Use, and Emergency Department Visits Involving Prescription Stimulants

    Science.gov (United States)

    Chen, Lian-Yu; Crum, Rosa M.; Strain, Eric C.; CalebAlexander, G.; Kaufmann, Christopher; Mojtabai, Ramin

    2018-01-01

    Objective Little is known regarding the temporal trends in prescription, nonmedical use and emergency department (ED) visits involving prescription stimulants in the United States. We aimed to examine the three national trends involving dextroamphetamine-amphetamin (Adderall) and methylphenidate in adults and adolescents. Method Three national surveys conducted between 2006-2011 were used: National Disease and Therapeutic Index (NDTI), a survey of office-based practices, National Survey on Drug Use and Health (NSDUH), a population survey of substance use, and Drug Abuse Warning Network (DAWN), a survey of ED visits. Ordinary least square regression was used to examine temporal changes over time and the associations between these three trends. Results In adolescents, treatment visits involving dextroamphetamine-amphetamine and methylphenidate decreased over time; nonmedical dextroamphetamine-amphetamine use remained stable while nonmedical methylphenidate use declined by 54.4% in 6 years. ED visits involving either medication remained stable. In adults, treatment visits involving dextroamphetamine-amphetamine remained unchanged while nonmedical use went up by 67% and ED visits went up by 156%. These three trends involving methylphenidate remained unchanged. The major source for both medications was a friend or relative across age groups; two-thirds of these friends/relatives had obtained the medication from a physician. Conclusions Trends of prescriptions for stimulants do not correspond to trends in reports of nonmedical use and ED visits. Increased nonmedical stimulant use may not be simply attributed to increased prescribing trends. Future studies should focus on deeper understanding of the proportion, risk factors and motivations for drug diversions. PMID:26890573

  3. Type 2 diabetes mellitus treatment patterns in U.S. nursing home residents.

    Science.gov (United States)

    Zarowitz, Barbara; Allen, Carrie; O'Shea, Terrence; Dalal, Mehul R; Haumschild, Mark; DiGenio, Andres

    2015-06-01

    The prevalence of type 2 diabetes mellitus (diabetes) in nursing home residents (NHRs) is increasing, concurrently with obesity and other comorbid conditions. NHR would benefit greatly from antidiabetic medications that would improve glycemic control and give a lower risk of hypoglycemia but that do not contribute to weight gain in obese individuals. To examine the prescription patterns to NHRs with diabetes, including the use of newer injectable therapies such as glucagon-like peptide-1 (GLP-1) receptor agonists. Treatment patterns of diabetes in NHR were analyzed using Minimum Data Set records and prescription claims from the Omnicare Senior Health Outcomes data repository (May 2011-September 2012). The prevalence of diabetes in this population of 229,283 NHRs was 35.4%. Among the 44,665 NHRs with diabetes and prescription claims data, the prevalence of obesity (40.3%) and multiple comorbidities (100%) was high. Approximately 20% of the NHRs with diabetes were aged diabetes that was untreated with medications during the study period. Insulin was the mainstay of treatment (>80%), followed by oral agents (54%). GLP-1 receptor agonist use was low (0.5%) and associated with poor treatment persistence. Considerations other than glycemic control may drive prescribing decisions, contrary to recommendations from the American Diabetes Association, American Medical Directors Association, and European Association for the Study of Diabetes.

  4. Identification and management of prescription drug abuse in pregnancy.

    Science.gov (United States)

    Worley, Julie

    2014-01-01

    Prescription drug abuse is a growing problem in the United States and many other countries. Estimates of prescription drug abuse rates during pregnancy range from 5% to 20%. The primary prescription drugs designated as controlled drugs with abuse potential in pregnancy are opiates prescribed for pain, benzodiazepines prescribed for anxiety, and stimulants prescribed for attention-deficit/hyperactivity disorder. Prescription drugs are obtained for abuse through diversion methods, such as purchasing them from others or by doctor shopping. The use of prescription drugs puts both the mother and the fetus at high risk during pregnancy. Identification of women who are abusing prescription drugs is important so that treatment can be ensured. It is crucial for healthcare professionals to use a multidisciplinary approach and be supportive and maintain a good rapport with pregnant women who abuse prescription drugs. Management includes inpatient hospitalization for detoxification and withdrawal symptoms, and in the case of opiate abuse, opiate maintenance is recommended for pregnant women for the duration of their pregnancy to reduce relapse rates and improve maternal and fetal outcomes. Other recommendations include referral for support groups and supportive housing.

  5. Nature, frequency and determinants of prescription modifications in Dutch community pharmacies

    Science.gov (United States)

    Buurma, Henk; de Smet, Peter A G M; van den Hoff, Olga P; Egberts, Antoine C G

    2001-01-01

    Aims To examine the nature, frequency and determinants of prescription modifications in Dutch community pharmacies. Methods A prospective case-control study comparing modified prescriptions with nonmodified prescriptions was carried out in 141 Dutch community pharmacies. 2014 modified prescriptions (cases), collected in the selected pharmacies on a predetermined day in a specific period (25th February until 12th March 1999) and 2581 nonmodified prescriptions (controls) randomly selected on the same day were studied. The nature and frequency of prescription modifications and patient, drug and prescriber related determinants for a modified prescription were assessed. Results The overall incidence of prescription modifications was 4.3%, with a mean of 14.3 modifications per pharmacy per day. For prescription only medicines (POM) the incidence was 4.9%. The majority of POM modifications concerned a clarification (71.8%). In 22.2% a prescription could potentially have had clinical consequences when not altered; in more than half of the latter it concerned a dose error (13.7% of all cases). POM prescriptions of patients of 40–65 years had a significantly lower chance of modification compared with those of younger people (OR = 0.74 [0.64–0.86]). With respect to medication-class, we found a higher chance of POM modifications in the respiratory domain (OR = 1.48 [1.23-1.79]) and a decreased chance for nervous system POMs (OR = 0.71 [0.61–0.83]). With regard to prescriber-related determinants modifications were found three times more often in non printed prescriptions than in printed ones (OR = 3.30 [2.90-3.75]). Compared with prescriptions by the patient's own GP, prescriptions of specialists (OR = 1.82 [1.57-2.11]), other GP's (OR = 1.49 [1.02-2.17]) and other prescribers such as dentists and midwives (OR = 1.95 [1.06-3.57]) gave a higher probability of prescription modifications. When a GP had no on-line access to the computer of the pharmacy the chance of a

  6. Nonmedical Prescription Drug Use: Theory and Policy Implications

    OpenAIRE

    Gabriele Camera; Bryan Engelhardt

    2014-01-01

    The illicit nonmedical use of prescription drugs is studied in a model where individuals with imperfectly observable health conditions seek prescription drugs for either medical or nonmedical reasons. The equilibrium number of medical and nonmedical users is endogenous and depends on economic and non-economic barriers to drugs consumption, such as pricing, health care costs, refill policies, monitoring programs, and the medical community’s prescription standards. The results show policies cen...

  7. Ataques de Nervios and their psychiatric correlates in Puerto Rican children from two different contexts.

    Science.gov (United States)

    López, Irene; Rivera, Fernando; Ramirez, Rafael; Guarnaccia, Peter J; Canino, Glorisa; Bird, Héctor R

    2009-12-01

    Among Latino adults and children, ataques de nervios has been associated with an array of psychiatric disorders. Using data from a probability sample of Puerto Rican children, aged 5 to 13 years (N = 2491), we assessed the lifetime prevalence and psychiatric correlates of ataques in youth residing in the South Bronx, New York and San Juan, Puerto Rico. Baseline site comparisons indicated that between 4% and 5% of children had a lifetime prevalence of ataques (either by child or parent report) and that ataques were associated with greater global impairment and a host of childhood disorders within the previous twelve months. Ataques were also correlated with greater exposure to violence, as well as more stressful life events for the South Bronx sample. After controlling for several covariates, ataques continued to be significantly associated with psychopathology. Ataques are, therefore, a significant correlate of global impairment and childhood psychopathology among Puerto Rican youth.

  8. Gender Differences in the Prevalence of Fibromyalgia and in Concomitant Medical and Psychiatric Disorders: A National Veterans Health Administration Study.

    Science.gov (United States)

    Arout, Caroline A; Sofuoglu, Mehmet; Bastian, Lori A; Rosenheck, Robert A

    2018-04-02

    Fibromyalgia is a poorly understood, chronically disabling pain syndrome. While research has focused on its clinical presentation and treatment, less is known about fibromyalgia's clinical epidemiology in real-world healthcare systems. Gender differences have been difficult to study because relatively few males are diagnosed with fibromyalgia. Veterans Health Administration (VHA) patients diagnosed with fibromyalgia nationwide in FY 2012 were compared to Veterans with other pain diagnoses on sociodemographic characteristics, medical and psychiatric diagnoses, health service use, and opioid and psychotropic prescription fills. Additional analyses compared characteristics of men and women diagnosed with fibromyalgia. Risk ratios and Cohen's d were used for bivariate comparisons, followed by logistic regression analyses to identify independent factors associated with a diagnosis of fibromyalgia in the VHA. Altogether, 77,087 of 2,216,621 Veterans with pain diagnoses (3.48%) were diagnosed with fibromyalgia. They were more likely to be female, younger than patients with other pain conditions, more likely to have multiple psychiatric comorbidities and other types of pain, and used more medical outpatient services. Women diagnosed with fibromyalgia were younger and more likely to have headaches, connective tissue diseases (CTD), and psychiatric comorbidities, while men had more comorbid medical conditions. In this large, predominantly older male sample of Veterans with pain diagnoses, those with fibromyalgia were far more likely to be women. Gender comparisons showed women with fibromyalgia were more likely to be diagnosed with psychiatric disorders and CTD, while males were more likely to be diagnosed with medical conditions. Fibromyalgia shows a striking, gender-dependent picture of multimorbidity, which should be considered in treatment.

  9. 76 FR 51310 - Branded Prescription Drug Fee

    Science.gov (United States)

    2011-08-18

    ... Branded Prescription Drug Fee AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed... issue of the Federal Register, the IRS is issuing temporary regulations relating to the branded... business of manufacturing or importing certain branded prescription drugs. The text of the temporary...

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

    Science.gov (United States)

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

    2015-10-16

    Drug overdose is the leading cause of injury death in the United States. The death rate from drug overdose in the United States more than doubled during 1999-2013, from 6.0 per 100,000 population in 1999 to 13.8 in 2013. The increase in drug overdoses is attributable primarily to the misuse and abuse of prescription drugs, especially opioid analgesics, sedatives/tranquilizers, and stimulants. Such drugs are prescribed widely in the United States, with substantial variation by state. Certain patients obtain drugs for nonmedical use or resale by obtaining overlapping prescriptions from multiple prescribers. The risk for overdose is directly associated with the use of multiple prescribers and daily dosages of >100 morphine milligram equivalents (MMEs) per day. 2013. The Prescription Behavior Surveillance System (PBSS) is a public health surveillance system that allows public health authorities to characterize and quantify the use and misuse of prescribed controlled substances. PBSS began collecting data in 2012 and is funded by CDC and the Food and Drug Administration. PBSS uses standard metrics to measure prescribing rates per 1,000 state residents by demographic variables, drug type, daily dose, and source of payment. Data from the system can be used to calculate rates of misuse by certain behavioral measures such as use of multiple prescribers and pharmacies within specified time periods. This report is based on 2013 de-identified data (most recent available) that represent approximately one fourth of the U.S. Data were submitted quarterly by prescription drug monitoring programs (PDMPs) in eight states (California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio, and West Virginia) that routinely collect data on every prescription for a controlled substance to help law enforcement and health care providers identify misuse or abuse of such drugs. In all eight states, opioid analgesics were prescribed approximately twice as often as stimulants or benzodiazepines

  11. Are Prescription Stimulants "Smart Pills"? The Epidemiology and Cognitive Neuroscience of Prescription Stimulant Use by Normal Healthy Individuals

    Science.gov (United States)

    Smith, M. Elizabeth; Farah, Martha J.

    2011-01-01

    Use of prescription stimulants by normal healthy individuals to enhance cognition is said to be on the rise. Who is using these medications for cognitive enhancement, and how prevalent is this practice? Do prescription stimulants in fact enhance cognition for normal healthy people? We review the epidemiological and cognitive neuroscience…

  12. Refugee children have fewer contacts to psychiatric healthcare services: an analysis of a subset of refugee children compared to Danish-born peers.

    Science.gov (United States)

    Barghadouch, Amina; Kristiansen, Maria; Jervelund, Signe Smith; Hjern, Anders; Montgomery, Edith; Norredam, Marie

    2016-08-01

    Studies show a high level of mental health problems among refugee children. This study examined whether a subset of refugee children living in Denmark accessed psychiatric healthcare services more than those born in the country. This study compared 24,427 refugee children from Asia, The Middle East, Sub-Saharan Africa and former Yugoslavia, who obtained residency in Denmark between 1 January 1993 and 31 December 2010 with 146,562 Danish-born children, matched 1:6 on age and sex. The study looked at contacts with psychiatric hospitals as well as psychologists and psychiatrists in private practice. Between 1 January 1996 and 30 June 2012, 3.5 % of the refugee children accessed psychiatric healthcare services compared to 7.7 % of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95 % CI 0.40-0.45) among refugee boys and 0.35 (95 % CI 0.33-0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services. Refugee children used fewer psychiatric healthcare services than Danish-born children. This may indicate that refugee children experience barriers in accessing psychiatric healthcare systems and do not receive adequate assessment of their mental health and subsequent referral to specialist services.

  13. Automated Prescription of Oblique Brain 3D MRSI

    OpenAIRE

    Ozhinsky, Eugene; Vigneron, Daniel B.; Chang, Susan M.; Nelson, Sarah J.

    2012-01-01

    Two major difficulties encountered in implementing Magnetic Resonance Spectroscopic Imaging (MRSI) in a clinical setting are limited coverage and difficulty in prescription. The goal of this project was to completely automate the process of 3D PRESS MRSI prescription, including placement of the selection box, saturation bands and shim volume, while maximizing the coverage of the brain. The automated prescription technique included acquisition of an anatomical MRI image, optimization of the ob...

  14. Influence of errors in prescriptions on the security of medicine

    Directory of Open Access Journals (Sweden)

    Puke K.

    2016-01-01

    Full Text Available All types of medication errors including missed doses, incorrect dosage forms, time intervals, and routes are essential encumbrances for qualitative pharmaceutical care and security of medicine [1]. Problems related to prescription errors are common in the healthcare profession, and are responsible for significant increase in costs, cases of morbidity and mortality [2]. The aim of the study was to analyze the common errors in prescriptions which were received in pharmacies and their effect on the security of medicine. Retrospective study was conducted between December 2013 and January 2014 in the pharmacy of Riga, Latvia. Prescriptions were analyzed to identify errors in Inscriptio, Praescriptio and the Signatura part. Of 200 prescriptions, only 14 (7% were filled correctly according to the legislative requirements in Latvia. The most common drug therapeutic class in the prescriptions was non-steroidal anti-inflammatory drugs (NSAID and other analgesics (21.1%. Unclear handwriting was observed in more than one third of all studied prescriptions (n=72; 36.0%. Mean age values of physicians were higher, but not significantly different, in the unclear compared to clear prescriptions, 59.5 ± 8.5 vs. 57.8 ± 10.6, respectively (p=0.253. Omission of the quantity of drug in the prescription part was the most frequent type of the error (n=112, 56.0%. High level of incorrect prescriptions was found during the period of study in the pharmacy. Overall, approximately 27% of prescriptions had significant failures, which could negatively affect therapeutic effect and safety of drug use.

  15. Psychiatry residents and dynamic psychiatry: two narratives, a survey, and some ideas to enhance recruitment.

    Science.gov (United States)

    Katz, Debra A; Tuttle, Jeffrey P; Housman, Beth T

    2011-01-01

    Psychiatric residency has undergone a major shift over the past 50 years with increasing emphasis on psychopharmacology evidence-based treatments, and competency-based requirements which has led to concerns that psychodynamic knowledge and skills are in jeopardy. Narratives of two residents who developed strong interest in psychodynamic psychotherapy and psychoanalytic training are presented to illustrate the important influences on their identities as psychodynamically oriented psychiatrists. Results from a recent survey of U.S. residents regarding psychodynamic psychiatry indicate that they value psychodynamic psychotherapy, want to incorporate psychotherapy into their careers as psychiatrists, and strongly endorse personal psychotherapy but view their psychodynamic skills as weak. Recommendations about how to enhance education and interest include (1) building or strengthening relationships with mentors, supervisors, and teachers, (2) emphasizing the importance of psychodynamic understanding of patients whether or not the resident is functioning as a therapist, (3) using psychopharmacology to engage residents in thinking psychodynamically, (4) encouraging personal psychotherapy for residents and helping find ways to make it affordable, (5) utilizing awards, visiting scholars, specialized programs, and distance learning, especially for programs without adequate resources, and (6) encouraging clinicians to become familiar with the research base in psychodynamic psychotherapy to correct biases and misperceptions.

  16. Alcohol Abuse and Other Psychiatric Disorders

    Science.gov (United States)

    ... Psychiatric Disorders Other Substance Abuse HIV/AIDS Other Psychiatric Disorders In the current Diagnostic and Statistical Manual ... and other substance use disorders are defined as psychiatric disorders. Many individuals who misuse alcohol also abuse ...

  17. Influence of pharmacists expertise on physicians prescription ...

    African Journals Online (AJOL)

    Purpose: To explore the influence of pharmacist factors on prescription decisions of physicians. Methods: A survey of literature was carried out across online databases and 12 relevant articles were identified. The influence of pharmacist factors on physician prescription decisions was identified in the articles. A conceptual ...

  18. Prescription Drug Plan Formulary, Pharmacy Network, and P...

    Data.gov (United States)

    U.S. Department of Health & Human Services — These public use files contain formulary, pharmacy network, and pricing data for Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug Plans...

  19. Antibiotic Prescription in Danish General Practice

    DEFF Research Database (Denmark)

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

    2016-01-01

    1. Background & Aim The overall aim of the project is to describe antibiotic consumption in Danish general practice with emphasis on specific types of antibiotics. The project will shed light on the impact of microbiological diagnostic methods (MDM) on the choice of antibiotic and the project...... will explore how the GPs prescription behaviour is influenced by selected factors. Antibiotics are essential when treating potentially lethal infections. An increasing development of resistant bacteria is considered one of the primary threats to public health. The majority of antibiotics (90%) are prescribed...... from general practice. The prescription of broad-spectrum antibiotics can cause unnecessary side effects for the individual and increases the risk of development of bacteria resistant to antibiotic treatment. Both the prescription of broad-spectrum antibiotics and the level of resistant bacteria...

  20. Prescription Drug Abuse: From Epidemiology to Public Policy

    OpenAIRE

    McHugh, R. Kathryn; Nielsen, Suzanne; Weiss, Roger D.

    2014-01-01

    Prescription drug abuse has reached an epidemic level in the United States. The prevalence of prescription drug abuse escalated rapidly beginning in the late 1990s, requiring a significant increase in research to better understand the nature and treatment of this problem. Since this time, a research literature has begun to develop and has provided important information about how prescription drug abuse is similar to, and different from the abuse of other substances. This introduction to a spe...

  1. Associate residency training directors in psychiatry: demographics, professional activities, and job satisfaction.

    Science.gov (United States)

    Arbuckle, Melissa R; Degolia, Sallie G; Esposito, Karin; Miller, Deborah A; Weinberg, Michael; Brenner, Adam M

    2012-09-01

    The purpose of this study was to characterize associate training director (ATD) positions in psychiatry. An on-line survey was e-mailed in 2009 to all ATDs identified through the American Association of Directors of Psychiatric Residency Training (AADPRT). Survey questions elicited information regarding demographics, professional activities, job satisfaction, and goals. Of 170 ATDs surveyed, 73 (42.9%) completed the survey. Most respondents (71.3%) had been in their positions for 3 years or less. Many ATDs indicated that they were involved in virtually all aspects of residency training; 75% of respondents agreed that they were happy with their experience. However, specific concerns included inadequate time and compensation for the ATD role in addition to a lack of mentorship and unclear job expectations. Thoughtful attention to the construction of the ATD role may improve job satisfaction.

  2. Automated Prescription of Oblique Brain 3D MRSI

    Science.gov (United States)

    Ozhinsky, Eugene; Vigneron, Daniel B.; Chang, Susan M.; Nelson, Sarah J.

    2012-01-01

    Two major difficulties encountered in implementing Magnetic Resonance Spectroscopic Imaging (MRSI) in a clinical setting are limited coverage and difficulty in prescription. The goal of this project was to completely automate the process of 3D PRESS MRSI prescription, including placement of the selection box, saturation bands and shim volume, while maximizing the coverage of the brain. The automated prescription technique included acquisition of an anatomical MRI image, optimization of the oblique selection box parameters, optimization of the placement of OVS saturation bands, and loading of the calculated parameters into a customized 3D MRSI pulse sequence. To validate the technique and compare its performance with existing protocols, 3D MRSI data were acquired from 6 exams from 3 healthy volunteers. To assess the performance of the automated 3D MRSI prescription for patients with brain tumors, the data were collected from 16 exams from 8 subjects with gliomas. This technique demonstrated robust coverage of the tumor, high consistency of prescription and very good data quality within the T2 lesion. PMID:22692829

  3. Using Healthcare Failure Mode and Effect Analysis to reduce medication errors in the process of drug prescription, validation and dispensing in hospitalised patients.

    Science.gov (United States)

    Vélez-Díaz-Pallarés, Manuel; Delgado-Silveira, Eva; Carretero-Accame, María Emilia; Bermejo-Vicedo, Teresa

    2013-01-01

    To identify actions to reduce medication errors in the process of drug prescription, validation and dispensing, and to evaluate the impact of their implementation. A Health Care Failure Mode and Effect Analysis (HFMEA) was supported by a before-and-after medication error study to measure the actual impact on error rate after the implementation of corrective actions in the process of drug prescription, validation and dispensing in wards equipped with computerised physician order entry (CPOE) and unit-dose distribution system (788 beds out of 1080) in a Spanish university hospital. The error study was carried out by two observers who reviewed medication orders on a daily basis to register prescription errors by physicians and validation errors by pharmacists. Drugs dispensed in the unit-dose trolleys were reviewed for dispensing errors. Error rates were expressed as the number of errors for each process divided by the total opportunities for error in that process times 100. A reduction in prescription errors was achieved by providing training for prescribers on CPOE, updating prescription procedures, improving clinical decision support and automating the software connection to the hospital census (relative risk reduction (RRR), 22.0%; 95% CI 12.1% to 31.8%). Validation errors were reduced after optimising time spent in educating pharmacy residents on patient safety, developing standardised validation procedures and improving aspects of the software's database (RRR, 19.4%; 95% CI 2.3% to 36.5%). Two actions reduced dispensing errors: reorganising the process of filling trolleys and drawing up a protocol for drug pharmacy checking before delivery (RRR, 38.5%; 95% CI 14.1% to 62.9%). HFMEA facilitated the identification of actions aimed at reducing medication errors in a healthcare setting, as the implementation of several of these led to a reduction in errors in the process of drug prescription, validation and dispensing.

  4. Prescription Writing Errors of Midwifery Students in Common Gynecological problems

    Directory of Open Access Journals (Sweden)

    Serveh Parang

    2014-04-01

    Full Text Available Background and aim: Giving improper prescriptions is common among medical practitioners, mostly graduates, in most communities even developed countries. So far, to our knowledge, no study has been conducted on prescription writing of graduate midwifery students. Therefore, this study aimed to detect prescription writing errors of midwifery students in common gynecological problems. Methods: In this descriptive cross-sectional study, 56 bachelor midwifery students, who had passed the theoretical and clinical courses of gynecology, were evaluated by Objective Structured Clinical Examination (OSCE. A demographic questionnaire and a standard checklist for writing the prescriptions and medications were used for data collection. SPSS Version 16 was used to carry out descriptive statistics. Findings: Most of the students were single, with the mean age of 23.0±1.7 years. Most errors were related to not recording the patients’ age and sex, diagnosis, chief complaint, and the prescriber’s name (observed in less than 10% of the prescriptions. The complete dosage schedule and drug name were stated only in 1.8±4.8 and 14±18.6 of prescriptions, respectively. In more than 93% of the cases, route of use and treatment duration were not recorded. Conclusion: According to the results, the number of prescription errors of midwifery students was high. Therefore, it is recommended to run educational courses on prescription writing skills (e.g. writing prescriptions based on World Health Organization (WHO guidelines for the midwifery students.

  5. Bodily differences between Cold- and Heat-prescription groups in Sasang medicine

    Directory of Open Access Journals (Sweden)

    Young Joo Park

    2016-06-01

    Conclusion: In the SY-type men, the chest circumference was significantly greater in the Heat-prescription group compared to the Cold-prescription group. In the TE-type men, the rib-to-pelvic circumference ratio was significantly higher in the Heat-prescription group than in the Cold-prescription group.

  6. [Analysis on traditional Chinese medicine prescriptions treating cancer-related anorexia syndrome based on grey system theory combined with multivariate analysis method and discovery of new prescriptions].

    Science.gov (United States)

    Chen, Song-Lin; Chen, Cong; Zhu, Hui; Li, Jing; Pang, Yan

    2016-01-01

    Cancer-related anorexia syndrome (CACS) is one of the main causes for death at present as well as a syndrome seriously harming patients' quality of life, treatment effect and survival time. In current clinical researches, there are fewer reports about empirical traditional Chinese medicine(TCM) prescriptions and patent prescriptions treating CACS, and prescription rules are rarely analyzed in a systematic manner. As the hidden rules are not excavated, it is hard to have an innovative discovery and knowledge of clinical medication. In this paper, the grey screening method combined with the multivariate statistical method was used to build the ″CACS prescriptions database″. Based on the database, totally 359 prescriptions were selected, the frequency of herbs in prescription was determined, and commonly combined drugs were evolved into 4 new prescriptions for different syndromes. Prescriptions of TCM in treatment of CACS gave priority to benefiting qi for strengthening spleen, also laid emphasis on replenishing kidney essence, dispersing stagnated liver-qi and dispersing lung-qi. Moreover, interdependence and mutual promotion of yin and yang should be taken into account to reflect TCM's holism and theory for treatment based on syndrome differentiation. The grey screening method, as a valuable traditional Chinese medicine research-supporting method, can be used to subjectively and objectively analyze prescription rules; and the new prescriptions can provide reference for the clinical use of TCM for treating CACS and the drug development. Copyright© by the Chinese Pharmaceutical Association.

  7. Direct-to-consumer advertising of prescription drugs.

    Science.gov (United States)

    Frosch, Dominick L; Grande, David

    2010-01-01

    In 2007, the pharmaceutical industry spent more than $4.9 billion on direct-to-consumer advertising (DTCA) of prescription drugs in the U.S. Controversy over DTCA has grown since the Food and Drug Administration liberalized its regulations in 1997. Proponents claim that such advertising educates consumers, promotes patient participation in clinical decisions, and improves patient adherence to medication instructions. Opponents argue that such advertising is meant to persuade, not educate, and that it promotes inappropriate use of prescription drugs, or diverts consumers from better alternatives. This Issue Brief summarizes the evidence about the effects of DTCA, and proposes guidelines for improving the utility of prescription drug advertising.

  8. Psychiatric morbidity in perimenopausal women

    Directory of Open Access Journals (Sweden)

    Biswajit L Jagtap

    2016-01-01

    Full Text Available Background: Women in the perimenopausal period are reported to be vulnerable to psychiatric disorders. Aim: To assess the psychiatric morbidity in perimenopausal women aged 45–55 years. Materials and Methods: This cross-sectional, observational, hospital-based study was conducted at the Department of Psychiatry in a tertiary care hospital attached to a medical college. The study sample consisted of consecutive women in perimenopause as diagnosed by a gynecologist and written informed consent for inclusion in the study. Women with a previous history of psychiatric illnesses, with a major medical illness, or who had undergone surgical menopause were excluded from the study. All women were evaluated with a brief questionnaire for collecting demographic and clinical information and the Mini International Neuropsychiatric Interview for assessing psychiatric disorders. Results: Of the 108 women in perimenopause included in the study, 31% had depressive disorder, 7% had anxiety, while 5% had depressive disorder with anxiety features. Psychiatric morbidity was significantly more in women having lesser education, from rural background, with a history of psychiatric illness in the family, a later age of menarche, and in the late stage of perimenopause. Conclusions: Women in the perimenopause affected by psychiatric morbidity were most commonly diagnosed with depression. As perimenopause is a time of vulnerability in women, attention to signs and symptoms of depression may be required so that they may lead a more productive life.

  9. 21 CFR 1306.22 - Refilling of prescriptions.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Refilling of prescriptions. 1306.22 Section 1306.22 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE PRESCRIPTIONS Controlled... 75 FR 16308, Mar. 31, 2010, § 1306.22 was revised, effective June 1, 2010. For the convenience of the...

  10. A comprehensive psychiatric service

    DEFF Research Database (Denmark)

    Wang, A G

    1984-01-01

    A comprehensive psychiatric service was established in 1969 in the Faroe Islands. This service was created as a department of a general hospital. The spheres covered by this department, operating in the midst of the community were: acute and chronic patients, a liaison-psychiatric service...

  11. [Inappropriate prescription in older patients: the STOPP/START criteria].

    LENUS (Irish Health Repository)

    Delgado Silveira, Eva

    2009-09-01

    Older people are a heterogeneous group of patients, often with multiple comorbidities for which they are prescribed a large number of drugs, leading to an increased risk of adverse drug reactions (ADR) and drug interactions. This risk is compounded by physiological age-related changes in physiology, changes in drug pharmacokinetics and pharmacodynamics, as well as by disease-related, functional and social issues. Inappropriate prescription of drugs is common in the older individuals and contributes to the increased risk of ADR. Several tools have been developed to detect potentially inappropriate prescription, the most frequently used in Spain being Beers\\' criteria. However, the value of these criteria is limited, especially as they were developed in a different healthcare system. In this article, the Spanish version of a new tool to detect potentially inappropriate prescriptions-STOPP (Screening Tool of Older Person\\'s Prescriptions) and START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) criteria-is presented. The creation, development, reliability, and use of these criteria in routine practice is described and discussed. These criteria have shown better sensitivity than Beers\\' criteria in detecting prescription problems and have the added value of being able to detect not only inappropriate prescription of some drugs, but also the omission of well indicated drugs. The STOPP\\/START criteria could become a useful screening tool to improve prescription in older people.

  12. Prescription Drug Monitoring Programs and Other Interventions to Combat Prescription Opioid Abuse

    Directory of Open Access Journals (Sweden)

    Bharath Chakravarthy

    2012-12-01

    Full Text Available The Center for Disease Control and Prevention (CDC has published significant data and trendsrelated to opioid prescription pain relievers (OPR. In 2008, 20,044 deaths were attributedto prescription drug overdose of which 14,800 (73.8% were due to OPR, an amount greaterthan the number of overdose deaths from heroin and cocaine combined. The majority of thesedeaths were unintentional. Between 1999-2008, overdose deaths from OPR increased almostfour-fold. Correspondingly, sales of OPR were four times greater in 2010 than in 1999. Mostsignificant to emergency physicians is the estimate that 39% of all opioids prescribed, administeredor continued come from the emergency department (ED. We present findings from theCDC’s Morbidity and Mortality Weekly Report (MMWR with commentary on current recommendationsand policies for curtailing the OPR epidemic.1

  13. Open Notes in Swedish Psychiatric Care (Part 1): Survey Among Psychiatric Care Professionals.

    Science.gov (United States)

    Petersson, Lena; Erlingsdóttir, Gudbjörg

    2018-02-02

    When the Swedish version of Open Notes, an electronic health record (EHR) service that allows patients online access, was introduced in hospitals, primary care, and specialized care in 2012, psychiatric care was exempt. This was because psychiatric notes were considered too sensitive for patient access. However, as the first region in Sweden, Region Skåne added adult psychiatry to its Open Notes service in 2015. This made it possible to carry out a unique baseline study to investigate how different health care professionals (HCPs) in adult psychiatric care in the region expect Open Notes to impact their patients and their practice. This is the first of two papers about the implementation of Open Notes in adult psychiatric care in Region Skåne. The objective of this study was to describe, compare, and discuss how different HCPs in adult psychiatric care in Region Skåne expect Open Notes to impact their patients and their own practice. A full population Web-based questionnaire was distributed to psychiatric care professionals in Region Skåne in late 2015. The response rate was 28.86% (871/3017). Analyses show that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between different professionals and attitudes to the Open Notes service. The results show that the psychiatric HCPs are generally of the opinion that the service would affect their own practice and their patients negatively. The most striking result was that more than 60% of both doctors (80/132, 60.6%) and psychologists (55/90, 61%) were concerned that they would be less candid in their documentation in the future. Open Notes can increase the transparency between patients and psychiatric HCPs because patients are able to access their EHRs online without delay and thus, can read notes that have not yet been approved by the responsible HCP. This may be one explanation as to why HCPs are concerned that the service will affect both their own work

  14. [Level of Development of Clinical Ethics Consultation in Psychiatry - Results of a Survey Among Psychiatric Acute Clinics and Forensic Psychiatric Hospitals].

    Science.gov (United States)

    Gather, Jakov; Kaufmann, Sarah; Otte, Ina; Juckel, Georg; Schildmann, Jan; Vollmann, Jochen

    2018-04-17

    The aim of this article is to assess the level of development of clinical ethics consultation in psychiatric institutions in North Rhine-Westphalia. Survey among medical directors, directors of nursing and administrative directors of all psychiatric acute clinics and forensic psychiatric hospitals in North Rhine-Westphalia. 113 persons working in psychiatric acute clinics responded (reponse rate: 48 %) and 13 persons working in forensic psychiatric hospitals (response rate 54 %). We received at least one response from 89 % of all psychiatric acute clinics and from 100 % of all forensic psychiatric hospitals. 90 % of the responding psychiatric acute clinics and 29 % of the responding forensic psychiatric hospitals have already implemented clinical ethics consultation. Clinical ethics consultation is more widespread in psychiatric institutions than was hitherto assumed. Future medical ethics research should therefore give greater attention to the methodology and the quality of clinical ethics consultation in psychiatric practice. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Using prescription monitoring program data to characterize out-of-pocket payments for opioid prescriptions in a state Medicaid program.

    Science.gov (United States)

    Hartung, Daniel M; Ahmed, Sharia M; Middleton, Luke; Van Otterloo, Joshua; Zhang, Kun; Keast, Shellie; Kim, Hyunjee; Johnston, Kirbee; Deyo, Richard A

    2017-09-01

    Out-of-pocket payment for prescription opioids is believed to be an indicator of abuse or diversion, but few studies describe its epidemiology. Prescription drug monitoring programs (PDMPs) collect controlled substance prescription fill data regardless of payment source and thus can be used to study this phenomenon. To estimate the frequency and characteristics of prescription fills for opioids that are likely paid out-of-pocket by individuals in the Oregon Medicaid program. Cross-sectional analysis using Oregon Medicaid administrative claims and PDMP data (2012 to 2013). Continuously enrolled nondually eligible Medicaid beneficiaries who could be linked to the PDMP with two opioid fills covered by Oregon Medicaid. Patient characteristics and fill characteristics for opioid fills that lacked a Medicaid pharmacy claim. Fill characteristics included opioid name, type, and association with indicators of high-risk opioid use. A total of 33 592 Medicaid beneficiaries filled a total of 555 103 opioid prescriptions. Of these opioid fills, 74 953 (13.5%) could not be matched to a Medicaid claim. Hydromorphone (30%), fentanyl (18%), and methadone (15%) were the most likely to lack a matching claim. The 3 largest predictors for missing claims were opioid fills that overlapped with other opioids (adjusted odds ratio [aOR] 1.37; 95% confidence interval [CI], 1.34-1.4), long-acting opioids (aOR 1.52; 95% CI, 1.47-1.57), and fills at multiple pharmacies (aOR 1.45; 95% CI, 1.39-1.52). Prescription opioid fills that were likely paid out-of-pocket were common and associated with several known indicators of high-risk opioid use. Copyright © 2017 John Wiley & Sons, Ltd.

  16. Encopresis: a guide for psychiatric nurses.

    Science.gov (United States)

    Hardy, Lyons T

    2009-10-01

    Encopresis is an elimination disorder that involves symptoms of fecal incontinence in children. It affects an estimated 1.5% to 7.5% of children ages 6 to 12 and accounts for approximately 3% to 6% of psychiatric referrals. The etiology of encopresis is thought to be related to physiologic problems such as constipation; however, it is also a psychiatric diagnosis and anecdotally may have some association with psychiatric problems. Publications on this association and publications directed toward psychiatric nurses are limited. Encopresis is typically treated with nutritional and medical management along with behavioral modification. Psychiatric nurses working with patients who have encopresis in inpatient settings will have unique concerns and challenges. This article gives an overview of published literature from the past 10 years on the etiology and treatment of encopresis. Specific suggestions for inpatient psychiatric nurses based on published literature and the author's professional experience are provided.

  17. Risk of suicide according to the level of psychiatric contact in the older people: Analysis of national health insurance databases in Taiwan.

    Science.gov (United States)

    Yeh, Shin-Ting; Ng, Yee-Yung; Wu, Shiao-Chi

    2017-04-01

    Suicide in the older people is a serious problem worldwide; however the effect of psychiatric contact on the risk of suicide has not been fully explored. The aim of this study was to investigate the relationship between psychiatric contact and suicide in the older people in Taiwan. A population-based database was used in this national case-control study. Propensity score matching was used to match older people who did and did not commit suicide from 2010 to 2012 by calendar year, gender, age, and area of residence. The level of psychiatric contact in the preceding year was classified as "no psychiatric contact," "only outpatient psychiatric contact," "psychiatric emergency room contact," or "psychiatric hospital admission". Conditional logistic regression analysis was used to assess associations between variables and the risk of suicide. A total of 2528 older people committed suicide from 2010 to 2012, with a crude suicide mortality rate of 3.37/10,000. Compared to those who had no psychiatric contact in the preceding year, the adjusted odds ratios of suicide were 10.15 (95% CI=5.8-17.7) for those who had psychiatric emergency room contact, 6.57 (95% CI=3.7-11.6) for those who had psychiatric hospital admissions, and 3.64 (95% CI=3.0-4.4) for those with only outpatient psychiatric contact. The risk of suicide was higher in those who had depression (OR=3.49, 95% CI=2.2-5.4) and bipolar disorder (OR=1.98, 95% CI=1.1-3.6). Patients with cancer were associated with suicide (OR=8.96, 95% CI=5.6-14.4). The positive association with suicide and the level of psychiatric contact in the preceding year in older people indicated that the health personnel need to do a better job in determining possible risk for older people who had psychiatric contact, especially in emergency visit or psychiatric admission. A systematic approach to quality improvement in these settings is both available and necessary. Careful discharge planning and safe transitions of care to outpatient

  18. A Theoretical Approach to Electronic Prescription System: Lesson Learned from Literature Review

    Science.gov (United States)

    Samadbeik, Mahnaz; Ahmadi, Maryam; Hosseini Asanjan, Seyed Masoud

    2013-01-01

    Context The tendency to use advanced technology in healthcare and the governmental policies have put forward electronic prescription. Electronic prescription is considered as the main solution to overcome the major drawbacks of the paper-based medication prescription, such as transcription errors. This study aims to provide practical information concerning electronic prescription system to a variety of stakeholders. Evidence Acquisition In this review study, PubMed, ISI Web of Science, Scopus, EMBASE databases, Iranian National Library Of Medicine (INLM) portal, Google Scholar, Google and Yahoo were searched for relevant English publications concerning the problems of paper-based prescription, and concept, features, levels, benefits, stakeholders and standards of electronic prescription system. Results There are many problems with the paper prescription system which, according to studies have jeopardized patients’ safety and negatively affected the outcomes of medication therapy. All of these problems are remedied through the implementation of e-prescriptions. Conclusions The sophistication of electronic prescription and integration with EHR will become a reality, if all its stakeholders collaborate in developing fast and secure electronic prescription systems. It is plausible that the required infrastructure should be provided for implementation of the national integrated electronic prescription systems in countries without the system. Given the barriers to the implementation and use, policymakers should consider multiple strategies and offer incentives to encourage e-prescription initiatives. This will result in widespread adoption of the system. PMID:24693376

  19. 42 CFR 415.184 - Psychiatric services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Psychiatric services. 415.184 Section 415.184 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Psychiatric services. To qualify for physician fee schedule payment for psychiatric services furnished under...

  20. The mental health consequences of nonmedical prescription drug use among adolescents.

    Science.gov (United States)

    Ali, Mir M; Dean, David; Lipari, Rachel; Dowd, William N; Aldridge, Arnie P; Novak, Scott P

    2015-03-01

    Nonmedical prescription drug use is estimated to be the second most abused category of drugs after marijuana among adolescents. Prescription drugs can be highly addictive and prolonged use can produce neurological changes and physiological dependence and could result in adverse mental health outcomes. This topic is largely unexplored, as current knowledge of possible mechanisms of the linkage between adverse mental health consequences and prescription drug misuse is limited. This study explores the relationship between nonmedical use of prescription drugs and depression outcomes among adolescents. Given their complex and confounded relationship, our purpose is to better understand the extent to which nonmedical use of prescription drugs is an antecedent of depressive episodes. Using data from the 2008-2012 National Survey on Drug Use and Health, the study employs a propensity score matching methodology to ascertain whether nonmedical use of prescription drugs is linked to major depressive episodes among adolescents. The results document a positive relationship between nonmedical prescription drug use and major depressive episodes among adolescents. Specifically, the results indicate that adolescents who used prescription drugs non-medically are 33% to 35% more likely to experience major depressive episodes compared to their non-abusing counterparts. This provides additional evidence about the potential public health consequences of misuse of prescription drugs on adverse mental health outcomes. Given the significant increased risk of major depressive episode among adolescents who use prescription drugs nonmedically, it seems that the prevention of nonmedical prescription drug use warrants the utilization of both educational and public health resources. An important area for future research is to understand how any policy initiatives in this area must strike a balance between the need to minimize the misuse of prescription drugs and the need to ensure access for

  1. Emergency department discharge prescription interventions by emergency medicine pharmacists.

    Science.gov (United States)

    Cesarz, Joseph L; Steffenhagen, Aaron L; Svenson, James; Hamedani, Azita G

    2013-02-01

    We determine the rate and details of interventions associated with emergency medicine pharmacist review of discharge prescriptions for patients discharged from the emergency department (ED). Additionally, we evaluate care providers' satisfaction with such services provided by emergency medicine pharmacists. This was a prospective observational study in the ED of an academic medical center that serves both adult and pediatric patients. Details of emergency medicine pharmacist interventions on discharge prescriptions were compiled with a standardized form. Interventions were categorized as error prevention or optimization of therapy. The staff of the ED was surveyed related to the influence and satisfaction of this new emergency medicine pharmacist-provided service. The 674 discharge prescriptions reviewed by emergency medicine pharmacists during the study period included 602 (89.3%) for adult patients and 72 (10.7%) for pediatric patients. Emergency medicine pharmacists intervened on 68 prescriptions, resulting in an intervention rate of 10.1% (95% confidence interval [CI] 8.0% to 12.7%). The intervention rate was 8.5% (95% CI 6.4% to 11.1%) for adult prescriptions and 23.6% for pediatric prescriptions (95% CI 14.7% to 35.3%) (difference 15.1%; 95% CI 5.1% to 25.2%). There were a similar number of interventions categorized as error prevention and optimization of medication therapy, 37 (54%) and 31 (46%), respectively. More than 95% of survey respondents believed that the new pharmacist services improved patient safety, optimized medication regimens, and improved patient satisfaction. Emergency medicine pharmacist review of discharge prescriptions for discharged ED patients has the potential to significantly improve patient care associated with suboptimal prescriptions and is highly valued by ED care providers. Copyright © 2012. Published by Mosby, Inc.

  2. Doctor Shopping Behavior and the Diversion of Prescription Opioids.

    Science.gov (United States)

    Simeone, Ronald

    2017-01-01

    "Doctor shopping" as a means of prescription opioid diversion is examined. The number and percentage of prescriptions and morphine-equivalent milligrams diverted in this manner are estimated by state and molecule for the period 2008-2012. Eleven billion prescriptions with unique patient, doctor, and pharmacy identifiers were used to construct diversion "events" that involved between 1 and 6 unique doctors and between 1 and 6 unique pharmacies. Diversion thresholds were established based on the probability of each contingency. A geographically widespread decline occurred between 2008 and 2012. The number of prescriptions diverted fell from approximately 4.30 million (1.75% of all prescriptions) in 2008 to approximately 3.37 million (1.27% of all prescriptions) in 2012, and the number of morphine-equivalent milligrams fell from approximately 6.55 metric tons (2.95% of total metric tons) in 2008 to approximately 4.87 metric tons (2.19% of total metric tons) in 2012. Diversion control efforts have likely been effective. But given increases in opioid-related deaths, opioid-related drug treatment admissions, and the more specific resurgence of heroin-related events, it is clear that additional public health measures are required.

  3. European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS)

    DEFF Research Database (Denmark)

    Weiser, Prisca; Becker, Thomas; Losert, Carolin

    2009-01-01

    of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities.Meanwhile a multi-disciplinary network...... by promoting behaviour-based and/or environment-based interventions. METHODS AND DESIGN: HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet...... consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well...

  4. [Prescription of olanzapine in children and adolescent psychiatric patients].

    Science.gov (United States)

    Frémaux, T; Reymann, J-M; Chevreuil, C; Bentué-Ferrer, D

    2007-01-01

    A review of the literature from 1996-2004 on the indications and adverse reactions concerning the use of olanzapine, a second generation antipsychotic agent, in children and adolescents with psychiatric illness is made in this article. Studies lasted for 2 to 3 months and a few had a follow up period up to a year. Olanzapine, dosed from 2.5 to 20 mg/day, is shown to be a useful drug in the treatment of child and adolescent onset schizophrenia, bipolar disorder, anorexia nervosa with delusions, pervasive developmental disorder, tic disorders, and aggression. OPEN AND DOUBLE-BLIND STUDIES: In 4 open labeled studies (26, 34, 39, 43) and 2 case reports (25), 53 patients, aged from 6-18 years old, afflicted by child onset schizophrenia, were treated with olanzapine for 1 1/2 weeks to one year; 19 had treatment resistant childhood schizophrenia and 34 a first episode. In the first group 13/19 showed improvement whereas, in the second group 27/34 were considered responders. Four patients in the first group who had responded to clozapine (stopped because of adverse events) did less well on olanzapine. In 5 studies, 4 open labeled (15, 20, 44) and 1 double blind (27), 59 adolescent onset schizophrenic patients were treated by olanzapine from 8 to 26 weeks; 50/59 patients were considered responders. In the open label study (20) comparing 43 adolescents treated by olanzapine (19 patients), risperidone (17 patients), or haloperidol (7 patients), improvement was significant in the three groups after 4 weeks of treatment and continued after 8 weeks. It is most interesting to mention that 2 months after the end of the study 71% (12/17) of the olanzapine group that had completed the study, 10/15 (67%) of the risperidone group, and 43% (3/7) of the haloperidol group had continued their treatment. Dropouts were for inefficacy and non-compliance in the olanzapine and risperidone groups whereas they were also for adverse events in the haloperidol group (2/4). A final double blind

  5. An audit of dental prescriptions between clinics and dental laboratories.

    Science.gov (United States)

    Stewart, C A

    2011-08-12

    To discover the quality of written instructions from dentists to dental technicians and the nature of non-compliant prescriptions. An audit of laboratory prescription compliance was conducted within an NHS Trust Dental Teaching Hospital to determine the level of communication between dentists and dental technicians. One hundred and fifty prescriptions were audited from dental undergraduates and qualified dentists throughout the different departments. A total of two-thirds of prescriptions were considered non-compliant and failed to meet relevant ethical and legal guidelines. This problem was seen throughout all departments and at all professional levels. A breakdown in communication between dentists and technicians through the use of prescriptions is evident even within a close working environment.

  6. Psychiatric diagnoses in patients with burning mouth syndrome and atypical odontalgia referred from psychiatric to dental facilities

    Science.gov (United States)

    Takenoshita, Miho; Sato, Tomoko; Kato, Yuichi; Katagiri, Ayano; Yoshikawa, Tatsuya; Sato, Yusuke; Matsushima, Eisuke; Sasaki, Yoshiyuki; Toyofuku, Akira

    2010-01-01

    Background Burning mouth syndrome (BMS) and atypical odontalgia (AO) are two conditions involving chronic oral pain in the absence of any organic cause. Psychiatrically they can both be considered as “somatoform disorder”. From the dental point of view, however, the two disorders are quite distinct. BMS is a burning or stinging sensation in the mouth in association with a normal mucosa whereas AO is most frequently associated with a continuous pain in the teeth or in a tooth socket after extraction in the absence of any identifiable cause. Because of the absence of organic causes, BMS and AO are often regarded as psychogenic conditions, although the relationship between oral pain and psychologic factors is still unclear. Some studies have analyzed the psychiatric diagnoses of patients with chronic oral pain who have been referred from dental facilities to psychiatric facilities. No study to date has investigated patients referred from psychiatric facilities to dental facilities. Objective To analyze the psychiatric diagnoses of chronic oral pain patients, diagnosed with BMS and AO, and referred from psychiatric facilities to dental facilities. Study design Psychiatric diagnoses and disease conditions of BMS or AO were investigated in 162 patients by reviewing patients’ medical records and referral forms. Psychiatric diagnoses were categorized according to the International Statistical Classification of Disease and Related Health Problems, Tenth Revision. Results The proportion of F4 classification (neurotic, stress-related, and somatoform disorders) in AO patients was significantly higher than in BMS patients. BMS patients were more frequently given a F3 classification (mood/affective disorders). However, 50.8% of BMS patients and 33.3% of AO patients had no specific psychiatric diagnoses. Conclusion Although BMS and AO are both chronic pain disorders occurring in the absence of any organic cause, the psychiatric diagnoses of patients with BMS and AO differ

  7. Retapamulin prescriptions and monitored off-label use.

    Science.gov (United States)

    Mundy, Linda M; Sampson, Tim; Logie, John W

    2014-08-01

    Retapamulin, a topical pleuromutilin that selectively inhibits bacterial protein synthesis, is approved for treatment of impetigo and secondarily infected traumatic lesions in adults and in children older than 9 months of age. A 5-year study was conducted to monitor prescription use in children younger than 9 months of age. Annual prescription events were monitored in the UK Clinical Practice Research Datalink (CPRD) and the Clinformatics™ DataMart Multiplan (IMPACT), a product of OptumInsight Life Sciences, Inc. (Eden Prairie, MN, USA), from the USA. In the CPRD, of 148 prescriptions, three (2 %) were identified in children aged less than 9 months between years 2008 and 2011. In IMPACT, of 59,210 claims for retapamulin in children, 1,951 (3.3 %) were categorized as definitive, or uncertain for, less than 9 months of age between 2007 and 2011. Retapamulin prescription events in children aged less than 9 months were relatively low compared with other recent estimations of off-label pediatric medicines. Our report provides a framework for future investigations and discussions that may facilitate off-label reporting schemes and promote pediatric drug safety.

  8. Analysis of costs to dispense prescriptions in independently owned, closed-door long-term care pharmacies.

    Science.gov (United States)

    Carroll, Norman V; Rupp, Michael T; Holdford, David A

    2014-03-01

    The need for accurate calculation of long-term care (LTC) pharmacies' costs to dispense (CTD) has become more important as payers have moved toward reimbursement models based on pharmacies' actual acquisition cost for drug products and the Centers for Medicare Medicaid Services (CMS) has implemented requirements that LTC pharmacies must dispense prescriptions for certain branded drugs in 14-day-or-less quantities. To (a) calculate the average cost that the typical independently owned, closed-door LTC pharmacy currently incurs to dispense and deliver a prescription to the resident of a client LTC facility and (b) estimate how CMS-mandated changes to a 14-day-or-less dispensing cycle would affect the typical LTC pharmacy's average CTD. The data requirements and measurement model were developed by academic researchers in consultation with an industry advisory committee of independent LTC pharmacy owners. A survey instrument was constructed to collect financial and operating data required to calculate the CTD. Surveys were distributed via 3 dissemination channels to approximately 1,000 independently owned, closed-door LTC pharmacies. The National Community Pharmacists Association mailed surveys to their LTC members; 3 major national wholesalers distributed surveys to their LTC customers through their newsletters; and 3 LTC group purchasing organizations distributed the surveys to their members through emails, newsletters, mailings, and/or regional meetings. Each pharmacy's CTD was calculated by dividing total LTC dispensing-related 
costs by the total number of prescriptions dispensed. Dispensing-related costs included costs incurred to physically dispense and deliver prescriptions (e.g., dispensing pharmacists' and technicians' salaries and costs of medication containers) and costs incurred to support the dispensing function (e.g., salaries of delivery and medical records personnel). A model based on dispensing-related fixed, variable, and semivariable costs was

  9. Towards Prescriptive Analytics in Cyber-Physical Systems

    DEFF Research Database (Denmark)

    Siksnys, Laurynas

    solving capability allowing to formulate optimization problems using SQL-like queries and to solve them “inside a database”, (4) a real-time data management architecture for processing instances of flexibility and prescription models under (soft or hard) timing constraints, and (5) a graphical user...... of (1) a unified multi-dimensional schema for storing flexibility and prescription models (and related data), (2) techniques to incrementally aggregate flexibility model instances and disaggregate prescription model instances, (3) a database management system (DBMS) with built-in optimization problem...... the introduced concepts are applicable in the real world. We believe that all this contribution makes a significant step towards developing planning-capable CPSs in the future....

  10. Prescription Drug Abuse

    Science.gov (United States)

    ... were prescribed to someone else or if your child is already taking other prescription medications. Set rules. Let your teen know that it's not OK to share medications with others — or to take drugs prescribed for others. Emphasize the importance of taking the prescribed dose and talking with ...

  11. Decreasing Psychiatric Admission Wait Time in the Emergency Department by Facilitating Psychiatric Discharges.

    Science.gov (United States)

    Stover, Pamela R; Harpin, Scott

    2015-12-01

    Limited capacity in a psychiatric unit contributes to long emergency department (ED) admission wait times. Regulatory and accrediting agencies urge hospitals nationally to improve patient flow for better access to care for all types of patients. The purpose of the current study was to decrease psychiatric admission wait time from 10.5 to 8 hours and increase the proportion of patients discharged by 11 a.m. from 20% to 50%. The current study compared pre- and post-intervention data. Plan-Do-Study-Act cycles aimed to improve discharge processes and timeliness through initiation of new practices. Admission wait time improved to an average of 5.1 hours (t = 3.87, p = 0.006). The proportion of discharges occurring by 11 a.m. increased to 46% (odds ratio = 3.42, p planning processes and timeliness in a psychiatric unit significantly decreased admission wait time from the ED, improving access to psychiatric care. Copyright 2015, SLACK Incorporated.

  12. Opioid prescriptions before and after high-energy trauma

    DEFF Research Database (Denmark)

    Zwisler, Stine T; Hallas, Jesper; Larsen, Morten S

    2015-01-01

    OBJECTIVE: To describe the legal use of opioids in adult patients before and after high-energy trauma. DESIGN: The study was a retrospective database study. SETTING: Clinical care outside hospitals. PATIENTS: All patients who suffered high-energy trauma and were brought to Odense University...... Hospital (OUH), Denmark, in 2007 and 2008 were retrieved from the trauma database. These patients were linked with data on opioid use from the regional prescription database. In all, 938 patients were included. MAIN OUTCOME MEASURE: Redemption of opioid prescription during the 6 months prior...... to a multitrauma or redemption of two or more prescriptions for opioids 6 months or later after a multitrauma. RESULTS: Of the 938 patients brought to OUH with severe trauma within the study period, 61 patients died (7 percent) and six of these had redeemed prescriptions for opioids within 6 months prior...

  13. Clinically useful predictors for premature mortality among psychiatric patients visiting a psychiatric emergency room

    DEFF Research Database (Denmark)

    Aagaard, Jørgen; Buus, Niels; Wernlund, Andreas Glahn

    2016-01-01

    OBJECTIVE: The aim of this study was to examine changes in the distribution of causes of death and mortality rates among psychiatric patients visiting a psychiatric emergency room (PER), to determine clinically useful predictors for avoiding premature mortality among these patients and to discuss...... linked to the Cause of Death Register and the Central Psychiatric Research Register, and logistic predictor analyses for premature death were performed. RESULTS: The standardised mortality ratio (SMR) of all visitors compared to the general Danish population was approximately 5. Overall, patients...

  14. Training in Tobacco Treatments in Psychiatry: A National Survey of Psychiatry Residency Training Directors

    Science.gov (United States)

    Prochaska, Judith J.; Fromont, Sebastien C.; Louie, Alan K.; Jacobs, Marc H.; Hall, Sharon M.

    2016-01-01

    Objective Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States. Method The authors recruited training directors to complete a survey of their program’s curriculum related to tobacco treatment, attitudes related to treating tobacco in psychiatry, and perceptions of residents’ skills for addressing nicotine dependence in psychiatric patients. Results Respondents were representative of the national pool. Half of the programs provided training in tobacco treatments for a median duration of 1 hour. Content areas covered varied greatly. Programs with tobacco-related training expressed more favorable attitudes toward addressing tobacco in psychiatry and were more likely to report confidence in their residents’ skills for treating nicotine dependence. Programs without tobacco training reported a lack of faculty expertise on tobacco treatments. Most training directors reported moderate to high interest in evaluating a model tobacco curriculum for psychiatry and stated they would dedicate an average of 4 hours of curriculum time. Conclusions The findings demonstrate the need for and interest in a model tobacco treatment curriculum for psychiatry residency training. Training psychiatrists offers the potential of delivering treatment to one of the largest remaining groups of smokers: patients with mental disorders. PMID:17021144

  15. Depression in elderly women resident in a long-stay nursing home.

    Science.gov (United States)

    Lampert, Melissa Agostini; Rosso, Ana Luiza Pereira

    2015-01-01

    Depression is the most common psychiatric disorder among the elderly: it is present in 23-40% of community-dwelling elderly and in 25-80% of institutionalized elderly. Depressive symptoms are most prevalent in elderly women because they more readily seek healthcare services, are more vulnerable to stress and live longer than men. To investigate the prevalence of depression and its comorbidities in a long-stay nursing home (NH). This retrospective, descriptive, epidemiological study was performed at a NH in southern Brazil and comprised the first part of a larger project to determine depression and its relationship with psychosocial factors in NH residents. Sociodemographic and medical data were obtained through the examination of medical files from November 2012 to January 2013. Depression was defined as the diagnosis reported by physicians in medical files and scores on the Geriatric Depression Scale (15-item version) above 5. Other clinical and psychiatric diagnoses were obtained from medical files. Out of a total of 142 elderly women, 51.4% had at least one psychiatric disorder, the most common being depression, affective bipolar disorder and mental retardation. Almost one third (32.3%) of the elderly women were depressed. The ward containing the highest number of cognitively and physically independent women contained 41.3% of the total depressed elderly. A total of 52.1% of all depressed elderly had other associated clinical or psychiatric disorders, with mental retardation and hypothyroidism being the most frequent. The prevalence of dementia was high in this NH. Further studies evaluating the psychosocial factors involved in depressed elders should be conducted in an effort to prevent depression and promote mental health in institutionalized elders.

  16. Depression in elderly women resident in a long-stay nursing home

    Directory of Open Access Journals (Sweden)

    Melissa Agostini Lampert

    Full Text Available Depression is the most common psychiatric disorder among the elderly: it is present in 23-40% of community-dwelling elderly and in 25-80% of institutionalized elderly. Depressive symptoms are most prevalent in elderly women because they more readily seek healthcare services, are more vulnerable to stress and live longer than men. OBJECTIVE: To investigate the prevalence of depression and its comorbidities in a long-stay nursing home (NH. METHODS: This retrospective, descriptive, epidemiological study was performed at a NH in southern Brazil and comprised the first part of a larger project to determine depression and its relationship with psychosocial factors in NH residents. Sociodemographic and medical data were obtained through the examination of medical files from November 2012 to January 2013. Depression was defined as the diagnosis reported by physicians in medical files and scores on the Geriatric Depression Scale (15-item version above 5. Other clinical and psychiatric diagnoses were obtained from medical files. RESULTS: Out of a total of 142 elderly women, 51.4% had at least one psychiatric disorder, the most common being depression, affective bipolar disorder and mental retardation. Almost one third (32.3% of the elderly women were depressed. The ward containing the highest number of cognitively and physically independent women contained 41.3% of the total depressed elderly. A total of 52.1% of all depressed elderly had other associated clinical or psychiatric disorders, with mental retardation and hypothyroidism being the most frequent. CONCLUSION: The prevalence of dementia was high in this NH. Further studies evaluating the psychosocial factors involved in depressed elders should be conducted in an effort to prevent depression and promote mental health in institutionalized elders.

  17. Inpatient Suicide in a Chinese Psychiatric Hospital

    Science.gov (United States)

    Li, Jie; Ran, Mao-Sheng; Hao, Yuantao; Zhao, Zhenhuan; Guo, Yangbo; Su, Jinghua; Lu, Huixian

    2008-01-01

    Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64…

  18. Influence of pharmaceutical marketing on prescription practices of physicians.

    Science.gov (United States)

    Narendran, Roshni; Narendranathan, M

    2013-01-01

    In India same drug molecules are sold under different brand names by different pharmaceuticals. To persuade the physicians to prescribe their brands pharmaceuticals engage in marketing techniques like giving samples, gifts, sponsoring travel etc. Many countries are striving to reduce the impact of incentives on prescription behaviour. This study explores the influence of pharmaceutical marketing on the prescription practices of doctors in India. There were 103 study subjects - 50 doctors and 53 sales personnel. Data collection was done by a self administered questionnaire. Data were collected on 36 variables which were supposed to influence prescription. The effectiveness of the promotional strategies on prescription behaviour was marked in a seven point Likert scale ranging from "not at all effective" (score=1) to "extremely effective" (score=7). Open ended questions were used to collect qualitative data. Good rapport with the doctor, launch meetings, reputation of the company, quality of the drug and brand names significantly influenced prescription behaviour, while direct mailers, advertisements in journals and giving letter pads and other brand reminders were less effective. Commonly used method of giving samples was not among the twenty most effective methods influencing prescription. Product quality and good company are still factors that influence prescription. Pharmaceutical marketing influences the choice of brands by a physician. The more expensive strategies involved in public relations are more effective. Sending mails and journal advertisements are less effective strategies. How expensive marketing strategies affect cost of the medicines has to be explored further.

  19. Oxytocin and Psychiatric Disorders

    Directory of Open Access Journals (Sweden)

    Gokce Nur Say

    2016-06-01

    Full Text Available Oxytocin is a neuropeptide that plays critical role in mother-infant bonding, pair bonding and prosocial behaviors. Several neuropsychiatric disorders such as autism, schizophrenia, affective disorders, anxiety disorders, attention deficit/hyperactivity disorder, alcohol/substance addiction, aggression, suicide, eating disorders and personality disorders show abnormalities of oxytocin system. These findings have given rise to the studies searching therapeutic use of oxytocin for psychi-atric disorders. The studies of oxytocin interventions in psychiatric disorders yielded potentially promising findings. This paper reviews the role of oxytocin in emotions, behavior and its effects in psychiatric disorders. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(2: 102-113

  20. Pharmacist Remote Review of Medication Prescriptions for Appropriateness in Pediatric Intensive Care Unit.

    Science.gov (United States)

    Lazaryan, Moran; Abu-Kishk, Ibrahim; Rosenfeld-Yehoshua, Noa; Berkovitch, Sofia; Toledano, Michal; Reshef, Iris; Kanari, Tal; Ziv-Baran, Tomer; Berkovitch, Matitiahu

    2016-01-01

    One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available. To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU). A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded. The review time for one medical record was 8.9 (95% CI, 6.9-10.9) min. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45-1.11) min. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8-18.8) and 12 (9-15) min, respectively, for patients with psychiatric-neurologic disorders compared to those without (p = 0.032). Usually, a daily workload of 240 min was needed for the pharmacist accompanying the round in contrast to 108 min per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9%, and made no comment on 36.9% of the recommendations. Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.

  1. Registration, psychiatric evaluation and adherence to psychiatric treatment after suicide attempt

    DEFF Research Database (Denmark)

    Nordentoft, Merete; Søgaard, Mette

    2005-01-01

    Persons who are treated at hospital after attempted suicide comprise a high-risk group for suicide. The proposal for a National Programme for Prevention of Suicide and Suicide Attempt in Denmark recommends that all persons who attempt suicide should be offered treatment and that treatment should....... Only few patients were not referred to any treatment at all, but among the patients referred to psychiatric treatment, only those admitted involuntarily received treatment in 100% of the planned cases. For outpatient treatment in the suicide prevention clinic, the percentage that attended planned...... be implemented, using a supportive and guiding principle. The aim of the present study is to investigate whether patients receive psychiatric evaluation after a suicide attempt, and whether they receive the psychiatric treatment to which they are referred. In the Copenhagen Hospital Corporation in four emergency...

  2. The nature of psychiatric disorders.

    Science.gov (United States)

    Kendler, Kenneth S

    2016-02-01

    A foundational question for the discipline of psychiatry is the nature of psychiatric disorders. What kinds of things are they? In this paper, I review and critique three major relevant theories: realism, pragmatism and constructivism. Realism assumes that the content of science is real and independent of human activities. I distinguish two "flavors" of realism: chemistry-based, for which the paradigmatic example is elements of the periodic table, and biology-based, for which the paradigm is species. The latter is a much better fit for psychiatry. Pragmatism articulates a sensible approach to psychiatric disorders just seeking categories that perform well in the world. But it makes no claim about the reality of those disorders. This is problematic, because we have a duty to advocate for our profession and our patients against other physicians who never doubt the reality of the disorders they treat. Constructivism has been associated with anti-psychiatry activists, but we should admit that social forces play a role in the creation of our diagnoses, as they do in many sciences. However, truly socially constructed psychiatric disorders are rare. I then describe powerful arguments against a realist theory of psychiatric disorders. Because so many prior psychiatric diagnoses have been proposed and then abandoned, can we really claim that our current nosologies have it right? Much of our current nosology arose from a series of historical figures and events which could have gone differently. If we re-run the tape of history over and over again, the DSM and ICD would not likely have the same categories on every iteration. Therefore, we should argue more confidently for the reality of broader constructs of psychiatric illness rather than our current diagnostic categories, which remain tentative. Finally, instead of thinking that our disorders are true because they correspond to clear entities in the world, we should consider a coherence theory of truth by which disorders

  3. 75 FR 12555 - Prescription Drug User Fee Act; Public Meeting

    Science.gov (United States)

    2010-03-16

    ...] Prescription Drug User Fee Act; Public Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice of... Prescription Drug User Fee Act (PDUFA). The legislative authority for PDUFA expires in September 2012. At that time, new legislation will be required for FDA to continue collecting user fees for the prescription...

  4. Antihypertensive use, prescription patterns, and cost of medications ...

    African Journals Online (AJOL)

    Antihypertensive use, prescription patterns, and cost of medications in a Teaching Hospital in Lagos, Nigeria. ... Conclusions: Antihypertensive prescription pattern was in accordance with the seventh report of Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure.

  5. Tamper-resistant prescription forms for narcotics in France:should we generalise them?

    Science.gov (United States)

    Daveluy, Amélie; Sauvaget, Lucie; Bastien, Angela; Lapeyre-Mestre, Maryse; Collin, Cédric; Richard, Nathalie; Haramburu, Françoise

    2018-03-27

    In France, prescription of narcotics must be written on a tamper-resistant prescription form with specific technical particularities. Dosage and daily dose of medicines shall be written out entirely in letters. These prescription forms are also mandatory for buprenorphine, clorazepate, clonazepam, tianeptine, buccal midazolam and zolpidem owing to traffic, abuse or diversion. In 2012, to assess the use of standard and tamper-resistant prescription forms and the acceptability of the generalization of the latter to all medicines, a national opinion survey was performed, with a postal questionnaire, within 3 randomized samples of 1,500 prescribers (physicians, dentists and midwives). Of the 403 participating prescribers (participation rate of 26.8%), 373 were physicians, 14 dentists and 16 midwives. Tamper-resistant prescription forms were used by 76.2% of prescribers, but only by 5.1% in a computerised version, whereas, for standard prescription forms, 61% used computer assisted prescription software. The main reason was the inability of the prescription software to print these forms or to respect the mandatory prescription rules for narcotics. Theft and falsification of prescriptions had ever occurred (working life). Most prescribers (62.5%) were against the generalization of tamper-resistant prescription forms. Those in favour were for a generalization to all medicines (65%) and not only to psychotropic agents. Generalization of tamper-resistant prescription forms is not a consensual solution to prevent medicines' diversion. Some prescribers alluded to the possibility of dematerialisation and electronic transmission of prescription forms, which could avoid theft, forgery or falsification. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  6. Striving for meaning-Life in supported housing for people with psychiatric disabilities.

    Science.gov (United States)

    Brolin, Rosita; Brunt, David; Rask, Mikael; Syrén, Susanne; Sandgren, Anna

    2016-01-01

    The aim of this study was to develop a grounded theory about people with psychiatric disabilities, living in supported housing. Interviews as well as observations during the interviews were analyzed together with secondary analyses of quantitative and qualitative material from previous studies. Being deprived of self-determination emerged as the main concern for residents in supported housing and striving for meaning emerged as the pattern of behavior through which this group resolves their main concern. Striving for meaning involves living in the present, striving for self-determination, strengthening self-esteem, emotional processing and resting from the present. The strategies facilitate each other and are used singly, together simultaneously, or alternately. If they are successful, a meaning in the present is perceived. If all the strategies fail repeatedly, escaping from the present is used in order to deal with being deprived of self-determination. The implications of the findings suggest prioritizing a reduction of the institutional nature of the social and physical environment, and to support the residents' self-determination.

  7. Psychiatric sequelae of induced abortion.

    Science.gov (United States)

    Gibbons, M

    1984-03-01

    An attempt is made to identify and document the problems of comparative evaluation of the more recent studies of psychiatric morbidity after abortion and to determine the current consensus so that when the results of the joint RCGP/RCOG study of the sequelae of induced abortion become available they can be viewed in a more informed context. The legalization of abortion has provided more opportunities for studies of subsequent morbidity. New laws have contributed to the changing attitudes of society, and the increasing acceptability of the operation has probably influenced the occurrence of psychiatric sequelae. The complexity of measuring psychiatric sequelae is evident from the many terms used to describe symptomatology and behavioral patterns and from the number of assessment techniques involved. Numerous techniques have been used to quantify psychiatric sequelae. Several authors conclude that few psychiatric problems follow an induced abortion, but many studies were deficient in methodology, material, or length of follow-up. A British study in 1975 reported a favorable outcome for a "representative sample" of 50 National Health Service patients: 68% of these patients had an absence of or only mild feelings of guilt, loss, or self reproach and considered abortion as the best solution to their problem. The 32% who had an adverse outcome reported moderate to severe feelings of guilt, regret, loss, and self reproach, and there was evidence of mental illness. In most of these cases the adverse outcome was related to the patient's environment since the abortion. A follow-up study of 126 women, which compared the overall reaction to therapeutic abortion between women with a history of previous mild psychiatric illness and those without reported that a significantly different emotional reaction could not be demonstrated between the 2 groups. In a survey among women seeking an abortion 271 who were referred for a psychiatric opinion regarding terminations of pregnancy

  8. Direct-to-consumer marketing of prescription drugs: a current perspective for neurologists and psychiatrists.

    Science.gov (United States)

    Hollon, Matthew F

    2004-01-01

    In the US and New Zealand, the past decade has seen tremendous growth in the marketing of prescription drugs directly to patients. The pharmaceutical industry has applied pressure in other countries to relax regulations governing such marketing although this has not yet been successful. While we still have much to learn about the potential impact on the public's health of direct-to-consumer (DTC) marketing, some data are available. This article summarises the current literature on the benefits and risks of DTC marketing. This marketing strategy has grown substantially in the US, but only select drugs are advertised. Whether there is net benefit or harm to the public's health as a result of DTC marketing depends critically on which drugs are advertised and the quality of the information provided in promotional material. Critical reviews of this promotional material suggest the information is of poor quality. Notably, 18% of the 50 drugs advertised most intensively in the US were medications used to treat psychiatric and neurological disorders. The impairments in decisional capacity often seen in psychiatric and neurological illness leave patients vunerable to the controlling influence of DTC marketing and, thus, undermine the patient autonomy that is said to be promoted by this marketing strategy. If there is any benefit from DTC marketing it is for significantly undertreated conditions. International restrictions on DTC marketing should remain in place until further evidence of net benefit or harm emerges from the DTC marketing experiment that is taking place in the US and New Zealand.

  9. Psychiatric aspects of induced abortion.

    Science.gov (United States)

    Stotland, Nada L

    2011-08-01

    Approximately one third of the women in the United States have an abortion during their lives. In the year 2008, 1.21 million abortions were performed in the United States (Jones and Koolstra, Perspect Sex Reprod Health 43:41-50, 2011). The psychiatric outcomes of abortion are scientifically well established (Adler et al., Science 248:41-43, 1990). Despite assertions to the contrary, there is no evidence that abortion causes psychiatric problems (Dagg, Am J Psychiatry 148:578-585, 1991). Those studies that report psychiatric sequelae suffer from severe methodological defects (Lagakos, N Engl J Med 354:1667-1669, 2006). Methodologically sound studies have demonstrated that there is a very low incidence of frank psychiatric illness after an abortion; women experience a wide variety of feelings over time, including, for some, transient sadness and grieving. However, the circumstances that lead a woman to terminate a pregnancy, including previous and/or ongoing psychiatric illness, are independently stressful and increase the likelihood of psychiatric illness over the already high baseline incidence and prevalence of mood and anxiety disorders among women of childbearing age. For optimal psychological outcomes, women, including adolescents, need to make autonomous and supported decisions about problem pregnancies. Clinicians can help patients facing these decisions and those who are working through feelings about having had abortions in the past.

  10. Potentially inappropriate prescriptions for older patients in long-term care

    Directory of Open Access Journals (Sweden)

    Laurin Danielle

    2004-10-01

    Full Text Available Abstract Background Inappropriate medication use is a major healthcare issue for the elderly population. This study explored the prevalence of potentially inappropriate prescriptions (PIPs in long-term care in metropolitan Quebec. Methods A cross sectional chart review of 2,633 long-term care older patients of the Quebec City area was performed. An explicit criteria list for PIPs was developed based on the literature and validated by a modified Delphi method. Medication orders were reviewed to describe prescribing patterns and to determine the prevalence of PIPs. A multivariate analysis was performed to identify predictors of PIPs. Results Almost all residents (94.0% were receiving one or more prescribed medication; on average patients had 4.8 prescribed medications. A majority (54.7% of treated patients had a potentially inappropriate prescription (PIP. Most common PIPs were drug interactions (33.9% of treated patients, followed by potentially inappropriate duration (23.6%, potentially inappropriate medication (14.7% and potentially inappropriate dosage (9.6%. PIPs were most frequent for medications of the central nervous system (10.8% of prescribed medication. The likelihood of PIP increased significantly as the number of drugs prescribed increased (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.33 – 1.43 and with the length of stay (OR: 1.78, CI: 1.43 – 2.20. On the other hand, the risk of receiving a PIP decreased with age. Conclusion Potentially inappropriate prescribing is a serious problem in the highly medicated long-term care population in metropolitan Quebec. Use of explicit criteria lists may help identify the most critical issues and prioritize interventions to improve quality of care and patient safety.

  11. Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol

    Directory of Open Access Journals (Sweden)

    Amélie Perrin

    2017-09-01

    Full Text Available Background: Each year, around one out of two nursing home (NH residents are hospitalized in France, and about half to the emergency department (ED. These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED. Methods/design: FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i.e. case versus control NH residents is determined by a multidisciplinary team of experts. Results: Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED. Discussion: A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization. Keywords: Inappropriate transfer, Nursing home resident, Emergency department transfer, Potentially avoidable transfer, Appropriateness of transfer, Inappropriate hospitalization

  12. The lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution.

    Science.gov (United States)

    Bimenyimana, E; Poggenpoel, M; Myburgh, C; van Niekerk, V

    2009-09-01

    Caring for good people is difficult enough; to care for people who are either aggressive or violent is even more difficult. This is what psychiatric nurses working in the psychiatric institution in which research was done are exposed to on a daily basis. The aim of the research was to explore and describe the lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution. A qualitative, explorative, descriptive, and contextual study design was utilised. Data was collected by means of semi-structured interviews and naïve sketches. Tesch 's (Creswell, 2004: 256) method of open coding and an independent coder were utilised for data analysis. This study shed some light on the lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution. The findings show that the level of violence and aggression to which psychiatric nurses are exposed is overwhelming and the consequences are alarming. The contributing factors to this violence and aggression are: the mental status and the conditions in which patients are admitted; the staff shortage; the lack of support among the members of the multidisciplinary team (MDT); and the lack of structured and comprehensive orientation among newly appointed staff members. As a result, psychiatric nurses are emotionally, psychologically, and physically affected. They then respond with the following emotions and behaviour: fear, anger, frustration, despair, hopelessness and helplessness, substance abuse, absenteeism, retaliation and the development of an "I don't care" attitude.

  13. Parental psychiatric hospitalisation and offspring schizophrenia

    DEFF Research Database (Denmark)

    Sørensen, Holger J; Mortensen, Erik L; Reinisch, June M

    2009-01-01

    The risk of schizophrenia has been linked with a family history of schizophrenia and less strongly with other psychiatric disorders in family members. Using data from the Copenhagen Perinatal Cohort and from the Danish Psychiatric Case Register, we studied the relationship between offspring risk...... of schizophrenia and a range of psychotic and non-psychotic psychiatric diagnoses in parents. Psychiatric admission data after 1969 were available for 7047 cohort members born between 1959 and 1961, and for 7006 mothers and 6993 fathers. Univariate analysis showed that neurosis, alcohol and substance dependence...... in both parents were associated with elevated risk of offspring schizophrenia; in addition, maternal schizophrenia, affective disorder and personality disorder were associated with elevated risk. Controlling for parental age, parental social status, and parental psychiatric co-diagnosis, offspring risk...

  14. Prescribing patterns for inpatients with schizophrenia spectrum disorders in a psychiatric hospital in Slovenia: Results of 16-month prospective, non-interventional clinical research.

    Science.gov (United States)

    Bole, Cvetka Bačar; Pišlar, Mitja; Mrhar, Aleš; Tavčar, Rok

    2017-06-01

    In Slovenia, there has been no evidence about the prescribing patterns for inpatients with psychotic disorders. The research aims to analyze drug utilization patterns for inpatients with psychotic disorder that are coded as F20-F29 according to International Classification of Diseases (ICD) 10 th revision (schizophrenia spectrum disorders). Prospective research was conducted at the Psychiatric Hospital Idrija. The medical records of the inpatients admitted over a 12-month period were collected from the beginning to the end of their hospitalization. A total of 311 inpatients with 446 hospitalizations were included, producing a total of 3954 medication prescriptions. Medications prescribed pro re nata (the use of as needed) were also taken into account. Antipsychotics (N=1149, 43% of prescriptions) were the most often prescribed medications, followed by anxiolytics, antiparkinsonians, antidepressants, mood stabilizers and cardiovascular drugs. A total of 256 (82%) inpatients received at least one pro re nata medication. It was observed that the studied population was treated with one antipsychotic on 27 percent of prescriptions. Inpatients with schizophrenia spectrum disorders were exposed to a large number of different drugs. They were not received only psychotropic drugs but also other medications. With the knowledge about medications the implementation of clinical pharmacy services to the psychiatrists would significantly improve medication of inpatients with psychotic disorders and polypharmacotherapy.

  15. Adherence to treatment guidelines for acute diarrhoea in children up to 12 years in Ujjain, India - a cross-sectional prescription analysis

    Directory of Open Access Journals (Sweden)

    Marrone Gaetano

    2011-01-01

    Full Text Available Abstract Background Diarrhoea accounts for 20% of all paediatric deaths in India. Despite WHO recommendations and IAP (Indian Academy of Paediatrics and Government of India treatment guidelines, few children suffering from acute diarrhoea in India receive low osmolarity oral rehydration solution (ORS and zinc from health care providers. The aim of this study was to analyse practitioners' prescriptions for acute diarrhoea for adherence to treatment guidelines and further to determine the factors affecting prescribing for diarrhoea in Ujjain, India. Methods This cross-sectional study was conducted in pharmacies and major hospitals of Ujjain, India. We included prescriptions from all practitioners, including those from modern medicine, Ayurveda, Homeopathy as well as informal health-care providers (IHPs. The data collection instrument was designed to include all the possible medications that are given for an episode of acute diarrhoea to children up to 12 years of age. Pharmacy assistants and resident medical officers transferred the information regarding the current diarrhoeal episode and the treatment given from the prescriptions and inpatient case sheets, respectively, to the data collection instrument. Results Information was collected from 843 diarrhoea prescriptions. We found only 6 prescriptions having the recommended treatment that is ORS along with Zinc, with no additional probiotics, antibiotics, racecadotril or antiemetics (except Domperidone for vomiting. ORS alone was prescribed in 58% of the prescriptions; while ORS with zinc was prescribed in 22% of prescriptions, however these also contained other drugs not included in the guidelines. Antibiotics were prescribed in 71% of prescriptions. Broad-spectrum antibiotics were prescribed and often in illogical fixed-dose combinations. One such illogical combination, ofloxacin with ornidazole, was the most frequent oral antibiotic prescribed (22% of antibiotics prescribed. Practitioners from

  16. Psychiatric disorders associated with Cushing's syndrome.

    Science.gov (United States)

    Bratek, Agnieszka; Koźmin-Burzyńska, Agnieszka; Górniak, Eliza; Krysta, Krzysztof

    2015-09-01

    Cushing's syndrome is the term used to describe a set of symptoms associated with hypercortisolism, which in most cases is caused by hypophysial microadenoma over-secreting adrenocorticotropic hormone. This endocrine disorder is often associated with psychiatric comorbidities. The most important include mood disorders, psychotic disorders, cognitive dysfunctions and anxiety disorders. The aim of this article was to review the prevalence, symptoms and consequences of psychiatric disorders in the course of Cushing's syndrome. We therefore performed a literature search using the following keywords: Cushing's syndrome and psychosis, Cushing's syndrome and mental disorders, Cushing's syndrome and depression, Cushing's syndrome and anxiety. The most prevalent psychiatric comorbidity of Cushing's syndrome is depression. Psychiatric manifestations can precede the onset of full-blown Cushing's syndrome and therefore be misdiagnosed. Despite the fact that treatment of the underlying endocrine disease in most cases alleviates psychiatric symptoms, the loss of brain volume persists. It is important to be alert to the symptoms of hypercortisolism in psychiatric patients to avoid misdiagnosis and enable them receiving adequate treatment.

  17. Psychiatric Advance Directives: Getting Started

    Science.gov (United States)

    ... News Legal Issues Search for: About PADs A psychiatric advance directive (PAD) is a legal document that ... decisions during a mental health crisis. Getting Started Psychiatric advance directives (PADs) are relatively new legal instruments ...

  18. The Effect of Psychiatric Rehabilitation on the Activity and Participation Level of Clients with Long-Term Psychiatric Disabilities

    NARCIS (Netherlands)

    Wel, Tom van; Felling, Albert; Persoon, Jean

    2003-01-01

    During the last decades of the 20th century, many psychiatric hospitals changed the living environments of their clients with long-term psychiatric disabilities. We investigated the effect of this environmental psychiatric rehabilitation and normalization process on the activity and participation

  19. Cultural Issues in Psychiatric Administration and Leadership.

    Science.gov (United States)

    Aggarwal, Neil Krishan

    2015-09-01

    This paper addresses cultural issues in psychiatric administration and leadership through two issues: (1) the changing culture of psychiatric practice based on new clinician performance metrics and (2) the culture of psychiatric administration and leadership in light of organizational cultural competence. Regarding the first issue, some observers have discussed the challenges of creating novel practice environments that balance business values of efficient performance with fiduciary values of treatment competence. This paper expands upon this discussion, demonstrating that some metrics from the Centers for Medicare & Medicaid Services, the nation's largest funder of postgraduate medical training, may penalize clinicians for patient medication behaviors that are unrelated to clinician performance. A focus on pharmacotherapy over psychotherapy in these metrics has unclear consequences for the future of psychiatric training. Regarding the second issue, studies of psychiatric administration and leadership reveal a disproportionate influence of older men in positions of power despite efforts to recruit women, minorities, and immigrants who increasingly constitute the psychiatric workforce. Organizational cultural competence initiatives can diversify institutional cultures so that psychiatric leaders better reflect the populations they serve. In both cases, psychiatric administrators and leaders play critical roles in ensuring that their organizations respond to social challenges.

  20. Residência em psiquiatria no Brasil: análise crítica Programas de pasantías en psiquiatría en Brasil: un análisis crítico Brazilian psychiatry medical residency programs: critical analysis

    Directory of Open Access Journals (Sweden)

    Bruno Mendonça Coêlho

    2005-04-01

    ía influenciaron en gran medida el diagnóstico y el tratamiento psiquiátricos. Sin embargo, el programa de pasantía psiquiatría en Brasil no se adecuó a esta nueva realidad. OBJETIVOS Y MÉTODO: Partiendo de recomendaciones de la World Psychiatry Association (WPA, investigamos en internet programas de pasantía brasileños, de países de las Américas y Europa. Comparándolos con las recomendaciones y datos del Institutional Program on the Core Training Curriculum for Psychiatry de la WPA, propusimos un currículum mínimo para el programa de pasantía en psiquiatría en Brasil. DISCUSIÓN: En la mayoría de los programas investigados, se destacan algunos aspectos: Duración mínima de tres años; práctica integral en neurología por periodo mínimo de un mes; programa incluyendo psicopatología, psicofarmacología, teorías psicoterapéuticas, emergencias psiquiátricas entre otras asignaturas; enseñanza y práctica de las diversas corrientes psicoterapéuticas; cobertura de las varias etapas de la vida (niños, adultos y ancianos; alcohol y drogas; periodos libres de los cuales el médico residente puede disponer para su formación complementaria (terapia, estudio o investigación; entre otros puntos importantes. CONCLUSIÓN: El modelo brasileño de pasantía en psiquiatría está desfasado en relación a la formación propuesta por la WPA (observada en diversos países, incluso en Latinoamérica. La pasantía necesita, siguiendo el modelo referenciado por la WPA y respetando a las diferencias regionales de cada escuela, suministrar las bases mínimas para una buena formación del psiquiatra.INTRODUCTION: The last decades have witnessed great advances in the field of Psychiatry, and the study of this discipline has become more complex. Advances in neurosciences as well as in classic studies on psychopathology, psychopharmacology, psychotherapy and neurology have helped psychiatric diagnosis and treatment. Nevertheless, Brazilian psychiatric medical residency programs did

  1. Drug interactions between common illicit drugs and prescription therapies.

    Science.gov (United States)

    Lindsey, Wesley T; Stewart, David; Childress, Darrell

    2012-07-01

    The aim was to summarize the clinical literature on interactions between common illicit drugs and prescription therapies. Medline, Iowa Drug Information Service, International Pharmaceutical Abstracts, EBSCO Academic Search Premier, and Google Scholar were searched from date of origin of database to March 2011. Search terms were cocaine, marijuana, cannabis, methamphetamine, amphetamine, ecstasy, N-methyl-3,4-methylenedioxymethamphetamine, methylenedioxymethamphetamine, heroin, gamma-hydroxybutyrate, sodium oxybate, and combined with interactions, drug interactions, and drug-drug interactions. This review focuses on established clinical evidence. All applicable full-text English language articles and abstracts found were evaluated and included in the review as appropriate. The interactions of illicit drugs with prescription therapies have the ability to potentiate or attenuate the effects of both the illicit agent and/or the prescription therapeutic agent, which can lead to toxic effects or a reduction in the prescription agent's therapeutic activity. Most texts and databases focus on theoretical or probable interactions due to the kinetic properties of the drugs and do not fully explore the pharmacodynamic and clinical implications of these interactions. Clinical trials with coadministration of illicit drugs and prescription drugs are discussed along with case reports that demonstrate a potential interaction between agents. The illicit drugs discussed are cocaine, marijuana, amphetamines, methylenedioxymethamphetamine, heroin, and sodium oxybate. Although the use of illicit drugs is widespread, there are little experimental or clinical data regarding the effects of these agents on common prescription therapies. Potential drug interactions between illicit drugs and prescription drugs are described and evaluated on the Drug Interaction Probability Scale by Horn and Hansten.

  2. Timing of psychiatric consultations - The impact of social vulnerability and level of psychiatric dysfunction

    NARCIS (Netherlands)

    de Jonge, P; Huyse, FJ; Ruinemans, GMF; Stiefel, FC; Lyons, JS; Slaets, JPJ

    2000-01-01

    The authors examined the timing of patient referrals to a psychiatric consultation-liaison service in relation to the patient's social vulnerability and level of psychiatric dysfunction. One hundred consecutive patients were assessed with the INTERMED, a method to document biopsychosocial and health

  3. 42 CFR 423.159 - Electronic prescription drug program.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Electronic prescription drug program. 423.159 Section 423.159 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...

  4. 76 FR 59898 - Branded Prescription Drug Fee; Correction

    Science.gov (United States)

    2011-09-28

    ... Branded Prescription Drug Fee; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION... Register on Thursday, August 18, 2011. The proposed regulation provides guidance relating to the branded... as follows: 1. On Page 51311, column 2, under the part heading PART 51--BRANDED PRESCRIPTION DRUGS...

  5. VIDEOCARE: Decentralised psychiatric emergency care through videoconferencing

    Directory of Open Access Journals (Sweden)

    Trondsen Marianne V

    2012-12-01

    Full Text Available Abstract Background Today the availability of specialists is limited for psychiatric patients in rural areas, especially during psychiatric emergencies. To overcome this challenge, the University Hospital of North Norway has implemented a new decentralised on-call system in psychiatric emergencies, by which psychiatrists are accessible by videoconference 24/7. In September 2011, the new on-call system was established in clinical practice for patients and health staff at three regional psychiatric centres in Northern Norway. Although a wide variety of therapies have been successfully delivered by videoconference, there is limited research on the use of videoconferenced consultations with patients in psychiatric emergencies. The aim of this study is to explore the use of videoconference in psychiatric emergencies based on the implementation of this first Norwegian tele-psychiatric service in emergency care. Methods/design The research project is an exploratory case study of a new videoconference service in operation. By applying in-depth interviews with patients, specialists and local health-care staff, we will identify factors that facilitate and hinder use of videoconferencing in psychiatric emergencies, and explore how videoconferenced consultations matter for patients, professional practice and cooperation between levels in psychiatric care. By using an on-going project as the site of research, the case is especially well-suited for generating reliable and valid empirical data. Discussion Results from the study will be of importance for understanding of how videoconferencing may support proper treatment and high-quality health care services in rural areas for patients in psychiatric emergencies.

  6. Prescription for herbal healing

    National Research Council Canada - National Science Library

    Balch, Phyllis A; Bell, Stacey J

    2012-01-01

    .... From the most trusted name in natural healing, Phyllis A. Balch's new edition of Prescription for Herbal Healing provides the most current research and comprehensive facts in an easy-to-read A- to-Z format, including...

  7. A study of suicide and attempted suicide by self-immolation in an Irish psychiatric population: an increasing problem.

    LENUS (Irish Health Repository)

    O'Donoghue, J M

    2012-02-03

    In the Western World self-immolation is an uncommon but dramatic method of attempting suicide. In-patients who attempt suicide by fire-setting tend to be female with severe psychopathology. In a previous study from the South of Ireland, seven cases from a psychiatric and prison population were identified in a five year period from 1984 to 1989. This would represent an annual rate of 1.07 per cent of burns treated in the burns unit at Cork University Hospital. In this study 12 cases were identified for the years 1994 and 1995. This represents an increase of 3.5 per cent from 1.07 to 4.6 per cent of all burns treated at the same institution. Ten of these patients had a previous psychiatric history and eight of them were resident on a psychiatric ward when they committed the act. Seven of the patients were found to have a high degree of suicide intent of whom four died of their injuries, which gives a mortality rate for this group of 33 per cent. Effective prevention policies are necessary if this increasing problem is to be curtailed.

  8. A model of the prescription-pharmaceutical sales process

    Directory of Open Access Journals (Sweden)

    Michael Stros

    2018-06-01

    Full Text Available The purpose of this paper is to determine the factors in marketing most relevant to achieving pharmaceutical sales success and their interrelations, as well as providing a prescription-pharmaceuticals sales process model. This will enable scholars to obtain a better understanding of the marketing process for prescription pharmaceuticals, as well as enabling marketers to apply more efficient marketing approaches. The study uses a unique data set, combining primary data and secondary data from the Swiss prescription-pharmaceuticals market. The data is analysed using a multiple-regression based model. A multi-level data structure is found, suggesting that factors concerning the specific brand and also the pharmaceutical substance itself are relevant to sales success. It is revealed that the factors most relevant to sales success are: order of market entry, perceived product-quality, average price, and marketing expenditures, leading to practical recommendations for scholars and marketing professionals. The study focuses only on the Swiss prescription-pharmaceuticals market, investigating five medical drug classes. The assumption is made that these results can be generalised to similar markets and drug classes. The study develops a conceptual prescription-pharmaceuticals sales-process model; offers practical guidelines and a good basis for further scholarly research are provided; and identifies several research gaps by giving proposals for future research.

  9. Off-label prescriptions in diabetic foot

    Directory of Open Access Journals (Sweden)

    Luís Jesuíno de Oliveira Andrade

    2014-09-01

    Full Text Available Prescription of a drug outside of the indications for which it was originally approved by regulators is internationally known as "off-label" prescription. We describe off-label treatments for the diabetic foot reported in international scientific literature. This is a qualitative and descriptive bibliographical review based on the results of a search of the Medline international database. The criteria for review were publication between January 1985 and November 2013, and the MeSH (Medical Subject Heading keywords "off-label use" OR "off-label" OR "off-label prescribing" plus "diabetic foot" were input on the search form. Nine studies were selected that contained information about off-label treatments for the diabetic foot. We conclude that the practice of off-label prescribing has potential benefits. In some situations an off-label prescription is the only treatment available for patients, either because a more targeted drug does not exist, or because other methods of treatment are ineffective or unavailable due to patient intolerance.

  10. Psychiatric Aspects of Infertility

    Directory of Open Access Journals (Sweden)

    Hacer Sezgin

    2014-06-01

    Full Text Available Infertility can be defined as a crisis with cultural, religious, and class related aspects, which coexists with medical, psychiatric, psychological, and social problems. Relation between psychiatric and psychological factors stem from a mutual interaction of both. Family is an important institution in maintaining human existence and raising individuals in line with society's expectations. Fertility and reproduction are seen as universal functions unique to women with raising children as the expected result of the family institution. Incidence of infertility has increased recently and can become a life crisis for a couple. Even though not being able to have a child affects both sexes emotionally, women feel greater amounts of stress, pressure, anxiety, and depression.Consequences of infertility arise from short and long-term devastating effects on both individual's physical and mental health, and marital system. Many studies focus on infertility related psychological and psychiatric disorders (depression, anxiety, grief, marital conflict, gender differences, relation between the causes of infertility and psychopathology, the effects of psychiatric evaluation and intervention -when necessaryon the course of infertility treatment, pregnancy rates, and childbirth. The most important underlying causes of high levels of stress and anxiety that infertile women experience are the loss of maternity, reproduction, sense of self, and genetic continuity. In this review article is to investigate the relationship between medically unexplained symptoms and psychiatric symptoms. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 165-185

  11. Income and the use of prescription drugs for near retirement individuals

    DEFF Research Database (Denmark)

    Leth-Petersen, Søren; Skipper, Niels

    Understanding how demand for prescription drugs responds to changes in income is important for assessing the welfare consequences of reforms affecting income. This becomes more imminent as age progresses, because the use of prescription drugs and the associated budgetary burden increases dramatic......Understanding how demand for prescription drugs responds to changes in income is important for assessing the welfare consequences of reforms affecting income. This becomes more imminent as age progresses, because the use of prescription drugs and the associated budgetary burden increases...... dramatically from about age 55. In this paper we estimate how demand for prescription drugs varies with income for a sample of near retirement individuals. Estimating the prescription drug demand response to income changes is complicated because an important explanatory variable, the health capital......, is unobserved, and because demand is potentially dynamic, for example because some drugs are habitual. The analysis is based on a novel panel data set with information about purchase of prescription drug demand for a very large number of Danish individuals over the period 1995-2003. Our preferred model...

  12. Direct-to-consumer prescription drug advertising: history, regulation, and issues.

    Science.gov (United States)

    Huh, Jisu; DeLorme, Denise E; Reid, Leonard N; An, Soontae

    2010-03-01

    Direct-to-consumer advertising has changed the way prescription drugs are marketed in the United States. This article traces the history of direct-to-consumer advertising of prescription and over-the-counter medications and describes how drug advertising is regulated and by whom. It also discusses the controversies that surround direct-to-consumer marketing of prescription drugs.

  13. Do Motives Matter?: Nonmedical Use of Prescription Medications among Adolescents

    Science.gov (United States)

    McCabe, Sean Esteban; Boyd, Carol J.

    2012-01-01

    Adolescents' motives for engaging in nonmedical prescription drug use is somewhat different than their reasons for using other drugs, such as marijuana. For some youth, nonmedical prescription drug use is an attempt to self-treat a medical condition, for others it is an effort to get high, and some youth misuse prescription drugs for both reasons.…

  14. Illegal "no prescription" internet access to narrow therapeutic index drugs.

    Science.gov (United States)

    Liang, Bryan A; Mackey, Tim K; Lovett, Kimberly M

    2013-05-01

    Narrow therapeutic index (NTI) drugs, because of proximity of therapeutic amounts to toxic amounts, require close professional oversight, particularly when switching formulations. However, safe use may be compromised by unsupervised switching through access to online "no prescription" Web sites. We assessed no prescription online availability of NTI drugs, using an academically published list (core NTI drugs). Using the Google search term "buy DRUG no prescription," we reviewed the first 5 search result pages for marketing of no prescription NTI drugs. We further assessed if National Association of Boards of Pharmacy (NABP) Not Recommended vendors were marketing NTI drugs. Searches were conducted from November 3, 2012 to January 3, 2013. For core NTI drugs, we found 13 of 14 NTI drugs (92%) marketed as available without prescription, all from NABP Not Recommended vendors. On the basis of these initial findings, we expanded our core list to 12 additional NTI drugs; 11 of 12 of these drugs (92%) were available from no prescription Web sites. Overall, 24 of 26 NTI drugs (92%) were illegally marketed as available online without the need for a prescription. Suspect online NTI drug access from no prescription vendors represents a significant patient safety risk because of potential patient drug switching and risk of counterfeit versions. Further, state health care exchanges with coverage limitations may drive patients to seek formulations online. Food and Drug Administration harmonization with tighter international NTI drug standards should be considered, and aggressive action against suspect online marketers should be a regulatory and public health priority. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.

  15. 77 FR 46653 - Branded Prescription Drug Fee; Hearing

    Science.gov (United States)

    2012-08-06

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 51 [REG-112805-10] RIN 1545-BJ39 Branded Prescription Drug Fee; Hearing AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of... document provides notice of public hearing on proposed regulations relating to the branded prescription...

  16. Prosthetic prescription in the Netherlands : an observational study

    NARCIS (Netherlands)

    van der Linde, H; Geertzen, JHB; Hofstad, CJ; Postema, K; Van Limbeek, Jacques

    2003-01-01

    Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to

  17. Prescription, dispensation and marketing patterns of methylphenidate

    Directory of Open Access Journals (Sweden)

    Edson Perini

    2014-12-01

    Full Text Available OBJECTIVE To analyze the patterns and legal requirements of methylphenidate consumption. METHODS We conducted a cross-sectional study of the data from prescription notification forms and balance lists of drugs sales – psychoactive and others – subject to special control in the fifth largest city of Brazil, in 2006. We determined the defined and prescribed daily doses, the average prescription and dispensation periods, and the regional sales distribution in the municipality. In addition, we estimated the costs of drug acquisition and analyzed the individual drug consumption profile using the Lorenz curve. RESULTS The balance lists data covered all notified sales of the drug while data from prescription notification forms covered 50.6% of the pharmacies that sold it, including those with the highest sales volumes. Total methylphenidate consumption was 0.37 DDD/1,000 inhabitants/day. Sales were concentrated in more developed areas, and regular-release tablets were the most commonly prescribed pharmaceutical formulation. In some regions of the city, approximately 20.0% of the prescriptions and dispensation exceeded 30 mg/day and 30 days of treatment. CONCLUSIONS Methylphenidate was widely consumed in the municipality and mainly in the most developed areas. Of note, the consumption of formulations with the higher abuse risk was the most predominant. Both its prescription and dispensation contrasted with current pharmacotherapeutic recommendations and legal requirements. Therefore, the commercialization of methylphenidate should be monitored more closely, and its use in the treatment of behavioral changes of psychological disorders needs to be discussed in detail, in line with the concepts of the quality use of medicines.

  18. The lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution

    Directory of Open Access Journals (Sweden)

    E. Bimenyimana

    2009-09-01

    Full Text Available Caring for good people is difficult enough; to care for people who are either aggressive or violent is even more difficult. This is what psychiatric nurses working in the psychiatric institution in which research was done are exposed to on a daily basis. The aim of the research was to explore and describe the lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution. A qualitative, explorative, descriptive, and contextual study design was utilised. Data was collected by means of semi-structured interviews and naïve sketches. Tesch’s (Creswell, 2004:256 method of open coding and an independent coder were utilised for data analysis. This study shed some light on the lived experience by psychiatric nurses of aggression and violence from patients in a Gauteng psychiatric institution. The findings show that the level of violence and aggression to which psychiatric nurses are exposed is overwhelming and the consequences are alarming. The contributing factors to this violence and aggression are: the mental status and the conditions in which patients are admitted; the staff shortage; the lack of support among the members of the multidisciplinary team (MDT; and the lack of structured and comprehensive orientation among newly appointed staff members. As a result, psychiatric nurses are emotionally, psychologically, and physically affected. They then respond with the following emotions and behaviour: fear, anger, frustration, despair, hopelessness and helplessness, substance abuse, absenteeism, retaliation and the development of an “I don’t care” attitude.

  19. Prescription medicine sharing experience among pharmacy students

    OpenAIRE

    Šliogerytė, Karolina

    2017-01-01

    K.Šliogeryte`s master thesis. Master thesis supervisor associate professor Jonas Grincevičius (2015/2016), lecturer J. Daukšienė(2016/2017); Lithuanian University of Health Sciences, Faculty of Pharmacy, Pharmaceutical technology and Social pharmacy department. – Kaunas. Master thesis: prescription medicine sharing experience among pharmacy students. The aim: to evaluate LUHS Pharmacy faculty students` experience in prescription drugs` sharing. Methods: empirical qualitative method...

  20. OCCUPATIONAL ROLE AFTER PSYCHIATRIC HOSPITALIZATION

    Directory of Open Access Journals (Sweden)

    GH.R GHASSEMI

    2003-03-01

    Full Text Available Introduction: Severe Psychiatricillness is accompanied by gross disturbances in patient's occupational role. This study presents a comparative picture of work performance before and after psychiatric hospitalization. Method: Subjects comprised 440 psychiatric admitters from Noor Medical center - Isfahan - Iran, who were followed from November 1999 to November 2000. Their work adjustment was measured by means of Weiss man's index. Data were computer analyzed using SPSS by running paired t- student and ANOVA. Results: Majority of the patients (53 % were without permanent sources of income before psychiatric hospitalization, about 12 percent of those who were working prior to hospitalization lost their job after being discharged from hospital. Better work adjustment before hospitalization was positively correlated with better work adjustment after discharge for working patients (r =0/66. Working ability of the patients after discharge was lesser than before the attack f9r patients with regular and irregular job (P < 001. Discussion: Job loss or poor working ability after psychiatric admission reported by several researchers and has bean confirmed in this study as well. These observatoins have been discussed in view of the current socio economic problems in the society and nature of psychiatric disturbances.

  1. Estimating the completeness of physician billing claims for diabetes case ascertainment using population-based prescription drug data.

    Science.gov (United States)

    Lix, L M; Kuwornu, J P; Kroeker, K; Kephart, G; Sikdar, K C; Smith, M; Quan, H

    2016-03-01

    Changes in physician reimbursement policies may hinder the collection of billing claims in administrative data; this can result in biased estimates of disease prevalence and incidence. However, the magnitude of data loss is largely unknown. The purpose of this study was to estimate completeness of capture of disease cases for Manitoba physicians paid by fee-for-service (FFS) and non-fee-for-service (NFFS) methods. Manitoba's administrative data were used to identify a cohort (≥ 20 years) with a new diabetes medication between 1 April, 2007, and 31 March, 2009. Cohort members were classified by payment method of the prescribing physician (i.e. FFS vs. NFFS). The cohort was then classified as missing or not missing a diabetes diagnosis using physician claims and hospital records. Then, χ2 statistics were used to test for differences in the characteristics of the two groups. The cohort consisted of 12 394 individuals; 86.4% had a prescription for a diabetes medication from an FFS physician. A total of 1172 physicians (81.8% FFS) prescribed these medications for the cohort. Cohort members with a prescription from an FFS physician were older and more likely to reside in the urban Winnipeg health region than those with a prescription from a NFFS physician. A greater percentage of NFFS physicians' cases were missing a diabetes diagnosis (18.7%vs. 14.9% for FFS physicians). The results suggest minimal loss of physician claims associated with remuneration policies in Manitoba. This method of assessing data completeness could be applied to other chronic diseases and jurisdictions to estimate completeness.

  2. Demand for a Medicare prescription drug benefit: exploring consumer preferences under a managed competition framework.

    Science.gov (United States)

    Cline, Richard R; Mott, David A

    2003-01-01

    Several proposals for adding a prescription drug benefit to the Medicare program rely on consumer choice and market forces to promote efficiency. However, little information exists regarding: 1) the extent of price sensitivity for such plans among Medicare beneficiaries, or 2) the extent to which drug-only insurance plans using various cost-control mechanisms might experience adverse selection. Using data from a survey of elderly Wisconsin residents regarding their likely choices from a menu of hypothetical drug plans, we show that respondents are likely to be price sensitive with respect to both premiums and out-of-pocket costs but that selection problems may arise in these markets. Outside intervention may be necessary to ensure the feasibility of a market-based approach to a Medicare drug benefit.

  3. Cultural Issues in Psychiatric Administration and Leadership

    Science.gov (United States)

    Aggarwal, Neil Krishan

    2016-01-01

    This paper addresses cultural issues in psychiatric administration and leadership through two issues: (1) the changing culture of psychiatric practice based on new clinician performance metrics and (2) the culture of psychiatric administration and leadership in light of organizational cultural competence. Regarding the first issue, some observers have discussed the challenges of creating novel practice environments that balance business values of efficient performance with fiduciary values of treatment competence. This paper expands upon this discussion, demonstrating that some metrics from the Centers for Medicare & Medicaid Services, the nation’s largest funder of postgraduate medical training, may penalize clinicians for patient medication behaviors that are unrelated to clinician performance. A focus on pharmacotherapy over psychotherapy in these metrics has unclear consequences for the future of psychiatric training. Regarding the second issue, studies of psychiatric administration and leadership reveal a disproportionate influence of older men in positions of power despite efforts to recruit women, minorities, and immigrants who increasingly constitute the psychiatric workforce. Organizational cultural competence initiatives can diversify institutional cultures so that psychiatric leaders better reflect the populations they serve. In both cases, psychiatric administrators and leaders play critical roles in ensuring that their organizations respond to social challenges. PMID:26071640

  4. Psychiatric disorders in bone marrow transplant patients

    International Nuclear Information System (INIS)

    Khan, A.G.; Irfan, M.; Shamsi, T.S.; Hussain, M.

    2007-01-01

    To identify the psychiatric illnesses in patients with hematological/oncological disorders encountered during blood and bone marrow transplantation. All consecutive patients, aged 15 years and above, who fulfilled inclusion and exclusion criteria and underwent blood and bone marrow transplantation, were enrolled in this study. Psychiatric assessment comprised of a semi-structured interview based on Present Status Examination (PSE). The psychiatric diagnosis was made on the basis of International Classification of Diseases (ICD-10) system of classification devised by W.H.O. Eighty patients, who fulfilled the inclusion criteria, were inducted in this study. Thirty (37.5%) cases were found to have psychiatric disorders. Out of the total, 60 (75%) were males and 20 (25%) females. Adjustment disorder was the most frequent diagnosis (n=12), followed by major depression (n=7). Rest of the diagnoses made were generalized anxiety disorder, acute psychotic disorder, delirium and depressive psychosis. High psychiatric morbidity associated with blood and bone marrow transplantation was observed. It indicates the importance of psychiatric intervention during the isolation period of BMT as well as pre-transplant psychiatric assessment and counseling regarding procedure. (author)

  5. Psychiatric disorders in myasthenia gravis

    Directory of Open Access Journals (Sweden)

    Mariana Inés Ybarra

    2011-04-01

    Full Text Available OBJECTIVE: To investigate the prevalence of psychiatric disorders in patients with myasthenia gravis (MG. METHOD: Forty-one patients with MG answered to a structured psychiatric interview (MINI-Plus. RESULTS: Eleven (26.1% patients were diagnosed with a depressive disorder and 19 (46.3% were diagnosed with an anxiety disorder. Patients with dysthymia were older (p=0.029 and had longer disease duration (p=0.006. Patients with social phobia also had longer disease duration (p=0.039. CONCLUSION: Psychiatric disorders in MG are common, especially depressive and anxiety disorders.

  6. 21 CFR 1306.13 - Partial filling of prescriptions.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Partial filling of prescriptions. 1306.13 Section 1306.13 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE PRESCRIPTIONS Controlled... by revising paragraph (a), effective June 1, 2010. For the convenience of the user, the revised text...

  7. 77 FR 48111 - Branded Prescription Drug Fee; Correction

    Science.gov (United States)

    2012-08-13

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 51 [REG-112805-10] RIN 1545-BJ39 Branded Prescription Drug Fee; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice..., August 6, 2012 (77 FR 46653) relating to the branded prescription drug fee imposed by the Affordable Care...

  8. Factors associated with family violence by persons with psychiatric disorders.

    Science.gov (United States)

    Labrum, Travis; Solomon, Phyllis L

    2016-10-30

    Family violence by persons with psychiatric disorders (PD) is a highly under-researched area. The primary objective of the present analysis was to identify perpetrator, victim, and interaction/relationship factors associated with this phenomenon. The secondary objective was to examine the extent to which the relationship between caregiving and family violence was mediated by limit-setting practices used towards relatives with PD. 573 adults across the U.S. with an adult relative with PD completed an online survey. Multivariate logistic regression was performed examining the association of factors with the occurrence of family violence. Mediation was assessed with Sobel testing. Family violence was significantly associated with the following factors: perpetrator-income, illegal drug use, psychiatric hospitalization, treatment attendance, and use of medications; victim-age, employment status, income, and mental health status; interaction/relationship-parental relationship, co-residence, use of limit-setting practices, representative payeeship, and unofficial money management. Mediation was statistically significant. Increasing access to mental health and/or substance abuse treatment may decrease the risk of family violence. Interventions may benefit from attempting to decrease/modify the use of limit-setting practices. Where family representative payeeship or unofficial money management exists, it is advisable for practitioners to assess and address financial coercion and promote greater collaboration in financial decision-making. Published by Elsevier Ireland Ltd.

  9. Getting a prescription filled

    Science.gov (United States)

    ... get a prescription from your provider, you may buy the medicine in different ways. LOCAL PHARMACIES The most common ... long-term medicines you use for chronic problems. Buy short-term medicines and drugs that need to be stored at ...

  10. Psychiatric aspects of Parkinson′s disease

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2015-01-01

    Full Text Available Parkinson′s disease (PD is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the "tip of the iceberg" of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control, sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD.

  11. Effective Alternative to Constipation Medication in Nursing Home Residents: Libera Study

    Directory of Open Access Journals (Sweden)

    Ismael Sobrón Monge

    2017-07-01

    Full Text Available Introduction: The aim of this study is to ascertain the impact of administering a dessert rich in fibre and sorbitol on the prescription of laxatives in nursing home residents with constipation. Material and methods: Single-centre, interventional prospective study in elderly nursing home residents diagnosed with constipation and treated with laxatives, in which each patient is his/her own comparator. A dessert rich in fibre and sorbitol (high-fibre Resource® Fruit Purée was given for 7 weeks. The main variable was the difference in days of pharmacological treatment with laxatives between the week before the start of the study and the last week of the study. Results: 40 patients were studied with a median age of 88.5 years (range: 72–101. After 7 weeks, the residents required a mean of 3.5 fewer days per week of treatment with laxatives. Patients receiving pharmacological medication decreased by 40%. Weekly bowel movements increased by a mean of 2 while gastrointestinal discomfort decreased. The intervention did not change previous intake. Adherence to the prescribed regimen was over 94%. A decrease in the number of days with laxative therapy was associated with: consuming 5 or more desserts a week, being over 85, having poor oral health and not suffering from malnutrition or food disorders. Conclusions: Dispensing a dessert rich in fibre and sorbitol may be an effective and safe alternative to laxatives in elderly nursing home residents with constipation, and may help to reduce polymedication in these patients.

  12. The influence of prescription monitoring programs on chronic pain management.

    Science.gov (United States)

    Wang, Jing; Christo, Paul J

    2009-01-01

    Abuse of prescribed controlled substance has become a serious social as well as health care issue over the past decade. A particularly alarming trend exists among patients aged 12 to 17. Common abuse behaviors include doctor shopping, drug theft, feigned pain symptoms to gain health care access, drug sharing, prescription forgery, and improper prescription practices. In response to this epidemic of abuse, many states have adopted prescription monitoring programs (PMPs). Such programs first originated in the early twentieth century. As of 2006, 38 states had such programs, many of which are supported by federal grants. As PMPs become more widespread, they have also increased in sophistication. By keeping a record of the prescription and dispensing of narcotics, these programs are able to build a comprehensive data network for tracking prescription medications. These databases aid law enforcement agencies in investigations of narcotic trafficking; they also help state regulatory boards to monitor improper prescription practices. This manuscript examines the basic structure of a PMP, including the way the data are collected and the way these data are stored and used. It also looks at the organizational differences amongst state programs. NASPER and Harold Rogers are two federal programs that provide funding to the state PMPs, and the current study examines the differences as well as similarities between these 2 programs. This study also compares the results of 2 reports: the U.S. General Accounting Office Study and the Twillman study.& Both studies have evaluated the efficiency of the PMPs. The U.S. General Accounting Office Study showed that while considerable differences exist among the state PMPs, these programs not only reduce the time and effort for law enforcement agencies to conduct investigations, but also cut the supply of prescription medications. However, the Twillman report suggests that prescription programs caused a shift in prescription practice, while

  13. Migraine: Clinical pattern and psychiatric comorbidity

    Directory of Open Access Journals (Sweden)

    Manjeet Singh Bhatia

    2012-01-01

    Full Text Available Background: Migraine is a common disorder which has psychiatric sequelae. Objective: The objective of this study was to determine the clinical pattern and psychiatric comorbidity of migraine. Materials and Methods: 100 cases of migraine seen over a period of one year were analysed to know the sociodemographic characteristics, clinical pattern and psychiatric morbidity. Results: Maximum patients were between 31-40 years of age group (40%, females (78.0%, married (76% and housewives (56.0%. Family history of migraine was present in 12% cases. Average age of onset was 22 years. Unilateral and throbbing type of headache was most common. The commonest frequency was one to two per week. Migraine without aura was commonest sub-type (80%. Generalized anxiety disorder (F41.1 was the most common psychiatric disorder (34%, followed by mixed anxiety and depressive disorder (F41.2 (18% and depressive episode (F32 (14%. In 22% cases, no psychiatric disorder could be elicited. Conclusion: The present study confirms that majority patients with migraine had psychiatric disorders. This needs timely detection and appropriate intervention to treat and control the migraine effectively.

  14. [Psychiatric readmissions: individual and organizational factors].

    Science.gov (United States)

    Plancke, Laurent; Amariei, Alina; Flament, Clara; Dumesnil, Chloé

    2017-01-01

    Psychiatric readmission often constitutes a criterion to assess the effects of various therapies, as well as the impact of organizational changes in the healthcare system. It is used to characterize relapse or decompensation. The purpose of this study was to determine readmission rates and identify individual and organizational factors associated with significant variations in these rates. Adult psychiatric readmissions were identified from the full-time hospital stays registered in psychiatric wards in 2011-2012 in the Nord and Pas-de-Calais departments of France, available in the medical the RimP psychiatric admission database. Readmission rates for various follow-up periods after discharge were measured by Kaplan-Meier survival analysis and multivariate analysis was conducted using the Cox proportional hazards model. Approximately 30,000 adults were hospitalized full-time in psychiatric units of the region during the study period. The 24-month readmission rate was 51.6% (95%CI: 50.8-52.3%). The Cox model showed that a diagnosis of schizophrenia (F2 - HR = 1.72 - 95%CI: 1.61-1.84 - p Psychiatric readmission is a very frequent event and is linked to organizational as well as individual factors.

  15. Impact of the Hydrocodone Schedule Change on Opioid Prescription Patterns in South Dakota.

    Science.gov (United States)

    Kuschel, Lauren M; Mort, Jane M

    2017-10-01

    Prescription opioid use is becoming increasingly common; consequently, opioid overdose deaths are increasing at an alarming rate. Hydrocodone, one of the most commonly abused opioids, was changed from a schedule III controlled substance to the more stringent schedule II to decrease abuse and diversion, effective Oct. 6, 2014. The objective of this study was to examine the impact of the hydrocodone schedule change on opioid prescribing in South Dakota. Opioid prescription patterns were examined in the following six-month phases: the baseline phase before the change, the transition phase when existing hydrocodone prescriptions could still be refilled, and the final phase. The South Dakota Board of Pharmacy Prescription Drug Monitoring Program provided aggregate monthly data for South Dakota opioid prescriptions (i.e., total number of prescriptions and days supplied), including urban and rural stratification. T-tests were performed on the monthly values for each phase to determine the significance of differences in prescription features between phases. The number of hydrocodone prescriptions significantly decreased 14 percent from baseline to final phase, while the days supplied per prescription significantly increased 7.4 percent. These changes were greater in rural areas than in urban areas. Conversely, the number of other opioid prescriptions significantly increased by 6.5 percent over this timeframe. The number of hydrocodone prescriptions decreased, while the days supplied per prescription increased. These changes were greater in rural areas than in urban areas. In addition, the number of other opioid prescriptions increased. These trends may reflect some unintended effects of the schedule change.

  16. Psychiatric comorbidity : fact or artifact?

    NARCIS (Netherlands)

    van Loo, Hanna; Romeijn, Johannes

    The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus

  17. Expanded pharmacy technician roles: Accepting verbal prescriptions and communicating prescription transfers.

    Science.gov (United States)

    Frost, Timothy P; Adams, Alex J

    2017-11-01

    As the role of the clinical pharmacist continues to develop and advance, it is critical to ensure pharmacists can operate in a practice environment and workflow that supports the full deployment of their clinical skills. When pharmacy technician roles are optimized, patient safety can be enhanced and pharmacists may dedicate more time to advanced clinical services. Currently, 17 states allow technicians to accept verbal prescriptions called in by a prescriber or prescriber's agent, or transfer a prescription order from one pharmacy to another. States that allow these activities generally put few legal limitations on them, and instead defer to the professional judgment of the supervising pharmacist whether to delegate these tasks or not. These activities were more likely to be seen in states that require technicians to be registered and certified, and in states that have accountability mechanisms (e.g., discipline authority) in place for technicians. There is little evidence to suggest these tasks cannot be performed safely and accurately by appropriately trained technicians, and the track record of success with these tasks spans four decades in some states. Pharmacists can adopt strong practice policies and procedures to mitigate the risk of harm from verbal orders, such as instituting read-back/spell-back techniques, or requiring the indication for each phoned-in medication, among other strategies. Pharmacists may also exercise discretion in deciding to whom to delegate these tasks. As the legal environment becomes more permissive, we foresee investment in more robust education and training of technicians to cover these activities. Thus, with the adoption of robust practice policies and procedures, delegation of verbal orders and prescription transfers can be safe and effective, remove undue stress on pharmacists, and potentially free up pharmacist time for higher-order clinical care. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Differences in prevalence of prescription opiate misuse among rural and urban probationers.

    Science.gov (United States)

    Havens, Jennifer R; Oser, Carrie B; Leukefeld, Carl G; Webster, J Matthew; Martin, Steven S; O'Connell, Daniel J; Surratt, Hilary L; Inciardi, James A

    2007-01-01

    We compared the prevalence of prescription opiate misuse among 2 cohorts of felony probationers (N = 1525). Multiple logistic regression was utilized to determine the independent correlates of prescription opiate misuse among rural (n = 782) and urban (n = 743) probationers participating in an HIV-intervention study. After adjustment for differences in demographic and drug use characteristics, rural participants were almost five times more likely than their urban counterparts to have misused prescription opiates. The prevalence of prescription opiate misuse was significantly higher among the rural probationers; however, given the paucity of illicit opiates and relatively recent emergence of prescription opiates in rural areas, rural substance abuse treatment may be ill-prepared to treat prescription opiate misuse.

  19. Study on drug costs associated with COPD prescription medicine in Denmark

    DEFF Research Database (Denmark)

    Jakobsen, M; Anker, N; Dollerup, J

    2013-01-01

    that the costs associated with COPD in Denmark are significant, but costs of prescription medicine for COPD were not analysed. OBJECTIVES: To analyse the societal costs associated with prescription medicine for COPD in Denmark. METHODS: The study was designed as a nationwide retrospective register study...... in 2010 with total costs of DKK 685 million (EUR 92 million). The average lifetime costs associated with COPD prescription medicine were estimated to be DKK 70,000-75,000 (EUR 9,416-10,089) per patient (2010 prices). CONCLUSION: The costs associated with prescription medicine for COPD in Denmark...... of the drug costs (ATC group R03) associated with COPD in the period 2001-2010. Data were retrieved from the Prescription Database, the National Patient Register and the Centralised Civil Register. The population comprised individuals (40+ years) who had at least one prescription of selected R03 drugs and who...

  20. STUDY ON DRUG COSTS ASSOCIATED WITH COPD PRESCRIPTION MEDICINE IN DENMARK

    DEFF Research Database (Denmark)

    Jakobsen, Iris Marie; Anker, Niels; Dolleru, Jens

    2012-01-01

    that the costs associated with COPD in Denmark are significant, but costs of prescription medicine for COPD were not analysed. OBJECTIVES: To analyse the societal costs associated with prescription medicine for COPD in Denmark. METHODS: The study was designed as a nationwide retrospective register study...... in 2010 with total costs of DKK 685 million (EUR 92 million). The average lifetime costs associated with COPD prescription medicine were estimated to be DKK 70,000-75,000 (EUR 9,416-10,089) per patient (2010 prices). CONCLUSION: The costs associated with prescription medicine for COPD in Denmark...... of the drug costs (ATC group R03) associated with COPD in the period 2001-2010. Data were retrieved from the Prescription Database, the National Patient Register and the Centralised Civil Register. The population comprised individuals (40+ years) who had at least one prescription of selected R03 drugs and who...

  1. Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis

    Science.gov (United States)

    Juurlink, David; Yao, Zhan; Camacho, Ximena; Paterson, J. Michael; Singh, Samantha; Dhalla, Irfan; Sproule, Beth; Mamdani, Muhammad

    2014-01-01

    Background The increased use of opioid analgesics, sedative hypnotics and stimulants, coupled with the associated risks of overdose have raised concerns around the inappropriate prescribing of these monitored drugs. We assessed the impact of new legislation, the Narcotics Safety and Awareness Act, and a centralized Narcotics Monitoring System (implemented November 2011 and May 2012, respectively), on the dispensing of prescriptions suggestive of misuse. Methods We conducted a time series analysis of publicly funded prescriptions for opioids, benzodiazepines and stimulants dispensed monthly in Ontario from January 2007 to May 2013, based on information in the Ontario Public Drug Benefit Database. In the primary analysis, a prescription was deemed potentially inappropriate if it was dispensed within 7 days of an earlier prescription and was for at least 30 tablets of a drug in the same class as the earlier prescription, but originated from a different physician and a different pharmacy. Results After enactment of the new legislation, the prevalence of potentially inappropriate opioid prescriptions decreased by 12.5% in 6 months (from 1.6% in October 2011 to 1.4% in April 2012; p = 0.01). No further significant change was observed after the introduction of the narcotic monitoring system (p = 0.8). By May 2013, the prevalence had dropped to 1.0%. Inappropriate benzodiazepine prescribing was significantly influenced by both the legislation (p significantly influenced by the introduction of the monitoring system in May 2012, falling from 0.7% in April 2012 to 0.3% in May 2013 (p = 0.02). Interpretation For a select group of drugs prone to misuse and diversion, legislation and a prescription monitoring program reduced the prevalence of prescriptions suggestive of misuse. This suggests that regulatory interventions can promote appropriate prescribing which could potentially be applied to other jurisdictions and drugs of concern. PMID:25485251

  2. A unique database for gathering data from a mobile app and medical prescription software: a useful data source to collect and analyse patient-reported outcomes of depression and anxiety symptoms.

    Science.gov (United States)

    Watanabe, Yoshinori; Hirano, Yoko; Asami, Yuko; Okada, Maki; Fujita, Kazuya

    2017-11-01

    A unique database named 'AN-SAPO' was developed by Iwato Corp. and Japan Brain Corp. in collaboration with the psychiatric clinics run by Himorogi Group in Japan. The AN-SAPO database includes patients' depression/anxiety score data from a mobile app named AN-SAPO and medical records from medical prescription software named 'ORCA'. On the mobile app, depression/anxiety severity can be evaluated by answering 20 brief questions and the scores are transferred to the AN-SAPO database together with the patients' medical records on ORCA. Currently, this database is used at the Himorogi Group's psychiatric clinics and has over 2000 patients' records accumulated since November 2013. Since the database covers patients' demographic data, prescribed drugs, and the efficacy and safety information, it could be a useful supporting tool for decision-making in clinical practice. We expect it to be utilised in wider areas of medical fields and for future pharmacovigilance and pharmacoepidemiological studies.

  3. Psychiatric outcomes after pediatric sports-related concussion.

    Science.gov (United States)

    Ellis, Michael J; Ritchie, Lesley J; Koltek, Mark; Hosain, Shahid; Cordingley, Dean; Chu, Stephanie; Selci, Erin; Leiter, Jeff; Russell, Kelly

    2015-12-01

    The objectives of this study were twofold: (1) to examine the prevalence of emotional symptoms among children and adolescents with a sports-related concussion (SRC) who were referred to a multidisciplinary pediatric concussion program and (2) to examine the prevalence, clinical features, risk factors, and management of postinjury psychiatric outcomes among those in this clinical population. The authors conducted a retrospective chart review of all patients with SRC referred to a multidisciplinary pediatric concussion program between September 2013 and October 2014. Clinical assessments carried out by a single neurosurgeon included clinical history, physical examination, and Post-Concussion Symptom Scale (PCSS) scoring. Postinjury psychiatric outcomes were defined as a subjective worsening of symptoms of a preinjury psychiatric disorder or new and isolated suicidal ideation or diagnosis of a novel psychiatric disorder (NPD). An NPD was defined as a newly diagnosed psychiatric disorder that occurred in a patient with or without a lifetime preinjury psychiatric disorder after a concussion. Clinical resources, therapeutic interventions, and clinical and return-to-play outcomes are summarized. One hundred seventy-four patients (mean age 14.2 years, 61.5% male) were included in the study. At least 1 emotional symptom was reported in 49.4% of the patients, and the median emotional PCSS subscore was 4 (interquartile range 1-8) among those who reported at least 1 emotional symptom. Overall, 20 (11.5%) of the patients met the study criteria for a postinjury psychiatric outcome, including 14 patients with an NPD, 2 patients with isolated suicidal ideation, and 4 patients with worsening symptoms of a preinjury psychiatric disorder. Female sex, a higher initial PCSS score, a higher emotional PCSS subscore, presence of a preinjury psychiatric history, and presence of a family history of psychiatric illness were significantly associated with postinjury psychiatric outcomes

  4. Nonmedical Prescription Drug Use among Midwestern Rural Adolescents

    Science.gov (United States)

    Park, Nicholas K.; Melander, Lisa; Sanchez, Shanell

    2016-01-01

    Prescription drug misuse has been an increasing problem in the United States, yet few studies have examined the protective factors that reduce risk of prescription drug abuse among rural adolescents. Using social control theory as a theoretical framework, we test whether parent, school, and community attachment reduce the likelihood of lifetime…

  5. 76 FR 59897 - Branded Prescription Drug Fee; Correction

    Science.gov (United States)

    2011-09-28

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 51 [TD 9544] RIN 1545-BK34 Branded... branded prescription drugs. This fee was enacted by section 9008 of the Patient Protection and Affordable...: This correction is effective on September 28, 2011 and applies to any fee on branded prescription drug...

  6. Empiric antibiotic prescription among febrile under-five Children in ...

    African Journals Online (AJOL)

    limiting viral infection and therefore, would not require antibiotics. Over prescription of antibiotics increases antibiotics exposure and development of resistance among patients. There is need to evaluate empiric antibiotic prescription in order to limit ...

  7. [Suicidal behavior: a psychiatric emergency situation, suicide prevention: a psychiatric obligation].

    Science.gov (United States)

    Wolfersdorf, M; Schneider, B; Schmidtke, A

    2015-09-01

    In German psychiatry suicidal behavior is seen as sign of a psychiatric crisis in a person in the context of psychopathology, psychodynamics and psychosocial situation. Psychiatric disorders are found in up to 90% of people who commit suicide and the time span following the decision to commit suicide is often very short, within 24 h. Suicide prevention is a central duty and obligation in psychiatry and psychotherapy. This article gives an overview on the current state of knowledge on suicide from a clinical point of view.

  8. Two Years of ePrescription in Slovenia - Applications and Potentials.

    Science.gov (United States)

    Stanimirovic, Dalibor; Savic, Dusan

    2018-01-01

    ePrescription is one of the most successful eHealth solutions in Slovenia. Since its national roll-out in early 2016, the quality of its operations has been constantly improving, and the number of users has been growing ever since to reach today's 90% of all healthcare providers. ePrescription facilitates more transparent and safer prescribing of medications, an overview of possible medication interactions, and reduction of administrative and opportunity costs. This paper initially explores the current state of ePrescription in Slovenia and different aspects of its application. Based on the research findings, the paper finally outlines potentials of ePrescription, which could be transformed into tangible benefits with particular implications for healthcare system. The research is based on focus group methodology. Structured discussions were conducted with eminent experts currently in charge of ePrescription (and other eHealth solutions) development and implementation in Slovenia. Research results imply that certain application aspects are relatively easy to define and evaluate, while the overall potentials of ePrescription are difficult to determine in many cases, and relatively unexplored in terms of their implications and operational feasibility.

  9. Continuity of pharmaceutical care for psychiatric patients

    NARCIS (Netherlands)

    Abdullah-Koolmees, Heshu

    2015-01-01

    Psychiatric diseases are common. The effective treatment of a psychiatric disease, its (somatic) side effects and any concurrent somatic diseases is important for the patient’s overall health and wellbeing. The studies conducted in psychiatric patients generally focus on the continuation of

  10. Psychiatric diagnoses, trauma, and suicidiality

    Directory of Open Access Journals (Sweden)

    Elklit Ask

    2007-04-01

    Full Text Available Abstract Background This study aimed to examine the associations between psychiatric diagnoses, trauma and suicidiality in psychiatric patients at intake. Methods During two months, all consecutive patients (n = 139 in a psychiatric hospital in Western Norway were interviewed (response rate 72%. Results Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma for longer periods of time. Only 7% acquired a PTSD diagnosis. The comorbidity of PTSD and other psychiatric diagnoses were 78%. A number of diagnoses were associated with specific traumas. Sixty-seven percent of the patients reported suicidal thoughts in the month prior to intake; thirty-one percent had attempted suicide in the preceding week. Suicidal ideation, self-harming behaviour, and suicide attempts were associated with specific traumas. Conclusion Traumatised patients appear to be under- or misdiagnosed which could have an impact on the efficiency of treatment.

  11. The Impact of Psychiatric Patient Boarding in Emergency Departments

    Directory of Open Access Journals (Sweden)

    B. A. Nicks

    2012-01-01

    Full Text Available Objectives. Studies have demonstrated the adverse effects of emergency department (ED boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits from January 2007-2008. The main outcomes were ED length of stay (LOS and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1% requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years, with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039–1140 versus 340 min, CI (304–375; <0.001 when compared to non-psychiatric admissions. The financial impact of psychiatric boarding accounted for a direct loss of ($1,198 compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients per psychiatric patient, and decreasing financial revenue.

  12. Two Cases Of Multiple Sclerosis Accompanying Psychiatric Symptoms

    Directory of Open Access Journals (Sweden)

    Ayşegül Şengel

    2007-10-01

    Full Text Available Scientific bacground: It has been reported that; Multiple Sclerosis (MS may be presented with many psychiatric symptoms such as anxiety, depression, mania and psychosis. MS cases, presented with psychiatric symptoms were also reported. Cases: Two MS cases, diagnosed as psychotic and bipolar disorder respectively, were reported in this paper. Both of the cases were responded to the steroid treatment, and neurological and psychiatric examinations were found to be normal after one month. CONCLUSION: MS cases might be presented with psychiatric complaints and symptoms except neurological ones. We conclude that; psychiatric evaluation as well as the neurological evaluation is important in the MS cases presented with psychiatric symptoms

  13. An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions.

    Science.gov (United States)

    Islam, M Mofizul; McRae, Ian S

    2014-08-16

    In an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriate therapeutic uses of these drugs with the risk of developing dependence. This article discusses pros and cons of PDMP in reducing diversion of prescription opioids, without hampering access to those medications for those with genuine needs, and highlights tensions around PDMP implementation. PDMPs may help alleviate diversion, over-prescription and fraudulent prescribing/dispensing; prompt drug treatment referrals; avoid awkward drug urine test; and inform spatial changes in prescribing practices and help designing tailored interventions. Fear of legal retribution, privacy and data security, potential confusion about addiction and pseudo-addiction, and potential undue pressure of detecting misuse/diversion - are the major problems. There are tensions about unintended consequence of excessive regulatory enforcements, corresponding collateral damages particularly about inadequate prescribing for patients with genuine needs, and mandatory consultation requirements of PDMP. In this era of information technology PDMP is likely to flourish and remain with us for a long time. A clear standard of practice against which physicians' care will be judged may expedite the utilisation of PDMP. In addition, adequate training on addiction and pain management along with public awareness, point-of-supply data entry from pharmacy, point-of-care real-time access to data, increasing access to addiction treatment and appropriate regulatory enforcement preferably through healthcare administration, together

  14. Psychiatric disorders in long-term sickness absence

    DEFF Research Database (Denmark)

    Søgaard, Hans Jørgen; Bech, Per

    2009-01-01

    % for any somatoform disorder. Multivariable analyses showed that female sex and unemployment were predictors of a psychiatric disorder, whereas living with children below 18 years and being a skilled worker carried a reduced risk of a psychiatric disorder. CONCLUSIONS: The high frequency of psychiatric...

  15. Psychiatric disorders of patients seeking obesity treatment

    Directory of Open Access Journals (Sweden)

    Lin Hung-Yen

    2013-01-01

    Full Text Available Abstract Background Obese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment. Methods Subjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment. Results Of the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group. Conclusion A high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.

  16. The Prescription Drug Marketing Act of 1987.

    Science.gov (United States)

    Greenberg, R B

    1988-10-01

    The Prescription Drug Marketing Act of 1987 is described, and its implications for hospitals and other health-care entities are discussed. The act, which became effective on July 21, 1988, is intended to reduce public health risks from adulterated, misbranded, and counterfeit drug products that enter the marketplace through drug diversion. The law provides that prescription drug products manufactured in the United States and exported can no longer be reimported, except by the product's manufacturer. It also establishes restrictions on sales of prescription drug products and samples. Samples of prescription drug products may be distributed only if a licensed prescriber requests them. Other distribution channels for samples specified in the law are permissible, provided records are maintained. Under the law, wholesale distributors must be licensed by the state and meet uniform standards. Penalties for violations of the law are also identified. According to FDA's advisory guidelines on the statute, the law will permit hospitals to return drug products, provided the return is made to the manufacturer or wholesaler and provided written notice is secured that the goods were received (for manufacturers) or the goods were destroyed or returned to the manufacturer (for wholesalers). The final chapter on drug diversion must await issuance of final FDA regulations.

  17. Exploring the Association Between Electronic Health Record Use and Burnout Among Psychiatry Residents and Faculty: a Pilot Survey Study.

    Science.gov (United States)

    Domaney, Nicholas M; Torous, John; Greenberg, William E

    2018-05-21

    Burnout is a phenomenon with profound negative effects on the US healthcare system. Little is known about the relationship between time spent working on electronic health record (EHR) and burnout among psychiatry residents. The purpose of this study is to generate preliminary data on EHR use and burnout among psychiatry residents and faculty. In August 2017, psychiatry residents and faculty at an academic medical center were given the Maslach Burnout Inventory (MBI), a standardized measurement tool for burnout, and a survey of factors related to EHR use and potential risk factors for burnout. MBI data along with selected burnout risk and protective factors were analyzed with R Studio software. Responses were obtained from 40 psychiatry residents (73%) and 12 clinical faculty members (40%). Residents reported 22 h per week using EHR on average. Mean score of residents surveyed in postgraduate year (PGY)-1-4 met criteria for high emotional exhaustion associated with burnout. The magnitude of correlation between EHR use and emotional exhaustion was stronger than for other burnout factors including sleep, exercise, and clinical service. Psychiatry residents show signs of high emotional exhaustion, which is associated with burnout. Results demonstrate a strong positive correlation between EHR use and resident burnout. Time spent on EHR use may be an area of importance for psychiatry program directors and other psychiatric educators to consider when seeking to minimize burnout and promote wellness.

  18. Pharmacist Remote Review of Medication Prescriptions for Appropriateness in Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Moran Lazaryan

    2016-08-01

    Full Text Available Background: One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available.Objective: To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU. Methods: A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded.Results: The review time for one medical record was 8.9 (95% CI, 6.9-10.9 minutes. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45-1.11 minutes. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8-18.8 and 12 (9-15 minutes, respectively, for patients with psychiatric-neurologic disorders compared to those without (p=0.032. Usually, a daily workload of 240 minutes was needed for the pharmacist accompanying the round in contrast to 108 minutes per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9% and made no comment on 36.9% of the recommendations. Conclusion: Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.

  19. Association of childhood abuse and prescription opioid use in early adulthood.

    Science.gov (United States)

    Austin, Anna E; Shanahan, Meghan E; Zvara, Bharathi J

    2018-01-01

    Previous research has examined the association of childhood abuse with opioid misuse and dependence in adulthood. However, little research has focused specifically on prescription opioids, and no studies have examined associations with prescription opioid use, a potential pathway to later opioid misuse and dependence. The aim of the present study was to examine the association of childhood emotional, physical, and sexual abuse with prescription opioid use in early adulthood. We used data from Waves I (12-18years) and IV (24-32years) of the National Longitudinal Study of Adolescent to Adult Health. At Wave IV, respondents reported experiences of childhood abuse occurring prior to age 18years and prescription opioid use in the last four weeks. We conducted multivariable logistic regression to examine associations of childhood abuse with recent prescription opioid use. In multivariable models adjusted for respondent sex, race/ethnicity, age, and socioeconomic status, childhood emotional abuse (OR=1.57, 95% CI 1.29, 1.90), physical abuse (OR=1.46, 95% CI 1.14, 1.87), and any childhood abuse (OR=1.51, 95% CI 1.24, 1.82) were significantly associated with recent prescription opioid use. Given continued increases in prescription opioid use and opioid-related morbidity and mortality in the U.S., understanding upstream social and environmental factors associated with prescription opioid use is important to strengthening and expanding current prevention and intervention strategies. Future research is needed to examine factors potentially mediating the association between childhood abuse and prescription opioid use in order to provide additional insights for prevention and intervention efforts. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Moral hazard and prescription medicine use in Australia--the patient perspective.

    Science.gov (United States)

    Doran, Evan; Robertson, Jane; Henry, David

    2005-04-01

    All Australian citizens are provided affordable access to prescription medicines through the nation's system of universal pharmaceutical subsidies--the pharmaceutical benefits scheme. The rapid increase in pharmaceutical related expenditure has generated the concern that Australians are taking advantage of prescription subsidies and are using more medicines than are necessary, thereby creating a 'moral hazard'. This concern is predicated on a number of assumptions about patient behaviour rather than on empirical observation. These assumptions amount to a view that patients are consumers who treat prescription medicines as common goods subject to informed and rational calculation of the cost and benefits of their use. This paper reports the findings of an in-depth interview study undertaken to explore how prescription cost influences Australians' medicine use. Qualitative data were analysed to compare medicine users' descriptions of the role of prescription cost in medicine use against the assumptions that underlie the belief in moral hazard. Moral hazard did not appear to be significantly operating in the accounts of medicine use collected for this study. Interviewees' accounts of medicine use revealed an act characterised by ambivalence, a mix of desire and antipathy, faith and suspicion. Medicines appeared in interviewees' accounts as both pharmacologically and symbolically potent substances, which despite their familiarity as objects, are often mysterious to non-expert patients. Cost appeared as a secondary factor in patients' decision to access a prescription medicine. Using a prescription was predicated on the medicine being necessary, with necessity typically established by an expert doctor prescribing the medicine. Prescription medicines did not appear as 'common goods' where subsidised access motivates a 'consumer' to demand more or make the prospect of prescription use more attractive or necessary.

  1. The effect of menstruation on psychiatric hospitalization.

    Science.gov (United States)

    Weston, Jaclyn; Speroni, Karen Gabel; Ellis, Terri; Daniel, Marlon G

    2012-07-01

    This study evaluated the effect of menstruation on psychiatric hospitalization. We conducted a retrospective chart review of the medical records of 177 women who met the eligibility criteria. Data collected included demographic details, primary and secondary diagnoses, date of last menstrual period (LMP), medication adherence, psychiatric hospitalization length of stay, previous psychiatric admissions (including those related to menstruation), discharge referrals, and readmissions. The majority of women were admitted for major depression, were single, Caucasian, and had a mean age of 34. A disproportionate percentage (37%) of women had their LMP within 5 days of psychiatric hospitalization (p = 0.0006). The overall average length of stay was 4.37 days, and 48.3% had a previous psychiatric admission. Medication adherence was routinely not documented (77.4%). Psychiatric hospitalizations for women are significantly greater within 5 days of their LMP. Nursing education and improved documentation are warranted to decrease the potential for readmission. Copyright 2012, SLACK Incorporated.

  2. The application characteristics of Zhongjing external prescription medicine

    Directory of Open Access Journals (Sweden)

    Hui Zhao

    2017-12-01

    Full Text Available Objective: To explore the application characteristics of Zhongjing prescription topical Chinese medicine. Methods: in this paper, according to the dosage form, Zhongjing topical agent will be divided into suppository, smoked lotion, apply is scattered, plug nasal powder four categories. Through an analysis on its books, records, and clinical applications, we are able to sum up the application characteristics of the zhongjing agent for external use. Results: in the clinical medicine, topical Zhongjing prescription cure of the disease has a long history of the role, through the analysis of Zhongjing topical prescription whole thinking, dialectical thinking, and thinking and characteristics of treatment technology that has the characteristics of topical drugs, dosage form differentiation flexible, external treatment for internal diseases, both inside and outside. Conclusion: topical medicine not only in the clinical treatment effect is good, and to inherit and develop Zhang Zhongjing thought of medicine, medical practice, law, strengthen Zhong Jing prescription and medicine, to enrich TCM clinical diagnosis and treatment methods to improve the clinical efficacy of traditional Chinese medicine, Chinese medicine clinics provide high standards of service for patients.

  3. Geographical and temporal variations in clozapine prescription for schizophrenia

    DEFF Research Database (Denmark)

    Nielsen, Jimmi; Røge, Rasmus; Schjerning, Ole

    2012-01-01

    Despite its unsurpassed efficacy in treatment-resistant schizophrenia, clozapine remains underutilized. Trends in the prescription of clozapine in patients with ICD-10 F20.x schizophrenia were assessed using data from Danish national registers. Three substudies were carried out: (i) an assessment...... of differences in national prescription patterns between 1996 and 2007 using a cross-sectional design; (ii) a comparison of time from first schizophrenia diagnosis to first prescription of clozapine in a five-year cohort study, using the Cox regression model, of two patient groups who were first diagnosed...

  4. Antibiotic prescriptions for outpatient acute rhinosinusitis in Canada, 2007-2013

    Science.gov (United States)

    Weese, Scott; Glass-Kaastra, Shiona; McIsaac, Warren

    2017-01-01

    Introduction Acute rhinosinusitis (ARS) is a respiratory disease commonly caused by viral infections. Physicians regularly prescribe antibiotics despite bacterial etiologies being uncommon. This is of concern, as this use adds to the selection pressure for resistance. Here we present the descriptive epidemiology of acute rhinosinusitis and corresponding antibiotic prescribing practices by Canadian outpatient physicians from 2007–2013. Materials/Methods Diagnosis and antibiotic prescription data for ARS were extracted from the Canadian Disease and Therapeutic Index for 2007 to 2013, and population data were acquired from Statistics Canada. ARS diagnosis and antibiotic prescription rates and frequencies of antibiotic classes were calculated. Results Eighty-eight percent of patients diagnosed with ARS in 2013 were adults, with a greater rate of antibiotic prescriptions observed among the adults relative to the pediatric patients (1632.9 and 468.6 antibiotic prescriptions per 10,000 inhabitants). Between 2007 and 2013, the ARS diagnosis rate decreased from 596 to 464 diagnoses per 10,000 inhabitants, while the percentage of diagnoses with antibiotic prescriptions at the national level remained stable (87% to 84%). From 2007 to 2013, prescription rates for macrolides decreased from 203.5 to 105.4 prescriptions per 10,000 inhabitants. In 2013, penicillins with extended spectrum were more commonly prescribed compared to macrolides among adult patients (153.5 and 105.4 prescriptions per 10,000 inhabitants, respectively). Conclusion This study is the first to describe physician antibiotic prescribing practices for treatment of ARS in Canada. Results show that antibiotic treatment for ARS represents an area for implementing antimicrobial stewardship, and through it, managing antibiotic resistance. Further work is required to better understand diagnosing practices and treatment criteria for ARS, and use this information to further assist physicians to limit unnecessary

  5. Understanding Adherence and Prescription Patterns Using Large-Scale Claims Data.

    Science.gov (United States)

    Bjarnadóttir, Margrét V; Malik, Sana; Onukwugha, Eberechukwu; Gooden, Tanisha; Plaisant, Catherine

    2016-02-01

    Advanced computing capabilities and novel visual analytics tools now allow us to move beyond the traditional cross-sectional summaries to analyze longitudinal prescription patterns and the impact of study design decisions. For example, design decisions regarding gaps and overlaps in prescription fill data are necessary for measuring adherence using prescription claims data. However, little is known regarding the impact of these decisions on measures of medication possession (e.g., medication possession ratio). The goal of the study was to demonstrate the use of visualization tools for pattern discovery, hypothesis generation, and study design. We utilized EventFlow, a novel discrete event sequence visualization software, to investigate patterns of prescription fills, including gaps and overlaps, utilizing large-scale healthcare claims data. The study analyzes data of individuals who had at least two prescriptions for one of five hypertension medication classes: ACE inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers, and diuretics. We focused on those members initiating therapy with diuretics (19.2%) who may have concurrently or subsequently take drugs in other classes as well. We identified longitudinal patterns in prescription fills for antihypertensive medications, investigated the implications of decisions regarding gap length and overlaps, and examined the impact on the average cost and adherence of the initial treatment episode. A total of 790,609 individuals are included in the study sample, 19.2% (N = 151,566) of whom started on diuretics first during the study period. The average age was 52.4 years and 53.1% of the population was female. When the allowable gap was zero, 34% of the population had continuous coverage and the average length of continuous coverage was 2 months. In contrast, when the allowable gap was 30 days, 69% of the population showed a single continuous prescription period with an average length of 5

  6. Psychiatric features in perpetrators of homicide-unsuccessful ...

    African Journals Online (AJOL)

    2013-03-01

    Mar 1, 2013 ... The high rate of psychiatric disorders diagnosed is in keeping with court referrals occurring ... was collected if available, and included gender, age, employment history, marital ... psychiatric symptoms and of psychiatric illness and treatment, as reported by the ... The identity of alleged perpetrators was kept ...

  7. Asthma prescription patterns for children: can GPs do better?

    NARCIS (Netherlands)

    Uijen, J.H.J.M.; Wouden, J.C. van der; Schellevis, F.G.; Willemsen, S.P.; Suijlekom-Smit, L.W.A. van; Bindels, P.J.E.

    2011-01-01

    Background: Assessing prescription patterns of asthma medication for children is helpful to optimize prescribing by general practitioners (GPs). The aim was to explore prescription patterns in children with physician-diagnosed asthma and its determinants in general practice. Methods: We used the

  8. Regionalised tertiary psychiatric residential facilities.

    Science.gov (United States)

    Lesage, Alain; Groden, David; Goldner, Elliot M; Gelinas, Daniel; Arnold, Leslie M

    2008-01-01

    Psychiatric hospitals remain the main venue for long-term mental health care and, despite widespread closures and downsizing, no country that built asylums in the last century has done away with them entirely--with the recent exception of Italy. Differentiated community-based residential alternatives have been developed over the past decades, with staffing levels that range from full-time professional, to daytime only, to part-time/on-call. This paper reviews the characteristics of community-based psychiatric residential care facilities as an alternative to long-term care in psychiatric hospitals. It describes five factors decision makers should consider: 1. number of residential places needed; 2. staffing levels; 3. physical setting; 4. programming; and 5. governance and financing. In Italy, facilities with full-time professional staff have been developed since the mid-1990s to accommodate the last cohorts of patients discharged from psychiatric hospitals. In the United Kingdom, experiments with hostel wards since the 1980s have shown that home-like, small-scale facilities with intensive treatment and rehabilitation programming can be effective for the most difficult-to-place patients. More recently in Australia, Community Care Units (CCUs) have been applying this concept. In the Canadian province of British Columbia (BC), Tertiary Psychiatric Residential Facilities (TPRFs) have been developed as part of an effort to regionalise health and social services and downsize and ultimately close its only psychiatric hospital. This type of service must be further developed in addition to the need for forensic, acute-care and intermediate-level beds, as well as for community-based care such as assertive community treatment and intensive case management. All these types of services, together with long-term community-based residential care, constitute the elements of a balanced mental health care system. As part of a region's balanced mental health care plan, these Tertiary

  9. Psychiatric comorbidity in forensic psychiatry.

    Science.gov (United States)

    Palijan, Tija Zarković; Muzinić, Lana; Radeljak, Sanja

    2009-09-01

    For the past several years a numerous studies in the field of forensic psychiatry confirmed a close relationship between violent offenders and comorbid substance abuse. The comorbid substance abuse in violent offenders was usually unrecognized and misdiagnosed. Furthermore, comorbidity in forensic psychiatry describes the co-occurrence of two or more conditions or psychiatric disorder known in the literature as dual diagnosis and defined by World Health Organization (WHO). In fact, many violent offenders have multiple psychiatric diagnoses. Recent studies have confirmed causal relationship between major psychiatric disorders and concomitant substance abuse (comorbidity) in 50-80% of forensic cases. In general, there is a high level of psychiatric comorbidity in forensic patients with prevalence of personality disorders (50-90%), mood disorders (20-60%) and psychotic disorders (15-20%) coupled with substance abuse disorders. Moreover, the high prevalence of psychiatric comorbidities could be found in mentally retarded individuals, as well as, in epileptic patients. Drugs and alcohol abuse can produce serious psychotoxic effects that may lead to extreme violent behavior and consequently to serious criminal offence such as physical assault, rape, armed robbery, attempted murder and homicide, all due to an altered brain function and generating psychotic-like symptoms. Studies have confirmed a significant statistical relevance in causal relationship between substance abuse and violent offences. In terms of forensic psychiatry, the comorbidity strongly contributes in the process of establishing psychiatric diagnosis of diminished mental capacity or insanity at the time of the offence in the course of clinical assessment and evaluation of violent offenders. Today, the primary focus of forensic psychiatry treatment services (in-patient or community) is management of the violent offenders with psychiatric comorbidity which requires a multilevel, evidence based approach to

  10. Use of a generic protocol in documentation of prescription errors in Estonia, Norway and Sweden

    Directory of Open Access Journals (Sweden)

    Haavik S

    2012-06-01

    Full Text Available Pharmacists have an important role in detecting, preventing, and solving prescription problems, which if left unresolved, may pose a risk of harming the patient.Objective: The objectives of this study were to evaluate the feasibility of a generic study instrument for documentation of prescription problems requiring contact with prescriber before dispensing. The study was organized: 1 by countries: Estonia, Norway and Sweden; 2 by type of prescriptions: handwritten prescriptions, printouts of prescriptions in the electronic medical record and electronically transmitted prescriptions to pharmacies; and 3 by recording method - self-completion by pharmacists and independent observers.Methods: Observational study with independent observers at community pharmacies in Estonia (n=4 and Sweden (n=7 and self-completed protocols in Norway (n=9.Results: Pharmacists’ in Estonia contacted the prescriber for 1.47% of the prescriptions, about 3 times as often as in Norway (0.45% and Sweden (0.38%. Handwritten prescriptions dominated among the problem prescriptions in Estonia (73.2%, printouts of prescriptions in the electronic medical record (89.1% in Norway and electronically transmitted prescriptions to pharmacies (55.9% in Sweden.More administrative errors were identified on handwritten prescriptions and printouts of prescriptions in the electronic medical record in Estonia and in Norway compared with electronically transmitted prescriptions to pharmacies in Sweden (p<0.05 for prescription types and p<0.01 for countries. However, clinically important errors and delivery problems appeared equally often on the different types of prescriptions. In all three countries, only few cases of drug interactions and adverse drug reactions were identified.Conclusion: Despite the different patterns of prescription problems in three countries, the instrument was feasible and can be regarded appropriate to document and classify prescription problems necessitating contact

  11. PRESCRIPTION OF PHYSICAL EXERCISES FOR ELDERLY

    Directory of Open Access Journals (Sweden)

    Sheilla Tribess

    2005-11-01

    Full Text Available The present study has as objective investigates the prescription of exercises for elderly, constant in the literature in portuguese language, under form of books, newspapers, annals and publications electronics. For so much, it tried to collect data with relationship to the following aspects: a Impact of the aging in the human organism; b evaluation of the components of the functional aptitude; and, c composition of a program of physical exercise. The aging process evidences changes in the levels antropométrics, neuromuscular, cardiovascular, lung, neural, besides the decrease of the agility, coordination, balance, flexibility, mobility to articulate and increase in the cartilage rigidity, tendons and ligaments. Those changes associated to the low level of physical activity in the elderly take to the decline of the functional capacity. The evaluation of the level of functional dependence becomes important to the elderly, because it will provide a prescription of physical exercises more addressed your needs, increasing the effectiveness of the program and reducing the risks. The general beginnings for the prescription of physical exercises for elderly are based in the modalities appropriate, intensity, duration, frequency and progression of the physical activity, with the objective of improving the life quality, to minimize the physiologic alterations, to improve the motive capacity and to provide benefits social, psychological and physical. Therefore, in the prescription of physical exercises for older people is necessary the training of the capacity aerobics, of the force, of the balance, of the time of reaction and movement and of the agility.

  12. An historical framework for psychiatric nosology.

    Science.gov (United States)

    Kendler, K S

    2009-12-01

    This essay, which seeks to provide an historical framework for our efforts to develop a scientific psychiatric nosology, begins by reviewing the classificatory approaches that arose in the early history of biological taxonomy. Initial attempts at species definition used top-down approaches advocated by experts and based on a few essential features of the organism chosen a priori. This approach was subsequently rejected on both conceptual and practical grounds and replaced by bottom-up approaches making use of a much wider array of features. Multiple parallels exist between the beginnings of biological taxonomy and psychiatric nosology. Like biological taxonomy, psychiatric nosology largely began with 'expert' classifications, typically influenced by a few essential features, articulated by one or more great 19th-century diagnosticians. Like biology, psychiatry is struggling toward more soundly based bottom-up approaches using diverse illness characteristics. The underemphasized historically contingent nature of our current psychiatric classification is illustrated by recounting the history of how 'Schneiderian' symptoms of schizophrenia entered into DSM-III. Given these historical contingencies, it is vital that our psychiatric nosologic enterprise be cumulative. This can be best achieved through a process of epistemic iteration. If we can develop a stable consensus in our theoretical orientation toward psychiatric illness, we can apply this approach, which has one crucial virtue. Regardless of the starting point, if each iteration (or revision) improves the performance of the nosology, the eventual success of the nosologic process, to optimally reflect the complex reality of psychiatric illness, is assured.

  13. An historical framework for psychiatric nosology

    Science.gov (United States)

    Kendler, K. S.

    2009-01-01

    This essay, which seeks to provide an historical framework for our efforts to develop a scientific psychiatric nosology, begins by reviewing the classificatory approaches that arose in the early history of biological taxonomy. Initial attempts at species definition used top-down approaches advocated by experts and based on a few essential features of the organism chosen a priori. This approach was subsequently rejected on both conceptual and practical grounds and replaced by bottom-up approaches making use of a much wider array of features. Multiple parallels exist between the beginnings of biological taxonomy and psychiatric nosology. Like biological taxonomy, psychiatric nosology largely began with ‘expert’ classifications, typically influenced by a few essential features, articulated by one or more great 19th-century diagnosticians. Like biology, psychiatry is struggling toward more soundly based bottom-up approaches using diverse illness characteristics. The underemphasized historically contingent nature of our current psychiatric classification is illustrated by recounting the history of how ‘Schneiderian’ symptoms of schizophrenia entered into DSM-III. Given these historical contingencies, it is vital that our psychiatric nosologic enterprise be cumulative. This can be best achieved through a process of epistemic iteration. If we can develop a stable consensus in our theoretical orientation toward psychiatric illness, we can apply this approach, which has one crucial virtue. Regardless of the starting point, if each iteration (or revision) improves the performance of the nosology, the eventual success of the nosologic process, to optimally reflect the complex reality of psychiatric illness, is assured. PMID:19368761

  14. College Students with Psychiatric Disabilities

    Science.gov (United States)

    Singh, Delar K.

    2011-01-01

    This paper focuses on college students with psychiatric disabilities. It defines and discusses various psychiatric conditions such as mood disorders, anxiety disorders, eating disorders, and personality disorders. It concludes with accommodations that a college professor can make to help these students succeed in higher education. (Contains 1…

  15. Psychiatric diagnoses in patients with burning mouth syndrome and atypical odontalgia referred from psychiatric to dental facilities

    Directory of Open Access Journals (Sweden)

    Miho Takenoshita

    2010-10-01

    Full Text Available Miho Takenoshita1, Tomoko Sato1, Yuichi Kato1, Ayano Katagiri1, Tatsuya Yoshikawa1, Yusuke Sato2, Eisuke Matsushima3, Yoshiyuki Sasaki4, Akira Toyofuku11Psychosomatic Dentistry, 2Complete Denture Prosthodontics, 3Liaison Psychiatry and Palliative Medicine, 4Center for Education and Research in Oral Health Care, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, JapanBackground: Burning mouth syndrome (BMS and atypical odontalgia (AO are two conditions involving chronic oral pain in the absence of any organic cause. Psychiatrically they can both be considered as “somatoform disorder”. From the dental point of view, however, the two disorders are quite distinct. BMS is a burning or stinging sensation in the mouth in association with a normal mucosa whereas AO is most frequently associated with a continuous pain in the teeth or in a tooth socket after extraction in the absence of any identifiable cause. Because of the absence of organic causes, BMS and AO are often regarded as psychogenic conditions, although the relationship between oral pain and psychologic factors is still unclear. Some studies have analyzed the psychiatric diagnoses of patients with chronic oral pain who have been referred from dental facilities to psychiatric facilities. No study to date has investigated patients referred from psychiatric facilities to dental facilities.Objective: To analyze the psychiatric diagnoses of chronic oral pain patients, diagnosed with BMS and AO, and referred from psychiatric facilities to dental facilities.Study design: Psychiatric diagnoses and disease conditions of BMS or AO were investigated in 162 patients by reviewing patients’ medical records and referral forms. Psychiatric diagnoses were categorized according to the International Statistical Classification of Disease and Related Health Problems, Tenth Revision.Results: The proportion of F4 classification (neurotic, stress

  16. Prescription Pattern Analysis of Nonsteroidal Anti-inflammatory Drugs in the Northeastern Iranian Population.

    Science.gov (United States)

    Zeinali, Majid; Tabeshpour, Jamshid; Maziar, Seyed Vahid; Taherzadeh, Zhila; Zirak, Mohammad Reza; Sent, Danielle; Azarkhiavi, Kamal Razavi; Eslami, Saeid

    2017-01-01

    Inappropriate nonsteroidal anti-inflammatory drugs (NSAIDs) therapy is a common cause of actual and potential adverse effects, such as bleeding and gastrointestinal ulceration, which exacerbates the patient's medical condition and might even be life threatening. We aimed to evaluate and analyze the prescription pattern of NSAIDs in Northeastern Iranian population and also provide suggestions for a more rational prescription behavior for such drugs. In this cross-sectional retrospective study, pattern of 1-year prescriptions was inspected based on 9.3 million prescriptions from two insurance companies. Type of NSAIDs, all dispensed doses and the number of NSAIDs ordered per prescription, and the route of administration for each patient were extracted from the databases. The prescription pattern of NSAIDs was analyzed seasonally. Out of 9,303,585 prescriptions, 19.3% contained at least one NSAID. Diclofenac was the most commonly prescribed NSAID (49.21%). At least two NSAIDs were simultaneously prescribed in 7% of prescriptions. General practitioners prescribed NSAIDs more frequently (67%) than specialists. Orthopedic surgeons and internists more frequently prescribed NSAIDs in comparison with other physicians (6% and 4%, respectively). Gastroprotective agents (GPAs) were coprescribed to only 7.62% of prescriptions. The frequency of NSAIDs prescription was relatively high in Northeast of Iran. A significant number of prescriptions were associated with irrational prescribing in both coadministration of NSAIDs and GPAs and NSAIDs combination. A strategy must be developed and implemented for prescribing and rational use of medications, e.g., continuing medical education regarding the potential risks of NSAIDs, importance of their appropriate and rational use, and necessity of appropriate prescription writing regarding both content and indication.

  17. The impact of psychiatric patient boarding in emergency departments.

    Science.gov (United States)

    Nicks, B A; Manthey, D M

    2012-01-01

    Objectives. Studies have demonstrated the adverse effects of emergency department (ED) boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits) from January 2007-2008. The main outcomes were ED length of stay (LOS) and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1%) requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years), with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039-1140) versus 340 min, CI (304-375); P boarding accounted for a direct loss of ($1,198) compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients) per psychiatric patient, and decreasing financial revenue.

  18. Cervical cancer: intracavitary dose specification and prescription

    International Nuclear Information System (INIS)

    Potish, R.A.; Gerbi, B.J.

    1987-01-01

    Dose and volume specifications for reporting intracavitary therapy were analyzed according to criteria recommended by the International Commission on Radiation Units and Measurements (ICRU). Ninety Fletcher-Suit radium applications were studied to examine the validity of the assumptions of the ICRU and the merit of their routine reporting. It was demonstrated that the reporting recommendations were inconsistent with clinical prescription systems and added little to dose specification. The distinction between dose specification and dose prescription was stressed

  19. Differences in psychotropic drug prescriptions among ethnic groups in the Netherlands.

    Science.gov (United States)

    Wittkampf, Laura Christina; Smeets, Hugo M; Knol, Mirjam J; Geerlings, Mirjam I; Braam, Arjan W; De Wit, Niek J

    2010-08-01

    Psychotropic drug use in Europe and the USA has increased in the past 20 years. The rise in mental health-care use instigated a debate about possible differences in prevalence rates between different ethnic groups in the Netherlands, although the exact differences were unknown. The aim of this study was to determine whether these minority groups were more or less likely than the native population to receive psychotropic drugs. A descriptive population study was conducted using the Agis Health Database, containing demographic and health-care consumption data of approximately 1.5 million inhabitants of the Netherlands. Rates of prescriptions of psychotropic drugs from 2001 to 2006 and adjusted odds ratios for psychotropic drug prescriptions among native Dutch, Turkish and Moroccan ethnic groups were calculated. These data were analysed using logistic regression, after being adjusted for age, gender and socioeconomic status. The mean year prevalence of psychotropic drug prescriptions from 2001 to 2006 was 14.0%. Except for a decrease in anxiolytic drugs, the prescriptions of psychotropic drugs increased from 2001 to 2006. These trends were the same for all of the ethnic groups considered. Among both the Moroccan and Turkish populations, there was a higher risk of antidepressant and antipsychotic drug prescriptions, and a pronounced lower risk of ADHD medication and lithium prescriptions compared to the native population. Among the Turkish population, the risk of anxiolytic drug prescriptions was greater than in the native population. Compared to the native population in the Netherlands, first- and second-generation Turkish and Moroccan immigrants had an increased risk of antidepressant and antipsychotic drug prescriptions and a decreased risk of ADHD medication and Lithium prescriptions. Further research is needed to clarify whether patients of different ethnic backgrounds with the same symptoms receive similar diagnosis and adequate treatment.

  20. Anxiety disorders: Psychiatric comorbidities and psychosocial ...

    African Journals Online (AJOL)

    2018-05-24

    May 24, 2018 ... psychiatric disorders, including other anxiety disorders, mood disorders, substance use disorders ... psychiatric comorbidities present among adults at a tertiary ..... clinical files as well as unclear handwriting and missing.

  1. The cerebellum and psychiatric disorders

    Directory of Open Access Journals (Sweden)

    Joseph ePhillips

    2015-05-01

    Full Text Available The cerebellum has been considered for a long time to play a role solely in motor coordination. However, studies over the past two decades have shown that the cerebellum also plays a key role in many motor, cognitive, and emotional processes. In addition, studies have also shown that the cerebellum is implicated in many psychiatric disorders including attention deficit hyperactivity disorder, autism spectrum disorders, schizophrenia, bipolar disorder, major depressive disorder and anxiety disorders. In this review, we discuss existing studies reporting cerebellar dysfunction in various psychiatric disorders. We will also discuss future directions for studies linking the cerebellum to psychiatric disorders.

  2. Electronic prescription as contributing factor for hospitalized patients' safety.

    Directory of Open Access Journals (Sweden)

    Gimenes FRE

    2006-03-01

    Full Text Available The following study was performed to identify factors related to medication errors in the computerized physician order entry and their advantages and disadvantages according to doctors, nursing team and administrative officers. It is a survey descriptive study carried out at three units of a Brazilian academic hospital in the southeast area. The study was divided in two phases. In the first phase, we analyzed a total of 1,349 prescriptions from general medical unit, surgical and orthopaedic wards during 30 days consecutively. A semi-structured instrument, elaborated by a group of researchers for the study proposals, was used. In the second phase, a semi-structured questionnaire was applied to the health professionals containing closed and open items approaching their opinion about the composition of electronic prescription, the advantages and disadvantages of them, and their suggestions for its improvement. Out of 1,349 prescriptions observed, 17.5% presented deletions, 25.0% medicines written manually and 17.0% of them were incomplete. Some of the advantages pointed by health professionals were its legibility (37.5%, little time spent when elaborating and emitting them (20.5% and the way they are a practical and organized (8%. The disadvantages pointed were repetition of previous prescriptions (34%, typing mistakes (17%, dependence on computers (11% and alterations made manually (7%. We conclude, this way, that the computerized prescription order entry represents a great progress among the strategies used to minimize medication errors caused by prescriptions badly formulated. However, it doesn't eradicate the possibility of medication error occurrences, needing some system modifications.

  3. A smart medication recommendation model for the electronic prescription.

    Science.gov (United States)

    Syed-Abdul, Shabbir; Nguyen, Alex; Huang, Frank; Jian, Wen-Shan; Iqbal, Usman; Yang, Vivian; Hsu, Min-Huei; Li, Yu-Chuan

    2014-11-01

    The report from the Institute of Medicine, To Err Is Human: Building a Safer Health System in 1999 drew a special attention towards preventable medical errors and patient safety. The American Reinvestment and Recovery Act of 2009 and federal criteria of 'Meaningful use' stage 1 mandated e-prescribing to be used by eligible providers in order to access Medicaid and Medicare incentive payments. Inappropriate prescribing has been identified as a preventable cause of at least 20% of drug-related adverse events. A few studies reported system-related errors and have offered targeted recommendations on improving and enhancing e-prescribing system. This study aims to enhance efficiency of the e-prescribing system by shortening the medication list, reducing the risk of inappropriate selection of medication, as well as in reducing the prescribing time of physicians. 103.48 million prescriptions from Taiwan's national health insurance claim data were used to compute Diagnosis-Medication association. Furthermore, 100,000 prescriptions were randomly selected to develop a smart medication recommendation model by using association rules of data mining. The important contribution of this model is to introduce a new concept called Mean Prescription Rank (MPR) of prescriptions and Coverage Rate (CR) of prescriptions. A proactive medication list (PML) was computed using MPR and CR. With this model the medication drop-down menu is significantly shortened, thereby reducing medication selection errors and prescription times. The physicians will still select relevant medications even in the case of inappropriate (unintentional) selection. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. The American Psychiatric Association's resource document on guidelines for psychiatric fitness-for-duty evaluations of physicians.

    Science.gov (United States)

    Anfang, Stuart A; Faulkner, Larry R; Fromson, John A; Gendel, Michael H

    2005-01-01

    The psychiatric evaluation of a physician's fitness for duty is an undertaking that is both important to patients' well-being and to the physician-subject of the evaluation. It is necessary that psychiatrists who agree to perform such evaluations proceed in a careful and thorough manner. This document was developed to provide general guidance to the psychiatric evaluators in these situations. It was prepared by the American Psychiatric Association (APA) Council on Psychiatry and Law and Corresponding Committee on Physician Health, Illness, and Impairment, of which the authors are members. The Resource Document was approved by the APA Joint Reference Committee in June 2004. APA Resource Documents do not represent official policy of the American Psychiatric Association. This Resource Document was edited to conform to Journal style and has therefore been modified slightly from the original document approved by the APA.

  5. Effects of a psychiatric intensive care unit in an acute psychiatric department.

    Science.gov (United States)

    Vaaler, A E; Morken, G; Fløvig, J C; Iversen, V C; Linaker, O M

    2006-01-01

    Psychiatric acute units use different levels of segregation to satisfy needs for containment and decrease in sensory input for behaviourally disturbed patients. Controlled studies evaluating the effects of the procedure are lacking. The aim of the present study was to compare effects in acutely admitted patients with the use of a psychiatric intensive care unit (PICU) and not in a psychiatric acute department. In a naturalistic study, one group of consecutively referred patients had access only to the PICU, the other group to the whole acute unit. Data were obtained for 56 and 62 patients using several scales. There were significant differences in reduction of behaviour associated with imminent, threatening incidents (Broset Violence Checklist), and actual number of such incidents (Staff Observation Aggression Scale-Revised) in favour of the group that was treated in a PICU. The principles of patient segregation in PICUs have favourable effects on behaviours associated with and the actual numbers of violent and threatening incidents.

  6. Patient-perceived content and formatting expectations for prescription container labeling.

    Science.gov (United States)

    Kebodeaux, Clark D; Peters, Golden L; Kindermann, Heather A; Hurd, Peter D; Berry, Tricia M

    2016-01-01

    The objectives of the study were to identify patient expectations for prescription label content and formatting and to explore how United States Pharmacopeia Chapter 17 Standards for prescription container labeling meet patient expectations. Focus group. St. Louis, Missouri, in July and August 2014. Patients 18 years and older who were taking at least 2 chronic prescription medications and managing their medications independently. Qualitative themes. Not applicable. Five focus groups (17 total participants) were conducted in St. Louis in 2014. Focus groups were audio-recorded and consent was obtained from the participants. The audio files were professionally transcribed. Atlas.ti software (version 7.5.3) was used to analyze the transcript data, which were then coded to identify key themes. To ensure consistency of interpretation, a constant comparative analytic framework approach was used. Analysis produced 6 themes related to patient perceptions and expectations of prescription label content and formatting: importance of drug name, dose, and directions; lack of side effects on the label; improved organization and larger font size; using the color red; lack of familiarity with auxiliary labels; and the importance of pharmacy information. Themes focused on how patients use prescription labels and the relative value of different aspects of prescription container labeling. Patient-perceived prescription content and formatting expectations for prescription container labeling were generally consistent with published USP Chapter 17 guidelines. The importance of pharmacy phone numbers, white space, and highlighting were noteworthy. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  7. PSYCHIATRIC COMORBIDITY IN PATIENTS WITH OPIOID DEPENDENCE

    Directory of Open Access Journals (Sweden)

    Shihab Kattukulathil

    2018-02-01

    Full Text Available BACKGROUND Opioid dependence is a major public health problem in Kerala. Presence of psychiatric disorder among opioid dependent patients worsens the scenario. To date no attempts have been made to analyse the magnitude and pattern of comorbid psychiatric disorders in the state. MATERIALS AND METHODS We assessed 30 patients with ICD-10 diagnosis of opioid dependence syndrome for the presence of comorbid psychiatric disorders using structured clinical interview for DSM IV Axis 1 disorder (SCID-1. Patients with opioid withdrawal state, delirium and acute medical emergencies were excluded. RESULTS 56.7% of our subjects had a comorbid psychiatric disorder. Major depressive disorder was the most common one (n=7, 23.3%. Prevalence of other disorders were generalised anxiety disorder (n=6, 20%, bipolar affective disorder (n=3, 10% and schizophrenia (n=1, 3.3%. CONCLUSION Comorbid Psychiatric disorders are highly prevalent in opioid dependence. There is a need for further large sample studies in the areas of comorbidities and in the integrated strategies for the identification and management of both opioid dependence and comorbid psychiatric disorders.

  8. 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.

  9. An Evidence-Based Approach To Exercise Prescriptions on ISS

    Science.gov (United States)

    Ploutz-Snyder, Lori

    2009-01-01

    This presentation describes current exercise countermeasures and exercise equipment for astronauts onboard the ISS. Additionally, a strategy for evaluating evidence supporting spaceflight exercise is described and a new exercise prescription is proposed. The current exercise regimen is not fully effective as the ISS exercise hardware does not allow for sufficient exercise intensity, the exercise prescription is adequate and crew members are noncompliant with the prescription. New ISS hardware is proposed, Advanced Resistance Exercise Device (ARED), which allows additional exercises, is instrumented for data acquisition and offers improved loading. The new T2 hardware offers a better harness and subject loading system, is instrumented to allow ground reaction force data, and offers improved speed. A strategy for developing a spaceflight exercise prescription is described and involves identifying exercise training programs that have been shown to maximize adaptive benefits of people exercising in both 0 and 1 g environments. Exercise intensity emerged as an important factor in maintaining physiologic adaptations in the spaceflight environment and interval training is suggested. New ISS exercise hardware should allow for exercise at intensities high enough to elicit adaptive responses. Additionally, new exercise prescriptions should incorporate higher intensity exercises and seek to optimize intensity, duration and frequency for greater efficiency.

  10. 42 CFR 456.482 - Medical, psychiatric, and social evaluations.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychiatric, and social evaluations. 456... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inpatient Psychiatric..., psychiatric, and social evaluations. If a facility provides inpatient psychiatric services to a recipient...

  11. Estimating the completeness of physician billing claims for diabetes case ascertainment using population-based prescription drug data

    Directory of Open Access Journals (Sweden)

    L. M. Lix

    2016-03-01

    Full Text Available Introduction: Changes in physician reimbursement policies may hinder the collection of billing claims in administrative data; this can result in biased estimates of disease prevalence and incidence. However, the magnitude of data loss is largely unknown. The purpose of this study was to estimate completeness of capture of disease cases for Manitoba physicians paid by fee-for-service (FFS and non-fee-for-service (NFFS methods. Methods: Manitoba’s administrative data were used to identify a cohort (Z 20 years with a new diabetes medication between 1 April, 2007, and 31 March, 2009. Cohort members were classified by payment method of the prescribing physician (i.e. FFS vs. NFFS. The cohort was then classified as missing or not missing a diabetes diagnosis using physician claims and hospital records. Then, w2 statistics were used to test for differences in the characteristics of the two groups. Results: The cohort consisted of 12 394 individuals; 86.4% had a prescription for a diabetes medication from an FFS physician. A total of 1172 physicians (81.8% FFS prescribed these medications for the cohort. Cohort members with a prescription from an FFS physician were older and more likely to reside in the urban Winnipeg health region than those with a prescription from a NFFS physician. A greater percentage of NFFS physicians’ cases were missing a diabetes diagnosis (18.7%vs. 14.9%for FFS physicians. Conclusion: The results suggest minimal loss of physician claims associated with remuneration policies in Manitoba. This method of assessing data completeness could be applied to other chronic diseases and jurisdictions to estimate completeness.

  12. Atopic dermatitis is associated with anxiety, depression, and suicidal ideation, but not with psychiatric hospitalization or suicide

    DEFF Research Database (Denmark)

    Thyssen, J P; Hamann, Carsten R; Linneberg, A

    2018-01-01

    of hospitalization and suicide. METHODS: We utilized questionnaire data from a large general population study with data on social habits and psychiatric symptoms to compare prevalences of depression, anxiety, suicidal ideation, and anxiety attacks, in adults with and without a history of AD. Additionally, we used...... nationwide hospital/clinic registry and prescription data to examine the risk of anxiety and depression in Danish adults with mild and moderate-severe AD, as well as the risk of hospitalization and suicide. RESULTS: In the general population study, those with AD reported clinician-diagnosed depression...... and anxiety more often than non-AD subjects, and had an increased prevalence of suicidal ideation and depressive symptoms. In the health registry study, moderate-severe AD patients had increased risk of antidepressant and anxiolytic medication use, while patients with mild AD only had increased risk...

  13. Chromosomal abnormalities in a psychiatric population

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, K.E.; Lubetsky, M.J.; Wenger, S.L.; Steele, M.W. [Univ. of Pittsburgh Medical Center, PA (United States)

    1995-02-27

    Over a 3.5 year period of time, 345 patients hospitalized for psychiatric problems were evaluated cytogenetically. The patient population included 76% males and 94% children with a mean age of 12 years. The criteria for testing was an undiagnosed etiology for mental retardation and/or autism. Cytogenetic studies identified 11, or 3%, with abnormal karyotypes, including 4 fragile X positive individuals (2 males, 2 females), and 8 with chromosomal aneuploidy, rearrangements, or deletions. While individuals with chromosomal abnormalities do not demonstrate specific behavioral, psychiatric, or developmental problems relative to other psychiatric patients, our results demonstrate the need for an increased awareness to order chromosomal analysis and fragile X testing in those individuals who have combinations of behavioral/psychiatric, learning, communication, or cognitive disturbance. 5 refs., 1 fig., 2 tabs.

  14. Preventing Prescription Drug Abuse in Adolescence: A Collaborative Approach

    Science.gov (United States)

    Jones, Beth A.; Fullwood, Harry; Hawthorn, Melissa

    2012-01-01

    With the growing awareness of adolescent prescription drug abuse, communities and schools are beginning to explore prevention and intervention strategies which are appropriate for their youth. This article provides a framework for developing a collaborative approach to prescription drug abuse prevention--called the Prevention Awareness Team--that…

  15. The light-cone gauge and the principal value prescription

    International Nuclear Information System (INIS)

    Pimentel, B.M.; Suzuki, A.T.

    1988-01-01

    The principal value prescription is used to treat the unphysical pole (K.n) -1 in the basic one-loop light-cone integral. It is shown that the prescription is well suited to such a task, contrary to what has been previously thought till now. (author) [pt

  16. Determinants of U.S. Prescription Drug Utilization using County Level Data.

    Science.gov (United States)

    Nianogo, Thierry; Okunade, Albert; Fofana, Demba; Chen, Weiwei

    2016-05-01

    Prescription drugs are the third largest component of U.S. healthcare expenditures. The 2006 Medicare Part D and the 2010 Affordable Care Act are catalysts for further growths in utilization becuase of insurance expansion effects. This research investigating the determinants of prescription drug utilization is timely, methodologically novel, and policy relevant. Differences in population health status, access to care, socioeconomics, demographics, and variations in per capita number of scripts filled at retail pharmacies across the U.S.A. justify fitting separate econometric models to county data of the states partitioned into low, medium, and high prescription drug users. Given the skewed distribution of per capita number of filled prescriptions (response variable), we fit the variance stabilizing Box-Cox power transformation regression models to 2011 county level data for investigating the correlates of prescription drug utilization separately for low, medium, and high utilization states. Maximum likelihood regression parameter estimates, including the optimal Box-Cox λ power transformations, differ across high (λ = 0.214), medium (λ = 0.942), and low (λ = 0.302) prescription drug utilization models. The estimated income elasticities of -0.634, 0.031, and -0.532 in high, medium, and low utilization models suggest that the economic behavior of prescriptions is not invariant across different utilization levels. Copyright © 2015 John Wiley & Sons, Ltd.

  17. Pricing of prescription drugs and its impact on physicians' choice behavior.

    Science.gov (United States)

    Miao-Sheng, Chen; Yu-Ti, Shih

    2008-09-01

    This research presents an analysis of Taiwan's health care market with the focus on the pricing of prescription drugs and its impact on physicians' choice behavior. Since the advent of Taiwan's national health insurance, with the competent authority being Bureau of National Health Insurance (BNHI), hospitals are allowed to sell prescription drugs to patients at prices above the purchasing prices, so each prescription drug has two prices: one at which drugs are sold to hospitals; the other which BNHI reimbursement to hospitals. The margin between the different prices is the sales discount that pharmaceutical companies offer to the hospitals. We find that sales discount has a great impact on physicians' choice behavior: i.e., physicians are price-sensitive to prescription drugs. In addition, it is found that too high a sales discount of a prescription drug would result in a too low weighted average price of that drug sold; thus BNHI would be more likely to adjust downward the rate it reimbursement to the hospital. This presents a sales strategy problem to pharmaceutical companies. To solve this, we use the distribution of physicians' evaluations of prescription drugs to establish a profit maximization model in hopes of helping companies to price drugs and find the optimal promotion expending. Ten popular prescription drugs are used in this research as examples.

  18. Pharmacologic management of non-cancer pain among nursing home residents.

    Science.gov (United States)

    Lapane, Kate L; Quilliam, Brian J; Chow, Wing; Kim, Myoung S

    2013-01-01

    Pain is common in nursing home settings. To describe scheduled analgesic use among nursing home (NH) residents experiencing non-cancer pain and evaluate factors associated with scheduled analgesic use. We identified 2508 residents living in one of 185 NHs predominantly from one for-profit chain, with pain recorded on two consecutive Minimum Data Set assessments. Pharmacy transaction files provided detailed medication information. Logistic regression models adjusted for clustering of residents in NHs identified factors related to scheduled prescription analgesics. Twenty-three percent had no scheduled analgesics prescribed. Those with scheduled analgesics were more likely to have excruciating pain (5.5% vs. 1.2%) and moderate pain documented (64.7% vs. 47.5%) than residents without scheduled analgesics. Hydrocodone (41.7%), short-acting oxycodone (16.6%), and long-acting fentanyl (9.4%) were common, and 13.8% reported any nonsteroidal anti-inflammatory agent use. Factors associated with decreased odds of scheduled analgesics included severe cognitive impairment (adjusted odds ratio [AOR] 0.56; 95% confidence interval [CI] 0.36 to 0.88), age more than 85 years (AOR 0.57; 95% CI 0.41 to 0.80), and Parkinson's disease (AOR 0.55; 95% CI 0.30 to 0.99). Factors associated with increased odds of scheduled analgesic use included history of fracture (AOR 1.79; 95% CI 1.16 to 2.76), diabetes (AOR 1.30; 95% CI 1.02 to 1.66), and higher Minimum Data Set mood scores (AOR 1.11; 95% CI 1.04 to 1.19). Some improvements in pharmacologic management of pain in NHs have been realized. Yet, presence of pain without scheduled analgesics prescribed was still common. Evidence-based procedures to assure adherence to clinical practice guidelines for pain management in this setting are warranted. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  19. Prevalence and pattern of prescription errors in a Nigerian kidney ...

    African Journals Online (AJOL)

    Setting: Kidney Care Centre is a public Specialist hospital. ... Main outcome measures: Prevalence of prescription errors, pattern of prescription errors, pharmacist's intervention. ... A medication quality assurance unit is needed in our hospitals.

  20. Analysis of prescription database extracted from standard textbooks of traditional Dai medicine.

    Science.gov (United States)

    Zhang, Chuang; Chongsuvivatwong, Virasakdi; Keawpradub, Niwat; Lin, Yanfang

    2012-08-29

    Traditional Dai Medicine (TDM) is one of the four major ethnomedicine of China. In 2007 a group of experts produced a set of seven Dai medical textbooks on this subject. The first two were selected as the main data source to analyse well recognized prescriptions. To quantify patterns of prescriptions, common ingredients, indications and usages of TDM. A relational database linking the prescriptions, ingredients, herb names, indications, and usages was set up. Frequency of pattern of combination and common ingredients were tabulated. A total of 200 prescriptions and 402 herbs were compiled. Prescriptions based on "wind" disorders, a detoxification theory that most commonly deals with symptoms of digestive system diseases, accounted for over one third of all prescriptions. The major methods of preparations mostly used roots and whole herbs. The information extracted from the relational database may be useful for understanding symptomatic treatments. Antidote and detoxification theory deserves further research.

  1. Prescription of hazardous drugs during pregnancy.

    Science.gov (United States)

    Malm, Heli; Martikainen, Jaana; Klaukka, Timo; Neuvonen, Pertti J

    2004-01-01

    Prescribing drugs to pregnant women requires the balancing of benefits and risks. Only a small proportion of drugs are known to be harmful to the fetus, but for the vast majority of drugs little evidence of fetal safety exists. To determine the prescription pattern of potentially and clearly harmful prescription drugs during pregnancy with reference to drug safety categorisation, and to define the drug groups primarily responsible for multiple drug use during pregnancy. A retrospective, register-based cohort study. Linkage of three nationwide registers in Finland. Data collection included prescription drugs purchased during the preconception period and each trimester in the pregnant cohort, and the corresponding time periods in the non-pregnant controls. The pregnancy safety categorisation was determined for each drug (Anatomic Therapeutic Chemical [ATC] code) by using the Swedish classification of approved medicinal products (Farmaceutiska Specialiteter i Sverige [FASS]) and if not available, the corresponding Australian (Australian Drug Evaluation Committee [ADEC]) or US categorisation (FDA). GROUPS STUDIED: Women applying for maternity support (maternal grants) during the year 1999 (n = 43 470) plus non-pregnant control women matched by age and hospital district (n = 43 470). In the pregnant cohort, 20.4% of women purchased at least one drug classified as potentially harmful during pregnancy, and 3.4% purchased at least one drug classified as clearly harmful. A significant decline occurred in the number of pregnant women purchasing potentially and clearly harmful drugs during the first trimester when compared with the preconception period, and the decline continued from the first to the second trimester. In the pregnant cohort, 107 (0.2%) women purchased at least ten different drugs during pregnancy. The drugs most commonly purchased in this group were topical corticosteroids and nasal preparations. The use of hazardous prescription drugs declines during

  2. Proscriptive versus prescriptive morality: two faces of moral regulation.

    Science.gov (United States)

    Janoff-Bulman, Ronnie; Sheikh, Sana; Hepp, Sebastian

    2009-03-01

    A distinction is made between two forms of morality on the basis of approach-avoidance differences in self-regulation. Prescriptive morality is sensitive to positive outcomes, activation-based, and focused on what we should do. Proscriptive morality is sensitive to negative outcomes, inhibition-based, and focused on what we should not do. Seven studies profile these two faces of morality, support their distinct motivational underpinnings, and provide evidence of moral asymmetry. Both are well-represented in individuals' moral repertoire and equivalent in terms of moral weight, but proscriptive morality is condemnatory and strict, whereas prescriptive morality is commendatory and not strict. More specifically, in these studies proscriptive morality was perceived as concrete, mandatory, and duty-based, whereas prescriptive morality was perceived as more abstract, discretionary, and based in duty or desire; proscriptive immorality resulted in greater blame, whereas prescriptive morality resulted in greater moral credit. Implications for broader social regulation, including cross-cultural differences and political orientation, are discussed.

  3. A Non-Interventional Naturalistic Study of the Prescription Patterns of Antipsychotics in Patients with Schizophrenia from the Spanish Province of Tarragona.

    Directory of Open Access Journals (Sweden)

    Ana M Gaviria

    Full Text Available The analysis of prescribing patterns in entire catchment areas contributes to global mapping of the use of antipsychotics and may improve treatment outcomes.To determine the pattern of long-term antipsychotic prescription in outpatients with schizophrenia in the province of Tarragona (Catalonia-Spain.A naturalistic, observational, retrospective, non-interventional study based on the analysis of registries of computerized medical records from an anonymized database of 1,765 patients with schizophrenia treated between 2011 and 2013.The most used antipsychotic was risperidone, identified in 463 (26.3% patients, followed by olanzapine in 249 (14.1%, paliperidone in 225 (12.7%, zuclopenthixol in 201 (11.4%, quetiapine in 141 (8%, aripiprazole in 100 (5.7%, and clozapine in 100 (5.7%. Almost 8 out of 10 patients (79.3% were treated with atypical or second-generation antipsychotics. Long-acting injectable (LAI formulations were used in 44.8% of patients. Antipsychotics were generally prescribed in their recommended doses, with clozapine, ziprasidone, LAI paliperidone, and LAI risperidone being prescribed at the higher end of their therapeutic ranges. Almost 7 out of 10 patients (69.6% were on antipsychotic polypharmacy, and 81.4% were on psychiatric medications aside from antipsychotics. Being prescribed quetiapine (OR 14.24, 95% CI 4.94-40.97, LAI (OR 9.99, 95% CI 6.45-15.45, psychiatric co-medications (OR 4.25, 95% CI 2.72-6.64, and paliperidone (OR 3.13, 95% CI 1.23-7.92 were all associated with an increased likelihood of polypharmacy. Being prescribed risperidone (OR 0.54, 95% CI 0.35-0.83 and older age (OR 0.98, 95% CI 0.97-0.99 were related to a low polypharmacy probability.Polypharmacy is the most common pattern of antipsychotic use in this region of Spain. Use of atypical antipsychotics is extensive. Most patients receive psychiatric co-medications such as anxiolytics or antidepressants. Polypharmacy is associated with the use of quetiapine or

  4. Brain tumors in patients primarly treated psychiatrically

    Directory of Open Access Journals (Sweden)

    Ignjatović-Ristić Dragana

    2011-01-01

    Full Text Available Introduction. Psychiatric symptoms are not rare manifestations of brain tumors. Brain tumors presented by symptoms of raised intracranial pressure, focal neurological signs, or convulsions are usually first seen by the neurologist or less frequently by the neurosurgeon in routine diagnostic procedures. On the other hand, when psychiatric symptoms are the first manifestation in “neurologically silent” brain tumors, the patients are sent to the psychiatrist for the treatment of psychiatric symptoms and brain tumors are left misdiagnosed for a long period of time. Case Report. We presented three patients with the diagnosed brain tumor where psychiatrist had been the first specialist to be consulted. In all three cases neurological examination was generally unremarkable with no focal signs or features of raised intracranial pressure. CT scan demonstrated right insular tumor in a female patient with obsessive-compulsive disorder (OCD; right parietal temporal tumor in a patient with delusions and depression and left frontal tumor in a patient with history of alcohol dependency. Conclusion. Psychiatric symptoms/disorders in patients with brain tumors are not specific enough and can have the same clinical presentation as the genuine psychiatric disorder. Therefore, we emphasize the consideration of neuroimaging in patients with abrupt beginning of psychiatric symptoms, in those with a change in mental status, or when headaches suddenly appear or in cases of treatment resistant psychiatric disorders regardless the lack of neurological symptoms.

  5. Connectomics in psychiatric research: advances and applications

    Directory of Open Access Journals (Sweden)

    Cao M

    2015-10-01

    Full Text Available Miao Cao,* Zhijiang Wang,* Yong He State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, People’s Republic of China *These authors contributed equally to this work Abstract: Psychiatric disorders disturb higher cognitive functions and severely compromise human health. However, the pathophysiological mechanisms underlying psychiatric disorders are very complex, and understanding these mechanisms remains a great challenge. Currently, many psychiatric disorders are hypothesized to reflect “faulty wiring” or aberrant connectivity in the brains. Imaging connectomics is arising as a promising methodological framework for describing the structural and functional connectivity patterns of the human brain. Recently, alterations of brain networks in the connectome have been reported in various psychiatric disorders, and these alterations may provide biomarkers for disease diagnosis and prognosis for the evaluation of treatment efficacy. Here, we summarize the current achievements in both the structural and functional connectomes in several major psychiatric disorders (eg, schizophrenia, attention-deficit/hyperactivity disorder, and autism based on multi-modal neuroimaging data. We highlight the current progress in the identification of these alterations and the hypotheses concerning the aberrant brain networks in individuals with psychiatric disorders and discuss the research questions that might contribute to a further mechanistic understanding of these disorders from a connectomic perspective.Keywords: psychiatric disorders, connectome, graph theory, functional connectivity, structural connectivity

  6. Use of empathy in psychiatric practice: constructivist grounded theory study

    Science.gov (United States)

    Watling, Chris

    2017-01-01

    Background Psychiatry has faced significant criticism for overreliance on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and medications with purported disregard for empathetic, humanistic interventions. Aims To develop an empirically based qualitative theory explaining how psychiatrists use empathy in day-to-day practice, to inform practice and teaching approaches. Method This study used constructivist grounded theory methodology to ask (a) ‘How do psychiatrists understand and use empathetic engagement in the day-to-day practice of psychiatry?’ and (b) ‘How do psychiatrists learn and teach the skills of empathetic engagement?’ The authors interviewed 17 academic psychiatrists and 4 residents and developed a theory by iterative coding of the collected data. Results This constructivist grounded theory of empathetic engagement in psychiatric practice considered three major elements: relational empathy, transactional empathy and instrumental empathy. As one moves from relational empathy through transactional empathy to instrumental empathy, the actions of the psychiatrist become more deliberate and interventional. Conclusions Participants were described by empathy-based interventions which are presented in a theory of ’empathetic engagement’. This is in contrast to a paradigm that sees psychiatry as purely based on neurobiological interventions, with psychotherapy and interpersonal interventions as completely separate activities from day-to-day psychiatric practice. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:28243463

  7. Variations in non-prescription drug consumption and expenditure: Determinants and policy implications.

    Science.gov (United States)

    Otto, Monica; Armeni, Patrizio; Jommi, Claudio

    2018-01-31

    This paper analyses the determinants of cross-regional variations in expenditure and consumption for non-prescription drugs using the Italian Health Care Service as a case study. This research question has never been posed in other literature contributions. Per capita income, the incidence of elderly people, the presence of distribution points alternative to community pharmacies (para-pharmacies and drug corners in supermarkets), and the disease prevalence were included as possible explanatory variables. A trade-off between consumption of non-prescription and prescription-only drugs was also investigated. Correlation was tested through linear regression models with regional fixed-effects. Demand-driven variables, including the prevalence of the target diseases and income, were found to be more influential than supply-side variables, such as the presence of alternative distribution points. Hence, the consumption of non-prescription drugs appears to respond to needs and is not induced by the supply. The expected trade-off between consumption for prescription-only and non-prescription drugs was not empirically found: increasing the use of non-prescription drugs did not automatically imply savings on prescription-only drugs covered by third payers. Despite some caveats (the short period of time covered by the longitudinal data and some missing monthly data), the regression model revealed a high explanatory power of the variability and a strong predictive ability of future values. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. Impact of boarding pediatric psychiatric patients on a medical ward.

    Science.gov (United States)

    Claudius, Ilene; Donofrio, J Joelle; Lam, Chun Nok; Santillanes, Genevieve

    2014-05-01

    Psychiatric disorders account for an increasing number of pediatric hospitalizations. Due to lack of psychiatric beds, patients on involuntary psychiatric holds may be admitted to medical units. Our objectives were to evaluate the rate of admission of psychiatric patients to a medical unit, psychiatric care provided, and estimated cost of care. The study involved retrospective chart review of all patients on involuntary psychiatric holds presenting to 1 pediatric emergency department from July 2009 to December 2010. We determined the rate of admission to a medical unit, the rate of counseling or psychiatric medication administration, and the estimated cost of nonmedical admissions (boarding) of patients on the medical unit. A total of 555 (50.1%) of 1108 patients on involuntary psychiatric holds were admitted to the pediatric medical unit. The majority (523 [94.2%]) were admitted for boarding because no psychiatric bed was available. Thirty-two (6.1%) patients admitted for isolated psychiatric reasons had counseling documented, and 105 (20.1%) received psychiatric medications. Patients admitted to an affiliated psychiatric hospital were significantly more likely to receive counseling and medications. Psychiatric patients were boarded in medical beds for 1169 days at an estimated cost of $2 232 790 or $4269 per patient over the 18-month period. We found high admission rates of patients on involuntary psychiatric holds to a pediatric medical unit with little psychiatric treatment in 1 hospital. Further research in other centers is required to determine the extent of the issue. Future studies of longer term outcomes (including readmission rates and assessments of functioning) are needed.

  9. Prescription writing practices in a rural tertiary care hospital in Western Maharashtra, India

    Directory of Open Access Journals (Sweden)

    Vaishali D Phalke

    2011-01-01

    Full Text Available BackgroundPrescription is a written order from physician to pharmacistwhich contains name of drug, its dose and its method ofdispensing and advice over consuming it. The frequency ofdrug prescription errors is high. Prescribing errorcontributes significantly towards adverse drug events. Thepresent study was undertaken to understand the currentprescription writing practices and to detect the commonerrors in them at a tertiary health care centre situated in arural area of Western Maharashtra, India.MethodA cross sectional study was conducted at a tertiary levelhospital located at a rural area of Maharashtra state, Indiaduring October 2009-March 2010. 499 prescriptions comingto medical store during period of one month wereconsidered for data analysis. Important informationregarding the patient, doctor, drug and the generaldescription of the prescription were obtained.ResultsAll the prescriptions were on the hospital pad. A significantnumber of the prescriptions (n=88, 17.6% were written inillegible handwriting and not easily readable. The name, ageand sex of the patient were mentioned is majority of theprescriptions. All the prescriptions (100% failed todemonstrate the presence of address, height and weight ofthe patient. Only the brand name of the drugs wasmentioned in all the prescriptions with none of them havingthe generic name. The strength, quantity and route ofadministration of the drug were found on 73.1%, 65.3% and75.2% prescriptions.ConclusionThere are widespread errors in prescription writing by thedoctors. Educational intervention programs and use ofcomputer can substantially contribute in the lowering ofsuch errors. A short course on prescription writing beforethe medical student enters the clinical field and strictmonitoring by the administrative authorities may also helpalleviate the problem.Word count: 2980Tables: 2

  10. Myths and realities of psychiatric disorders

    International Nuclear Information System (INIS)

    Farjam, A.

    2001-01-01

    Prevalence of psychiatric disorders is on the rise and causing massive global health burden which myths and misconceptions about psychiatric disorders and their available treatment abound in our society. Stigma attached with these disorders is phenomenal. This leads to avoidance of the patients in seeking prompt and appropriate treatment. This demands an instant realization of the gravity of the problems related with mental health and adoption of appropriate measures to increase awareness, in both masses and the health professionals of psychiatric disorders and their scientific treatment. (author)

  11. A multileaf collimator field prescription preparation system for conventional radiotherapy

    International Nuclear Information System (INIS)

    Du, M.N.; Yu, C. X.; Symons, M.; Yan, D.; Taylor, R.; Matter, R.C.; Gustafson, G.; Martinez, A.; Wong, J.W.

    1995-01-01

    Purpose: The purpose of this work is to develop a prescription preparation system for efficient field shaping using a multileaf collimator that can be used in community settings as well as research institutions. The efficiency advantage of the computer-controlled multileaf collimator, over cerrobend blocks, to shape radiation fields has been shown in conformal treatments, which typically require complete volumetric computerized tomographic data for three-dimensional radiation treatment planning--a utility not readily available to the general community. As a result, most patients today are treated with conventional radiation therapy. Therefore, we believe that it is very important to fully use the same efficiency advantage of multileaf collimator as a block replacement in conventional practice. Methods and Material: The multileaf collimator prescription preparation system developed by us acquires prescription images from different sources, including film scanner and radiation treatment planning systems. The multileaf collimator angle and leaf positions are set from the desired field contour defined on the prescription image, by minimizing the area discrepancies. Interactive graphical tools include manual adjustment of collimator angle and leaf positions, and definition of portions of the field edges that require maximal conformation. Data files of the final leaf positions are transferred to the multileaf collimator controller via a dedicated communication link. Results: We have implemented the field prescription preparation system and a network model for integrating the multileaf collimator and other radiotherapy modalities for routine treatments. For routine plan evaluation, isodose contours measured with film in solid water phantom at prescription depth are overlaid on the prescription image. Preliminary study indicates that the efficiency advantage of the MLC over cerrobend blocks in conformal therapy also holds true for conventional treatments. Conclusion: Our

  12. Education as Prescription for Patients with Type 2 Diabetes Mellitus: Compliance and Efficacy in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Mi Yeon Kim

    2012-12-01

    Full Text Available BackgroundDiabetes self-management education has an important role in diabetes management. The efficacy of education has been proven in several randomized trials. However, the status of diabetes education programs in real Korean clinical practice has not yet been evaluated in terms of patient compliance with the education prescription.MethodsWe retrospectively analyzed clinical and laboratory data from all patients who were ordered to undergo diabetes education during 2009 at Samsung Medical Center, Seoul, Korea (n=2,291. After excluding ineligible subjects, 588 patients were included in the analysis.ResultsAmong the 588 patients, 433 received education. The overall compliance rate was 73.6%, which was significantly higher in the subjects with a short duration or living in a rural area compared to those with a long duration (85.0% vs. 65.1%, respectively; P<0.001 or living in an urban area (78.2% vs. 70.4%, respectively; P=0.037. The hemoglobin A1c decreased greater in the compliant group (from 7.84±1.54 at baseline to 6.79±1.06 at 3 months and 6.97±1.20 at 12 months after prescription in the compliant group vs. from 7.74±1.25 to 7.14±1.02 and 7.24±1.24 in the non-compliant group; P=0.001. The decrease in hemoglobin A1c was greater in the subjects with a short duration (P=0.032.ConclusionIn our study a large percent of patients refuse to get education despite having a prescription from their physician. This refusal rate was higher in the patients with long-standing diabetes or in urban residence. Furthermore, education was more effective in patients with a short duration of diabetes in clinical practice.

  13. 42 CFR 456.170 - Medical, psychiatric, and social evaluations.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medical, psychiatric, and social evaluations. 456... Hospitals Medical, Psychiatric, and Social Evaluations and Admission Review § 456.170 Medical, psychiatric... recipient's need for care in the hospital; and appropriate professional personnel must make a psychiatric...

  14. Are we adequately preparing the next generation of physicians to prescribe exercise as prevention and treatment? Residents express the desire for more training in exercise prescription

    Directory of Open Access Journals (Sweden)

    Kara Solmundson

    2016-10-01

    Conclusions: FMR report EP is important, yet do not perceive they are sufficiently prepared to provide EP. In future curricular development, medical educators should consider residents’ low knowledge, competence, perceived program support, and their expressed desire for more training in exercise prescription.

  15. Sales promotion by wholesalers affects general practitioners' prescription behaviours in Japan.

    Science.gov (United States)

    Shimura, Hirohisa

    2018-01-01

    Background : One method for promoting drugs in Japan has been utilizing wholesalers for promotion; however, the effectiveness of the sales promotion has been brought into question. Methods : A total of 74,552 responses were collected from an internet survey of 511 prescribing doctors in hospitals with less than 19 beds, which recalled the visits by wholesalers' sales representatives (MS) in 2014. Each assessed the degree to which MS and/or sales representatives from a pharmaceutical company (MR) influenced a decision to prescribe each drug. The responses were analysed using the chi-square test and Goodman-Kruskal's gamma to evaluate the association between MS calls and doctors' prescription orders. Results : Results showed a significant effect of the MS calls on doctors' behaviours in terms of new drug prescriptions and subsequent behaviours. The results by therapeutic category showed a similar strong influence of the joint calls on new prescriptions on some therapeutic classes. The MS calls significantly influenced doctors to maintain and increase the prescription volume (p sales promotion on the part of MSs and MRs adds value to the prescription decisions. Moreover, results suggest that MSs enhance prescription outcomes in competitive therapeutic categories.

  16. Automated Individual Prescription of Exercise with an XML-based Expert System.

    Science.gov (United States)

    Jang, S; Park, S R; Jang, Y; Park, J; Yoon, Y; Park, S

    2005-01-01

    Continuously motivating people to exercise regularly is more important than finding a barriers such as lack of time, cost of equipment or gym membership, lack of nearby facilities and poor weather or night-time lighting. Our proposed system presents practicable methods of motivation through a web-based exercise prescription service. Users are instructed to exercise according to their physical ability by means of an automated individual prescription of exercise checked and approved by a personal trainer or exercise specialist after being tested with the HIMS, fitness assessment system. Furthermore, utilizing BIOFIT exercise prescriptions scheduled by an expert system can help users exercise systematically. Automated individual prescriptions are built in XML based documents because the data needs to be flexible, expansible and convertible structures to process diverse exercise templates. Web-based exercise prescription service makes users stay interested in exercise even if they live in many different environments.

  17. Can antibiotic prescriptions in respiratory tract infections be improved? A cluster-randomized educational intervention in general practice – The Prescription Peer Academic Detailing (Rx-PAD Study [NCT00272155

    Directory of Open Access Journals (Sweden)

    Rognstad Sture

    2006-06-01

    Full Text Available Abstract Background More than half of all antibiotic prescriptions in general practice are issued for respiratory tract infections (RTIs, despite convincing evidence that many of these infections are caused by viruses. Frequent misuse of antimicrobial agents is of great global health concern, as we face an emerging worldwide threat of bacterial antibiotic resistance. There is an increasing need to identify determinants and patterns of antibiotic prescribing, in order to identify where clinical practice can be improved. Methods/Design Approximately 80 peer continuing medical education (CME groups in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs, who are trained GPs, will conduct the educational outreach visits. During these visits, evidence-based recommendations of antibiotic prescriptions for RTIs will be presented and software will be handed out for installation in participants PCs, enabling collection of prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD. Individual feedback reports will be sent all participating GPs during and one year after the intervention. Main outcomes are baseline proportion of inappropriate antibiotic prescriptions for RTIs and change in prescription patterns compared to baseline one year after the initiation of the tailored pedagogic intervention. Discussion Improvement of prescription patterns in medical practice is a challenging task. A thorough evaluation of guidelines for antibiotic treatment in RTIs may impose important benefits, whereas inappropriate prescribing entails substantial costs, as well as undesirable consequences like development

  18. Understanding Nonprescription and Prescription Drug Misuse in Late Adolescence/Young Adulthood

    Directory of Open Access Journals (Sweden)

    Sasha A. Fleary

    2013-01-01

    Full Text Available This study explored the extent to which nonprescription and prescription drugs misuse among adolescents/young adults are related to their perception that it is safer than illicit drugs, ease of access, and lower societal stigma. Adolescents/young adults (; , completed an online survey about their nonprescription and prescription drug misuse, other substance use, and correlates of use. Perceived risk, societal stigma, and access to nonprescription and prescription drugs were predictive of misuse. Results support program planners working towards targeting perceived risk and societal stigma in reducing misuse and the need to restrict and monitor access to nonprescription and prescription drugs for adolescents/young adults.

  19. Deregulation of allopathic prescription and medical practice in India: Benefits and pitfalls

    Directory of Open Access Journals (Sweden)

    Raman Kumar

    2016-01-01

    Full Text Available In the background of debates on Universal Health Coverage, skill transfer from the medical practice license holders to other health-care providers such as nurse practitioner has become a global norm. In India, where the world's largest numbers of medical graduates are produced, this discussion is expanding to extremes and serious suggestions are coming forward for the development of legal framework for allowing dentists, homeopaths, pharmacists, and half duration trained doctors; permission to issue allopathic prescription. Allopathic medical prescription. It is noteworthy that this discussion only pertains to the pharmaceutical products retailed through “allopathic medical prescriptions.” A prescription is not only advice for patient's recovery but it also is a legitimate order for the sale of controlled drugs and pharmaceutical product; thereby functions as a regulatory tool for consumption of pharmaceutical products at retail level. Who is ultimately going to benefit from this prescription deregulation? This editorial explores benefits and pitfalls of prescription and medical practice deregulation.

  20. Analysis of prescription database extracted from standard textbooks of traditional Dai medicine

    Directory of Open Access Journals (Sweden)

    Zhang Chuang

    2012-08-01

    Full Text Available Abstract Background Traditional Dai Medicine (TDM is one of the four major ethnomedicine of China. In 2007 a group of experts produced a set of seven Dai medical textbooks on this subject. The first two were selected as the main data source to analyse well recognized prescriptions. Objective To quantify patterns of prescriptions, common ingredients, indications and usages of TDM. Methods A relational database linking the prescriptions, ingredients, herb names, indications, and usages was set up. Frequency of pattern of combination and common ingredients were tabulated. Results A total of 200 prescriptions and 402 herbs were compiled. Prescriptions based on "wind" disorders, a detoxification theory that most commonly deals with symptoms of digestive system diseases, accounted for over one third of all prescriptions. The major methods of preparations mostly used roots and whole herbs. Conclusion The information extracted from the relational database may be useful for understanding symptomatic treatments. Antidote and detoxification theory deserves further research.